Improving the transition from hospital to home for older adults
In Canada, health services used by older adults and their caregivers involve an array of public and private services including home and community-based services, acute care and primary care along with social services.
These services tend to operate in ‘silos’ independent of each other. Often, older adults and their caregivers are required to navigate within and between these services to sustain their health, yet they experience inherent challenges in doing so which are detrimental to themselves and the healthcare system. Transitional care programs ensure the coordination and continuity of healthcare for people with complex health problems. Research evidence existed that examined many outcomes of transitional care programs, but our team identified a need to systematically examine the research evidence to inform healthcare decision makers about the further development of these programs.
In 2015, Dr Lori Weeks was sponsored by the School of Nursing at Dalhousie University to complete the JBI Comprehensive Systematic Review Training Program. During that program, Dr Weeks began developing a systematic review protocol focused on transitional care programs. She led a team to complete the JBI systematic review that was published in 2018: The impact of transitional care programs on health services utilization in community-dwelling older adults.
The results of this systematic review provided evidence about the impact of these programs on healthcare utilisation. The research team identified four major conclusions through completing this systematic review.
1. Transitional care programs reduce rehospitalisation rates over time, with the largest effects seen at 30 days.
2. Transitional care programs may increase the utilisation of primary care services and thus have a favourable impact on preventative care.
3. Transitional care programs may reduce home healthcare usage.
4. Transitional care programs of one month or less appear to be as effective as longer interventions in reducing hospital usage.
Dr Weeks was invited to share the results of the systematic review to several groups, including a group developing a provincial senior’s strategy; staff working in a provincial health authority; and practitioners, academics and students at a geriatric medicine seminar, and a webinar to the Canadian College of Health Leaders.
The systematic review directly contributed to the development of a current research study funded by the Nova Scotia Health Research Foundation (now Research Nova Scotia) 'Hospital to Home (H2H): Supporting the Transition from Hospital to Home for Older Adults.' The completed systematic review also helped to gain a great deal of support from healthcare decision makers in the province. For example, key team members identified the results of our systematic review as evidence for supporting further research on improving the transition from hospital to home. In her letter of support for our grant, Susan Stevens, Senior Director of Continuing Care, Nova Scotia Health, wrote:
"I am excited about the opportunity to build on the findings of their recent systematic review related to the impact of transitional care on health system utilization. Working together we can make important and far-reaching changes to health care delivery in our province for this vulnerable group of citizens and their families… This research couldn’t come at a better time to inform planning and service delivery work underway… we have prioritized work in both acute care and continuing care to improve the quality of care and experience of care for frail older adults."
The acute care partner in this study is a hospital in Nova Scotia. This hospital serves a high number of older adults, many of whom wait for various periods of time in hospital after they are medically discharged. A key issue identified was to identify how to increase the number of older adults who are able to successfully transition from hospital back to their own homes with enhanced supports instead of moving to a long-term care home. Thus, we endeavoured to identify factors that contribute to older adult patients being assessed as requiring long-term care when they could potentially return home with enhanced supports.
We interviewed three local older adult patients, their family or friend caregivers, and healthcare professionals. Our results showed that home care services for older adults are often being sought too late, after hospital re-admission, or a rapid decline in health status when family caregivers are already experiencing caregiver burnout. This research further emphasised the need for transitional care programs to reduce healthcare costs and improve the delivery and quality of home care services to better support older adult patients and their family or friend caregivers and to ensure hospitalised older adults are not unnecessarily admitted to nursing homes. Additional knowledge about transitional care programs in Canada was desired by members of our team working in the health care system.
While completing the systematic review was extremely beneficial in synthesising knowledge about the impact of transitional care programs on health system utilisation, the team learned little about transitional care programs in Canada as only two of the included studies in the systematic review were conducted in Canada. This led the team to conduct an exploratory study, using funds received from the Nursing Research and Development Fund, Dalhousie University, to gain an in-depth understanding of transitional care programs across Canada by selecting a small number of exemplar transitional care programs and describing how each program functions to support older adults and their caregivers.
The results of this study of 10 transitional care programs highlighted key facilitators and barriers that will contribute to the further development of transitional care; for example, a key facilitator identified was interprofessional collaboration across care settings, and a key barrier was the lack of health system infrastructure to support tele-homecare and electronic medical records.
"Our team recently developed a lay summary of our findings and is distributing it widely, including to our partners in the health system working in continuing care and acute care", says Dr Weeks.
Based on feedback from our partners in the health system who wanted to know more about transitional care programs across Canada that are not represented in published studies, we are currently developing the protocol to conduct a national systematic review of grey literature. The results of this JBI systematic review will provide detailed information about the similarities and differences in how transitional care programs are being implemented, their barriers and facilitators, and outcomes on older adults, their caregivers, and the healthcare system. The results of this systematic review will provide important information that will help to inform the development of transitional care in our province, the country, and in other countries who can adapt the findings to their own contexts.
Further Resouces
JBI Comprehensive Systematic Review Training Program
Lori E. Weeks, Marilyn Macdonald, Ruth Martin-Misener, Elaine Moody, Brittany Barber
School of Nursing, Dalhousie University, Halifax, NS, Canada
Lori E. Weeks, Marilyn Macdonald and Ruth Martin-Misene
Elaine Moody and Brittany Barber
Disclaimer
Republished with permission from World Evidence-Based Healthcare Day
https://worldebhcday.org/stories/story?ebhc_impact_story_id=78