Assessing electronic information access and use in long-term care facilities in north Texas

INTRODUCTION

In order to establish and maintain a local health information infrastructure in the Denton, Dallas, Fort Worth Metroplex area among long-term care facilities, Texas Woman's University conducted an exploratory information and technology audit to establish baseline data concerning electronic information access and use. While the information needs of health care professionals and consumers in various settings have been well documented, little research has been done specific to hospices, nursing homes, and long-term care facilities. The audit was designed to assess the current state of information technologies and information access within the target audience. Specifically, the project sought to determine if target institutions were equipped with Internet-connected workstations, if training was available regarding use of electronic information resources, and if support was provided concerning the information needs of health care consumers as well as health care professionals.

BACKGROUND AND SIGNIFICANCE

The Dallas, Denton, and Tarrant counties region—housing the Dallas, Denton, Fort Worth Metroplex—is located in north central Texas. The area is home to a rapidly growing population, with the elderly constituting a significant portion of individuals residing in the region. Dallas County covers approximately 880 square miles, Denton County 900 square miles, and Tarrant County 864 square miles [1]. The tri-county region includes an estimated population of more than 3,715,500 people in urban, suburban, and rural communities. Dallas County hosts the second largest population in the state, Tarrant County the fourth, and Denton County the ninth. Approximately 9% of Dallas County residents are age sixty-five or older, as are about 9% of Tarrant County residents and 5% of Denton County residents. Some 308,623 individuals age sixty-five or older are estimated to reside in the tri-county region. While individuals age sixty-five or older are not the only consumers of services offered by hospices, nursing homes, and long-term care facilities in the area, the elderly constitute the largest patient population served by these agencies.

In addition to the elderly, the tri-county region hosts a large population of individuals with human immuno-deficiency virus (HIV)/acquired immune deficiency syndrome (AIDS). More than 14,000 cases of AIDS in the metropolitan area have been reported to the Centers for Disease Control and Prevention over the course of the epidemic [2]. In 1997, Dallas County reported 811 new AIDS cases for the year, Denton County 31, and Tarrant County 301 [3]. Like the elderly, many of these individuals eventually require residential medical or nursing care.

The dramatic growth in the number of Americans age sixty-five or over, in addition to other burgeoning debilitated populations like the one consisting of individuals with end-stage AIDS, has contributed to the increase in resources devoted to residential care for the aged or infirm. Although the total number of nursing homes in the United States has continued to decline since 1985, the number of beds has continued to increase [4]. Similarly, the number of home health or hospice care agencies has continued to increase nationwide since 1992 [5]. This trend in the long-term care system is reflected in the current demography of residential health facilities in the state of Texas. The state has determined that home and community support service agencies are the fastest growing licensing program in the Health Facility Licensing Division of the Texas Department of Health [6].

Through its Health Facility Licensing Division, Texas licenses more than 4,000 home and community support service agencies and thirteen special care facilities. The state defines home and community support service agencies as those agencies that offer home health services, hospice, or personal assistance services for pay or other consideration in a client's residence, an independent living environment, or another appropriate location. Special care facilities are designated as those institutions or establishments that provide a continuum of nursing or medical care services primarily to persons with AIDS or other terminal illnesses, including special residential care facilities. Both types of licensed institutions—home and community support service agencies and special care facilities—cater to the long-term care needs of the aged or infirm.

Dallas, Denton, and Tarrant counties are home to a variety of health care facilities, including more than 274 nursing homes, 17 adult day care centers, 6 Alzheimer's facilities, 75 hospices, and 41 long-term care facilities. Given the geographic region; amount of elderly inhabitants and people with AIDS; volume of diverse settings providing long-term, hospice, or nursing home care; and number of health professionals employed by these facilities significant information needs exist within the study's target population.

METHODOLOGY

In 1999, Texas Woman's University conducted an information and technology audit among nursing homes, hospices, and long-term care facilities in the tri-county region. A survey instrument was designed with both forced choice and open-ended items (Appendix A). The purpose of the survey was to assess computer workstation availability and Internet connectivity at target locations. Data were sought to determine access to and use of electronic information resources, including National Library of Medicine (NLM) databases and health-related Internet sites. In addition, the questionnaire addressed the issue of training regarding use of electronic information resources. Basic demographic information for each institution was also requested.

In order to garner an adequate return rate for this exploratory study, a two-tiered approach to data collection was employed. In March 1999, surveys were mailed to contact personnel at 412 institutions located in Dallas, Denton, and Tarrant Counties providing residential hospice, long-term, or nursing home care. A cover letter and postage-paid return envelope were included with each survey. A total of forty surveys were returned, yielding a 10% return rate. During the months of May and June, those who had not replied via mail were then contacted by telephone. This contact resulted in another 102 usable survey responses, increasing the overall return rate to 35%.

RESULTS

Of the 142 responses, 71 were from nursing homes, 19 from hospices, 24 from long-term care facilities, and 28 were from other residential facilities. Of the responding institutions, only one was affiliated with an academic institution. The mean patient population served by respondents was 120. The mean full-time staff employed was 75; mean part-time staff was 25.

When asked about assisting patients with gathering health information, 82% of the 142 respondents stated that they would assist patients. However, only 5% of this same group stated that they provided workstations for patients to gather health information.

As far as supporting staff information needs, of the 141 who responded to this section (there was one “no response”), only 84 (60%) provided staff workstations. Within this same group, 61 (73%) indicated that their staff workstations had access to the Internet, but only 34 respondents (41%) stated that they currently used the Internet and Web to gather health information. In addition, 8 who did not respond to the question of staff workstations having Internet access stated that they did in fact use the Internet and Web to gather health information. Ultimately, this information resulted in 70% of the total population surveyed stating that their institution did not gather health information via the Internet. However, 99 (38%) respondents who did not use the Internet and the Web stated that they planned on using this resource in the future.

Of the 42 institutions who did use the Internet and Web to gather health information, only 40% offered employee training regarding the most effective use of this type of information technology. Seventeen of the 42 institutions that use the Internet indicated that they used MEDLINE or other NLM resources. In addition, the majority of those who did use NLM databases (59%) indicated that they used them only rarely.

CONCLUSION

Results of this exploratory study provide insight into the current state of electronic information access and use within hospices, long-term care facilities, and nursing homes located in north Texas. Given the results of the information and technology audit, electronic information resources are not actively used to gather health information at the target locations by anyone. In addition, responses demonstrate the need for a training program regarding information resource use and applicability for staff employed at these institutions. Survey responses also reflect the paucity in patient access to information resources in nursing homes, long-term care facilities, and hospices in the tri-county region. Although much has been done to facilitate information intervention in hospitals and academic health sciences center settings, little has been done in residential long-term care facilities in north Texas.

APPENDIX A

Information access and technology survey

Information access and technology survey