"We're Almost Guests in Their Clinical Care": Inpatient Provider Attitudes Toward Chronic Disease Management

Saul Blecker, Talia Meisel, Victoria Vaughan Dickson, Donna Shelley, Leora I. Horwitz

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Many hospitalized patients have at least 1 chronic disease that is not optimally controlled. The purpose of this study was to explore inpatient provider attitudes about chronic disease management and, in particular, barriers and facilitators of chronic disease management in the hospital.

METHODS: We conducted a qualitative study of semi-structured interviews of 31 inpatient providers from an academic medical center. We interviewed attending physicians, resident physicians, physician assistants, and nurse practitioners from various specialties about attitudes, experiences with, and barriers and facilitators towards chronic disease management in the hospital. Qualitative data were analyzed using constant comparative analysis.

RESULTS: Providers perceived that hospitalizations offer an opportunity to improve chronic disease management, as patients are evaluated by a new care team and observed in a controlled environment. Providers perceived clinical benefits to in-hospital chronic care, including improvements in readmission and length of stay, but expressed concerns for risks related to adverse events and distraction from the acute problem. Barriers included provider lack of comfort with managing chronic diseases, poor communication between inpatient and outpatient providers, and hospital-system focus on patient discharge. A strong relationship with the outpatient provider and involvement of specialists were facilitators of inpatient chronic disease management.

CONCLUSIONS: Providers perceived benefits to in-hospital chronic disease management for both processes of care and clinical outcomes. Efforts to increase inpatient chronic disease management will need to overcome barriers in multiple domains. Journal of Hospital Medicine 2017;12:162-167.

Original languageEnglish (US)
Pages (from-to)162-167
Number of pages6
JournalJournal of Hospital Medicine
Volume12
Issue number3
DOIs
StatePublished - Mar 1 2017

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Disease Management
Inpatients
Chronic Disease
Outpatients
Hospital Medicine
Physicians
Physician Assistants
Controlled Environment
Nurse Practitioners
Patient Discharge
Length of Stay
Hospitalization
Communication
Interviews

ASJC Scopus subject areas

  • Leadership and Management
  • Fundamentals and skills
  • Health Policy
  • Care Planning
  • Assessment and Diagnosis

Cite this

"We're Almost Guests in Their Clinical Care" : Inpatient Provider Attitudes Toward Chronic Disease Management. / Blecker, Saul; Meisel, Talia; Vaughan Dickson, Victoria; Shelley, Donna; Horwitz, Leora I.

In: Journal of Hospital Medicine, Vol. 12, No. 3, 01.03.2017, p. 162-167.

Research output: Contribution to journalArticle

Blecker, Saul ; Meisel, Talia ; Vaughan Dickson, Victoria ; Shelley, Donna ; Horwitz, Leora I. / "We're Almost Guests in Their Clinical Care" : Inpatient Provider Attitudes Toward Chronic Disease Management. In: Journal of Hospital Medicine. 2017 ; Vol. 12, No. 3. pp. 162-167.
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