Partners at Care Transitions: exploring healthcare professionals’ perspectives of excellence at care transitions for older people

Baxter, Ruth; O’Hara, Jane; Murray, Jenni; Sheard, Laura; Cracknell, Alison; Foy, Robbie; Wright, John; Lawton, Rebecca

doi:10.1136/bmjopen-2018-022468

Cited by 10 publications

(10 citation statements)

References 31 publications

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“…Ethical approvals were granted by the University of Leeds, UK. Full details of the methods used are available in the published protocol [40]. The study contributes to the Partners at Care Transitions (PACT) programme of research which aims to develop an intervention to improve the safety and experience of older people during transitions from hospital to home [41].…”

Section: Study Design and Ethicsmentioning

confidence: 99%

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Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives

Baxter¹,

Shannon²,

Murray³

et al. 2020

BMC Health Serv Res

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Background: Transitions of care are often risky, particularly for older people, and shorter hospital stays mean that patients can go home with ongoing care needs. Most previous research has focused on fundamental system flaws, however, care generally goes right far more often than it goes wrong. We explored staff perceptions of how high performing general practice and hospital specialty teams deliver safe transitional care to older people as they transition from hospital to home. Methods: We conducted a qualitative study in six general practices and four hospital specialties that demonstrated exceptionally low or reducing readmission rates over time. Data were also collected across four community teams that worked into or with these high-performing teams. In total, 157 multidisciplinary staff participated in semistructured focus groups or interviews and 9 meetings relating to discharge were observed. A pen portrait approach was used to explore how teams across a variety of different contexts support successful transitions and overcome challenges faced in their daily roles. Results: Across healthcare contexts, staff perceived three key themes to facilitate safe transitions of care: knowing the patient, knowing each other, and bridging gaps in the system. Transitions appeared to be safest when all three themes were in place. However, staff faced various challenges in doing these three things particularly when crossing boundaries between settings. Due to pressures and constraints, staff generally felt they were only able to attempt to overcome these challenges when delivering care to patients with particularly complex transitional care needs. Conclusions: It is hypothesised that exceptionally safe transitions of care may be delivered to patients who have particularly complex health and/or social care needs. In these situations, staff attempt to know the patient, they exploit existing relationships across care settings, and act to bridge gaps in the system. Systematically reinforcing such enablers may improve the delivery of safe transitional care to a wider range of patients. Trial registration: The study was registered on the UK Clinical Research Network Study Portfolio (references 35272 and 36174).

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Section: Study Design and Ethicsmentioning

confidence: 99%

“…Up to six high-performing general practices and hospital specialties were purposively sampled to represent a range of healthcare contexts (see [40] for full details). General practices were selected using routine data regarding list size, deprivation, and the proportion of patients over 75 years / in nursing homes [42].…”

Section: Setting and Site Selectionmentioning

confidence: 99%

Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives

Baxter¹,

Shannon²,

Murray³

et al. 2020

BMC Health Serv Res

Self Cite

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“…We have provided evidence that the PACT-M can be used as a metric for discharge and continuity of care quality and can be used to identify areas for improvement of services targeted to care transitions. The present research is one of five work streams that collectively aim to gain a more insightful understanding of care transitions from patients' [25] and clinical professionals' [60] point of view. We will evaluate the PACT-M implementation as part of the intervention evaluation process that will be conducted by our fellow researchers of this programme of work, through a randomised controlled trial, which will provide evidence of the role and impact of PACT-M in the wider context of healthcare improvement.…”

Section: Consequencesmentioning

confidence: 99%

Validation of the Partners at Care Transitions Measure (PACT-M): assessing the quality and safety of care transitions for older people in the UK

