Background: Communication between referring Veterans Health Administration (VHA) facilities and home health care agencies in the community is imperative for comprehensive care for Veterans. However, to date little is known about communication during care transitions from VHA facilities to home health care. The purpose of the present study is to conduct a preliminary exploratory survey in eight VHA facilities to better understand VHA hospitalist provider perceptions of Veteran care transitions to community home health care.
Methods: To conduct a survey at multiple sites, the study team obtained National VA Union approval and local IRB designation as a quality improvement project. The study team, consisting of researchers and hospital medicine physicians, developed the survey questions to capture perceptions on adequacy, sufficiency, and timeliness of home health orders, instructions for patient care, Veteran preparedness for home health care, access to patient health and instructions for communication with the VA hospital.The research team identified eight site champions, or hospital medicine physicians located at eight sites, who disseminated the survey to the hospitalists at their sites. Site champions also provided feedback on the survey and recruitment efforts. Survey data was collected using VA-approved Research Electronic Data Capture (REDCap) browser-based software. During the survey period, which occurred from March to July 2020, site champions sent email reminders to their respective hospitalist groups to complete the survey. The research team exported the de-identified survey data from the REDCap system and ran descriptive statistics analyses on the results using Microsoft Excel (version 1808, Seattle, Washington, United States).
Results: The survey response rate was 24% (N=37) across eight VA facilities. All respondents held an MD. The majority of respondents (75%) completed residency training in the last 10 years. 60% of hospitalists responded that home health agencies are only occasionally or rarely provided with sufficient information about a patient’s hospitalization at the time of discharge. 65% of hospitalists indicated the information about how to contact the hospital treatment team with questions about a Veteran’s management is less than sufficient or not at all sufficient. 70% of hospitalists think it would be very useful to provide home health services with internet-based access to a Veteran’s hospital medical record to further guide management. 60% of hospitalists only occasionally or rarely review existing home health orders to determine if they are still needed after discharge.
Conclusions: Findings from this survey highlight areas in which Veteran care transitions from VHA facilities to community home health care can be improved. Results suggest that the VHA should explore opportunities to increase sufficient communication and exchange of Veteran health information from referring facilities to home health agencies in the community. Potential solutions for this may include providing community home health agencies access to Veteran charts via internet-based access to the electronic health record. Potential solutions might include updating the VHA community care referral form for more clear transfer of patient information, creating a standardized contact mechanism for questions, and mandating community care order review prior to all discharges.