Key Care Provision Aspects That Affect Care Transition in the Long-Term Care Systems: Preliminary Review Findings

Wieczorek, Estera; Kocot, Ewa; Evers, Silvia M. A. A.; Sowada, Christoph; Pavlova, Milena

doi:10.3390/ijerph19116402

Cited by 2 publications

(1 citation statement)

References 36 publications

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“…Although multiple transitions may be indicative of the heterogeneity of needs associated with neurological disability [52,53], nonetheless, this picture warrants further consideration of the nature of transitions and how these might afect recovery and outcomes. For example, more transitions can increase the likelihood of adverse events [54,55], contribute to suboptimal or fragmented care [56], and undermine person-centred pathways. Tese impacts may be exacerbated if systems themselves are segmented and convoluted as the Australian health care system arguably is.…”

Section: Discussionmentioning

confidence: 99%

Care Transitions for People with Acquired Neurological Disability in the First 12 Months following Inpatient Rehabilitation: Health Service Use and Obstacles

Xie,

Nielsen,

Kendall

et al. 2023

Health & Social Care in the Community

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Due to their complex and fluctuating needs requiring multiple transitions of care through different services and systems, the early postdischarge period is one of the vulnerabilities for people with acquired neurological disability. This study aimed to (1) map and examine system-level care transitions, including change in transition patterns and service use among people with acquired neurological disability during the first 12 months postdischarge and (2) explore the relationship between early perceptions (3 months postdischarge) of obstacles and difficulty with health service access to the pattern of care transitions. From July 2019 to March 2020, this study recruited 93 participants with acquired neurological disability resulting from acquired brain (44%) or spinal cord injury (56%) from a tertiary hospital in Queensland, Australia. Data linkage methods were used to capture system-level care transitions as movements between three levels of health care: primary, specialist, and emergency care. Health service use during care transitions was also characterised. Standardised questionnaires were used to measure obstacles and difficulty accessing health services in relation to transportation, finance, and resource availability at 3 months postdischarge. The median number of care transitions was 8 (range: 0–47), and the most frequent category of care transition pattern was where participants transit between all levels of care: primary, specialist, and emergency (n = 51/93, 54.8%). However, the frequency, direction, and sequence of transitions between different levels of care were diverse amongst participants. Most participants used primary (96%) and specialist (97%) services, while 59% used emergency services. Overall, postdischarge care transitions were common and highly variable for people with acquired neurological disability. Early perceptions of transportation being an obstacle to service access was a marginally significant contributor ( p = 0.051 ) to more care transitions. Further research to delineate the characteristics and complications of care transitions and service use will aid in developing more personalised, coordinated postdischarge trajectories.

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Section: Discussionmentioning

confidence: 99%

Care Transitions for People with Acquired Neurological Disability in the First 12 Months following Inpatient Rehabilitation: Health Service Use and Obstacles

Xie,

Nielsen,

Kendall

et al. 2023

Health & Social Care in the Community

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Development of a tool for assessing the performance of long-term care systems in relation to care transition: Transitional Care Assessment Tool in Long-Term Care (TCAT-LTC)

Wieczorek,

Kocot,

Evers

et al. 2023

BMC Geriatr

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Background Improving the quality and safety of care transitions is a priority in many countries. Carrying out performance measurements play a significant role in improving quality of decisions undertaken by different actors involved in reforms. Therefore, the main objective of this paper is to present the development of an evaluation tool for assessing the performance of long-term care systems in relation to care transition, namely the Transitional Care Assessment Tool in Long-Term Care (TCAT-LTC). This study is performed as part of a larger European TRANS-SENIOR project. Methods The development of the TCAT-LTC involved three steps. First, we developed a conceptual model based on Donabedian’s quality framework and literature review. Second, we carried out a thorough process of item pool generation using deductive (systematic literature review) and deductive-inductive methods (in-depth interviews) with experts in the field of long-term care. Third, we conducted preliminary validation of the tool by asking experts in research and practice to provide an opinion on a tool and to assess content validity. Future fourth step will involve a tool’s pilot with country experts from Germany, the Netherlands and Poland. Results By applying methodological triangulation, we developed the TCAT-LTC, which consists of 2 themes, 12 categories and 63 items. Themes include organizational and financial aspects. Organizational aspects include categories such as communication, transfer of information, availability and coordination of resources, training and education of staff, education/support of the patient/informal caregiver, involvement of the patient/informal caregiver, telemedicine and e-Health, and social care. Financial aspects include categories such as primary care, hospital, and long-term care. We also present the instructions on the application of the TCAT-LTC. Conclusions In this paper, we presented the development of the TCAT-LTC evaluation tool for assessing the performance of long-term care systems in relation to care transition. The TCAT-LTC is the first tool to assess the performance of long-term care systems in relation to care transition. Assessments can be carried out at the national and international level and enable to monitor, evaluate, and compare performance of the long-term care systems in relation to care transition within and across countries.

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Key Care Provision Aspects That Affect Care Transition in the Long-Term Care Systems: Preliminary Review Findings

Cited by 2 publications

References 36 publications

Care Transitions for People with Acquired Neurological Disability in the First 12 Months following Inpatient Rehabilitation: Health Service Use and Obstacles

Care Transitions for People with Acquired Neurological Disability in the First 12 Months following Inpatient Rehabilitation: Health Service Use and Obstacles

Development of a tool for assessing the performance of long-term care systems in relation to care transition: Transitional Care Assessment Tool in Long-Term Care (TCAT-LTC)

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