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Hellzén O, Ness TM, Ingstad K, Ludvigsen MS, Nissen AM, Devik SA. Adapting to home care in Norway: A longitudinal case study of older Adults' experiences. J Aging Stud 2024; 68:101215. [PMID: 38458722 DOI: 10.1016/j.jaging.2024.101215] [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: 06/21/2023] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 03/10/2024]
Abstract
This study aimed to describe how older adults with complex health problems manage their everyday lives in their own homes and how they interact with given home care. In this multiple-case study, a total of 14 individual interviews were conducted with five older adults over the course of one year. Deductive and inductive content analyses were performed. Three descriptive categories were each identified in the deductive ('home care as interpersonal continuity', 'home care as information continuity' and 'home care as management continuity') and inductive analyses ('Lack of social contact with carers', 'Desire to be heard throughout the care process' and 'Carers are short on time'). Quality home care services are difficult to realize if interpersonal interaction is subordinated to effective task-solving.
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Affiliation(s)
- Ove Hellzén
- Department of Nursing, Mid-Sweden University, Sundsvall, Sweden.
| | - Tove Mentsen Ness
- Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway.
| | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway.
| | - Mette Spliid Ludvigsen
- Department of Clinical Medicine-Randers Regional Hospital, Aarhus University, Aarhus, Denmark.
| | | | - Siri Andreassen Devik
- Centre of Care Research, Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, Namsos, Norway..
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Crick JP, Juckett L, Salsberry M, Quatman C, Quatman-Yates CC. Experience and Hospital Context Influence Fall Prevention Practice by Physical Therapists: A Survey Study. J Healthc Qual 2023; 45:191-199. [PMID: 37010318 DOI: 10.1097/jhq.0000000000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Falls in and following hospitalization are common and problematic. Little is understood about the factors that impede or promote effective implementation of fall prevention practices. PURPOSE AND RELEVANCE Physical therapists are commonly consulted for acute care patients at risk for falling. The purpose of this study is to understand therapist perceptions of their effectiveness in fall prevention and to explore the impact of contextual factors on practice patterns to prevent falls surrounding hospitalization. METHODS Survey questions were tailored to the constructs of hospital culture, structural characteristics, networks and communications, and implementation climate, in addition to inquiries regarding practice patterns and attitudes/beliefs. RESULTS Overall, 179 surveys were analyzed. Most therapists (n = 135, 75.4%) affirmed their hospital prioritizes best practices for fall prevention, although fewer agreed that therapists other than themselves provide optimal fall prevention intervention (n = 105, 58.7%). Less practice experience was associated with greater odds of affirming that contextual factors influence fall prevention practice (odds ratio 3.90, p < .001). Respondents who agreed that their hospital system prioritizes best practices for fall prevention had 14 times the odds of believing that their system prioritizes making improvements ( p = .002). CONCLUSIONS/IMPLICATIONS As experience influences fall prevention practice, quality assurance and improvement initiatives should be used to ensure minimum specifications of practice.
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Transição do idoso do hospital para o domicílio na perspectiva do cuidador/idoso: revisão de escopo. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ar03631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Bowley JJ, Faulkner K, Finch J, Gavaghan B, Foster M. Understanding the Experiences of Rural- and Remote-Living Patients Accessing Sub-Acute Care in Queensland: A Qualitative Descriptive Analysi. J Multidiscip Healthc 2022; 15:2945-2955. [PMID: 36582587 PMCID: PMC9793724 DOI: 10.2147/jmdh.s391738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The challenges associated with equitable healthcare access are often more pronounced for individuals living in rural and remote locations, compared to those in metropolitan locations. This study examined the health care transitions of rural- and remote-living patients with on-going sub-acute needs, following acute hospital discharge. This was done with the aim of exploring these patients' experiences of client-centeredness and continuity of care, and identifying common challenges faced by rural and remote sub-acute patients accessing and transitioning to and through sub-acute care in a non-metropolitan context. Materials and Methods Semi-structured interviews were conducted with 37 sub-acute patients. A qualitative descriptive approach was used to analyze the interview data and explore key emergent themes in relation to client-centeredness, continuity of care, and sub-acute transition challenges. Results Interview participants' average length of stay in sub-acute care was 31.6 days (range = 8-86 days), with most transitioning from larger regional and metropolitan hospitals to on-going rural or remote sub-acute care (n = 19; 53%). Client-centeredness was primarily characterized by the quality of interpersonal experiences with staff, patient and familial involvement in care planning, and the degree to which patients felt their wishes were respected and advocated for. Continuity of care was characterized by access to and participation in rehabilitation services, and access to family and social supports. Challenges associated with sub-acute transitions were explored. Discussion The findings suggest important implications for health care providers, including the need to implement earlier and more frequent opportunities for patient involvement throughout the sub-acute journey. The results offer a unique perspective on the way that continuity of care is experienced and conceptualized by rural and remote patients, suggesting a revision of what is required to achieve equitable care continuity for rural and remote residents receiving care far from home. Conclusion It is pertinent for health care providers to consider the unique complexities associated with accessing on-going health care as a rural or remote Australian resident, and to develop mechanisms that support equitable access and continuity and facilitate continuity of care closer to home.
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Affiliation(s)
- Jessica J Bowley
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Queensland, Australia,Correspondence: Jessica J Bowley, The Hopkins Centre, Griffith University, 170 Kessels Road, Brisbane, Queensland, Australia, Tel +61 3735 8136, Email
| | - Kirstie Faulkner
- Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Jennifer Finch
- Allied Health Professions’ Office of Queensland, Clinical Excellence Queensland, Brisbane, Queensland, Australia
| | - Belinda Gavaghan
- Allied Health Professions’ Office of Queensland, Clinical Excellence Queensland, Brisbane, Queensland, Australia
| | - Michele Foster
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Brisbane, Queensland, Australia
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Boockvar KS, Koufacos NS, May J, Schwartzkopf AL, Guerrero VM, Judon KM, Schubert CC, Franzosa E, Dixon BE. Effect of Health Information Exchange Plus a Care Transitions Intervention on Post-Hospital Outcomes Among VA Primary Care Patients: a Randomized Clinical Trial. J Gen Intern Med 2022; 37:4054-4061. [PMID: 35199262 PMCID: PMC9708976 DOI: 10.1007/s11606-022-07397-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 01/04/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Health information exchange (HIE) notifications when patients experience cross-system acute care encounters offer an opportunity to provide timely transitions interventions to improve care across systems. OBJECTIVE To compare HIE notification followed by a post-hospital care transitions intervention (CTI) with HIE notification alone. DESIGN Cluster-randomized controlled trial with group assignment by primary care team. PATIENTS Veterans 65 or older who received primary care at 2 VA facilities who consented to HIE and had a non-VA hospital admission or emergency department visit between 2016 and 2019. INTERVENTIONS For all subjects, real-time HIE notification of the non-VA acute care encounter was sent to the VA primary care provider. Subjects assigned to HIE plus CTI received home visits and telephone calls from a VA social worker for 30 days after arrival home, focused on patient activation, medication and condition knowledge, patient-centered record-keeping, and follow-up. MEASURES Primary outcome: 90-day hospital admission or readmission. SECONDARY OUTCOMES emergency department visits, timely VA primary care team telephone and in-person follow-up, patients' understanding of their condition(s) and medication(s) using the Care Transitions Measure, and high-risk medication discrepancies. KEY RESULTS A total of 347 non-VA acute care encounters were included and assigned: 159 to HIE plus CTI and 188 to HIE alone. Veterans were 76.9 years old on average, 98.5% male, 67.8% White, 17.1% Black, and 15.1% other (including Hispanic). There was no difference in 90-day hospital admission or readmission between the HIE-plus-CTI and HIE-alone groups (25.8% vs. 20.2%, respectively; risk diff 5.6%; 95% CI - 3.3 to 14.5%, p = .25). There was also no difference in secondary outcomes. CONCLUSIONS A care transitions intervention did not improve outcomes for veterans after a non-VA acute care encounter, as compared with HIE notification alone. Additional research is warranted to identify transitions services across systems that are implementable and could improve outcomes.
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Affiliation(s)
- Kenneth S Boockvar
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA.
