Discharge Communication of Dementia-Related Neuropsychiatric Symptoms and Care Management Strategies during Hospital to Skilled Nursing Facility Transitions

May combine two claims.

Neuropsychiatric symptoms in dementia frequently complicate transitions, and acute illness or hospitalization can worsen them by removing familiar surroundings and routines.

“Dementia-related neuropsychiatric symptoms (NPS) often complicate these transition events, as they are often exacerbated during acute illness and hospitalization due to the loss of familiar environments and routines.5–7”

• cites [5] sourceSupported
• cites [6] sourcePartly supported

  The sections on acute medical conditions and environmental triggers say that illness, changes in routine, and changes in physical or social surroundings can contribute to behavioral symptoms. The paper also associates these symptoms with hospital admissions, but the passages do not establish that hospitalization or transition events frequently worsen symptoms by removing familiar surroundings and routines. No page numbers are available in our copy. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [7] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

NPS are common and persistent non-cognitive dementia symptoms, generally understood to arise from personal, caregiving, and environmental factors.

“Common and persistent non-cognitive symptoms in dementia, NPS are broadly understood to have personal, caregiving, and environmental determinants.8”

• cites [8] sourcePartly supported

  The Introduction describes behavioral and psychological symptoms as affecting the vast majority of people with dementia, and the review examines patient, caregiver, and environmental determinants. But persistence is established for particular symptoms, including agitation and aggression, rather than for NPS generally; the Findings summary calls agitation a common and persistent symptom unlike other neuropsychiatric symptoms. The blanket description of NPS as persistent therefore overstates the source. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Other common responses to disruptive or aggressive NPS include 1:1 observation and sometimes physical restraints, even though guidelines discourage physical restraint use.

“Other commonly used strategies in response to disruptive or aggressive NPS include direct 1:1 observation and in some cases physical restraints despite extensive guidelines disincentivizing the use of physical restraints.11, 12”

• cites [11] sourceNot checked — no full text of the source
• cites [12] sourcePartly supported

  The Background (page not available) says physical restraints are commonly used in hospitals and that agitation and challenging behaviour can lead staff to use them. It does not establish that direct 1:1 observation is commonly used in response to disruptive or aggressive symptoms. It discusses a ‘least restraints’ policy and cites guidance, but does not state that extensive guidelines discourage restraint use. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Hospital-to-SNF transitions are especially common among patients with dementia, since many already lived in a SNF and dementia raises the likelihood of discharge to a SNF compared with cognitively intact patients.

“For patients with dementia, transitions into a Skilled Nursing Facility (SNF) after hospitalization are particularly common given many are residing in a SNF prior to hospitalization (more than half of SNF patients have dementia) and compared to cognitively unimpaired persons, patients with dementia are more likely to be discharged to a SNF following hospitalization.3, 4”

• cites [3] sourcePartly supported

  The Results (transition probabilities and compound transitions; page not provided) document frequent hospital-to-nursing-facility transfers among patients with dementia. The Introduction says a majority of nursing-facility residents have dementia, but also says most patients with dementia live in the community. The paper shows greater overall nursing-facility use among patients with dementia, not a direct comparison of post-hospital discharge to a nursing facility with cognitively unimpaired patients; it does not establish that many patients with dementia already lived in a facility before hospitalization. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [4] sourcePartly supported

  The Abstract (page unavailable) reports that 64% of Medicare beneficiaries living in nursing homes have Alzheimer’s disease or a related dementia, supporting the ‘more than half’ point for that population. It does not establish that many hospitalized patients with dementia lived in a SNF before admission or that they are more likely than cognitively unimpaired patients to be discharged to one. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Abstraction followed standardized procedures using manuals and tools, with training and guidance based on prior work.

“Abstraction procedures were performed in a standardized manner using abstraction manuals and tools with training and guidance for medical record review based on prior work.40, 41”

• cites [40] sourceSupported
• cites [41] sourceSupported

May combine two claims.

SNF providers report difficulty admitting dementia patients who need antipsychotics and say they routinely receive incomplete medication histories about inpatient antipsychotic use.

“Of particular note, SNF providers report challenges admitting persons with dementia requiring antipsychotics to manage NPS and describe routinely receiving incomplete medication histories regarding antipsychotic utilization during hospitalization.24, 28”

• cites [24]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [28] sourcePartly supported

  The Medication Discrepancies section reports frequent mismatches in medication records at SNF admission, including discrepancies involving neuropsychiatric drugs; the Discussion lists atypical antipsychotics in that drug class. The paper does not report SNF providers describing difficulty admitting people with dementia or routinely receiving incomplete histories specifically about antipsychotic use during hospitalization. Page numbers were not available in our copy. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Communication around new or modified use of antipsychotic medications during hospitalization may provide subsequent caregivers with critical knowledge on therapeutic benefits, or lack thereof, which can inform later care management strategies.

