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Provider-To-Provider Communication About Care Transitions: Considering Different Health Technology Tools. J Healthc Qual 2023; 45:133-139. [PMID: 36848603 DOI: 10.1097/jhq.0000000000000375] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
ABSTRACT Transitions in patient care require exchanges of information between providers. This period of transition presents a range of challenges, and inadequate transitions can have serious consequences for patients. Our objective was to understand providers' perspectives about patient care transitions, especially around communication between providers and the role of health information technology in provider-to-provider communication. Semi-structured interviews were conducted. Deductive-dominant thematic analysis was used to allow categorization of data based on general themes derived from the interview guides, as well as identification of emergent themes. We characterized three main themes involving providers' perspectives about care transitions. Themes included communication challenges, communication preferences, and suggestions for improving the care transition processes. With respect to challenges around communication, providers highlighted four main concerns. These concerns included the existence of too many methods of communication, high volume of communication, challenges with involvement of multiple providers delivering longitudinal care, and difficulty communicating with providers outside the health system. Providers noted opportunities to improve transitions including improving standardization, enhancing the specialty to primary care transition process, and increasing communication back to the referring provider. Implementation and evaluation of these improvements could be considered by health systems to enhance care transitions.
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Rodriguez HP, Kyalwazi MJ, Lewis VA, Rubio K, Shortell SM. Adoption of Patient-Reported Outcomes by Health Systems and Physician Practices in the USA. J Gen Intern Med 2022; 37:3885-3892. [PMID: 35484368 PMCID: PMC9640524 DOI: 10.1007/s11606-022-07631-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROs) can help clinicians adjust treatments and deliver patient-centered care, but organizational adoption of PROs remains low. OBJECTIVE This study examines the extent of PRO adoption among health systems and physician practices nationally and examines the organizational capabilities associated with more extensive PRO adoption. DESIGN Two nationally representative surveys were analyzed in parallel to assess health system and physician practice capabilities associated with adoption of PROs of disability, pain, and depression. PARTICIPANTS A total of 323 US health system and 2,190 physician practice respondents METHODS: Multivariable regression models separately estimated the association of health system and physician practice capabilities associated with system-level and practice-level adoption of PROs. MAIN MEASURES Health system and physician practice adoption of PROs for depression, pain, and disability. KEY RESULTS Pain (50.6%) and depression (43.8%) PROs were more commonly adopted by all hospitals and medical groups within health systems compared to disability PROs (26.5%). In adjusted analyses, systems with more advanced health IT functions were more likely to use disability (p<0.05) and depression (p<0.01) PROs than systems with less advanced health IT. Practice-level advanced health IT was positively associated with use of depression PRO (p<0.05), but not disability or pain PRO use. Practices with more chronic care management processes, broader medical and social risk screening, and more processes to support patient responsiveness were more likely to adopt each of the three PROs. Compared to independent physician practices, system-owned practices and community health centers were less likely to adopt PROs. CONCLUSIONS Chronic care management programs, routine screening, and patient-centered care initiatives can enable PRO adoption at the practice level. Developing these practice-level capabilities may improve PRO adoption more than solely expanding health IT functions.
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Affiliation(s)
- Hector P Rodriguez
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
| | - Martin J Kyalwazi
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Valerie A Lewis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
| | - Karl Rubio
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Stephen M Shortell
- Division of Health Policy and Management, School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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Simon B, Amelung VE. [10 Years Accountable Care Organizations in the USA: Impulses for Health Care Reform in Germany?]. DAS GESUNDHEITSWESEN 2022; 84:e12-e24. [PMID: 35114697 DOI: 10.1055/a-1718-3332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
GOAL OF THE STUDY An intent of the Patient Protection and Affordable Care Acts (ACA), also know as Obama Care, was to slow the expenditure growth in the public Medicare-System by shifting the accountability for health care outcomes and costs to the provider. For this purpose, provider were allowed to form networks, which would then take accountability for a defined population - Accountable Care Organizations (ACOs). Ten years after the introduction of ACOs, this paper looks at the impact of ACOs both on quality of care and costs of care to assess if ACOs can be a model of care delivery for Germany. METHODS In a mixed-method approach, a rapid review was conducted in Health System Evidence and PubMed. This was supported with further papers identified using the snowballing-technique. After screening the abstracts, we included articles containing information on cost- and/or quality impact of US-Medicare-ACOs. The findings of the rapid review were challenged with 16 ACO-experts and stakeholder in the USA. RESULTS In total, we included 60 publications which incorporated 6 reports that were either conducted directly by governmental institutions or ordered by them, along with 3 previous reviews. Among these, 31 contained information on costs of care, 18 contained information on quality of care and 11 had information on both aspects. The publications show that ACOs reduced costs of of care. Cost reductions were achieved compared to historic costs, to populations not cared for in ACOs, and counterfactuals. Quality of care stayed the same or improved. CONCLUSION ACOs contributed to slowing the cost growth in US Medicare without compromising quality of care. Thus, a transferal of this model of care to Germany should be considered. However, various policies have led to ACOs failing to unleash their full potential. Against this background, and against the background of stark differences between US Medicare and the German health care system, a critical reflection of the necessary policies underlying ACOs-like structures in Germany, needs to be undertaken.
