Visual Analytics for Pattern Discovery in Home Care

Summary

Background

Visualization can reduce the cognitive load of information, allowing users to easily interpret and assess large amounts of data. The purpose of our study was to examine home health data using visual analysis techniques to discover clinically salient associations between patient characteristics with problem-oriented health outcomes of older adult home health patients during the home health service period.

Methods

Knowledge, Behavior and Status ratings at discharge as well as change from admission to discharge that was coded using the Omaha System was collected from a dataset on 988 deidentified patient data from 15 home health agencies. SPSS Visualization Designer v1.0 was used to visually analyze patterns between independent and outcome variables using heat maps and histograms. Visualizations suggesting clinical salience were tested for significance using correlation analysis.

Results

The mean age of the patients was 80 years, with the majority female (66%). Of the 150 visualizations, 69 potentially meaningful patterns were statistically evaluated through bivariate associations, revealing 21 significant associations. Further, 14 associations between episode length and Charlson co-morbidity index mainly with urinary related diagnoses and problems remained significant after adjustment analyses. Through visual analysis, the adverse association of the longer home health episode length and higher Charlson co-morbidity index with behavior or status outcomes for patients with impaired urinary function was revealed.

Conclusions

We have demonstrated the use of visual analysis to discover novel patterns that described high-needs subgroups among the older home health patient population. The effective presentation of these data patterns can allow clinicians to identify areas of patient improvement, and time periods that are most effective for implementing home health interventions to improve patient outcomes.

Citation: Radhakrishnan K, Monsen KA, Bae S-H, Zhang W. Visual analytics for pattern discovery in home care: Clinical relevance for quality improvement.

Keywords

Visualization - home health nursing - Omaha System - urinary incontinence - patient outcomes

 

Conflicts of Interest

The authors do not report any conflict of interest in conducting this study.

