Struggles with infrastructures of information concerning hospital-to-home transitions

Norlyk, Annelise; Deleuran, Cecilia Lykke; Martinsen, Bente

doi:10.12968/bjcn.2020.25.1.10

Cited by 20 publications

(27 citation statements)

References 22 publications

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“…Transitioning across health care settings is a complex experience for older adults and their caregivers [ 1 , 2 ]. Older adults [ 3 ] and family caregivers (ie, family members, friends, or neighbors) who provide unpaid assistance or care to someone living with an injury, disability, or illness [ 4 ] frequently experience unmet care needs as the patients leave the hospital and transition to home [ 5 - 10 ].…”

Section: Introductionmentioning

confidence: 99%

Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations

Kokorelias¹,

Nelson²,

Tang³

et al. 2022

JMIR Aging

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Background Digital health technologies have been proposed to support hospital-to-home transition for older adults. The COVID-19 pandemic and the associated physical distancing guidelines have propelled a shift toward digital health technologies. However, the characteristics of older adults who participated in digital health research interventions to support hospital-to-home transitions remain unclear. This information is needed to assess whether current digital health interventions are generalizable to the needs of the broader older adult population. Objective This rapid review of the existing literature aimed to identify the characteristics of the populations targeted by studies testing the implementation of digital health interventions designed to support hospital-to-home transitions, identify the characteristics of the samples included in studies testing digital health interventions used to support hospital-to-home transitions, and create recommendations for enhancing the diversity of samples within future hospital-to-home digital health interventions. Methods A rapid review methodology based on scoping review guidelines by Arksey and O’Malley was developed. A search for peer-reviewed literature published between 2010 and 2021 on digital health solutions that support hospital-to-home transitions for older adults was conducted using MEDLINE, Embase, and CINAHL databases. The data were analyzed using descriptive statistics and qualitative content analysis. The Sex- and Gender-Based Analysis Plus lens theoretically guided the study design, analysis, and interpretation. Results A total of 34 studies met the inclusion criteria. Our findings indicate that many groups of older adults were excluded from these interventions and remain understudied. Specifically, the oldest old and those living with cognitive impairments were excluded from the studies included in this review. In addition, very few studies have described the characteristics related to gender diversity, education, race, ethnicity, and culture. None of the studies commented on the sexual orientation of the participants. Conclusions This is the first review, to our knowledge, that has mapped the literature focusing on the inclusion of older adults in digital hospital-to-home interventions. The findings suggest that the literature on digital health interventions tends to operationalize older adults as a homogenous group, ignoring the heterogeneity in older age definitions. Inconsistency in the literature surrounding the characteristics of the included participants suggests a need for further study to better understand how digital technologies to support hospital-to-home transitions can be inclusive.

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Section: Introductionmentioning

confidence: 99%

Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations

Kokorelias¹,

Nelson²,

Tang³

et al. 2022

JMIR Aging

View full text Add to dashboard Cite

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“…One US study named adequate resource and time allocation factors such as opportunities to interact and communicate intra- and inter-professionally, as instrumental to the improvement of homecare nursing [ 40 ], including reduction of hospital readmission rates [ 55 ]. Nevertheless, a qualitative US study found that homecare nurses often had difficulty accessing medical information, leading to the use of more time than allocated [ 56 ]. The same study reported that homecare nurses commonly had to make care decisions based on the observations of nursing assistants, who have less education and training, while more and more tasks are assigned to them [ 56 ].…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, a qualitative US study found that homecare nurses often had difficulty accessing medical information, leading to the use of more time than allocated [ 56 ]. The same study reported that homecare nurses commonly had to make care decisions based on the observations of nursing assistants, who have less education and training, while more and more tasks are assigned to them [ 56 ]. In addition, agencies assigning smaller numbers of cases to each case manager performed better regarding overall quality of care [ 44 ].…”

Section: Introductionmentioning

confidence: 99%

Factors associated with homecare coordination and quality of care: a research protocol for a national multi-center cross-sectional study

