A Failure to Communicate: A Qualitative Exploration of Care Coordination Between Hospitalists and Primary Care Providers Around Patient Hospitalizations

Jones, Christine; Vu, Maihan B.; O’Donnell, Christopher; Anderson, Mary E.; Patel, Saroj Kumar; Wald, Heidi L.; Coleman, Eric A.; DeWalt, Darren A.

doi:10.1007/s11606-014-3056-x

Cited by 127 publications

(153 citation statements)

References 10 publications

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“…26,27 Breakdowns in communication are common when patients are discharged from one setting to another, such as from the hospital to home. 28 Because family members and friends often bridge settings alongside patients, 26,29 timely access to accurate information about the patient's health and discharge plan could improve transitional care 30 and help avert risky or redundant diagnostic procedures when a patient is incapacitated and unable to communicate.…”

Section: Capturing and Executing Patient Preferences For Familymentioning

confidence: 99%

Family Caregivers and Consumer Health Information Technology

2015

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Health information technology has been embraced as a strategy to facilitate patients' access to their health information and engagement in care. However, not all patients are able to access, or are capable of using, a computer or mobile device. Although family caregivers assist individuals with some of the most challenging and costly health needs, their role in health information technology is largely undefined and poorly understood. This perspective discusses challenges and opportunities of engaging family caregivers through the use of consumer-oriented health information technology. We compile existing evidence to make the case that involving family caregivers in health information technology as desired by patients is technically feasible and consistent with the principles of patient-centered and family-centered care. We discuss how more explicit and purposeful engagement of family caregivers in health information technology could advance clinical quality and patient safety by increasing the transparency, accuracy, and comprehensiveness of patient health information across settings of care. Finally, we describe how clarifying and executing patients' desires to involve family members or friends through health information technology would provide family caregivers greater legitimacy, convenience, and timeliness in health system interactions, and facilitate stronger partnerships between patients, family caregivers, and health care professionals.KEY WORDS: health information technology; electronic health records; family caregivers.

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Section: Capturing and Executing Patient Preferences For Familymentioning

confidence: 99%

Family Caregivers and Consumer Health Information Technology

2015

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“…1,2 Despite financial incentives and growing attention from the medical community, significant inter-provider variability exists with regard to perceived responsibility in the post-discharge period. 3,4 A recent study of practicing hospitalists found that 29 % believed their responsibility for patients ended at the time of discharge, while 26 % believed their responsibility extended beyond 2 weeks. 5 Primary care providers express similar variability regarding the timing and content of their responsibility for patients after discharge.…”

Section: Introductionmentioning

confidence: 99%

“…5 Primary care providers express similar variability regarding the timing and content of their responsibility for patients after discharge. 4,6 As a result, a responsibility gap often exists for recently discharged patients in which the delineation between inpatient and outpatient provider responsibilities is undefined.…”

Section: Introductionmentioning

confidence: 99%

Internal Medicine Residents’ Perceived Responsibility for Patients at Hospital Discharge: A National Survey

et al. 2016

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BACKGROUND: Medical residents are routinely entrusted with transitions of care, yet little is known about the duration or content of their perceived responsibility for patients they discharge from the hospital. OBJECTIVE: To examine the duration and content of internal medicine residents' perceived responsibility for patients they discharge from the hospital. The secondary objective was to determine whether specific individual experiences and characteristics correlate with perceived responsibility. DESIGN: Multi-site, cross-sectional 24-question survey delivered via email or paper-based form. PARTICIPANTS: Internal medicine residents (post-graduate years 1-3) at nine university and community-based internal medicine training programs in the United States. MAIN MEASURES: Perceived responsibility for patients after discharge as measured by a previously developed single-item tool for duration of responsibility and novel domain-specific questions assessing attitudes towards specific transition of care behaviors. KEY RESULTS: Of 817 residents surveyed, 469 responded (57.4 %). One quarter of residents (26.1 %) indicated that their responsibility for patients ended at discharge, while 19.3 % reported perceived responsibility extending beyond 2 weeks. Perceived duration of responsibility did not correlate with level of training (P = 0.57), program type (P = 0.28), career path (P = 0.12), or presence of burnout (P = 0.59). The majority of residents indicated they were responsible for six of eight transitional care tasks (85.1-99.3 % strongly agree or agree). Approximately half of residents (57 %) indicated that it was their responsibility to directly contact patients' primary care providers at discharge. and 21.6 % indicated that it was their responsibility to ensure that patients attended their follow-up appointments. CONCLUSIONS: Internal medicine residents demonstrate variability in perceived duration of responsibility for recently discharged patients. Neither the duration nor the content of residents' perceived responsibility was consistently associated with level of training, program type, career path, or burnout, suggesting there may be unmeasured factors such as professional role modeling that shape these perceptions.

