Supporting Occupational Therapists in Predischarge Home Visit Decision-Making: Development and Evaluation of a Decision-Making Support Tool

Abstract

Introduction: With little evidence to guide practice, the decision to conduct a predischarge home visit poses challenges for occupational therapists. This study is aimed at evaluating the impact of a newly developed support tool for home visit decision-making on therapists’ confidence, ease, and accuracy in decision-making and stakeholders’ satisfaction in the communication of the decision and examining its clinical utility and reliability. Method: The predischarge home visit decision-making support tool was trialed by occupational therapists from five facilities across an Australian metropolitan health service. Using a pre–post study design, therapists completed a purposefully developed questionnaire on decision-making practice including ease and confidence in decision-making. Accuracy of decision-making was also evaluated using case studies. Clinical utility and reliability data was also gathered. Results: While therapists’ confidence and ease in decision-making did not change with use of the tool, accuracy in decision-making improved regardless of therapist’s experience in home visiting. The interrater reliability of the tool was moderate, with a Fleiss’ kappa value of 0.51. Good internal consistency was demonstrated with the removal of one item (α = 0.83). Clinical utility was supported with therapists rating the tool as timely and easy to use. Conclusion: The developed tool offers therapists a reliable tool to support clinical practice, by providing guidance in clinically reasoning the decision to conduct a home visit.