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- The New Jewish Home, New York, NY, USA.
| | - Nicholas S Koufacos
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Justine May
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
| | - Ashley L Schwartzkopf
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
| | - Vivian M Guerrero
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Kimberly M Judon
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
| | - Cathy C Schubert
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Emily Franzosa
- James J. Peters VA Medical Center, Geriatrics Research Education & Clinical Center, Bronx, NY, 10468, USA
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Brian E Dixon
- Richard L. Roudebush VA Medical Center, Center for Health Information and Communication, Indianapolis, IN, USA
- Department of Epidemiology, Indiana University Fairbanks School of Public Health, Indianapolis, IN, USA
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, USA
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Gridley K, Baxter K, Birks Y, Newbould L, Allan S, Roland D, Malisauskaite G, Jones K. Social care causes of delayed transfer of care (DTOC) from hospital for older people: Unpicking the nuances of 'provider capacity' and 'patient choice'. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4982-e4991. [PMID: 35841589 PMCID: PMC10084034 DOI: 10.1111/hsc.13911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Unnecessarily prolonged stays in hospitals can have negative impacts on patients and present avoidable costs to health and social care systems. This paper presents the qualitative findings of a multi-methods study of the social care causes of delayed transfers of care (DTOC) for older people in England. The quantitative strand of this study found that DTOC are significantly affected by homecare supply. In this paper, we explore in depth how and why social care capacity factors lead to delays, from the perspectives of those working within the system. We examined the local transfer arrangements in six English local authority (LA) sites that were purposively sampled to include a range of DTOC performance and LA characteristics. Between March and December 2018, 52 professionals involved in arranging or facilitating discharge from hospitals in these sites provided qualitative data, primarily through semi-structured interviews. Topics included discharge teams and processes, strategic issues and perceived causes of delays. The thematic analysis uncovered the nuances behind the causes of DTOC previously categorised broadly as 'provider capacity' and 'patient choice'. In particular, our analysis highlights the lack of fit between available provision and the needs of people leaving hospital (theme 1); workforce inconsistencies (theme 2) and a myth of patient choice (theme 3). We are now at a turning point in the development of policy to reduce DTOC in the English system, with the full implications of a new national discharge to assess programme yet to be seen. Our research shows the significance of the alignment of service capacity, including the type and location of provision, with the needs and preferences of those leaving hospital. As the new system becomes established, attendance to such nuances behind blockages in the system will be more important than ever.
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Affiliation(s)
- Kate Gridley
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Kate Baxter
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Yvonne Birks
- Social Policy Research UnitUniversity of YorkYorkUK
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Topham EW, Bristol A, Luther B, Elmore CE, Johnson E, Wallace AS. Caregiver Inclusion in IDEAL Discharge Teaching: Implications for Transitions From Hospital to Home. Prof Case Manag 2022; 27:181-193. [PMID: 35617533 PMCID: PMC9177052 DOI: 10.1097/ncm.0000000000000563] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Despite recognition that unpaid (e.g., family, friends) caregivers (caregivers) play an important role in successful transitions home after hospitalization, limited information is available about whether and how caregiver experiences of discharge align with current strategies for providing high-quality discharge processes, and how these experiences at discharge impact successful transitions home. The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted postdischarge patient outcomes. METHODS We conducted in-depth, case interviews with four English-speaking caregivers (61-75 years of age). Content analysis was framed by the nature of caregiver involvement proposed by the Agency for Healthcare Research and Quality's (AHRQ's) IDEAL (Include, Discuss, Educate, Assess, Listen) discharge planning strategy. RESULTS Caregivers reported receiving clear discharge instructions, or basic education, and yet felt only passively included in discharge teaching. Once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to postdischarge knowledge gaps. CONCLUSION The experiences of these caregivers demonstrate how their limited, passive involvement in discharge education may result in suboptimal patient outcomes after hospitalization. Our findings suggest that structured programs aimed at increasing caregiver involvement in discharge, particularly related to assessment of caregiver problem solving, planning, and postdischarge support, are important in efforts seeking to improve care transitions and postdischarge outcomes. IMPLICATIONS FOR CASE MANAGEMENT This study assesses caregivers' experience with discharge planning and problems they encounter post-discharge, providing case managers with important information regarding the effectiveness of discharge processes. This study of caregiver experiences suggests that the IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.
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Affiliation(s)
- Emily Wahlquist Topham
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Alycia Bristol
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Brenda Luther
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Catherine E Elmore
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Erin Johnson
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Andrea S Wallace
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
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Koufacos NS, May J, Judon KM, Franzosa E, Dixon BE, Schubert CC, Schwartzkopf AL, Guerrero VM, Traylor M, Boockvar KS. Improving Patient Activation among Older Veterans: Results from a Social Worker-Led Care Transitions Intervention. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2022; 65:63-77. [PMID: 34053407 PMCID: PMC8982469 DOI: 10.1080/01634372.2021.1932003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 05/14/2021] [Accepted: 05/16/2021] [Indexed: 06/12/2023]
Abstract
Older veterans enrolled in the Veterans Health Administration (VHA) often use both VHA and non-VHA providers for their care. This dual use, especially around an inpatient visit, can lead to fragmented care during the time of transition post-discharge. Interventions that target patient activation may be valuable ways to help veterans manage complex medication regimens and care plans from multiple providers. The Care Transitions Intervention (CTI) is an evidence-based model that helps older adults gain confidence and skills to achieve their health goals post-discharge. Our study examined the impact of CTI upon patient activation for veterans discharged from non-VHA hospitals. In total, 158 interventions were conducted for 87 veterans. From baseline to follow-up there was a significant 1.7-point increase in patient activation scores, from 5.4 to 7.1. This association was only found among those who completed the intervention. The most common barriers to completion were difficulty reaching the veteran by phone, patient declining the intervention, and rehospitalization during the 30 days post-discharge. Care transitions guided by social workers may be a promising way to improve patient activation. However, future research and practice should address barriers to completion and examine the impact of increased patient activation on health outcomes.
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Affiliation(s)
- Nicholas S Koufacos
- Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA
| | - Justine May
- Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA
| | - Kimberly M Judon
- Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA
| | - Emily Franzosa
- Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brian E Dixon
- Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA
- Department of Epidemiology, Indiana University, Fairbanks School of Public Health, Indianapolis, Indiana, USA
- Center for Biomedical Informatics, Regenstrief Institute, Center for Biomedical Informatics, Indianapolis, Indiana, USA
| | - Cathy C Schubert
- Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA
- Department of Medicine, Indiana University, School of Medicine, Indianapolis, Indiana, USA
| | - Ashley L Schwartzkopf
- Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA
| | - Vivian M Guerrero
- Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA
| | - Morgan Traylor
- Center for Health Information and Communication, Health Services Research & Development Service, Richard L. Roudebush VA, Indianapolis, Indiana, USA
| | - Kenneth S Boockvar
- Geriatric Research Education and Clinical Center, James J. Peters VA, Bronx, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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9
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Kokorelias KM, Shiers-Hanley JE, Rios J, Knoepfli A, Hitzig SL. Factors Influencing the Implementation of Patient Navigation Programs for Adults with Complex Needs: A Scoping Review of the Literature. Health Serv Insights 2021; 14:11786329211033267. [PMID: 34349519 PMCID: PMC8287353 DOI: 10.1177/11786329211033267] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
Patient navigation is a model of care that aims to improve access to care by reducing the complexity of navigating health, education, and social services across the continuum of care and care settings. Little is known about the processes that facilitate or impede the implementation of patient navigation programs (PNPs). We conducted a scoping review to identify and summarize the current state of knowledge regarding the implementation and outcomes of existing implemented PNPs. We employed a 6-stage scoping review framework to identify and review eligible articles. Sixty-articles met the inclusion criteria (58 peer-reviewed and 2 grey literature). The Consolidated Framework for Implementation Research served as the theoretical framework during analysis to help extract factors relevant to implementation of navigator programs. Results of the scoping review are reported thematically. Influences on implementation were identified: (a) planning to ensure alignment with organizational need (b) funding (c) multidisciplinary engagement (d) establishing workflow (e) mechanisms for communication (f) stakeholders to encourage buy-in (g) appropriate caseload (h) in kind resources. PNPs improve the experiences of patients and families. The findings of this scoping review provides implementation considerations of PNPs across global care settings. Strategies for overcoming pragmatic and logistical issues must be developed for optimal implementation.
