WASHINGTON – A new report from the National Research Council recommends steps the Food and Drug Administration and other agencies and professional associations can take to ensure that the medical devices and health information technology used in home health care are easy and safe for laypeople to use and that caregivers, whether formal or informal, are well-trained.
For many reasons -- including the rising cost of health care, the aging of the U.S. population, and patients' desire to remain in their homes -- health care is increasingly moving from formal medical facilities into homes. A wide range of procedures, therapies, and monitoring tasks are now carried out far from any hospital or clinic, often with no health care professional on-site. So far, however, little attention has been paid to ensuring that this transition of care into the home happens safely and effectively.
The report recommends that FDA promote the development of new standards for labels on medical devices intended for use in the home, as well as for the accompanying instructional materials, to ensure that they are understandable to nonprofessionals. Standards and guidance for labeling these devices are currently lacking.
FDA also should make it easier for people to report problems with medical devices they use in the home; its current systems for reporting adverse events are not easy for laypeople to use. In addition to making these systems user-friendly, the agency should collect more data that could help identify the root causes of adverse events involving devices and should develop and promote a more convenient way for lay users and professionals to report problems.
In addition, FDA and the Office of the National Coordinator for Health Information Technology should work together to regulate, certify, and monitor applications that integrate medical devices and health information technologies -- for example, devices that monitor patients' blood pressure and provide results to patients and their doctors. The Office of the National Coordinator for Health Information Technology should also work with other agencies to establish guidelines and standards for making consumer health information technologies usable and accessible.
The way home caregivers are trained needs to be improved, the report adds. Professional practice and advocacy groups should develop certification, credentialing, and training standards that will prepare formal caregivers to practice in the home. They should develop informational and training materials for informal caregivers as well.
The report recommends that the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, and other federal agencies collaborate to facilitate adequate access to health- and safety-related home modifications, especially for those who cannot afford them, enabling people whose homes contain safety hazards or obstacles that limit self-care to obtain the modifications they need.
The study was sponsored by the Agency for Healthcare Research and Quality. The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies. They are private, nonprofit institutions that provide science, technology, and health policy advice under a congressional charter. The Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering. For more information, visit http://national-academies.org. A committee roster follows.
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Pre-publication copies of Health Care Comes Home: The Human Factors are available from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242 or on the Internet at http://www.nap.edu. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).
NATIONAL RESEARCH COUNCIL
Division of Behavioral and Social Sciences and Education
Committee on the Role of Human Factors in Home Health Care
David H. Wegman (chair)
Professor
School of Health and Environment
University of Massachusetts
Lowell
Sara J. Czaja
Professor
Departments of Psychiatry and Behavioral
Sciences and Industrial Engineering;
Director
Center on Research and Education for Aging and Technology Enhancement; and
Co-Director
Center on Aging
Miller School of Medicine
University of Miami
Miami
K. Eric DeJonge
Director of Geriatrics
Medical House Call Program
Washington Hospital Center
Washington, D.C.
Daryle Jean Gardner-Bonneau
Principal
Bonneau & Associates; and
Adjunct Associate Professor
Western Michigan University
Portage
Michael Christopher Gibbons
Associate Director
Johns Hopkins Urban Health Institute, and
Assistant Professor of Medicine, Public Health, and Health Informatics
Johns Hopkins Medical Institutions
Baltimore
Laura N. Gitlin
Professor
School of Nursing
Johns Hopkins University
Baltimore
Judith Tabolt Matthews
Senior Research Associate, and
Associate Director
Gerontology Program
University Center for Social and Urban Research
Pittsburgh
Misha Pavel
Program Director
Smart Health and Well-being Program
National Science Foundation
Arlington, Va.
Jon Pynoos
UPS Foundation Professor of Gerontology, Policy, Planning, and Development
Davis School of Gerontology
Ethel Percy Anrus Gerontology Center
University of Southern California
Los Angeles
Robert M. Schumacher
Managing Director and Co-Owner
User Centric Inc.
Oakbrook Terrace, Ill.
Jennifer L. Wolff
Associate Professor
Department of Health Policy and Management
Johns Hopkins Bloomberg School of Public Health
Baltimore
STAFF
Mary Ellen O'Connell
Study Director