difference between research article and short communication

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The lost art of short communications in academia

Jeremiah joven joaquin.

1 Department of Philosophy, De La Salle University, 2401 Taft Avenue, 0922 Manila, Philippines

Raymond R. Tan

2 Department of Chemical Engineering, De La Salle University, 2401 Taft Avenue, 0922 Manila, Philippines

Short communications are an integral part of academic journal publishing since they serve as a forum for scholarly debate on recently published journal articles. Their prestige and popularity, however, have been declining in the present academic setting. In this short note, we offer several reasons for this phenomenon.

In their letter to editor, Turki et al., ( 2018 ) showed why letters to journal editors are of great importance in the scientific community. 1 In this note, we continue this discussion and extend it to short communications in general. Short communications may come as commentaries, opinions, reply articles, abstracts, research briefs, notes, notices, and correspondences to the editor. Alternative terminologies are also used by some journals (e.g., “microarticles” instead of “short communications” and “matters arising” instead of “letters to the editor”). Generally, short papers reporting primary research results are peer reviewed, while policies on those giving opinions, comments, or perspectives vary widely across journals (Cappell, 2010 ; Peh & Ng, 2010 ). Here, we refer to such brief papers collectively unless otherwise stated.

In principle, short communications in academic journals provide an avenue for rapid publication of potentially important results and up-to-date information, without the detailed documentation that comes with a full-length research article (Baldwin, 2014 ). However, this does not mean that they do not have precise methods and robust results as full-length papers. After all, a 1000-word medical paper may describe the results of a clinical trial on a set of 2000 patients. 2

There are notable examples of groundbreaking short communications in the history of twentieth century science. In the physical sciences, for example, the Nobel Prize-winning discovery of the double-helix structure of DNA was reported by Watson and Crick ( 1953 ) in a two-page note in Nature less than a month after it was submitted. This work is now one of the cornerstones of modern biotechnology. It also illustrates the role of short papers as a means of rapid dissemination of findings in a highly competitive setting where authors do not want to get scooped by other research groups. Moreover, a letter to the editor by Seifritz ( 1990 ) in the same journal proposed to accelerate the natural weathering of minerals to capture CO 2 from the atmosphere. It is too early to say if this technique will eventually play a major role in global climate change mitigation efforts in the coming decades, but this brief contribution of under 300 words has spawned an important sub-area of carbon management research, and now has over 400 citations in the Scopus database.

In the more formal sciences, like mathematics and logic, the discipline-defining paper by Nash ( 1950 ) in the Proceedings of National Academy of Sciences catapulted game theory as the standard explanatory model in economics. The short note by Church ( 1936 ) in the Journal of Symbolic Logic , along with other related papers of the era, paved the way in the development of the top-down approaches to artificial intelligence. An abstract published by Kripke ( 1959 ) in the same journal announced the possible worlds semantics for modal logics, which is now the standard semantical device used in formal linguistics and philosophy.

More recently, the COVID-19 pandemic has shown the importance of short communications in medical sciences and public health journals. At the onset of the pandemic, experts and scholars were grappling about the nature of the disease, the public health policies needed to contain its spread, and the vaccine protocols that would eventually eradicate it. Short communications in the Journal of the American Medical Association, Lancet (Elsevier), Journal of Public Health (Oxford), and other high quality academic journals proved to be an invaluable resource of up-to-date peer reviewed information about COVID-19. A notable example is a research note published at the onset of the pandemic in February 2020 that first described the likely role of asymptomatic transmission in propagating COVID-19 (Bai et al., 2020 ). This result contributed to the implementation of various control measures, including lockdowns, throughout the world.

Despite the numerous cases of successful short communications, their status in present academia seems to be in a decline. 3 For example, some universities regard them with less prestige than full articles when it comes to academic career assessments. We offer five hypotheses to explain this trend.

First, some academics may simply have a wrong impression about the nature of short communications in academics journals because the very terms used to label them are misleading. Terms like “Commentary”, “Opinion Piece”, “Critical Notice”, “Letter to the Editor”, and others of the same ilk may give the impression that the articles in these sections are of the same quality as those found in popular magazines such as Time or The Economist . 4 Because of these misleading terms, some academics may have the impression that published short communications have not gone through the same peer-review rigor that full-length research articles have gone through (Cappell, 2010 ; Kirsch, 2008 ).

Second, some academics think that the emergence of other (digital) platforms like preprint servers (e.g., arXiv.org), academic blogs, social media (e.g., Twitter and FaceBook), and even the personal websites of academics make short communications obsolete (Alperin et al., 2019 ; Wang & Zan 2019 ). The thought is that since one could already “publish” his/her full paper in these platforms (and have it readily reviewed and checked by peers), there is no need to communicate initial results as short papers in academic journals (Mandavilli, 2011 ). In particular, preprints can get significant publicity and media mileage even without the benefit of the quality assurance that comes with peer review. Moreover, there is related worry about being scooped by others. Published initial results in short communications are still not viewed as full research articles. Thus, an academic may think that someone else may beat him or her to the punch if s/he just publish a short communication. A historical case in point is the well-known simulated annealing algorithm for solving optimization problems, which is widely attributed to Kirkpatrick et al. ( 1983 ). A competing work was published concurrently as a largely forgotten short communication (Smith et al., 1983 ); to date, the latter paper has been cited just 43 times in the Scopus database, compared to over 28,000 for the former.

Third, with the current pressure to have more indexed and cited research articles in their portfolios, most academics do not see publishing short communications could increase their academic standing (Neghina & Nenghina 2011 ). Not all published abstracts, letters to the editor, and commentary papers are indexed in Scopus or Web of Science (WoS). Since most universities put premium in Scopus- or WoS-indexed publications, academics might be more motivated to write full-length papers than short ones. This argument, of course, extends to the academic’s citation count considerations and the measure of the overall academic impact of his/her work; the additional delay incurred in preparing a full-length research article is viewed as justified by the prospect of more future citations. 5

Fourth, journal editors themselves may consider these short papers either to be archaic and irrelevant in contemporary research discourse, or as being detrimental to journal performance metrics such as Impact Factor or CiteScore. The decreasing rate of publication of these brief contributions in mainstream literature can then lead to a vicious evolutionary spiral, with rejection rates escalating steadily because editors and reviewers alike become increasingly unfamiliar with proper norms to apply in evaluating new submissions. In response, potential authors may then become reluctant to invest energy into a high-risk, low-reward publication option. 6

Finally, fifth, the original purpose of rapid publication has weakened due to technological shifts of journals. In addition to the aforementioned trend in the rapid dissemination of preliminary findings via preprints (Johansson et al., 2018 ), scientific literature is now processed primarily in electronic form. Delays associated with the physical transfer of documents are a thing of the past. Peer review is carried out over the Internet, and many journals now keep track of and publicly report manuscript turnover time as a performance metric. Accepted manuscripts that are technically still “in press” are usually accessible to readers (and de facto published) long before the final versions come out in print. This technology-driven trend has made it easier for researchers to establish priority using the conventional route of the full research article over short papers.

Given this trend and its drivers, we feel that short communications will likely lose their high status in the academe. Unless journal editors and administrators themselves do something about it, writing short communications may be a lost art in many disciplines in the near future. The implication is that potentially groundbreaking ideas similar to those we cited here may slip through the cracks and never see the light of day. To avert this trend, editors need to make a concerted effort to ensure that brief papers remain an important part of journal portfolios.

Author’s contributions

The authors jointly did the conceptualization, writing, and editing of this work.

No funding was received for this work.

Declarations

The authors declared that there is no conflict of interest.

1 A similar argument was presented by Afifi ( 2006 ), Satyanarayana, et al. ( 1999 ) and Tierney, O’Rourke & Fenton ( 2015 ).

2 Our thanks to the referee for highlighting this point.

3 The exception here lies in disciplines (e.g., the health sciences) with robust traditions in the use of short communications coupled with supplementary information to document details not found in the main manuscript.

4 This is not to say that articles in popular magazines are not of good quality—in fact, some could be considered as literary masterpieces.

5 It must be noted, however, that an early bibliometric study by Satyanarayana et al. ( 1999 ) found no significant difference in citations of short communications and full papers. Their results were of limited scope and there have been no published attempts to extend or update their analysis.

6 However, this hypothesis remains to be proven through a proper bibliometric study. Detailed journal acceptance statistics are generally not published is a major stumbling block for such investigations.

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How to Write Effective Brief Communications

When you need to publish important research results quickly or present a vital reanalysis of a previously published paper to an interested audience, a brief communication might be the perfect answer. Brief communications, also known as short or rapid communications, allow researchers to effectively report high-quality findings that may not be suitable for a full research article and to debate recently published articles.

Brief communication basics

Brief communications appear in scholarly journals in many forms, such as correspondence, commentaries, opinions, abstracts, notes, and research briefs. These types of short communications have always played an important role in academia, although recently their popularity has been diminishing.

The COVID-19 pandemic highlighted the crucial role that short communications can play. 1 Because of the need to understand the nature of the virus, to facilitate the creation of a vaccine, and to enact policies to keep the public safe, the rapid publication of research and information was essential. Many high-quality academic journals, such as the Journal of the American Medical Association , Lancet , and the Journal of Public Health , published peer-reviewed short communications quickly, thus, providing an invaluable service to researchers, experts, and the public.

However, due to changes in publishing technology and in the perception of prestige, the popularity of short communications has been declining within the academic community. 1 Researchers who are under pressure to publish often do not believe brief communications will help advance their career as much as regular research articles can. Journal editors frequently place a low priority on short communications as being detrimental to journal metrics such as impact scores. Additionally, as the publication of preprints has increased, the rapid nature of short communications has become less of a difference maker.

Short communications that report primary research are typically peer reviewed and published with the same high-quality standards as longer research articles. In most journals, the difference between brief communications and regular research articles is in the amount of research reported and the complexity of the results. 2

Writing effective brief communications

The types and requirements for short communication publication varies by journal. If you’re planning to submit any type of brief communication, be sure to carefully check the submission guidelines from your target journal. Although each type of article will have different specifications, those reporting original research have the strictest requirements. A few typical requirements for research briefs are described below.

• Structure: Short communications reporting primary research usually include a title page (similar to that of a standard research article), abstract, and main text, which is written under a findings heading without any subheadings or with short informative headings, depending on the journal. The submission guidelines from Acta Veterinaria Scandinavica state, “The first section should briefly explain the background and aim, followed by sections mentioning materials, methods, results and their discussion and finally a very short conclusion.” 1
• Word count: The word count requirement again varies by journal but is usually limited to 1,500-2,500 words.
• Length: The maximum number of pages allowed by short communication journals varies greatly. However, they are generally limited to between 3 and 10 printed pages.
• Figures/tables: The number of figures and tables included in a brief communication are also typically limited by the publication journal. Usually, only 2 to 4 total figures and tables are allowed.
• Declarations: For articles reporting on primary research, the declarations required in standard research articles are also required for short communications. These include conflict of interest, funding, availability of data, authors’ contributions, and acknowledgements.
• Ethical issues: Even brief communications, if the research involves human participants, data, or tissue or animals, require a statement on ethics consent or approval, similar to what is needed in a standard research report.
• References: The number of references included should also be restricted. Journal guidelines for short communication submissions generally put the limit at 20-25 references.

General tips for writing brief communications

Finally, in preparing any type of brief communication article for submission, it might be useful to keep in mind a couple of general tips.

• All scientific writing requires clear, concise, and grammatically correct language to be understandable and effective. However, because of the compactness of the form, this is especially important for short communications. It is always helpful to get a colleague, language service or smart editing tool to review your article for language quality.
• The most important tip for effectively writing brief communications is that the short communication journal guidelines should be read and followed carefully, as the submission requirements and processes are different for every journal.

If you’re planning to submit a piece to a short communication journal, congratulations! You will be participating in a long and valuable tradition in academic publishing.

• Joaquin, J.J., Tan, R.R. The lost art of short communications in academia. Scientometrics 126, 9633–9637 (2021). https://doi.org/10.1007/s11192-021-04192-7
• Acta Veterinaria Scandinavica. Brief communication. https://actavetscand.biomedcentral.com/submission-guidelines/preparing-your-manuscript/brief-communication [Accessed December 19, 2022]

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• 7 Ways to Improve Your Academic Writing Process
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• Insights blog

Different types of research articles

A guide for early career researchers.

In scholarly literature, there are many different kinds of articles published every year. Original research articles are often the first thing you think of when you hear the words ‘journal article’. In reality, research work often results in a whole mixture of different outputs and it’s not just the final research article that can be published.

Finding a home to publish supporting work in different formats can help you start publishing sooner, allowing you to build your publication record and research profile.

But before you do, it’s very important that you check the  instructions for authors  and the  aims and scope  of the journal(s) you’d like to submit to. These will tell you whether they accept the type of article you’re thinking of writing and what requirements they have around it.

Understanding the different kind of articles

There’s a huge variety of different types of articles – some unique to individual journals – so it’s important to explore your options carefully. While it would be impossible to cover every single article type here, below you’ll find a guide to the most common research articles and outputs you could consider submitting for publication.

Book review

Many academic journals publish book reviews, which aim to provide insight and opinion on recently published scholarly books. Writing book reviews is often a good way to begin academic writing. It can help you get your name known in your field and give you valuable experience of publishing before you write a full-length article.

If you’re keen to write a book review, a good place to start is looking for journals that publish or advertise the books they have available for review. Then it’s just a matter of putting yourself forward for one of them.

