About

Kathryn H. Bowles, PhD, RN, FAAN, FACMI, is a Professor of Nursing and the van Ameringen Chair in Nursing Excellence at Penn Nursing. Her research primarily focuses on improving healthcare for at-risk older adults through the use of information technology and health informatics, particularly in the context of discharge planning and transitional care to reduce hospital readmissions. She has developed and validated decision-support methodologies to identify patients who need post-acute care, and her work has led to the creation of software tools such as the Discharge Decision Support System (D2S2), which helps hospitals assess patient needs and optimize workflow. Dr. Bowles's research has been funded by NIH and other agencies, and she currently leads the I-TRANSFER study, which aims to implement evidence-based protocols for sepsis survivors across multiple health systems. She is also actively involved in teaching and mentoring doctoral students, directing the Health Informatics Minor at Penn, and collaborating with various interdisciplinary institutes. Her contributions to nursing and health informatics have been recognized through numerous awards, including induction into the National Academy of Medicine.

Research topics

• Political Science
• Medicine
• Medical emergency

Selected publications

• Virtual health coaching to improve self-care among informal caregivers of hospitalized older adults during a transition in care: Randomized controlled trial study protocol

  Contemporary Clinical Trials · 2026-04-22

  article
  PublisherDOI

• Defining diagnostic disclosure in the acute care setting: A concept analysis

  International Journal of Nursing Studies · 2026-04-01

  articleOpen accessSenior author

  BACKGROUND: Patients are often unaware of their medical diagnoses, impeding their ability to effectively self-manage their conditions. Diagnostic disclosure, the act of clinicians making diagnoses known to patients, can enhance patient awareness, understanding, and adherence to recommended treatments and care plans. Published literature about diagnostic disclosure is limited to dementia, autism, and cancer, and although diagnostic disclosure commonly occurs during hospitalization, what it entails is rarely considered in the acute care setting. Developing a clear definition of diagnostic disclosure in acute care is essential to understand its potential impact. AIM: Develop conceptual and operational definitions of diagnostic disclosure in the acute care setting. METHODS: The Walker and Avant eight-step approach to concept analysis was employed to identify defining attributes, antecedents, and consequences of diagnostic disclosure in the acute care setting. Four databases (PubMed, CINAHL, Scopus, EMBASE) were searched using keywords and controlled vocabulary to identify studies related to diagnostic disclosure among adult populations in the acute care setting. This search yielded 2052 unique articles, of which 37 (published between 1994 and 2025) met inclusion criteria. RESULTS: No articles that used the term "diagnostic disclosure" provided a definition. Therefore, two defining attributes, The Disclosure Process and Diagnostic Content, identified in the literature guided the development of conceptual and operational definitions. Diagnostic disclosure is defined as the process through which a clinician names and explains a patient's diagnosis. Diagnostic disclosure can be measured by the "fullness" of the diagnostic content disclosed. For example, "full" diagnostic disclosure involves both naming and explaining the diagnosis, whereas partial disclosure may either name or euphemistically explain the diagnosis. Model, Borderline, Related, and Contrary Cases further circumscribe the concept. Antecedents included Clinician Attitudes and Beliefs, Clinician Skill, Patient Characteristics, Patient Curiosity, Characteristics of the Diagnosis, Cultural Context, Family Consent, Environment, and The Diagnostic Process. Consequences included The Patient's Right, Information-Seeking Patients, Shared Decision-Making, Grief and Coping, Disease Adaptation, Strengthened Relationships, Adherence and Self-Care, and Well-Being and Quality of Life. CONCLUSIONS: The definitions provided advance our understanding of diagnostic disclosure with implications for practice and future research. A clearly defined concept sets the foundation to measure, predict, and investigate diagnostic disclosure further. This analysis identifies diagnostic disclosure as critical to patient-centered care, with potential to improve communication, enhance self-care, and prevent rehospitalization. Future efforts should focus on testing the operational definition, evaluating effects on patient outcomes, and surveying patients, caregivers, and clinicians to inform clinical integration.