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Affiliation(s)
- Kristina M Kokorelias
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
| | - Jessica E Shiers-Hanley
- Hazel McCallion Academic Learning
Centre, University of Toronto, Toronto, ON, Canada
- Department of Occupational Science
& Occupational Therapy, Temerty Faculty of Medicine, University of Toronto
| | - Jorge Rios
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
| | - Amanda Knoepfli
- Sunnybrook Health Sciences Centre,
Toronto, ON, Canada
- SPRINT Senior Care, Toronto, ON,
Canada
| | - Sander L Hitzig
- St. John’s Rehab Research Program,
Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON,
Canada
- Department of Occupational Science
& Occupational Therapy, Temerty Faculty of Medicine, University of Toronto
- Rehabilitation Sciences Institute,
Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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10
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Sheehan J, Laver K, Bhopti A, Rahja M, Usherwood T, Clemson L, Lannin NA. Methods and Effectiveness of Communication Between Hospital Allied Health and Primary Care Practitioners: A Systematic Narrative Review. J Multidiscip Healthc 2021; 14:493-511. [PMID: 33654406 PMCID: PMC7910528 DOI: 10.2147/jmdh.s295549] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/14/2021] [Indexed: 12/22/2022] Open
Abstract
Background There is a compelling rationale that effective communication between hospital allied health and primary care practitioners may improve the quality and continuity of patient care. It is not known which methods of communication to use, nor how effectively they facilitate the transition of care when a patient is discharged home from hospital. Our systematic review aims to investigate the methods and effectiveness of communication between hospital allied health and primary care practitioners. Methods Systematic review of quantitative and qualitative studies with narrative synthesis. Medline, CINAHL, EMBASE, PsycInfo and Proquest Nursing and Allied Health Sources were searched from January 2003 until January 2020 for studies that examined hospital-based allied health professionals communicating with community-based primary care practitioners. Risk of bias in the different study designs was appraised using recognized tools and a content analysis conducted of the methodologies used. Results From the located 12,281 papers (duplicates removed), 24 studies met the inclusion criteria with hospital allied health communicating in some form with primary care practitioners. While none of the included studies specifically investigated the methods or effectiveness of communication between hospital allied health and primary care practitioners, 12 of the 24 studies described processes that addressed components of their discharge communication. Four enablers to effective communication between hospital allied health and primary care practitioners were identified: multidisciplinary care plans, patient and caregiver involvement, health information technology and a designated person for follow up/care management. Conclusion There is currently no “gold standard” method or measure of communication between hospital allied health and primary care practitioners. There is an urgent need to develop and evaluate multidisciplinary communication with enhanced information technologies to improve collaboration across care settings and facilitate the continuity of integrated people-centered care.
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Affiliation(s)
- Jacinta Sheehan
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Anoo Bhopti
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Miia Rahja
- Department of Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, Australia
| | - Tim Usherwood
- Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,The George Institute for Global Health, Sydney, Australia
| | - Lindy Clemson
- School of Health Sciences, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia
| | - Natasha A Lannin
- Department of Occupational Therapy, Social Work and Social Policy, School of Allied Health, La Trobe University, Melbourne, Australia.,Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia.,Alfred Health (Allied Health), Melbourne, Australia
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11
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'There was no preamble': Comparing the Transition from Hospital to Home in Different Care Settings. Can J Aging 2020; 40:282-292. [PMID: 33190652 DOI: 10.1017/s0714980820000380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Our qualitative descriptive study compared how older patients and their informal caregivers experienced the care transition from acute care or rehabilitation to home. We recruited patients 65 years of age or older, or their informal caregivers, from in-patient units within acute care hospitals and rehabilitation facilities to participate in semi-structured interviews. We identified emergent themes via thematic analysis. In all, 16 patients and four patient caregivers participated. Across all care settings, caregivers were integral in facilitating the transition as well as experiencing variable discharge preparation, health care providers' optimizing transitions, and missed care and medication discrepancies at transition points. Orthopedic and rehabilitation patients more commonly voiced prior transition experiences in discharge preparation, including having to unexpectedly coordinate and wait for outpatient services. Differing responses between acute care and orthopedic settings suggest that transitional care practices and policies favor an individualized approach that considers patients' previous experiences, needs, and care expectations.
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12
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O'Hara JK, Baxter R, Hardicre N. 'Handing over to the patient': A FRAM analysis of transitional care combining multiple stakeholder perspectives. APPLIED ERGONOMICS 2020; 85:103060. [PMID: 32174348 DOI: 10.1016/j.apergo.2020.103060] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/18/2019] [Accepted: 01/13/2020] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The period following discharge can present risks for older adults. Most research has focused on hospital discharge with less attention paid to on-going care needs. Despite evidence that patients undertake 'invisible work' to improve care safety, their reported willingness to be involved in care, and the consensus that successful transitions interventions include patient involvement, in reality, this is variable. Further, little research has viewed transitional care as a 'system', with gaps, interdependencies and variability across settings, nor the role of patients and families in supporting the system resilience. RESEARCH OBJECTIVES 1) model transitional care from multiple perspectives using the Functional Resonance Analysis Method (FRAM); 2) use the model to develop a theory of change to support intervention development. METHOD We drew data from two studies: i) exploring the perspective of older adults across transitional care, and ii) exploring how health services experience transitional care. We employed the FRAM to develop a model of transitional care, with a system boundary spanning an older patient's admission to hospital, through to thirty days post-discharge. FINDINGS Modelling transitional care from multiple perspectives was challenging. 27 functions were identified with interdependencies between hospital-based functions and patient-led functions once home, the success of which may impact on transitions 'outcomes' (e.g. safety events, readmissions). The model supported development of a theory of change, to guide future intervention development. CONCLUSIONS Supporting certain patient-facing upstream hospital functions (e.g. encouraging mobility, supporting a better understanding of medication and condition), may lead to improved outcomes for patients following hospital discharge.
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Affiliation(s)
- Jane K O'Hara
- School of Healthcare, Baines Wing, University of Leeds, Leeds, LS2 9JT, UK. Jane.O'
| | - Ruth Baxter
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Natasha Hardicre
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
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13
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O'Neill M, Ryan A, Tracey A, Laird L. "You're at their mercy": Older peoples' experiences of moving from home to a care home: A grounded theory study. Int J Older People Nurs 2020; 15:e12305. [PMID: 31997550 DOI: 10.1111/opn.12305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 11/27/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Internationally, it is recognised that the transition to a care home environment can be an emotional and stressful occasion for older people and their families. There is a paucity of research that takes into consideration the initial phase of the relocation process, incorporating individuals' experiences of the move. AIM To explore individuals' experiences of moving into a care home. This paper has a specific focus on the preplacement (7 days) and immediate postplacement (within 3 days) period of the move to the care home. DESIGN A grounded theory method was used to conduct semi-structured interviews with 23 participants. RESULTS Data analysis revealed five distinct categories that captured the experience of the preplacement and immediate postplacement period. These were as follows: (a) inevitability of the move: "I had to come here," (b) making the move: "Abrupt Departures," (c) decision-making and exercising choice: "What can I do, I have no choice," (d) maintaining identity: "Holding on to self" and (e) maintaining connections: "I like my family to be near." Together, these five categories formed the basis of the concept "You're at their Mercy" which encapsulates the perceived transition experience of the older people within the study. Participants felt that the move was out of their control and that they were "at the mercy" of others who made decisions about their long-term care. CONCLUSIONS Moving to a care home represents a uniquely significant relocation experience for the individual. Key factors influencing the move were the individuals' perceived lack of autonomy in the pre- and postrelocating period of moving to a care home. Nurses have a key role to play in working with older people to influence policy and practice around decision-making, planning and moving to a care home with greater emphasis on autonomy and choice so that older people do not feel "at the mercy" of others as they navigate such a major transition. IMPLICATIONS FOR PRACTICE There is a need to standardise approaches and develop person-centred interventions to support older people considering relocation to a care home and nurses have a key role to play in making this happen.
