Adler-Milstein Julia, Raphael Katherine, O'Malley Terrence A, Cross Dori A
Department of Medicine, Center for Clinical Informatics and Improvement Research, University of California, San Francisco, San Francisco.
Department of Health Policy, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
JAMA Netw Open. 2021 Jan 4;4(1):e2033980. doi: 10.1001/jamanetworkopen.2020.33980.
Patient transitions from hospitals to skilled nursing facilities (SNFs) require robust information sharing. After a decade of investment in health information technology infrastructure and new incentives to promote hospital-SNF coordination in the US, the current state of information sharing at this critical transition is unknown.
To measure the completeness, timeliness, and usability of information shared by hospitals when discharging patients to SNFs, and to identify relational and structural characteristics associated with better hospital-SNF information sharing.
DESIGN, SETTING, AND PARTICIPANTS: Survey of 500 SNFs from a US nationally representative sample (265 respondents representing 471 hospital-SNF pairs; response rate of 53.0%) that collected detailed data on information sharing that supports care transitions from each of the 2 hospitals from which they receive the largest volume of patient referrals. Survey administration occurred between January 2019 and March 2020.
Overall assessment of information completeness, timeliness, and usability using 5-point Likert scales. Detailed measures, including (1) completeness-routine sharing of 23 specific information types; (2) timeliness-how often information arrived after the patient; and (3) usability-whether information was duplicative, extraneous, or not tailored to SNF needs. In addition, 8 relational characteristics (eg, shared staffing, collaborative meetings, and referral volume) and 10 structural characteristics (eg, size, ownership, and staffing) were assessed as potential factors associated with better information sharing.
Of 471 hospital-SNF pairs, 64 (13.5%) reported excellent performance on all 3 dimensions of information sharing, whereas 141 (30.0%) were at or below the mean performance on all dimensions. Social status (missing in 309 pairs [65.7%]) and behavioral status (missing in 319 pairs [67.7%]) were the most common types of missing information. Receipt of hospital information was delayed, sometimes (159 pairs [33.8%]) or often (77 pairs [16.4%]) arriving after the patient. In total, 358 pairs [76.0%] reported at least 1 usability shortcoming. Having a hospital clinician on site at the SNF was associated in multivariate analysis with more complete (odds ratio, 1.72; 95% CI, 1.07-2.78; P = .03), timely (odds ratio, 1.76; 95% CI, 1.08-2.88; P = .02), and usable (odds ratio, 1.64; 95% CI, 1.02-2.63; P = .04) information sharing. Hospital accountable care organization participation was associated with more timely information sharing (odds ratio, 1.88; 95% CI, 1.13-3.14; P = .02).
In this study, US SNFs reported significant shortcomings in the completeness, timeliness, and usability of information provided by hospitals to support patient transitions. These shortcomings are likely associated with a suboptimal transition experience. Shared clinicians represent a potential strategy to improve information sharing but are costly. New payment models such as accountable care organizations may offer a more scalable approach but were only associated with more timely sharing.
患者从医院向专业护理机构（SNF）的过渡需要强有力的信息共享。在美国对健康信息技术基础设施投入了十年并出台了促进医院与SNF协调的新激励措施之后，这一关键过渡阶段信息共享的现状尚不清楚。
衡量医院在将患者转诊至SNF时所共享信息的完整性、及时性和可用性，并确定与更好的医院 - SNF信息共享相关的关系和结构特征。
设计、设置和参与者：对来自美国全国代表性样本的500家SNF进行调查（265名受访者代表471对医院 - SNF；回复率为53.0%），收集了关于信息共享的详细数据，这些信息支持从它们接收患者转诊量最大的两家医院中的每一家进行护理过渡。调查于2019年1月至2020年3月进行。
使用5点李克特量表对信息完整性、及时性和可用性进行总体评估。详细指标包括：（1）完整性——23种特定信息类型的常规共享；（2）及时性——信息在患者之后到达的频率；（3）可用性——信息是否重复、无关或未针对SNF需求进行定制。此外，评估了8个关系特征（如共享人员配置、协作会议和转诊量）和10个结构特征（如规模、所有权和人员配置）作为与更好的信息共享相关的潜在因素。
在471对医院 - SNF中，64对（13.5%）在信息共享的所有三个维度上均表现出色，而141对（30.0%）在所有维度上的表现均处于或低于平均水平。社会状况（在309对中缺失[65.7%]）和行为状况（在31