You can check whether a journal publishes book reviews by browsing previous issues or by seeing if a book review editor is listed on the editorial board. In addition, some journals publish other types of reviews, such as film, product, or exhibition reviews, so it’s worth bearing those in mind as options as well.

Get familiar with instructions for authors

Be prepared, speed up your submission, and make sure nothing is forgotten by understanding a journal’s individual requirements.

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Case report

A medical case report – also sometimes called a clinical case study – is an original short report that provides details of a single patient case.

Case reports include detailed information on the symptoms, signs, diagnosis, treatment, and follow-up of an individual patient. They remain one of the cornerstones of medical progress and provide many new ideas in medicine.

Depending on the journal, a case report doesn’t necessarily need to describe an especially novel or unusual case as there is benefit from collecting details of many standard cases.

Take a look at  F1000Research’s guidance on case reports , to understand more about what’s required in them. And don’t forget that for all studies involving human participants, informed written consent to take part in the research must be obtained from the participants –  find out more about consent to publish.

Clinical study

In medicine, a clinical study report is a type of article that provides in-depth detail on the methods and results of a clinical trial. They’re typically similar in length and format to original research articles.

Most journals now require that you register protocols for clinical trials you’re involved with in a publicly accessible registry. A list of eligible registries can be found on the  WHO International Clinical Trials Registry Platform (ICTRP) . Trials can also be registered at  clinicaltrials.gov  or the  EU Clinical Trials Register . Once registered, your trial will be assigned a clinical trial number (CTN).

Before you submit a clinical study, you’ll need to include clinical trial numbers and registration dates in the manuscript, usually in the abstract and methods sections.

Commentaries and letters to editors

Letters to editors, as well as ‘replies’ and ‘discussions’, are usually brief comments on topical issues of public and political interest (related to the research field of the journal), anecdotal material, or readers’ reactions to material published in the journal.

Commentaries are similar, though they may be slightly more in-depth, responding to articles recently published in the journal. There may be a ‘target article’ which various commentators are invited to respond to.

You’ll need to look through previous issues of any journal you’re interested in writing for and review the instructions for authors to see which types of these articles (if any) they accept.

Conference materials

Many of our medical journals  accept conference material supplements. These are open access peer-reviewed, permanent, and citable publications within the journal. Conference material supplements record research around a common thread, as presented at a workshop, congress, or conference, for the scientific record. They can include the following types of articles:

Poster extracts

Conference abstracts

Presentation extracts

Find out more about submitting conference materials.

Data notes  are a short peer-reviewed article type that concisely describe research data stored in a repository. Publishing a data note can help you to maximize the impact of your data and gain appropriate credit for your research.

Data notes promote the potential reuse of research data and include details of why and how the data were created. They do not include any analysis but they can be linked to a research article incorporating analysis of the published dataset, as well as the results and conclusions.

F1000Research  enables you to publish your data note rapidly and openly via an author-centric platform. There is also a growing range of options for publishing data notes in Taylor & Francis journals, including in  All Life  and  Big Earth Data .

Read our guide to data notes to find out more.

Letters or short reports

Letters or short reports (sometimes known as brief communications or rapid communications) are brief reports of data from original research.

Editors publish these reports where they believe the data will be interesting to many researchers and could stimulate further research in the field. There are even entire journals dedicated to publishing letters.

As they’re relatively short, the format is useful for researchers with results that are time sensitive (for example, those in highly competitive or quickly-changing disciplines). This format often has strict length limits, so some experimental details may not be published until the authors write a full original research article.

Brief reports  (previously called Research Notes) are a type of short report published by  F1000Research  – part of the Taylor & Francis Group. To find out more about the requirements for a brief report, take a look at  F1000Research’s guidance .

Method article

A method article is a medium length peer-reviewed, research-focused article type that aims to answer a specific question. It also describes an advancement or development of current methodological approaches and research procedures (akin to a research article), following the standard layout for research articles. This includes new study methods, substantive modifications to existing methods, or innovative applications of existing methods to new models or scientific questions. These should include adequate and appropriate validation to be considered, and any datasets associated with the paper must publish all experimental controls and make full datasets available.  

Posters and slides

With F1000Research, you can publish scholarly posters and slides covering basic scientific, translational, and clinical research within the life sciences and medicine. You can find out more about how to publish posters and slides  on the F1000Research website .

Registered report

A  Registered Report  consists of two different kinds of articles: a study protocol and an original research article.

This is because the review process for Registered Reports is divided into two stages. In Stage 1, reviewers assess study protocols before data is collected. In Stage 2, reviewers consider the full published study as an original research article, including results and interpretation.

Taking this approach, you can get an in-principle acceptance of your research article before you start collecting data. We’ve got  further guidance on Registered Reports here , and you can also  read F1000Research’s guidance on preparing a Registered Report .

Research article

Original research articles are the most common type of journal article. They’re detailed studies reporting new work and are classified as primary literature.

You may find them referred to as original articles, research articles, research, or even just articles, depending on the journal.

Typically, especially in STEM subjects, these articles will include Abstract, Introduction, Methods, Results, Discussion, and Conclusion sections. However, you should always check the instructions for authors of your chosen journal to see whether it specifies how your article should be structured. If you’re planning to write an original research article, take a look at our guidance on  writing a journal article .

Review article

Review articles provide critical and constructive analysis of existing published literature in a field. They’re usually structured to provide a summary of existing literature, analysis, and comparison. Often, they identify specific gaps or problems and provide recommendations for future research.

Unlike original research articles, review articles are considered as secondary literature. This means that they generally don’t present new data from the author’s experimental work, but instead provide analysis or interpretation of a body of primary research on a specific topic. Secondary literature is an important part of the academic ecosystem because it can help explain new or different positions and ideas about primary research, identify gaps in research around a topic, or spot important trends that one individual research article may not.

There are 3 main types of review article

Literature review

Presents the current knowledge including substantive findings as well as theoretical and methodological contributions to a particular topic.

Systematic review

Identifies, appraises and synthesizes all the empirical evidence that meets pre-specified eligibility criteria to answer a specific research question. Researchers conducting systematic reviews use explicit, systematic methods that are selected with a view aimed at minimizing bias, to produce more reliable findings to inform decision making.

Meta-analysis

A quantitative, formal, epidemiological study design used to systematically assess the results of previous research to derive conclusions about that body of research. Typically, but not necessarily, a meta-analysis study is based on randomized, controlled clinical trials.

Take a look at our guide to  writing a review article  for more guidance on what’s required.

Software tool articles

A  software tool article  – published by  F1000Research  – describes the rationale for the development of a new software tool and details of the code used for its construction.

The article should provide examples of suitable input data sets and include an example of the output that can be expected from the tool and how this output should be interpreted. Software tool articles submitted to F1000Research should be written in open access programming languages. Take a look at  their guidance  for more details on what’s required of a software tool article.

Further resources

Ready to write your article, but not sure where to start?

For more guidance on how to prepare and write an article for a journal you can download the  Writing your paper eBook .

Short Communications

A Short communication generally takes one of the following forms: • A substantial re-analysis of a previously published article in EJNMMI Research or in another journal. • An article that may not cover 'standard research' but that is of general interest to the broad readership of EJNMMI Research . • A brief report of research findings adequate for the journal's scope and of particular interest to the community.

Short communications may be edited for clarity or length and may be subject to peer review at the editors' discretion. Short reports of research work will be peer reviewed.

All article types are eligible for visual abstracts, with the exception of editorials and letters to the editor. The visual abstract should summarize the main aspects of the paper graphically and in an appealing way, and therefore must be consistent with the paper’s content. The visual abstract should include the title, images, tables, graphs or charts and a brief key takeaway message, i.e., a conclusion. 

• Template: please use the PowerPoint template provided below to prepare your visual abstract. 
• Title should not be capitalized. 
• Authors: do not include the list of authors or their affiliations. 
• Font: make sure to keep the font (Arial or Times New Roman) and font size (12 for the conclusion and 14 for the title) as indicated in the template. 
• Figures: the visual abstract can contain one, two or three figures – feel free to customize the template accordingly. Please only use figures that are already in the text. 
• Key takeaways/conclusion is limited to 100 words. If applicable, also indicate in the conclusion whether you received funding for this research by adding "This study was sponsored by ? company." 

The visual abstract should be properly labelled and submitted in PowerPoint format with the rest of the paper via Editorial Manager. The editors reserve the right to reject the visual abstract and publish the paper without it.

PowerPoint Template

Radiochemistry Nomenclature Guidelines

The EJNMMI Journal Family endorses the application of the International Consensus Radiochemistry Nomenclature Guidelines for contributions to the journals. A three page summary of the guidelines, highlighting the most relevant issues used in the notation of radiopharmaceuticals and related terms, is available at EJNMMI Radiopharmacy and Chemistry . The Editors-in-Chief of the EJNMMI Journal Family strongly recommend all manuscripts meet these guidelines submission, and all reviewers are asked to check, wherever possible, that the guidelines are followed. Their endorsement can be found here . 

The full paper with all recommendations is published in “Consensus nomenclature rules for radiopharmaceutical chemistry — setting the record straight”, Coenen and Gee et al. (2017), Nuclear Medicine and Biology   here .

Preparing your manuscript

The title page should:

• "A versus B in the treatment of C: a randomized controlled trial", "X is a risk factor for Y: a case control study", "What is the impact of factor X on subject Y: A systematic review"
• or for non-clinical or non-research studies: a description of what the article reports
• if a collaboration group should be listed as an author, please list the group name as an author. If you would like the names of the individual members of the group to be searchable through their individual PubMed records, please include this information in the “Acknowledgements” section in accordance with the instructions below
• Large Language Models (LLMs), such as ChatGPT , do not currently satisfy our authorship criteria . Notably an attribution of authorship carries with it accountability for the work, which cannot be effectively applied to LLMs. Use of an LLM should be properly documented in the Methods section (and if a Methods section is not available, in a suitable alternative part) of the manuscript
• indicate the corresponding author

This should contain the body of the article, and may also be broken into subsections with short, informative headings.

List of abbreviations

If abbreviations are used in the text they should be defined in the text at first use, and a list of abbreviations should be provided.

Declarations

All manuscripts must contain the following sections under the heading 'Declarations':

Ethics approval and consent to participate

Consent for publication.

• Availability of data and material

Competing interests

Authors' contributions, acknowledgements.

• Authors' information (optional)

Please see below for details on the information to be included in these sections.

If any of the sections are not relevant to your manuscript, please include the heading and write 'Not applicable' for that section.

Manuscripts reporting studies involving human participants, human data or human tissue must:

• include a statement on ethics approval and consent (even where the need for approval was waived)
• include the name of the ethics committee that approved the study and the committee’s reference number if appropriate

Studies involving animals must include a statement on ethics approval.

See our  editorial policies  for more information.

If your manuscript does not report on or involve the use of any animal or human data or tissue, please state “Not applicable” in this section.

If your manuscript contains any individual person’s data in any form (including individual details, images or videos), consent to publish must be obtained from that person, or in the case of children, their parent or legal guardian. All presentations of case reports must have consent to publish.

You can use your institutional consent form if you prefer. You should not send the form to us on submission, but we may request to see a copy at any stage (including after publication).

See our  editorial policies  for more information on consent for publication.

If your manuscript does not contain data from any individual person, please state “Not applicable” in this section.

Availability of data and materials

All manuscripts must include an ‘Availability of data and materials’ statement. Data availability statements should include information on where data supporting the results reported in the article can be found including, where applicable, hyperlinks to publicly archived datasets analysed or generated during the study. By data we mean the minimal dataset that would be necessary to interpret, replicate and build upon the findings reported in the article. We recognise it is not always possible to share research data publicly, for instance when individual privacy could be compromised, and in such instances data availability should still be stated in the manuscript along with any conditions for access.

Data availability statements can take one of the following forms (or a combination of more than one if required for multiple datasets):

• The datasets generated and/or analysed during the current study are available in the [NAME] repository, [PERSISTENT WEB LINK TO DATASETS]
• The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
• All data generated or analysed during this study are included in this published article [and its supplementary information files].
• The datasets generated and/or analysed during the current study are not publicly available due [REASON WHY DATA ARE NOT PUBLIC] but are available from the corresponding author on reasonable request.
• Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.
• The data that support the findings of this study are available from [third party name] but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of [third party name].
• Not applicable. If your manuscript does not contain any data, please state 'Not applicable' in this section.

More examples of template data availability statements, which include examples of openly available and restricted access datasets, are available  here .

SpringerOpen  also requires that authors cite any publicly available data on which the conclusions of the paper rely in the manuscript. Data citations should include a persistent identifier (such as a DOI) and should ideally be included in the reference list. Citations of datasets, when they appear in the reference list, should include the minimum information recommended by DataCite and follow journal style. Dataset identifiers including DOIs should be expressed as full URLs. For example:

Hao Z, AghaKouchak A, Nakhjiri N, Farahmand A. Global integrated drought monitoring and prediction system (GIDMaPS) data sets. figshare. 2014.  http://dx.doi.org/10.6084/m9.figshare.853801

With the corresponding text in the Availability of data and materials statement:

The datasets generated during and/or analysed during the current study are available in the [NAME] repository, [PERSISTENT WEB LINK TO DATASETS]. [Reference number]

All financial and non-financial competing interests must be declared in this section.

See our  editorial policies  for a full explanation of competing interests. If you are unsure whether you or any of your co-authors have a competing interest please contact the editorial office.

Please use the authors’ initials to refer to each authors' competing interests in this section.