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Affiliation(s)
- Marie O'Neill
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Londonderry, UK
| | - Assumpta Ryan
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Londonderry, UK
| | | | - Liz Laird
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Londonderry, UK
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14
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Callister C, Jones J, Schroeder S, Breathett K, Dollar B, Sanghvi UJ, Harnke B, Lum HD, Jones CD. Caregiver Experiences of Care Coordination for Recently Discharged Patients: A Qualitative Metasynthesis. West J Nurs Res 2019; 42:649-659. [PMID: 31585516 DOI: 10.1177/0193945919880183] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Caregivers of patients often provide key support for patients after hospitalization. This qualitative metasynthesis describes caregiver perspectives about care coordination for patients discharged from the hospital. A literature search of Ovid Medline and CINAHL completed on May 23, 2018, identified 1,546 studies. Twelve articles were included in the final metasynthesis. Caregiver perspectives about care coordination were compiled into overall themes. A subanalysis of studies in which patients were discharged with home health services was completed. Five main themes emerged related to caregiver perspectives on care coordination after hospitalization: (a) Suboptimal access to clinicians after discharge, (b) Feeling disregarded by clinicians, (c) Need for information and training at discharge, (d) Overwhelming responsibilities to manage appointments and medications, and (e) Need for emotional support.Findings from this metasynthesis suggest the need for clinicians to engage with caregivers to provide support, training, and communication after hospital discharge.
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Affiliation(s)
- Catherine Callister
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shara Schroeder
- College of Liberal Arts and Sciences, Department of Sociology, University of Colorado, Denver, CO, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, University of Arizona, Sarver Heart Center, Tucson, AZ, USA
| | - Blythe Dollar
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Urvi Jhaveri Sanghvi
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ben Harnke
- Health Sciences Library University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
| | - Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Veterans Affairs Medical Center, Aurora, Colorado, USA
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15
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Chase JAD, Russell D, Rice M, Abbott C, Bowles KH, Mehr DR. Caregivers' Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting. J Patient Exp 2019; 7:561-569. [PMID: 33062879 PMCID: PMC7534114 DOI: 10.1177/2374373519869156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.
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Affiliation(s)
- Jo-Ana D Chase
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Meridith Rice
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Carmen Abbott
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Kathryn H Bowles
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, USA
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16
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Murray J, Hardicre N, Birks Y, O'Hara J, Lawton R. How older people enact care involvement during transition from hospital to home: A systematic review and model. Health Expect 2019; 22:883-893. [PMID: 31301114 PMCID: PMC6803411 DOI: 10.1111/hex.12930] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/02/2019] [Accepted: 05/19/2019] [Indexed: 12/13/2022] Open
Abstract
Background Current models of patient‐enacted involvement do not capture the nuanced dynamic and interactional nature of involvement in care. This is important for the development of flexible interventions that can support patients to ‘reach‐in’ to complex health‐care systems. Objective To develop a dynamic and interactional model of patient‐enacted involvement in care. Search strategy Electronic search strategy run in five databases and adapted to run in an Internet search engine supplemented with searching of reference lists and forward citations. Inclusion criteria Qualitative empirical published reports of older people's experiences of care transitions from hospital to home. Data extraction and synthesis Reported findings meeting our definition of involvement in care initially coded into an existing framework. Progression from deductive to inductive coding leads to the development of a new framework and thereafter a model representing changing states of involvement. Main results Patients and caregivers occupy and move through multiple states of involvement in response to perceived interactions with health‐care professionals as they attempt to resolve health‐ and well‐being‐related goals. ‘Non‐involvement’, ‘information‐acting’, ‘challenging and chasing’ and ‘autonomous‐acting’ were the main states of involvement. Feeling uninvolved as a consequence of perceived exclusion leads patients to act autonomously, creating the potential to cause harm. Discussion and conclusion The model suggests that involvement is highly challenging for older people during care transitions. Going forward, interventions which seek to support patient involvement should attempt to address the dynamic states of involvement and their mediating factors.
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Affiliation(s)
- Jenni Murray
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK
| | - Natasha Hardicre
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK
| | - Yvonne Birks
- Social Policy Research Unit, University of York, York, UK
| | - Jane O'Hara
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK.,Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Bradford, UK.,School of Psychology, University of Leeds, Leeds, UK
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17
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Hestevik CH, Molin M, Debesay J, Bergland A, Bye A. Older persons' experiences of adapting to daily life at home after hospital discharge: a qualitative metasummary. BMC Health Serv Res 2019; 19:224. [PMID: 30975144 PMCID: PMC6460679 DOI: 10.1186/s12913-019-4035-z] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/24/2019] [Indexed: 12/03/2022] Open
Abstract
Background Researchers have shown that hospitalisation can decrease older persons’ ability to manage life at home after hospital discharge. Inadequate practices of discharge can be associated with adverse outcomes and an increased risk of readmission. This review systematically summarises qualitative findings portraying older persons’ experiences adapting to daily life at home after hospital discharge. Methods A metasummary of qualitative findings using Sandelowski and Barroso’s method. Data from 13 studies are included, following specific selection criteria, and categorised into four main themes. Results Four main themes emerged from the material: (1) Experiencing an insecure and unsafe transition, (2) settling into a new situation at home, (3) what would I do without my informal caregiver? and (4) experience of a paternalistic medical model. Conclusions The results emphasise the importance of assessment and planning, information and education, preparation of the home environment, the involvement of the older person and caregivers and supporting self-management in the discharge and follow-up care processes at home. Better communication between older persons, hospital providers and home care providers is needed to improve the coordination of care and facilitate recovery at home. The organisational structure may need to be redefined and reorganised to secure continuity of care and the wellbeing of older persons in transitional care situations. Electronic supplementary material The online version of this article (10.1186/s12913-019-4035-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Marianne Molin
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Bjørknes University College, Lovisenberggata 13, 0456, Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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18
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Hoffman GJ, Shuman CJ, Montie M, Anderson CA, Titler MG. Caregivers' views of older adult fall risk and prevention during hospital-to-home transitions. Appl Nurs Res 2019; 47:10-15. [PMID: 31113538 DOI: 10.1016/j.apnr.2019.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/15/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Geoffrey J Hoffman
- University of Michigan School of Nursing, 400 N. Ingalls, Room 4352, Ann Arbor, MI 48109-5482, United States of America.
| | - Clayton J Shuman
- University of Michigan School of Nursing, United States of America
| | - Mary Montie
- Detroit Medical Center, United States of America
| | | | - Marita G Titler
- University of Michigan School of Nursing, United States of America
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19
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Chase JAD, Russell D, Rice M, Abbott C, Bowles KH, Mehr DR. Caregivers' Perceptions Managing Functional Needs Among Older Adults Receiving Post-Acute Home Health Care. Res Gerontol Nurs 2019; 12:174-183. [PMID: 30901481 DOI: 10.3928/19404921-20190319-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/15/2019] [Indexed: 11/20/2022]
Abstract
Caregivers play important roles in managing the physical functioning (PF) needs of older adults transitioning home after a hospitalization. Training and support of caregivers in the post-acute home health care (HHC) setting should incorporate caregivers' perspectives. To explore caregivers' experiences managing PF needs in the post-acute HHC setting, semi-structured telephone interviews of 20 caregivers were conducted. Conventional content analysis revealed patient-, caregiving task-, caregiver-, and home environment-related themes consistent with the Theory of Dependent Care. Caregivers highlighted the dynamics and contributors of PF needs for older patients in the post-acute HHC setting and depicted the enormity of caregiving tasks needed to manage older patients' PF needs. Caregivers also described their perceived roles and challenges in managing PF deficits, including a sense of isolation when they were the sole caregiver. Findings from this research can guide nursing efforts to target caregiver training and support during this critical care transition. [Res Gerontol Nurs. 2019; 12(4):174-183.].
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20
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Abu HO, Anatchkova MD, Erskine NA, Lewis J, McManus DD, Kiefe CI, Santry HP. Are we "missing the big picture" in transitions of care? Perspectives of healthcare providers managing patients with unplanned hospitalization. Appl Nurs Res 2018; 44:60-66. [PMID: 30389062 PMCID: PMC6221456 DOI: 10.1016/j.apnr.2018.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 07/26/2018] [Accepted: 09/16/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Healthcare providers play a critical role in the care transitions. Therefore, efforts to improve this process should be informed by their perspectives. AIM The study objective was to explore the factors that negatively/positively influence care transitions following an unplanned hospitalization from the perspective of healthcare providers. METHODS A qualitative study using semi-structured interviews conducted between February and September of 2016 at a single academic medical center. We enrolled fifteen healthcare providers from multiple disciplines involved in the management of patients experiencing an unplanned hospitalization. Respondents shared their experiences with care transitions and identified factors within and outside of the discharging health facility that impede or facilitate this process. Transcribed interviews were analyzed using emerging themes from the interviews. RESULTS We identified six themes and associated subthemes from the interviews on factors that influence care transitions. Three themes focused on factors within the discharging healthcare facility: untailored and overloaded patient discharge information, timing of the post-discharge care conversation, provider-to-patient and provider-to-provider miscommunication. The other three themes were related to external factors including caregiver involvement, having a safe and stable housing environment, and access to healthcare and community resources. Providers discussed how these factors positively/negatively influence the hospital-to-home transition. CONCLUSIONS Our study identifies factors within and outside the discharging healthcare facility that influence care transitions, ultimately affect patient-centered outcomes and provider satisfaction with delivered care. Strategies aimed at improving the quality of care transitions should address these barriers and actively engage healthcare providers who are pivotal in care transitions.
