Johns Hopkins Studies Broken Communication Between Home Health, Doctors

Home health care providers know the struggle of coordinating well with physicians, and research underway could shed light on how communication between the two groups is failing—and what can be done to improve it.

Researchers from Johns Hopkins University in Baltimore are undertaking a study that will seek to understand how home health care agencies interact with physicians that assign home health care services.

The study, “Communication and Care Coordination Between Home Health Care Agencies and Clinicians with Providers Who Order and Certify Home Health Care Services,” is funded through a $100,000 grant provided by the Alliance for Home Health Quality and Innovation, a nonprofit industry consortium that invests in research and education.


Better communication will likely lead to better care coordination, researchers postulate, so they want to gauge the current relationship and ask providers important questions.

“In this project, we are interested in gaining the perspective of home health agencies around communication,” Cynthia Boyd, professor of medicine at Johns Hopkins Bloomberg School of Public Health, told Home Health Care News. “How do we improve communication and care coordination? These are often vulnerable patients with high risks of [hospital] readmission. How do we make communication better and show how we got to where we are?”

The study will start with a qualitative phase, where researchers will speak with a diverse group of home health agencies to understand what they don’t know about this issue. It’s a good place to start “when you don’t know all the questions you should be asking,” according to Boyd.


From there, researchers will conduct a survey that will strive to be systematic and diverse in its reach, either by mail or electronically, and will ask questions pertaining to communication, coordination and care plan certification.

Coordinating perspectives

While this grant will look at the home health care perspective, researchers have already conducted a study with physicians that will be released in an upcoming issue of the Annals of Internal Medicine. 

“Having looked at it from the physician side, we thought it was only fair to come at it and see how the home health agencies are viewing the same issues,” Bruce Leff, director of The Center for Transformative Geriatric Research and professor of medicine at Johns Hopkins, told HHCN. “They also have a really hard job…These patients are complex. That communication is important.”

Leff is also a board member of the Alliance and credited with creating the hospital-at-home model at Johns Hopkins.

Researchers already see several issues with communication between physicians and home health agencies. Physicians frequently don’t have enough time to review notes from home health providers, while agencies find it difficult to get doctors on the phone for questions or new signatures. In addition, more paperwork for care plans—often sent via fax—can end up piling up in a physician’s office.

Issues like these pose problems for care quality but also regulatory compliance, as face-to-face documentation and other requirements demand collaboration between home health agencies and physicians.

The issue came to a head in Illinois in June 2016, just prior to the start of the now-defunct pre-claim review demonstration (PCRD). Home health agencies were very concerned at the time that physicians wouldn’t be able to sign off on care plans quickly enough to meet the demands of pre-claim submissions, which required agencies to submit claims much earlier on in the care process.

“The pity is that [there is] a tremendous opportunity to improve care,” Leff said. “We know the communication is broken on the doctor side, we’re curious on the home health side. The goal of this research is to pull back the covers a bit and figure out where we are [in order] to work on this problem in a meaningful way.”

The study will likely get underway within the next month; an application for the qualitative phase is currently under review. The survey will likely take place in summer 2018.

The John Hopkins study is just one of the Alliance’s planned grants in 2018, according to Jennifer Schiller, director of policy communications and research with the Alliance. The association opened up a request for proposals at the end of 2017 and plans to continue fulfilling several funding grants for additional home care research this year.

Written by Amy Baxter

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