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Impact of Nurse-Physician Communication on Patient Health Examined in New Interdisciplinary Study

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Dr. Linda Gerber, professor of Public Health and professor of epidemiology in Medicine

An interdisciplinary team of researchers from Weill Cornell Medical College and the Visiting Nurse Service of New York are investigating how patient health is impacted by communication between visiting nurses and physicians.

The 18-month, $250,000 study funded by the Aetna Foundation and led by Weill Cornell researchers Dr. Linda Gerber, professor of Public Health and professor of epidemiology in Medicine, and Dr. Matthew Press, the Nanette Laitman Clinical Scholar in Public Health — Quality of Care Research, assistant professor of Public Health and assistant professor of Medicine, is focused on the communication between home health nurses and physicians caring for recently hospitalized Medicare patients with congestive heart failure. In collaboration with Dr. Penny Feldman, associate professor of Public Health at Weill Cornell and Visiting Nurse Service of New York senior vice president, research and evaluation, and Dr. Timothy Peng, director of analytics and senior research associate at the Visiting Nurse Service of New York Center for Home Care Policy and Research, they are trying to determine if there is a relationship between unsuccessful communication and a patient's risk of readmission to the hospital within 30 days of his or her initial discharge.

"Many Medicare patients receive home health care after discharge from the hospital," Dr. Press said. "Visiting nurses are the eyes and ears in a patient's home. In order for them to be able to coordinate care with physicians, there needs to be an open line of communication. There's a lot at stake when a patient comes out of the hospital."

Dr. Matthew Press, the Nanette Laitman Clinical Scholar in Public Health -- Quality of Care Research, assistant professor of Public Health and assistant professor of Medicine

"The Visiting Nurse Service of New York is committed to preventing avoidable hospitalizations through all types of collaboration and information exchange. But nothing is more important than open communication between the nurse, the physician and the patient," Dr. Feldman said. "That is why we are so pleased to collaborate with our Weill Cornell colleagues on this study."

According to the Medicare Payment Advisory Commission, 3.4 million Medicare beneficiaries nationwide receive home health care each year at a cost of nearly $20 billion. About one third of these episodes of care are for patients recently discharged from the hospital. Yet 2.6 million seniors — nearly one in five Medicare patients — discharged from the hospital are readmitted within 30 days, costing Medicare more than $26 billion every year. Medication errors, poor communication between providers from the inpatient to outpatient settings and preventable adverse events have been cited by the federal government as potential causes.

"Care transition is a very critical point in helping patients manage their chronic conditions," said Dr. Gerber, who has worked with the Visiting Nurse Service of New York on three prior studies. "Communication is key during these transitions. This is a good point to look at what works and what doesn't work."

The 10-member team is scouring the electronic health records of some-7,000 patients who used the Visiting Nurse Service of New York in 2008 and 2009 looking for documentation of attempted communication between nurses and physicians. The researchers will then merge those data with Medicare claims data to determine if the patient was readmitted to the hospital and if readmission was associated with failed communication attempts.

"Hospital readmission has become an extremely hot button issue in health policy because not only does it signify potential problems in quality of care, but it's also expensive," Dr. Press said. "Reducing readmissions is a big part of the health care reform law, so there's a lot of interest at the policy level and research level in better understanding what causes readmissions and figuring out how to reduce them."

In that vein, the researchers have conducted focus groups of Visiting Nurse Service of New York home care nurses and plan to interview physicians to ask the medical professionals directly about their communication experiences, focusing on potential barriers and ways to improve dialogue in the hopes of preventing readmissions.

"There's increasing recognition that health care doesn't revolve entirely around physicians," Dr. Press said. "There are a lot of other people who are vitally important, and we need to make sure that they are all on the same page and working together. The home health nurse-physician relationship has barely been explored in the research. This is a pretty novel study that we're taking on to explore that relationship and try to make it better."

"There's potential for a lot of good coming out of this study. We may be able to uncover potential issues and suggest achievable remedies" Dr. Gerber added.

This study is one of a portfolio of research projects examining integrated health care and care coordination the Aetna Foundation have funded this year. Grants of $250,000 were also awarded to Community Health Center, Inc., headquartered in Middletown, Conn., and the National Assembly on School-Based Health Care in Washington, D.C, among others. Improving health care through better integrated and coordinated care is one of the Foundation's three priority areas.

"These three studies, which examine care coordination in different health care settings and among different populations, will provide us with much-needed understanding of coordinated care," said Dr. Gillian Barclay, vice president of the Aetna Foundation. "The more precisely we can envision what coordinated care looks like and how best to weave it into the everyday delivery of health care, the closer we can get to an optimal delivery of care that produces the best outcomes at the lowest cost."

Weill Cornell's research team intends to publish its results in at least one peer-reviewed journal while sharing their findings at national meetings, local task forces and within home health agencies across the nation to immediately effect change.

"We hope to get the conversation started about how to fix (communication problems as it relates to readmissions)," Dr. Press said. "It might be a way to improve care transitions without necessarily making substantial new investments in new programs and new personnel. Home health care is a resource that already exists. Our goal is to make it as good as possible."

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