Möckli

Simon

Meyer‐Massetti

et al. 2021

BMC Health Serv Res

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Introduction The persistent fragmentation of home healthcare reflects inadequate coordination between care providers. Still, while factors at the system (e.g., regulations) and organisational (e.g., work environment) levels crucially influence homecare organisation, coordination and ultimately quality, knowledge of these factors and their relationships in homecare settings remains limited. Objectives This study has three aims: [1] to explore how system-level regulations lead to disparities between homecare agencies’ structures, processes and work environments; [2] to explore how system- and organisation-level factors affect agency-level homecare coordination; and [3] to explore how agency-level care coordination is related to patient-level quality of care. Design and methods This study focuses on a national multi-center cross-sectional survey in Swiss homecare settings. It will target 100 homecare agencies, their employees and clients for recruitment, with data collection period planned from January to June 2021. We will assess regulations and financing mechanisms (via public records), agency characteristics (via agency questionnaire data) and homecare employees’ working environments and coordination activities, as well as staff- and patient-level perceptions of coordination and quality of care (via questionnaires for homecare employees, clients and informal caregivers). All collected data will be subjected to descriptive and multi-level analyses. Discussion The first results are expected by December 2021. Knowledge of factors linked to quality of care is essential to plan and implement quality improvement strategies. This study will help to identify modifiable factors at multiple health system levels that might serve as access points to improve coordination and quality of care.

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“…managerial reforms, than previously (Grima et al, 2020;Noordegraaf, 2011). Furthermore, communication about discharges from hospitals to local services also appears to be deteriorating (Norlyk et al, 2020). However, others studies show how electronic communication makes patient transitions between hospital and community care more efficient as the quality of the information has improved (Melby et al, 2015).…”

Section: Resultsmentioning

confidence: 98%

Structural disavowal and personal inundation of responsibility – a local perspective on pressure on mental health front-line professionalsStrukturell ansvarsfraskrivelse og individuell ansvarsoversvømmelse – kommunalt perspektiv på dilemmaer i profesjonelt arbeidet med rus og psykisk helse

Bjørkquist

Ramsdal

2021

European Journal of Social Work

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This article examines how professionals in front-line mental health and addiction services respond to the dilemmas of implementing policies at the local level of the service system. In their daily work, front-line health and social work professionals must find ways to cope with challenges balancing limited resources, professional ethical standards and client needs for varied and flexible services. Front-line professionals have significant space for discretion in finding ways to cope with these dilemmas. We discuss these ways as a drift towards moral dispositions. Drawing on qualitative interviews with local managers and professionals, we find that front-line professionals find themselves at the bottom of the service line where one cannot 'decentralise' responsibilities any more. We describe and denote this as 'structural disavowal of responsibility', as patients with severe mental health diagnoses are often discharged from specialist services to primary care that lacks the necessary resources. Furthermore, front-line professionals improvise by including measures found in the local community and even their private lives, making their work exceedingly stressful. This is denoted 'personal inundation of responsibility'. We argue that the moral disposition of front-line professionals hence should be extended to encompass personal inundation as one perversion of their responsibilities. SAMMENDRAG Denne artikkelen undersøker hvordan profesjonelle i førstelinjen i rus-og psykisk helsetjenester responderer på dilemmaer ved implementering av nasjonal politikk på kommunalt nivå. Profesjonelle i førstelinjen må daglig finne måter å håndtere dilemmaer på som inkluderer begrensede ressurser, yrkesetiske standarder og brukernes behov for ulike og fleksible tjenester. De profesjonelle har betydelig rom for skjønn når de skal finne måter å håndtere disse dilemmaene på. Vi diskuterer disse måtene som et driv mot 'moral dispositions'. På bakgrunn av kvalitative intervjuer med ledere og ansatte på kommunalt nivå, finner vi at profesjonelle i førstelinjen befinner seg på bunnen av tjenestelinjen KEYWORDS Discretion; front-line professionals; health and social work; mental health; organisation of services NØKKELORD skjønn; profesjonelle i førstelinje; organisering av tjenester; psykisk helse helse; sosialt arbeid

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Struggles with infrastructures of information concerning hospital-to-home transitions

Cited by 20 publications

References 22 publications

Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations

Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations

Factors associated with homecare coordination and quality of care: a research protocol for a national multi-center cross-sectional study

Structural disavowal and personal inundation of responsibility – a local perspective on pressure on mental health front-line professionalsStrukturell ansvarsfraskrivelse og individuell ansvarsoversvømmelse – kommunalt perspektiv på dilemmaer i profesjonelt arbeidet med rus og psykisk helse

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