期刊
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
卷 23, 期 6, 页码 962-+出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jamda.2022.03.008
关键词
Nursing homes; SNFist; post-acute care; long-term care; qualitative research
资金
- National Institute on Aging [K01AG057824]
- National Institute on Aging
Physicians with expertise in nursing home care generally agree that SNFists provide higher quality care for residents than other physicians. However, a uniform definition of a SNFist based on competencies and standardized performance measures is needed. Unbillable and underreimbursed services create disincentives for physicians to specialize in nursing home care. Policy makers may consider adjusting Medicare reimbursements to incentivize more physicians to specialize in nursing home care.
Objective: To identify the perceptions of physicians with expertise in nursing home care on the value of physicians who primarily practice in nursing homes, often referred to as SNFists, with the goal of enriching our understanding of specialization in nursing home care. Design: Qualitative analysis of semistructured interviews. Setting and Participants: Virtual interviews conducted January 18-29, 2021. Participants included 35 physicians across the United States, who currently or previously served as medical directors or attending physicians in nursing homes. Methods: Interviews were conducted virtually on Zoom and professionally transcribed. Outcomes were themes resulting from thematic analysis. Results: Participants had a mean 19.5 (SD = 11.3) years of experience working in nursing homes; 17 (48.6%) were female; the most common medical specializations were geriatrics (18; 51.4%), family medicine (8; 22.9%), internal medicine (7; 20.0%), physiatry (1; 2.9%), and pulmonology (1; 2.9%). Ten (28.6%) participants were SNFists. We identified 6 themes emphasized by participants: (1) An unclear definition and loose qualifications for SNFists may affect the quality of care; (2) Specific competencies are needed to be a good SNFist; (3) SNFists are distinguished by their unique practice approach and often provide services that are unbillable or underreimbursed; (4) SNFists achieve better outcomes, but opinions varied on performance measures; (5) SNFists may contribute to discontinuity of care; (6) SNFists remained in nursing homes during the COVID-19 pandemic. Conclusions and Implications: There is a strong consensus among physicians with expertise in nursing home care that SNFists provide higher quality care for residents than other physicians. However, a uniform definition of a SNFist based on competencies in addition to standardized performance measures are needed. Unbillable and underreimbursed services create disincentives to physicians becoming SNFists. Policy makers may consider modifying Medicare reimbursements to incentivize more physicians to specialize in nursing home care. (C) 2022 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据