Making Function Part of the Conversation: Clinician Perspectives on Measuring Functional Status in Primary Care.
Making Function Part of the Conversation: Clinician Perspectives on Measuring Functional Status in Primary Care.
复制标题
让功能成为对话的一部分：临床医生对初级保健功能状态测量的看法。
DOI：
10.1111/jgs.15677
复制
发表时间：
2019
影响因子：
6.3
通讯作者：
Brown,RebeccaT
中科院分区：
文献类型：
--
作者：
Nicosia,FrancescaM;Spar,MalenaJ;Steinman,MichaelA;Lee,SeiJ;Brown,RebeccaT
OBJECTIVESAlthough there is increasing interest in using functional status to guide clinical decision making, function is seldom routinely assessed in primary care. We explored clinician perspectives on barriers and facilitators to routine measurement of older adults' functional status in primary care settings.DESIGNQualitative study using semistructured interviews.SETTINGPrimary care and geriatrics clinics at six Veterans Affairs Medical Centers.PARTICIPANTSTwenty‐four primary care providers, including 17 from primary care clinics and 7 from geriatrics clinics.MEASUREMENTSWe conducted interviews to elicit clinician perspectives about functional status measurement, including barriers and facilitators to routine assessment. We analyzed transcripts iteratively using a hybrid inductive and deductive thematic approach.RESULTSInterviews revealed three distinct aspects to measuring function: screening and assessment, documentation, and use of data to inform care. Barriers and facilitators to screening and assessment included time availability, clinic processes, and degree of interdisciplinary environment. Barriers and facilitators to documentation included the usability and integration of electronic instruments into workflows and the availability of a standardized location to document function in the electronic medical record. Barriers and facilitators to use of data included the availability of a standardized location to retrieve data on function, the availability of appropriate referrals and services, and provider knowledge of available resources to address functional impairments. To address these barriers, providers emphasized the critical importance of connecting measurement of function directly to improved patient care.CONCLUSIONAlthough clinicians emphasized the importance of measuring function, they also cautioned against additional workload burdens, cumbersome electronic documentation, and measurement of function without ensuring that these data are used to improve care. Approaches to functional status measurement must address these barriers to improve care and outcomes for older adults. J Am Geriatr Soc 67:493–502, 2019.
OBJECTIVESAlthough there is increasing interest in using functional status to guide clinical decision making, function is seldom routinely assessed in primary care. We explored clinician perspectives on barriers and facilitators to routine measurement of older adults' functional status in primary care settings.DESIGNQualitative study using semistructured interviews.SETTINGPrimary care and geriatrics clinics at six Veterans Affairs Medical Centers.PARTICIPANTSTwenty‐four primary care providers, including 17 from primary care clinics and 7 from geriatrics clinics.MEASUREMENTSWe conducted interviews to elicit clinician perspectives about functional status measurement, including barriers and facilitators to routine assessment. We analyzed transcripts iteratively using a hybrid inductive and deductive thematic approach.RESULTSInterviews revealed three distinct aspects to measuring function: screening and assessment, documentation, and use of data to inform care. Barriers and facilitators to screening and assessment included time availability, clinic processes, and degree of interdisciplinary environment. Barriers and facilitators to documentation included the usability and integration of electronic instruments into workflows and the availability of a standardized location to document function in the electronic medical record. Barriers and facilitators to use of data included the availability of a standardized location to retrieve data on function, the availability of appropriate referrals and services, and provider knowledge of available resources to address functional impairments. To address these barriers, providers emphasized the critical importance of connecting measurement of function directly to improved patient care.CONCLUSIONAlthough clinicians emphasized the importance of measuring function, they also cautioned against additional workload burdens, cumbersome electronic documentation, and measurement of function without ensuring that these data are used to improve care. Approaches to functional status measurement must address these barriers to improve care and outcomes for older adults. J Am Geriatr Soc 67:493–502, 2019.