Making Function Part of the Conversation: Clinician Perspectives on Measuring Functional Status in Primary Care
| Autor: | Malena J. Spar, Francesca M. Nicosia, Rebecca T. Brown, Michael A. Steinman, Sei J. Lee |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Attitude of Health Personnel media_common.quotation_subject Veterans Health 030204 cardiovascular system & hematology Article 03 medical and health sciences 0302 clinical medicine Documentation Nursing Activities of Daily Living medicine Electronic Health Records Humans 030212 general & internal medicine Function (engineering) Geriatric Assessment Veterans Affairs Qualitative Research Aged media_common Geriatrics Primary Health Care Delivery of Health Care Integrated business.industry Communication Barriers Workload Usability Physical Functional Performance Quality Improvement United States United States Department of Veterans Affairs Workflow Female Geriatrics and Gerontology business Qualitative research |
| Zdroj: | Journal of the American Geriatrics Society. 67:493-502 |
| ISSN: | 1532-5415 0002-8614 |
| DOI: | 10.1111/jgs.15677 |
| Popis: | Objectives Although there is increasing interest in using functional status to guide clinical decision making, function is seldom routinely assessed in primary care. We explored clinician perspectives on barriers and facilitators to routine measurement of older adults' functional status in primary care settings. Design Qualitative study using semistructured interviews. Setting Primary care and geriatrics clinics at six Veterans Affairs Medical Centers. Participants Twenty-four primary care providers, including 17 from primary care clinics and 7 from geriatrics clinics. Measurements We conducted interviews to elicit clinician perspectives about functional status measurement, including barriers and facilitators to routine assessment. We analyzed transcripts iteratively using a hybrid inductive and deductive thematic approach. Results Interviews revealed three distinct aspects to measuring function: screening and assessment, documentation, and use of data to inform care. Barriers and facilitators to screening and assessment included time availability, clinic processes, and degree of interdisciplinary environment. Barriers and facilitators to documentation included the usability and integration of electronic instruments into workflows and the availability of a standardized location to document function in the electronic medical record. Barriers and facilitators to use of data included the availability of a standardized location to retrieve data on function, the availability of appropriate referrals and services, and provider knowledge of available resources to address functional impairments. To address these barriers, providers emphasized the critical importance of connecting measurement of function directly to improved patient care. Conclusion Although clinicians emphasized the importance of measuring function, they also cautioned against additional workload burdens, cumbersome electronic documentation, and measurement of function without ensuring that these data are used to improve care. Approaches to functional status measurement must address these barriers to improve care and outcomes for older adults. J Am Geriatr Soc 67:493-502, 2019. |
| Databáze: | OpenAIRE |
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