Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Centre for Education Research & Innovation - Western University, London, ON, Canada.
BMC Health Serv Res. 2021 Sep 10;21(1):950. doi: 10.1186/s12913-021-06841-2.
A disconnect exists between the idealized model of every patient having a family physician (FP) who acts as the central hub for care, and the reality of health care where patients must navigate a network of different providers. This disconnect is particularly evident when hospitalized multimorbid patients transition back into the community. These discharges are identified as high-risk due to lapses in care continuity. The aim of this study was to identify and explore the networks of care providers in a sample of hospitalized, complex patients, and better understand the nature of their attachments to these providers as a means of discovering novel approaches for improving discharge planning.
This was a constructivist grounded theory study. Data included interviews from 30 patients admitted to an inpatient internal medicine service of a midsized academic hospital in Ontario, Canada. Analysis and data collection proceeded iteratively with sampling progressing from purposive to theoretical.
We identified network of care configurations commonly found in patients with multiple medical comorbidities receiving care from multiple different providers admitted to an internal medicine service. FPs and specialists form the network's scaffold. The involvement of physicians in the network dictated not only how patients experienced transitions in care but the degree of reliance on social supports and personal capacities. The ideal for the multimorbid patient is an optimally involved FP that remains at the centre, even when patients require more subspecialized care. However, in cases where a rostered FP is non-existent or inadequate, increased involvement and advocacy from specialists is crucial.
Our results have implications for transition planning in hospitalized complex patients. Recognizing salient network features can help identify patients who would benefit from enhanced discharge support.
每个患者都有家庭医生（FP）作为医疗服务核心的理想化模式与患者必须在不同提供者网络中进行导航的实际医疗保健之间存在脱节。当患有多种疾病的住院患者重新回到社区时，这种脱节尤为明显。这些出院被认为是高风险的，因为存在护理连续性的中断。本研究旨在确定和探索一组住院复杂患者的护理提供者网络，并更好地了解他们与这些提供者的关系性质，以寻找改善出院计划的新方法。
这是一项建构主义扎根理论研究。数据包括来自加拿大安大略省一家中型学术医院内科住院服务的 30 名患者的访谈。分析和数据收集是迭代进行的，抽样从有目的到理论进行。
我们确定了在接受内科服务的患有多种合并症的患者中常见的护理网络配置。家庭医生和专科医生构成了网络的支架。网络中医生的参与不仅决定了患者的护理过渡期体验，还决定了对社会支持和个人能力的依赖程度。患有多种合并症的患者的理想状态是一位最佳参与的家庭医生，即使患者需要更专业的护理，他也能处于核心地位。然而，在没有或不足够的指定家庭医生的情况下，专科医生的更多参与和倡导至关重要。
我们的研究结果对住院复杂患者的过渡计划有影响。识别重要的网络特征可以帮助确定需要增强出院支持的患者。