  PublisherDOI

• Supporting Family Caregiver Health in Heart Failure: Longitudinal Associations Between Heart Failure Caregiver Self-Care and Patient Hospitalizations

  Journal of Cardiac Failure · 2026-03-01

  articleOpen access

  BACKGROUND: Health coaching has been shown to reduce heart failure (HF) caregiver stress and increase caregiver engagement in healthy lifestyle behaviors ("self-care"). The objective of this study was to examine potential downstream effects of improvements in self-care of the caregiver on HF patient hospitalization outcomes. METHODS AND RESULTS: Data were from a randomized controlled trial testing the efficacy of a health coaching intervention versus information-only control on HF caregiver self-care. Self-care of the caregiver was measured using the Self-Care Inventory. Care recipient hospitalizations and hospitalization days were abstracted from the medical record. Zero-inflated negative binomial models were used to assess the extent to which caregiver self-care improvement, of any degree and regardless of intervention condition, was predictive of patient hospitalization and hospitalization days, adjusting for common confounders. The sample included 125 HF patient-caregiver dyads from both groups, 61.6% of which were spousal/partnered. Nearly two-thirds (62.4%) of caregivers demonstrated self-care improvement. Approximately a quarter (25.6%) of patients experienced at least one hospitalization. Adjusting for confounders, patients with caregivers who improved in self-care experienced significantly fewer hospitalizations (IRR 0.332, 95% CI 0.131, 0.841, p=0.02). No significant effect was observed for hospital days (IRR 0.773, 95% CI 0.271, 2.206). CONCLUSIONS: Improvement in HF caregiver self-care was associated with a 67% decrease in patient hospitalizations. Our findings support additional investment in research, programs, and policies that support caregiver health. Our findings may also reassure caregivers, patients, and clinicians that investing time in supporting caregiver health is time well spent and may have potential benefits for patient outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, [NCT number blinded for review].

  PublisherOA PDFDOI

• Response to Letter to the Editor by Drs Goyal and Taylor

  Medical Care · 2025-06-30

  articleSenior authorCorresponding
  PublisherDOI

• Developing a “Caregiving Record” for Home Health Patients with Dementia

  Alzheimer s & Dementia · 2025-12-01

  articleOpen accessSenior author

  BACKGROUND: Home health care (HH) provides skilled nursing, therapy, and aide services in the home. One-third of HH patients have diagnosed dementia and these individuals rely heavily on support from family and unpaid caregivers during HH care. Yet, caregiving context is not systematically assessed in HH, presenting a barrier to high-quality care for patients with dementia. Partnering with a major HH agency, we develop a "caregiving record": an assessment tool to record relevant caregiving context information and workflow to share this data with frontline clinicians. METHOD: Under the guiding principles of participatory ergonomics, a user-centered approach to intervention development, we employed a mix of formative and qualitative research methods to identify and refine a set of assessment items, test assessment content validity, and determine the preferred process for capturing and sharing this information within existing clinical workflows. Research activities included informational interviews with HH agency administrators, structured focus groups with HH clinicians (n = 18) and caregivers for patients with dementia (n = 10), recurring co-design workgroup with administrators and clinicians (n = 13), and cognitive interviews with clinicians (n = 10) and caregivers (n = 11). RESULT: The final "caregiving record" assessment includes 10 items across three domains: (1) Primary caregiver identity and availability, (2) Caregiving network composition and tasks, and (3) Primary caregiver role-related strain. The assessment received a Scale-Content Validity Index score of 0.89 from clinicians and caregivers, indicating strong content validity. Using existing clinical workflows and IT infrastructure, the co-design workgroup identified the preferred workflow as: fielding assessment items via phone call to caregivers 2 days after HH start of care and capturing results in a HIPAA-compliant survey platform, then leveraging existing data management programs to automatically upload this information as a formatted care coordination note in the patient record. CONCLUSION: Providing a "caregiving record" for HH patients with dementia is a promising opportunity to improve HH care delivery for this population, with both clinicians and caregivers enthusiastic about such a process. Initial evaluation of the caregiving record demonstrates strong content validity and feasibility within a "real-world" clinical setting.

