Discharge care quality in hospitalised elderly patients: Extended validation of the Discharge Care Experiences Survey

Improving patient activation with a tailored nursing discharge teaching intervention for multimorbid inpatients: A quasi-experimental study

OBJECTIVE

Preliminary effectiveness test of a novel structured personalized discharge teaching intervention for multimorbid inpatients.

METHODS

Using a 2-group sequential pre/post-intervention design, the sample comprised 68 pre-intervention control group and 70 post- intervention group participants. The discharge teaching intervention by trained clinical nurses used structured tools to engage patients and individualize discharge teaching. Outcomes measures included Patient Activation Measure, Readiness for Hospital Discharge Scale, Discharge Care Experiences Survey, and readmission with 10 days post-discharge.

RESULTS

The intervention had a statistically significant positive effect on improving patient activation (M=4.8; p = 0.05) from admission to post-discharge. The participation subscale of the Discharge Care Experiences Survey was higher in the intervention (M=4.1, SD=0.7) than the control group (M=3.8, SD=0.7; t (127)= -2.79, p = .01, effect size= .34). There were no significant between-group differences in Readiness for Hospital Discharge Scale and readmission.

CONCLUSIONS

Our results suggest that a structured personalized discharge teaching intervention can improve patient activation and participation in discharge care. Further refinement of the intervention is needed to evaluate and improve specific components of the intervention.

PRACTICE IMPLICATIONS

Structured personalized discharge teaching should include patient engagement strategies in the teaching-learning process.

Comparison between the Chief Care Manager and the Normal Care Manager on Hospitalization and Discharge Coordination Activities in Japan: An Online Cross-Sectional Study of Care Managers in Aichi Prefecture

The Japanese long-term care insurance system came into operation in the year 2000 and the chief care manager certification system was established in 2006 to improve the quality of care management. Certified chief care managers are expected to perform the role of a specialist. The purpose of this study was to determine the impact of the chief care manager certificate in coordination with hospitals. In this online cross-sectional survey, responses were obtained from 448 care managers engaged in long-term care activities with all in-home long-term care support providers. Among these 448 care managers, 301 had the chief care manager certificate. Of these care managers, ≥90% regularly asked their patients about their "values" and ≥80% provided their patients with hospitalization and discharge support. Of the care managers who provided their patients with hospitalization support, 80% provided the hospitals with information regarding patient "values" at the time of hospitalization, and 50% provided the hospitals with information regarding patient "values" and information. The chief care manager certificate had positive effects on confidence in hospitalization and discharge support. However, no significant difference was observed between the activities of chief and normal care managers in terms of hospitalization and discharge support.

Outcomes of complex discharge planning in older adults with complex needs: a scoping review

In this scoping review, we aimed to evaluate the effectiveness of integrated multidisciplinary team discharge planning and identify common outcomes among older adults with complex needs, focusing on a safe transition from the hospital to the community. We performed a literature search for relevant articles using seven electronic databases and agreed search terms. Only articles published in English were included. In total, 23,772 articles were identified, with 27 articles meeting the inclusion criteria. A preponderance of patients aged ≥65 years and women was inferred based on population demographics. Initiatives on complex discharge planning were noted across most Western countries. Common outcomes of complex discharge planning were functionality (n = 11) including frailty (n = 4), quality of life (n = 11), and patient-centered factors including psychosocial needs (n = 9). Various outcomes from complex discharge planning initiatives and pathways were explored in this scoping review. None of the selected studies covered all nine domains of outcome assessment. Further research is needed involving follow-up studies after complex discharge planning interventions to assess their true effectiveness or value.

Measurement tools that assess the quality of transitional care from patients' perspective: A literature review

AIM

Transitional care is important for improving the quality of life of patients discharged from hospitals. Patient-reported experience measures help improve transitional care quality. Thus, this literature review aimed to identify and appraise measurement tools that assess transitional care quality from the patient's perspective and identify its components.

METHODS

Development and validation studies were systematically searched in the PubMed and CINAHL databases. The review team appraised the methodological quality and statistical results of measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology.

