Fragmented Clinical Communication Hampers Care Coordination

Clinical communication across community-based healthcare settings and primary care providers (PCPs) is fragmented, which limits care coordination to support the complex needs of persons living with dementia (PLWD), according to a study published in JAMIA.

The researchers conducted six focus groups with 33 adult day care center (ADC) staff and individual semistructured interviews with 22 PCPs in California.

The study found complex communication workflows across community-based settings, like ADCs, that limit direct communication between providers and require informal caregivers to serve as intermediaries.

Additionally, the researchers found that clinical communication between ADC and PCPs relies heavily on antiquated methods of communication, such as fax and phone, which contributes to delayed and fragmented care for PLWD.

ADC staff and PCPs alike agreed on the importance of effective communication across community-based settings. ADCs possess rich information about the health and social needs of PLWD based on in-depth observations and interactions, the study authors noted.

However, the research revealed that ADCs lack ways to summarize and share clinical information to support care coordination. Rather, most information exchanged between PCPs and ADCs is done to comply with regulatory requirements.

PCPs in the study reported that they were overwhelmed by forms and regulatory documents, making it difficult to focus on key information from ADC requests. EHR inbox burden for PCPs can contribute to clinician burnout, and the number of messages received by PCPs has risen even further during the COVID-19 pandemic.

Other studies have found that most PCPs report that they only rarely or occasionally carefully read care order forms from home health services, producing potential patient safety issues. While stakeholders have developed prototypes to assist in home health and PCP clinical communication, they have not been implemented in practice.

Additionally, the study authors found that ADCs and PCPs expected informal caregivers to take primary responsibility for ensuring care coordination and tracking medical information. While engaged informal caregivers are often willing to fulfill these responsibilities, they may lack the time, resources, and health education needed to do so.

To improve care coordination for PLWD across ADC and PCPs, the researchers emphasized that a conceptual shift is needed.

“PCPs and ADCs must move away from exchanging information solely to comply with regulatory guidelines,” the study authors wrote. “Instead, the community-based care team needs to be reimagined to include the informal caregiver and ADC staff, in addition to the PCPs. All members of the team must be provided with tools to organize and share information.”

Also, when information is exchanged, the researchers noted that it must be in a succinct format to avoid adding to existing clinician burden.

“The SBAR method, highlighted as a key communication model by the Agency for Healthcare Research and Quality, was commonly cited by both ADC staff and PCPs as an effective method of exchanging information when a new clinical problem arises,” the researchers wrote. “This streamlined format limits inclusion of extraneous details.”

The researchers noted several limitations to their study. First, the sample was limited to a single state. Since ADCs are regulated on a state-by-state basis, communication patterns may reflect state-based regulations and may not be widely generalizable. However, the authors said that their findings were generally consistent with other studies of communication patterns among community-based providers.

In addition, the analysis did not include the perspectives of informal caregivers, despite them being a part of the communication process.

“Future studies should explore how best to incorporate them within the care team and strengthen their perspectives when developing person- and family-centered aged care models,” the study authors wrote.