Older Adult Patients and Care Partners as Knowledge Brokers in Fragmented Health Care

Abstract

Objective: To describe older adult patients' and care partners' knowledge broker roles during emergency department (ED) visits.

Background: Older adult patients are vulnerable to communication and coordination challenges during an ED visit, which can be exacerbated by the time and resource constrained ED environment. Yet, as a constant throughout the patient journey, patients and care partners can act as an information conduit, or knowledge broker, between fragmented care systems to attain high-quality, safe care.

Methods: Participants included 14 older adult patients ($\ge$ 65 years old) and their care partners (e.g., spouse, adult child) who presented to the ED after having experienced a fall. Human factors researchers collected observation data from patients, care partners and clinician interactions during the patient's ED visit. We used an inductive content analysis to determine the role of patients and care partners as knowledge brokers.

Results: We found that patients and care partners act as knowledge brokers by providing information about diagnostic testing, medications, the patient's health history, and care accommodations at the disposition location. Patients and care partners filled the role of knowledge broker proactively (i.e. offer information) and reactively (i.e. are asked to provide information by clinicians or staff), within-ED work system and across work systems (e.g., between the ED and hospital), and in anticipation of future knowledge brokering.

Conclusion: Patients and care partners, acting as knowledge brokers, often fill gaps in communication and participate in care coordination that assists in mitigating health care fragmentation.

Keywords: care fragmentation; care transitions and handoffs; emergency medicine; patient engagement and self-care; patient safety; patient-provider communication; work system.

Figure 1.

Within- and across-system roles involved in knowledge brokering