University of Waterloo, Waterloo, Ontario, Canada.
University of Waterloo, Waterloo, Ontario, Canada.
J Am Med Dir Assoc. 2019 Apr;20(4):414-419.e1. doi: 10.1016/j.jamda.2019.01.147. Epub 2019 Mar 7.
Improving care transitions is of critical importance for older patients, especially those with complex care needs. Our study examined the "Transitions of Care" (ToC) of complex, post-acute older adults at multiple time points. The objective of this article is to identify domains relevant to health care transitions of post-acute older patients with hip fracture so as to inform future ToC interventions.
Here we conducted a framework-based synthesis of the 12 peer-reviewed manuscripts that were published from our multisite, ethnographic study.
All 12 manuscripts were based on 1 study, described here. Data were collected in multiple regions, in acute and sub-acute care wards, rehabilitation programs, home care agencies, long-term care and assisted living facilities, and patients' private homes. We completed 51 interviews with 23 postoperative hip fracture patients aged ≥65 years, 24 interviews with 19 family caregivers, and 96 interviews with 92 health care providers. Interviews with patients, family caregivers, and health care providers were conducted at each transition point for a total of 171 individual interviews.
Taken together, our framework analysis of the 12 manuscripts identified 8 themes related to ToC. Two themes, patient complexity and system constraints, are contextual factors that tend to impede ToC and may be less amenable to change. The remaining 6 themes, patient involvement and choice, family caregiver roles, strong relationships, coordination of roles, documentation, and information sharing, have the potential to support and improve ToC.
With comprehensive data from a range of stakeholders, collected at multiple transition points along the health care continuum, in our final 6 themes we identify potential points of intervention for clinicians and teams seeking to improve ToC for older complex patients.
改善老年人的医疗过渡至关重要，尤其是那些有复杂护理需求的老年人。我们的研究考察了多个时间点的复杂、急性后老年人的“医疗过渡”（ToC）。本文的目的是确定与髋部骨折的急性后老年患者的医疗过渡相关的领域，以便为未来的 ToC 干预提供信息。
我们对从我们的多地点民族志研究中发表的 12 篇同行评议文献进行了基于框架的综合分析。
所有 12 篇论文都基于这里描述的一项研究。数据收集于多个地区，包括急性和亚急性护理病房、康复计划、家庭护理机构、长期护理和辅助生活设施以及患者的私人住宅。我们对 23 名年龄≥65 岁的术后髋部骨折患者进行了 51 次访谈，对 19 名家庭照顾者进行了 24 次访谈，对 92 名医疗保健提供者进行了 96 次访谈。在每个过渡点对患者、家庭照顾者和医疗保健提供者进行访谈，总共进行了 171 次单独访谈。
综合来看，我们对 12 篇论文的框架分析确定了 8 个与 ToC 相关的主题。两个主题，患者的复杂性和系统约束，是阻碍 ToC 的背景因素，可能不太容易改变。其余 6 个主题，患者的参与和选择、家庭照顾者的角色、牢固的关系、角色协调、文件记录和信息共享，有潜力支持和改善 ToC。
通过从一系列利益相关者那里获得全面的数据，并在医疗保健连续体的多个过渡点收集数据，在我们的最后 6 个主题中，我们确定了寻求改善老年复杂患者 ToC 的临床医生和团队的潜在干预点。
