UHF report outlines wide-ranging strategies aimed at helping patients and families assess and make informed choices when post-acute care is needed
NEW YORK, NEW YORK March 13, 2019—With one in five U.S. hospital patients requiring continued medical care after discharge—a number likely to grow as the population ages and the burden of chronic illness rises—a multi-pronged approach is essential to helping patients and their families make the best possible decision about post-hospital care, says a report released today by United Hospital Fund (UHF).
Pathways to Progress on Difficult Decisions in Post-Acute Care is the fourth and final in a series of reports by UHF that explore how fragmented care settings and payment systems, unclear regulations, and information gaps all play a role in limiting the guidance hospital staff can provide patients and their families during the rush to arrange care in the home, a rehabilitation center, nursing home, or other setting after hospitalization. The reports explain how patients and their families are often in the dark about their options, and must make care decisions with insufficient information and support at a time when they may be particularly frail and vulnerable.
Based on a year-long inquiry, with support from the New York State Health Foundation (NYSHealth), UHF’s new report lays out a range of strategies for tackling the roadblocks to more informed decision-making. Strategies for change are organized around six potential policy levers: engaging patients and families, improving discharge planning, bridging health system silos, addressing regulatory and payment policy barriers, enhancing public information and transparency, and increasing public awareness.
“There is a lot on the line in decisions about post-acute care, where the wrong choice can carry devastating consequences—declining health, loss of independence, and additional financial burdens,” said report co-author Lynn Rogut, director, Quality Measurement and Care Transformation, of UHF’s Quality Institute. “The good news is that there is no shortage of ideas about how to improve decision support.”
Key steps for improving the process include clarifying legal restrictions that limit the advice hospital staff can provide during discharge planning, and lifting the burden of research and decision-making placed on patients and families. As an example, hospital staff could provide more timely communication by bringing relevant quality information to the bedside through closed circuit television, tablets, and apps.
Shared decision-making, a process where a designated care team member introduces information about the range of post-acute care choices to patients and families, reviews associated risks and benefits, elicits their preferences, and helps them reach a decision based on what matters most to them, also holds great promise as a solution. “Decision support innovations that engage patients and caregivers and integrate their self-reports about concerns, priorities, and discharge preparedness would be another important advance,” said Anne-Marie J. Audet, MD, MSc, SM report co-author and senior medical officer of UHF’s Quality Institute.
Creating the conditions in which patients are more likely to understand their options and choose higher quality providers will also require attention to persistent, systemic problems such as insufficient accountability and coordination across care settings, communication breakdowns, gaps in information available at the point of care, lack of public awareness about uneven quality, and burdensome regulatory complexities that make navigating the U.S. health care system so difficult for patients and families.
“Tackling the complex barriers this report has identified will take sustained action on multiple levels,” said UHF president Anthony Shih MD, MPH. “Fostering closer alignment and collaboration among patients, families, hospital staff, post-acute care providers, payers, and policymakers will not be easy, but it is central to better serving patients and families and improving outcomes.”
“Choosing where to seek post-hospital care after being discharged can be among the hardest decisions patients and their families have to make, especially during what is often a time of incredible stress," said David Sandman, PhD, president and CEO of NYSHealth. "Although there may be resources available, many families aren’t aware of their options or feel rushed in their decision-making. This report makes clear that changes are needed and provides a roadmap for helping patients assess their options and make informed choices.”
The Difficult Decision reports were based on interviews with patients and their families, health care providers, researchers, policymakers, and other stakeholders, as well as UHF’s own research. The three other reports in the Difficult Decisions project are:
• Difficult Decisions About Post-Acute Care and Why They Matter,
• The Illusion of Choice: Why Decisions About Post-Acute Care Are Difficult for Patients and Family Caregivers
• Health Care Provider Perspectives on Discharge Planning: From Hospital to Skilled Nursing Facility.
All four reports can be downloaded from UHF’s website here.
About United Hospital Fund
United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs please visit our website at www.uhfnyc.org and follow us on Twitter.