Communication gaps between doctors and home-based healthcare providers are a big risk for elderly patients, according to a new study.
Researchers interviewed six focus groups of home health nurses and staff to analyze challenges to coordinating care for patients recently discharged from the hospital. The participants cited concerns like lack of access to patient records and resistance from hospital clinicians about accountability, according to the study published in the Journal of General Internal Medicine.
The home health workers said they often receive medication lists that are incomplete or inaccurate because of the number of doctors involved in patient care. And many also said that when they reached out to primary care providers, they weren't in the loop about patient care, either. Some weren't even informed when their patients were hospitalized.
Another challenge is that many payers require physicians to order home health services, so if a patient is receiving primary care from an advanced practice nurse or other clinician, it's harder to get approval for care at home.
Christine Jones, M.D., assistant professor at the University of Colorado School of Medicine and the study’s lead author, said in an announcement that the findings show hospital-employed doctors could do more to coordinate with providers outside of their hospitals.
"As hospitalists, we need to think about what happens beyond the hospital walls and how we can support our patients after discharge, especially when it comes to home health care patients who can be very vulnerable." Jones said.
The researchers offered several solutions to the problems, including:
- Allowing home-based healthcare agencies direct access to electronic health records and direct phone lines to contact physicians;
- Pushing for policies that allow nurse practitioners and physician assistants to order home-based care;
- Making sure hospitalists are accountable for home care orders until primary care doctors can see patients and take over;
- Creating better lines of communication with primary care physicians to make care transitions safer.