Departments of Pediatrics and
Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Hosp Pediatr. 2020 Aug;10(8):657-662. doi: 10.1542/hpeds.2020-0068. Epub 2020 Jul 6.
There is limited research about best practices for transitioning children with medical complexity (CMC) from hospital to home. Our objectives were to describe issues related to transitioning CMC from hospital to home health care and identify strategies to improve this transition.
This qualitative study was conducted in western North Carolina between 2012 and 2014 and involved a focus group of 14 hospital- and community-based stakeholders and 4 focus groups of 18 home health nurses. Focus groups were audio-recorded and transcribed verbatim, and transcriptions were managed in ATLAS.ti software. By using content analysis, recurrent themes related to transitioning CMC from hospital to home were identified.
Themes in 4 domains emerged. (1) Home health orders: home health care providers desired hospital-based providers to write accurate and specific orders, notify them in advance about discharge to order specialized supplies, and avoid changing orders at the last minute. (2) Communication: participants found discharge summaries useful but did not always receive them. Communication between hospital-based clinicians, home health care providers, and the child's primary care physician about the hospitalization and home care was important. (3) Resources: home health care providers needed hospital-based clinicians to be a resource during the early period of transition home. (4) Caregiver preparation: participants emphasized caregiver preparation about medical care of CMC, home health nursing, and the differences between hospital and home care practices in the care of CMC.
There are gaps in the system of transitional care of CMC. Potential strategies to improve transitional care of CMC between the hospital and home health care services exist.
关于如何将患有复杂疾病的儿童（CMC）从医院过渡到家庭护理，目前的研究还很有限。我们的目标是描述与 CMC 从医院过渡到家庭健康护理相关的问题，并确定改善这一过渡的策略。
本定性研究于 2012 年至 2014 年在北卡罗来纳州西部进行，涉及 14 名医院和社区利益相关者的焦点小组以及 4 名家庭健康护士的 4 个焦点小组。焦点小组进行了录音并逐字转录，转录内容在 ATLAS.ti 软件中进行管理。通过内容分析，确定了与 CMC 从医院过渡到家庭相关的反复出现的主题。
出现了 4 个领域的主题。（1）家庭健康医嘱：家庭健康护理提供者希望医院提供准确、具体的医嘱，提前通知他们出院以订购特殊用品，并避免在最后一刻更改医嘱。（2）沟通：参与者发现出院小结很有用，但并不总是收到。医院临床医生、家庭健康护理提供者和儿童的初级保健医生之间关于住院和家庭护理的沟通非常重要。（3）资源：家庭健康护理提供者在过渡回家的早期阶段需要医院临床医生的支持。（4）照顾者准备：参与者强调了对 CMC 医疗护理、家庭健康护理以及 CMC 护理中医院和家庭护理实践差异的照顾者准备。
在 CMC 的过渡护理系统中存在差距。存在潜在的策略来改善 CMC 从医院到家庭健康护理的过渡护理。
