Perceived Costs of Care Influence Post-Acute Care Choices by Clinicians, Patients, and Caregivers.
constraints of insurance
cost of care
post-acute care
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
received:
11
10
2018
revised:
19
11
2018
accepted:
20
11
2018
pubmed:
2
2
2019
medline:
22
5
2020
entrez:
2
2
2019
Statut:
ppublish
Résumé
Older adults frequently receive post-acute care (PAC) after hospital discharge, but little is known about how perceived costs influence PAC choices. This research study sought to understand how clinicians, patients, and their caregivers evaluate the cost of skilled nursing facility (SNF) care in their decisions about whether to utilize SNFs after hospital discharge. Guided by principles of social constructivist theory, we conducted a qualitative interpretative study using semistructured interviews with clinicians, patients, and caregivers. The study took place in three SNFs and three hospitals located in an urban area. Purposive sampling was used to maximize variability in SNFs, hospitals, units within hospitals, and staff. A total of 104 participants made up the study: 25 hospital clinicians, 20 SNF clinicians, 20 hospital patients, 15 SNF patients, 14 hospital caregivers, and 10 SNF caregivers who were directly involved in patients' transition from acute hospitalization to SNFs. Central themes related to how perceived costs of care influence PAC choices. Clinicians, patients, and caregivers did not understand the nuances of SNF insurance coverage or out-of-pocket costs. They felt constrained by insurance coverage in their discharge disposition choices and faced delays in hospital discharge due to insurance authorization processes. Some clinicians reacted to these constraints by "documenting failure," sending patients home to "fail" so they could justify SNF to insurers. Others changed their recommendations to provide patients "some" postdischarge care, even if inadequate, because of cost constraints. Clinicians discussed conserving resources to take maximal advantage of insurance-covered SNF days. Overall, cost constraint resulted in patient safety concerns, clinician professional dilemma, and moral distress. Improving patient and caregiver understanding about costs and constraints of PAC would improve decision making. There is a need for improved comprehension of cost and insurance coverage of SNF care for informed patient and provider decision making at the time of hospital discharge. J Am Geriatr Soc 67:703-710, 2019.
Sections du résumé
BACKGROUND/OBJECTIVE
Older adults frequently receive post-acute care (PAC) after hospital discharge, but little is known about how perceived costs influence PAC choices. This research study sought to understand how clinicians, patients, and their caregivers evaluate the cost of skilled nursing facility (SNF) care in their decisions about whether to utilize SNFs after hospital discharge.
DESIGN
Guided by principles of social constructivist theory, we conducted a qualitative interpretative study using semistructured interviews with clinicians, patients, and caregivers.
SETTING
The study took place in three SNFs and three hospitals located in an urban area. Purposive sampling was used to maximize variability in SNFs, hospitals, units within hospitals, and staff.
PARTICIPANTS
A total of 104 participants made up the study: 25 hospital clinicians, 20 SNF clinicians, 20 hospital patients, 15 SNF patients, 14 hospital caregivers, and 10 SNF caregivers who were directly involved in patients' transition from acute hospitalization to SNFs.
MEASUREMENTS
Central themes related to how perceived costs of care influence PAC choices.
RESULTS
Clinicians, patients, and caregivers did not understand the nuances of SNF insurance coverage or out-of-pocket costs. They felt constrained by insurance coverage in their discharge disposition choices and faced delays in hospital discharge due to insurance authorization processes. Some clinicians reacted to these constraints by "documenting failure," sending patients home to "fail" so they could justify SNF to insurers. Others changed their recommendations to provide patients "some" postdischarge care, even if inadequate, because of cost constraints. Clinicians discussed conserving resources to take maximal advantage of insurance-covered SNF days. Overall, cost constraint resulted in patient safety concerns, clinician professional dilemma, and moral distress.
CONCLUSION
Improving patient and caregiver understanding about costs and constraints of PAC would improve decision making. There is a need for improved comprehension of cost and insurance coverage of SNF care for informed patient and provider decision making at the time of hospital discharge. J Am Geriatr Soc 67:703-710, 2019.
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
703-710Subventions
Organisme : HSRD VA
ID : IK2 HX001796
Pays : United States
Organisme : NIA NIH HHS
ID : R03 AG050885
Pays : United States
Organisme : NIA NIH HHS
ID : R03AG050885
Pays : United States
Organisme : VA HSR&D Career Development Award
ID : 1IK2 HX001796
Pays : International
Commentaires et corrections
Type : CommentIn
Informations de copyright
Published 2019. This article is a U.S. Government work and is in the public domain in the USA.