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Affiliation(s)
- Hawa O Abu
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Milena D Anatchkova
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA; Evidera, Waltham, MA, USA.
| | - Nathaniel A Erskine
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Joanne Lewis
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA.
| | - David D McManus
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Catarina I Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Heena P Santry
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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21
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Deutsch A, Heinemann AW, Cook KF, Foster L, Miskovic A, Goldsmith A, Cella D. Inpatient Rehabilitation Quality of Care From the Patient's Perspective: Effect of Data Collection Timing and Patient Characteristics. Arch Phys Med Rehabil 2018; 100:1032-1041. [PMID: 30476488 DOI: 10.1016/j.apmr.2018.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 10/11/2018] [Accepted: 10/19/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare, by collection time and patient characteristics, inpatient rehabilitation quality measure scores calculated using patient-reported data. DESIGN Cohort study of rehabilitation inpatients with neurologic conditions who reported their experience of care and pain status at discharge and 1month after discharge. SETTING Two inpatient rehabilitation facilities (IRFs). PARTICIPANTS Patients with neurologic conditions (N=391). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We calculated 18 quality measure scores using participants' responses to 55 experience of care and health status questions addressing communication, support and encouragement, care coordination, discharge information, goals, new medications, responsiveness of staff, cleanliness, quietness, pain management, care transitions, overall hospital rating, willingness to recommend, and pain. RESULTS Of the 391 participants reporting at discharge, 277 (71%) also reported postdischarge after multiple attempts by e-mail, mail, and telephone. Discharge experience of care quality scores ranged from 25% (responsiveness of hospital staff) to 75% (willingness to recommend hospital); corresponding postdischarge scores were 32% to 87%, respectively. Five of the 16 experience of care quality scores increased significantly between discharge and postdischarge. The percentage of participants reporting high pain levels at discharge did not change across time periods. Patients with less education, older age, higher motor and cognitive function, and those who were not Hispanic or black had more favorable quality measure scores. CONCLUSION Patients' experience of care responses tended to be more favorable after discharge compared to discharge, suggesting that survey timing is important. Responses were more favorable for patients with selected characteristics, suggesting the possible need for risk adjustment if patient-reported quality measure scores are compared across IRFs.
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Affiliation(s)
- Anne Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Quality Measurement and Health Policy Program, RTI International, Chicago, IL.
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Karon F Cook
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Linda Foster
- Alexian Brothers Rehabilitation Hospital, Elk Grove Village, IL
| | - Ana Miskovic
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL
| | - Arielle Goldsmith
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL
| | - David Cella
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
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22
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Pedersen MK, Mark E, Uhrenfeldt L. Hospital readmission: Older married male patients' experiences of life conditions and critical incidents affecting the course of care, a qualitative study. Scand J Caring Sci 2018; 32:1379-1389. [PMID: 29920715 DOI: 10.1111/scs.12583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 04/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the frequency of hospital readmissions, there is still a relatively incomplete understanding of the broader array of factors pertaining to readmission in older persons. Few studies have explored how older persons experience readmission and their perceptions of circumstances affecting the course of care. Research indicates that males experience poorer health outcomes and are at higher risk of readmission compared to women. AIM To explore life conditions and critical incidents pertained to hospital readmission from the perspective of older males. METHODS The study used a qualitative explorative design using the Critical Incident Technique. A purposive sample of four males aged 65-75 were recruited from two internal medical wards. Data were collected through narrative double interviews. The study was registered by the North Denmark Region's joint notification of health research (ID 2008-58-0028). FINDINGS The analysis revealed four themes of life conditions: 'Ambiguity of ageing', 'Living with the burden of illness', 'Realisation of dependency' and 'Growing sense of vulnerability and mortality'. Critical incidents comprised four areas: 'Balancing demands and resources in everyday life', 'Back home again - a period of recovery', 'Care interaction' and 'Navigating within and between healthcare system(s)'. CONCLUSION This study illustrated the interconnectedness, dynamics and complexity of life conditions and critical incidents that over time and across diverse healthcare sectors affected the course of care in older persons. Hospital readmissions seem related to a complex web of interacting life conditions and critical incidents rather than growing age or specific illnesses.
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Affiliation(s)
- Mona Kyndi Pedersen
- Clinic for Internal Medicine, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Edith Mark
- Clinic for Internal Medicine, Aalborg University Hospital, Aalborg, Denmark.,Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - Lisbeth Uhrenfeldt
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
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23
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Hahn-Goldberg S, Jeffs L, Troup A, Kubba R, Okrainec K. "We are doing it together"; The integral role of caregivers in a patients' transition home from the medicine unit. PLoS One 2018; 13:e0197831. [PMID: 29795623 PMCID: PMC5993108 DOI: 10.1371/journal.pone.0197831] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 05/09/2018] [Indexed: 11/19/2022] Open
Abstract
Background An admission to hospital for acute illness can be difficult for patients and lead to high levels of anxiety. Patients are given a lot of information throughout their hospital stay and instructions at discharge to follow when they get home. For complex medical patients, the ability to retain, understand, and adhere to these instructions is a critical marker of a successful transition. This study was undertaken to explore factors impacting the ability of patients to understand and adhere to instructions. Methods A qualitative design of interviews with patients and caregivers was used. Participants were adult patients and caregivers with congestive heart failure, chronic obstructive pulmonary disease, or community-acquired pneumonia being discharged home from three academic acute care hospitals in Ontario, Canada. Semi structured interviews were conducted with participants within one week following their discharge from hospital. Interviews were audiotaped and transcribed. Five independent researchers participated in an iterative process of coding, reviewing, and analyzing the interviews using direct content analysis. Results In total, 27 participants completed qualitative interviews. Analysis revealed the role of the caregiver to be critical in its relation to the ability of patients to understand and adhere to discharge instructions. Within the topic of caregiving, we draw on three areas of insight: The first clarified how caregivers support patients after they are discharged home from the hospital. The second highlighted how caregiver involvement impacts patient understanding and adherence to discharge instructions. The third revealed system factors that influence a caregiver’s involvement when receiving discharge instructions. Conclusion Caregivers play an important role in the transition of a complex medical patient by impacting a patient’s ability to understand and adhere to their discharge instructions. The themes identified in this paper highlight opportunities for healthcare providers and institutions to effectively involve caregivers during transitions from acute care hospitals to home.
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Affiliation(s)
- Shoshana Hahn-Goldberg
- OpenLab, University Health Network, Toronto, Ontario, Canada
- School of Health Policy and Management, Yok University, Toronto, Ontario, Canada
- * E-mail:
| | - Lianne Jeffs
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Amy Troup
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Rasha Kubba
- OpenLab, University Health Network, Toronto, Ontario, Canada
| | - Karen Okrainec
- University Health Network, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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24
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Abstract
Purpose
The purpose of the paper is to examine the care transitions of older people who transfer between home, acute and sub-acute care to determine if there were common transition types and areas for improvements.
Design/methodology/approach
A longitudinal case study design was used to examine care transitions of 19 older people and their carers as a series of transitions and a whole-of-system experience. Case study accounts synthesising semi-structured interviews with function and service use data from medical records were compared.
Findings
Three types of care transitions were derived from the analysis: manageable, unstable and disrupted. Each type had distinguishing characteristics and older people could experience elements of all types across the system. Transition types varied according to personal and systemic factors.
Originality/value
This study identifies types of care transition experiences across acute, sub-acute and primary care from the perspective of older people and their carers. Understanding transition types and their features can assist health professionals to better target strategies within and across the system and improve patient experiences as a whole.
