“Did I Do as Best as the System Would Let Me?” Healthcare Professional Views on Hospital to Home Care Transitions
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Patients are vulnerable to poor quality, fragmented care as they transition from hospital to home. Few studies examine the discharge process from the perspectives of multiple healthcare professionals.
To understand care transitions from the perspective of diverse healthcare professionals, and identify recommendations for process improvement.
Cross sectional qualitative study.
PARTICIPANTS AND SETTING
Clinicians, care teams, and administrators from the inpatient general medicine services at one urban, academic hospital; two outpatient primary care clinics; and one Medicaid managed care plan.
We conducted 13 focus groups and two in-depth interviews with participants prior to initiating a hospital-funded, multi-component transitional care intervention for uninsured and low-income publicly insured patients, the Care Transitions Innovation (C-TraIn). We used thematic analysis to identify emergent themes and a cross-case comparative analysis to describe variation by participant role and setting.
Poor transitional care reflected healthcare system fragmentation, limiting the ability of healthcare professionals to provide optimal patient care. Lack of standardized processes, poor multidisciplinary communication within the hospital, and fragmented communication across settings led to chaotic, unsystematic transitions, poor patient outcomes, and feelings of futility and dissatisfaction among providers. Patients with complex psychosocial needs were especially vulnerable during care transitions. Recommended changes to improve transitional care included improving hospital multidisciplinary hospital rounds, clarifying accountability as patients move across settings, standardizing discharge processes, and providing additional medical staff training.
Hospital to home care transitions are critical junctures that can impact health outcomes, experience of care, and costs. Transitional care quality improvement initiatives must address system fragmentation, reduce communication barriers within and between settings, and ensure adequate professional training.
KEY WORDStransition and discharge planning continuity of care communication quality improvement
We would like to thank the providers and administrative staff who participated in this research and who continue to support implementation of the Care Transitions Innovation (C-TraIn). We are also grateful to Sonya Howk, MPA:HA and Dora Raymaker, MS for their assistance with data collection.
Funding for this project is provided by Oregon Health & Science University (OHSU), Portland, OR and by a Clinical and Translational Science Award to OHSU (National Institute of Health/National Center for Research Resources grant No. 1 UL1 RR024140 01).
Presented in part at the 34th annual meeting of the Society of General Internal Medicine, Phoenix, Arizona, May 4–7, 2011 and the Academy for Healthcare Improvement, Arlington, VA, May 7–8, 2012.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
- 2.Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. Can Med Assoc J. 2004;170(3):345–349.Google Scholar
- 11.Society, of Hospital Medicine. Project BOOST: Better Outcomes for Older adults through Safe Transitions. Society of Hospital Medicine, Philadelphia, PA. 2012. Available at: www.hospitalmedicine.org/boost. Accessed June 22 2012.
- 14.U.S. Congress. House Committee on Ways and Means, Committee on Energy and Commerce, Committee on Education and Labor. Compilation of Patient Protection and Affordable Care Act: as Amended Through 1 November 2010, Including Patient Protection and Affordable Care Act health-related portions of the Health Care and Education Reconciliation Act of 2010. Washington: U.S. Government Printing Office; 2010.Google Scholar
- 15.Minott J. Reducing Hospital Readmissions. Washington: Academy Health; 2008.Google Scholar
- 16.Englander H, Kansagara D. Planning and designing the Care Transitions Innovation (C-TraIn) for uninsured and Medicaid patients. J Hosp Med. 2012. doi: 10.1002/jhm.1926.
- 17.Oregon, Health & Science University. Administrative Data 2009, 2010. Portland: Oregon Health & Science University; 2010.Google Scholar
- 19.Kuzel A. Sampling in qualitative inquiry. In: Crabtree BF, Miller WL, eds. Doing Qualitative Research. 2nd ed. Thousand Oaks: Sage Publications; 1999:33–45.Google Scholar
- 21.Crabtree BF, Miller WL. Doing Qualitative Research. 2nd ed. Thousand Oaks: Sage Publications, Inc; 1999.Google Scholar
- 22.Khan S, VanWynsberghe R. Cultivating the Under-Mined: Cross-Case Analysis as Knowledge Mobilization. Forum: Qualitative Social Research; 2008.Google Scholar
- 24.Committee, on Quality of Health Care in America, Institute, of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century: The National Academies Press; 2001.Google Scholar
- 27.Foust JB, Vuckovic N, Henriquez E. Hospital to home health care transition: patient, caregiver, and clinician perspectives. West J Nurs Res. 2011.Google Scholar
- 30.American, Academy of Family Physicians (AAFP), American, Academy of Pediatrics (AAP), American, College of Physicians (ACP), American, Osteopathic Association (AOA). Joint Principles of the Patient Centered Medical Home. 2007. Available at: http://www.pcpcc.net/content/joint-principles-patient-centered-medical-home. Accessed June 22 2012.
- 36.Eskildsen M, Bonsall J, Miller A, Ohuabunwa U, Payne C, Rimler E. Handover and Care Transitions Training for Internal Medicine Residents. MedEdPORTAL. 2012. Available at: www.mededportal.org/publication/9101. Accessed June 22 2012.