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Affiliation(s)
- Benedikt Simon
- Harkness Fellowship, Commonwealth Fund, New York, United States.,Chief Officer Integrated and Digital Care, Asklepios Kliniken GmbH & Co. KGaA, Hamburg, Germany
| | - Volker Eric Amelung
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Germany
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Cross DA, Stevens MA, Spivack SB, Murray GF, Rodriguez HP, Lewis VA. Survey of Information Exchange and Advanced Use of Other Health Information Technology in Primary Care Settings: Capabilities In and Outside of the Safety Net. Med Care 2022; 60:140-148. [PMID: 35030563 PMCID: PMC8966676 DOI: 10.1097/mlr.0000000000001673] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Advanced use of health information technology (IT) functionalities can support more comprehensive, coordinated, and patient-centered primary care services. Safety net practices may benefit disproportionately from these investments, but it is unclear whether IT use in these settings has kept pace and what organizational factors are associated with varying use of these features. OBJECTIVE The aim was to estimate advanced use of health IT use in safety net versus nonsafety net primary care practices. We explore domains of patient engagement, population health management (decision support and registries), and electronic information exchange. We examine organizational characteristics that may differentially predict advanced use of IT across these settings, with a focus on health system ownership and/or membership in an independent practice network as key factors that may indicate available incentives and resources to support these efforts. RESEARCH DESIGN We conduct cross-sectional analysis of a national survey of physician practices (n=1776). We use logistic regression to predict advanced IT use in each of our domains based on safety net status and other organizational characteristics. We then use interaction models to assess whether ownership or network membership moderate the relationship between safety net status and advanced use of health IT. RESULTS Health IT use was common across primary care practices, but advanced use of health IT functionalities ranged only from 30% to 50% use. Safety net settings have kept pace with adoption of features for patient engagement and population management, yet lag in information exchange capabilities compared with nonsafety net practices (odds ratio=0.52 for federally qualified health centers, P<0.001; odds ratio=0.66 for other safety net, P=0.03). However, when safety net practices are members of a health system or practice network, health IT capabilities are comparable to nonsafety net sites. CONCLUSIONS All outpatient settings would benefit from improved electronic health record usability and implementation support that facilitates advanced use of health IT. Safety net practices, particularly those without other sources of centralized support, need targeted resources to maintain equitable access to information exchange capabilities.
