The human factors of home health care: a conceptual model for examining safety and quality concerns.

OBJECTIVE: Increases in longevity, a growing elderly population, variation of skill and knowledge among home providers, and a steady migration of medical devices and technologies into the home are placing new demands on home heath care. The paper examines the human factors challenges associated with these converging trends.
METHODS: A growing literature base relevant to home health care is examined, and with the aid of a socio-technical systems model, the paper explores safety and quality concerns to which the converging trends are likely to give rise.
FINDINGS: The sensory, physical, and cognitive limitations of patients and their caregivers play a key role in the ability of patients to manage home health care needs. Other major components affecting successful home health care management are the nature of health care tasks undertaken, the design features of the physical environment, the medical devices and technologies used, the social and community environments, and distal but relevant external factors that shape the context of care. Home health care stakeholders can avoid foreseeable threats to safety and quality by recognizing that components need to be designed in a way that takes into account their interactions with one another and with the capabilities and limitations of patients and their providers.
CONCLUSIONS: By examining the major components and interdependencies of the home health care delivery system, a human factors perspective offers insights into ways that safety and quality can be compromised and can help pave the way for new modes of thinking in home health care policy.