Improving patient discharge and reducing hospital readmissions by using Intervention Mapping
Hesselink, Gijs (Radboud University Medical Center)
Zegers, M. (Radboud University Medical Center)
Vernooij-Dassen, M. (Radboud University Medical Center)
Barach, Paul (University College Cork)
Kalkman, Cor (University Medical Center Utrecht)
Flink, M. (Karolinska University Hospital and Karolinska Institutet (Suècia))
Öhlén, G. (Karolinska University Hospital and Karolinska Institutet (Suècia))
Olsson, M. (Karolinska University Hospital and Karolinska Institutet (Suècia))
Bergenbrant, S. (Karolinska University Hospital and Karolinska Institutet (Suècia))
Orrego, Carola (Universitat Autònoma de Barcelona. Institut Universitari Avedis Donabedian)
Suñol Sala, Rosa (Universitat Autònoma de Barcelona. Institut Universitari Avedis Donabedian)
Toccafondi, G. (Clinical Risk Management and Patient Safety Centre (Itàlia))
Venneri, F. (Clinical Risk Management and Patient Safety Centre (Itàlia))
Dudzik-Urbaniak, Ewa (National Center for Quality Assessment in Health Care (Polònia))
Kutryba, Barbara (National Center for Quality Assessment in Health Care (Polònia))
Schoonhoven, L. (Radboud University Medical Center)
Wollersheim, H. (Radboud University Medical Center)

Data:	2014
Resum:	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, wellcoordinated 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.
Ajuts:	European Commission 223409
Nota:	This work was supported by a grant from the European Union, the Framework Programme of the European Commission (FP7-HEALTH-F2-2008-223409)
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	BMC health services research, Vol. 14 (2014) , p. 389, ISSN 1472-6963

DOI: 10.1186/1472-6963-14-389
PMID: 25218406

11 p, 388.6 KB

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