Oikonomou

Page

Lawton

et al. 2020

BMC Health Serv Res

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Background The Partners at Care Transitions Measure (PACT-M) is a patient-reported questionnaire for evaluation of the quality and safety of care transitions from hospital to home, as experienced by older adults. PACT-M has two components; PACT-M 1 to capture the immediate post discharge period and PACT-M 2 to assess the experience of managing care at home. In this study, we aim to examine the psychometric properties, factor structure, validity and reliability of the PACT-M. Methods We administered the PACT-M over the phone and by mail, within one week post discharge with 138 participants and one month after discharge with 110 participants. We performed principal components analysis and factors were assessed for internal consistency, reliability and construct validity. Results Reliability was assessed by calculating Cronbach’s alpha for the 9-item PACT-M 1 and 8-item PACT-M 2 and exploratory factor analysis was performed to evaluate dimensionality of the scales. Principal components analysis was chosen using pair-wise deletion. Both PACT-M 1 and PACT-M 2 showed high internal consistency and good internal reliability values and conveyed unidimensional scale characteristics with high reliability scores; above 0.8. Conclusions The PACT-M has shown evidence to suggest that it is a reliable measure to capture patients’ perception of the quality of discharge arrangements and also on patients’ ability to manage their care at home one month post discharge. PACT-M 1 is a marker of patient experience of transition and PACT-M 2 of coping at home.

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“…The PACT programme of research, therefore, asks whether supported involvement of older patients and their families in their care improves patient experience and safety at transitions of care. Through our earlier work [14,33,34], we have designed an intervention which supports patients to 'know more' and 'do more' during their hospital stay so that they can manage their care at home post-discharge. The present study assesses the feasibility of delivering this intervention and the trial methodology in order to refine the intervention and protocol for a definitive cRCT trial.…”

Section: Discussionmentioning

confidence: 99%

Improving patient experience and safety at transitions of care through the Your Care Needs You (YCNY) intervention: a study protocol for a cluster randomised controlled feasibility trial

Baxter¹,

Murray²,

O’Hara

et al. 2020

Pilot Feasibility Stud

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Background: Patients, particularly older people, often experience safety issues when transitioning from hospital to home. Although the evidence is currently equivocal as to how we can improve this transition of care, interventions that support patient involvement may be more effective. The 'Your Care Needs You' (YCNY) intervention supports patients to 'know more' and 'do more' whilst in hospital in order that they better understand their health condition and medications, maintain their daily activities, and can seek help at home if required. The intervention aims to reduce emergency hospital readmissions and improve safety and experience during the transition to home. Methods: As part of the Partners At Care Transitions (PACT) programme of research, a multi-centred cluster randomised controlled trial (cRCT) will be conducted to explore the feasibility of the YCNY intervention and trial methodology. Data will be used to refine the intervention and develop a protocol for a definitive cRCT. Ten acute hospital wards (the clusters) from varying medical specialties including older peoples' medicine, trauma and orthopaedics, cardiology, intermediate care, and stroke will be randomised to deliver YCNY or usual care on a 3:2 basis. Up to 200 patients aged 75 years and over and discharged to their own homes will be recruited to the study. Patients will complete follow-up questionnaires at 5-, 30-, and 90-days post-discharge and readmission data up to 90-days post-discharge will be extracted from their medical records. Study outcomes will include measures of feasibility (e.g. screening, recruitment, and retention data) and processes required to collect routine data at a patient and ward level. In addition, interviews and observations involving up to 24 patients/carers and 28 staff will be conducted to qualitatively assess the acceptability, usefulness, and feasibility of the intervention and implementation package to patients and staff. A separate sub-study will be conducted to explore how accurately primary outcome data (30-day emergency hospital readmissions) can be gathered for the definitive cRCT.

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Partners at Care Transitions: exploring healthcare professionals’ perspectives of excellence at care transitions for older people

Cited by 10 publications

References 31 publications

Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives

Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives

Validation of the Partners at Care Transitions Measure (PACT-M): assessing the quality and safety of care transitions for older people in the UK

Improving patient experience and safety at transitions of care through the Your Care Needs You (YCNY) intervention: a study protocol for a cluster randomised controlled feasibility trial

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