A qualitative analysis of communication workflows between adult day service centers and primary care providers

Abstract

Objectives Our study documented communication workflows across adult day care centers (ADCs) and primary care providers (PCPs) around complex needs of persons living with dementia (PLWD). We also identified barriers and facilitators to productive communication in clinical decision support and clinical information systems. Materials and Methods We conducted 6 focus groups with ADC staff (N = 33) and individual semistructured interviews with PCPs (N = 22) in California. The eHealth Enhanced Chronic Care Model was used to frame the directed qualitative content analysis. Results Our results captured cumbersome and ineffective workflows currently used to exchange information across PCPs and ADCs. Stakeholders characterized current communication as (1) infrequent, (2) delayed, (3) incomplete, (4) unreliable, (5) irrelevant, and (6) generic. Conversely, communication that was bidirectional, relevant, succinct, and interdisciplinary was needed to elevate the standard of care for PLWD. Discussion and Conclusion ADCs possess a wealth of information that can support clinical decision-making across community-based providers involved in the care of PLWD, especially PCPs. However, effective information exchange is mired by complicated workflows that rely on antiquated technologies (eg, facsimile) and standard templates. Current information exchange largely focuses on satisfying regulatory guidelines rather than supporting clinical decision-making. Integrating community-based services into the health care continuum is a necessary step in elevating the standard of care for PLWD. In the absence of interoperable electronic health records, which may not be financially viable for ADCs, other options, such as mobile health, should be explored to facilitate productive information exchange of personalized relevant information.

“The Sun Came Up Because You Got Here…”: A Qualitative Exploration of Person-Centered Care Strategies Used by Adult Day Care Centers to Manage Behavioral and Psychological Symptoms of Dementia

“…This study’s clinical implications reveal the untapped potential for integrating ADCs into care. Previous research has demonstrated that processes are still siloed within individual ADCs (Dabelko-Schoeny et al, 2020; Zhong et al, 2022), and ADCs are rarely recognized as part of the health care continuum. Centers can help develop care partner toolkits and handbooks to lighten the burden of afterhours caregiving as well as share strategies used by the staff that can be reinforced at home and in other care settings.…”

Using mHealth to Improve Communication in Adult Day Services Around the Needs of People With Dementia: Mixed Methods Assessment of Acceptability and Feasibility

“…Results indicated that ADS staff wanted to exchange information bidirectionally with other care team members. They sought technology that would reduce their reliance on fax and voicemail while enabling them to share serial observations of a person living with dementia's day-to-day health with all members of the care team (eg, ADS staff, health care providers, and caregivers) [7].…”

“…Ineffective communication in health care has been associated with costs exceeding US $10 billion, in addition to adverse outcomes and increased mortality [5,6]. We previously found that communication between free-standing community-based ADS centers is hampered by reliance on antiquated methods of information exchange that challenge information sharing and care coordination [7]. When ADS clients experience acute changes in health status or behavior, information is typically reported to primary care providers through fax or voicemail messages, which often results in nonresponse, delayed diagnosis, referral or treatment, and inadequate follow-up.…”

Introducing a Clinical Summary Template From the Adult Day Center to Support Decision Making by Primary Care Providers

“…It is estimated that 92% of ADCs lack interoperable electronic health record systems. 5 , 6 Blood pressures outside of normal parameters or acute changes in users’ behavior, for example, are typically reported to primary care providers (PCPs) via facsimile or voicemail message, resulting in a delayed or non-response. This can lead to delayed referrals, diagnoses, and treatment, as well as medication errors and inadequate follow-up that result in negative sequelae.…”

“…PCPs and ADC staff mutually agree that effective communication has 4 characteristics: bidirectional, interdisciplinary, succinct, and relevant. 6 To operationalize these components, we developed CareMOBI, ( M health for Organizations to B olster I nterconnectedness) a mobile health (mhealth) application prototype designed to facilitate streamlined communication between ADCs and members of the care team (ie, PCPs and family caregivers) around the health of a mutual patient. A key function of CareMOBI is to synthesize information collected outside of the provider’s office (ie,: in the ADC or at home) and distill the most relevant data points into an exportable clinical summary that can help inform clinical decision making by the PCP.…”