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25
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Harvey D, Foster M, Strivens E, Quigley R. Improving care coordination for community-dwelling older Australians: a longitudinal qualitative study. AUST HEALTH REV 2017; 41:144-150. [PMID: 27333204 DOI: 10.1071/ah16054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/21/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to describe the care transition experiences of older people who transfer between subacute and primary care, and to identify factors that influence these experiences. A further aim of the study was to identify ways to enhance the Geriatric Evaluation and Management (GEM) model of care and improve local coordination of services for older people. Methods The present study was an exploratory, longitudinal case study involving repeat interviews with 19 patients and carers, patient chart audits and three focus groups with service providers. Interview transcripts were coded and synthesised to identify recurring themes. Results Patients and carers experienced care transitions as dislocating and unpredictable within a complex and turbulent service context. The experience was characterised by precarious self-management in the community, floundering with unmet needs and holistic care within the GEM service. Patient and carer attitudes to seeking help, quality and timeliness of communication and information exchange, and system pressure affected care transition experiences. Conclusion Further policy and practice attention, including embedding early intervention and prevention, strengthening links between levels of care by building on existing programs and educative and self-help initiatives for patients and carers is recommended to improve care transition experiences and optimise the impact of the GEM model of care. What is known about the topic? Older people with complex care needs experience frequent care transitions because of fluctuating health and fragmentation of aged care services in Australia. The GEM model of care promotes multidisciplinary, coordinated care to improve care transitions and outcomes for older people with complex care needs. What does this paper add? The present study highlights the crucial role of the GEM service, but found there is a lack of systemised linkages within and across levels of care that disrupts coordinated care and affects care transition experiences. There are underutilised opportunities for early intervention and prevention across the system, including the emergency department and general practice. What are the implications for practitioners? Comprehensive screening, assessment and intervention in primary and acute care, formalised transition processes and enhanced support for patients and carers to access timely, appropriate care is required to achieve quality, coordinated care transitions for older people.
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Affiliation(s)
- Desley Harvey
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
| | - Michele Foster
- School of Social Work and Human Services, Menzies Health Institute Queensland, Griffith University, Meadowbrook, Qld 4131, Australia. Email
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
| | - Rachel Quigley
- Cairns and Hinterland Hospital and Health Service, PO Box 902, Cairns, Qld 4870, Australia.
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26
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Sykes S, Baillie L, Thomas B, Scotter J, Martin F. Enhancing Care Transitions for Older People through Interprofessional Simulation: A Mixed Method Evaluation. Int J Integr Care 2017; 17:3. [PMID: 29588636 PMCID: PMC5853909 DOI: 10.5334/ijic.3055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/11/2017] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The educational needs of the health and social care workforce for delivering effective integrated care are important. This paper reports on the development, pilot and evaluation of an interprofessional simulation course, which aimed to support integrated care models for care transitions for older people from hospital to home. THEORY AND METHODS The course development was informed by a literature review and a scoping exercise with the health and social care workforce. The course ran six times and was attended by health and social care professionals from hospital and community (n = 49). The evaluation aimed to elicit staff perceptions of their learning about care transfers of older people and to explore application of learning into practice and perceived outcomes. The study used a sequential mixed method design with questionnaires completed pre (n = 44) and post (n = 47) course and interviews (n = 9) 2-5 months later. RESULTS Participants evaluated interprofessional simulation as a successful strategy. Post-course, participants identified learning points and at the interviews, similar themes with examples of application in practice were: Understanding individual needs and empathy; Communicating with patients and families; Interprofessional working; Working across settings to achieve effective care transitions. CONCLUSIONS AND DISCUSSION An interprofessional simulation course successfully brought together health and social care professionals across settings to develop integrated care skills and improve care transitions for older people with complex needs from hospital to home.
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Affiliation(s)
- Susie Sykes
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, GB
| | - Lesley Baillie
- School of Health, Wellbeing and Social Care, Open University, Walton Hall, Milton Keynes, MK7 6AA, GB
| | - Beth Thomas
- Simulation and Interactive Learning (SaIL) Centre, Guy’s and St Thomas’ NHS Foundation Trust, GB
| | - Judy Scotter
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, GB
| | - Fiona Martin
- Clever Together, 2 Primrose Street, London, EC2A 2EX, GB
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27
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De Regge M, De Pourcq K, Meijboom B, Trybou J, Mortier E, Eeckloo K. The role of hospitals in bridging the care continuum: a systematic review of coordination of care and follow-up for adults with chronic conditions. BMC Health Serv Res 2017; 17:550. [PMID: 28793893 PMCID: PMC5551032 DOI: 10.1186/s12913-017-2500-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 08/02/2017] [Indexed: 12/19/2022] Open
Abstract
Background Multiple studies have investigated the outcome of integrated care programs for chronically ill patients. However, few studies have addressed the specific role hospitals can play in the downstream collaboration for chronic disease management. Our objective here is to provide a comprehensive overview of the role of the hospitals by synthesizing the advantages and disadvantages of hospital interference in the chronic discourse for chronically ill patients found in published empirical studies. Method Systematic literature review. Two reviewers independently investigated relevant studies using a standardized search strategy. Results Thirty-two articles were included in the systematic review. Overall, the quality of the included studies is high. Four important themes were identified: the impact of transitional care interventions initiated from the hospital’s side, the role of specialized care settings, the comparison of inpatient and outpatient care, and the effect of chronic care coordination on the experience of patients. Conclusion Our results show that hospitals can play an important role in transitional care interventions and the coordination of chronic care with better outcomes for the patients by taking a leading role in integrated care programs. Above that, the patient experiences are positively influenced by the coordinating role of a specialist. Specialized care settings, as components of the hospital, facilitate the coordination of the care processes. In the future, specialized care centers and primary care could play a more extensive role in care for chronic patients by collaborating.
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Affiliation(s)
- Melissa De Regge
- Faculty of Economics and Business Administration, Department of Innovation, Entrepreneurship, and Service Management, Ghent University, Tweekerkenstraat 2, B-9000, Ghent, Belgium. .,Department of Strategic Policy Cell, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Kaat De Pourcq
- Faculty of Economics and Business Administration, Department of Innovation, Entrepreneurship, and Service Management, Ghent University, Tweekerkenstraat 2, B-9000, Ghent, Belgium
| | - Bert Meijboom
- Faculty of Economics, Department of Management, Tilburg University, Tilburg, The Netherlands.,Department Tranzo, Tilburg University, Tilburg, The Netherlands
| | - Jeroen Trybou
- Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
| | - Eric Mortier
- Faculty of Medicine and Health Sciences, Department of Anaesthesiology, Ghent University, Ghent University Hospital, Ghent, Belgium
| | - Kristof Eeckloo
- Department of Strategic Policy Cell, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.,Faculty of Medicine and Health Sciences, Department of Public Health, Ghent University, Ghent, Belgium
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28
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Jeffs L, Saragosa M, Law M, Kuluski K, Espin S, Merkley J, Bell CM. Elucidating the information exchange during interfacility care transitions: Insights from a Qualitative Study. BMJ Open 2017; 7:e015400. [PMID: 28706095 PMCID: PMC5734419 DOI: 10.1136/bmjopen-2016-015400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the perceptions of patients, their caregivers and healthcare professionals associated with the exchange of information during transitioning from two acute care hospitals to one rehabilitation hospital. DESIGN An exploratory qualitative study using semi-structured interviews and observation. PARTICIPANTS AND SETTING Patients over the age of 65 years admitted to an orthopaedic unit for a non-elective admission, their caregivers and healthcare professionals involved in their care. Participating sites included orthopaedic inpatient units from two acute care teaching hospitals and one orthopaedic unit at a rehabilitation hospital in an urban setting. FINDINGS Three distinct themes emerged from participants' narrative of their transitional care experience: (1) having no clue what the care plan is, (2) being told and notified about the plan and (3) experiencing challenges absorbing information. Participating patients and their caregivers reported not being engaged in an active discussion with healthcare professionals about their care transition plan. Several healthcare professionals described withholding information within the plan until they themselves were clear about the transition outcomes. CONCLUSION This study highlights the need to increase efforts to ensure that effective information exchanges occur during transition from acute care hospital to rehabilitation settings.
