1
|
Berghetti L, Danielle MBA, Winter VDB, Petersen AGP, Lorenzini E, Kolankiewicz ACB. Transition of care of patients with chronic diseases and its relation with clinical and sociodemographic characteristics. Rev Lat Am Enfermagem 2023; 31:e4013. [PMID: 37820218 PMCID: PMC10561803 DOI: 10.1590/1518-8345.6594.4013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/19/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE evaluate the transition of care from the perspective of people living with chronic diseases and identify its relation with clinical and sociodemographic characteristics. METHOD cross-sectional study with 487 patients who were discharged from a hospital. Clinical and sociodemographic characterization instruments were used, as well as the Care Transitions Measure-15, which measures Preparation for self-management, Secured preferences, Understanding about medications and Care plan factors. Descriptive and inferential statistical analysis. RESULTS the transition of care was satisfactory (76.8±10.4). Average of the factors: Preparation for self-management (82.2±10.8), Secured preferences (84.7±14.3), Understanding about medications (75.7±13.7) and Care plan (64.5±13.2). Female patients had a higher average in the understanding about medications factor. Whites and residents in the urban area better evaluated the Care plan factor. The highest mean was observed for the Secured preferences factor (84.7±14.3) and the lowest for the Care plan factor (64.5±13.2). In all factors, significant differences were found in the variables (surgical patient, carrying clinical artifacts and not being hospitalized for COVID-19). Patients hospitalized for up to five days showed statistical difference in Preparation for self-management and Understanding about medications factors. In patients who were not readmitted within 30 days of discharge, Preparation for self-management was better. The better the Preparation for self-management, the lower the 30-day readmission rates. CONCLUSION in patients living with chronic diseases, sociodemographic and clinical variables are associated with the transition of care. Patients who better evaluated preparation for self-management had fewer readmissions within 30 days. (1) Brazilian study that evaluated the transition of care of patients with CNCDs. (2) Women had a higher average in the understanding about medications factor. (3) Whites and residents in the urban area better evaluated the care plan. (4) Better preparation for self-management reduces length of stay and readmissions. (5) Better preparation for understanding about medications reduces hospitalization time.
Collapse
Affiliation(s)
- Larissa Berghetti
- Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, RS, Brasil
| | | | | | | | - Elisiane Lorenzini
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil
- Becaria del Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil
| | - Adriane Cristina Bernat Kolankiewicz
- Universidade Regional do Noroeste do Estado do Rio Grande do Sul, Ijuí, RS, Brasil
- Becaria del Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brasil
| |
Collapse
|
2
|
Transição do cuidado de pessoas idosas do hospital para casa. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ao00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
3
|
Abstract
Advancements in medical science and technology, along with global increases in life expectancy, are changing the way health care services are delivered to the aging society. Telerehabilitation refers to rehabilitation services involving evaluation and treatment. It is an attractive option for older adults who may have multiple comorbidities. Limited access to in-person services and the concern about potential exposure to severe acute respiratory syndrome coronavirus-2 during this pandemic accelerated the implementation of telerehabilitation. This article review the scope, need, and implementation of telehealth and telerehabilitation in the aging population from the perspective of clinicians, patients, and caregivers.
Collapse
Affiliation(s)
- Mooyeon Oh-Park
- Department of Rehabilitation Medicine, Albert Einstein College of Medicine, Montefiore Health System, Burke Rehabilitation Hospital, 785 Mamaroneck Avenue, White Plains, NY 10605, USA.