• References

• 1 Home Health Providers. Centers for Medicare & Medicaid Services web site. http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/HHAs.html Updated April 9, 2013. Accessed February 5, 2014.
• 2 Henderson R. Employment outlook: 2010–2020: industry employment and output projections to 2020. Monthly Labor Rev 2012; 135 (01) 65-83.
• 3 CY 2014 Home Health Prospective Payment System Rate Update, Conversion to ICD-10-CM, Home Health Quality Reporting Requirements, and Cost Allocation of Home Health Survey Expenses. Centers for Medicare & Medicaid Services web site. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Pay ment/HomeHealthPPS/Home-Health-Prospective-Payment-System-Regulations-and-Notices-Items/ CMS-1450-P.html Published July 3, 2013. Accessed September 27, 2014.
• 4 Bowles KH, Holland DE, Horowitz DA. A comparison of in-person home care, home care with telephone contact and home care with telemonitoring for disease management. J Telemed Telecare 2009; 15 (07) 344-350.
• 5 Institute of Medicine. Capturing Social and Behavioral Domains in Electronic Health Records: Phase 1. Washington, DC: The National Academies Press; 2014
• 6 Institute of Medicine. Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2. Washington, DC: The National Academies Press; 2014
• 7 Martin KS. The Omaha System: A Key to Practice, Documentation, and Information Management. 2nd ed. Omaha, NE: Health Connections Press; 2005
• 8 Monsen KA, Peterson JJ, Mathiason MA, Kim E, Lee S, Chi CL, Pieczkiewicz DS. Data visualization techniques to showcase nursing care quality. Computers, Informatics, Nursing 2015; 33 (10) 417-426.
• 9 Bui AAT, Aberle DR, Kangarloo H. Timeline: visualizing integrated patient records. Inf Technol Biomed 2007; 11 (04) 462-473.
• 10 Monsen KA, Peterson JJ, Mathiason MA, Kim E, Lee S, Chi CL, Pieczkiewicz DS. Data visualization techniques to showcase nursing care quality. Comput Inform Nurs 2015; 33 (10) 417-426.
• 11 Torsvik T, Lillebo B, Mikkelsen G. Presentation of clinical laboratory results: an experimental comparison of four visualization techniques. J Am Med Inform Assoc 2013; 20 (02) 325-331.
• 12 West VL, Borland D, Hammond WE. Innovative information visualization of electronic health record data: a systematic review. J Am Med Inform Assoc 2015; 22: 330-339.
• 13 Kim E, Monsen KA, Pieczkiewicz D. Visualization of Omaha System data enables data-driven analysis of outcomes. Poster presented at the American Medical Informatics Association Annual Meeting. November 19, 2013. Washington, DC.:
• 14 Votava B, Monsen KA. Visualization of patterns in public health nurse intervention data. Poster presented at the American Public Health Association Annual Meeting. November 16, 2014. New Orleans.:
• 15 Westra BL, Oancea C, Savik K, Marek KD. The feasibility of integrating the Omaha System data across home care agencies and vendors. Comput Inform Nurs 2010; 28 (03) 162-171.
• 16 Omaha System. The Omaha System: Solving the clinical data-information puzzle. http://omahasystem.org Updated May 26, 2015.
• 17 Topaz M, Golfenshtein N, Bowles KH. The Omaha System: a systematic review of the recent literature. J Am Med Inform Assoc 2014; 21 (01) 163-170.
• 18 2011 OASIS requirements in new and accredited HHAs seeking Medicare certification. Centers for Medicare & Medicaid Services web site. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assess ment-Instruments/OASIS/downloads/seekingmedicarecert.pdf Published 2011. Accessed August 18, 2015.
• 19 Madigan EA, Fortinsky RH. Interrater reliability of the outcomes and assessment information set: results from the field. Gerontologist 2004; 44 (05) 689-692.
• 20 Riggs JS, Madigan EA, Fortinsky RH. Home health care nursing visit intensity and heart failure patient outcomes. Home Health Care Manag Pract 2011; 23 (06) 412-420.
• 21 Diseases and injuries tabular index. ICD-9-CM web site. http://icd9cm.chrisendres.com/index.php?action=contents Published October 1, 2008 Accessed March 15, 2015.
• 22 Wilkinson L, Friendly M. The History of the Cluster Heat Map. The American Statistician 2009; 63 (02) 179-184.
• 23 Kirk A. Data Visualization: A Successful Design Process. Birmingham, UK: Packt Publishing; 2012.;
• 24 Gehlenborg N, Wong B. Points of view: heat maps. Nat Methods 2012; 09 (03) 213-213.
• 25 Hu TW, Wagner TH, Bentkover JD, Leblanc K, Zhou SZ, Hunt T. Costs of urinary incontinence and overactive bladder in the United States: a comparative study. Urology 2004; 63 (03) 461-465.
• 26 John G, Gerstel E, Jung M, Dallenbach P, Faltin D, Petoud V, Zumwald C, Rutschmann OT. Urinary incontinence as a marker of higher mortality in patients receiving home care services. BJU Int 2014; 113 (01) 113-119.
• 27 Westra BL, Bliss DZ, Savik K, Hou Y, Borchert A. Effectiveness of wound, ostomy, and continence nurses on agency-level wound and incontinence outcomes in home care. Home Healthc Nurse 2014; 32 (02) 119-127.
• 28 Sims J, Browning C, Lundgren-Lindquist B, Kendig H. Urinary incontinence in a community sample of older adults: prevalence and impact on quality of life. Disabil Rehabil 2011; 33 (15–16): 1389-1398.
• 29 Du YF, Ou HY, Beverly EA, Chiu CJ. Achieving glycemic control in elderly patients with type 2 diabetes: a critical comparison of current options. Clin Interv Aging 2014; 09: 1963-1980.
• 30 Eckerblad J, Theander K, Ekdahl A, Unosson M, Wirehn A, Milberg A, Krevers B, Jaarsma T. Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study. BMC Geriatr 2015; 15: 1.
• 31 Morrissey MB, Viola D, Shi Q. Relationship between pain and chronic illness among seriously ill older adults: expanding role for palliative social work. J Soc Work End Life Palliat Care 2014; 10 (01) 8-33.
• 32 Institute of Medicine. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. 2011. National Academies Press; Washington (DC):
• 33 American Geriatrics Society. Pharmacological management of persistent pain in older persons. J Amer Geri Soc 2009; 57 (08) 1331-1346.
• 34 Barber JB, Gibson SJ. Treatment of chronic non-malignant pain in the elderly: Safety considerations. Drug Safety 2009; 32 (06) 457-474.