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Affiliation(s)
- Dori A Cross
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
| | - Maria A Stevens
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Steven B Spivack
- Center for Outcomes and Evaluation, Yale School of Medicine, New Haven, CT
| | - Genevra F Murray
- Department of General Internal Medicine, Boston Medical Center, Boston, MA
| | - Hector P Rodriguez
- Department of Health Policy and Management, University of California-Berkeley School of Public Health, Berkeley, CA
| | - Valerie A Lewis
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC
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Valverde PA, Ayele R, Leonard C, Cumbler E, Allyn R, Burke RE. Gaps in Hospital and Skilled Nursing Facility Responsibilities During Transitions of Care: a Comparison of Hospital and SNF Clinicians' Perspectives. J Gen Intern Med 2021; 36:2251-2258. [PMID: 33532965 PMCID: PMC8342702 DOI: 10.1007/s11606-020-06511-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adverse outcomes are common in transitions from hospital to skilled nursing facilities (SNFs). Gaps in transitional care processes contribute to these outcomes, but it is unclear whether hospital and SNF clinicians have the same perception about who is responsible for filling these gaps in care transitions. OBJECTIVE We sought to understand the perspectives of hospital and SNF clinicians on their roles and responsibilities in transitional care processes, to identify areas of congruence and gaps that could be addressed to improve transitions. DESIGN Semi-structured interviews with interdisciplinary hospital and SNF providers. PARTICIPANTS Forty-one clinicians across 3 hospitals and 3 SNFs including nurses (8), social workers (7), physicians (8), physical and occupational therapists (12), and other staff (6). APPROACH Using team-based approach to deductive analysis, we mapped responses to the 10 domains of the Ideal Transitions of Care Framework (ITCF) to identify areas of agreement and gaps between hospitals and SNFs. KEY RESULTS Although both clinician groups had similar conceptions of an ideal transitions of care, their perspectives included significant gaps in responsibilities in 8 of the 10 domains of ITCF, including Discharge Planning; Complete Communication of Information; Availability, Timeliness, Clarity and Organization of Information; Medication Safety; Educating Patients to Promote Self-Management; Enlisting Help of Social and Community Supports; Coordinating Care Among Team Members; and Managing Symptoms After Discharge. CONCLUSIONS As hospitals and SNFs increasingly are held jointly responsible for the outcomes of patients transitioning between them, clarity in roles and responsibilities between hospital and SNF staff are needed. Improving transitions of care may require site-level efforts, joint hospital-SNF initiatives, and national financial, regulatory, and technological fixes. In the meantime, building effective hospital-SNF partnerships is increasingly important to delivering high-quality care to a vulnerable older adult population.
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Affiliation(s)
- Patricia A Valverde
- Denver-Seattle Center of Innovation at Eastern Colorado VA Healthcare System, Denver, CO, USA. .,Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, 80045, USA.
| | - Roman Ayele
- Denver-Seattle Center of Innovation at Eastern Colorado VA Healthcare System, Denver, CO, USA.,Health Systems, Management and Policy Department, Colorado School of Public Health, Aurora, CO, USA
| | - Chelsea Leonard
- Denver-Seattle Center of Innovation at Eastern Colorado VA Healthcare System, Denver, CO, USA
| | - Ethan Cumbler
- Division of Hospital Medicine, Departments of Medicine and Surgery, School of Medicine, University of Colorado, Aurora, CO, USA
| | - Rebecca Allyn
- Department of Medicine, Denver Health and Hospital Authority, Denver, CO, USA
| | - Robert E Burke
- VA Center for Health Equity Research and Promotion (CHERP), Corporal Crescenz VA Medical Center, Philadelphia, PA, USA.,Section of Hospital Medicine, Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Chen J, Amaize A, Barath D. Evaluating Telehealth Adoption and Related Barriers Among Hospitals Located in Rural and Urban Areas. J Rural Health 2020; 37:801-811. [PMID: 33180363 PMCID: PMC8202816 DOI: 10.1111/jrh.12534] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Purpose To assess telehealth adoption among hospitals located in rural and urban areas, and identify barriers related to enhanced telehealth capabilities in the areas of patient engagement and health information exchange (HIE) capacity with external providers and community partners. Methods We used the 2018 American Hospital Association (AHA) Annual Survey and IT Supplement Survey. We applied state fixed effects multivariate analyses and Oaxaca decomposition to estimate the variation of outcomes of interest by hospital geographies. Findings Our research showed substantial differences in telehealth adoption among hospitals located in rural, micropolitan, and metropolitan areas, where adoption rates increase with urbanicity. Rural hospitals were least likely to have telehealth systems with patient engagement capabilities such as the ability to view their health information online and electronically transmit medical information to a third party. They were also the least likely to report that clinical information was available electronically from outside providers. Our model explained 65% of the rural/urban difference in telehealth adoption, 55% of the number of telehealth services adopted, and 43%‐49% of the rural/urban difference in telehealth barriers. Conclusion Findings demonstrated significant barriers to telehealth use among hospitals located in rural and urban areas. For rural hospitals, barriers include lack of HIE capacity among health care providers in the community, and lack of patient engagement capability.
