“Just tell me in a simple way”: A qualitative study on opportunities to improve the transition from acute hospital care to home from the perspectives of patients with traumatic brain injury, families, and providers

Abstract

Objective: The purpose of this study was to identify areas to improve the transition from acute hospital care to home for patients with traumatic brain injury and their families. Design: Qualitative, descriptive. Setting: Level I trauma centered located in the Southeastern United States. Subjects: A total of 36 participants (12 patients with traumatic brain injury, 8 family caregivers, 16 providers). Main Measures: We conducted 55 semi-structured interviews with participants and used conventional content analysis to analyze the data. Results: Findings showed patients, families, and providers recommend three areas for improvement in the transition home from acute hospital care, described in three themes. Theme 1 was “improving patient and family education,” with the following sub-themes: (a) TBI-related information and (b) discharge preparation. Theme 2 was “additional provider guidance,” with the following sub-themes: (a) communication about patient’s recovery timeline and (b) recovery roadmap development. Theme 3 was “increasing systems-level support,” with the following sub-themes: (a) scheduling follow-up appointments, (b) using a patient navigator, (c) creating a provider follow-up structure, (d) linking pre-discharge care with post-discharge resources, and (e) addressing social issues. Conclusions: These findings delineate multiple areas where patients and families need additional support and education during the transition from acute hospital care to home in ways that are currently not being addressed. Findings may be used to improve education and support from providers and health systems given to patients with traumatic brain injury and families and to inform development and testing of transitional care interventions from acute hospital care to home.

Negotiating the transition from acute hospital care to home: perspectives of patients with traumatic brain injury, caregivers and healthcare providers

“…Lack of focus on discharge home from acute hospital care leaves a critical knowledge gap these findings help to fill. The present study contributes to the literature by demonstrating four areas for improvement in the transitional care process to ensure TBI patients and families are adequately supported, building on prior research (Naylor et al, 2011;Oyesanya et al, 2021b). Although a comprehensive integrated system of care across the TBI treatment continuum is currently lacking (Oyesanya et al, 2021b;Turner et al, 2008), this study could be used to adapt transitional care models with other patient populations (Bettger et al, 2012).…”

“…As limited transitional care literature includes caregivers, we include caregivers' perspectives on their needs. Given limited and fragmented care currently available to US TBI patients, findings can inform improvements to current TBI transitional care models, as few TBIspecific transitional care models exist (Oyesanya et al, 2021b). Our prior work on this topic points to improvements in patient and family education, pre-and post-discharge HCP support, and systems-level support to address health, healthcare, and social needs of TBI patients and families transitioning home from acute hospital care (Oyesanya et al, 2021b).…”

“…Given limited and fragmented care currently available to US TBI patients, findings can inform improvements to current TBI transitional care models, as few TBIspecific transitional care models exist (Oyesanya et al, 2021b). Our prior work on this topic points to improvements in patient and family education, pre-and post-discharge HCP support, and systems-level support to address health, healthcare, and social needs of TBI patients and families transitioning home from acute hospital care (Oyesanya et al, 2021b). Taken together, these findings and research on successful transitions with other populations (Labson, 2015) suggest a multi-faceted intervention where HCPs support patients and caregivers in goal setting and attainment, patient safety, and patient engagement in healthrelated activities, such as attending follow-up appointments, to improve patient and caregiver satisfaction and engagement during care transitions after a TBI.…”

“…Most research on this topic has been conducted near discharge from inpatient rehabilitation (Oyesanya, 2017). Experiences from acute hospital care to home and HCP perceptions of patient/family needs during this transition have not been studied (Oyesanya et al, 2021b). The purpose of this study was to explore experiences transitioning home from acute hospital care from the perspectives of younger TBI patients, caregivers and HCPs.…”

“…The purpose of this study was to explore experiences transitioning home from acute hospital care from the perspectives of younger TBI patients, caregivers and HCPs. Findings are needed to inform transitional care interventions for younger TBI patients and families as no standards currently exist for this patient population returning home (Oyesanya et al, 2021b).…”