If you do not have any competing interests, please state "The authors declare that they have no competing interests" in this section.

All sources of funding for the research reported should be declared. The role of the funding body in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript should be declared.

The individual contributions of authors to the manuscript should be specified in this section. Guidance and criteria for authorship can be found in our  editorial policies .

Please use initials to refer to each author's contribution in this section, for example: "FC analyzed and interpreted the patient data regarding the hematological disease and the transplant. RH performed the histological examination of the kidney, and was a major contributor in writing the manuscript. All authors read and approved the final manuscript."

Please acknowledge anyone who contributed towards the article who does not meet the criteria for authorship including anyone who provided professional writing services or materials.

Authors should obtain permission to acknowledge from all those mentioned in the Acknowledgements section.

See our  editorial policies  for a full explanation of acknowledgements and authorship criteria.

If you do not have anyone to acknowledge, please write "Not applicable" in this section.

Group authorship (for manuscripts involving a collaboration group): if you would like the names of the individual members of a collaboration Group to be searchable through their individual PubMed records, please ensure that the title of the collaboration Group is included on the title page and in the submission system and also include collaborating author names as the last paragraph of the “Acknowledgements” section. Please add authors in the format First Name, Middle initial(s) (optional), Last Name. You can add institution or country information for each author if you wish, but this should be consistent across all authors.

Please note that individual names may not be present in the PubMed record at the time a published article is initially included in PubMed as it takes PubMed additional time to code this information.

Authors' information

This section is optional.

You may choose to use this section to include any relevant information about the author(s) that may aid the reader's interpretation of the article, and understand the standpoint of the author(s). This may include details about the authors' qualifications, current positions they hold at institutions or societies, or any other relevant background information. Please refer to authors using their initials. Note this section should not be used to describe any competing interests.

Footnotes should be designated within the text using a superscript number. It is not allowed to use footnotes for references/citations.

Examples of the Vancouver reference style are shown below. 

See our editorial policies for author guidance on good citation practice.

Web links and URLs: All web links and URLs, including links to the authors' own websites, should be given a reference number and included in the reference list rather than within the text of the manuscript. They should be provided in full, including both the title of the site and the URL, as well as the date the site was accessed, in the following format: The Mouse Tumor Biology Database. http://tumor.informatics.jax.org/mtbwi/index.do . Accessed 20 May 2013. If an author or group of authors can clearly be associated with a web link, such as for weblogs, then they should be included in the reference.

Example reference style:

Article within a journal

Smith JJ. The world of science. Am J Sci. 1999;36:234-5.

Article within a journal (no page numbers)

Rohrmann S, Overvad K, Bueno-de-Mesquita HB, Jakobsen MU, Egeberg R, Tjønneland A, et al. Meat consumption and mortality - results from the European Prospective Investigation into Cancer and Nutrition. BMC Medicine. 2013;11:63.

Article within a journal by DOI

Slifka MK, Whitton JL. Clinical implications of dysregulated cytokine production. Dig J Mol Med. 2000; doi:10.1007/s801090000086.

Article within a journal supplement

Frumin AM, Nussbaum J, Esposito M. Functional asplenia: demonstration of splenic activity by bone marrow scan. Blood 1979;59 Suppl 1:26-32.

Book chapter, or an article within a book

Wyllie AH, Kerr JFR, Currie AR. Cell death: the significance of apoptosis. In: Bourne GH, Danielli JF, Jeon KW, editors. International review of cytology. London: Academic; 1980. p. 251-306.

OnlineFirst chapter in a series (without a volume designation but with a DOI)

Saito Y, Hyuga H. Rate equation approaches to amplification of enantiomeric excess and chiral symmetry breaking. Top Curr Chem. 2007. doi:10.1007/128_2006_108.

Complete book, authored

Blenkinsopp A, Paxton P. Symptoms in the pharmacy: a guide to the management of common illness. 3rd ed. Oxford: Blackwell Science; 1998.

Online document

Doe J. Title of subordinate document. In: The dictionary of substances and their effects. Royal Society of Chemistry. 1999. http://www.rsc.org/dose/title of subordinate document. Accessed 15 Jan 1999.

Online database

Healthwise Knowledgebase. US Pharmacopeia, Rockville. 1998. http://www.healthwise.org. Accessed 21 Sept 1998.

Supplementary material/private homepage

Doe J. Title of supplementary material. 2000. http://www.privatehomepage.com. Accessed 22 Feb 2000.

University site

Doe, J: Title of preprint. http://www.uni-heidelberg.de/mydata.html (1999). Accessed 25 Dec 1999.

Doe, J: Trivial HTTP, RFC2169. ftp://ftp.isi.edu/in-notes/rfc2169.txt (1999). Accessed 12 Nov 1999.

Organization site

ISSN International Centre: The ISSN register. http://www.issn.org (2006). Accessed 20 Feb 2007.

Dataset with persistent identifier

Zheng L-Y, Guo X-S, He B, Sun L-J, Peng Y, Dong S-S, et al. Genome data from sweet and grain sorghum (Sorghum bicolor). GigaScience Database. 2011. http://dx.doi.org/10.5524/100012 .

General formatting information

Manuscripts must be written in concise English. For help on scientific writing, or preparing your manuscript in English, please see Springer's  Author Academy .

Quick points:

• Use double line spacing
• Include line and page numbering
• Use SI units: Please ensure that all special characters used are embedded in the text, otherwise they will be lost during conversion to PDF
• Do not use page breaks in your manuscript

File formats

The following word processor file formats are acceptable for the main manuscript document:

• Microsoft word (DOC, DOCX)
• Rich text format (RTF)
• TeX/LaTeX 

Please note: editable files are required for processing in production. If your manuscript contains any non-editable files (such as PDFs) you will be required to re-submit an editable file if your manuscript is accepted.

For more information, see ' Preparing figures ' below.

Additional information for TeX/LaTeX users

You are encouraged to use the Springer Nature LaTeX template when preparing a submission. A PDF of your manuscript files will be compiled during submission using pdfLaTeX and TexLive 2021. All relevant editable source files must be uploaded during the submission process. Failing to submit these source files will cause unnecessary delays in the production process.  

Style and language

For editors and reviewers to accurately assess the work presented in your manuscript you need to ensure the English language is of sufficient quality to be understood. If you need help with writing in English you should consider:

• Getting a fast, free online grammar check .
• Visiting the English language tutorial which covers the common mistakes when writing in English.
• Asking a colleague who is proficient in English to review your manuscript for clarity.
• Using a professional language editing service where editors will improve the English to ensure that your meaning is clear and identify problems that require your review. Two such services are provided by our affiliates Nature Research Editing Service and American Journal Experts . SpringerOpen authors are entitled to a 10% discount on their first submission to either of these services. To claim 10% off English editing from Nature Research Editing Service, click here . To claim 10% off American Journal Experts, click here .

Please note that the use of a language editing service is not a requirement for publication in EJNMMI Research and does not imply or guarantee that the article will be selected for peer review or accepted.  为便于编辑和评审专家准确评估您稿件中陈述的研究工作，您需要确保文稿英语语言质量足以令人理解。如果您需要英文写作方面的帮助，您可以考虑：

• 获取快速、免费的在线  语法检查 。
• 查看一些有关英语写作中常见语言错误的 教程 。
• 请一位以英语为母语的同事审阅您的稿件是否表意清晰。
• 使用专业语言编辑服务，编辑人员会对英语进行润色，以确保您的意思表达清晰，并提出需要您复核的问题。例如我们的附属机构 Nature Research Editing Service 以及合作伙伴 American Journal Experts 都可以提供此类专业服务。SpringerOpen作者享受首次订单10%优惠，该优惠同时适用于两家公司。您只需点击以下链接即可开始。使用 Nature Research Editing Service的编辑润色10%的优惠服务，请点击 这里 。使用 American Journal Experts的10%优惠服务，请点击 这里 。

请注意，使用语言编辑服务并非在期刊上发表文章的必要条件，这也并不意味或保证文章将被选中进行同行评议或被接受。 エディターと査読者があなたの論文を正しく評価するには、使用されている英語の質が十分であることが必要とされます。英語での論文執筆に際してサポートが必要な場合には、次のオプションがあります：

• 高速なオンライン  文法チェック  を無料で受ける。
• 英語で執筆する際のよくある間違いに関する 英語のチュートリアル を参照する。
• 英語を母国語とする同僚に、原稿内の英語が明確であるかをチェックしてもらう。
• プロの英文校正サービスを利用する。校正者が原稿の意味を明確にしたり、問題点を指摘し、英語を向上させます。 Nature Research Editing Service と American Journal Experts の2つは弊社と提携しているサービスです。SpringerOpenのジャーナルの著者は、いずれかのサービスを初めて利用する際に、10%の割引を受けることができます。Nature Research Editing Serviceの10%割引を受けるには、 こちらをクリックしてください 。. American Journal Expertsの10%割引を受けるには、 こちらをクリックしてください 。

英文校正サービスの利用は、このジャーナルに掲載されるための条件ではないこと、また論文審査や受理を保証するものではないことに留意してください。 영어 원고의 경우, 에디터 및 리뷰어들이 귀하의 원고에 실린 결과물을 정확하게 평가할 수 있도록, 그들이 충분히 이해할 수 있을 만한 수준으로 작성되어야 합니다. 만약 영작문과 관련하여 도움을 받기를 원하신다면 다음의 사항들을 고려하여 주십시오:

• 영어 튜토리얼 페이지 에 방문하여 영어로 글을 쓸 때 자주하는 실수들을 확인합니다.
• 귀하의 원고의 표현을 명확히 해줄 영어 원어민 동료를 찾아서 리뷰를 의뢰합니다
• 리뷰에 대비하여, 원고의 의미를 명확하게 해주고 리뷰에서 요구하는 문제점들을 식별해서 영문 수준을 향상시켜주는 전문 영문 교정 서비스를 이용합니다. Nature Research Editing Service 와 American Journal Experts 에서 저희와 협약을 통해 서비스를 제공하고 있습니다. SpringerOpen에서는 위의 두 가지의 서비스를 첫 논문 투고를 위해 사용하시는 경우, 10%의 할인을 제공하고 있습니다. Nature Research Editing Service이용시 10% 할인을 요청하기 위해서는 여기 를 클릭해 주시고, American Journal Experts 이용시 10% 할인을 요청하기 위해서는 여기 를 클릭해 주십시오.

영문 교정 서비스는 게재를 위한 요구사항은 아니며, 해당 서비스의 이용이 피어 리뷰에 논문이 선택되거나 게재가 수락되는 것을 의미하거나 보장하지 않습니다.

Data and materials

For all journals, SpringerOpen strongly encourages all datasets on which the conclusions of the manuscript rely to be either deposited in publicly available repositories (where available and appropriate) or presented in the main paper or additional supporting files, in machine-readable format (such as spread sheets rather than PDFs) whenever possible. Please see the list of recommended repositories in our editorial policies.

For some journals, deposition of the data on which the conclusions of the manuscript rely is an absolute requirement. Please check the Instructions for Authors for the relevant journal and article type for journal specific policies.

For all manuscripts, information about data availability should be detailed in an ‘Availability of data and materials’ section. For more information on the content of this section, please see the Declarations section of the relevant journal’s Instruction for Authors. For more information on SpringerOpen's policies on data availability, please see our editorial policies .

Formatting the 'Availability of data and materials' section of your manuscript

The following format for the 'Availability of data and materials section of your manuscript should be used:

"The dataset(s) supporting the conclusions of this article is(are) available in the [repository name] repository, [unique persistent identifier and hyperlink to dataset(s) in http:// format]."

The following format is required when data are included as additional files:

"The dataset(s) supporting the conclusions of this article is(are) included within the article (and its additional file(s))."

For databases, this section should state the web/ftp address at which the database is available and any restrictions to its use by non-academics.

For software, this section should include:

• Project name: e.g. My bioinformatics project
• Project home page: e.g. http://sourceforge.net/projects/mged
• Archived version: DOI or unique identifier of archived software or code in repository (e.g. enodo)
• Operating system(s): e.g. Platform independent
• Programming language: e.g. Java
• Other requirements: e.g. Java 1.3.1 or higher, Tomcat 4.0 or higher
• License: e.g. GNU GPL, FreeBSD etc.
• Any restrictions to use by non-academics: e.g. licence needed

Information on available repositories for other types of scientific data, including clinical data, can be found in our editorial policies .

What should be cited?

Only articles, clinical trial registration records and abstracts that have been published or are in press, or are available through public e-print/preprint servers, may be cited.

Unpublished abstracts, unpublished data and personal communications should not be included in the reference list, but may be included in the text and referred to as "unpublished observations" or "personal communications" giving the names of the involved researchers. Obtaining permission to quote personal communications and unpublished data from the cited colleagues is the responsibility of the author. Either footnotes or endnotes are permitted. Journal abbreviations follow Index Medicus/MEDLINE.

Any in press articles cited within the references and necessary for the reviewers' assessment of the manuscript should be made available if requested by the editorial office.

Preparing figures

When preparing figures, please follow the formatting instructions below.

