Bridging the gap: a comparison of patient and provider perspectives on an electronic health record-based discharge communication tool (Preprint)

Abstract

BACKGROUND Hospital discharge for older adult patients carries risks. Effective patient-provider communication is crucial for post-acute care. Technology-based communication tools are promising in improving patient experience and outcomes. However, there is limited evidence comparing patient and provider user experiences on a large-scale basis, hindering the exploration of true patient-provider shared understanding. OBJECTIVE This study aimed to evaluate an electronic health record-based discharge communication tool by examining and comparing patient and provider perspectives. METHODS This study comprised a cross-sectional self-administered staff survey and a pre-post cross-sectional patient survey. Physicians, nurses, and older adult patients aged 65 and older discharged from four public hospitals were included. Patient-provider comparison items focused on three aspects of the design quality of the tool (information clarity, adequacy, and usefulness) and overall satisfaction with the tool. Additionally, patients’ experience of discharge information and their medication-taking behaviors before and after the program implementation were compared based on a validated local patient experience survey instrument. Providers’ perceived usefulness of this tool to their work and implementation intentions were measured based on the Technology Acceptance Model to enhance understanding of their experiences by conducting structural equation modeling analysis. RESULTS A total of 1,375 and 2,353 valid responses were received from providers and patients, respectively. Patients’ overall satisfaction with this communication tool is significantly higher than providers', as well as the information clarity and usefulness presented by this tool (P<0.001). However, patients rated significantly lower on information adequacy than that of providers (P<0.001). Meanwhile, patients reported a significant improvement in their experience of discharge medication information and fewer patients reported side effects encounters after the program implementation (11.6% vs 9.0%, P=0.04). However, providers showed inconsistent implementation fidelity. Providers’ perceived quality of the tool design (β coefficient, 0.24 [95%CI, 0.08 to 0.40]) and perceived usefulness to their work (β coefficient, 0.57 [95%CI, 0.43 to 0.71]) significantly impacted their satisfaction. Satisfaction can significantly impact implementation intentions (β coefficient, 0.40 [95%CI, 0.17 to 0.64]), which further impacts implementation behaviors (β coefficient, 0.16 [95%CI, 0.10 to 0.23]). CONCLUSIONS A notable disparity exists between patients and healthcare providers. This may hinder the achievement of the tool's benefits. Future research should aim for a comprehensive overview of implementation barriers and corresponding strategies to enhance staff performance and facilitate patient-provider shared understanding.