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Post-Discharge Communication Between Home Health Nurses and Physicians: Measurement, Quality, and Outcomes.

TitlePost-Discharge Communication Between Home Health Nurses and Physicians: Measurement, Quality, and Outcomes.
Publication TypeJournal Article
Year of Publication2015
AuthorsPress MJ, Gerber LM, Peng TR, Pesko MF, Feldman PH, Ouchida K, Sridharan S, Bao Y, Barron Y, Casalino LP
JournalJ Am Geriatr Soc
Volume63
Issue7
Pagination1299-305
Date Published2015 Jul
ISSN1532-5415
KeywordsAged, 80 and over, Algorithms, Electronic Health Records, Female, Heart Failure, Humans, Interdisciplinary Communication, Male, Medicare, Natural Language Processing, New York, Nurses, Community Health, Physicians, Quality Assurance, Health Care, Retrospective Studies, Treatment Outcome, United States
Abstract

OBJECTIVES: To use natural language processing (NLP) of text from electronic medical records (EMRs) to identify failed communication attempts between home health nurses and physicians, to identify predictors of communication failure, and to assess the association between communication failure and hospital readmission.

DESIGN: Retrospective cohort study.

SETTING: Visiting Nurse Service of New York (VNSNY), the nation's largest freestanding home health agency.

PARTICIPANTS: Medicare beneficiaries with congestive heart failure who received home health care from VNSNY after hospital discharge in 2008-09 (N = 5,698).

MEASUREMENTS: Patient-level measures of communication failure and risk-adjusted 30-day all-cause readmission.

RESULTS: Identification of failed communication attempts using NLP had high external validity (kappa = 0.850, P < .001). A mean of 8% of communication attempts failed per episode of home care; failure rates were higher for black patients and lower for patients from higher median income ZIP codes. The association between communication failure and readmission was not significant with adjustment for patient, nurse, physician, and hospital factors.

CONCLUSION: NLP of EMRs can be used to identify failed communication attempts between home health nurses and physicians, but other variables mostly explained the association between communication failure and readmission. Communication failures may contribute to readmissions in more-serious clinical situations, an association that this study may have been underpowered to detect.

DOI10.1111/jgs.13491
Alternate JournalJ Am Geriatr Soc
PubMed ID26115315
Category: 
Faculty Publication