• Figure titles (max 15 words) and legends (max 300 words) should be provided in the main manuscript, not in the graphic file.
• Tables should NOT be submitted as figures but should be included in the main manuscript file.
• Multi-panel figures (those with parts a, b, c, d etc.) should be submitted as a single composite file that contains all parts of the figure.
• Figures should be numbered in the order they are first mentioned in the text, and uploaded in this order.
• Figures should be uploaded in the correct orientation.
• Figure keys should be incorporated into the graphic, not into the legend of the figure.
• Each figure should be closely cropped to minimize the amount of white space surrounding the illustration. Cropping figures improves accuracy when placing the figure in combination with other elements when the accepted manuscript is prepared for publication on our site. For more information on individual figure file formats, see our detailed instructions.
• Individual figure files should not exceed 10 MB. If a suitable format is chosen, this file size is adequate for extremely high quality figures.
• Please note that it is the responsibility of the author(s) to obtain permission from the copyright holder to reproduce figures (or tables) that have previously been published elsewhere. In order for all figures to be open access, authors must have permission from the rights holder if they wish to include images that have been published elsewhere in non open access journals. Permission should be indicated in the figure legend, and the original source included in the reference list.

Figure file types

We accept the following file formats for figures:

• EPS (suitable for diagrams and/or images)
• PDF (suitable for diagrams and/or images)
• Microsoft Word (suitable for diagrams and/or images, figures must be a single page)
• PowerPoint (suitable for diagrams and/or images, figures must be a single page)
• TIFF (suitable for images)
• JPEG (suitable for photographic images, less suitable for graphical images)
• PNG (suitable for images)
• BMP (suitable for images)
• CDX (ChemDraw - suitable for molecular structures)

Figure size and resolution

Figures are resized during publication of the final full text and PDF versions to conform to the SpringerOpen standard dimensions, which are detailed below.

Figures on the web:

• width of 600 pixels (standard), 1200 pixels (high resolution).

Figures in the final PDF version:

• width of 85 mm for half page width figure
• width of 170 mm for full page width figure
• maximum height of 225 mm for figure and legend
• image resolution of approximately 300 dpi (dots per inch) at the final size

Figures should be designed such that all information, including text, is legible at these dimensions. All lines should be wider than 0.25 pt when constrained to standard figure widths. All fonts must be embedded.

Figure file compression

Vector figures should if possible be submitted as PDF files, which are usually more compact than EPS files.

• TIFF files should be saved with LZW compression, which is lossless (decreases file size without decreasing quality) in order to minimize upload time.
• JPEG files should be saved at maximum quality.
• Conversion of images between file types (especially lossy formats such as JPEG) should be kept to a minimum to avoid degradation of quality.

If you have any questions or are experiencing a problem with figures, please contact the customer service team at [email protected] .

Preparing tables

When preparing tables, please follow the formatting instructions below.

• Tables should be numbered and cited in the text in sequence using Arabic numerals (i.e. Table 1, Table 2 etc.).
• Tables less than one A4 or Letter page in length can be placed in the appropriate location within the manuscript.
• Tables larger than one A4 or Letter page in length can be placed at the end of the document text file. Please cite and indicate where the table should appear at the relevant location in the text file so that the table can be added in the correct place during production.
• Larger datasets, or tables too wide for A4 or Letter landscape page can be uploaded as additional files. Please see [below] for more information.
• Tabular data provided as additional files can be uploaded as an Excel spreadsheet (.xls ) or comma separated values (.csv). Please use the standard file extensions.
• Table titles (max 15 words) should be included above the table, and legends (max 300 words) should be included underneath the table.
• Tables should not be embedded as figures or spreadsheet files, but should be formatted using ‘Table object’ function in your word processing program.
• Color and shading may not be used. Parts of the table can be highlighted using superscript, numbering, lettering, symbols or bold text, the meaning of which should be explained in a table legend.
• Commas should not be used to indicate numerical values.

If you have any questions or are experiencing a problem with tables, please contact the customer service team at [email protected] .

Preparing additional files

As the length and quantity of data is not restricted for many article types, authors can provide datasets, tables, movies, or other information as additional files.

All Additional files will be published along with the accepted article. Do not include files such as patient consent forms, certificates of language editing, or revised versions of the main manuscript document with tracked changes. Such files, if requested, should be sent by email to the journal’s editorial email address, quoting the manuscript reference number.

Results that would otherwise be indicated as "data not shown" should be included as additional files. Since many web links and URLs rapidly become broken, SpringerOpen requires that supporting data are included as additional files, or deposited in a recognized repository. Please do not link to data on a personal/departmental website. Do not include any individual participant details. The maximum file size for additional files is 20 MB each, and files will be virus-scanned on submission. Each additional file should be cited in sequence within the main body of text.

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Types of journal manuscripts

There are several different types of journal manuscripts, including Rapid Communications, Original Research, Review Articles, and Case Studies.

Original Research:

This is the most common type of journal manuscript. It may be called an Original Article,Research Article, or just Article, depending on the journal. The Original Research format is suitable for many different fields and different types of studies. It includes full Introduction, Methods, Results, and Discussion sections.

Rapid Communications:

These papers communicate findings that editors believe will be interesting to many researchers, and that will likely stimulate further research in the field. Rapid Communicationsare usually published soon after submission to the journal, so this format is useful for scientists with results that are time sensitive (for example, those in highly competitive or quickly-changing disciplines). This format often has strict length limits, so some experimentaldetails may not be published until the authors write a full Original Research manuscript. Many journals also refer to this type of manuscript as a Letter.

Review Articles:

Review Articles provide a comprehensive summary of research on a certain topic, and a perspective on the state of the field and where it is heading. They are often written by leaders in a particular discipline after invitation from the editors of a journal. Reviews are often widely read (for example, by researchers looking for a full introduction to a field) and highly cited.Reviews commonly cite approximately 100 primary research articles.

If you would like to write a Review but have not been invited by a journal, be sure to send a presubmission enquiry letter to the journal editor to propose your Review manuscript before you spend time writing it.

Case Studies:

These articles report specific instances of interesting phenomena. A goal of Case Studies is to make other researchers aware of the possibility that a specific phenomenon might occur. This type of study is often used in medicine to report the occurrence of previously unknown or emerging pathologies.

--- Commentary ---

Original URL: http://www.springer.com/authors/journal+authors/journal+authors+academy?SGWID=0-1726414-12-837305-0

Picture Remarks:

Preparation of Manuscripts – short communications

A Short Communication is intended for the presentation of brief observations that do not warrant a full-length paper. Short communication should be submitted the same way as a full-length paper.

The Short Communication manuscript in general:

• Total length should not exceed 10 double lined standard pages including illustrative material (in total no more than 3 figures and tables)
• Each Short Communication must have an Abstract limited to 100 words
• Manuscript should be formatted without section headings in the body of the text
• All the required parts (Introduction, Materials & Methods, Results and Discussion) except for the Literature must be given in single section
• Should be typed in 12 points Times New Roman font
• No part of the manuscript should be underlined and written using capital letters

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The relevance of short communication in scholarly journals: An empirical study

• Published: January 1999
• Volume 44 , pages 47–58, ( 1999 )

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• K. Satyanarayana 1 ,
• D. Srivastava 1 &
• V. Sreenivas 1  

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This study aims to examine whether rapid communications exert more influence/impact on subsequent research. Citation analysis of Short Communications (SCs) and Main Articles (MAs) from 1983 and 1990 for 5 high impact biomedical journals was carried out for a five year period following publication.

The mean citations cumulated for the five year period showed no consistent trend. Some journals showed more citations for SCs while some showed more for MAs. The mean citations (range) for SCs and MAs for the 1983 and 1990 papers respectively were as follows: Gene : 14.13 (0-61) and 38.79 (0-677), 9.73 (0-93) and 13.17 (0-44); Journal of Clinical Investigation (JCI): 79.77 (3-202) and 27.52 (0-86), 50.52 (0-254) and 33.53 (0-151); Journal of Experimental Medicine (JEM): 39.80 (0-200) and 49.20 (0-403), 47.26 (0-258) and 50.27 (0-173); and Journal of Biological Chemistry (JBC); 36.21 (0-380) and 19.67 (0-53), 37.19 (0-273) and 26.84 (0-185). SCs of Journal of Cell Biology (JCB) had a mean citation of 25.84 per article with a range of 0-98, while the MAs had a mean citation of 33.13 with the range 4-122 during 1983-87.

The citation peak was seen about three years after publication for all the journals during both the periods. The mean cumulative citations showed a progressive increase over the five years for both types of papers, in all journals and for both the 5 year periods. The initial differences observed persisted even four years after the year of publication. No significant differences were observed in the distribution of the cumulative 5 year citations between the SCs and MAs. An index of speed of citation per article showed no substantial differences between SCs and MAs with MAs showing an edge over SCs. Both MAs and SCs of all the journals showed nearly same average time per citation per article further confirming that the SCs do not enjoy the advantage of speedier citation.

The results show that the generally perceived feeling of SCs getting cited more frequently and faster does not appear to be valid. Hence, the practice of publishing SCs on a priority basis is perhaps not warranted.

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Satyanarayana, K., Srivastava, D. & Sreenivas, V. The relevance of short communication in scholarly journals: An empirical study. Scientometrics 44 , 47–58 (1999). https://doi.org/10.1007/BF02458477

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What is the impact factor of my short communication paper?

Recently I published a paper in as a short communication in a Springer Journal in Natural Science discipline (Impact Factor 3.56). It was a short paper within 2500 words and 3 figures although the figures can be split up to 8-10 independent figures to make it a full length research paper.

I shared this paper in the social media after it got published. A few of my contacts asked me why I published it as a short communication, rather than as a full research article. They also mentioned that short communications are in general not treated as peer reviewed articles even if it underwent a rigorous review process. They have now suggested making it a full paper with some additional results.

My questions are:

• Does this publication really have no Impact factor as of the Journal?
• Does people cite the results published in short communications?
• Is it always possible to extend the short communicated articles to full length? If possible, then can I copy all or some of the point-to-point texts and results already published in the short communications? Will it be considered as self plagiarism?
• paper-submission
• self-plagiarism
• bibliometrics

• Communications are prestigious in many fields. At least they should show novelty and urgency. Of course, nowadays it is not always true, but still they get screened more thoroughly even before referee assignment. By the way a single paper would have a certain impact, say the number of time it is cited, but not an IF. This is made clear in answers below. –  Alchimista Commented Jul 8, 2020 at 11:21

Impact factors are assigned to journals not papers. No paper has an impact factor. The impact factor of the journal you published in, and the format makes no difference to that (as long as it is a peer reviewed format).

In my field (molecular biology/genomics/bioinformatics) people absolutely cite short communications.

Once a paper is published, you cannot publish exactly the same work as a full length article. You might publish further analysis of the same data, or the same analysis on different data, or different work that comes to the same conclusions, but you cannot just expand this same work to a new paper. Your new paper must also acknowledge the existance of the previous, and therefore would probably not be seen as as novel as the first one.

• 1 Agreed. At least in my field, communications are often used to report some extremely interesting and new finding in a quick (both writing and peer-reviewing) way, one of the reasons they are often cited a lot. In one of the major chemistry journals (Angewandte Chemie), communications are the standard form of publication. –  Snijderfrey Commented Jul 7, 2020 at 17:55
• @Ian Sudbery . My intention was to ask whether does the short communication has same value as of full research articles published in one Journal. It is very well known many Journals do publish many type of articles, even just news of less than 500 words, do you think/confirm all published stuffs in a Journal carry same values? –  Kay Commented Jul 8, 2020 at 1:42
• The value of work is determined by its content, not by its form. Let me put it this way: if some is just going to judge you on the journal title they see on a publication list, they are not going to know whether its a short communication.Some one who is going to look at the work will judge it on its merits. –  Ian Sudbery Commented Jul 8, 2020 at 9:08
• Articles generally have more content than short communications, and therefore, on average, might be more valuable. But not necessarily so - a 7 fig article can just be incremental, where as a 3 fig short comm can change the world. Note that 7 fig articles also have many panels per figure, and often many supplementary figures as well, not just the same amount of content spread out more. –  Ian Sudbery Commented Jul 8, 2020 at 9:13
• @IanSudbery It seems very difficult for me to understand. Anyway, thanks for the inputs. In my understanding, the journal journals 'Nature' or 'Science' mostly publish very few pages even less than 3 pages, but they carry one of the highest values now a days. So pages doesn't matter. What matters is the contents and information. So I don't agree that full article will be more valuable than short communications in the same journal just due to more content. For you information, my short communication paper has also supplements with another 5 Figures and 3 Tables. –  Kay Commented Jul 9, 2020 at 3:27

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• Published: 05 September 2024

Bridging the generational gap between nurses and nurse managers: a qualitative study from Qatar

• Ahmad A. Abujaber 1 ,
• Abdulqadir J. Nashwan   ORCID: orcid.org/0000-0003-4845-4119 1 ,
• Mark D. Santos 1 ,
• Nabeel F. Al-Lobaney 1 ,
• Rejo G. Mathew 1 ,
• Jamsheer P. Alikutty 1 ,
• Jibin Kunjavara 3 &
• Albara M. Alomari 2  

BMC Nursing volume  23 , Article number:  623 ( 2024 ) Cite this article

Metrics details

The nursing workforce comprises multiple generations, each with unique values, beliefs, and expectations that can influence communication, work ethic, and professional relationships. In Qatar, the generational gap between nurses and nurse managers poses challenges to effective communication and teamwork, impacting job satisfaction and patient outcomes.

This study investigates the generational gap between nurses and nurse managers in Qatar, aiming to identify strategies to enhance collaboration and create a positive work environment.

A qualitative research design was used, involving semi-structured interviews with 20 participants, including frontline nurses and senior nurse managers. Participants were purposively sampled to represent different generations. Data were collected through face-to-face and virtual interviews, then transcribed and thematically analyzed.

