title: Older Adults and Management of Medical Devices in the Home: Five Requirements for Appropriate Use.
abstract: Medical devices, or instruments or tools to manage disease, are increasingly used in the home, yet there have been limited evaluations of how older adults and caregivers safely use these devices. This study concerns a qualitative evaluation of (1) barriers and facilitators of appropriate use, and (2) outcomes of inappropriate use, among older adults at the transition from hospital to home with skilled home health care (SHHC). Guided by a human factors engineering work system model, the authors (1) conducted direct observations with contextual inquiry of the start-of-care or resumption-of-care SHHC provider visit, and (2) semi-structured interviews with 24 older adults and their informal caregivers, and 39 SHHC providers and administrators. Five requirements for the appropriate use of home medical devices were identified. A systems approach integrating the hospital with the SHHC agency is needed to make the use of home medical devices safer.
authors.affiliation: 1 Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.|2 Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Keller
authors.affiliation: 2 Armstrong Institute of Patient Safety and Quality, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Ayse P
authors.initials: AP
authors.lastname: Gurses
authors.affiliation: 3 Living Environments Laboratory, Department of Industrial and Systems Engineering, Center for Quality and Productivity Improvement, College of Engineering, Wisconsin Institutes for Discovery, University of Wisconsin-Madison , Madison, Wisconsin.|4 Geriatrics Research Education and Clinical Center , William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
authors.forename: Nicole
authors.initials: N
authors.lastname: Werner
authors.affiliation: 5 Johns Hopkins Home Care Group , Baltimore, Maryland.
authors.forename: Dawn
authors.initials: D
authors.lastname: Hohl
authors.affiliation: 6 Division of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.
authors.forename: Ashley
authors.initials: A
authors.lastname: Hughes
authors.affiliation: 6 Division of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.|7 Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland.|8 Department of Community and Public Health, Johns Hopkins School of Nursing , Baltimore, Maryland.
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.affiliation: 6 Division of Geriatric Medicine, Department of Medicine, Johns Hopkins University School of Medicine , Baltimore, Maryland.|9 Department of Clinical Investigation, Johns Hopkins University Bloomberg School of Public Health , Baltimore, Maryland.
authors.forename: Alicia I
authors.initials: AI
authors.lastname: Arbaje
mesh_terms: D000368:Aged; D017028:Caregivers; D004864:Equipment and Supplies / Q000592:standards*; D006804:Ergonomics; D005260:Female; D006701:Home Nursing / Q000592:standards*; D006801:Humans; D008297:Male; D061214:Patient Safety; D036301:Qualitative Research
keywords: elderly; geriatrics; home health; hospital discharge; human factors; medical devices