Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah; Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah.
Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
J Surg Res. 2019 Dec;244:174-180. doi: 10.1016/j.jss.2019.06.049. Epub 2019 Jul 9.
The exchange of health information between primary care providers (PCPs) and surgeons is critical during transitions of care for older patients with multiple comorbidities; however, it is unknown to what extent this process occurs. This study was designed to characterize the extent to which factors associated with older patient's recovery, such as functional status, cognitive status, social status, and emotional factors, are shared among PCPs and surgical providers during care transitions.
We prospectively identified 15 patients aged over 60 y with ≥3 comorbidities referred for general and vascular surgery procedures at a Veterans Administrative and academic medical center. Semistructured Critical Decision Method interviews were conducted with patients along with their surgical providers and referring PCPs. Thematic content analysis was performed independently by five reviewers on the cognitive processes associated with functional status, cognitive status, social status, and emotional factors. Interrater reliability between providers and patients was assessed using Cohen's kappa.
Forty-seven Critical Decision Method interviews were conducted, which included 20 paired interviews between a PCP and a surgeon and 16 paired interviews that involved a patient and a provider. The majority of patients reported experiencing poor information exchange between their PCP and surgeon (58%) and feeling they were primarily responsible for communicating their own health information during care transitions (67%). In paired interviews between PCPs and surgeons, there was nearly perfect agreement for the shared knowledge of cognitive (kappa: 0.83) and emotional (kappa 1) factors. In contrast, there was only minimal agreement for shared knowledge of functional status (kappa 0.38) and social status (kappa: 0.34).
Information exchange between PCPs and surgical providers is often discordant during transitions of surgical care for medically complex older patients, particularly when it pertains to communicating their functional or social status.
初级保健提供者（PCP）和外科医生之间的健康信息交流对于患有多种合并症的老年患者的护理过渡至关重要；然而，尚不清楚这种情况发生的程度。本研究旨在描述在护理过渡期间，与老年患者康复相关的因素（如功能状态、认知状态、社会地位和情绪因素）在 PCP 和外科医生之间共享的程度。
我们前瞻性地确定了 15 名年龄在 60 岁以上且有≥3 种合并症的患者，他们在退伍军人管理局和学术医疗中心接受普通和血管外科手术。对患者及其外科医生和转诊 PCP 进行半结构化关键决策方法访谈。五位审阅者独立对与功能状态、认知状态、社会地位和情绪因素相关的认知过程进行主题内容分析。使用 Cohen's kappa 评估提供者和患者之间的提供者间可靠性。
共进行了 47 次关键决策方法访谈，其中包括 20 次 PCP 和外科医生之间的配对访谈以及 16 次涉及患者和提供者的配对访谈。大多数患者报告说，他们的 PCP 和外科医生之间的信息交流很差（58%），并且他们在护理过渡期间主要负责传达自己的健康信息（67%）。在 PCP 和外科医生之间的配对访谈中，对认知（kappa：0.83）和情绪（kappa 1）因素的共享知识几乎完全一致。相比之下，对功能状态（kappa 0.38）和社会地位（kappa：0.34）的共享知识的一致性仅很小。
在为患有多种合并症的老年患者进行手术护理过渡期间，PCP 和外科医生之间的信息交流常常不一致，尤其是在传达他们的功能或社会地位方面。
