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. 2024 Aug 16;7(3):ooae079.
doi: 10.1093/jamiaopen/ooae079. eCollection 2024 Oct.

Incorporating patient, caregiver, and provider perspectives in the co-design of an app to guide Hospital at Home admission decisions: a qualitative analysis

Marc Kowalkowski  1   2 , Tara Eaton  2 , Kelly W Reeves  3 , Justin Kramer  2   4 , Stephanie Murphy  5   6 , Colleen Hole  7   8 , Shih-Hsiung Chou  9 , Amanda Aneralla  10 , Andrew McWilliams  6   11
Affiliations

Incorporating patient, caregiver, and provider perspectives in the co-design of an app to guide Hospital at Home admission decisions: a qualitative analysis

Marc Kowalkowski et al. JAMIA Open. .

Abstract

Objective: Hospital at Home (HaH) programs currently lack decision support tools to help efficiently navigate the complex decision-making process surrounding HaH as a care option. We assessed user needs and perspectives to guide early prototyping and co-creation of 4PACS (Partnering Patients and Providers for Personalized Acute Care Selection), a decision support app to help patients make an informed decision when presented with discrete hospitalization options.

Methods: From December 2021 to January 2022, we conducted semi-structured interviews via telephone with patients and caregivers recruited from Atrium Health's HaH program and physicians and a nurse with experience referring patients to HaH. Interviews were evaluated using thematic analysis. The findings were synthesized to create illustrative user descriptions to aid 4PACS development.

Results: In total, 12 stakeholders participated (3 patients, 2 caregivers, 7 providers [physicians/nurse]). We identified 4 primary themes: attitudes about HaH; 4PACS app content and information needs; barriers to 4PACS implementation; and facilitators to 4PACS implementation. We characterized 3 user descriptions (one per stakeholder group) to support 4PACS design decisions. User needs included patient selection criteria, clear program details, and descriptions of HaH components to inform care expectations. Implementation barriers included conflict between app recommendations and clinical judgement, inability to adequately represent patient-risk profile, and provider burden. Implementation facilitators included ease of use, auto-populating features, and appropriate health literacy.

Conclusions: The findings indicate important information gaps and user needs to help inform 4PACS design and barriers and facilitators to implementing 4PACS in the decision-making process of choosing between hospital-level care options.

Keywords: Hospital at Home; clinical reasoning; decision aid; digital health; shared decision making.

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Conflict of interest statement

M.K., T.E., A.M., and K.W.R. report receiving grant support from the National Institutes of Health outside of the submitted work. S.M. reports receiving salary support from Medically Home Group, Inc. currently but not at the time the study was completed. At the time of study data collection and analysis, A.A. was employed at Atrium Health. All other authors have no conflicts to disclose.

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