Variability in skilled nursing facility screening and admission processes: Implications for value-based purchasing.
Variability in skilled nursing facility screening and admission processes: Implications for value-based purchasing.
复制标题
熟练的护理设施筛查和入学过程的可变性：对基于价值购买的影响。
DOI：
10.1097/hmr.0000000000000225
复制
发表时间：
2020
影响因子：
2.5
通讯作者：
Burke RE
中科院分区：
文献类型：
--
作者：
Lawrence E;Casler JJ;Jones J;Leonard C;Ladebue A;Ayele R;Cumbler E;Allyn R;Burke RE
住院的老年人越来越多地进入专业护理机构（SNF）进行出院后护理。然而，人们对SNF如何筛选和评估潜在的新入学者知之甚少。在一个越来越重视急性期后护理结果的时代，这些过程可能是提高SNF护理价值的干预措施的重要目标。本研究的目的是了解：（1）SNF临床医生如何评估住院的老年人，并作出决定，让患者进入SNF;（2）在以价值为基础的支付改革的背景下，目前的做法的局限性和好处。我们使用半结构化访谈来了解三个独特SNF的18名临床医生的观点-包括医生，护士，治疗师和联络员。所有的成绩单进行了分析，使用一般的归纳主题为基础的方法。我们发现，筛查和入院过程因SNF而异，并且这种差异受到三个关键外部压力的影响：（1）医疗文件的不一致和不充分的转移;（2）医院工作人员对SNF流程和能力缺乏了解;（3）鼓励医院迅速出院的医院支付模式。不同的SNF对这些压力的反应各不相同。例如，应对这些压力的筛选和评估过程包括获得电子医疗记录，在接受SNF之前提供住院医生咨询，以及拒绝那些被认为是更简单的康复患者的更复杂的患者。我们发现，设施行为是由内部和外部因素驱动的，在基于价值的购买时代，这些因素对公平获得医疗服务有影响。SNF可以通过增加其在医院-SNF关系中的代理权，并优先考虑更仔细的患者筛查，以满足患者需求和设施能力，最有效地应对这些压力。
Hospitalized older adults are increasingly admitted to skilled nursing facilities (SNFs) for post-hospital care. However, little is known about how SNFs screen and evaluate potential new admissions. In an era of increasing emphasis on post-acute care outcomes, these processes may represent an important target for interventions to improve the value of SNF care. The aim of this study was to understand: (1) How SNF clinicians evaluate hospitalized older adults and make decisions to admit patients to a SNF; and (2) the limitations and benefits of current practices in the context of value-based payment reforms. We used semi-structured interviews to understand the perspective of 18 clinicians at three unique SNFs– including physicians, nurses, therapists, and liaisons. All transcripts were analyzed using a general inductive theme-based approach. We found that the screening and admission processes varied by SNF and that variability was influenced by three key external pressures: (1) inconsistent and inadequate transfer of medical documentation; (2) lack of understanding among hospital staff of SNF processes and capabilities; and (3) hospital payment models that encouraged hospitals to discharge patients rapidly. Responses to these pressures varied across SNFs. For example, screening and evaluation processes to respond to these pressures included gaining access to electronic medical records, providing inpatient physician consultations prior to SNF acceptance and turning away more complex patients for those perceived to be more straightforward rehabilitation patients. We found facility behavior was driven by internal and external factors with implications for equitable access to care in the era of value-based purchasing. SNFs can most effectively respond to these pressures by increasing their agency within hospital-SNF relationships and prioritizing more careful patient screening to match patient needs and facility capabilities.