Singh Hardeep, Tang Terence, Steele Gray Carolyn, Kokorelias Kristina, Thombs Rachel, Plett Donna, Heffernan Matthew, Jarach Carlotta M, Armas Alana, Law Susan, Cunningham Heather V, Nie Jason Xin, Ellen Moriah E, Thavorn Kednapa, Nelson Michelle LA
Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
March of Dimes Canada, Toronto, ON, Canada.
JMIR Aging. 2022 May 19;5(2):e35929. doi: 10.2196/35929.
Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions.
To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions.
This 2-phase rapid review involved a selective review of providers' roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults' hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1.
In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients' status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions.
This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2020-045596.
老年人在从医院过渡到家庭的过程中发生不良事件的风险很高。实施障碍阻碍了旨在支持从医院到家庭过渡的各种数字健康技术在临床上的广泛应用。
为指导一种支持从医院到家庭过渡的数字健康干预措施（数字桥梁干预）的开发，本综述的具体目标是描述医疗保健提供者在支持老年人从医院到家庭过渡过程中的各种角色和功能，使未来的技术更有针对性地支持他们的工作；描述用于促进老年人从医院到家庭过渡的数字健康干预措施的类型，并阐明这些干预措施如何支持提供者的角色和功能；描述从这些干预措施的设计和实施中吸取的经验教训；并确定在数字桥梁干预措施和其他以过渡为重点的数字健康干预措施中改善技术与提供者功能匹配的机会。
这项分两阶段的快速综述包括对提供者在从医院到家庭过渡过程中的角色及其功能的选择性综述（第1阶段），以及对用于支持老年人从医院到家庭过渡的数字健康干预措施的结构化文献综述（第2阶段）。在分析过程中，将第2阶段确定的技术功能与第1阶段确定的提供者角色和功能联系起来。
在第1阶段，确定了促进从医院到家庭过渡的各种提供者角色，包括特定的导航角色以及护士和医生的角色。提供者执行的关键过渡功能与三类医疗连续性（即信息连续性、管理连续性和关系连续性）相关。第2阶段纳入了142篇报告针对各种医疗状况或群体的数字健康干预措施的文章。大多数数字健康干预措施支持管理连续性（例如，出院后对患者状况的随访、评估和监测），而信息连续性和关系连续性得到的支持最少。从这些干预措施中吸取的经验教训分为与技术和研究相关的挑战与机会，并为指导以过渡为重点的数字健康干预措施的设计提供了若干建议。
本综述强调数字桥梁和其他数字健康干预措施需要使数字健康干预措施的设计和提供与提供者功能保持一致，与老年人一起设计和测试干预措施，并检查多层次结果。
国际注册报告识别码（IRRID）：RR2-10.1136/bmjopen-2020-045596。
