Tara Kiran1, David Wells2, Karen Okrainec2, Carol Kennedy2, Kimberly Devotta2, Gracia Mabaya2, Lacey Phillips2, Amy Lang2, Pat O'Campo2. 1. Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), Institute of Health Policy, Management and Evaluation (Kiran) and Dalla Lana School of Public Health (Devotta, O'Campo), University of Toronto; Centre for Urban Health Solutions (Kiran, Devotta, O'Campo), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Ontario Health (Quality Business Unit) (Kiran, Wells, Kennedy, Mabaya, Phillips, Lang); Department of Medicine (Okrainec), University Health Network and University of Toronto, Toronto, Ont. tara.kiran@utoronto.ca. 2. Department of Family and Community Medicine (Kiran), St. Michael's Hospital; Department of Family and Community Medicine (Kiran), Institute of Health Policy, Management and Evaluation (Kiran) and Dalla Lana School of Public Health (Devotta, O'Campo), University of Toronto; Centre for Urban Health Solutions (Kiran, Devotta, O'Campo), Li Ka Shing Knowledge Institute of St. Michael's Hospital; Ontario Health (Quality Business Unit) (Kiran, Wells, Kennedy, Mabaya, Phillips, Lang); Department of Medicine (Okrainec), University Health Network and University of Toronto, Toronto, Ont.
Abstract
BACKGROUND: Improving the quality of care for patients who return home after a hospital stay is an international priority; however, few jurisdictions have engaged broadly with patients and caregivers to understand what most affects their experience transitioning home. We performed Ontario-wide group concept mapping, beginning with a brainstorming phase, to understand patient and caregiver priorities in the transition. METHODS: We used group concept mapping to engage patients and caregivers who had lived experience transitioning from hospital to home in Ontario in the previous 3 years. We report on the first phase, brainstorming, conducted over 10 weeks beginning Jan. 11, 2018 via an online survey or facilitated group discussion. Participants responded to a single focal prompt: "When leaving the hospital for home, some thing(s) that affected the experience were: ____." The study team identified recurrent concepts and overarching themes. Patients and caregivers informed the study design, recruitment and data interpretation. RESULTS: In all, 665 people (263 patients [39.5%], 352 caregivers [52.9%] and 50 people who were both patient and caregiver [7.5%]) participated in brainstorming online, and 71 people participated in 1 of 8 group discussions. Participants identified 6 key areas affecting their experience of transition from hospital to home: home and community care, the discharge process, medical follow-up after discharge, medications, patient and caregiver education, and the kindness and caring of the health care team in hospital. Most notable were challenges with the timeliness, sufficiency, reliability and consistency of publicly funded home care services. INTERPRETATION: Patients and caregivers from across Ontario noted a range of issues affecting their experience transitioning from hospital to home, particularly the quality and sufficiency of publicly funded home care. Our findings will be used to inform a provincial quality standard on the transition from hospital to home. Copyright 2020, Joule Inc. or its licensors.
BACKGROUND: Improving the quality of care for patients who return home after a hospital stay is an international priority; however, few jurisdictions have engaged broadly with patients and caregivers to understand what most affects their experience transitioning home. We performed Ontario-wide group concept mapping, beginning with a brainstorming phase, to understand patient and caregiver priorities in the transition. METHODS: We used group concept mapping to engage patients and caregivers who had lived experience transitioning from hospital to home in Ontario in the previous 3 years. We report on the first phase, brainstorming, conducted over 10 weeks beginning Jan. 11, 2018 via an online survey or facilitated group discussion. Participants responded to a single focal prompt: "When leaving the hospital for home, some thing(s) that affected the experience were: ____." The study team identified recurrent concepts and overarching themes. Patients and caregivers informed the study design, recruitment and data interpretation. RESULTS: In all, 665 people (263 patients [39.5%], 352 caregivers [52.9%] and 50 people who were both patient and caregiver [7.5%]) participated in brainstorming online, and 71 people participated in 1 of 8 group discussions. Participants identified 6 key areas affecting their experience of transition from hospital to home: home and community care, the discharge process, medical follow-up after discharge, medications, patient and caregiver education, and the kindness and caring of the health care team in hospital. Most notable were challenges with the timeliness, sufficiency, reliability and consistency of publicly funded home care services. INTERPRETATION:Patients and caregivers from across Ontario noted a range of issues affecting their experience transitioning from hospital to home, particularly the quality and sufficiency of publicly funded home care. Our findings will be used to inform a provincial quality standard on the transition from hospital to home. Copyright 2020, Joule Inc. or its licensors.
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