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“…5 Their portrait of a care period characterized by unclear provider accountability and inadequate knowledge on the part of both providers and patients is painfully familiar to those who treat patients across the post-hospital care transition. 6 Their findings are disquieting but not altogether surprising: an implicit lack of investment in the transitional care of the discharged patient that providers attribute to inadequate time, failures of communication attributed to poor technological resources in systems that continue to depend largely on one-way pager and fax technology, and persistent clinical loose ends despite proliferation of health information technology.…”

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confidence: 99%

Passing Beyond a Wing and a Prayer after Hospital Discharge

Hansen¹

2015

J GEN INTERN MED

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T here is an anxious moment in American football, when a trailing team with seconds left in the game may attempt to win by throwing a long pass down the field, hoping for a lastsecond touchdown. As a spectator, it is thrilling but frustrating-if only the trailing team had worked better together, had been a better team, this high-risk and low-yield strategy might have been avoided. Such a gambit has been termed the "Hail Mary" pass, and the analogy can be made between it and the often disappointing approach to handoffs of care following hospitalization. In recent years, with impetus for change provided by the Hospital Readmission Reduction Penalty within the Affordable Care Act, as well as interest across diverse payors to reward value in healthcare, the standard of care at hospital discharge is changing. Post-discharge callbacks, pharmacist-guided medication reconciliation, and timely ambulatory follow-up after discharge are examples of tactics that are proliferating in an attempt to provide post-discharge care that can guarantee wellness following hospitalization. And while there is evidence of improvement in rates of rehospitalization, 1 the evidence is also mixed, with many of these pillars of high-quality care transitions failing to reliably demonstrate effectiveness. [2][3][4] Despite intense research attention on care transitions in recent years, our understanding of readmission risk and how to remedy risk with interventions generalizable across socioeconomic spectra and care settings is remarkably limited. Is poor teamwork across the discharge transition limiting the effectiveness of our interventions and continuing to leave only "Hail Mary" options?In this issue of JGIM, Jones and colleagues describe the key roles interprofessional relationships and communication play in establishing the climate for success of transitional care management. 5 Their portrait of a care period characterized by unclear provider accountability and inadequate knowledge on the part of both providers and patients is painfully familiar to those who treat patients across the post-hospital care transition. 6 Their findings are disquieting but not altogether surprising: an implicit lack of investment in the transitional care of the discharged patient that providers attribute to inadequate time, failures of communication attributed to poor technological resources in systems that continue to depend largely on one-way pager and fax technology, and persistent clinical loose ends despite proliferation of health information technology.This study reinforces and adds qualitative physician perspective to previous findings regarding poor discharge handoffs. It has been reported that of the 25 % of discharged patients requiring additional workup, over one-third fail to complete recommended follow-up. 7 Direct communication is the exception rather than the norm, and written communication via discharge summary has occurred at the time of the first post-discharge visit less than one-third of the time. 8 The standard of care for discharge summary c...

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A Failure to Communicate: A Qualitative Exploration of Care Coordination Between Hospitalists and Primary Care Providers Around Patient Hospitalizations

Cited by 127 publications

References 10 publications

Family Caregivers and Consumer Health Information Technology

Family Caregivers and Consumer Health Information Technology

Internal Medicine Residents’ Perceived Responsibility for Patients at Hospital Discharge: A National Survey

Passing Beyond a Wing and a Prayer after Hospital Discharge

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