Four key themes emerged: Optimizing the Work Environment : Older generations preferred transformational and situational leadership, while younger nurses valued respect, teamwork, accountability, and professionalism. Strengthening Work Atmosphere through Communication and values : Older nurses favored face-to-face communication, while younger nurses preferred digital tools. Cultivating Respect and Empathy : Younger nurses emphasized fairness in assignments and promotions, while older nurses focused on empathy and understanding. Dynamic Enhancement of Healthcare Systems : Younger nurses were more adaptable to technology and professional development, while older nurses prioritized clinical care and patient outcomes.

The study reveals significant generational differences in leadership preferences, communication styles, and adaptability to technology. Addressing these gaps through effective leadership, ongoing education, and open communication can improve job satisfaction and patient care.

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Introduction

The nursing profession faces a significant challenge of a multigenerational workforce that can cause conflict and hinder effective communication, especially between nurse managers and nurses [ 1 ]. In addition, a literature review of studies conducted over the past two decades indicates that the generational gap between nurses and nurse managers is a complex phenomenon requiring concerted efforts to address it [ 2 , 3 ].

The nursing workforce comprises four generations, including the Baby Boomers (born between 1946 and 1964), Generation X (born between 1965 and 1979), Generation Y or Millennials (born between 1980 and 1994), and Generation Z (born after 1995) [ 4 ]. These generations have unique values, beliefs, attitudes, and expectations that influence their communication style, work ethic, and approach to work [ 4 ].

In 2013, Hendricks and Cope discussed the impact of generational differences on the nursing workforce and the challenges it presents for nurse managers [ 5 ]. They searched various databases electronically and found that generational diversity affects nurses’ attitudes, beliefs, work habits, and expectations. The paper suggested that accepting and embracing this diversity can lead to a more harmonious work environment and facilitate nurse retention [ 5 ].

The article focused on the cultural and work ethic differences between Baby Boomers and Generation Xers, with Baby Boomers primarily managing the workforce [ 6 ]. Baby Boomers are described as driven and dedicated, equating work with self-worth and personal fulfillment [ 6 ]. At the same time, Generation Xers have ideas of an acceptable workplace, and their terms of employment are usually non-negotiable [ 6 ]. The article summarized recent literature and studies to guide healthcare leadership in recruiting, retaining, and managing Generation X workers in the nursing field [ 6 ].

Similarly, Carver & Candela (2008) conducted a study to inform nurse managers about the generational differences among nurses and how they affect the work environment [ 7 ]. With four generations in the nursing workforce, understanding the characteristics of each generation can lead to increased job satisfaction, productivity, and decreased turnover [ 7 ]. Considering generational differences as part of an overall strategy to increase organizational commitment can improve nursing work environments and address the global nursing shortage [ 7 ]. Managers should increase their knowledge of generational diversity to tap into the strengths of each generation [ 7 ]. In addition, Younger nurses have different career expectations than their older colleagues [ 8 ]. They seek a balanced lifestyle with reasonable work hours, demand to use the latest technology, and expect to be vocal team members [ 8 ].

Managing a multigenerational workforce requires recognizing and valuing the strengths of each generation. Leaders who maximize everyone’s talents and address individual and generational needs can create synergy and improve team performance. Each generation brings unique strengths to the workforce that should be celebrated and utilized to the organization’s advantage. Meeting the needs of each employee, such as providing opportunities for advancement, work/life balance, compensation, benefits, and learning and development, can lead to higher-functioning work teams [ 9 ]. Nurse leaders should know their employees’ multigenerational characteristics and expectations and provide timely and specific feedback to manage them effectively [ 9 ]. With an appreciation of multigenerational differences and a commitment to higher-functioning work teams, leaders can improve organizational efficiency and patient care outcomes [ 9 ].

To bridge the generational gap in nursing, the SIT offers a comprehensive approach to enhancing communication, collaboration, and teamwork between nurses and nurse managers [ 5 ]. This involves acknowledging and respecting each generation’s unique characteristics, values, and experiences, which fosters a better understanding and more effective cooperation. Establishing a shared vision and goal for patient care unites nurses and nurse managers, helping to overcome any multigenerational conflicts that might arise in the workplace [ 5 ]. Additionally, encouraging multigenerational communication and mentoring is vital. This can be facilitated through programs where experienced nurses share their knowledge and skills with younger colleagues, promoting a cohesive and supportive team environment. Furthermore, providing training and development opportunities tailored to each generation’s diverse learning styles and preferences is essential for building a more skilled and competent workforce [ 10 ].

The literature indicates that the generational gap between nurses and nurse managers is a global complex phenomenon that can affect communication, work values, job satisfaction, retention, and quality of care [ 11 ]. Nursing leaders can recognize generational differences in values and behaviors as potential strengths. By gaining a deeper understanding of generational influences, these insights can be harnessed to develop effective strategies that sustain the diverse yet shrinking nursing workforce. Leveraging generational differences can also create positive work environments, enhance quality and productivity, and ultimately improve patient care. As generational differences increasingly become a critical aspect of diversity, it is essential to understand the dynamics between work engagement and meaningful work across generational cohorts to tailor approaches that align with each organization’s unique needs [ 12 , 13 ].

Understanding how to bridge the generational gap in nursing is crucial for nurses and nurse managers to work together effectively and provide better patient care, ultimately leading to improved patient outcomes. This study aims to enhance workplace communication and collaboration by identifying and addressing the factors contributing to multigenerational workplace conflicts. By doing so, nurses and nurse managers can build more cohesive and supportive teams, resulting in a more positive work environment. Finally, addressing the generational gap in nursing benefits the workplace and enables the organization to develop a more engaged and motivated workforce. Multigenerational learning and development opportunities can increase job satisfaction and retention. Recognizing and valuing the unique perspectives and experiences each generation brings is essential.

Study significance

To the best of our knowledge, no studies have been conducted in Qatar that addressed the generational gap among nurses. In line with this, the study aims to identify and compare the work engagement levels and managerial approaches among nurses and nurse managers across different generations and explore and propose effective strategies for improving communication, collaboration, and job contentment in an intergenerational work environment. The findings will contribute to the nursing profession’s knowledge and provide practical solutions for managing a diverse nursing workforce in Qatar.

This study utilized a descriptive qualitative research design. After considering the participants’ time limits, commitments, and convenience, data were collected through semi-structured interviews with nurses and nurse managers (Executive and assistant executive directors of nursing). The authors developed the interview questions for this study (Supplementary File 1). Participants were recruited from healthcare facilities within the organization through purposive sampling. The sample size was determined based on the data saturation point, where no new themes or perspectives emerged. Interviews were conducted face-to-face or virtually, depending on the participant’s preference and availability. With the participant’s permission, interviews were audio-recorded to aid in accurate transcription and were thematically analyzed.

Development of the interview guide

The interview guide was thoughtfully developed to capture participants’ experiences and insights effectively. The process began with an in-depth review of studies examining the generational gap between nurses and managers, identifying key themes such as work engagement, organizational environment, communication, and technological advancement. These themes provided the framework for creating open-ended questions to elicit detailed and reflective responses. Probing questions were also included to deepen the data collected by clarifying and expanding on participants’ initial answers. The draft questions underwent multiple rounds of review and refinement to ensure clarity, relevance, and the elimination of bias, with potential input from qualitative research experts.

Qualitative research aimed to generate a deep understanding of the generational gap between nurses and their managers. This understanding could not be answered in a quantitative approach. Several strategies were employed throughout the research process to ensure the credibility of the findings.

Firstly, to ensure the credibility of the data collected, the researcher established trust and rapport with the participants. This was achieved by being transparent about the research aims, building rapport, and showing genuine interest in the participants’ experiences. The researcher also ensured that the participants felt comfortable sharing their experiences and opinions by creating a safe and non-judgmental environment.

Secondly, data triangulation was used to enhance the credibility of the data. Data triangulation involves using multiple data sources to provide a more comprehensive understanding of the phenomenon being studied.

Thirdly, the researcher conducted member checking to validate the data collected. Member checking involved sharing the findings with the participants and asking for their feedback on whether the findings accurately represented their experiences and opinions. This process ensured that the researcher’s interpretation of the data aligned with the participants’ experiences and perceptions.

Fourthly, the researcher engaged in reflexivity throughout the research process. Reflexivity involves reflecting on the researcher’s biases, values, and assumptions that might have influenced the research process and findings. By being aware of their biases, the researcher ensured they did not influence the data collection or interpretation of the findings.

Finally, the researcher used a systematic and rigorous approach to analyze the data collected. This study used thematic analysis to identify patterns and themes in the data. The analysis was conducted using a coding scheme, and the findings were supported with quotes from the participants, enhancing the credibility of the findings.

Study population and setting

The participants were approached using a purposive sampling technique. A total of 20 participants were expected to join the study. All participants were approached based on an email from the corporate nursing mail group. The participants of this study met the following criteria: they represented diverse generations, with 3–4 from each of the subsequent generations: Generation X (1965–1980), Generation Y (1981–1996), and Generation Z (1997–2012); they had joined HMC for at least one year; and they were willing to participate in the study.

Study procedures

Before conducting the study, the researcher had obtained the consent of the participants (Research Information Sheet). Interviews were done face-to-face or virtually, depending on the participants’ preferences and availability. During the interviews, conversations were audio-recorded to facilitate transcriptions of the responses, completed within 24 h of the interview, and reviewed by two study researchers. The data saturation was determined by redundancy of information is indicated when similar patterns, themes, or categories keep appearing in the data, and no new information is being uncovered during additional interviews or data collection efforts.

The richness and depth of the data collected are critical. Saturation is considered reached when the data sufficiently explores and explains the research questions and key concepts, providing a comprehensive understanding of the phenomenon. Data saturation was reached after twenty interviews; however, two additional interviews were conducted to confirm this. Ethical principles were strictly observed, primarily explaining the nature and purpose of the study before obtaining their consent to participate. Identifiers were removed from the transcripts, and codes were used to label participants (e.g., Participants 1, 2, etc.). Participants were informed that they had the right to withdraw from the study at any time should they decide not to participate in further sessions.

Data analysis

Initially, all interviews were professionally transcribed verbatim, with pseudonyms used to anonymize participants and protect their identities. Both authors (JK and NFA) thoroughly read and re-read the transcripts multiple times to become familiar with the content and ensure the transcripts accurately reflected the audio recordings. then applied an inductive coding approach, deriving codes directly from the data rather than imposing them beforehand. This involved systematically identifying and highlighting significant quotes and segments within the transcripts that were relevant to the research questions. These initial codes were subsequently organized into potential themes by grouping together codes that shared a common essence or underlying concept. Following this, the researchers organized these initial codes into potential themes by grouping codes that shared a common essence or underlying concept.

The potential themes underwent a two-phase review and refinement process. In the first phase, the researchers reviewed the coded data extracts to ensure they coherently supported the identified themes. In the second phase, the themes were examined in relation to the entire data set to confirm that they accurately represented the data and captured the full range of participants’ experiences. Some themes were modified, combined, or discarded during this process based on their relevance and data representation.

The final step involved crafting a coherent and compelling narrative that provided a detailed account of each theme. The report included illustrative quotes from participants to substantiate the themes and vividly depict their experiences. This structured approach ensured that the analysis was thorough and that the resulting themes were deeply rooted in the data. By following Braun and Clarke’s six-step process, the study moved from raw transcripts to well-defined themes that offer meaningful insights into the generational gap among nurses and Nurse managers.

This study had a cohort of ten frontline nurses from the new generation and ten senior nurse managers from the old generation, as shown in Table  1 . The mean age of the new generation was 32.4 years (SD 4.9 years). The nurses had an average of 8.3 years of overall work experience (SD 3.09 years), specifically at Hamad Medical Corporation (HMC); they had a mean work experience of 4.7 years (SD 1.1 years). Gender distribution among the participants was 80% male and 20% female. This demographic profile reveals a well-experienced group, particularly regarding their tenure at HMC, providing a stable basis for analyzing their professional perspectives and experiences.

On the other hand, the old generation demographics: 60% were Executive Directors and 40% were Assistant Executives. Most participants belonged to Generation X (ages 44 to 59 years old), suggesting a consistent age distribution. On average, the executives had 27.9 years of overall work experience (SD 9.46 years), highlighting substantial professional tenure with considerable variability. Specifically, their mean work experience at Hamad Medical Corporation (HMC) was 17.4 years (SD 8.24 years), reflecting a diverse range of service durations at this institution. The gender distribution was evenly split, with 50% male and 50% female participants. Details on the demographic data of the old generation participants are detailed in Table  2 . Three major themes were derived from the study, as illustrated in Fig.  1 .

The major themes and Sub-Themes derived from the study

Optimizing the working environment

Healthy work environments that maximize the health and well-being of nurses are essential in achieving good patient and societal outcomes, as well as optimal organizational performance. This theme consisted of three sub-themes: Influencing leadership style, Patient outcome and nurse satisfaction, and Adaptation of technological advancement.

Influential leadership styles

When investigating the leadership style, all older generations consistently agreed to prefer the transformational one because of its capacity to inspire and motivate frontline staff. However, to respond to specific situational demands, the older generation in our study modified and combined aspects of situational and democratic leadership.

Which type of leadership I’m following is transformational leadership. But sometimes , we can take that democratic leadership in some situations , but not all of it. We can say situational leadership at the same time. But any leadership style you will follow should be , I can tell , a combination of some practice and attitude toward your staff”. (Participant 17).