| | - Henry L Lew
- Department of Communication Sciences and Disorders, University of Hawai'i at Mānoa, John A. Burns School of Medicine, 677 Ala Moana Boulevard, Suite 625, Honolulu, HI 96813, USA; Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Preeti Raghavan
- Department of Physical Medicine and Rehabilitation and Neurology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| |
Collapse
|
4
|
Oikonomou E, Page B, Lawton R, Murray J, Higham H, Vincent C. Validation of the Partners at Care Transitions Measure (PACT-M): assessing the quality and safety of care transitions for older people in the UK. BMC Health Serv Res 2020; 20:608. [PMID: 32611336 PMCID: PMC7329420 DOI: 10.1186/s12913-020-05369-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 05/26/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The Partners at Care Transitions Measure (PACT-M) is a patient-reported questionnaire for evaluation of the quality and safety of care transitions from hospital to home, as experienced by older adults. PACT-M has two components; PACT-M 1 to capture the immediate post discharge period and PACT-M 2 to assess the experience of managing care at home. In this study, we aim to examine the psychometric properties, factor structure, validity and reliability of the PACT-M. METHODS We administered the PACT-M over the phone and by mail, within one week post discharge with 138 participants and one month after discharge with 110 participants. We performed principal components analysis and factors were assessed for internal consistency, reliability and construct validity. RESULTS Reliability was assessed by calculating Cronbach's alpha for the 9-item PACT-M 1 and 8-item PACT-M 2 and exploratory factor analysis was performed to evaluate dimensionality of the scales. Principal components analysis was chosen using pair-wise deletion. Both PACT-M 1 and PACT-M 2 showed high internal consistency and good internal reliability values and conveyed unidimensional scale characteristics with high reliability scores; above 0.8. CONCLUSIONS The PACT-M has shown evidence to suggest that it is a reliable measure to capture patients' perception of the quality of discharge arrangements and also on patients' ability to manage their care at home one month post discharge. PACT-M 1 is a marker of patient experience of transition and PACT-M 2 of coping at home.
Collapse
Affiliation(s)
| | | | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute For Health Research, Bradford, UK
| | - Jenni Murray
- Bradford Institute For Health Research, Bradford, UK
| | | | | |
Collapse
|
5
|
Oikonomou E, Chatburn E, Higham H, Murray J, Lawton R, Vincent C. Developing a measure to assess the quality of care transitions for older people. BMC Health Serv Res 2019; 19:505. [PMID: 31324171 PMCID: PMC6642522 DOI: 10.1186/s12913-019-4306-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 06/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The transition of older patients (over 65 years of age) from hospital to their own home is a time when patients are at high risk. No measure currently exists to assess the experience, quality and safety of care transitions relevant to UK population. We aim to describe the development and initial testing of the Partners at Care Transitions Measure (PACT-M) as a patient-reported questionnaire for evaluation of the quality and safety of care transitions from hospital to home in older patients. METHODS We used an established measure development procedure which includes conceptualising the components of care transitions, item development, conducting a modified Delphi process and pilot-testing of the PACT-M with patients over 65 years old using telephone administration. RESULTS Pilot testing of the PACT-M suggests that the components identified cover the issues of most importance to patients. Face validity testing showed that the measure in its current form is acceptable to older patients. CONCLUSIONS The measure developed in this study shows promise for use by those involved in planning, implementing and evaluating discharge care, and could be used to inform interventions to improve the transition from hospital to home for older patients.
Collapse
Affiliation(s)
| | | | | | - Jenni Murray
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | | | | |
Collapse
|
6
|
Gilboa Y, Maeir T, Karni S, Eisenberg ME, Liebergall M, Schwartz I, Kaufman Y. Effectiveness of a tele-rehabilitation intervention to improve performance and reduce morbidity for people post hip fracture - study protocol for a randomized controlled trial. BMC Geriatr 2019; 19:135. [PMID: 31109289 PMCID: PMC6528189 DOI: 10.1186/s12877-019-1141-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most surviving hip-fracture patients experience reduced mobility and lose some of their functional ability, which increases the risk of complications and rehospitalization. Post-discharge transitional programs to reduce readmissions and disabilities have shown some success. Telerehabilitation refers to the use of technologies to provide rehabilitation services to people in their homes. Considering the need for long-term follow-up care for people with hip fracture, in-home telerehabilitation could increase independence, decrease hospital stays and reduce the burden for caregivers. The objective of this study is to investigate the effectiveness of an intervention program based on telerehabilitation on activities of daily living (ADL), quality of life (QOL), depression and burden on caregivers compared to face-to-face home visits and usual care of community-dwelling older adults after hip fracture. METHODS/DESIGN This will be a three-armed randomized control trial (RCT) including pre/post intervention and follow-up. The trial will include 90 older people with hip fractures who will be randomly assigned to a telerehabilitation group (N = 30), face-to-face visits (N = 30) and a control group. The aim of the intervention is to improve the transition from rehabilitation units to community dwelling. It will include 10 videoconferencing/ face-to-face sessions from an occupational therapist in the presence of the primary caregiver. Each session will be utilized to guide the participants to achieve their self-identified goals, focusing on problem-solving for daily life situations and on the ability to implement the discussed strategies for a variety of activities. Outcome measures include Functional Independence Measure (FIM) for evaluation of ADL, SF-12 for evaluation of Health-related QOL, The Geriatric Depression Scale (GDS) and The Zarit Caregiver Burden Scale. Data will be analyzed using Repeated measures MANOVA. DISCUSSION The current study will enable the cost-effectiveness examination of a suggested rehabilitation service based on available technology. The proposed intervention will increase accessibility of in-home rehabilitation services, improve function and health, and reduce economic burden. TRIAL REGISTRATION NCT03376750 (12/15/2017).
