Objectives
To identify perceived barriers to communication between hospital and nursing home
at the time of patient transfer and examine associations between perceived barriers
and hospital and nursing home characteristics.
Design
Mailed survey.
Setting
Medicare- or Medicaid-certified nursing homes in New York State.
Participants
Nursing home administrators, with input from other nursing home staff.
Measurements
Respondents rated the importance as a barrier to hospital-nursing home communication
of (1) hospital providers' attitude, time, effort, training, payment, and familiarity
with nursing home patients; (2) unplanned and off-hours transfers; (3) HIPAA privacy
regulations; and (4) lost or failed information transmission. Associations were determined
between barriers and the following organizational characteristics: (1) hospital-nursing
home affiliations, pharmacy or laboratory agreements, cross-site staff visits, and
cross-site physician care; (2) hospital size, teaching status, and frequency of geriatrics
specialty care; (3) nursing home size, location, type, staffing, and Medicare quality
indicators; and (4) hospital-to-nursing home communication, consistency of hospital
care with health care goals, and communication quality improvement efforts.
Results
Of 647 questionnaires sent, 229 were returned (35.4%). The most frequently reported
perceived barriers to communication were sudden or unplanned transfers (44.4%), transfers
that occur at night or on the weekend (41.4%), and hospital providers' lack of effort
(51.0%), lack of familiarity with patients (45.0%), and lack of time (43.5%). Increased
hospital size, teaching hospitals, and urban nursing home location were associated
with greater perceived importance of these barriers, and cross-site staff visits and
hospital provision of laboratory and pharmacy services to the nursing home were associated
with lower perceived importance of these barriers.
Conclusions
Hospital and nursing home characteristics and interorganizational relationships were
associated with nursing home administrators' perceptions of barriers to hospital-nursing
home communication. These findings may inform design and targeting of interventions
to improve intersite communication processes.
Keywords
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Article info
Publication history
Published online: March 15, 2010
Footnotes
Financial support was provided by a Mount Sinai School of Medicine Summer Research Fellowship (F.S.), a Pfizer/Foundation for Health in Aging Junior Faculty Scholarship for Research on Health Outcomes in Geriatrics (K.S.B.), and the New York State Department of Health. K.S.B. is currently a Research Career Development Awardee from the VA Health Services Research and Development Service.
Identification
Copyright
Published by Elsevier Inc.