On the other hand, the new generation perceives leadership style by retrieving the inner values of their leaders, such as respect, teamwork, accountability, and professionalism.

“Actually , our leaders primarily lead by maintaining a good relationship , and he is making sense of decreasing the distance between the higher and lower positions. So , I can say that I share the same attitudes and values with my senior managers , but it might differ from one person to another.” ( Participant 1).

Enhanced patient outcomes and nurses’ satisfaction

The older generation perceived the working environment as a motivator for enhancing patient outcomes. Mainly, they are putting serving humanity at the top of their priority, which might be achieved through creativity, collaboration, and compassion. As articulated by Participant 7, “I believe that exerting the best effort in one’s job demonstrates ownership and respect for the profession. Serving humanity , I prioritize creativity , collaboration , and compassion in my work”.

This quote demonstrates the deep values held by this group, highlighting their strategy of combining individual achievement with a wider humanitarian influence.

The new generation views the working environment as a vital element in improving nurses’ satisfaction, considering many contributing factors, such as the current status of the global economy and the opportunities for nurses to work and move abroad. As elaborated by Participant 13,

“I think we can see a difference between the young and the old generation , and I think the way they look at nursing as a profession. There is a big difference between all the new generations , and I can see how the old generation looks at it. The older generation is looking at ways to help people. It is a way to provide support for older people. Unfortunately , I think the new generation has started looking at it as a job—more than a way of helping people. And I believe there are many different reasons for this. I think about the economic status around the world , and the other thing that you know is that I believe the world is open nowadays for nurses to travel around. Therefore , it’s started becoming a job more than a profession. Unfortunately , that’s why people start looking at it in a completely different way , which is not something good.” (Participant 13).

Adaptation to technological advancements

When examining the technological aspects, the older generation acknowledges the presence of the gab. Most of them believe the gap exists because they adhere to the old practices they learned previously.

“There is a noticeable difference between the younger and older generations of nurses , primarily due to advancements in technology and medical knowledge. Younger nurses are often more up-to-date with the latest care techniques and medical research , as they can access various modern resources. Older nurses , however , may adhere to practices they learned earlier in their careers , which might not incorporate recent technological changes”. (Participant 16)

On the other hand, the new generation views new technologies as an easy-to-adopt opportunity. They like to use the new potentials that come with AI. For example, the new generation is becoming more dependent on technology due to the greater benefits it provides compared to traditional approaches in terms of diagnosis and treatment.

“Technology is a significant factor for us , being part of the newer generation. It’s very important in our year of nursing. We use computers , advanced machines , and electronic documentation , which differ from past practices.”(participant 10) . “The younger generation is adapting more easily to new technologies and software , like using EMR for documentation. The older generation , who are used to manual documentation , find it harder to adapt to this new system in patient care. I’ve also heard that some facilities are using GPS and AI systems to assist in diagnoses and results. So , artificial intelligence is becoming a part of nursing , and younger generations are adapting more easily to it. It will take time for the older generation to adapt because they are accustomed to different practices”. (Participant 8)

Strengthening the work atmosphere through communication and values

Effective communication enhances working relationships and knowledge translation and reduces conflict responsible for errors, improving patient safety. This theme consisted of three sub-themes, diverse and practical communication approaches, positive work atmosphere cultivation, and emphasis on shared values across teams.

Diverse and effective communication approaches

The older generation emphasizes the importance of training sessions on communication skills and advanced technologies to bridge the gap with the new generation. Moreover, they believe the new generation needs to be more skilled in direct interpersonal communication.

“Effective communication strategies that bridge generational gaps should be promoted. This could include training on communication best practices and the use of technology for older nurses and encouraging younger nurses to develop strong interpersonal skills for face-to-face interactions”. (Participant 20) “The older generations , always think of , they are more of insightful , in terms of , in the meetings they will be able to translate or interpret the information much differently. And that’s how I see.”( Participants − 18) .

According to the new generation, effective and direct communication without any mediator can enhance the work atmosphere and ease professional communication with older generations. It can help the new generation have more chances to interact with the old generation.

“Certainly , open and direct communication is helpful. As previously said , it is crucial to have someone who can assist in communicating with my manager in my home country. Establishing a direct line of communication with my management and developing a robust professional connection without intermediaries is vital. I appreciate the older generation’s facilitation of an open-door policy , as it cultivates a direct and efficient communication atmosphere.” (Participant 1).

Positive work atmosphere cultivation

When examining the intergenerational dynamics in the workplace, the findings indicated that differences in experience, training, and access to technology significantly impact the work environment and the level of collaboration among employees. As one participant articulated,

“The work atmosphere impacts collaboration. I think it does impact that and impacts these differences from one generation to another. It’s not about good and bad , but it’s rather about the differences in the experiences , differences in the training , and differences in the work environment as well as the availability of technology. So , I would say that there is a difference.” (Participant 19). However, the new generation focuses on the technological aspect and how that might affect the work atmosphere positively.

Emphasis on shared values across teams

Conflicts arise when older generations rely on experience while new generations prefer evidence-based practices. This affects workplace shared values.

“For instance , there might be a conflict over a non-scientifically backed common practice. The older generation might argue that they’ve been doing it for years without issues. However , from a knowledge-based perspective , the practice might be incorrect. Overall , the older generation’s viewpoint is based on their experience , where they haven’t seen negative outcomes. Conversely , the new generation would argue based on scientific principles and current best practices. The older generation might resist changing to these new practices. So , conflicts like these might arise from differing viewpoints on practices and approaches.” (Participant 9) .

The new generations perceive shared values as part of the staff-manager relationship and can’t isolate it. When the old generation leads, the staff investigates the old generation’s way of leading, which will affect the new generation’s attitudes and values. Consequently, the new generation still takes the old generation as an example to be followed. This meaning can be found in Participant 1 answers. “Actually , our leaders primarily lead by maintaining a good relationship , and he is making sense of decreasing the distance between the higher and lower positions. So , I can say that I share the same attitudes and values with my senior managers , but it might differ from one person to another.” ( Participant 1) .

Cultivating respect and empathy

This theme focuses on two subthemes: commitment to fairness and fostering a sense of purpose among staff.

Commitment to fairness

The results of the older generation highlight the importance of fostering empathy in the workplace. Participant 20 suggests promoting understanding by encouraging the new generation to consider their colleagues’ perspectives and motivations, enhancing mutual respect and cooperation.

“Encourage Empathy: Foster empathy among employees by encouraging them to put themselves in each other’s shoes. Encouraging individuals to consider the motivations and experiences of their colleagues can lead to better understanding” (Participant 20). “They can challenge you as a leader and they can challenge each other. That’s how you build a better workplace to have a conversation , a clear professional conversation. If you want to build a professional conversation , the two respect the critiques to respect the differences. So those differences are not conflicts. Differences are differences of opinion due to the experiences everybody can brings in.”(Participants 18) .

However, the new generation demands that older generations be more open to work-related discussions, assignments, and promotion opportunities. They believe the new generation has a greater chance to be promoted if they get a fair chance as they are equipped and well-educated. This was clear by Participant 9.“ Compared to the older generation , the new generation of nurses has more opportunities for service and promotion based on education. In the past , nurses often held diplomas or auxiliary nursing qualifications , with the attitude focused primarily on patient care. Now , there’s a trend towards having more knowledgeable nurses capable of providing advanced care”( Participant 9).

Fostering a sense of purpose among staff

A sense of purpose plays a crucial role in developing cohesive nursing teams by promoting transparent communication and mutual learning, as emphasized by Participant 18.

“The most effective way that I felt worked during this period is the mentorship , working closely with the people and letting them have open communication all the time , providing the proper support , and providing the platform to share the experience and knowledge while you are learning or why they are learning from , and this learning process will be from both. So , this sharing of information through a clear mentorship , in one way or another , will create a culture of mutual respect , and this will end with time; this is not just easy; it takes time. But eventually , if it is done appropriately from the beginning , it will formulate a more cohesive nursing team.“(Participant 18).

The sense of purpose was more obvious among the new generation’s responses, as can be seen in Participant 7’s response: “ Our teamwork is initially built on collaboration , where each nurse supports and enhances the work of others.”

Dynamic enhancement of healthcare systems

The new generation is more adaptable to technological changes and modern healthcare systems. They often embrace new approaches and value work-life balance and a more collaborative approach to patient care. Older nurses have been exposed to a traditional healthcare system and may have had to adapt to technological changes later in their careers.

Continuous education and professional development

The new generation is involved in all nursing and patient care areas. They are advancing in roles such as nurse advocates and nurse researchers. So, the new generation is expanding into new fields and trying to improve the nursing career by pursuing education and professional development. In contrast, the older generation focuses more on clinical areas and patient outcomes.

“There are more options available now , especially for the younger generations. Previously , options were limited. You would start at a hospital or a specific department and stay there. With education and different pathways , you can work in patient care or move into education or other areas. This variety of options makes it easier for the younger generations.” (Participant:8) . “The other thing that when you are dealing with the old generation , you’ll find the love to be with the patient , patient bedside dealing with the patient day today.” (Participant:13) .

Promotion of organizational openness and transparency

The old generation perceived transparency as the need for the new and old generations to openly discuss changes, address concerns, and collaboratively adapt to evolving practices, fostering a transparent and supportive environment in the nursing profession. “Create an environment where nurses and nurse managers can openly discuss changes in the profession , address concerns , and work together to adapt” (Participant 20).

The new generation perceives transparency as a valuable key to promoting change. Participant No. 1’s answers reveal this meaning: “By open communication , that will help. Straight communication and effective communication indeed will help in preparing for the change. As I mentioned before , I need some help or someone to communicate with my manager in my home country. Also , by ensuring that there is no second person between you and your manager , maintain good relationships.”(Participant:1).

This study assessed the generational gap between the new and the old generation. We have identified four main themes: optimizing the working environment, strengthening the work atmosphere through communication and values, cultivating respect and empathy, and dynamic enhancement of healthcare systems. Overall, the results of this study identify the generational gap between these two generations. Moreover, the findings of this research shed light on significant subthemes that highlight the evolving dynamics within the nursing profession, particularly the differences and similarities between new and old generations. The demographic data provided a clear understanding of the structure of both generations, with a notable representation of male staff nurses in the new generation and a diverse range of experiences in healthcare.

Working environment

Perceiving the work environment was evident as a generational gap in our study; the leadership style and other subthemes were also identified. This study discovered that the older generation significantly promotes effective leadership styles, including transformational and situational leadership. These styles enhance teamwork, promote autonomy, and ensure a supportive work environment. This is consistent with the findings of Cummings et al. (2018), who highlighted that transformational leadership positively impacts nurse satisfaction and patient outcomes by fostering a supportive and communicative work environment [ 14 ]. Furthermore, situational leadership is vital for the older generation in dynamic critical care units, offering flexibility to address staff readiness levels effectively [ 15 ].

On the other hand, the new generation stressed the importance of inner values such as respect, teamwork, accountability, and professionalism rather than the leadership style of the old generation. The new generation’s focus on internal values suggests a potential shift in organizational culture that prioritizes individual integrity and an attitude of collaboration over traditional hierarchical leadership approaches. This trend indicates that future healthcare entities’ strategies may incrementally prioritize cultivating an environment where ethical behaviors, mutual respect, and collective responsibility play crucial roles in achieving organizational success. This result is consistent with another study done by Boamah et al. (2018), who found that supportive leadership practices enhance nurses’ work engagement and patient care quality, emphasizing the need for recognition and acknowledgment strategies to boost job satisfaction [ 16 ].

In addition, our study evidently shows generational differences in adaptation to technological advancements, with the new generation demonstrating a higher ability to adopt new technologies into their practice. This finding is supported by Lera et al. (2020), who noted that the new generation is more comfortable with modern digital tools and evidence-based practices​ than the old generation [ 17 ].

Strengthening work atmosphere through communication and values

The current study has found that generational differences in communication preferences exist, with the new generation leveraging technology for more accessible communication. In contrast, the old generation prefers face-to-face interactions for clearer understanding. This aligns with the findings of Rosi et al. (2019), who noted that younger healthcare professionals are more likely to use digital communication tools, whereas the older generation favors traditional methods [ 18 ]. Effective communication strategies that bridge these generational gaps are crucial. Training on communication best practices and the use of technology for the old generation, as well as encouraging the new generation to develop strong interpersonal skills for face-to-face interactions, are crucial [ 19 ].

Regular feedback mechanisms are crucial for identifying and addressing concerns related to the work atmosphere. Boamah et al. (2018) suggest that understanding and addressing generational differences in work preferences can improve team cohesion and reduce conflicts, ultimately leading to better patient care [ 16 ]. The study participants also emphasized the importance of feedback in creating a positive work environment, consistent with the findings of Lin et al. (2021), who stressed the value of input in fostering a supportive workplace [ 20 ]. The current study found that creating a work culture where debate is encouraged, disagreements are respectful, and active listening helps build a team-oriented mindset. This finding aligns with research by Flores et al. (2023), who noted that promoting shared values and respectful communication enhances team cohesion and collaboration [ 21 ].

The current study has found another generational gap in respect and empathy. The new generation emphasizes the importance of having fair assignments, work-related discussions, and promotion opportunities [ 22 ]. Choi et al. (2018), consistent with our study, reported that fair clinical assignments will enhance staff satisfaction, improve nurses’ working conditions, and positively impact patient outcomes [ 23 ].

