Sociotechnical Influences on Outcomes in Telehomecare

Abstract

Telehomecare utilizes electronic communication technologies to support care when distance separates home health nurses from their patients. Telehomecare nurses, or Care Coordinators, use text-based technology to monitor chronically ill patients. Successful home health care outcomes depend on social and technical interactions within diverse patient, caregiver and nurse triad groups. No theory or analysis method for evaluating telehomecare service delivery as a multi-level system exists. Therefore, it is not known which characteristics of interpersonal relationships influence outcomes. This research examined trust, interdependence, communication and technology integration influence on outcomes of satisfaction and self-care. The Sociotechnical Systems Theory and Social Relations Model served as guides to explore individual, relational and group effects on patient quality outcomes. The purpose of this research is to examine the relationships among patients', caregivers' and nurses' social and technical characteristics and quality outcomes in telehomecare.Three VHA sites in the western U.S. participated in this descriptive, multi-level, correlational study. Forty-three groups comprised of patient, nurse and caregiver provided survey data on social and technical characteristics. Additionally, patients provided data on outcomes. All scales performed well, except trust. Results show statistically significant bivariate correlations demonstrate associations between characteristics and outcomes at multi-levels: interdependence with satisfaction at individual and dyad levels; communication with satisfaction at all levels of analysis and simple self care at individual levels; technology integration with satisfaction at group levels as wells as simple and complex self care at individual levels. The principle of joint optimization states that service delivery systems function optimally only if the social and technical characteristics of the subsystem groups fit the demands of each other and the environment. A measure of joint optimization is computed for outcome predictability using multiple regressions. Joint optimization for three social and one technical characteristic was shown to have significant influences on the patient's perception of being well cared for.Many implications of this research for nursing practice in telehomecare are discussed. Telehomecare nurses can use the results of this study to guide optimal practice methods to provide quality outcomes for their patients. This study provides a basis for further best practice research in telehomecare.