Integrated care for older adults transitioning between hospital and the community
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Date
2018-11-05
Authors
Brown, Cara L.
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Abstract
Statement of the problem: Hospital to community transitions for older adults are associated with poor outcomes. Integrated care is a health care approach with the potential to reduce and/or ease these transitions, but there is little empirical evidence on the topic. The objectives of this thesis were to: 1) systematically examine existing literature on this topic; 2) characterize older adults who would most benefit from integrated care to support care transitions; and, 3) explore the feasibility of indicators to measure clinical integrated care delivery for care transitions.
Methods: Objective 1 was achieved with a scoping review. Objectives 2 and 3 were addressed with a retrospective chart review; data were extracted from 214 hospital medical records. For objective 2, personal characteristics were examined in relation to three outcomes representing potentially avoidable health care using multivariate logistic regression. For objective 3, literature on the elements of integrated care was used to develop clinical indicators. Reliable indicators were further explored at an individual and ward level using descriptive and inferential statistics.
Results: The scoping review indicated that there has been little systematic measurement of integrated care. The findings from objective 2 highlighted the population most at risk of institutional use that could be targeted by integrated care initiatives: those with both mental and physical health impairments. Work from objective 3 resulted in 28 clinical integrated care indicators grouped in 4 domains. In the study context, application of integrated care was variable between indicators, as well as at the individual and ward level.
Discussion: This thesis unites three linked bodies of work that contribute to the advancement of knowledge on integrated care for care transitions. It provides: directions for future research through identification of gaps in the literature; identification of populations to target with integrated care; and a framework and indicators for assessing the level of integrated care being applied at the individual level.
Conclusion: This work provides an important knowledge base to understand care transitions through the lens of integrated care for researchers and policymakers seeking to improve the quality of care transitions for older adults with complex care needs.
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Keywords
Social care, Health care, Scoping review, Chart review, Quality Indicators, Discharge planning
Citation
Brown, C.L. & Menec, V. (2018). Integrated care approaches used for transitions from hospital to community care for older adults: A scoping review. Canadian Journal on Aging, 37(2), 145-170. http://dx.doi.org/10.1017/S0714980818000065.
Brown, C.L & Menec, V. (2018). Health, social, and functional characteristics of older adults with continuing care needs: Implications for integrated care. Journal of Aging and Health (Online first). DOI: 10.1177/0898264318759856.
Brown, C.L & Menec, V. (2018). Health, social, and functional characteristics of older adults with continuing care needs: Implications for integrated care. Journal of Aging and Health (Online first). DOI: 10.1177/0898264318759856.