Implementation, spread and impact of the Patient Oriented Discharge Summary (PODS) across Ontario hospitals: a mixed methods evaluation

BMC Health Services Research

George Tomlinson¹  John Matelski²  Audrey Chaput³  Betty Oldershaw⁴  Chaim Bell⁵  Murray Krahn⁶  Ann Turcotte⁷  Sheila Hogan⁸  Shoshana Hahn-Goldberg⁹  Tai Huynh⁹  Howard Abrams⁹  Craig Madho⁹  Christine Ferguson^1,10  Connie Free^1,11  Bonnie Nicholas^1,12  Karen Okrainec^1,13  Valeria Rac^1,13 

[1] Biostatistics Research Unit, University Health Network, Toronto, Canada;Biostatistics Research Unity, University Health Network, Toronto, Canada;Caregiver Advisor, University Health Network, Toronto, Canada;Chatham Kent Health Alliance, Chatham, Canada;Department of Medicine, Sinai Health System, Toronto, Canada;Faculty of Medicine, University of Toronto, Toronto, Canada;London Health Sciences Centre, London, Canada;Markham Stouffville Hospital, Markham, Canada;OpenLab, University Health Network, Toronto, Canada;Renfrew Victoria Hospital, Renfrew, Canada;St. Josephs General Hospital Elliot Lake, Elliot Lake, Canada;Thunder Bay Regional Health Sciences Centre, Thunder Bay, Canada;Toronto General Hospital Research Institute, University Health Network, Toronto, Canada;

关键词: Implementation;    Discharge;    Patient Centred;    Transitions in care;    Local adaptability;    Triangulation;    Patient experience;    Quality improvement;    Hospital;   

DOI  :  10.1186/s12913-021-06374-8

来源: Springer

【 摘 要 】

BackgroundTraditional discharge processes lack a patient-centred focus. This project studied the implementation and effectiveness of an individualized discharge tool across Ontario hospitals. The Patient Oriented Discharge Summary (PODS) is an individualized discharge tool with guidelines that was co-designed with patients and families to enable a patient-centred process.MethodsTwenty one acute-care and rehabilitation hospitals in Ontario, Canada engaged in a community of practice and worked over a period of 18 months to implement PODS. An effectiveness-implementation hybrid design using a triangulation approach was used with hospital-collected data, patient and provider surveys, and interviews of project teams. Key outcomes included: penetration and fidelity of the intervention, change in patient-centred processes, patient and provider satisfaction and experience, and healthcare utilization. Statistical methods included linear mixed effects models and generalized estimating equations.ResultsOf 65,221 discharges across hospitals, 41,884 patients (64%) received a PODS. There was variation in reach and implementation pattern between sites, though none of the between site covariates was significantly associated with implementation success. Both high participation in the community of practice and high fidelity were associated with higher penetration. PODS improved family involvement during discharge teaching (7% increase, p = 0.026), use of teach-back (11% increase, p < 0.001) and discussion of help needed (6% increase, p = 0.041). Although unscheduled healthcare utilization decreased with PODS implementation, it was not statistically significant.ConclusionsThis project highlighted the system-wide adaptability and ease of implementing PODS across multiple patient groups and hospital settings. PODS demonstrated an improvement in patient-centred discharge processes linked to quality standards and health outcomes. A community of practice and high quality content may be needed for successful implementation.

【 授权许可】

CC BY