Patient Preferences for Information on Post-Acute Care Services

Sefcik, Justine S.; Nock, Rebecca H.; Flores, Emilia J.; Chase, Jo‐Ana D.; Bradway, Christine; Potashnik, Sheryl; Bowles, Kathryn H.

doi:10.3928/19404921-20160120-01

Cited by 19 publications

(29 citation statements)

References 30 publications

(42 reference statements)

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“…This is consistent with existing literature, which has found that home health case managers do not provide quality information or make recommendations but merely provide lists of agency names and contact information . It is also consistent with research that has highlighted the importance of providing information to patients because consumer understanding of postacute services is associated with decision‐making . In the present study, respondents reported feeling that medical staff were not allowed to offer guidance or recommendations, even though most nursing home admissions come from the hospital and hospital discharge planners are key stakeholders in the placement process.…”

Section: Discussionsupporting

confidence: 89%

Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives

Gadbois

Tyler

Mor

2017

J American Geriatrics Society

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Background/Objectives This research seeks to describe patients' experiences during the hospital discharge planning and skilled nursing facility (SNF) selection process. Design Semi-structured interviews, focusing on discharge planning and nursing facility selection, including how facilities were chosen, who was involved, and what factors were important in decision-making. Setting 14 SNFs in five cities across the United States. Participants 98 newly-admitted, previously community-dwelling SNF patients and/or their family members. Measurement Semi-structured interviews were qualitatively coded to identify underlying themes. Results Most respondents reported receiving only a list of SNF names and addresses from discharge planners and that hospital staff were minimally involved. Patients' choice of SNF was most often influenced by proximity to home and prior experience with the facility. Most respondents reported being satisfied with their placement, although many stated that they would have been willing to travel further to another SNF were it recommended. Many reported feeling rushed and unprepared, stating that they did not know where or how to get help. Conclusion SNF placement is a stressful transition, occurring when patients are physically vulnerable and with limited guidance from discharge planners. Therefore, most patients select a facility based on its location, perhaps because they are provided with no other information. Given CMS's proposed changes to the discharge planning process, this research highlights the value of providing patients and family caregivers with both quality data and assistance in interpreting it.

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Section: Discussionsupporting

confidence: 89%

Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives

Gadbois

Tyler

Mor

2017

J American Geriatrics Society

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“…This study was approved by the University of Pennsylvania's Institutional Review Board. Other findings from the larger study are published elsewhere (7). …”

Section: Methodsmentioning

confidence: 62%

“…Presenting explanations of the professional services PAC encompasses such as medication reconciliation, continued monitoring of symptoms, teaching, care coordination, pain management, and wound care could improve acceptance of these valuable services. Informing patients and families about the specifics of potential services they might receive and how a particular service matches their needs, may provide important opportunities for making more informed decisions (7). Educational campaigns aimed at providers and patients and their family caregivers may benefit the PAC industry by highlighting positive aspects, dispelling negative stereotypes, and managing expectations as in reality family caregivers may not be able to meet PAC needs as is often the hope.…”

Section: Discussionmentioning

confidence: 99%

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Why older adults may decline offers of post-acute care services: A qualitative descriptive study

et al. 2017

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The most common post-acute care (PAC) services available to patients after hospital discharge include home care, skilled nursing facilities, nursing homes, inpatient rehabilitation, and hospice. Patients who need PAC and receive services have better outcomes, however almost one-third of those offered services decline. Little research exists on PAC decision-making and why patients may decline services. This qualitative descriptive study explored the responses of thirty older adults to the question: “Can you, from the patient point of view, tell me why someone would not want post hospital care?” Three themes emerged. Participants may decline due to 1) previous negative experiences with PAC, or 2) a preference to be home. Some participants stated, “I'd be there” and would not decline services. Participants also discussed 3) why other patients might decline PAC which included patients’ past experiences, fear of the unknown, and preferences. Clinical implications include assessing patients’ knowledge and experience before providing recommendations.

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“…Prior studies explored the rising cost of PAC and its impact on overall healthcare spending, quality of care, and outcomes . Few studies have explored what hospitalized patients would like to know to make informed decisions about their PAC placement including information on the upfront financial cost of services as well as insurance coverage . Patient‐physician communication on out‐of‐pocket costs may occur infrequently, leading some to recommend physician communication with patients about out‐of‐pocket costs as an important but neglected aspect of clinical practice .…”

Section: Discussionmentioning

confidence: 99%

Perceived Costs of Care Influence Post‐Acute Care Choices by Clinicians, Patients, and Caregivers

Ayele

Jones

Ladebue

et al. 2019

J American Geriatrics Society

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Background/Objective Older adults frequently receive post‐acute care (PAC) after hospital discharge, but little is known about how perceived costs influence PAC choices. This research study sought to understand how clinicians, patients, and their caregivers evaluate the cost of skilled nursing facility (SNF) care in their decisions about whether to utilize SNFs after hospital discharge. Design Guided by principles of social constructivist theory, we conducted a qualitative interpretative study using semistructured interviews with clinicians, patients, and caregivers. Setting The study took place in three SNFs and three hospitals located in an urban area. Purposive sampling was used to maximize variability in SNFs, hospitals, units within hospitals, and staff. Participants A total of 104 participants made up the study: 25 hospital clinicians, 20 SNF clinicians, 20 hospital patients, 15 SNF patients, 14 hospital caregivers, and 10 SNF caregivers who were directly involved in patients’ transition from acute hospitalization to SNFs. Measurements Central themes related to how perceived costs of care influence PAC choices. Results Clinicians, patients, and caregivers did not understand the nuances of SNF insurance coverage or out‐of‐pocket costs. They felt constrained by insurance coverage in their discharge disposition choices and faced delays in hospital discharge due to insurance authorization processes. Some clinicians reacted to these constraints by “documenting failure,” sending patients home to “fail” so they could justify SNF to insurers. Others changed their recommendations to provide patients “some” postdischarge care, even if inadequate, because of cost constraints. Clinicians discussed conserving resources to take maximal advantage of insurance‐covered SNF days. Overall, cost constraint resulted in patient safety concerns, clinician professional dilemma, and moral distress. Conclusion Improving patient and caregiver understanding about costs and constraints of PAC would improve decision making. There is a need for improved comprehension of cost and insurance coverage of SNF care for informed patient and provider decision making at the time of hospital discharge. J Am Geriatr Soc 67:703–710, 2019.

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Patient Preferences for Information on Post-Acute Care Services

Cited by 19 publications

References 30 publications

Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives

Selecting a Skilled Nursing Facility for Postacute Care: Individual and Family Perspectives

Why older adults may decline offers of post-acute care services: A qualitative descriptive study

Perceived Costs of Care Influence Post‐Acute Care Choices by Clinicians, Patients, and Caregivers

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