Patients' and Providers' Views on Causes and Consequences of Healthcare Fragmentation in the Ambulatory Setting: a Qualitative Study
Patients' and Providers' Views on Causes and Consequences of Healthcare Fragmentation in the Ambulatory Setting: a Qualitative Study
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DOI：
10.1007/s11606-019-04859-1
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发表时间：
2019-06-01
影响因子：
5.7
通讯作者：
Abramson, Erika L.
中科院分区：
文献类型：
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作者：
Kern, Lisa M.;Safford, Monika M.;Abramson, Erika L.
背景：慢性疾病患者通常会看到多个门诊提供者，他们可能会或可能不会相互沟通。照顾同一患者的提供者之间的信息差距可能会对患者造成伤害。然而，人们对医疗保健分散的确切原因和后果的了解还不够充分，无法设计干预措施来解决这些问题。目的：我们试图引出患者和提供者对医疗保健碎片化的原因和后果的看法。设计和参与者：我们于2017年6月至8月在纽约市一家学术医院的初级保健实践中对患者和提供者（主治医生和执业护士）的焦点小组进行了定性研究。患者参与者为患有两种慢性疾病的说英语的成年人。方法：每个焦点小组持续1小时，并问同样的两个问题：“为什么你认为有些病人从许多不同的提供者那里得到照顾，而另一些没有？”和“你认为病人从许多不同的提供者那里得到照顾会发生什么？”数据收集继续进行，直到达到数据饱和点。主题分析用于确定主题和次主题。主要结果：我们进行了6个焦点小组，共有46名参与者（25名患者和21名提供者）。研究参与者确定了41个独特的碎片化原因，这些原因源于医疗保健系统的4个不同层面（患者、提供者、医疗保健组织和医疗保健环境）；大多数原因与医疗需要无关。与会者还确定了分裂的24种独特后果，其中3种是可取的，21种是不可取的。结论：本研究的结果为如何减少医疗保健碎片化提供了详细的路线图。负面后果的数量和严重程度（包括医疗差错、误诊、费用增加和提供者倦怠）突出表明，迫切需要采取干预措施，直接解决这一问题。
BACKGROUND: Patients with chronic conditions routinely see multiple outpatient providers, who may or may not communicate with each other. Gaps in information across providers caring for the same patient can lead to harm for patients. However, the exact causes and consequences of healthcare fragmentation are not understood well enough to design interventions to address them.OBJECTIVE: We sought to elicit patients' and providers' views on the causes and consequences of healthcare fragmentation.DESIGN AND PARTICIPANTS: We conducted a qualitative study with focus groups of patients and, separately, of providers (attending physicians and nurse practitioners) at an academic hospital-based primary care practice in New York City in June-August 2017. Patient participants were English-speaking adults with 2 chronic conditions.APPROACH: Each focus group lasted 1 h and asked the same two questions: "Why do you think some patients receive care from many different providers and others do not?" and "What do you think happens as a result of patients receiving care from many different providers?" Data collection continued until a point of data saturation was reached. Thematic analysis was used to identify themes and subthemes.KEY RESULTS: We conducted 6 focus groups with a total of 46 participants (25 patients and 21 providers). Study participants identified 41 unique causes of fragmentation, which originate from 4 different levels of the healthcare system (patient, provider, healthcare organization, and healthcare environment); most causes were not related to medical need. Participants also identified 24 unique consequences of fragmentation, of which 3 were desirable and 21 were undesirable.CONCLUSIONS: The results of this study offer a granular roadmap for how to decrease healthcare fragmentation. The large number and severity of negative consequences (including medical errors, misdiagnosis, increased cost, and provider burnout) underscore the urgent need for interventions to address this problem directly.