University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Am Med Dir Assoc. 2010 May;11(4):239-45. doi: 10.1016/j.jamda.2009.08.006. Epub 2010 Mar 12.
To identify perceived barriers to communication between hospital and nursing home at the time of patient transfer and examine associations between perceived barriers and hospital and nursing home characteristics.
Mailed survey.
Medicare- or Medicaid-certified nursing homes in New York State.
Nursing home administrators, with input from other nursing home staff.
Respondents rated the importance as a barrier to hospital-nursing home communication of (1) hospital providers' attitude, time, effort, training, payment, and familiarity with nursing home patients; (2) unplanned and off-hours transfers; (3) HIPAA privacy regulations; and (4) lost or failed information transmission. Associations were determined between barriers and the following organizational characteristics: (1) hospital-nursing home affiliations, pharmacy or laboratory agreements, cross-site staff visits, and cross-site physician care; (2) hospital size, teaching status, and frequency of geriatrics specialty care; (3) nursing home size, location, type, staffing, and Medicare quality indicators; and (4) hospital-to-nursing home communication, consistency of hospital care with health care goals, and communication quality improvement efforts.
Of 647 questionnaires sent, 229 were returned (35.4%). The most frequently reported perceived barriers to communication were sudden or unplanned transfers (44.4%), transfers that occur at night or on the weekend (41.4%), and hospital providers' lack of effort (51.0%), lack of familiarity with patients (45.0%), and lack of time (43.5%). Increased hospital size, teaching hospitals, and urban nursing home location were associated with greater perceived importance of these barriers, and cross-site staff visits and hospital provision of laboratory and pharmacy services to the nursing home were associated with lower perceived importance of these barriers.
Hospital and nursing home characteristics and interorganizational relationships were associated with nursing home administrators' perceptions of barriers to hospital-nursing home communication. These findings may inform design and targeting of interventions to improve intersite communication processes.
确定患者转院时医院与养老院之间沟通的感知障碍，并检验感知障碍与医院和养老院特征之间的关联。
邮寄调查。
纽约州符合医疗保险或医疗补助条件的养老院。
养老院管理员，其他养老院工作人员提供意见。
受访者对医院与养老院沟通的重要性进行了评估，认为以下因素构成了障碍：（1）医院提供者对养老院患者的态度、时间、努力、培训、报酬和熟悉程度；（2）非计划和非工作时间的转院；（3）HIPAA 隐私法规；（4）信息传输丢失或失败。确定障碍与以下组织特征之间的关联：（1）医院与养老院的隶属关系、药房或实验室协议、现场工作人员互访以及现场医生护理；（2）医院规模、教学地位以及老年病专科护理的频率；（3）养老院规模、位置、类型、人员配备以及医疗保险质量指标；（4）医院到养老院的沟通、医院护理与医疗保健目标的一致性以及沟通质量改进工作。
在发送的 647 份问卷中，有 229 份（35.4%）被退回。沟通障碍感知度最高的障碍依次为突然或非计划转院（44.4%）、夜间或周末转院（41.4%）、医院提供者缺乏努力（51.0%）、不熟悉患者（45.0%）以及缺乏时间（43.5%）。医院规模较大、教学医院和城市养老院位置与感知障碍的重要性增加有关，而现场工作人员互访以及医院向养老院提供实验室和药房服务与感知障碍的重要性降低有关。
医院和养老院的特征以及组织间关系与养老院管理员对医院与养老院之间沟通障碍的看法有关。这些发现可能为改善现场沟通流程的干预措施的设计和目标定位提供信息。