Collapse
Affiliation(s)
- Yafit Gilboa
- School of Occupational Therapy, Faculty of Medicine, Hadassah and the Hebrew University of Jerusalem, Mount Scopus, 91240 Jerusalem, Israel
| | - Talia Maeir
- School of Occupational Therapy, Faculty of Medicine, Hadassah and the Hebrew University of Jerusalem, Mount Scopus, 91240 Jerusalem, Israel
| | - Sharon Karni
- Herzog Medical Center, Givat Shaul, P.O.Box 3900, 91035 Jerusalem, Israel
| | | | - Meir Liebergall
- Hadassah University Hospital, P.O.Box 12000, 91120 Jerusalem, Israel
| | - Isabella Schwartz
- Hadassah University Hospital, P.O.Box 12000, 91120 Jerusalem, Israel
| | - Yakir Kaufman
- Herzog Medical Center, Givat Shaul, P.O.Box 3900, 91035 Jerusalem, Israel
| |
Collapse
|
7
|
Flink M, Tessma M, Cvancarova Småstuen M, Lindblad M, Coleman EA, Ekstedt M. Measuring care transitions in Sweden: validation of the care transitions measure. Int J Qual Health Care 2018; 30:291-297. [PMID: 29432554 PMCID: PMC5928451 DOI: 10.1093/intqhc/mzy001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/17/2018] [Indexed: 01/17/2023] Open
Abstract
Objective To translate and assess the validity and reliability of the original American Care Transitions Measure, both the 15-item and the shortened 3-item versions, in a sample of people in transition from hospital to home within Sweden. Design Translation of survey items, evaluation of psychometric properties. Setting Ten surgical and medical wards at five hospitals in Sweden. Participants Patients discharged from surgical and medical wards. Main outcome measure Psychometric properties of the Swedish versions of the 15-item (CTM-15) and the 3-item (CTM-3) Care Transition Measure. Results We compared the fit of nine models among a sample of 194 Swedish patients. Cronbach’s alpha was 0.946 for CTM-15 and 0.74 for CTM-3. The model indices for CTM-15 and CTM-3 were strongly indicative of inferior goodness-of-fit between the hypothesized one-factor model and the sample data. A multidimensional three-factor model revealed a better fit compared with CTM-15 and CTM-3 one factor models. The one-factor solution, representing 4 items (CTM-4), showed an acceptable fit of the data, and was far superior to the one-factor CTM-15 and CTM-3 and the three-factor multidimensional models. The Cronbach’s alpha for CTM-4 was 0.85. Conclusions CTM-15 with multidimensional three-factor model was a better model than both CTM-15 and CTM-3 one-factor models. CTM-4 is a valid and reliable measure of care transfer among patients in medical and surgical wards in Sweden. It seems the Swedish CTM is best represented by the short Swedish version (CTM-4) unidimensional construct.
