Conceptualizing Transitional Care After Critical Illness Using Stakeholder Perspectives: A Qualitative Content Analysis

Abstract

Background Over half of critical illness survivors have new or worsened functional impairments. Yet, the United States lacks wide-scale transitional care infrastructure to promote wellbeing and prevent rehospitalization after critical illness. Evidence-based transitional care interventions urgently need to be adapted to address this gap. Thus, as a first step, we engaged diverse stakeholders to describe perspectives on transitional care delivery for critical illness survivors. Methods Qualitative content analysis of interviews with 11 critical illness survivors, 11 family caregivers, ten home health providers, nine primary care physicians and one primary care nurse practitioner; and focus groups with two home health teams, seven groups of inpatient providers and one group of administrators (total n = 69). Data collection took place in Western Pennsylvania between February 2020 and March 2022. We used pilot-tested interview guides to elicit perceived care needs, probing for barriers, facilitators, and social determinants of health. Five trained coders analyzed transcripts. We unified codes into themes and checked accuracy and completeness with participants. Results All stakeholders perceived that survivors’ unmet needs contributed to incomplete or unsatisfactory transitions. They identified barriers and facilitators of care that mapped easily to evidence-based transitional care intervention models. Social determinants of health were omnipresent factors in post-ICU care delivery. The data generated a hypothesis that strengths-based intervention models which target indicators of wellbeing (rather than deficit-based approaches managing symptoms) will improve outcomes among critical illness survivors. An additional hypothesis is that implementation strategies must design for health equity. Conclusions These findings suggest the need to adapt transitional care interventions to better foster wellbeing after critical illness. Six implementation strategies addressing administrative infrastructure and policy relevance (i.e. optimizing: incentives, record systems, quality monitoring, accountability, networking, and funding) could promote wide-scale dissemination of post-ICU transitional care delivery models.