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Affiliation(s)
- Lianne Jeffs
- St Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's, Toronto, Canada
| | - Marianne Saragosa
- St Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's, Toronto, Canada
| | - Madelyn Law
- Department of Health Science, Brock University, St Michael's, Toronto, Canada
| | - Kerry Kuluski
- Community Health Sciences, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Jane Merkley
- Executive Offices, Sinai Health System, Toronto, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Canada
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29
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Abstract
Purpose
Quality care transitions of older people across acute, sub-acute and primary care are critical to safety and cost, which is the reason interventions to improve practice are a priority. Yet, given the complexity of providers and services involved it is often difficult to know the types of tensions that arise in day-to-day transition work or how front-line workers will respond. To that end, this innovative study differs from the largely descriptive studies by conceptualising care transitions as street-level work in order to capture how transition practice takes shape within the complexities and dynamics of the local setting. The paper aims to discuss these issues.
Design/methodology/approach
Data were collected from 23 hospital health professionals and community service providers across primary, sub-acute and acute care through focus groups. A thematic analysis and interrogation of themes using street-level concepts derived three key themes.
Findings
The themes of risk logics and dilemmas of fragmentation make explicit both the local constraints and opportunities of care transitions and how these intersect to engender a particular logic of practice. By revealing the various discretionary tactics adopted by front-line providers, the third theme simultaneously highlights how discretionary spaces might represent both possibilities and problematics for balancing organisational and patient needs.
Originality/value
The study contributes to the knowledge of street-level work in health settings and specifically, the nature of transition work. Importantly, it benefits policy and practice by uncovering mechanisms that could facilitate and impede quality transitions in discrete settings.
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30
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Abstract
BACKGROUND Family carers, as a "shadow workforce", are foundational to the day-to-day integration of health service delivery for older family members living with complex health needs. This paper utilises Haggerty's model of continuity of care to explore the contribution of family carers' to the provision of care and support for an older family member's chronic condition within the context of health service delivery. METHODS We analysed data from interviews of 13 family carers in a case study of primary health care in New Zealand - a Maori Provider Organisation - to determine the alignment of family caregiving with the three levels of continuity of care (relational continuity, informational continuity, and management continuity). RESULTS We found alignment of family caregiving tasks, responsibilities, and relationships with the three levels of continuity of care. Family carers 1) partnered with providers to extend chronic care to the home; 2) transferred and contributed information from one provider/service to another; 3) supported consistent and flexible management of care. DISCUSSION The Maori Provider Organisation supported family carer-provider partnership enabled by shared Maori cultural values and social mandate of building family-centred wellbeing. Relational continuity was the most important level of continuity of care; it sets precedence for family carers and providers to establish the other levels - informational and management - continuity of care for their family member cared for. Family carers need to be considered as active partners working alongside responsive primary health care providers and organisation in the implementation of chronic care.
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31
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Gustavson AM, Jones J, Morrow KJ, Stevens-Lapsley JE. Preparing for the Future of Post-Acute Care: A Metasynthesis of Qualitative Studies. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2017; 29:70-80. [PMID: 34908822 DOI: 10.1177/1084822316678195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Despite poor outcomes for older adults following hospitalization, practice patterns of post-acute care clinicians and factors impacting quality of care are not well studied, which limits advancements in clinical care. Qualitative research on the factors that influence physician practice patterns with respect to older adults has been studied and may provide a framework for hypothesizing factors relevant to other post-acute care clinicians. Three themes emerged from this qualitative metasynthesis: (1) Current medical education and clinical guidelines are not aligned with the multifaceted care needed for older adults, (2) communication gaps impact quality of care, and (3) health policies constrain quality of care. Identifying potential factors that impact practice patterns in post-acute care providers may guide future research initiatives that shape health professional education and system policies.
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Affiliation(s)
- Allison M Gustavson
- University of Colorado, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, Aurora, CO, USA
| | | | - Kelly J Morrow
- University of Colorado, College of Nursing, Aurora, CO, USA.,University of Nevada, School of Nursing, Las Vegas, NV, USA
| | - Jennifer E Stevens-Lapsley
- University of Colorado, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, Aurora, CO, USA.,Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center, Denver, CO, USA
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32
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Gustavson AM, Falvey JR, Jankowski CM, Stevens-Lapsley JE. Public Health Impact of Frailty: Role of Physical Therapists. J Frailty Aging 2017; 6:2-5. [PMID: 28244550 DOI: 10.14283/jfa.2017.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Frailty is an emerging and immediate public health concern given the growing aging population. The condition of frailty is characterized by a reduction in physiologic reserve, which places frail older adults at considerable risk for further functional decline, hospitalization, institutionalization, and death. Recent research suggests that frailty may be reversible, which could result in significant improvement in public health. Thus, a strong impetus exists to develop strategies for frail older adults that achieve the Triple Aim through better promotion of population health, optimization of patient experiences, and delivery of high-quality care at minimal cost. Physical therapists often treat frail older adults, yet how physical therapists can contribute to preventing or reversing frailty in healthcare settings has not been described, and may potentially influence patient outcomes and healthcare spending. Therefore, the purpose of this publication is to outline the potential role of physical therapists in achieving the Triple Aim for the frail older adult population.
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Affiliation(s)
- A M Gustavson
- Jennifer E. Stevens-Lapsley, University of Colorado, 13121 East 17th Avenue, Aurora, CO 80045, Office: (303) 724-9170, Fax: (303) 724-9016,
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33
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Jeffs L, Kuluski K, Law M, Saragosa M, Espin S, Ferris E, Merkley J, Dusek B, Kastner M, Bell CM. Identifying Effective Nurse-Led Care Transition Interventions for Older Adults With Complex Needs Using a Structured Expert Panel. Worldviews Evid Based Nurs 2017; 14:136-144. [DOI: 10.1111/wvn.12196] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Lianne Jeffs
- St. Michael's Hospital Volunteer Association Chair in Nursing Research Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute St. Michael's Hospital, Associate Professor, Lawrence S. Bloomberg Faculty of Nursing and Institute of Health, Policy, Management and Evaluation; University of Toronto; Toronto ON Canada
| | - Kerry Kuluski
- Research Scientist, Sinai Health System; Lunenfeld-Tanenbaum Research Institute; Toronto ON Canada
| | - Madelyn Law
- Associate Professor; Brock University; St. Catherines ON Canada
| | | | - Sherry Espin
- Associate Professor; Ryerson University; Toronto ON Canada
| | - Ella Ferris
- Former Executive Vice-President-Programs; Chief Nursing Executive, and Chief Health Disciplines Executive; St. Michael's Hospital Toronto ON Canada
| | - Jane Merkley
- Executive Vice President Patient Care; Quality and Chief Nurse Executive Sinai Health System; Toronto ON Canada
| | - Brenda Dusek
- Former Program Manager; Registered Nurses’ Association of Ontario; Toronto ON Canada
| | - Monika Kastner
- Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute; St. Michael's Hospital; Toronto ON Canada
| | - Chaim M. Bell
- Clinician Scientist; Sinai Health System; Toronto ON Canada
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34
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Jeffs L, Saragosa M, Law MP, Kuluski K, Espin S, Merkley J. The role of caregivers in interfacility care transitions: a qualitative study. Patient Prefer Adherence 2017; 11:1443-1450. [PMID: 28860727 PMCID: PMC5572948 DOI: 10.2147/ppa.s136058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A qualitative design was used to explore the nature of caregiver involvement in care transitions of patients being transferred from an acute care hospital to a rehabilitation hospital. Participants included older adults (n=13), informal caregivers (n=9), and health care professionals (n=50) from inpatient orthopedic units in two academic health science centers and one orthopedic inpatient rehabilitation unit. Semistructured interviews were conducted, audio-taped, and transcribed. Directed content analysis revealed the following four themes: watching, being an active care provider, advocating, and navigating the health care system. Participants described being actively involved in the care of their family member, yet they were not actively engaged by health care professionals to be involved in the care of their family member. There is a need to reconcile the tension between the level of involvement of caregivers in the care of family members who are patients and the level of engagement throughout the care transition. By providing relevant information and authentically engaging caregivers as equal partners in the care transition, they are better able to navigate the health care system post-transfer to the rehabilitation setting and discharge to home.