Collapse
Affiliation(s)
- Maria Flink
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Tomtebodavägaen 18A, 17177 Stockholm, Sweden.,Department of Social Work, Karolinska University Hospital, C2:64, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Mesfin Tessma
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Tomtebodavägaen 18A, 17177 Stockholm, Sweden
| | - Milada Cvancarova Småstuen
- HiOA, Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences Department of Nursing and Health Promotion, Pilestredet 32, Oslo, Norway
| | - Marléne Lindblad
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Tomtebodavägaen 18A, 17177 Stockholm, Sweden.,Department of Health Care Sciences, Ersta Sköndal University College, Stigbergsgatan 30, Box 11189, 100 61 Stockholm, Sweden
| | - Eric A Coleman
- Division of Health Care Policy and Research, University of Colorado Denver Anschutz Medical Campus, 13199 East Montview Blvd., Suite 400 Campus, Box: F480 Aurora, CO 80045-7201, USA
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Tomtebodavägaen 18A, 17177 Stockholm, Sweden.,School of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Stagneliusgatan 14, 391 82 Kalmar, Sweden
| |
Collapse
|
8
|
Cao X, Chen L, Diao Y, Tian L, Liu W, Jiang X. Validity and reliability of the Chinese version of the care transition measure. PLoS One 2015; 10:e0127403. [PMID: 26000708 PMCID: PMC4441382 DOI: 10.1371/journal.pone.0127403] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 04/15/2015] [Indexed: 02/05/2023] Open
Abstract
Background The 15-item care transition measure (CTM-15) is a reliable and valid instrument assessing the quality of care transition from patients’ perspectives. The aim of this study was to evaluate the psychometric properties of the CTM-15 and the CTM-3 (a 3-item short version of the CTM-15) in Mainland China. Methodology/Findings This was a cross-sectional study with a convenience sample of 646 patients in a general tertiary-level hospital in Chengdu, China. The results indicated that the Cronbach’s α values of the Chinese version of the two measures were 0.90 and 0.56, and the test-retest reliability values were 0.91 and 0.87, respectively. Three factors were extracted for the CTM-15 in Chinese populations. The CTM-15 and the CTM-3 scores discriminated well between patients with and without re-hospitalization for their index condition. The CTM-15 and the CTM-3 had significant positive relationships with self-rated health status. The CTM-3 score was significantly related to the CTM-15 score, and the CTM-3 score accounted for 64.23% of the variance of the CTM-15 score. Conclusions/Significance This study has demonstrated the psychometric properties of the CTM-15 and the CTM-3 in Mainland China. Although the Cronbach’s α value of the CTM-3 is suboptimal, it has exhibited high test-retest reliability, convergent validity and criterion validity. Therefore, the CTM-3 can substitute the CTM-15 as a performance measurement tool when the sample size is large enough to compensate its suboptimal reliability or the reduced response burden is a concern.
Collapse
Affiliation(s)
- Xiaoyi Cao
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Lin Chen
- Hemodialysis Center, Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Yongshu Diao
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Lang Tian
- Department of hepatobiliary surgery, Sichuan Cancer Hospital, Chengdu, Sichuan Province, People’s Republic of China
| | - Wenjie Liu
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
| | - Xiaolian Jiang
- Department of Nursing, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People’s Republic of China
- * E-mail:
| |
Collapse
|
9
|
Soulakis ND, Carson MB, Lee YJ, Schneider DH, Skeehan CT, Scholtens DM. Visualizing collaborative electronic health record usage for hospitalized patients with heart failure. J Am Med Inform Assoc 2015; 22:299-311. [PMID: 25710558 PMCID: PMC4394967 DOI: 10.1093/jamia/ocu017] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective To visualize and describe collaborative electronic health record (EHR) usage for hospitalized patients with heart failure. Materials and methods We identified records of patients with heart failure and all associated healthcare provider record usage through queries of the Northwestern Medicine Enterprise Data Warehouse. We constructed a network by equating access and updates of a patient’s EHR to a provider-patient interaction. We then considered shared patient record access as the basis for a second network that we termed the provider collaboration network. We calculated network statistics, the modularity of provider interactions, and provider cliques. Results We identified 548 patient records accessed by 5113 healthcare providers in 2012. The provider collaboration network had 1504 nodes and 83 998 edges. We identified 7 major provider collaboration modules. Average clique size was 87.9 providers. We used a graph database to demonstrate an ad hoc query of our provider-patient network. Discussion Our analysis suggests a large number of healthcare providers across a wide variety of professions access records of patients with heart failure during their hospital stay. This shared record access tends to take place not only in a pairwise manner but also among large groups of providers. Conclusion EHRs encode valuable interactions, implicitly or explicitly, between patients and providers. Network analysis provided strong evidence of multidisciplinary record access of patients with heart failure across teams of 100+ providers. Further investigation may lead to clearer understanding of how record access information can be used to strategically guide care coordination for patients hospitalized for heart failure.
