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Study suggests importance of medical communication

Nursing homes that score higher on accountability, communication provide better outcomes

Physician attentiveness and communication have a strong relationship with the quality of the care for nursing home residents, according to a study led by University researchers, which was published online in the Journal of the American Medical Directors Association April 7.

The researchers collected data using surveys given to nursing directors and nursing home administrators, said Dean of the School of Public Health Terrie Wetle, a co-author of the study. The surveys addressed physician attentiveness, communication and effectiveness. This data was combined with measures of health care quality, such as referrals to hospice care and the number of unnecessary hospital admissions. The sum of the data suggest that strong physician communication and attentiveness are correlated with better health outcomes.

“There were many, many fewer avoidable hospitalizations in nursing homes that had a good score on accountability and communication,” Wetle said.

Wetle noted that this conclusion may seem obvious but that it was necessary to collect data that supports the claim. Earlier research has looked at the connection between physician communication and patient outcomes in the hospital setting. But this connection had yet to be studied in nursing homes, and this study is the first to develop a scale system for measuring these factors, she said.

More people die in nursing homes every year than in hospitals, but nursing home health care is less understood than acute hospital care, Wetle said.

A main difference between hospitals and nursing homes is that­ — as the name implies — nurses provide greater breadth of care in a nursing home than in a hospital.

Doctors see patients less frequently in nursing homes but are still responsible for prescribing medications and treating patients. As a result, physicians rely on nurses to a greater extent in nursing homes to inform them of patients’ symptoms and the courses of chronic illnesses, Wetle said.

In the nursing home, a “clear and trusted line of communication is more important” and “requires a higher level of trust in order to be effective,” Wetle said.

This line of research began as a series of interviews with the family members of patients who died in nursing homes. Many of the respondents said they had never spoken with their family member’s doctor in the nursing home, Wetle said, adding that this led to subsequent research on medical care and communication in nursing homes.

Julie Lima, manager of data acquisition and senior programmer analyst at the Center for Gerontology and Healthcare Research at the School of Public Health, and Orna Intrator, professor of public health sciences at the University of Rochester Medical Center, collaborated with Wetle on the study.

Wetle said she plans to perform additional research in the field by interviewing individuals about their experiences. Intrator will continue survey-based research in conjunction with the Veterans Administration, Wetle added.

Barbara Bates-Jensen, associate professor at the University of California at Los Angeles School of Nursing, echoed the view that nurses play a larger role in nursing home care since physicians may only occasionally visit the patients.

Nursing home care is also provided by nursing aides and other staff members, Bates-Jensen said, so the “level of education affects the communication that occurs.”


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