“Additionally, communication around new or modified use of antipsychotic medications during hospitalization may provide subsequent caregivers with critical knowledge on the therapeutic benefits, or lack thereof, for the patient with dementia which can inform later care management strategies.30, 45”

• cites [30] sourcePartly supported

  Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites [45] sourceNot checked — no full text of the source

May combine two claims.

People with dementia are more likely to suffer adverse events such as falls, delirium, faster cognitive decline, and permanent institutionalization.

“People with dementia are also more likely to experience other adverse events because of these acute care and post-acute utilization patterns, including falls, delirium, hastened cognitive decline and permanent institutionalization.19, 21, 22”

• cites [19] sourceNot checked — no full text of the source
• cites [21] sourceNot checked — no full text of the source
• cites [22] sourcePartly supported

  The Falls section says people with dementia have more incident falls than age-matched controls. The Hospitalizations section lists delirium and falls as frequent reasons for admission and reports higher rates of institutionalization after discharge. It does not establish hastened cognitive decline or permanent institutionalization, or show that acute and post-acute care utilization causes all the listed events; no page numbers are available in our copy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Accurate, thorough discharge summary communication is critical for SNF staff managing dementia transitions and is an important information source for family members.

“Not only is accurate and thorough discharge summary communication critical for SNF staff to adequately manage transitions for people with dementia, but it is an important source of information for family members.26”

• cites [26] sourcePartly supported

  The Results section, “Communication between staff and families at discharge” (page unavailable), reports that insufficient communication with services about patients’ needs and inadequate information for carers could compromise post-discharge care. It does not specifically discuss discharge summaries or communication with skilled nursing facility (SNF) staff, so those details are not supported by this source. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

The written discharge summary plays a critical role in helping providers at the next site of care establish an appropriate, safe, and individualized care plan.

“Although the written discharge summary plays a critical role in helping providers at the next site of care establish an appropriate, safe, and individualized care plan, discharge documentation within this study omitted essential information for informing safe care for persons with dementia at remarkably high rates with many NPS and care management strategies being omitted more than 75% of the time”

• cites [43] sourceCould not verify

  The Methods (page unavailable) describe using claims to track discharge destinations and subsequent care settings, not written discharge summaries. Searches for discharge summaries, information transfer, and care plans found no passage in our copy stating that summaries help receiving providers establish safe, individualized care plans. (LLM, conf=0.73)

  Experimental — accuracy not yet measured

May combine two claims.

Family members are key decision-makers in SNF transitions, but they may lack the detailed, accurate hospital-stay knowledge needed to make informed decisions.

“Family members are integral stakeholders in decision-making surrounding transitions into SNF settings; however they may be unable to make informed decisions without detailed, accurate knowledge of the patient’s hospital stay.33, 34”

• cites [33] sourcePartly supported

  Results §§3.24 and 3.26 (page unavailable) describe family members making placement decisions under pressure, with limited communication and information about care options and the transition process. They do not say that families lack detailed, accurate knowledge of the patient’s hospital stay specifically. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [34]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Hip/femur fracture and stroke were chosen because they account for many SNF admissions and carry high risk of adverse outcomes.

“These conditions were selected as they constitute a high proportion of SNF admissions and are at high risk for adverse outcomes.36–38”

• cites [36] sourceNot checked — no full text of the source
• cites [37] sourceNot checked — no full text of the source
• cites [38] sourcePartly supported

  The Results > Unexpected Adverse Events section (page unavailable) reports serious adverse events among stroke survivors after inpatient rehabilitation, supporting the adverse-outcome rationale for stroke. The paper does not establish that stroke or hip/femur fracture accounts for a high proportion of SNF admissions, or assess adverse-outcome risk among patients admitted for hip/femur fracture. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Recent provider-perspective studies and a caregiver review identify poor transfer of NPS information as a major cause of poorly coordinated transitions and of stress and critical events like avoidable death or re-hospitalization.

