Vol XX, December `05

Study investigators asked medical directors to complete a survey about 10 admissions to the nursing facility. The questionnaires addressed the presence or absence of various pieces of information on admission, including:

• Advance directives
• Pertinent lab results
• Scheduled follow-up appointments
• Discharge medication list
• Indicators for essential medications
• Discharge instructions
• Functional status

The survey results, which included 161 responses, produced some interesting findings:

• If the nursing home had an affiliation with a nursing school, it was more likely to "do worse" in terms of complete information for several areas: infection control, progress notes, essential medications, and list of allergies.
• If the nursing home was affiliated with a medical school, it was more likely to "do worse" in several information domains: infection control, progress notes, scheduled follow-up, essential medications, list of allergies, and discharge instructions.
• Facilities that were for-profit or part of a chain were likely to have better information in several areas.

Katz emphasized that these findings are just the beginning; and he identified several necessary steps and issues to address regarding this issue:

• Objective review of transfer information from a full spectrum of facilities
• Acknowledgement of a reciprocal relationship between nursing homes and hospitals
• Inclusion of other mediating factors in future studies, such as staff organization
• Targeting education of providers at all kinds of training opportunities

"Our study on this issue confirms that information transfer is an ongoing, natural problem that calls for several targeted studies to address and resolve," stated Katz. However, he cautioned, "JCAHO [Joint Commission for the Accreditation of Healthcare Organizations] is looking at this issue, so it could change overnight."