An integrated hospital-to-home transitional care intervention for older adults with stroke and multimorbidity: A feasibility study

Abstract

Background: Stroke is the leading cause of death and adult disability in Canada. Eighty percent of older adults (≥65 years) who have suffered a stroke will return to their homes, and 60% will require ongoing rehabilitation. The transition between hospital and home is often fragmented, leading to adverse health outcomes, hospital readmissions, and increased health-care costs. This study examined the feasibility of a 6-month integrated transitional care stroke intervention (TCSI), and explored its effects on health outcomes, patient and provider experience, and cost in 30 community-living older adults (≥55 years) with stroke and multimorbidity (≥2 chronic conditions) using outpatient stroke rehabilitation services. Methods: The TCSI is a 6-month intervention delivered by an interprofessional (IP) team (occupational therapist, physiotherapist, speech language pathologist, registered nurse, social worker). It involved care coordination, home visiting, and IP case conferences, supported by a web-based application. A qualitative descriptive approach was used to explore the feasibility of implementing the intervention. A prospective one-group pretest/posttest was used to evaluate the effects of the intervention on health outcomes and use and costs of health services, from baseline to 6 months. Results: Participants had an average of eight comorbid conditions. The intervention was feasible and acceptable to both older adults and providers. From baseline to 6 months, there was no statistically significant difference in health outcomes. However, there was a significant reduction in the total per person use and costs of health services. Conclusions: This study established the feasibility of conducting a larger randomized controlled trial of this intervention.

Inclusion of Older Adults in Digital Health Technologies to Support Hospital-to-Home Transitions: Secondary Analysis of a Rapid Review and Equity-Informed Recommendations

“…The search process is outlined in Figure 1 . A total of 16 studies were conducted in Europe [ 79 - 94 ], 12 were conducted in North America [ 3 , 73 , 95 - 105 ], 3 in Asia [ 106 - 108 ], and 2 in Australia [ 109 , 110 ]. Multimedia Appendix 1 shows the distribution of studies based on location.…”

“…In addition, of 34 studies, 1 (n=1, 3%) study used qualitative methodology [ 111 ], 1 (n=1, 3%) study was a report [ 98 ], and another used a case study design (n=1, 3%) [ 81 ]. A total of 9% (n=3) of studies used a mixed methods methodology [ 3 , 87 , 96 ], whereas the remaining studies (28/34, 82%) used a quantitative methodological approach. Of the 28 quantitative studies, 8 (n=8, 28%) used a randomized controlled trial design [ 89 , 90 , 97 , 101 , 106 , 107 , 109 , 110 ].…”

“…A total of 7 studies reported smaller sample sizes because of particular inclusion and exclusion criteria and limitations of the interventions (eg, dropouts) [ 3 , 87 , 90 , 91 , 100 , 102 , 105 ]. However, a small sample size was a deliberate choice for scholars in 2 studies [ 3 , 100 ].…”

“…Multimedia Appendix 2 [ 3 , 83 - 94 , 100 - 103 , 105 - 108 , 110 , 111 ] summarizes the breadth of the methodological characteristics, aims of the studies, and a brief description of the digital interventions in detail. Briefly, web-based, tablet, and mobile app tools are the most common means of delivering digital interventions [ 3 , 83 - 94 , 100 - 103 , 105 - 108 , 110 , 111 ]. Electronic health records and databases [ 79 , 81 , 95 , 97 , 98 , 102 , 104 ] have been widely used for digital innovation.…”

“…Transitioning across health care settings is a complex experience for older adults and their caregivers [ 1 , 2 ]. Older adults [ 3 ] and family caregivers (ie, family members, friends, or neighbors) who provide unpaid assistance or care to someone living with an injury, disability, or illness [ 4 ] frequently experience unmet care needs as the patients leave the hospital and transition to home [ 5 - 10 ]. Transitions in care are often more difficult for older adults who experience frequent hospitalizations and are often discharged with ongoing and complex care needs exceeding those that existed at the initial hospitalization [ 11 , 12 ].…”