Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review

Abstract

BackgroundProvision of high quality transitional care is a challenge for health care providers in many western countries. This systematic review was conducted to (1) identify and synthesise research, using randomised control trial designs, on the quality of transitional care interventions compared with standard hospital discharge for older people with chronic illnesses, and (2) make recommendations for research and practice.MethodsEight databases were searched; CINAHL, Psychinfo, Medline, Proquest, Academic Search Complete, Masterfile Premier, SocIndex, Humanities and Social Sciences Collection, in addition to the Cochrane Collaboration, Joanna Briggs Institute and Google Scholar. Results were screened to identify peer reviewed journal articles reporting analysis of quality indicator outcomes in relation to a transitional care intervention involving discharge care in hospital and follow-up support in the home. Studies were limited to those published between January 1990 and May 2013. Study participants included people 60 years of age or older living in their own homes who were undergoing care transitions from hospital to home. Data relating to study characteristics and research findings were extracted from the included articles. Two reviewers independently assessed studies for risk of bias.ResultsTwelve articles met the inclusion criteria. Transitional care interventions reported in most studies reduced re-hospitalizations, with the exception of general practitioner and primary care nurse models. All 12 studies included outcome measures of re-hospitalization and length of stay indicating a quality focus on effectiveness, efficiency, and safety/risk. Patient satisfaction was assessed in six of the 12 studies and was mostly found to be high. Other outcomes reflecting person and family centred care were limited including those pertaining to the patient and carer experience, carer burden and support, and emotional support for older people and their carers. Limited outcome measures were reported reflecting timeliness, equity, efficiencies for community providers, and symptom management.ConclusionsGaps in the evidence base were apparent in the quality domains of timeliness, equity, efficiencies for community providers, effectiveness/symptom management, and domains of person and family centred care. Further research that involves the person and their family/caregiver in transitional care interventions is needed.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-346) contains supplementary material, which is available to authorized users.

Perencanaan Pulang Efektif Meningkatkan Kemampuan Ibu Merawat Anak dengan Pneumonia Di Rumah

“…Perencanaan pulang yang telah dilaksanakan selama ini kebanyakan dianggap sebagai resume pulang (Lees, 2013). Informasi yang disampaikan meliputi kapan jadwal kunjungan ulang, diet yang harus diterapkan di rumah dan tindakan terkait perawatan yang harus dilakukan di rumah (Allen, Hutchinson, Brown, & Livingston, 2014).…”

Team-based versus traditional primary care models and short-term outcomes after hospital discharge

“…Interventions to reduce 30-day readmissions and postdischarge emergency department visits have targeted organizational factors that play a role in care coordination, both in hospital [21][22][23][24] and in outpatient settings. 25 Most interventions studied have been resource intensive and implemented in local settings.…”

Transitional Care for Older Adults with Chronic Illnesses as a Vulnerable Population: Theoretical Framework and Future Directions in Nursing

“…Hospitalization of an older adult potentially creates a multidimensional transition experience for the individual, family members, and social supports [4]. Daves et al [21] counter.…”

“…Furthermore, when appropriate care or resources are not available in the community, older patients will often remain in high-level care such as intensive care, exacerbating wait times for others in need of a hospital bed [1,3]. Therefore, comprehensive and wellexecuted discharge plans including the acceptance of changes in functional capacity, reconciliation of medications ordered at admission and at hospital discharge, coordination of follow-up diagnostic tests and appointments, and assessment of community Son, Youn-Jung · You, Mi-Ae resources are required [2,4].…”

“…Transitional care refers to the multiple transfers that patients make between healthcare practitioners and/or care settings during an episode of illness [5,6]. Transitional care as a part of integrated care encompasses a broad range of services and environments designed to promote the safe and timely passage of patients between levels of health care and across care settings [2,8] and it can be considered as a part of prevention of re-hospitalization programs within care transition programs in chronic care [4]. Transitional care includes pre-hospital discharge planning and immediate post-hospital discharge follow-up at the next location of care [2,9].…”