Department of Child and Family Development, San Diego State University, San Diego, CA, USA.
Child and Adolescent Services Research Center, San Diego, CA, USA.
BMC Health Serv Res. 2022 Apr 2;22(1):437. doi: 10.1186/s12913-022-07748-2.
Mental health care transitions are increasingly prioritized given their potential to optimize care delivery and patient outcomes, especially those focused on the transition from inpatient to outpatient mental health care. However, limited efforts to date characterize such mental health transition practices, especially those spanning multiple service setting contexts. Examination of key influences of inpatient to outpatient mental health care transitions across care contexts is needed to inform ongoing and future efforts to improve mental health care transitions. The current work aims to characterize multilevel influences of mental health care transitions across three United States-based mental health system contexts.
A comparative multiple case study design was used to characterize transition practices within the literature examining children's, non-VA adult, and VA adult service contexts. Andersen's (1995) Behavioral Health Service Use Model was applied to identify and characterize relevant distinct and common domains of focus in care transitions across systems.
Several key influences to mental health care transitions were identified spanning the environmental, individual, and health behavior domains, including: community capacity or availability, cross-system or agency collaboration, provider training and experience related to mental health care transitions, client care experience and expectations, and client clinical characteristics or complexity.
Synthesis illustrated several common factors across system contexts as well as unique factors for further consideration. Our findings inform key considerations and recommendations for ongoing and future efforts aiming to plan, expand, and better support mental health care transitions. These include timely information sharing, enhanced care coordination and cross setting and provider communication, continued provider/client education, and appropriate tailoring of services to improve mental health care transitions.
鉴于精神卫生保健过渡有可能优化护理服务和患者预后，特别是那些专注于从住院到门诊精神卫生保健过渡的情况，因此越来越重视精神卫生保健过渡。然而，迄今为止，在描述这种精神卫生过渡实践方面所做的努力有限，特别是那些跨越多个服务环境背景的实践。需要研究住院到门诊精神卫生保健过渡在整个护理环境中的关键影响因素，以便为正在进行和未来改善精神卫生保健过渡的工作提供信息。目前的工作旨在描述三个基于美国的精神卫生系统背景下精神卫生保健过渡的多层次影响。
采用比较多案例研究设计，在研究儿童、非退伍军人事务部成人和退伍军人事务部成人服务环境的文献中描述过渡实践。应用安德森（1995 年）的行为健康服务使用模型，以确定和描述系统间过渡护理中相关的独特和共同关注领域。
确定了几个关键的精神卫生保健过渡影响因素，涵盖环境、个体和健康行为领域，包括：社区能力或可用性、跨系统或机构合作、与精神卫生保健过渡相关的提供者培训和经验、患者护理体验和期望以及患者临床特征或复杂性。
综合结果说明了几个系统环境共有的因素以及需要进一步考虑的独特因素。我们的研究结果为正在进行和未来旨在规划、扩大和更好地支持精神卫生保健过渡的努力提供了关键的考虑因素和建议。这些建议包括及时的信息共享、增强的护理协调以及跨环境和提供者的沟通、持续的提供者/患者教育以及适当调整服务以改善精神卫生保健过渡。
