Klinisyen Sesi: Evde Sağlık Hizmetlerinde Dokümantasyon Etkisi ve Disiplinlerarası İşbirliği Üzerine Niteliksel Bir Çalışma

Özet (abstract)

Background: Documentation burden is essential to home health care, but excessive documentation is a recognized driver of clinician dissatisfaction and workforce attrition in home health care. Prior quantitative research has found that documentation is the single most negatively rated domain of home health practice, however, the discipline-specific lived experiences underpinning this finding remain poorly characterized. Objective: To examine documentation experiences of home health clinicians across 4 disciplines physical therapy (PT), speech-language pathology (SLP), occupational therapy (OT), and registered nursing (RN), using a convergent mixed-methods design that integrates qualitative thematic analysis with System Usability Scale (SUS) quantification. Methods: Thirty-two semi-structured interviews were conducted with home health clinicians (PT = 8, SLP = 8, OT = 8, RN = 8) between April and June 2026. Transcripts were analyzed inductively using reflexive thematic analysis. Participants concurrently completed the SUS to quantify perceived electronic medical record (EMR) usability. Qualitative themes and SUS data were triangulated within a convergent parallel framework. Results: Six themes emerged: (1) documentation burden and temporal displacement, (2) redundancy and clinically irrelevant documentation demands, (3) technology acceptance and tool friction, (4) device preference and ergonomic adaptation, (5) OASIS complexity and regulatory overreach, and (6) interdisciplinary information gaps and collaboration barriers. Mean SUS score was 67.3 (SD: 20.2, range 30-100), falling below the established above average threshold of 68. PTs reported the lowest mean SUS (64.7) and RNs the highest (70.6). Qualitative data revealed distinct discipline-specific burden profiles that SUS scores alone could not fully characterize. Conclusions: Home health EMR systems are perceived as below average in usability across all disciplines. Documentation burden manifests as temporal displacement, regulatory redundancy, scope creep beyond clinical purview, and fragmented interdisciplinary information architecture. Targeted responses, including EMR workflow redesign, ambient AI documentation, and OASIS regulatory reform are warranted to address documentation-driven attrition in home health. Clinical relevance: Home health clinicians spend up to 90% of their workday on documentation, time displaced from patients into personal hours, eroding work-life boundaries, and accelerating burnout. This study identifies 6 discipline-specific documentation burden patterns that current EMR systems fail to address, providing an actionable evidence base for targeted regulatory reform, EMR redesign, and AI implementation policy in home health.

Yazarların özeti; kaynağından alınmıştır. Home Health Care Management & Practice, 2026 · DOI ↗