Collapse
Affiliation(s)
- Nicholas D Soulakis
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Matthew B Carson
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA Center For Healthcare Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, IL, USA
| | - Young Ji Lee
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel H Schneider
- Northwestern University Clinical and Translational Sciences Institute, Chicago, IL, USA
| | - Connor T Skeehan
- Division of Health and Biomedical Informatics, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Denise M Scholtens
- Division of Biostatistics, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
10
|
Anatchkova MD, Barysauskas CM, Kinney RL, Kiefe CI, Ash AS, Lombardini L, Allison JJ. Psychometric evaluation of the Care Transition Measure in TRACE-CORE: do we need a better measure? J Am Heart Assoc 2014; 3:e001053. [PMID: 24901109 PMCID: PMC4309102 DOI: 10.1161/jaha.114.001053] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The quality of transitional care is associated with important health outcomes such as rehospitalization and costs. The widely used Care Transitions Measure (CTM‐15) was developed with a classic test theory approach; its short version (CTM‐3) was included in the CAHPS Hospital Survey. We conducted a psychometric evaluation of both measures and explored whether item response theory (IRT) could produce a more precise measure. Methods and Results As part of the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education, 1545 participants were interviewed during an acute coronary syndrome hospitalization, providing information on general health status (Short Form‐36), CTM‐15, health utilization, and care process questions at 1 month postdischarge. We used classic and IRT analyses and compared the measurement precision of CTM‐15–, CTM‐3–, and CTM‐IRT–based score using relative validity. Participants were 79% non‐Hispanic white and 67% male, with an average age of 62 years. The CTM‐15 had good internal consistency (Cronbach's α=0.95) but demonstrated acquiescence bias (8.7% participants responded “Strongly agree” and 19% responded “Agree” to all items) and limited score variability. These problems were more pronounced for the CTM‐3. The CTM‐15 differentiated between patient groups defined by self‐reported health status, health care utilization, and care transition process indicators. Differences between groups were small (2 to 3 points). There was no gain in measurement precision from IRT scoring. The CTM‐3 was not significantly lower for patients reporting rehospitalization or emergency department visits. Conclusion We identified psychometric challenges of the CTM, which may limit its value in research and practice. These results are in line with emerging evidence of gaps in the validity of the measure.
Collapse
Affiliation(s)
- Milena D Anatchkova
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
| | - Constance M Barysauskas
- Department of Biostatistics and Computational Biology, Dana Farber Cancer Institute, Harvard Medical School, Boston, MA (C.M.B.)
| | - Rebecca L Kinney
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
| | - Arlene S Ash
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
| | - Lisa Lombardini
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
| | - Jeroan J Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA (M.D.A., R.L.K., C.I.K., A.S.A., L.L., J.J.A.)
| |
Collapse
|
11
|
"Just another fish in the pond": the transitional care experience of a hip fracture patient. Int J Integr Care 2013; 13:e023. [PMID: 23882170 PMCID: PMC3718274 DOI: 10.5334/ijic.1103] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 04/19/2013] [Accepted: 04/21/2013] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Miscommunication and lack of coordination can compromise care quality and patient safety during transitions in care, especially for medically complex older adults. Little research has been done to investigate care transitions from the perspective of those receiving and providing care. METHODS This study explored multiple care transitions for an elderly hip fracture patient, post-surgery. Interviews and observations were conducted with the patient, their family caregivers, and health care providers, at each point of transition between four different care settings. RESULTS FOUR KEY THEMES WERE IDENTIFIED OVER THE PATIENTS CARE TRAJECTORY: 'Missing Crucial Coversations'-Patient and family caregivers did not feel involved or informed about decisions in care; 'Who's Who'-Confusion about the role of health care providers; 'Ready or Not'-Not knowing what to expect or what is expected; and, 'Playing by the Rules'-Health system policies and procedures hinder individualized care. CONCLUSION Study findings point to the need for the health care system to engage patients and family caregivers more fully and consistently in the process of care transitions as well as the importance of understanding these processes from multiple perspectives. Recommendations for system integration are proposed with a focus on transitional care.
Collapse
|