Journal of General Internal Medicine

, Volume 17, Issue 4, pp 253–257

Survey of primary care physicians and home care clinicians

An assessment of communication and collaboration
  • David G. Fairchild
  • Joanne Hogan
  • Rebecca Smith
  • Michelle Portnow
  • David W. Bates
Original Articles

Abstract

CONTEXT: Providing home care in the United States is expensive, and significant geographic variation exists in the utilization of these services. However, few data exist on how well physicians and home care providers communicate and coordinate care for patients.

OBJECTIVE: To assess communication and collaboration between primary care physicians (PCPs) and home care clinicians (HCCs) within 1 primary care network.

DESIGN: Mail survey.

SETTING: Boston.

PARTICIPANTS: Sixty-seven PCPs from 1 academic medical center-affiliated primary care network and 820 HCCs from 8 regional home care agencies.

MEASUREMENTS: Provider responses

RESULTS: Ninety percent of PCPs and 63% of HCCs responded. The majority (54%) of PCPs reported that they only “rarely” or “occasionally” read carefully the home care order forms sent to them for signature. Further, when asked to rate their prospective involvement in the decision making about home care, only 24% of PCPs and 25% of HCCs rated this as “excellent” or “very good.” Although more HCCs (79%) than PCPs (47%) reported overall satisfaction with communication and collaboration, 28% of HCCs felt they provided more services to patients than clinically necessary.

CONCLUSIONS: PCPs from 1 provider network and the HCCs with whom they coordinate home care were both dissatisfied with many aspects of communication and collaboration regarding home care services. Moreover, neither group felt in control of home care decision making. These findings are of concern because poor coordination of home care may adversely affect quality and contribute to inappropriate utilization of these services.

Key words

home care primary care communication integrated health care resource utilization 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Helbing C, Sangl JA, Silverman HA, Home health agency benefits. Health Care Finance Rev. 1992;Annual Supplement: 125S–48S.Google Scholar
  2. 2.
    United States General Accounting Office. Medicare Home Health Care: Prospective Payment System Will Need Refinement as Data Become Available. Gao Letter Report. 4/07/2000. Washington, DC: U.S. Government Printing Office; 2000.Google Scholar
  3. 3.
    United States General Accounting Office. Medicare Home Health Care: Prospective Payment System Could Reverse Recent Declines in Spending. GAO Letter Report 09/08/2000. Washington, DC: U.S. Government Printing Office; 2000.Google Scholar
  4. 4.
    Welch HG, Wennberg DE, Welch WP. The use of Medicare home health care services. New Engl J Med. 1996;335:324–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Kenney GM, Dubay LC. Explaining area variation in the use of Medicare home health services. Med Care. 1992;30:43–57.PubMedCrossRefGoogle Scholar
  6. 6.
    Hughes SL, Ulasevich A, Weaver FM, et al. Impact of home care on hospital days: a meta analysis. Health Serv Res. 1997;32:415–32.PubMedGoogle Scholar
  7. 7.
    Anttila SK, Huhtala HS, Pekurinen MJ, Pitkajarvi TK. Cost-effectiveness of an innovative four-year post-discharge programme for elderly patients—prospective follow-up of hospital and nursing home use in project elderly and randomized controls. Scand J Public Health. 2000;28:41–6.PubMedGoogle Scholar
  8. 8.
    Higginson I. Palliative care services in the community: what do family doctors want? J Palliat Care. 1999;15:21–5.PubMedGoogle Scholar
  9. 9.
    Nolan TW. Understanding medical systems. Ann Intern Med. 1998;128:293–8.PubMedGoogle Scholar
  10. 10.
    Levine M, Gent M, Hirsh J, et al. A comparison of low-molecular-weight heparin administered primarily at home with unfractionated heparin administered in the hospital for proximal deep-vein thrombosis. N Engl J Med. 1996;334:677–81.PubMedCrossRefGoogle Scholar
  11. 11.
    Mamon J, Steinwachs DM, Fahey M, Bone LR, Oktay J, Klein L. Impact of hospital discharge planning on meeting patient needs after returning home. Health Serv Res. 1992;2:155–75.Google Scholar
  12. 12.
    Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders. JAMA. 1999;281:613–20.PubMedCrossRefGoogle Scholar
  13. 13.
    Naylor M, Brooten D, Jones R, Lavizzo-Mourey R, Mezey M, Pauly M. Comprehensive discharge planning for the hospitalized elderly. Ann Intern Med. 1994;120:999–1006.PubMedGoogle Scholar
  14. 14.
    Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM. A multidisciplinary intervention to prevent the read-mission of elderly patients with congestive heart failure. N Engl J Med. 1995;333:1190–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Boling PA. The value of targeted case management during transitional care. JAMA. 1999;281:656–7.PubMedCrossRefGoogle Scholar
  16. 16.
    Stuck AE, Aronow HU, Steiner A, et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med. 1995;333:1184–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Williams FG, Warrick LH, Christianson JB, Netting FE. Critical factors for successful hospital-based case management. Health Care Manage Rev. 1993;18:63–70.PubMedGoogle Scholar
  18. 18.
    Hibberd PA. The primary/secondary interface. Cross-boundry teamwork—missing link for seamless care? J Clin Nurs. 1998;7:274–82.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2002

Authors and Affiliations

  • David G. Fairchild
    • 1
    • 3
    • 2
  • Joanne Hogan
    • 3
  • Rebecca Smith
    • 3
  • Michelle Portnow
    • 3
  • David W. Bates
    • 1
    • 3
  1. 1.Department of Medicinethe Division of General MedicineBoston
  2. 2.Harvard Medical SchoolBoston
  3. 3.Brigham and Women’s HospitalBoston

Personalised recommendations