From Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA (LC, KJW, DK, KVR); Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia (DK); Hofstra Northwell School of Medicine, Hempstead, NY (KLS, KVR).
J Am Board Fam Med. 2018 Sep-Oct;31(5):682-690. doi: 10.3122/jabfm.2018.05.180034.
Failures of care coordination among health care providers are known to lead to poorer health outcomes for patients with complex medical needs. However, there has been limited research into the perspectives of patients who receive care from a variety of health care providers. This qualitative study sought to characterize the factors leading to emergency department (ED) patient satisfaction and dissatisfaction with their care coordination.
Semistructured telephone interviews were conducted with 25 adult patients following ED visits about their experiences with their care coordination. All patients interviewed had 2 or more ED visits and hospitalizations in the past year and/or health providers in more than one health system. Interview transcripts were coded and analyzed following a modified grounded theory approach.
Four broad categories of themes emerged from the patient interviews covering the following: (1) perceptions of care coordination between their providers, (2) the role of electronic health records, (3) challenges with information exchange between health systems, and (4) sources of support for care coordination activities, emphasizing the important role of the primary care provider.
Patients with multiple health care providers identified significant barriers to communication among providers and inadequate support with care coordination activities. Expansion of team-based models of primary care and prioritizing interoperable technology for sharing patient health information between providers will be critical to improving the patient experience and the safety of transitions of care.
众所周知，医疗保健提供者之间的护理协调失败会导致有复杂医疗需求的患者健康状况恶化。然而，对于从各种医疗保健提供者那里接受护理的患者的观点，研究还很有限。这项定性研究旨在描述导致急诊（ED）患者对其护理协调满意和不满意的因素。
对 25 名在 ED 就诊后接受护理的成年患者进行了半结构化电话访谈，了解他们在护理协调方面的经历。所有接受采访的患者在过去一年中都有 2 次或更多次 ED 就诊和住院治疗，并且/或者在多个医疗系统中有多个医疗服务提供者。根据改进的扎根理论方法，对访谈记录进行编码和分析。
从患者访谈中得出了四个广泛的主题类别，涵盖以下内容：（1）对提供者之间护理协调的看法，（2）电子健康记录的作用，（3）医疗系统之间信息交换的挑战，以及（4）护理协调活动的支持来源，强调了初级保健提供者的重要作用。
有多个医疗服务提供者的患者发现提供者之间的沟通存在重大障碍，并且在护理协调活动方面缺乏支持。扩大以团队为基础的初级保健模式，并优先考虑用于在提供者之间共享患者健康信息的互操作技术，对于改善患者体验和护理交接的安全性至关重要。
