Integrated transitional care: patient, informal caregiver and health care provider perspectives on care transitions for older persons with hip fracture

Abstract

IntroductionComplex older adults, such as those with hip fracture, frequently require care from multiple professionals across a variety of settings. Integrated care both between providers and across settings is important to ensure care quality and patient safety. The purpose of this study was to determine the core factors related to poorly integrated care when hip fracture patients transition between care settings.MethodsA qualitative, focused ethnographic approach was used to guide data collection and analysis. Patients, their informal caregivers and health care providers were interviewed and observed at each care transition. A total of 45 individual interviews were conducted. Interview transcripts and field notes were coded and analysed to uncover emerging themes in the data.ResultsFour factors related to poorly integrated transitional care were identified: confusion with communication about care, unclear roles and responsibilities, diluted personal ownership over care, and role strain due to system constraints.ConclusionsOur research supports a broader notion of collaborative practice that extends beyond specific care settings and includes an appropriate, informed role for patients and informal caregivers. This research can help guide system-level and setting-specific interventions designed to promote high-quality, patient-centred care during care transitions.

Understanding informal carers’ experiences of caring for older people with a hip fracture: a systematic review of qualitative studies

“…Moreover, healthcare policies of early discharge and fewer resources for rehabilitation [39][40][41] could push individuals to assume the role of carer: "I think that the sorrowing part that I see, is that it's just all about money, that's all it seems to be…we probably have one of the best health care systems in the world but it's cracking at the seams and you can see it. If this experience taught me anything it was that our health care system is in jeopardy now" [42 p.7].…”

Understanding patient and relative/carer experience of hip fracture in acute care: A qualitative study protocol

“…Frequently the unexpected role and the number of activities that occurred felt overwhelming. Stress, anxiety, frustration, sadness, confusion and lack of time to balance the new role with their personal-life were common feelings identified by carers (Giosa et al, 2014;Nahm et al, 2010;Toscan et al, 2011). Moreover, carers often described the hospital setting and procedures as uninviting and expressed their discontent with the lack of information they received (Giosa et al, 2014).…”

Collaboration in a primary care setting: strategies for a family nurse practitioner caring for the frail older adult

“…Clear communication has been identified as a critical factor in collaboration to ensure a positive outcome (Boeckxstaens & de Graff, 2011 ;Metzelthin et al , 2013 ;Park et al, 2014;Toscan et al , 2012). This clarity might be achieved through technological knowledge to facilitate connectivity or the physical space required to meet and to exchange ideas and updates.…”

“…The concern was confidentiality assurances and the security of private and personal information. In any case, It is not sufficient to only establish a care plan, as the plan need to be reviewed, monitored, and adapted as situations and circumstances change (Boeckxstaens & de Graaf, 2011;Davey et al, 2005 ;Toscan et al, 2012). Legault et al (2012) found that care plans can be enhanced by prioritizing targeted areas, and assigning tasks to individual health care providers, or to the frail older adult patient themselves.…”

“…Ten of the sixteen articles reviewed identified time as a facilitator to effective collaboration (Baxter & Markle-Reid, 2009;de Stampa et al , 2009;Goodman et al , 2011 ;Legare et al, 2013;Legault et al , 2012;Metzelthin et al , 2013 ;Skultety & Zeiss, 2006;Toscan et al, 2012;Tracey et al , 2013). In this context, time is a resource that is often lacking in collaborative development and can result in workload issues for individual provider services on a professional level.…”