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Affiliation(s)
- Lianne Jeffs
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
- Correspondence: Lianne Jeffs, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Room 720, 209 Victoria Street, Toronto, ON M5B 1T8, Canada, Tel +1 416 864 6060 ext 77644, Email
| | - Marianne Saragosa
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
| | - Madelyn P Law
- Department of Health Science, Brock University, St Catharines
| | - Kerry Kuluski
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University
| | - Jane Merkley
- Executive Offices, Sinai Health System, Toronto, ON, Canada
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35
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Rustad EC, Seiger Cronfalk B, Furnes B, Dysvik E. Next of kin's experiences of information and responsibility during their older relatives’ care transitions from hospital to municipal health care. J Clin Nurs 2016; 26:964-974. [DOI: 10.1111/jocn.13511] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Else Cathrine Rustad
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
- Faculty of Health and Caring sciences; Stord Haugesund University College; Stord Norway
- Department of Clinical Medicine; Helse Fonna Local Health Authority; Haugesund Norway
| | - Berit Seiger Cronfalk
- Palliative Research Center; Ersta Sklöndal University College; Stockholm Sweden
- Faculty of Health and Caring Sciences; Stord Haugesund University College; Haugesund Norway
- Department of Oncology-Pathology; Karolinska Institute; Stockholm Sweden
| | - Bodil Furnes
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
| | - Elin Dysvik
- Department of Health Studies; Faculty of Social Sciences; University of Stavanger; Stavanger Norway
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Role of Physical Therapists in Reducing Hospital Readmissions: Optimizing Outcomes for Older Adults During Care Transitions From Hospital to Community. Phys Ther 2016; 96:1125-34. [PMID: 26939601 PMCID: PMC4992143 DOI: 10.2522/ptj.20150526] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 02/19/2016] [Indexed: 11/17/2022]
Abstract
Hospital readmissions in older adult populations are an emerging quality indicator for acute care hospitals. Recent evidence has linked functional decline during and after hospitalization with an elevated risk of hospital readmission. However, models of care that have been developed to reduce hospital readmission rates do not adequately address functional deficits. Physical therapists, as experts in optimizing physical function, have a strong opportunity to contribute meaningfully to care transition models and demonstrate the value of physical therapy interventions in reducing readmissions. Thus, the purposes of this perspective article are: (1) to describe the need for physical therapist input during care transitions for older adults and (2) to outline strategies for expanding physical therapy participation in care transitions for older adults, with an overall goal of reducing avoidable 30-day hospital readmissions.
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Lim SY, Jarvenpaa SL, Lanham HJ. Barriers to Interorganizational Knowledge Transfer in Post-Hospital Care Transitions: Review and Directions for Information Systems Research. J MANAGE INFORM SYST 2015. [DOI: 10.1080/07421222.2015.1095013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Health care is continuously undergoing evolutionary changes. These changes have been very dramatic for the end users. Instead of simple physician office visits and lengthy hospital stays, we are now faced with short hospital stays, office visits to different specialty providers, and an array of choices around them. With the present highway of choices between illness and wellness, it is important for transitions between these two to be affordable, advantageous to patients, and uncomplicated. This article discusses the choices patients and health care providers must make as the number of care options increase along with the risks and benefits.
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Biffl SE, Biffl WL. Improving transitions of care for complex pediatric trauma patients from inpatient rehabilitation to home: an observational pilot study. Patient Saf Surg 2015; 9:33. [PMID: 26478744 PMCID: PMC4608179 DOI: 10.1186/s13037-015-0078-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 10/05/2015] [Indexed: 11/10/2022] Open
Abstract
Background Patients requiring inpatient pediatric rehabilitation following trauma or disabling illness often require complex care after hospital discharge. The patients and their families are at risk for loss of continuity of care and increased stress which can adversely affect functional and medical outcomes. This pilot study assesses the complexity of need and difficulty with obtaining services at the time of transition from inpatient to outpatient care for pediatric rehabilitation. Additionally we explored the intervention of a post discharge phone call from an experienced rehabilitation nurse to address any issues identified in this period. Methods A rehabilitation nurse made scripted post discharge phone calls to patients and families 1–2 weeks after discharge from inpatient pediatric rehabilitation inquiring about medical appointments, medications, therapies, adaptive equipment and transition back to school. Results were recorded by the nurse then analyzed and tabulated by a rehabilitation physician. Results Eighty two percent of patients had needs in 4–5 of the areas assessed as part of their discharge recommendations. Eighty four percent of those families contacted had difficulty with at least one area at discharge. In all cases of confusion or difficulty with the recommendations, the nurse was able to provide needed guidance to ameliorate the situation. Conclusions This pilot study indicates that pediatric rehabilitation patient require complex care as they transition to an outpatient setting. There is significant confusion and families often have difficulty obtaining necessary care in an efficient and effective way during this transition. A post discharge phone call from an experienced rehabilitation nurse could address most of the issues that arise during the transition. This pilot study indicates a need for more investigation into interventions to improve the transition process for pediatric rehabilitation patients and suggests a post discharge phone call program could be useful intervention for pediatric rehabilitation patients and other patient populations requiring complex care such as polytrauma patients.
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Affiliation(s)
- Susan E Biffl
- Children's Hospital Colorado, 13123 East 16th Avenue B285, Aurora, CO 80045 USA ; Denver Health and Hospital, Denver, CO USA ; University of Colorado School of Medicine, Aurora, CO USA
| | - Walter L Biffl
- Denver Health and Hospital, Denver, CO USA ; University of Colorado School of Medicine, Aurora, CO USA
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Jackson PD, Biggins MS, Cowan L, French B, Hopkins SL, Uphold CR. Evidence Summary and Recommendations for Improved Communication during Care Transitions. Rehabil Nurs 2015; 41:135-48. [PMID: 26391532 DOI: 10.1002/rnj.230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Communication between levels of care can be complex for any patient. For the Servicemember or Veteran with complex medical issues, who needs transitioning between multiple levels of care, this communication involves detailed, individualized information pivotal to quality clinical outcomes and patient/family satisfaction. These complex cases also typically include communication between multiple family members. PURPOSE The purpose was to summarize the evidence and present recommendations for facilitating effective transitions of patient care within the complex Veterans Affairs (VA) Polytrauma System of Care. DESIGN Evidence Based Review. METHODS Selected members of the VA Office of Nursing Service Polytrauma Field Advisory Committee conducted an evidence-based review, and queried a clinical panel of polytrauma nursing experts and direct care rehabilitation nurses. FINDINGS Search results, key practice recommendations, a plan of care template, and future plans for dissemination and implementation are presented. CONCLUSIONS Communication is a key to success when managing many details and requires both focus and knowledge of larger systems. CLINICAL RELEVANCE Direct communication, using a standardized approach, is recommended for successful patient transitions.
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Affiliation(s)
| | | | - Linda Cowan
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | | | | | - Constance R Uphold
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
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Gabrielsson-Järhult F, Nilsen P. On the threshold: older people's concerns about needs after discharge from hospital. Scand J Caring Sci 2015; 30:135-44. [DOI: 10.1111/scs.12231] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 02/25/2015] [Indexed: 11/30/2022]
Affiliation(s)
| | - Per Nilsen
- Division of Community Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
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Baillie L, Gallini A, Corser R, Elworthy G, Scotcher A, Barrand A. Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study. Int J Integr Care 2014; 14:e009. [PMID: 24868193 PMCID: PMC4027893 DOI: 10.5334/ijic.1175] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 01/29/2014] [Accepted: 02/07/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services. THEORY AND METHODS The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n = 17); focus groups (n = 9) with ward staff (n = 36); interviews with frail older people (n = 4). The data were analysed using the framework approach. FINDINGS THREE THEMES ARE PRESENTED: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions. DISCUSSION AND CONCLUSIONS A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other's roles and build relationships and trust.
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Affiliation(s)
- Lesley Baillie
- Faculty of Health and Social Care, Florence Nightingale Foundation Chair of Clinical Nursing Practice, London South Bank University and University College London Hospitals, London, UK
| | - Andrew Gallini
- Nursing for the Hospital of St John & St Elizabeth, London, UK
| | | | - Gina Elworthy
- University of Bedfordshire, Oxford House Campus, Aylesbury, UK
| | - Ann Scotcher
- University of Bedfordshire, Oxford House Campus, Aylesbury, UK
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Miller ET. Unpredictability of a disability. Rehabil Nurs 2012; 37:269. [PMID: 23212950 DOI: 10.1002/rnj.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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