|dc.description.abstract||Background. Due to inadequate information sharing systems, primary care and home care providers in Ontario have some of the lowest rates of communication in Canada and among all OECD countries. As a result, clinicians are frustrated, resources are wasted, and vulnerable patients are put at risk for adverse events such as falls. Introducing a home care-to-primary care information sharing system that prompts primary care providers to address falls risk, namely, the Patient Falls Risk Report may be effective for supporting clinical practices.
Research Questions. The research questions in this study are as follows: (1) what are primary care providers views on integrating the Patient Falls Risk Report into their workflow; (2) what impacts do primary care providers believe that the Patient Falls Risk Report would have on patient care; (3) what criticisms, suggestions for improvement, or future developments do primary care providers suggest for the Patient Falls Risk Report; and (4) how usable is the Patient Falls Risk Report?
Methods. This mixed-methods intervention development study examined if the Patient Falls Risk Report, a one-page document for sharing falls-related clinical information from the interRAI-HC, is useful to primary care providers using the Behaviour Change Wheel theoretical framework and elements of usability testing. In Phase One, one-on-one qualitative interviews were conducted, and a constructivist approach to thematic analysis was used to answer research questions one, two, and three, and inform revisions of the Patient Falls Risk Report. In Phase Two, self-report surveys based on the System Usability Scale (SUS) were conducted on Qualtrics and the quantitative data was descriptively analyzed with Excel 2004 and SAS University Edition to answer research question four.
Results. A sample of 9 interview participants and 27 survey participants was obtained. In the interviews, barriers in opportunity, capability, and motivation were identified which contributed to increased reliance on patient self-report, intuition, and reactive approaches to identifying falls risk. Thus, all participants stated that they would integrate use of the Patient Falls Risk Report in their practices. Due to its utility and usability, most interview participants believed that the Patient Falls Risk Report could support patient care by sharing relevant falls-related information and reminding providers of best-practice falls prevention guidelines. However, various criticisms were identified including lack of clarity in language, insufficient detail, and limited support for shared care planning. After two rounds of revisions and integrating interview participants’ suggestions for improvement, the surveys determined that the Patient Falls Risk Report was highly usable with an overall SUS score of 83.4 (95% CI = 78.7, 88.2).
Discussion. Primary care culture, structure, and tradition have a substantial influence on falls prevention approaches and influence the views and actions of primary care providers. The current health-system context, previous implementations, theory, and research suggest that the Patient Falls Risk Report would be feasible to integrate into primary care workflows. However, how and to what extent the report would support a shift toward proactive falls prevention was debated. The ways in which the Patient Falls Risk Report could impact patient care, were examined through an analysis of clinical- and system-level advantages, disadvantages, and limitations. Developments to the Patient Falls Risk Report to enhance its advantages and mitigate disadvantages and limitations included saving space, adding clarity, adding detail, aligning with provider priorities, and emphasizing validity. Some major challenges within the Patient Falls Risk Report could not be mitigated, thus future improvements to the report and health sector overall were suggested. All in all, the Patient Falls Risk Report is useable and will likely support primary care providers in identifying falls-related risk factors and validated care planning options.
Future directions. Future research ought to examine the effectiveness of the Patient Falls Risk Report and expand on some important findings in this study. Implementation of the Patient Falls Risk Report will support information sharing in Ontario’s health sector and help keep vulnerable patients from being overlooked.||en