01 May UHF Says Better Information, Fewer Regs, Needed to Help Patients Make Better Care Decisions
With one in five hospital patients across the nation requiring continuous medical care after discharge – a number likely to grow with the graying of the population and the burden of chronic illnesses rises – a multipronged approach is essential to helping these patients and their families make the best possible medical decision about post-hospital care, says a recently released report by United Hospital Fund (UHF).
According to UHF report, Pathways to Progress on Difficult Decisions in Post-Acute Care, is the fourth and final in its a series of reports that explore how fragmented care settings and payment systems, unclear regulations, and information gaps all play a role in limiting the guidance hospital staff can provide their patients and their families during the haste to plan care at home, a rehabilitation center, nursing home, or other care setting after hospitalization.
The Difficult Decision reports were based on interviews with patients and their families, health care providers, researchers, policymakers, and other stakeholders, as well as UHF’s own research. These reports explain how patients and their families are often times left in the dark about their care options, and must make care decisions without sufficient information and support at a time when they may be particularly frail and vulnerable.
Report Outlines Strategies to Enhance Patient Decision-Making
Based on a year-long review, with support from the New York State Health Foundation (NYSHealth), UHF’s 25-page report released in March, lays out an assortment of strategies for tackling the roadblocks to more informed decision-making. Strategies for change are organized around six potential policy tools: engaging patients and their families, improving discharge planning, bridging health system silos, addressing regulatory and payment poliy barriers, improving public information and transparency, and increasing public awareness.
“There is a lot on the line in decisions about post-acute care, where the wrong choice can carry devastating consequences—declining health, loss of independence additional financial burdens,” said report co-author Lynn Rogut, director, Quality Measurement and Care Transformation, of UHF’s Quality Institute in a statement announcing the release of the report. “The good news is that there is no shortage of ideas about how to improve decision support,” says Rogut.
UHF’s report says that key steps for improving the process include clarifying legal restrictions that limit the advice hospital staff can provide during discharge planning along with and lifting the burden of research and decision-making placed on patients and their families. For instance, the report notes that hospital staff could provide more timely communication by bringing relevant quality information to the bedside through closed circuit television, tablets, and apps.
Shared decision-making, a process where a designated health care team member introduces information about the range of post-acute care choices to patients and their families, reviews associated risks and benefits, elicits their preferences, and helps them reach a decision based on what matters most to them, also holds great promise as a solution, says UHF’s report. “Decision support innovations that engage patients and caregivers and integrate their self-reports about concerns, priorities, and discharge preparedness would be another important advance,” said Anne-Marie J. Audet, MD, MSc, SM report co-author and senior medical officer of UHF’s Quality Institute.
Creating the conditions in which patients are more likely to understand their options and choose higher quality providers will also require attention to persistent, systemic problems such as insufficient accountability and coordination across care settings, communication breakdowns, gaps in information available at the point of care, lack of public awareness about uneven quality, and burdensome regulatory complexities that make navigating the U.S. health care system so difficult for patients and families.
“Tackling the complex barriers this report has identified will take sustained action on multiple levels,” said UHF president Anthony Shih, MD, MPH. “Fostering closer alignment and collaboration among patients, families, hospital staff, post-acute care providers, payers, and policymakers will not be easy, but it is central to better serving patients and families and improving outcomes.”
Giving Patients a Road Map for Assessing Options
“Choosing where to seek post-hospital care after being discharged can be among the hardest decisions patients and their families have to make, especially during what is often a time of incredible stress,” said David Sandman, PhD, president and CEO of NYSHealth. “Although there may be resources available, many families aren’t aware of their options or feel rushed in their decision-making. This report makes clear that changes are needed and provides a road map for helping patients assess their options and make informed choices,” he adds.
UHF’s four reports in the Difficult Decisions project are: Difficult Decisions About Post-Acute Care and Why They Matter; The Illusion of Choice: Why Decisions About Post-Acute Care Are Difficult for Patients and Family Caregivers; Health Care Provider Perspectives on Discharge Planning: From Hospital to Skilled Nursing Facility; and the latest,. Pathways to Progress on Difficult Decisions in Post-Acute Care. All four reports can be downloaded from UHF’s website, www.uhfnyc.org/initiatives/post-acute-care/.
UHF, a New York City-based nonprofit organization, works to build a more effective health care system for every New York resident. UHF analyzes public policy to inform decision-makers, find common ground among diverse stakeholders, and develops and supports innovative programs that improve the quality, accessibility, affordability, and experience of patient care.