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Affiliation(s)
- Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
| | - Aitalohi Amaize
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
| | - Deanna Barath
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
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Health Information Technology and Accountable Care Organizations: A Systematic Review and Future Directions. EGEMS 2019; 7:24. [PMID: 31328131 PMCID: PMC6625537 DOI: 10.5334/egems.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Since the inception of Accountable Care Organizations (ACOs), many have acknowledged the potential synergy between ACOs and health information technology (IT) in meeting quality and cost goals. Objective: We conducted a systematic review of the literature in order to describe what research has been conducted at the intersection of health IT and ACOs and identify directions for future research. Methods: We identified empirical studies discussing the use of health IT via PubMed search with subsequent snowball reference review. The type of health IT, how health IT was included in the study, use of theory, population, and findings were extracted from each study. Results: Our search resulted in 32 studies describing the intersection of health IT and ACOs, mainly in the form of electronic health records and health information exchange. Studies were divided into three streams by purpose; those that considered health IT as a factor for ACO participation, health IT use by current ACOs, and ACO performance as a function of health IT capabilities. Although most studies found a positive association between health IT and ACO participation, studies that address the performance of ACOs in terms of their health IT capabilities show more mixed results. Conclusions: In order to better understand this emerging relationship between health IT and ACO performance, we propose future research should consider more quasi-experimental studies, the use of theory, and merging health, quality, cost, and health IT use data across ACO member organizations.
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Abstract
Limited research exists which aids in structuring health IT contracts in an era of performance-based payments. We provide an assessment of common approaches to contracting and measuring of performance in practice. We conducted a review of existing literature and compliment this approach with a survey of healthcare professionals directly involved with health IT systems to further understand and classify current approaches. We identified architypes for structuring healthcare IT performance contracts to include: (1) internal operations, (2) external evaluation and (3) joint agreement for the delivery of value-based care.
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Affiliation(s)
- Thomas R Martin
- a St. Joseph's University Department of Health Services , Philadelphia , PA , USA
| | - Hamlet Gasoyan
- b Department of Health Services Administration and Policy , College of Public Health, Temple University , Philadelphia , PA , USA
| | - David J Wierz
- a St. Joseph's University Department of Health Services , Philadelphia , PA , USA
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The geriatric information flow model. HEALTH AND TECHNOLOGY 2018. [DOI: 10.1007/s12553-018-0230-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Rahman M, Gadbois EA, Tyler DA, Mor V. Hospital-Skilled Nursing Facility Collaboration: A Mixed-Methods Approach to Understanding the Effect of Linkage Strategies. Health Serv Res 2018; 53:4808-4828. [PMID: 30079445 DOI: 10.1111/1475-6773.13016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To characterize the nature and degree of hospitals' efforts to collaborate with skilled nursing facilities (SNFs) and associated patient outcomes. DATA SOURCES/STUDY SETTING Qualitative data were collected through 138 interviews with staff in 16 hospitals and 25 SNFs in eight markets across the United States in 2015. Quantitative data include Medicare claims data for the 290,603 patients discharged from those 16 hospitals between 2008 and 2015. STUDY DESIGN/DATA COLLECTION Semi-structured interviews with hospital and SNF staff were coded and used to classify hospitals' collaboration efforts with SNFs into high versus low collaboration hospitals, and risk-adjusted, claims-based hospital readmission rates from SNF were compared. PRINCIPAL FINDINGS Hospital collaboration efforts were defined as establishing SNF partners, transition management initiatives, and hospital staff visits to SNFs. High collaboration hospitals were more likely to send patients to SNFs (as opposed to home, home with home health, or other PAC settings), sent a higher share of patients to high quality SNFs, and had fewer hospital readmissions from SNF sooner than did low collaboration hospitals. CONCLUSIONS Although collaboration with SNF requires significant administrative and clinical time investment, it is associated with positive patient outcomes.
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Affiliation(s)
- Momotazur Rahman
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI
| | - Emily A Gadbois
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI
| | - Denise A Tyler
- Aging, Disability& Long-Term Care, RTI International, Waltham, MA
| | - Vincent Mor
- Center for Gerontology and Healthcare Research, Brown University, Providence, RI
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Johnson TJ, Brownlee MJ. Development and innovation of system resources to optimize patient care. Am J Health Syst Pharm 2018; 75:465-472. [DOI: 10.2146/ajhp170402] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Michael J. Brownlee
- University of Iowa Health Care, Iowa City, IA
- University of Iowa College of Pharmacy, Iowa City, IA
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