Date Presented 3/30/2017
Care coordination is a national priority of health care reform. Effective communication is essential for coordinated care. This session will present the results of a qualitative study examining rehabilitation providers’ interdisciplinary communication practices in SNF for hip fracture patients.
Primary Author and Speaker: Brenda Fagan
Contributing Authors: Natalie Leland, Jenny Martinez, Carin Wong
PURPOSE: The Improving Medicare Post-Acute Care Transformation (IMPACT) Act (2014) aims to improve postacute care (PAC) health care services delivery and patient outcomes by providing standardized, patient-centered, high-quality coordinated care. As PAC providers, skilled nursing facilities (SNFs) are tasked with meeting the priorities of this legislation. Efforts to improve patient outcomes through the delivery of coordinated care must include strategies for effective interdisciplinary communication (Brown, 2009). Thus, in order to achieve sustainable quality improvement and develop evidence-based communication processes, stakeholder perspectives must be considered. Therefore, the purpose of this study is to explore PAC interdisciplinary communication topics and strategies used for facilitating coordinated care.
DESIGN: A qualitative approach was used to capture the types of information and strategies used by rehabilitation providers to facilitate coordinated care when communicating with the interdisciplinary team (e.g., nursing staff). Purposive sampling of SNFs (N = 13) in Los Angeles County was done to capture a diverse group of facilities that differed in characteristics known to impact care delivery (e.g., profit status, staffing ratios, and resources; Leland, Gozalo, Teno, & Mor, 2012). Rehabilitation providers (N = 99) participated in focus groups, including occupational therapists and occupational therapy assistants as well as physical therapists and physical therapy assistants. Eligible participants had to be employed at the SNF where focus groups were held, to have at least 1 yr of experience, and to be able to communicate in English. Fieldwork students were excluded from the study.
METHOD: One-hour focus groups were led by a trained interviewer and used semistructured, open-ended questions. Topics included patient care priorities, facilitators to delivery, and rehabilitation providers’ role in coordinated care. Focus groups were audio recorded and transcribed, and field notes were taken. Recordings were reviewed for familiarization and compared with field notes for accuracy. Each transcript was coded individually by multiple coders. Initial codes were developed, analyzed, grouped, and compared across the research team. Themes were then reviewed and compared with selected quotes and the entirety of coded data. Qualitative data analysis software Atlas.ti (Berlin, Germany) was used to organize and facilitate data analysis.
RESULTS: Promoting consistent follow through of care between disciplines emerged as a key priority of interdisciplinary communication for care coordination. In particular, bidirectional communication with nursing was reinforced across all focus group sessions. Specific examples of communication to support desired patient outcomes included optimizing patient safety, pain management, and progress toward goals. Verbal communication was identified as the preferred and most frequently used strategy for relaying information. Written communication was used less frequently and primarily to reiterate verbally communicated information.
CONCLUSION: Findings provide foundational knowledge to help understand the elements of interdisciplinary communication in the context of PAC patient care coordination. Furthermore, this study identified the variety of strategies used by the interdisciplinary team to convey key patient information and emphasizes the need for further research to understand the effectiveness of strategies used as well as the perspectives of the entire interdisciplinary care team.
IMPACT STATEMENT: As quality initiatives in PAC advance and care coordination measures are developed, the findings of this study highlight the complex and important role of communication for ensuring safe, high-quality coordinated care for optimal patient outcomes.
References
Brown, R. (2009). The promise of care coordination: Models that decrease hospitalizations and improve outcomes for Medicare beneficiaries with chronic illnesses. New York: Mathematica Policy Research.
IMPACT (Improving Medicare Post-Acute Care Transformation) Act, Pub. L. 113–185, 42 U.S.C. § 1305 (2014).
Leland, N. E., Gozalo, P., Teno, J., & Mor, V. (2012). Falls in newly admitted nursing home residents: A national study. Journal of the American Geriatrics Society, 60, 939–945. https://doi.org/10.1111/j.1532-5415.2012.03931.x
