Perceptions of event notification following discharge to improve geriatric care: qualitative interviews of care team members from a 2-site cluster randomized trial

Abstract

Objective To assess primary care teams’ perceptions of a health information exchange (HIE) event notification intervention for geriatric patients in 2 Veterans Health Administration (VHA) medical centers. Materials and Methods We conducted a qualitative evaluation of an event notification alerting primary care teams to non-VHA hospital admissions and emergency department visits. Data were collected through semistructured interviews (n = 23) of primary care team physicians, nurses and medical assistants. Study design and analysis were guided by the Consolidated Framework for Implementation Research (CFIR). Results Team members found the alerts necessary, helpful for filling information gaps, and effective in supporting timely follow-up care, although some expressed concern over scheduling capacity and distinguishing alerts from other VHA notices. Participants also suggested improvements including additional data on patients’ diagnosis and discharge instructions, timing alerts to patients’ discharge (including clear next steps), including additional team members to ensure alerts were acted upon, and implementing a single sign-on. Discussion Primary care team members perceived timely event notification of non-VHA emergency department visits and hospital admissions as potentially improving post-discharge follow-up and patient outcomes. However, they were sometimes unsure of next steps and suggested the alerts and platform could be streamlined for easier use. Conclusions Event notifications may be a valuable tool in coordinating care for high-risk older patients. Future intervention research should explore the optimal amount and types of information and delivery method across sites and test the integration of alerts into broader care coordination efforts.

Effect of Health Information Exchange Plus a Care Transitions Intervention on Post-Hospital Outcomes Among VA Primary Care Patients: a Randomized Clinical Trial

“…In our prior work, we showed that HIE notification of acute care encounters improves primary care team follow-up as compared to a no-notification control group, 47 and that primary care team members found the notifications helpful for filling information gaps and supporting timely follow-up. 8 Others have shown a 2.9% reduction in 30day readmissions associated with HIE electronic notifications. 23 Though the comparison condition in this study, electronic notifications of outside encounters is not yet a standard of care.…”

“…7 VA providers are often not aware of non-VA encounters until notified by non-VA providers, patients, or families. 8 This is likely one reason dual VA and non-VA system use is associated with higher hospital admission and readmission rates and greater adverse events, 9,10 in particular for older veterans. 5,11,12 Health information exchange (HIE) allows health-care providers and patients to access and securely share medical information electronically.…”

Improving Care Coordination Between Veterans Health Administration Primary Care Teams and Community Home Health Aide Providers: A Qualitative Study

“…Even when information is shared between home health and medical providers, primary care teams may not act upon it. Several studies have found primary care physicians frequently did not respond to communication from home health nurses (Norton et al, 2021; Smith et al, 2016), and medical teams may view outside notifications (e.g., notification of an acute episode) as an additional burden in their already full schedules (Franzosa et al, 2021; Vest & Ancker, 2017). Effectively sharing information will require workflows that allow primary care teams to efficiently act on information, identifying the team members who need to share and receive information and the ideal timing and content.…”

Enhancing cancer prevention and survivorship care with a videoconferencing model for continuing education: a mixed-methods study to identify barriers and incentives to participation

“…The CFIR synthesizes constructs from multiple theories into a robust framework and has been found effective for guiding the successful implementation of programmatic innovations in numerous health care domains. 11–15 This framework, first published in 2009 and since updated, features a list of constructs categorized into five domains (Innovation Characteristics, Outer Setting, Inner Setting, Individual Characteristics, and Process) and provides a way to systematically assess barriers and facilitators to either prepare for or assess the implementation of an innovation. 16…”