RESULTS

A total of 30 studies and seven instruments were identified. The target population was patients discharged from hospital to a home or nursing home (mean age = 52-84 years). The measurement time was before or after the discharge. The number of items in the original versions of the measures ranged from eight to 41, with short versions ranging from three to 12. The overall methodological quality of structural validity, internal consistency, and hypotheses testing was mostly "very good or adequate," according to COSMIN criteria. However, content validity and development were mostly "inadequate or doubtful" or not reported. The main components of included measures comprised "self-care after discharge," "providing information to the patient," "patient engagement in the care plan," and "dealing with patient's concerns."

CONCLUSION

The quality appraisal results and identified components are useful for choosing measurement tools in clinical practice and research. The Care Transitions Measure is the most widely validated measurement tool.

Implementation and preliminary testing of a theory-guided nursing discharge teaching intervention for adult inpatients aged 50 and over with multimorbidity: a pragmatic feasibility study protocol

BACKGROUND

Discharge teaching by nurses during hospitalization is essential to provide multimorbid inpatients with the knowledge and skills to self-manage their health conditions. However, available disease-specific teaching guidelines do not address the cumulative complexity of multiple chronic diseases that occur with greater frequency in older adults. Therefore, there is a need for a discharge teaching intervention which uses concepts that specifically address the needs of these patients, such as considering their level of activation (i.e. knowledge, skills and confidence to self-manage their health) and the burden of multimorbid disease. The objectives of this pragmatic study will be to (1) test the feasibility of implementing a nursing discharge teaching intervention and (2) conduct a preliminary test of this novel discharge teaching intervention with adult inpatients age 50 or greater who have multiple comorbid conditions.

METHODS

This study uses a two-group pre-posttest design. Participants are drawn from medical units in three hospitals in the French-speaking part of Switzerland. The implementation of the intervention will be facilitated by implementation strategies from the Theoretical Domains Framework and the Behavior Change Wheel and will target change in nurses' teaching behaviours. Implementation outcomes will include measures of feasibility of the implementation strategies and the intervention process. Participants in the intervention group will receive tailored discharge teaching by trained teaching nurses. Patient outcomes will inform the preliminary testing of the intervention and will be measured with validated questionnaires assessing patients' activation level, health confidence, perceived readiness for discharge, experience with the discharge process and rate of and time to readmission.

DISCUSSION

The study takes a pragmatic approach to examining the feasibility of implementing the discharge teaching intervention to contribute to the knowledge development within the context of the real-world practice setting. Results will provide the foundation for clinical trials to build evidence for widespread adoption of this intervention.

TRIAL REGISTRATION

The trial is registered at ClinicalTrials.gov (ID: NCT04253665 ) on the 30 of January 2020 and has been approved by the Cantonal Ethics Committee Vaud in Switzerland (2020-00141).

Measuring discharge quality based on elderly patients' experiences with discharge conversation: a cross-sectional study

Background

Discharge conversation is an essential part of preparing patients for the period after hospitalisation. Successful communication during such conversations is associated with improved health outcomes for patients.

Objective

To investigate the association between discharge conversation and discharge quality assessed by measuring elderly patients' experiences.

Methods

In this cross-sectional study, we surveyed all patients ≥65 years who had been discharged from two medical units in two hospitals in Western Norway 30 days prior. We measured patient experiences using two previously validated instruments: The Discharge Care Experiences Survey Modified (DICARES-M) and The Nordic Patient Experiences Questionnaire (NORPEQ). We examined differences in characteristics between patients who reported having a discharge conversation with those who did not, and used regression analyses to examine the associations of the DICARES-M and NORPEQ with the usefulness of discharge conversation.

Results

Of the 1418 invited patients, 487 (34%) returned the survey. Their mean age was 78.5 years (SD=8.3) and 52% were women. The total sample mean scores for the DICARES-M and NORPEQ were 3.9 (SD=0.7, range: 1.5-5.0) and 4.0 (SD=0.7, range: 2.2-5.0), respectively. Higher DICARES-M and NORPEQ scores were found for patients who reported having a discharge conversation (74%) compared with those who did not (15%), or were unsure (11%) whether they had a conversation (p<0.001). Patients who considered the conversation more useful had significantly higher scores on both the DICARES-M and NORPEQ (p<0.001).

Conclusions

Reported discharge conversation at the hospital was correlated with positive patient experiences measurements indicating the increased quality of hospital discharge care. The reported usefulness of the conversation had a significant association with discharge care quality.