Hospital to home care-transitions : Qualitative study of stakeholders' priorities and challenges

Care transitions (CT's) are a public health issue, especially for the elderly, because they are a prevalent, possibly epidemic cause of medical errors impacting patient morbidity, mortality, and costs. Yet different stakeholders lack common definitions concerning central aspects of CT's. This study examined how varied groups define the process itself, how their definitions of problems converge and differ and the implications of the situation.

A snowball sample of stakeholders chosen by type underwent a semi-structured interview which was qualitatively analyzed for themes and intergroup differences. Stakeholders interviewed included 8 administrators, 13 physicians, 7 nurses, 4 social workers, 6 patients, and 7 experts.

CT's definitions differed by stakeholder group. Hospital administrators focused on organizational problems and financial incentives, physicians on communication failures and team management, nurses on discharge, social workers on insurance coverage and psycho-social issues, patients on difficulty understanding the many different jargon-laden languages.

Common problems and barriers included communication, discharge process, psycho-social issues and insurance coverage. No global shared analysis about principal reasons of poor transitions emerged even among the same team.

Limitations : This was a heuristic study with a limited sample.

Care transitions are a key area to focus on to improve public health outcomes related to care processes. Stakeholders differing definitions and perceptions may limit their ability to use quick fixes to fix CT's. All agree on that communication, discharge process and money isses contribute to the current chaos. Future needs include standards for research, meta-analyses, and an indexed warehouse of current projects.