Johns Hopkins University, Baltimore, Maryland (C.M.B., B.L., J.L.W., D.L.R., O.C.S.).
Duke University, Durham, North Carolina (J.B.).
Ann Intern Med. 2018 May 15;168(10):695-701. doi: 10.7326/M17-2219. Epub 2018 Apr 3.
Physicians are required to certify a plan of care for patients who receive Medicare skilled home health care (SHHC) services. The Centers for Medicare & Medicaid Services form 485 (CMS-485) is typically used for certification of SHHC plans of care and for interactions between SHHC agencies and physicians. Little is known about how physicians use the CMS-485 or their perceptions of its usefulness with respect to coordinating care with SHHC agencies.
To determine how physicians interact with SHHC agencies and use the CMS-485 in care coordination for patients receiving SHHC services.
Mailed survey.
Nationally representative random sample.
Physicians from the American Medical Association Physician Masterfile specializing in family or general medicine (excluding adolescent and sports medicine), geriatrics, geriatric psychiatry, internal medicine, or hospice and palliative medicine.
Time spent reviewing the plan of care and experiences with making changes and communicating with SHHC clinicians.
The response rate after 3 mailings was 53% (1044 of 1968). Of 1005 respondents who provided patient care, 72% had certified at least 1 plan of care in the past year. Nearly half (47%) reported spending less than 1 minute reviewing the CMS-485 before certification, whereas 21% reported spending at least 2 minutes. Physicians typically interacted with multiple SHHC agencies by fax or mail. Approximately 80% rarely or never changed an order on the CMS-485, and 78.3% rarely or never contacted SHHC clinicians with questions about information. The mean reported ease of contacting the SHHC agency was 4.7 (SD, 2.3) on a scale of 1 (easy) to 10 (difficult).
Self-reported data and 53% response rate.
The CMS-485 does not meaningfully engage physicians. Physicians spend little time reviewing or acting on the SHHC plan of care. Strategies to enhance meaningful communication between SHHC agencies and physicians are needed.
National Institute on Aging and National Institute of Mental Health.
接受医疗保险熟练家庭保健服务 (SHHC) 的患者需要医生认证护理计划。医疗保险和医疗补助服务中心表格 485 (CMS-485) 通常用于认证 SHHC 护理计划和 SHHC 机构与医生之间的交互。关于医生如何使用 CMS-485 或他们对其在与 SHHC 机构协调护理方面的有用性的看法，知之甚少。
确定医生如何与 SHHC 机构互动以及在协调接受 SHHC 服务的患者的护理时使用 CMS-485。
邮寄调查。
全国代表性随机样本。
美国医学协会医师主文件中专门从事家庭或一般医学（不包括青少年和运动医学）、老年医学、老年精神病学、内科或临终关怀和姑息医学的医师。
花在审查护理计划上的时间以及在进行更改和与 SHHC 临床医生沟通方面的经验。
经过 3 次邮件发送后的回复率为 53%（1968 名中的 1044 名）。在 1005 名提供患者护理的受访者中，有 72%在过去一年中认证了至少 1 份护理计划。近一半 (47%) 报告在认证前花不到 1 分钟时间审查 CMS-485，而 21% 报告花了至少 2 分钟。医生通常通过传真或邮件与多个 SHHC 机构进行互动。大约 80%的医生很少或从未更改 CMS-485 上的医嘱，78.3%的医生很少或从未就信息问题联系 SHHC 临床医生。报告的与 SHHC 机构联系的平均便利性为 4.7（SD，2.3），范围为 1（容易）到 10（困难）。
自我报告的数据和 53%的回复率。
CMS-485 并没有真正让医生参与进来。医生花很少的时间审查或对 SHHC 护理计划采取行动。需要制定策略来加强 SHHC 机构和医生之间的有意义沟通。
国家老龄化研究所和国家心理健康研究所。
