The typical hospital case manager has little information to provide about home health agencies for discharged patients, even though state and federal quality reports are available on the Web, according to a recent study by Brown University in Providence, R.I. Through focus group interviews with 13 home health care consumers and 28 case managers at five Rhode Island hospitals, the researchers learned that no one was aware of state or federal home health care quality reports. Such reports include patient satisfaction ratings and data on outcomes such as hospital readmissions. The study has been published in the Journal General Internal Medicine.
The study’s finding was a surprise, according to lead author Rosa Baier, associate director of Brown University’s Center for Long Term Care Quality and Innovation and senior scientist at the Providence-based Healthcentric Advisors, which administered the study. Healthcentric Advisors is contracted by the Rhode Island Department of Health to run the state’s public reporting program.
The researchers also informally surveyed another 40 case managers in five other states, finding that in seven out of every eight cases, those managers also shared only bare bones lists that provided no quality information from, or references to, online reports. “Their process seems very similar to what is happening in Rhode Island,” Baier said in prepared statement.
Senior author Melissa Clark, professor of epidemiology in the Brown University School of Public Health, said the findings are notable in light of recent changes in health care policy and payments designed to reward quality in outcomes.
The focus group participants also yielded other insights about potential barriers to informing patients’ decision making about home health care. Most importantly, case managers reported feeling that federal laws or hospital policy prohibited them from answering patients’ questions about which agency they recommended or patients should choose.
The authors’ research includes two more phases. The first focused on creating a Web-based quality report tailored to include what patients and family members said they would like to know. The final phase, currently underway, involves conducting a randomized, controlled trial in which the investigators are testing whether offering the new quality report to consumers has an effect on their experience choosing home care and on the choices they make.
After conducting the focus groups, Baier and the Rhode Island Department of Health also began pushing updates about the existing quality reports to local hospitals instead of posting updates online for hospital staff to seek independently. Medicare and state public reporting programs should consider other ways of making hospital case managers more aware of the quality reports, Baier said, since case managers routinely help patients make decisions during hospital discharge and can make patients aware of existing quality reports if they themselves are aware of these resources.
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