“Recent studies detailing the perspectives of hospital and SNF providers and a review examining perspectives of family caregivers identify inadequate transfer of information regarding NPS as a major factor in poorly orchestrated transitions and contributor to unnecessary patient, caregiver and staff stress, as well as critical events such as avoidable death or re-hospitalization.24–26”

• cites [24]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [25] sourceNot checked — no full text of the source
• cites [26] sourcePartly supported

  The Results sections on communication and preparation for discharge describe inadequate information-sharing, poorly coordinated planning, and carer distress. The section on coping post discharge also reports readmissions associated with carers’ inability to cope, including with problematic behavior. The review does not identify inadequate transfer of NPS information specifically as a major cause of these outcomes, or link it to staff stress or avoidable death. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Neuropsychiatric symptoms are both common and persistent in moderate to advanced disease stages.

“However, evidence suggests that NPS are both common and persistent in moderate to advanced disease stages.6, 55”

• cites [6] sourceSupported
• cites [55] sourceSupported

May combine two claims.

Several evidence-based transitional care models have excluded older adults with cognitive impairment in their initial testing, and thus their impact on care specific to persons with dementia remains unclear.

“However, it is also important to note that several evidence-based transitional care models have excluded older adults with cognitive impairment in their initial testing, and thus their impact on care specific to persons with dementia remains unclear.66”

• cites [66] sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Both the Transitional Care Model and the Interventions to Reduce Acute Care Transfers program have been shown to improve transitional care outcomes for various older adult populations.

“Though TCM and INTERACT® target different points in the care continuum, both programs have been shown to improve transitional care outcomes for various older adult populations.62–65”

• cites [62] sourceNot checked — no full text of the source
• cites [63] sourceNot checked — no full text of the source
• cites [64] sourceNot checked — no full text of the source
• cites [65] sourcePartly supported

  The Results report reduced hospitalization rates among skilled nursing facilities that increased INTERACT use, supporting the INTERACT portion of the claim. But the paper also reports no differential reduction between intervention and control facilities in that group; it establishes an association, not that INTERACT itself improved outcomes. This citation does not need to support the Transitional Care Model portion, which may be covered by the other citations. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Individuals with dementia are generally over-represented among those using long-term care, and consequently the findings may reflect a dementia population with more advanced disease.

“However, it is likely that individuals with dementia are generally over-represented among those using long-term care, and consequentially findings may reflect a dementia population with more advanced disease.16”

• cites [16] sourcePartly supported

  The Results report that a dementia diagnosis was associated with more than sixfold higher odds of nursing-home residence six months after hospitalization, supporting an association between dementia and long-term care use in the studied older adults. The paper does not establish that people with dementia are generally over-represented across long-term care settings, and it does not assess whether residents with dementia have more advanced disease. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Approaches have been developed to streamline integration of updated clinical data from other clinical disciplines into the discharge summary using algorithms built into the electronic health record.

“In response, approaches have been developed to streamline integration of updated clinical data from other clinical disciplines into the discharge summary using algorithms built into the electronic health record.49”

• cites [49] sourcePartly supported

  The Pre-implementation section describes an EHR discharge-summary template with auto-populated elements, supporting the general idea of streamlining information entry. It does not say that built-in algorithms integrate updated clinical data from other clinical disciplines into the summary. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Providers may believe that information about preexisting or secondary diagnoses is already included in the patient's health record.

“Similarly, information specific to preexisting or secondary diagnoses, such as dementia, are more frequently omitted in discharge summaries, potentially because providers may believe this information to already be included in the patient’s health record.50, 51”

• cites [50] sourceNot checked — no full text of the source
• cites [51] sourcePartly supported

  The Results (Table 3; page unavailable) show that a second diagnosis appeared in 76.9% of discharge summaries, compared with 97.9% for the primary diagnosis, supporting the point that secondary diagnoses were omitted more often. The paper does not say that providers omitted them because they believed the information was already in the patient’s health record; that proposed explanation is unsupported. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Behavioral symptoms in particular are under-recognized and under-documented throughout hospitalization, meaning that any strategy designed to improve inter-setting communication may also need to necessitate improvements in recognition of condition-specific neuropsychiatric symptoms and management strategies in the acute care setting.

“However, a major consideration regarding practical implementation of these approaches is the fact that behavioral symptoms in particular are under-recognized and under-documented throughout hospitalization, meaning that any strategy designed to improve inter-setting communication may also need to necessitate improvements in recognition of condition-specific neuropsychiatric symptoms and management”

• cites [61] sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

Across patients with hip/femur fracture and stroke, documentation on neuropsychiatric symptoms was relatively consistent, though patients with hip/femur fracture had more documentation on anxiety and agitation/aggression while patients with stroke had more documentation on irritability/lability.

“Across patients with hip/femur fracture and stroke, documentation on NPS was relatively consistent, though patients with hip/femur fracture had more documentation on anxiety and agitation/aggression while patients with a stroke had more documentation on irritability/lability (Table 2).”

