Division of Hospital Medicine, University of California, San Francisco, 533 Parnassus Avenue, Room U127A, Box 131, San Francisco, CA, 94143-0131, USA.
J Gen Intern Med. 2012 Nov;27(11):1484-91. doi: 10.1007/s11606-012-2117-2. Epub 2012 Jun 16.
Coordinated transitions from hospital to shelter for homeless patients may improve outcomes, yet patient-centered data to guide interventions are lacking.
To understand patients' experiences of transitions from hospital to a homeless shelter, and determine aspects of these experiences associated with perceived quality of these transitions.
Mixed methods with a community-based participatory research approach, in partnership with personnel and clients from a homeless shelter.
Ninety-eight homeless individuals at a shelter who reported at least one acute care visit to an area hospital in the last year.
Using semi-structured interviews, we collected quantitative and qualitative data about transitions in care from the hospital to the shelter. We analyzed qualitative data using the constant comparative method to determine patients' perspectives on the discharge experience, and we analyzed quantitative data using frequency analysis to determine factors associated with poor outcomes from patients' perspective.
Using qualitative analysis, we found homeless participants with a recent acute care visit perceived an overall lack of coordination between the hospital and shelter at the time of discharge. They also described how expectations of suboptimal coordination exacerbate delays in seeking care, and made three recommendations for improvement: 1) Hospital providers should consider housing a health concern; 2) Hospital and shelter providers should communicate during discharge planning; 3) Discharge planning should include safe transportation. In quantitative analysis of recent hospital experiences, 44 % of participants reported that housing status was assessed and 42 % reported that transportation was discussed. Twenty-seven percent reported discharge occurred after dark; 11 % reported staying on the streets with no shelter on the first night after discharge.
Homeless patients in our community perceived suboptimal coordination in transitions of care from the hospital to the shelter. These patients recommended improved assessment of housing status, communication between hospital and shelter providers, and arrangement of safe transportation to improve discharge safety and avoid discharge to the streets without shelter.
协调 homeless patients 从医院到庇护所的过渡可能会改善结果，但缺乏以患者为中心的数据来指导干预措施。
了解患者从医院过渡到庇护所的经历，并确定这些经历与感知过渡质量相关的方面。
混合方法，采用社区参与式研究方法，与庇护所的人员和客户合作。
98 名在庇护所的 homeless 个体，他们在过去一年中至少有一次因急性病就诊于当地医院。
使用半结构化访谈，我们从医院到庇护所收集了关于护理过渡的定量和定性数据。我们使用恒比法对定性数据进行分析，以确定患者对出院体验的看法，我们使用频率分析对定量数据进行分析，以确定从患者角度来看与不良结果相关的因素。
使用定性分析，我们发现最近接受过急性护理的 homeless 参与者认为在出院时医院和庇护所之间总体缺乏协调。他们还描述了对低水平协调的期望如何加剧了寻求护理的延迟，并提出了三项改进建议：1）医院提供者应考虑将住房问题作为健康问题；2）医院和庇护所提供者应在出院计划期间进行沟通；3）出院计划应包括安全的交通。在最近医院经历的定量分析中，44%的参与者报告说住房状况得到了评估，42%的参与者报告说交通问题得到了讨论。27%的参与者报告说出院发生在天黑后；11%的参与者报告说在出院后的第一个晚上无家可归，在街上流浪。
我们社区的 homeless 患者认为从医院到庇护所的护理过渡协调不佳。这些患者建议改进住房状况评估、医院和庇护所提供者之间的沟通，以及安全交通的安排，以提高出院安全性，避免无家可归者在出院后流落街头。
