Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, OR 97239, USA.
J Gen Intern Med. 2012 Dec;27(12):1649-56. doi: 10.1007/s11606-012-2169-3. Epub 2012 Jul 25.
Patients are vulnerable to poor quality, fragmented care as they transition from hospital to home. Few studies examine the discharge process from the perspectives of multiple healthcare professionals.
To understand care transitions from the perspective of diverse healthcare professionals, and identify recommendations for process improvement.
Cross sectional qualitative study.
Clinicians, care teams, and administrators from the inpatient general medicine services at one urban, academic hospital; two outpatient primary care clinics; and one Medicaid managed care plan.
We conducted 13 focus groups and two in-depth interviews with participants prior to initiating a hospital-funded, multi-component transitional care intervention for uninsured and low-income publicly insured patients, the Care Transitions Innovation (C-TraIn). We used thematic analysis to identify emergent themes and a cross-case comparative analysis to describe variation by participant role and setting.
Poor transitional care reflected healthcare system fragmentation, limiting the ability of healthcare professionals to provide optimal patient care. Lack of standardized processes, poor multidisciplinary communication within the hospital, and fragmented communication across settings led to chaotic, unsystematic transitions, poor patient outcomes, and feelings of futility and dissatisfaction among providers. Patients with complex psychosocial needs were especially vulnerable during care transitions. Recommended changes to improve transitional care included improving hospital multidisciplinary hospital rounds, clarifying accountability as patients move across settings, standardizing discharge processes, and providing additional medical staff training.
Hospital to home care transitions are critical junctures that can impact health outcomes, experience of care, and costs. Transitional care quality improvement initiatives must address system fragmentation, reduce communication barriers within and between settings, and ensure adequate professional training.
患者在从医院过渡到家庭时，容易面临医疗质量差和护理碎片化的问题。很少有研究从多个医疗保健专业人员的角度来考察出院过程。
从不同医疗保健专业人员的角度了解护理过渡，并确定改进流程的建议。
跨截面定性研究。
一家城市学术医院的住院内科服务的临床医生、护理团队和管理人员；两个初级保健门诊诊所；以及一个医疗补助管理式医疗计划。
在启动一项针对无保险和低收入公共保险患者的、由医院资助的、多组件过渡性护理干预措施（即 Care Transitions Innovation，C-TraIn）之前，我们对参与者进行了 13 次焦点小组和 2 次深入访谈。我们使用主题分析来识别新兴主题，并使用跨案例比较分析来描述参与者角色和环境的变化。
较差的过渡性护理反映了医疗体系的碎片化，限制了医疗保健专业人员为患者提供最佳护理的能力。缺乏标准化的流程、医院内多学科沟通不畅以及跨环境沟通的碎片化导致了混乱、无系统的过渡，患者的预后较差，以及提供者的徒劳感和不满。具有复杂心理社会需求的患者在护理过渡期间尤其脆弱。建议改善过渡性护理的措施包括改善医院多学科病房查房、明确患者在不同环境之间移动的责任、标准化出院流程以及提供更多的医疗人员培训。
医院到家庭的护理过渡是关键的转折点，可能会影响健康结果、护理体验和成本。过渡性护理质量改进倡议必须解决系统碎片化问题，减少内部和之间的沟通障碍，并确保提供足够的专业培训。
