Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan 4;4(1):e2033980.
doi: 10.1001/jamanetworkopen.2020.33980.

Information Sharing Practices Between US Hospitals and Skilled Nursing Facilities to Support Care Transitions

Julia Adler-Milstein  1 , Katherine Raphael  2 , Terrence A O'Malley  3 , Dori A Cross  4
Affiliations

Information Sharing Practices Between US Hospitals and Skilled Nursing Facilities to Support Care Transitions

Julia Adler-Milstein et al. JAMA Netw Open. .

Abstract

Importance: Patient transitions from hospitals to skilled nursing facilities (SNFs) require robust information sharing. After a decade of investment in health information technology infrastructure and new incentives to promote hospital-SNF coordination in the US, the current state of information sharing at this critical transition is unknown.

Objective: To measure the completeness, timeliness, and usability of information shared by hospitals when discharging patients to SNFs, and to identify relational and structural characteristics associated with better hospital-SNF information sharing.

Design, setting, and participants: Survey of 500 SNFs from a US nationally representative sample (265 respondents representing 471 hospital-SNF pairs; response rate of 53.0%) that collected detailed data on information sharing that supports care transitions from each of the 2 hospitals from which they receive the largest volume of patient referrals. Survey administration occurred between January 2019 and March 2020.

Main outcomes and measures: Overall assessment of information completeness, timeliness, and usability using 5-point Likert scales. Detailed measures, including (1) completeness-routine sharing of 23 specific information types; (2) timeliness-how often information arrived after the patient; and (3) usability-whether information was duplicative, extraneous, or not tailored to SNF needs. In addition, 8 relational characteristics (eg, shared staffing, collaborative meetings, and referral volume) and 10 structural characteristics (eg, size, ownership, and staffing) were assessed as potential factors associated with better information sharing.

Results: Of 471 hospital-SNF pairs, 64 (13.5%) reported excellent performance on all 3 dimensions of information sharing, whereas 141 (30.0%) were at or below the mean performance on all dimensions. Social status (missing in 309 pairs [65.7%]) and behavioral status (missing in 319 pairs [67.7%]) were the most common types of missing information. Receipt of hospital information was delayed, sometimes (159 pairs [33.8%]) or often (77 pairs [16.4%]) arriving after the patient. In total, 358 pairs [76.0%] reported at least 1 usability shortcoming. Having a hospital clinician on site at the SNF was associated in multivariate analysis with more complete (odds ratio, 1.72; 95% CI, 1.07-2.78; P = .03), timely (odds ratio, 1.76; 95% CI, 1.08-2.88; P = .02), and usable (odds ratio, 1.64; 95% CI, 1.02-2.63; P = .04) information sharing. Hospital accountable care organization participation was associated with more timely information sharing (odds ratio, 1.88; 95% CI, 1.13-3.14; P = .02).

Conclusions and relevance: In this study, US SNFs reported significant shortcomings in the completeness, timeliness, and usability of information provided by hospitals to support patient transitions. These shortcomings are likely associated with a suboptimal transition experience. Shared clinicians represent a potential strategy to improve information sharing but are costly. New payment models such as accountable care organizations may offer a more scalable approach but were only associated with more timely sharing.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Adler-Milstein reported receiving grants from The John A. Hartford Foundation during the conduct of the study; being a Project Connect board member and shareholder outside the submitted work; and serving as an uncompensated advisor to CommonWell Health Alliance. Dr O’Malley reported receiving grants from the University of California, San Francisco during the conduct of the study; receiving personal fees from Marquis Health Services North End Rehabilitation and Healthcare Center, from Genesis Skilled Nursing and Rehabilitation Chelsea, and from Genesis Lighthouse Nursing Care Center Revere outside the submitted work; and serving on the ONC Health Information Technology Advisory Committee. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Skilled Nursing Facility (SNF) Ratings: Completeness, Timeliness, and Usability of Information to Support Care Transitions
Data are for 471 hospital-SNF pairs. A rating of 5 on a Likert scale of 1 to 5 points indicated excellent performance, whereas a rating of 3 or lower indicated below-average performance.
Figure 2.
Figure 2.. Completeness of Information Received by Skilled Nursing Facilities (SNFs) From Hospitals to Support Care Transitions
Right panel includes information elements missing for more than 20% of hospital-SNF pairs. Missingness of all 23 data elements included in the survey is reported in the eAppendix in the Supplement.
Figure 3.
Figure 3.. Usability of Information Received by Skilled Nursing Facilities (SNFs) From Hospitals to Support Care Transitions
See this image and copyright information in PMC

Comment in

References

    1. Coleman EA. Falling through the cracks: challenges and opportunities for improving transitional care for persons with continuous complex care needs. J Am Geriatr Soc. 2003;51(4):549-555. doi: 10.1046/j.1532-5415.2003.51185.x - DOI - PubMed
    1. Coleman EA, Berenson RA. Lost in transition: challenges and opportunities for improving the quality of transitional care. Ann Intern Med. 2004;141(7):533-536. doi: 10.7326/0003-4819-141-7-200410050-00009 - DOI - PubMed
    1. Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822-1828. doi: 10.1001/archinte.166.17.1822 - DOI - PubMed
    1. Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18(8):646-651. doi: 10.1046/j.1525-1497.2003.20722.x - DOI - PMC - PubMed
    1. Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med. 2003;138(3):161-167. doi: 10.7326/0003-4819-138-3-200302040-00007 - DOI - PubMed

Publication types