Communication Breakdown: 60% of Home Health Workers Lack Adequate Information From Hospitals

As the U.S. health care system shifts towards value-based care, financial incentives are encouraging hospitals to work with home health organizations to improve patient outcomes.

But despite the push, 60% of home health workers say they lack adequate patient information from hospitals to inform care, often leaving patients unprepared for treatment.

That’s according to a new study from the University of Colorado Anschutz Medical Campus. As part of the study, which appeared in The Journal of Post-Acute and Long-Term Medicine, researchers sent a 48-question online survey to employees at 56 home health agencies across Colorado between January and June 2017. Ultimately, 41% of 122 recipients responded, including nurses, managers, administrators and quality assurance clinicians.

Their responses indicate poor communication is hurting patients and delaying care, with 44% of participants reporting they often or always encounter problems directly related to receiving inadequate patient information from hospitals.

“[Home health care] nurses and staff may not have all of the information they need to provide the best possible transitional care for patients, which could contribute to medication discrepancies between referring provider and [home health care] medication lists,” lead author Christine D. Jones, assistant professor at the University of Colorado School of Medicine, told Home Health Care News.

Past studies have confirmed medication discrepancies are a problem: 94% of patients had at least one medication discrepancy when comparing referring provider and home health care medication lists.

“These medication errors may in turn contribute to hospital readmissions and emergency department visits for patients,” Jones said.

That contributes to the high price of avoidable hospital readmissions, which costs Medicare about $17 billion per year, according to data from the Center for Health Information and Analysis.

Beyond Colorado

While study respondents were confined to Colorado, the problems they’re facing are not.

“I’m actually surprised the numbers aren’t larger,” Cindy Seawright, owner and operator of an Interim HealthCare franchise in Redding, California, told HHCN. “In our organization, I would say it’s probably more like eight out of 10 patients that we get from hospitals or skilled nursing facilities (SNFs) [that] we don’t get enough information [about] to be able to go out and provide the care that patients actually need.”

The agency often receives inaccurate patient histories, incomplete medication profiles, incorrect primary physician information and outdated patient phone numbers and addresses, Seawright said.

“It brings a total delay in care for that patient,” Seawright added. “With our regulations, we can’t go see a patient without having that primary doctor. We can deal with not having a medication profile or a history and physical. It makes it more work for the clinician when they go out there and get that information, but if we don’t have a primary care physician who will follow the patient to home health, we cannot open that patient to service.”

Communication-related issues delay 50% of her patients from receiving care for at least a day or two, she estimated.

Additionally, Seawright says referred patients are often inadequately prepared to receive care, another issue in-line with findings from the study: 52% of respondents said patients weren’t ready to receive home health care.

Chesapeake, Virginia-based BrightStar Care franchise owner Michael Walton told HHCN that his agency has faced similar problems

“Our office does not feel that appropriate time is taken, whether it be [during] discharge from acute care or from a SNF, to really discuss the comprehensive picture and needs required to manage [patients], thus putting clients at risk for medical instability,” Walton said.

Common failings include mismatched expectations about what the services entail as well as more extreme issues — such as ignorance of patients that they were referred to home health in the first place.

“A lot of times when we call a patient to introduce our agency — because that’s when we validate their address and everything — a lot of them are like, ‘Who are you? Why are you calling me? I had no clue we were even going to be having home health services,’” Seawright said.

Improving communication

The key to improving communication between hospitals and home health agencies lies in giving providers access to electronic health records (EHRs), the study found.

“Home health nurses with access [to EHRs] had fewer problems related to lack of information and were more likely to have information about medications and contact isolation, which could directly affect patient care,” Jones said.

Again, results are in-line with what Seawright has seen at her Redding Interim HealthCare franchise. Communication problems are much less prominent with a local hospital that allows Interim’s staff direct access to its EHRs, she said.

“When we get a referral, if we don’t have all the accurate information, we are able to log in ourselves to the hospitals portal and print out the information that’s not available to us,” Seawright said. “That has made a significant improvement, but only one hospital in our area has done that.”

The Visiting Nurse Service of New York (VNSNY) has had similar positive experiences, Andria Castellanos, the nonprofit’s EVP and chief of provider services, told HHCN.

VNSNY is the largest home health nonprofit in the country, serving more than 33,000 patients per day.

“We enjoy integrated and very collaborative relationships with many of our hospital partners,” Castellanos said. “We often participate in the design and development of special programs targeted to unique patient populations, and that’s important, because when we are able to work together with our hospital partners, from the ground up, we have information flow readily available and are able to provide critical care management across the entire continuum of care.”

But not all home health providers are as lucky.

While more than 96% of survey respondents indicated that internet-based access to a patient’s hospital record would be at least somewhat useful, only 44% reported having access to EHRs for referring hospitals or clinics.

Additionally, communication problems often still exist for providers with EHR access.

In fact, 78% of respondents with EHR access reported at least some difficulty reaching clinicians to ask follow up questions after a patient has been discharged.

“I often have to call multiple times,” one respondent quoted in the study wrote. “I am often ignored and don’t get calls back from anyone.”