  PublisherOA PDFDOI

• Clinician-Identified Health Characteristics and Palliative Care Eligibility: Is Dementia Overlooked?

  The American Journal of Managed Care · 2025-11-01

  articleSenior author

  OBJECTIVES: Community-based palliative care provides support for community-dwelling individuals with elevated mortality risk, including those with dementia, who are underserved by palliative care. However, clinicians' eligibility assessment processes are not well understood. This study evaluates the relationship between the factors that clinicians indicate are important and the eligibility determinations for a community-based palliative care program. STUDY DESIGN: Retrospective cohort analysis of July 2022 to December 2023 Medicare administrative claims data for a Medicare Advantage plan offering community-based palliative care. Participants included all members of the Medicare Advantage insurance plan who were identified as being at elevated risk for mortality and evaluated for palliative care need. METHODS: Multivariate logistic regression examined the relationship between eligibility determinations for a community-based palliative care program (outcome) and 4 factors that palliative care team members identify as important for determining palliative care need: diagnoses, symptom management, functional ability, and health care utilization. RESULTS: Of 343 palliative care evaluations (for 322 unique patients), 38% were of patients who identified as African American/Black, 38% as White, 9% as Asian/Pacific Islander, and 15% as other races; 41% were of patients who identified as Hispanic/Latino (measured separately from race); 80% were of female patients; and the mean patient age was 88 years. Of these, 169 (49%) evaluations were for patients who were eligible for palliative care. In multivariate logistic regression analysis of the factors team members deemed important when determining eligibility, only dementia was significantly associated-and negatively-with the final eligibility decision (adjusted OR, 0.45; 95% CI, 0.26-0.75; P = .003). CONCLUSIONS: There is a potential mismatch between what clinicians identify as important in determining palliative care need and final eligibility determinations. Patients with dementia were less likely to be referred for palliative care despite elevated risk of mortality, indicating a potential missed opportunity.

  PublisherDOI

• Comparing the influence of social risk factors on machine learning model performance across racial and ethnic groups in home healthcare

  Nursing Outlook · 2025-05-01 · 1 citations

  articleOpen access
  PublisherOA PDFDOI

• Understanding Home Health Agencies' Perspectives Toward Telehealth Use Among Home Health Stakeholders in the Post–COVID-19 Era: Qualitative Interview Study

  Journal of Medical Internet Research · 2025-06-12 · 1 citations

  articleOpen access

  Background: In the United States, the COVID-19 pandemic accelerated the adoption of telehealth in home health care (HHC), but its sustainability remains uncertain. Despite telehealth's potential benefits, including improved patient monitoring and expanded access, the lack of reimbursement and regulatory constraints may limit widespread adoption. Understanding how home health agencies (HHAs) perceive these challenges is critical for shaping future telehealth policy. Objective: To examine HHA stakeholders' perspectives on the adoption, implementation, and sustainability of telehealth in the postpandemic era, with particular attention to operational benefits, financial and regulatory barriers, and the impact of new Centers for Medicare & Medicaid Services (CMS) billing codes (G-codes) for telehealth documentation. Methods: Qualitative study using semistructured interviews conducted between February and December 2024. The study followed the Practical Implementation Sustainability Model (PRISM) framework for data collection and analysis. Participants were recruited from HHAs and home health policy organizations across the United States, representing a range of agency types and geographic regions. A purposive and snowball sampling strategy was used to recruit 14 stakeholders, including HHA leaders, HHC clinicians, and policy experts. Interviews were transcribed and analyzed thematically using both deductive codes from the PRISM framework and inductive codes to capture emergent themes. Participants described their experiences with telehealth in HHC, including its operational feasibility, clinical utility, financial impact, and response to new CMS G-codes introduced in July 2023 for telehealth documentation. Primary topics of focus included stakeholders' perceptions of telehealth's benefits, barriers, and future viability in HHC. Results: Stakeholders identified 4 key themes: (1) telehealth offers operational efficiencies (eg, increased patient touchpoints and workforce support) and clinical benefits (eg, improved patient monitoring and potential reduction in rehospitalizations); (2) the lack of CMS reimbursement makes telehealth adoption financially unsustainable for many HHAs; (3) specific HHAs, particularly those integrated with health systems or serving high-risk patient populations, may derive sufficient benefits to continue telehealth use despite financial constraints; and (4) current regulatory policies, including new CMS G-codes, increase administrative burden without providing financial incentives and discouraging telehealth adoption. Conclusions: While stakeholders recognize the benefits of telehealth in HHC, financial and regulatory challenges pose substantial barriers to its sustainability. Policymakers must weigh the advantages of telehealth reimbursement and regulatory support against concerns about wasteful care.