May combine two claims.

Across patients with hip/femur fracture and stroke, care management strategies were documented in relatively proportionate numbers, though patients with hip/femur fracture had more documentation indicating use of 1:1 supervision.

“Across patients with hip/femur fracture and stroke, care management strategies were documented in relatively proportionate number, though patients with hip/femur fracture had more documentation indicating use of 1:1 supervision (Table 2).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interrater reliability was assessed on a random 10% sample using Cohen's kappa, and disagreements were resolved by a third team member.

“Interrater reliability and agreement assessment were evaluated for a randomly selected 10% of all patient records using Cohen’s κ, with disagreements on specific extraction and categorization of clinical documentation resolved by a third team member.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Because identifying individual NPS and their causes is difficult, telling the next care setting about specific NPS and current management strategies is essential for high-quality care coordination in this population.

“Because efforts to prevent negative sequelae that accompany NPS are often hindered by difficulty identifying individual NPS and their underlying causes, alerting the next setting of care to specific NPS and existing management strategies is a critical component of high quality care coordination for this population.”

May combine two claims.

The final analytic sample was 298 patients for NPS, fall risk, restraints, and 1:1 supervision, and 296 for antipsychotics because two patients lacked medication administration record data.

“This yielded a final analytic sample of 298 patients for evaluation of NPS, fall risk, restraints and 1:1 supervision, and 296 for evaluation of antipsychotic medications as 2 patients had missing medication administration record data in their EHR.”

May combine two claims.

Across all abstracted variables, overall agreement was 95% and the average Cohen's kappa was 0.89.

“Across all abstracted variables, overall percent agreement was 95%, and the Cohen’s κ average was 0.89.”

Classified as probably not a substantial claim.

Discharge to SNF was verified by a SNF claim within two days of hospital discharge.

“Discharge to SNF settings was identified by evaluating documented discharge disposition which is mandatorily recorded by hospital staff and was verified by presence of a SNF claim within 2 days of hospital discharge.”

May combine two claims.

Hospital management of NPS often uses chemical restraints, mainly antipsychotics, which carry an FDA Black Box warning for dementia because of higher risks of cerebrovascular events and death.

“Management of NPS in hospital settings often includes the use of chemical restraints, primarily antipsychotic medications, which have received a United States Food and Drug Administration (FDA) Black Box warning for their use among persons with dementia attributable to increased risk for cerebrovascular events and death.9, 10”

• cites [9]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [10] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Identification of NPS in abstraction materials was guided by the Neuropsychiatric Inventory.

“Guidance on identifying NPS within clinical documentation contained within abstraction manuals and tools was informed by the Neuropsychiatric Inventory.42”

• cites [42] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

All abstractors received detailed training with manuals and tools, including supervised piloting of standardized record-access and abstraction methods.

“All abstractors received detailed training with abstraction manuals and tools, which included demonstrated and supervised piloting of standardized methods for accessing medical records and abstracting study variables.”

May combine two claims.

Poor communication or omission of NPS and management strategy information may substantially hinder nursing facilities from creating safe, individualized, person-centered care plans and may raise re-hospitalization risk.

“Under-communication and omission of information about NPS and care management strategies may significantly limit the nursing facilities’ ability to develop a safe, individualized, person-centered care plan and subsequently increase risk for re-hospitalization.24, 25”

• cites [24]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [25] sourceNot checked — no full text of the source

May combine two claims.

Written discharge summaries are used for admitting orders and remain the only mandated communication between providers after hospitalization in the United States.

“Written discharge summaries are relied on for admitting orders in this context as they have historically been, and continue to be, the only mandated form of communication between providers following hospitalization in the United States.31”

• cites [31]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Authoring providers may not consider clinical data elements generated by other disciplines as important for inclusion in the discharge summary.

“Authoring providers may not consider these data elements as important for inclusion in the discharge summary.”

Classified as probably not a substantial claim. May combine two claims.

Omission rates were computed at the patient level and only for patients who had clinical documentation of the specific symptom or management strategy.

“Omission rates were only calculated for patients who had clinical documentation for a particular symptom or care management strategy and were calculated at a patient level.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

The high rate of omission could reflect several practice patterns and issues related to structured requirements within written discharge summaries.

“The high rate of omission could reflect several practice patterns and issues related to structured requirements within written discharge summaries.”

May combine two claims.

The omission rates are significant because behavioral care needs are challenging to prepare for, and lack of preparation can have serious safety implications for persons with dementia who may be at high risk for adverse events such as falling or elopement, and even re-hospitalization.

