Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
UMass Memorial Health Care, Worcester, MA, USA.
BMC Health Serv Res. 2021 Sep 28;21(1):1021. doi: 10.1186/s12913-021-07031-w.
After hospital discharge, patients can experience symptoms prompting them to seek acute medical attention. Early evaluation of patients' post-discharge symptoms by healthcare providers may improve appropriate healthcare utilization and patient safety. Post-discharge follow-up phone calls, which are used for routine transitional care in U.S. hospitals, serve as an important channel for provider-patient communication about symptoms. This study aimed to assess the facilitators and barriers to evaluating and triaging pain symptoms in cardiovascular patients through follow-up phone calls after their discharge from a large healthcare system in Central Massachusetts. We also discuss strategies that may help address the identified barriers.
Guided by the Practical, Robust, Implementation and Sustainability Model (PRISM), we completed semi-structured interviews with 7 nurses and 16 patients in 2020. Selected nurses conducted (or supervised) post-discharge follow-up calls on behalf of 5 clinical teams (2 primary care; 3 cardiology). We used thematic analysis to identify themes from interviews and mapped them to the domains of the PRISM model.
Participants described common facilitators and barriers related to the four domains of PRISM: Intervention (I), Recipients (R), Implementation and Sustainability Infrastructure (ISI), and External Environment (EE). Facilitators include: (1) patients being willing to receive provider follow-up (R); (2) nurses experienced in symptom assessment (R); (3) good care coordination within individual clinical teams (R); (4) electronic health record system and call templates to support follow-up calls (ISI); and (5) national and institutional policies to support post-discharge follow-up (EE). Barriers include: (1) limitations of conducting symptom assessment by provider-initiated follow-up calls (I); (2) difficulty connecting patients and providers in a timely manner (R); (3) suboptimal coordination for transitional care among primary care and cardiology providers (R); and (4) lack of emphasis on post-discharge follow-up call reimbursement among cardiology clinics (EE). Specific barriers for pain assessment include: (1) concerns with pain medication misuse (R); and (2) no standardized pain assessment and triage protocol (ISI).
Strategies to empower patients, facilitate timely patient-provider communication, and support care coordination regarding pain evaluation and treatment may reduce the barriers and improve processes and outcomes of pain assessment and triage.
患者出院后可能会出现促使其寻求急性医疗关注的症状。医疗保健提供者对患者出院后症状的早期评估可能会改善适当的医疗保健利用和患者安全。出院后电话随访是美国医院常规过渡性护理的一种方式，是医患之间就症状进行沟通的重要渠道。本研究旨在评估通过马萨诸塞州中部一家大型医疗保健系统的出院后电话随访，评估和分诊心血管患者疼痛症状的促进因素和障碍。我们还讨论了可能有助于解决已确定障碍的策略。
在实用、稳健、实施和可持续性模型（PRISM）的指导下，我们在 2020 年对 7 名护士和 16 名患者进行了半结构化访谈。选定的护士代表 5 个临床团队（2 个初级保健；3 个心脏病学）进行（或监督）出院后随访电话。我们使用主题分析从访谈中识别主题，并将其映射到 PRISM 模型的领域。
参与者描述了与 PRISM 的四个领域相关的常见促进因素和障碍：干预（I）、接受者（R）、实施和可持续性基础设施（ISI）和外部环境（EE）。促进因素包括：（1）患者愿意接受提供者的随访（R）；（2）有经验的护士进行症状评估（R）；（3）各临床团队内部的良好护理协调（R）；（4）电子健康记录系统和呼叫模板支持随访电话（ISI）；以及（5）国家和机构政策支持出院后随访（EE）。障碍包括：（1）通过提供者发起的随访电话进行症状评估的局限性（I）；（2）及时将患者与提供者联系起来的困难（R）；（3）初级保健和心脏病学提供者之间过渡性护理协调不佳（R）；以及（4）心脏病学诊所对出院后随访电话报销缺乏重视（EE）。疼痛评估的具体障碍包括：（1）对止痛药滥用的担忧（R）；以及（2）没有标准化的疼痛评估和分诊协议（ISI）。
赋予患者权力、促进及时的医患沟通以及支持疼痛评估和分诊的护理协调的策略，可以减少障碍并改善疼痛评估和分诊的流程和结果。