Professional self-concept is crucial to staff satisfaction, retention, and well-being [ 24 ]. The sense of purpose is part of the nurse’s professional self-concept; hence, the old generation, especially the leaders, must promote staff well-being by considering their purpose and fostering an environment of mutual benefit [ 25 ]. This finding aligns with the current study, which revealed that the new generation views a sense of purpose as fundamental to their professional needs.

The healthcare system is generally considered a significant influence on nursing careers. Regardless of generation, the healthcare system affects nurses and healthcare providers as it is continuously changed, modified, and developed, creating new challenges and opportunities for healthcare providers.

The progression of nursing practice has been significantly influenced by advancements in education and professional development, leading to a shift in roles and opportunities for nurses. The new generation, who are more adaptable to technological changes and evidence-based practices, are increasingly moving into diverse roles beyond traditional clinical settings. They are now prominent in fields such as nurse advocacy, research, and education, reflecting a broadening of the nursing profession and ultimately enhancing healthcare systems. This shift contrasts with the experiences of the older generation who have primarily focused on direct patient care within clinical environments. Recent studies support this trend. For instance, a study found that new nurses are more likely to engage in continuous education and seek roles that allow for more incredible professional growth and diversification than older nurses [ 26 ].

Our study revealed that creating an environment that promotes openness and transparency is essential for fostering effective communication and collaboration between different generations of nurses. Fostering mentorship and knowledge sharing bridges the generational gap and ensures the transmission of valuable experiences and practices. An open dialogue between nurses and nurse managers about changes in the profession, concerns, and adaptation strategies is critical for cohesive teamwork. These findings are consistent with Bragadóttir et al. (2022), which indicate that organizational transparency and open communication channels significantly enhance teamwork and job satisfaction among nursing staff [ 24 ].

This study highlights the evolving dynamics within the nursing profession, focusing on generational differences and similarities. The new generation is more skillful at integrating technology and embracing diverse roles beyond traditional clinical settings, whereas the old generation brings valuable experience and historical perspectives. Effective leadership, continuous education, and open communication are critical for optimizing the work environment, enhancing nurse satisfaction, and improving patient outcomes. Bridging the generational gap through mentorship and fostering a culture of respect and empathy are essential for a cohesive and resilient healthcare system.

Recommendations

Future research should explore strategies to effectively bridge the generational gap in nursing by integrating leadership styles, communication preferences, and technology adoption across different generations. Longitudinal studies could examine how generational dynamics evolve as new generations enter the workforce and older generations transition out, providing insights into the sustainability of organizational changes. Additionally, expanding research to diverse healthcare settings and cultural contexts would enhance the generalizability of findings. At the same time, intervention studies could test the effectiveness of tailored mentorship programs, continuous education initiatives, and organizational transparency in fostering intergenerational collaboration and improving patient care outcomes.

The study’s methodology, including potential sampling bias due to purposive selection, interviewer bias, and the subjective nature of data saturation, could also influence the results. Additionally, the context-specific nature of the study and the use of virtual interviews might limit the depth and transferability of the findings. Finally, time constraints may have restricted the comprehensiveness of the data collected.

Implications for nursing management

Nurse managers should adopt a multi-faceted leadership approach, embracing both transformational and situational styles, to meet the diverse needs of a multigenerational workforce. Implementing targeted communication training and fostering an environment of respect and empathy can improve team cohesion and patient outcomes. Investing in continuous professional development and technological training will further support the integration of new and experienced nurses.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to acknowledge the nurses and nurse managers who participated in the study.

This study was funded by the Medical Research Center at Hamad Medical Corporation (MRC-01-23-206).

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Department of Nursing, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar

Ahmad A. Abujaber, Abdulqadir J. Nashwan, Mark D. Santos, Nabeel F. Al-Lobaney, Rejo G. Mathew & Jamsheer P. Alikutty

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Albara M. Alomari

Nursing and Midwifery Research Department, Hamad Medical Corporation, Doha, Qatar

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Contributions

AAA, AJN: Conceptualization. NFA, MDS, JK: Formal analysis.AAA, AJN, MDS, NFA, RGM, JPA, JK, AMA: Methodology, Data curation, Manuscript writing (draft and final review). All authors read and approved the final manuscript.

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Correspondence to Abdulqadir J. Nashwan .

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This study was approved by the Medical Research Center of Hamad Medical Corporation (MRC-01-23-206). The study has been conducted in accordance with the ethical standards noted in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consents were obtained from all the participants.

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Abujaber, A.A., Nashwan, A.J., Santos, M.D. et al. Bridging the generational gap between nurses and nurse managers: a qualitative study from Qatar. BMC Nurs 23 , 623 (2024). https://doi.org/10.1186/s12912-024-02296-y

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Associations among claims-based care fragmentation, self-reported gaps in care coordination, and self-reported adverse events

• Lisa M. Kern 1 ,
• Jennifer D. Lau 1 ,
• Mangala Rajan 1 ,
• J. David Rhodes 2 ,
• Lawrence P. Casalino 1 ,
• Lisandro D. Colantonio 2 ,
• Laura C. Pinheiro 1 &
• Monika M. Safford 1  

BMC Health Services Research volume  24 , Article number:  1045 ( 2024 ) Cite this article

Metrics details

Fragmentation of care (that is, the use of multiple ambulatory providers without a dominant provider) may increase the risk of gaps in communication among providers. However, it is unclear whether people with fragmented care (as measured in claims) perceive more gaps in communication among their providers. It is also unclear whether people who perceive gaps in communication experience them as clinically significant (that is, whether they experience adverse events that they attribute to poor coordination).

We conducted a longitudinal study using data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, including a survey on perceptions of healthcare (2017–2018) and linked fee-for-service Medicare claims (for the 12 months prior to the survey) ( N  = 4,296). We estimated correlation coefficients to determine associations between claims-based and self-reported numbers of ambulatory visits and ambulatory providers. We then used logistic regression to determine associations between claims-based fragmentation (measured with the reversed Bice-Boxerman Index [rBBI]) and self-reported gaps in care coordination and, separately, between claims-based fragmentation and self-reported adverse events that the respondent attributed to poor coordination.

The correlation coefficient between claims-based and self-report was 0.37 for the number of visits and 0.38 for the number of providers ( p  < 0.0001 for each). Individuals with high fragmentation by claims (rBBI ≥ 0.85) had a 23% increased adjusted odds of reporting any gap in care coordination (95% CI 3%, 48%) and, separately, a 61% increased adjusted odds of reporting an adverse event that they attributed to poor coordination (95% CI 11%, 134%).

Conclusions

Medicare beneficiaries with claims-based fragmentation also report gaps in communication among their providers. Moreover, these gaps appear to be clinically significant, with beneficiaries reporting adverse events that they attribute to poor coordination.

Peer Review reports

Introduction

Care continuity is the repeated use of a specific ambulatory provider over time, whereas the inverse - care fragmentation - is the use of many ambulatory providers without a dominant provider [ 1 ]. Studies of care continuity or care fragmentation have typically used administrative claims as the gold standard method for measurement [ 2 ]. Claims contain comprehensive data on ambulatory visit utilization, which can be used to determine the components of the continuity or fragmentation scores, including the number of ambulatory visits, the number of ambulatory providers, and the distribution of visits across those providers. Claims are considered the gold standard because of their completeness. However, the disadvantages of claims are that they are generally not accessible to clinicians, are expensive for researchers to obtain, are not easy to analyze, and are often available only after a substantial time lag has occurred (typically several years).

It would potentially be useful if patients could report their own patterns of ambulatory utilization, as patient self-report would be faster and less expensive to obtain than claims. Perhaps even more importantly, it would be useful if patients could report whether they are aware of gaps in communication among providers, which can occur because of fragmented care; information about gaps in communication is not available in claims and is potentially actionable. However, the accuracy of patient-reported ambulatory utilization and the relationship between self-reported gaps in care coordination and claims-based fragmentation is unclear. Prior studies have attempted to determine the correlation between patient-reported continuity and claims-based continuity, but their results have varied, with studies finding a positive correlation, [ 3 ] no correlation, [ 4 ] or mixed results (with some components of self-reported measures being associated with claims-based measures but not all) [ 5 , 6 , 7 ]. In addition, previous studies have not collected data on whether patients thought the gaps in care coordination resulted in adverse consequences.

Thus, we sought to determine: (1) the association between self-reported and claims-based ambulatory utilization, (2) the association between claims-based fragmentation scores and self-reported gaps in care coordination, and (3) the association between claims-based fragmentation scores and self-reported adverse events that the participants thought could have been prevented with better care coordination.

We conducted a longitudinal study, capturing self-reported gaps in care coordination through a survey in 2017–2018 and comparing it to claims-based fragmentation. This study was conducted among REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study participants who were 65 years or older at the time of the survey. The study protocol was approved by the Institutional Review Boards of Weill Cornell Medicine and the University of Alabama at Birmingham.

Between 2003 and 2007, the REGARDS study enrolled 30,239 community-dwelling Black and White adults age ≥ 45 years [ 8 ]. Black adults and individuals living in the Southeastern US were oversampled, because the study was designed to elucidate reasons for racial and geographic differences in stroke mortality [ 8 ]. REGARDS participants, or their proxies if they could not be reached, were contacted by telephone every 6 months to detect study outcomes (e.g., stroke, myocardial infarction). A second in-home visit was conducted approximately 10 years after baseline. REGARDS has linked its data with fee-for-service Medicare claims [ 9 ]. All participants provided written informed consent.

Between August 2017 and November 2018, REGARDS included in its routine 6-month follow-up calls a 22-question survey module on experiences with healthcare, which has been published previously [ 10 ]. REGARDS participants could opt out of this survey module, even if they chose to participate in the rest of the follow-up call. Of the 22 questions, 8 were related to perceptions of care coordination, 8 related to preventable adverse events, and 6 related to healthcare utilization (including ambulatory visits, ambulatory providers, emergency department visits, and hospitalizations). Questions about perceptions of care coordination typically used a 6-month look-back period, and questions about adverse events and healthcare utilization used 12 months [ 10 ].

Data from REGARDS’ primary data collection

We used the following self-reported variables collected at the REGARDS study baseline: biological sex, race (Black/White), educational attainment, history of stroke, region of the U.S., and type of census tract (rural, suburban, or urban), which had been derived by the REGARDS study from the participants’ addresses. We used the following variables from the REGARDS second in-home visit: age, annual household income, hypertension (self-reported, self-reported use of antihypertensive medication, systolic blood pressure ≥ 140 mmHg, or diastolic blood pressure ≥ 90 mmHg), hyperlipidemia (self-reported, use of lipid-lowering medication, total cholesterol ≥ 240 mg/dL, low density lipoprotein cholesterol ≥ 160 mg/dL, or high-density lipoprotein cholesterol ≤ 40 mg/dL), diabetes (self-reported, use of oral glucose-lowering medication, use of insulin, fasting glucose ≥ 126 mg/dL, or nonfasting glucose ≥ 200 mg/dL), myocardial infarction (self-reported or evidence on the study electrocardiogram), kidney disease (self-reported kidney failure, or estimated glomerular filtration rate < 60 mL/min/1.73 m2), and atrial fibrillation (self-reported, or evidence on the study electrocardiogram). We supplemented this information with REGARDS’ adjudicated events for stroke and myocardial infarction [ 11 , 12 ]. We also used data from the healthcare experiences survey described above.

Data from REGARDS-linked medicare fee-for-service claims

We used Medicare beneficiary files to determine monthly enrollment status. We used deduplicated Medicare fee-for-service claims from the Carrier and Outpatient files to identify ambulatory visits for the 12-month period preceding the healthcare experiences survey for each respondent. Ambulatory visits were defined using a National Committee for Quality Assurance (NQCA) definition that was restricted to Clinical Procedure Terminology (CPT) codes for in-person, evaluation-and-management visits for adults in an office setting [ 13 , 14 ]. The NCQA definition of ambulatory visits does not include emergency department (ED) visits. We identified unique ambulatory providers by using the identifiers in the claims, mapped to the National Plan and Provider Enumeration System (NPPES) dataset [ 15 ]. We also used Outpatient and Inpatient Medicare claims to capture ED visits and hospital admissions.

Derivation of the study cohort

We included individuals who: (1) had completed the healthcare experiences survey, (2) were 65 years or older at the time of the survey, (3) had consented to have their REGARDS data linked to Medicare claims, and (4) had continuous fee-for-service coverage for the 12 months prior to the survey. We further restricted the cohort to those with 4 or more ambulatory visits in the 12 months prior to the survey, because measuring fragmentation with fewer than 4 visits is unreliable [ 16 ]. We excluded those with claims-based outlier values (> 99th percentile) for number of ambulatory visits or number of ambulatory providers, as those values are likely erroneous. We also excluded those who did not complete the REGARDS second in-home visit.

Derived variables

Calculating self-reported gaps in care coordination.

We used our previously published methods for calculating self-reported gaps in care coordination [ 17 ]. Briefly, for each of the eight questions on perceptions of care coordination, we dichotomized the response scales to identify problems with care coordination, which we refer to as “gaps” in care coordination. We combined two similar questions that asked about how often and how quickly a respondent received test results, leaving seven unique items. We calculated the frequency of responses that indicated a gap in care coordination for each of these seven items, as well as the frequency of reporting any gap. We also calculated the frequency of each of and any of four self-reported adverse events that respondents reported could have been prevented with better care coordination (i.e., a test that was repeated because the doctor did not have access to the first test, a drug-drug interaction that occurred in the context of multiple prescribers, an ED visit that could have been prevented with better communication across providers, and a hospital admission that could have been prevented with better communication across providers).

