Soo Chan Carusone1,2, Bill O'Leary1,3, Simone McWatt1, Ann Stewart1,4, Shelley Craig3, David J Brennan3. 1. Casey House, Toronto, Ontario, Canada. 2. Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, Canada. 3. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada. 4. Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Transitions in care are a high-risk time for patients. Complex patients account for the largest proportion of healthcare costs but experience lower quality and discontinuity of care. The experiences of complex patients can be used to identify gaps in hospital discharge practices and design interventions to improve outcomes. METHODS: We used a case study approach with serial interviews and chart abstraction to explore the hospital discharge and transition experience over 6 weeks. Participants were recruited from a small hospital in Toronto that provides care to complex patients living with human immunodeficiency virus (HIV). Framework analysis was used to compare data across time-points and sources. RESULTS: Data were collected from 9 cases. Participants presented with complex medical and psychosocial challenges, including substance use (n = 9), mental health diagnoses (n = 8) and a mean of 5 medical comorbidities in addition to HIV. Data were analyzed and reported in 4 key themes: 1) social support; 2) discharge process and transition experience; 3) post-discharge follow-up; and 4) patient priorities. After hospital discharge, the complexity of participants' lives resulted in a change in priorities and subsequent divergence from the discharge plan. Despite the comprehensive discharge plans, with referrals designed to support their health and activities of daily living, participants experienced challenges with social support and referral uptake, resulting in a loss of stability achieved while in hospital. CONCLUSION: Further investigation and changes in practice are necessary to ensure that discharge plans for complex patients are realistic within the context of their lives outside of the hospital. Journal of Hospital Medicine 2017;12:5-10.
BACKGROUND: Transitions in care are a high-risk time for patients. Complex patients account for the largest proportion of healthcare costs but experience lower quality and discontinuity of care. The experiences of complex patients can be used to identify gaps in hospital discharge practices and design interventions to improve outcomes. METHODS: We used a case study approach with serial interviews and chart abstraction to explore the hospital discharge and transition experience over 6 weeks. Participants were recruited from a small hospital in Toronto that provides care to complex patients living with human immunodeficiency virus (HIV). Framework analysis was used to compare data across time-points and sources. RESULTS: Data were collected from 9 cases. Participants presented with complex medical and psychosocial challenges, including substance use (n = 9), mental health diagnoses (n = 8) and a mean of 5 medical comorbidities in addition to HIV. Data were analyzed and reported in 4 key themes: 1) social support; 2) discharge process and transition experience; 3) post-discharge follow-up; and 4) patient priorities. After hospital discharge, the complexity of participants' lives resulted in a change in priorities and subsequent divergence from the discharge plan. Despite the comprehensive discharge plans, with referrals designed to support their health and activities of daily living, participants experienced challenges with social support and referral uptake, resulting in a loss of stability achieved while in hospital. CONCLUSION: Further investigation and changes in practice are necessary to ensure that discharge plans for complex patients are realistic within the context of their lives outside of the hospital. Journal of Hospital Medicine 2017;12:5-10.
Authors: Andrew David Eaton; Soo Chan Carusone; Shelley L Craig; Erin Telegdi; John W McCullagh; David McClure; Walter Wilson; Leonardo Zuniga; Kevin Berney; Galo F Ginocchio; Gordon A Wells; Michael Montess; Adam Busch; Nick Boyce; Carol Strike; Ann Stewart Journal: BMJ Open Date: 2019-03-30 Impact factor: 2.692
Authors: Tony Antoniou; Erin Graves; Lesley Plumptre; Ann Stewart; Soo Chan Carusone Journal: Open Forum Infect Dis Date: 2019-01-19 Impact factor: 3.835