Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO.
J Am Med Dir Assoc. 2019 Apr;20(4):487-491. doi: 10.1016/j.jamda.2019.01.004. Epub 2019 Feb 22.
To evaluate the quality of communication between hospitals and home health care (HHC) clinicians and patient preparedness to receive HHC in a statewide sample of HHC nurses and staff.
A web-based 48-question cross-sectional survey of HHC nurses and staff in Colorado to describe the quality of communication after hospital discharge and patient preparedness to receive HHC from the perspective of HHC nurses and staff. Questions were on a Likert scale, with optional free-text questions.
Between January and June 2017, we sent a web-based survey to individuals from the 56 HHC agencies in the Home Care Association of Colorado that indicated willingness to participate.
We received responses from 50 of 122 individuals (41% individual response rate) representing 14 of 56 HHC agencies (25% agency response rate). Half of the respondents were HHC nurses, the remainder were managers, administrators, or quality assurance clinicians. Among respondents, 60% (n = 30) reported receiving insufficient information to guide patient management in HHC and 44% (n = 22) reported encountering problems related to inadequate patient information. Additional tests recommended by hospital clinicians was the communication domain most frequently identified as insufficient (58%). More than half of respondents (52%) indicated that patient preparation to receive HHC was inadequate, with patient expectations frequently including extended-hours caregiving, housekeeping, and transportation, which are beyond the scope of HHC. Respondents with electronic health record (EHR) access for referring providers were less likely to encounter problems related to a lack of information (27% vs 57% without EHR access, P = .04). Respondents with EHR access were also more likely to have sufficient information about medications and contact isolation.
CONCLUSIONS/IMPLICATIONS: Communication between hospitals and HHC is suboptimal, and patients are often not prepared to receive HHC. Providing EHR access for HHC clinicians is a promising solution to improve the quality of communication.
评估医院与家庭保健（HHC）临床医生之间沟通的质量，以及从 HHC 护士和工作人员的角度评估患者接受 HHC 的准备情况，该研究在科罗拉多州的 HHC 护士和工作人员中进行了一项全州范围的样本调查。
一项针对科罗拉多州 HHC 护士和工作人员的基于网络的 48 个问题的横断面调查，用于描述出院后 HHC 护士和工作人员对沟通质量的看法以及患者接受 HHC 的准备情况。问题采用李克特量表，并有可选的自由文本问题。
2017 年 1 月至 6 月期间，我们向科罗拉多州家庭保健协会的 56 家 HHC 机构中表示愿意参与的个人发送了一份基于网络的调查。
我们收到了来自 56 家 HHC 机构中的 14 家（25%的机构回应率）的 50 名个人（41%的个人回应率）的回复。受访者中有一半是 HHC 护士，其余的是经理、管理人员或质量保证临床医生。在受访者中，60%（n=30）报告说他们收到的信息不足以指导 HHC 中的患者管理，44%（n=22）报告说遇到了与患者信息不足相关的问题。医院临床医生推荐的额外检查是最常被认为不足的沟通领域（58%）。超过一半的受访者（52%）表示患者接受 HHC 的准备不足，患者的期望经常包括延长时间的护理、家政和交通，这些都超出了 HHC 的范围。有电子病历（EHR）访问权限的受访者遇到与信息缺乏相关的问题的可能性较小（27%比没有 EHR 访问权限的受访者 57%，P=0.04）。有 EHR 访问权限的受访者更有可能获得有关药物和接触隔离的充分信息。
结论/意义：医院与 HHC 之间的沟通不理想，患者通常没有准备好接受 HHC。为 HHC 临床医生提供 EHR 访问权限是改善沟通质量的一种有前途的解决方案。
