Boockvar Kenneth S, Fridman Bella
Geriatric Research, Education, and Clinical Center, Bronx Veterans Affairs Medical Center, Bronx, NY 10468, USA.
J Am Med Dir Assoc. 2005 Sep-Oct;6(5):310-5. doi: 10.1016/j.jamda.2005.04.004.
The study objectives were (1) to test whether interfacility communication of health information at the time of patient transfer changed as a result of implementation of US privacy protection measures (HIPAA) in April 2003, and (2) to examine patient, transfer, and illness characteristics correlated with interfacility transfer document completion.
Observational study.
Individuals transferred between a 514-bed urban nursing home and a 1171-bed academic hospital in New York City.
Research staff reviewed medical records of patients transferred both ways between nursing home and hospital, examining interfacility transfer documents for 12 items important for continuity of care. Transfer document completeness equaled the percentage of items recorded and legible in transfer documents. Transfers were classified by direction (nursing home-to-hospital [NH-to-H] or hospital-to-nursing home [H-to-NH]), urgency (urgent or not), timing (weekday 9 am to 6 pm or other), and by whether they occurred before 12 am April 14, 2003 (pre-HIPAA), or after (post-HIPAA).
Seventy-eight nursing home residents experienced 100 hospital admissions. NH-to-H transfer documents were more complete than H-to-NH documents (86.7% vs 69.0%; P = .002). There were no significant differences between content of transfer documents between pre- and post-HIPAA transfers in either direction of transfer, with and without controlling for patient and illness characteristics. Older age, female gender, dementia diagnosis, shorter duration of nursing home residence, and off-hours hospital transfer were associated with less complete NH-to-H transfer documents, and shorter hospital length of stay was associated with less complete H-to-NH transfer documents.
There was no change in written health information communicated during patient transfer between an urban nursing home and an academic hospital before and after HIPAA privacy protection measures were implemented. This suggests that the rule's intent to not restrict the sharing of information needed to treat patients is being followed by providers at these sites in the situation of interfacility patient transfer.
本研究的目的是：（1）检验2003年4月美国隐私保护措施（《健康保险流通与责任法案》）实施后，患者转院时医疗机构间健康信息的沟通是否发生变化；（2）检查与医疗机构间转院文件填写情况相关的患者、转院及疾病特征。
观察性研究。
纽约市一家拥有514张床位的城市养老院与一家拥有1171张床位的学术医院之间转诊的患者。
研究人员查阅了在养老院和医院之间双向转诊患者的病历，检查了医疗机构间转院文件中对连续性医疗至关重要的12项内容。转院文件完整性等于转院文件中记录且清晰可读的项目所占百分比。转院按方向（养老院到医院[NH到H]或医院到养老院[H到NH]）、紧急程度（紧急或非紧急）、时间（工作日上午9点至下午6点或其他时间），以及是否发生在2003年4月14日上午12点之前（《健康保险流通与责任法案》实施前）或之后（《健康保险流通与责任法案》实施后）进行分类。
78名养老院居民经历了100次住院治疗。从养老院到医院（NH到H）的转院文件比从医院到养老院（H到NH）的文件更完整（86.7%对69.0%；P = 0.002）。在控制或未控制患者及疾病特征的情况下，《健康保险流通与责任法案》实施前后，两个转院方向的转院文件内容均无显著差异。年龄较大、女性、痴呆症诊断、在养老院居住时间较短以及非工作时间的医院转院与从养老院到医院（NH到H）的转院文件填写不完整有关，而住院时间较短与从医院到养老院（H到NH）的转院文件填写不完整有关。
在实施《健康保险流通与责任法案》隐私保护措施前后，城市养老院与学术医院之间患者转院时书面健康信息的沟通没有变化。这表明在医疗机构间患者转院的情况下，这些机构的提供者遵循了该法规不限制治疗患者所需信息共享的意图。