  PublisherDOI

• Improving Care Transitions for Sepsis Survivors to Home Health Care: The I-TRANSFER Experience

  Innovation in Aging · 2025-12-01

  articleOpen access1st authorCorresponding

  Abstract Older adult sepsis survivors are at high risk for readmission, with a median time-to readmission of 11 days, making timely attention post-discharge critical. However, providing timely post-acute care is difficult partly due to care transition challenges —such as barriers in identifying sepsis, sharing critical information, and activating timely post-acute follow-up. I-TRANSFER evaluates the implementation and impact of a protocol for timely home health (HH) and outpatient visits within one-week post-discharge for Medicare sepsis survivors. Herein, we describe ERIC implementation strategies used to overcome barriers to timely post-acute care during the I-TRANSFER implementation. Five health systems (16 hospitals) in four states partnered on implementation with five HH agencies. Barriers and facilitators identified via needs assessment interviews were coded using thematic analysis. Findings were shared and strategies developed with implementation teams over 18 months. Strategies were mapped by the research team to the Expert Recommendations for Implementing Change (ERIC) taxonomy. Barriers and strategies were discussed in 36 planning and 145 implementation meetings. To identify sepsis patients, sites modified EHRs (alerts/reports), educated providers, and improved documentation. For information transfer, strategies included referral flags, reminders, notes, staff education, and securing a new sepsis aftercare ICD-10 code. For timely outpatient care, appointments were achieved using centralized support, revised roles, and telemedicine. Implementation strategies addressed barriers from diagnosis through outpatient follow-up, offering actionable guidance and scalable solutions to enhance hospital-to-home and outpatient transitions for older adults and prevent poor discharge outcomes. Mapping to the ERIC taxonomy provides a standardized way to describe the strategies across implementations.

  PublisherOA PDFDOI

• Why Is Community-Based Palliative Care Declined? Older Adult, Caregiver, and Provider Perspectives.

  PubMed · 2025-07-30

  article

  Incremental adjustments in PC communication may facilitate uptake, including providing explanations that are distinct from hospice, tailored to care needs, focused on reducing illness burden, and introduced by the current care team.

  PublisherDOI

Recent grants

• I-TRANSFER Improving TRansitions ANd outcomeS oF sEpsis suRvivors

  NIH · $1.2M · 2015–2026

• Individualized Care for At Risk Older Adults

  NIH · $7.4M · 2007–2029

• NIH Grant R43NR013609

  NIH · $187k · 2013

• NIH Grant R01DP000215

  NIH · $149k · 2006

• Decision Support: Optimizing Post Acute Referrals and Effect on Patient Outcomes

  NIH · $3.6M · 2001–2016

Frequent coauthors

• Maxim Topaz

  Columbia University

  143 shared

• David Russell

  104 shared

• Margaret V. McDonald

  96 shared

• Mary D. Naylor

  78 shared

• Paulina S. Sockolow

  Drexel University

  76 shared

• Jo‐Ana D. Chase

  Cochrane

  72 shared

• Diane E. Holland

  WinnMed

  72 shared

• Alicia I. Arbaje

  Johns Hopkins University

  54 shared

Labs

• Kathryn H. Bowles LabPI

Awards & honors

• Claire M. Fagin Distinguished Researcher Award, University o…
• Harriet H. Werley Award, Best Nursing Informatics Paper at t…
• Best Student Paper at the American Medical Informatics Assoc…
• Senior Methodologist Award, Omaha System Partnership (2017)
• Inducted into the Sigma Theta Tau Nursing Research Hall of F…