A Qualitative Study of Choosing Home Health Care After Hospitalization: The Unintended Consequences of 'Patient Choice' Requirements
A Qualitative Study of Choosing Home Health Care After Hospitalization: The Unintended Consequences of 'Patient Choice' Requirements
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DOI：
10.1007/s11606-014-3164-7
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发表时间：
2015-05-01
影响因子：
5.7
通讯作者：
Clark, Melissa
中科院分区：
文献类型：
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作者：
Baier, Rosa R.;Wysocki, Andrea;Clark, Melissa
尽管医院越来越多地对患者出院后的结果负责，这使他们有动力帮助患者选择高绩效的家庭健康机构，我们对质量报告如何为决策提供信息知之甚少。2我们的目的是了解在东北部的一个州，质量报告在选择家庭护理时是如何使用的（罗得岛）本研究包括家庭健康消费者的焦点小组和医院病例管理者的结构化访谈。参与了这项研究。我们通过每次会议的录音来确定关键主题和说明性引用，然后由三名独立的评论员进行重复检查和内容分析。没有参与者知道现有的州或医疗保险家庭健康机构的公开报告。个案管理人员向消费者提供代理商名单，消费者通常会要求个案管理人员告诉他们选择哪些代理商或哪些代理商是最好的;但个案管理人员感到无法直接回应消费者的帮助选择请求，因为他们没有额外的信息可以提供，也因为他们担心违反要求患者自由选择的联邦法律。个案管理者也认为，机构的质量差别不大，尽管他们承认，他们可能没有意识到与出院后护理有关的问题。家庭健康消费者和医院的个案管理者没有意识到有关家庭健康质量的公开报告，这限制了消费者做出明智决定的能力，也限制了个案管理者在决策过程中帮助他们的能力。否则，病例管理人员被禁止向患者推荐特定的提供者，并认为“患者选择”法限制了他们回应患者在选择家庭保健机构方面的帮助请求的能力。公共报告可以作为工具销售，病例管理者可以使用这些工具来帮助患者区分提供者，同时支持患者自主权。
Although hospitals are increasingly held accountable for patients' post-discharge outcomes, giving them incentive to help patients choose high-performing home health agencies, little is known about how quality reports inform decision making.We aimed to learn how quality reports are used when choosing home care in one northeast state (Rhode Island) .The study consisted of focus groups with home health consumers and structured interviews with hospital case managers.Thirteen consumers and 28 case managers from five hospitals participated in the study.We identified key themes and illustrative quotes by audiotaping each session, and then three independent reviewers conducted repeated examination and content analysis.No participants were aware of existing state or Medicare home health agency public reports. Case managers provided agency lists to consumers, who routinely asked case managers to tell them which agencies to choose or which were best; but case managers felt unable to directly respond to consumers' requests for help in making the choice, because they did not have additional information to provide and because they feared violating federal laws requiring freedom of patient choice. Case managers also felt that there was little difference in agency quality, although they acknowledged they might not be aware of problems related to post-hospital care.Home health consumers and hospital case managers were unaware of public reports about home health quality, which limited consumers' ability to make informed decisions and case mangers' ability to assist them in that decision-making process. Case managers were otherwise prohibited from recommending specific providers to patients and viewed the 'patient choice' laws as restricting their ability to respond to patients' requests for help in choosing home health agencies. Public reports can be marketed as tools that case managers can use to help patients differentiate among providers, while supporting patient autonomy.