“Altogether, these omission rates are significant as behavioral care needs are challenging to prepare for, and a lack of preparation can have serious safety implications for persons with dementia who may be at high risk for adverse events such as falling or elopement, and even re-hospitalization.24”

• cites [24]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• AssumptionRests on an assumption: Behavioral care needs are challenging to prepare for.

Classified as probably not a substantial claim.

The study adopted a conservative, event-centered count of NPS documentation rather than counting mentions, to avoid bias from a less sensitive approximation.

“This approach was adopted to provide a conservative and event-centered estimate of NPS documentation frequency, rather than for example counting the number of times descriptors such as “agitation” are mentioned which would serve as a less sensitive approximation for NPS events and introduce additional bias.”

Classified as probably not a substantial claim.

Four medical record abstractors with bachelor's or master's degrees and nursing or medical training independently extracted NPS and management strategy data from each patient's EHR.

“Four medical record abstractors, with Bachelor’s and Master’s-level degrees and concurrent or prior training in nursing and medicine, independently reviewed and extracted data on NPS and care management strategies from each patient’s EHR.”

May combine two claims.

Although the study ascertained that 30% of patients received nursing home care in the year leading up to their index hospitalization and were thus likely newly eligible for skilled nursing facility benefits in continuation of pre-existing long-term care, it was unable to confirm long versus short-term designation via longitudinal skilled nursing facility claims data.

“Additionally, although we were able to ascertain that 30% of patients received nursing home care in the year leading up to their index hospitalization and were thus likely newly eligible for SNF benefits in continuation of pre-existing long-term care, we were unable to confirm long vs short-term designation via longitudinal SNF claims data.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

There may be other patient factors, like comorbid psychiatric conditions or delirium, that impact occurrence and communication of neuropsychiatric symptoms and care management strategies that are not controlled for in calculating rates of omission.

“There may be other patient factors, like comorbid psychiatric conditions or delirium, that impact occurrence and communication of NPS and care management strategies that are not controlled for in calculating rates of omission.”

Probably not a substantial claim: may not pass S3 (load-bearing).

This study examined discharge communication in a limited sample of patients from two hospital settings from the years 2003-2009.

“This study has limitations, particularly given it examined discharge communication in a limited sample of patients from two hospital settings from the years 2003–2009.”

Probably not a substantial claim: may not pass S2 (checkable).

These study findings lend support to the need for additional evaluation of the contribution of poor discharge communication to negative post-acute outcomes and events.

“Provided the extensive reports of substantial disparities, bounce-backs, and stressful transitions that persons with dementia experience after hospitalization, these study findings lend support to the need for additional evaluation of the contribution of poor discharge communication to negative post-acute outcomes and events.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Because information about neuropsychiatric symptoms or management strategies is not a mandated component of written discharge summaries, authoring providers may not consider or think to include it in written discharge communication.

“It is also possible that, because information about NPS or management strategies are not mandated components of written discharge summaries, authoring providers may not consider or think to include them in written discharge communication.”

May combine two claims.

This study evaluated omissions of information in discharge communication as compared to clinical documentation in the electronic health record, and as such, likely under-documents the true prevalence of dementia-specific symptoms.

“This study evaluated omissions of information in discharge communication as compared to clinical documentation in the EHR, and as such, likely under-documents the true prevalence of dementia-specific symptoms.”

May combine two claims.

Providers may differentially document and communicate information regarding care management strategies in order to avoid discharge delays and increase the likelihood of placement in a skilled nursing facility.

“As such, providers may differentially document and communicate information regarding care management strategies in order to avoid discharge delays and increase likelihood of placement in a SNF.”

Probably not a substantial claim: may not pass S2 (checkable).

These approaches could be integrated into communication during hospital to skilled nursing facility transitions for patients with dementia.

“These approaches could be integrated into communication during hospital to SNF transitions for patients with dementia.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A likely concern in moving towards more comprehensive discharge communication is increased documentation burden and potential inaccuracy in information communicated under the current model of authoring discharge summaries, which often relies on one provider to author the discharge communication.

“In moving towards more comprehensive discharge communication, a likely concern is increased documentation burden and potential inaccuracy in information communicated under the current model of authoring discharge summaries, which often relies on one provider to author the discharge communication.31”

• cites [31]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The decision to discharge older adults to a skilled nursing facility setting is often made without a standardized system or framework and is often used as a safety net for older adults.

“Prior research also highlights that the decision to discharge older adults to a SNF setting is often made without a standardized system or framework, and is often used as a “safety net” for older adults.53”

• cites [53] sourceNot checked — no full text of the source