Calculating claims-based fragmentation

For each participant, we determined the number of ambulatory visits, the number of ambulatory providers, and the percentage of visits with the most frequently seen provider over the 12 months prior to the survey. We then calculated a fragmentation score using the previously validated Bice-Boxerman Index (BBI) [ 2 , 16 , 18 , 19 , 20 ]. This index captures both “dispersion” (the spread of ambulatory visits across providers) and “density” (the relative share of visits by each provider) [ 21 ]. Patterns of care characterized by high dispersion (many providers) and low density (a relatively low proportion of visits by each provider) receive worse scores (indicating more fragmentation) than patterns with low dispersion and high density. The original BBI ranges from 0 (each visit with a different provider) to 1 (all visits with same provider). To facilitate interpretation, we reversed the index, calculating 1 minus BBI, so that higher scores reflected more fragmentation [ 14 , 22 ]. Note that this measure treats all physicians the same way, whether they are generalists or specialists.

Statistical analysis

We used descriptive statistics to characterize the study sample, self-reported healthcare utilization, and claims-based healthcare utilization. Using correlation coefficients (for continuous variables), we determined agreement between self-reported and claims-based numbers of ambulatory visits and, separately, between self-reported and claims-based numbers of ambulatory providers. Using kappa statistics (for dichotomous variables), we determined agreement between any (that is, ≥ 1 vs. 0) self-reported and claims-based ED visit and, separately, between any self-reported and claims-based hospitalization.

We then classified participants into three groups based on their fragmentation scores. We defined high fragmentation as a score of ≥ 0.85, based on previous work showing that this cut point is independently associated with an increased risk of hospitalization [ 20 ]. Because the distribution of fragmentation scores is skewed, [ 23 ] we further defined medium fragmentation as a score from 0.70 to < 0.85 and low fragmentation as a score < 0.70.

We used descriptive statistics to characterize claims-based ambulatory care patterns by fragmentation group. We also used descriptive statistics to show responses to survey questions by fragmentation group, making pairwise comparisons using Pearson’s chi-squared test or Fisher’s exact test (if a cell size was < 5).

We conducted unadjusted and adjusted logistic regression models, using fragmentation group as the independent variable and any self-reported gap in care coordination as the dependent variable. The adjusted models were built in a stepwise fashion, first adjusting for demographic characteristics and then adding adjustment for clinical characteristics. We repeated these models substituting any self-reported adverse event attributed to poor coordination as the dependent variable. Models were performed using a complete case approach and then re-run using multiple imputation for missing co-variates; the most frequently missing co-variate was annual household income (missing for 15%).

Analyses were conducted using SAS (version 9.4; Cary, NC). P -values ≤ 0.05 were considered significant.

Study sample

We identified 4,296 individuals who met the inclusion criteria (Fig.  1 ). The average age of these participants was 78.1 years old (SD 6.7). Approximately half (54.3%) were female. Nearly one-fourth (24.4%) were Black. Nearly one-third (29.6%) had an annual household income of <$35,000, and more than one-fourth (28.1%) had a high school education or less. More than half (59.3%) lived in the Southeastern region of the U.S. Approximately one-tenth (13.2%) lived in a rural area. More than two-thirds had hypertension (70.2%) or hyperlipidemia (69.1%). The frequency of other chronic conditions is shown in Table  1 .

Derivation of study cohort

Agreement between self-reported and claims-based healthcare utilization

There was a weak correlation between self-reported and claims-based ambulatory visits and ambulatory providers (with correlation coefficients of 0.37 and 0.38 respectively, Table  2 ). There was moderate agreement between self-reported and claims-based ED visits and hospital admissions), with kappa statistics of 0.45 and 0.52, respectively. For the first three of these measures, the self-reported value was lower than the claims-based values. Participants reported an average of 6.0 visits over the past year, whereas by claims the same individuals had an average of 13.1 visits. Similarly, the participants reported having an average of 3.1 ambulatory providers, whereas claims found an average of 6.2 providers. Approximately one-fifth of respondents (19.5%) reported having at least one ED visit, whereas claims found ED visits for 29.6% of respondents. Similar proportions were found for hospital admissions (16.5% by self-report vs. 15.8% for claims).

Differences across groups by claims-based fragmentation score

Overall, those with 4 or more ambulatory visits had a median of 11 visits to 6 providers, with a median of 36% of visits with the most frequently seen provider, and a median fragmentation score of 0.84 (Table 3 ). The distributions of these variables are shown in the Appendix. Of the 4,296 participants in the study, 2,052 (47.8%) had high fragmentation, 1,543 (35.9%) had medium fragmentation, and 701 (16.3%) had low fragmentation (Table  3 ). Participants in the high fragmentation group had a median of 13 ambulatory visits to 7 unique providers (by claims), with the most frequently seen provider accounting for 27% of visits, yielding a median fragmentation score of 0.90. Participants in the medium fragmentation group had a median of 11 visits to 5 providers, with the most frequently seen provider accounting for 43% of visits, yielding a median fragmentation score of 0.80. By contrast, those with low fragmentation had a median of 8 visits to 3 providers, with the most frequently seen provider accounting for 64% of visits, with a median fragmentation score of 0.60.

Association between self-reported gaps in care coordination and claims-based fragmentation

There were statistically significant differences across claims-based fragmentation groups for 4 of the 7 unique questions on perceptions of care coordination (Table  4 ). For example, 11.8% of high fragmentation participants reported that they only somewhat received or did not receive help they needed from their doctor’s office to manage care among different providers and services, compared to 7.9% of low fragmentation participants ( p  < 0.01). Similarly, 10.8% of high fragmentation participants reported that they do not think their doctors communicate with each other about their healthcare, compared to 6.6% of low fragmentation participants ( p  = 0.001). The proportions of participants rating the coordination of care among all of the health professionals that they see as fair or poor were 8% of high fragmentation participants and 3.6% for low fragmentation participants ( p  < 0.001). The medium fragmentation group had proportions between the high and low fragmentation groups. Overall, in these unadjusted comparisons, those with high fragmentation were more likely than those with low fragmentation to report any of the 7 gaps in care coordination (37.8% vs. 33.7%, p  = 0.049).

This association persisted after adjustment for demographic and clinical characteristics, regardless of whether we used a complete case approach or multiple imputation for missing co-variates (Table  5 ). In the fully adjusted model that used multiple imputation, having high fragmentation was associated with a 24% increase in the odds of reporting any gap in care coordination, compared to low fragmentation (adjusted odds ratio [AOR] 1.24; 95% confidence interval [CI] 1.03, 1.48).

Association between claims-based fragmentation and self-reported adverse events

There were no statistically significant differences across fragmentation groups in the frequency with which respondents reported repeat tests (Table  4 ). Those with medium fragmentation reported more drug-drug interactions than the low fragmentation group, but the difference between high and low fragmentation was not statistically significant.

The high fragmentation group was more likely to have an ED visit than the low fragmentation group (21.7% vs. 11.8%, p  < 0.001), but there was no statistically significant difference in the proportions of respondents who thought that their ED visit could have been prevented or could have been prevented with better communication among providers.

The high fragmentation group was also more likely to have a hospital admission than the low fragmentation group (19.4% vs. 10.3%, p  < 0.001), but there was no statistically significant difference in the proportions of respondents who thought that their hospital admission could have been prevented or could have been prevented with better communication.

When any of the four adverse events were considered (that is, repeat test, drug-drug interaction, ED visit that could have been prevented with better communication, and hospital admission that could have been prevented with better communication), 7.9% of those with high fragmentation and 5.3% of those with low fragmentation reported any adverse event ( p  = 0.02). Adjusting for co-variates and using multiple imputation for missing co-variates, high fragmentation was significantly associated with a 61% increase in the odds of any self-reported adverse event, compared to low fragmentation (Table  5 , AOR 1.61, 95% CI 1.11, 2.34).

In this national study of 4,296 Medicare beneficiaries, we found a positive correlation between self-reported and claims-based ambulatory utilization, with correlation coefficients of 0.37 for the number of visits and 0.38 for the number of providers ( p  < 0.0001 for each). Participants substantially underestimated their ambulatory utilization, compared to claims; they reported an average of 6.0 visits to 3.1 providers, whereas claims identified an average of 13.1 visits to 6.2 providers ( p  < 0.0001 for each). Nearly half of participants (47.8%) had highly fragmented care by claims. More than a third of participants reported a gap in care coordination, and between 5% and 8% of participants reported adverse events that they attributed to poor care coordination. Those with high fragmentation by claims had a 24% increased adjusted odds of experiencing a gap in care coordination (95% CI 3%, 48%) and, separately, a 61% increased adjusted odds of a self-reported adverse event that they attributed to poor coordination (95% CI 11%, 134%).

In the context of the literature, our findings align with the previous study that found a positive correlation between self-reported and claims-based measures of ambulatory utilization, and the magnitude of association in our study was similar to theirs ( r  = 0.30) [ 3 ]. Our study is thus distinct from previous work that found mixed or null results [ 4 , 5 , 6 , 7 ]. We found slightly lower agreement between self-report vs. claims-based ED visits and hospitalizations (kappa of 0.45 for ED visits and 0.52 for hospitalizations), compared to the literature’s kappa of 0.65 for ED visits and 0.64 for hospitalizations, although the difference could be explained by our use of a 12-month look-back period compared to others’ use of a 6-month look-back [ 24 ]. Our study adds to the literature with the novel finding of a positive association between claims-based fragmentation and self-reported adverse events that respondents attribute to poor coordination of care.

The directions of the associations between self-reported and claims-based ambulatory utilization, claims-based fragmentation and self-reported gaps in care coordination, and claims-based fragmentation and self-reported adverse events were all consistent. Together, these findings suggest that patients are aware of when their care is fragmented, even if they underestimate the full extent of fragmentation. The findings further suggest that patient-reported gaps in care coordination and patient-reported adverse events could be considered important patient-centered outcomes.

Previous studies have measured patient-reported gaps in care coordination, but they have tended to use them as a measure of quality and satisfaction at the population level, [ 25 , 26 ] not as a measure to be collected and addressed at the individual level in real time. If patients are aware of gaps in care coordination and can see preventable harm unfolding, it would be important for the medical community to elicit those observations and act to address them.

Although this study does not validate patient perceptions of harm against objective documentation of adverse events, another study found that patient reports are correct more often than not; in that study, 64% of safety concerns reported by patients were validated upon clinician review and that 57% of those confirmed problems resulted in a change in the patients’ record or care plan [ 27 ]. Patients’ perceptions of care coordination are not routinely elicited, and more research is needed to determine whether addressing patients’ concerns can favorably affect their care.

There are several limitations of this study. We do not have objective data on appropriateness of care or on communication among providers. In addition, this study took place within the context of a cohort study, and those who participate in cohort studies may be different from those who do not. However, empirical data suggest that REGARDS participants with linked fee-for-service Medicare claims are representative of fee-for-service Medicare beneficiaries broadly [ 9 ]. Strengths of this study include a national sample, large sample size, diverse sample, and use of previously tested measures for claims-based fragmentation and self-reported gaps in care coordination.

In conclusion, our study found positive associations among claims-based fragmentation, self-reported gaps in care coordination, and self-reported adverse events. While claims-based fragmentation may remain the gold standard for capturing ambulatory utilization, this study suggests that self-reported measures could play an important complementary role. Future studies could use self-reported gaps in coordination as a starting point for identifying opportunities for intervention at the individual level. The fact that people are reporting adverse events that they attribute to a failure of care coordination warrants more attention.

Data availability

The data used for this study include data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, which is based at the University of Alabama at Birmingham, linked to claims data owned by the Centers for Medicare & Medicaid Services. The REGARDS-Medicare linked dataset is not publicly available due to constraints of the data use agreement. Researchers interested in using REGARDS data can send an email to [email protected]. See also the following website for more information: https://www.uab.edu/soph/regardsstudy/researchers.

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The REGARDS study is co-funded by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging, of the National Institutes of Health, Department of Health and Human Services (U01 NS041588). This work was supported by ancillary studies to REGARDS, with funding from the National Heart, Lung, and Blood Institute (R01 HL135199 and R01HL165452). The funding agencies played no role in the design or conduct of the study, and no role in data management, data analysis, interpretation of data, or preparation of the manuscript. The REGARDS Executive Committee reviewed and approved this manuscript prior to submission, ensuring adherence to standards for describing the REGARDS study.

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Substantial contributions to the conception or design of the work: LMK, JDR, LPC, MMS. The acquisition of data: LMK, JDR, MMS. The analysis of data: JDL, MR. The interpretation of data: LMK, JDL, MR, JDR, LPC, LDC, LCP, MMS. Drafting the work: LMK. Reviewing it critically for important intellectual content: LMK, JDL, MR, JDR, LPC, LDC, LCP, MMS. Approval of the final manuscript: LMK, JDL, MR, JDR, LPC, LDC, LCP, MMS.

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LMK is a consultant to Mathematica, Inc.LDC and MMS receive support from Amgen, Inc.MMS is the founder of MedExplain, a patient education company.

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Kern, L.M., Lau, J.D., Rajan, M. et al. Associations among claims-based care fragmentation, self-reported gaps in care coordination, and self-reported adverse events. BMC Health Serv Res 24 , 1045 (2024). https://doi.org/10.1186/s12913-024-11440-y

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Received : 15 March 2024

Accepted : 14 August 2024

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DOI : https://doi.org/10.1186/s12913-024-11440-y

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