Information Sharing Practices Between US Hospitals and Skilled Nursing Facilities to Support Care Transitions.
Information Sharing Practices Between US Hospitals and Skilled Nursing Facilities to Support Care Transitions.
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DOI：
10.1001/jamanetworkopen.2020.33980
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发表时间：
2021-01-04
影响因子：
13.8
通讯作者：
Cross DA
中科院分区：
文献类型：
--
作者：
Adler-Milstein J;Raphael K;O'Malley TA;Cross DA
美国医院和专业护理机构（SNF）之间的信息共享支持护理过渡的现状是什么？与更好的共享相关的特征是什么？在一项包括471对医院-SNF关于信息共享的回复的美国全国代表性调查中，SNF报告称，关键信息经常缺失（功能、精神和行为状态以及在医院联系谁以进行随访问题）、延迟（通常在患者之后到达）和难以使用（出院文件具有重复和无关信息）。在SNF现场有一名医院临床医生与更完整、及时和可用的信息共享相关。这项研究发现了信息共享的许多方面的缺点，引起了人们对患者从医院到SNF的过渡护理体验的担忧。患者从医院到专业护理机构（SNF）的过渡需要强大的信息共享。在美国，经过十年对卫生信息技术基础设施的投资和促进医院-SNF协调的新激励措施之后，目前在这一关键过渡时期的信息共享状况尚不清楚。测量患者出院至SNF时医院共享信息的完整性、及时性和可用性，并确定与更好的医院-SNF信息共享相关的关系和结构特征。对来自美国全国代表性样本的500个SNF进行调查（265名受访者代表471个医院-SNF对;回复率为53.0%），收集了有关信息共享的详细数据，这些信息共享支持来自两家医院的护理过渡，其中两家医院的患者转诊量最大。调查管理于2019年1月至2020年3月期间进行。使用5点Likert量表对信息完整性、及时性和可用性进行总体评估。详细的测量，包括（1）完整性-23种特定信息类型的常规共享;（2）及时性-信息在患者之后到达的频率;（3）可用性-信息是否重复，无关，或不适合SNF的需求。此外，8个关系特征（例如，共享人员配置，协作会议和转诊量）和10个结构特征（例如，规模，所有权和人员配置）被评估为与更好的信息共享相关的潜在因素。在471对医院-SNF中，64对（13.5%）报告在所有3个信息共享维度上表现出色，而141对（30.0%）在所有维度上表现处于或低于平均水平。社会地位（309对[65.7%]缺失）和行为状态（319对[67.7%]缺失）是最常见的缺失信息类型。医院信息接收延迟，有时（159对[33.8%]）或经常（77对[16.4%]）在患者之后到达。总共有358对[76.0%]报告了至少1个可用性缺陷。在多变量分析中，在SNF现场有一名医院临床医生与更完整的（比值比，1.72; 95% CI，1.07-2.78; P = .03），及时（比值比，1.76; 95%CI，1.08-2.88; P = .02），和可用（比值比，1.64; 95%CI，1.02-2.63; P = .04）信息共享。医院责任医疗机构参与与更及时的信息共享相关（比值比，1.88; 95%CI，1.13-3.14; P = .02）。在这项研究中，美国SNF报告了医院为支持患者过渡而提供的信息在完整性、及时性和可用性方面的重大缺陷。这些缺点可能与次优的过渡体验有关。共享临床医生代表了改善信息共享的潜在策略，但成本高昂。新的支付模式，如负责任的护理组织可能提供一个更可扩展的方法，但只与更及时的共享。本调查研究评估了信息共享的完整性、及时性和可用性的现状，并确定了与更好的共享相关的特征，以支持医院和专业护理机构之间的患者护理过渡。
What is the current state of information sharing to support care transitions between hospitals and skilled nursing facilities (SNFs) in the US, and what characteristics are associated with better sharing? In a US nationally representative survey that included responses from 471 hospital-SNF pairs about information sharing, SNFs reported that key information was often missing (functional, mental, and behavioral status as well as whom to contact at the hospital with follow-up questions), delayed (often arriving after the patient), and difficult to use (discharge documents with duplicative and extraneous information). Having a hospital clinician on site at the SNF was associated with more complete, timely, and usable information sharing. This study finds shortcomings across numerous dimensions of information sharing, raising concerns about patients’ transitional care experience from hospitals to SNFs. Patient transitions from hospitals to skilled nursing facilities (SNFs) require robust information sharing. After a decade of investment in health information technology infrastructure and new incentives to promote hospital-SNF coordination in the US, the current state of information sharing at this critical transition is unknown. To measure the completeness, timeliness, and usability of information shared by hospitals when discharging patients to SNFs, and to identify relational and structural characteristics associated with better hospital-SNF information sharing. Survey of 500 SNFs from a US nationally representative sample (265 respondents representing 471 hospital-SNF pairs; response rate of 53.0%) that collected detailed data on information sharing that supports care transitions from each of the 2 hospitals from which they receive the largest volume of patient referrals. Survey administration occurred between January 2019 and March 2020. Overall assessment of information completeness, timeliness, and usability using 5-point Likert scales. Detailed measures, including (1) completeness—routine sharing of 23 specific information types; (2) timeliness—how often information arrived after the patient; and (3) usability—whether information was duplicative, extraneous, or not tailored to SNF needs. In addition, 8 relational characteristics (eg, shared staffing, collaborative meetings, and referral volume) and 10 structural characteristics (eg, size, ownership, and staffing) were assessed as potential factors associated with better information sharing. Of 471 hospital-SNF pairs, 64 (13.5%) reported excellent performance on all 3 dimensions of information sharing, whereas 141 (30.0%) were at or below the mean performance on all dimensions. Social status (missing in 309 pairs [65.7%]) and behavioral status (missing in 319 pairs [67.7%]) were the most common types of missing information. Receipt of hospital information was delayed, sometimes (159 pairs [33.8%]) or often (77 pairs [16.4%]) arriving after the patient. In total, 358 pairs [76.0%] reported at least 1 usability shortcoming. Having a hospital clinician on site at the SNF was associated in multivariate analysis with more complete (odds ratio, 1.72; 95% CI, 1.07-2.78; P = .03), timely (odds ratio, 1.76; 95% CI, 1.08-2.88; P = .02), and usable (odds ratio, 1.64; 95% CI, 1.02-2.63; P = .04) information sharing. Hospital accountable care organization participation was associated with more timely information sharing (odds ratio, 1.88; 95% CI, 1.13-3.14; P = .02). In this study, US SNFs reported significant shortcomings in the completeness, timeliness, and usability of information provided by hospitals to support patient transitions. These shortcomings are likely associated with a suboptimal transition experience. Shared clinicians represent a potential strategy to improve information sharing but are costly. New payment models such as accountable care organizations may offer a more scalable approach but were only associated with more timely sharing. This survey study evaluates the current state of the completeness, timeliness, and usability of information sharing, and identifies characteristics associated with better sharing, to support patient care transitions between hospitals and skilled nursing facilities.
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发表时间：
2003-04-01
影响因子：
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发表时间：
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影响因子：
2.3
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影响因子：
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