期刊论文详细信息
BMC Health Services Research
Improving patient discharge and reducing hospital readmissions by using Intervention Mapping
Hub Wollersheim6  Lisette Schoonhoven6  Basia Kutryba4  Ewa Dudzik-Urbaniak4  Francesco Venneri1,10  Giulio Toccafondi1,10  Rosa Suñol8  Carola Orrego8  Susanne Bergenbrant2  Mariann Olsson5  Gunnar Ön1  Maria Flink5  Cor Kalkman9  Paul Barach3  Myrra Vernooij-Dassen7  Marieke Zegers6  Gijs Hesselink6 
[1]Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
[2]Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
[3]University College Cork, Cork, Ireland
[4]National Center for Quality Assessment in Health Care, Krakow, Poland
[5]Department of Social Work, Karolinska University Hospital, Stockholm, Sweden
[6]Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), 114 IQ healthcare, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
[7]Radboud University Medical Center, Department of Primary Care, Nijmegen, The Netherlands
[8]Avedis Donabedian Institute, Universidad Autónoma de Barcelona, Barcelona, Spain
[9]Patient Safety Center, University Medical Center Utrecht, Utrecht, The Netherlands
[10]Clinical Risk Management and Patient Safety Centre, Tuscany region, Italy
关键词: Adverse events;    Intervention mapping;    Patient readmission;    Patient discharge;    Patient handoff;   
Others  :  1126432
DOI  :  10.1186/1472-6963-14-389
 received in 2014-03-19, accepted in 2014-09-10, published in 14
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【 摘 要 】

Background

There is a growing impetus to reorganize the hospital discharge process to reduce avoidable readmissions and costs. The aim of this study was to provide insight into hospital discharge problems and underlying causes, and to give an overview of solutions that guide providers and policy-makers in improving hospital discharge.

Methods

The Intervention Mapping framework was used. First, a problem analysis studying the scale, causes, and consequences of ineffective hospital discharge was carried out. The analysis was based on primary data from 26 focus group interviews and 321 individual interviews with patients and relatives, and involved hospital and community care providers. Second, improvements in terms of intervention outcomes, performance objectives and change objectives were specified. Third, 220 experts were consulted and a systematic review of effective discharge interventions was carried out to select theory-based methods and practical strategies required to achieve change and better performance.

Results

Ineffective discharge is related to factors at the level of the individual care provider, the patient, the relationship between providers, and the organisational and technical support for care providers. Providers can reduce hospital readmission rates and adverse events by focusing on high-quality discharge information, well-coordinated care, and direct and timely communication with their counterpart colleagues. Patients, or their carers, should participate in the discharge process and be well aware of their health status and treatment. Assessment by hospital care providers whether discharge information is accurate and understood by patients and their community counterparts, are important examples of overcoming identified barriers to effective discharge. Discharge templates, medication reconciliation, a liaison nurse or pharmacist, regular site visits and teach-back are identified as effective and promising strategies to achieve the desired behavioural and environmental change.

Conclusions

This study provides a comprehensive guiding framework for providers and policy-makers to improve patient handover from hospital to primary care.

【 授权许可】

   
2014 Hesselink et al.; licensee BioMed Central Ltd.

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