A qualitative study of urban hospital transitional care

Submitted: 5 December 2017
Accepted: 25 April 2018
Published: 31 August 2018
Abstract Views: 2312
PDF: 573
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This study is part of a mixed methods evaluation of a large urban medical center transitional care practice (NMG-TC). The NMG-TC provides integrated physical and behavioral health care for high need patients referred from the hospital emergency department or inpatient units and who lack a usual source of primary care. The study was designed for internal quality improvement and sought to evaluate staff perceptions of successful transitions for their medically and socially complex patients, and alternatively, the obstacles most likely to negatively impact patient outcomes. All 16 NMG-TC patient care staff were interviewed in a collaborative effort to produce empowered testimony that might go beyond expected clinical narratives. The interview schedule included questions on risk stratification, integrated mental health care, provider to provider handoffs, and how staff deal with key social determinates of patients’ health. The constant comparative method was used to deductively derive themes reflecting key domains of transitional care practice. Seven themes emerged: i) the need to quickly assess patient complexity; ii) emphasizing caring for major mental health and substance use issues; iii) obstacles to care for uninsured, often undocumented patients; iv) the intractability of homelessness; v) expertise in advancing patients’ health literacy, engagement and activation; vi) fragmented handoffs from hospital care and vii) to primary care in the community. Respondent stories emphasized methods of nurturing patients’ self-efficacy in a very challenging urban health environment. Findings will be used to conceptualize pragmatic, potentially high-impact transitional care quality improvement initiatives capable of better addressing frequent hospital use.

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Citations

Kim CS, Flanders SA. In the Clinic. Transitions of care. Ann Intern Med. 2013;158(5 Pt 1):ITC3-1. DOI: https://doi.org/10.7326/0003-4819-158-5-201303050-01003
Feinglass J, Mallama CA, Rogers A, Teter C, Hurt C, Schaeffer C. Using hospital use trends to improve transitional care. Healthc (Amst). 2017. DOI: https://doi.org/10.1016/j.hjdsi.2017.08.001
Kuraski KS. Intercoder reliability for validating conclusions Drawn from open-ended interview data Field Methods. 2000;12:172-194. DOI: https://doi.org/10.1177/1525822X0001200301
Kangovi S, Barg FK, Carter T, et al. Challenges faced by patients with low socioeconomic status during the post-hospital transition. J Gen Intern Med. 2014;29(2):283-289. DOI: https://doi.org/10.1007/s11606-013-2571-5
Bergamo C, Juarez-Colunga E, Capp R. Association of mental health disorders and Medicaid with ED admissions for ambulatory care-sensitive condition conditions. Am J Emerg Med. 2016;34(5):820-824. DOI: https://doi.org/10.1016/j.ajem.2016.01.023
Strunin L, Stone M, Jack B. Understanding rehospitalization risk: can hospital discharge be modified to reduce recurrent hospitalization? J Hosp Med. 2007;2(5):297-304. DOI: https://doi.org/10.1002/jhm.206
Kangovi S, Barg FK, Carter T, Long JA, Shannon R, Grande D. Understanding why patients of low socioeconomic status prefer hospitals over ambulatory care. Health Aff (Millwood). 2013;32(7):1196-1203. DOI: https://doi.org/10.1377/hlthaff.2012.0825
Capp R, Misky GJ, Lindrooth RC, et al. Coordination Program Reduced Acute Care Use And Increased Primary Care Visits Among Frequent Emergency Care Users. Health Aff (Millwood). 2017;36(10):1705-1711. DOI: https://doi.org/10.1377/hlthaff.2017.0612
Hengartner MP, Passalacqua S, Heim G, Andreae A, Rossler W, von Wyl A. The Post-Discharge Network Coordination Programme: A Randomized Controlled Trial to Evaluate the Efficacy of an Intervention Aimed at Reducing Rehospitalizations and Improving Mental Health. Front Psychiatry. 2016;7:27. DOI: https://doi.org/10.3389/fpsyt.2016.00027
Shaffer SL, Hutchison SL, Ayers AM, et al. Brief Critical Time Intervention to Reduce Psychiatric Rehospitalization. Psychiatr Serv. 2015;66(11):1155-1161. DOI: https://doi.org/10.1176/appi.ps.201400362
Vigod SN, Kurdyak PA, Dennis CL, et al. Transitional interventions to reduce early psychiatric readmissions in adults: systematic review. Br J Psychiatry. 2013;202(3):187-194. DOI: https://doi.org/10.1192/bjp.bp.112.115030
Lamanna D, Stergiopoulos V, Durbin J, O'Campo P, Poremski D, Tepper J. Promoting continuity of care for homeless adults with unmet health needs: The role of brief interventions. Health Soc Care Community. 2017. DOI: https://doi.org/10.1111/hsc.12461
Billings J, Raven MC. Dispelling an urban legend: frequent emergency department users have substantial burden of disease. Health Aff (Millwood). 2013;32(12):2099-2108. DOI: https://doi.org/10.1377/hlthaff.2012.1276
Anderson GF, Ballreich J, Bleich S, et al. Attributes common to programs that successfully treat high-need, high-cost individuals. Am J Manag Care. 2015;21(11):e597-600.
Boutwell AE, Johnson MB, Watkins R. Analysis of a Social Work-Based Model of Transitional Care to Reduce Hospital Readmissions: Preliminary Data. J Am Geriatr Soc. 2016;64(5):1104-1107. DOI: https://doi.org/10.1111/jgs.14086
Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822-1828. DOI: https://doi.org/10.1001/archinte.166.17.1822
Golden AG, Tewary S, Dang S, Roos BA. Care management's challenges and opportunities to reduce the rapid rehospitalization of frail community-dwelling older adults. Gerontologist. 2010;50(4):451-458. DOI: https://doi.org/10.1093/geront/gnq015
Bindman AB, Blum JD, Kronick R. Medicare's transitional care payment--a step toward the medical home. The New England journal of medicine. 2013;368(8):692-694. DOI: https://doi.org/10.1056/NEJMp1214122
Windh J, Atkins GL, Simon L, Smith L, Tumlinson A. Key Components for Successful LTSS Integration: Lessons from Five Exemplar Plans. In: Alliance L-TQ, ed. Project to Develop the Business Case for LTSS Integration: the SCAN Foundation; 2016:1-127.
Feinglass J, Norman G, Golden RL, Muramatsu N, Gelder M, Cornwell T. Integrating Social Services and Home-Based Primary Care for High-Risk Patients. Popul Health Manag. 2017. DOI: https://doi.org/10.1089/pop.2017.0026

Supporting Agencies

Grant from the Ortho S.A. Sprague Memorial Institute

How to Cite

Feinglass, Joe, Samuel Wein, Caroline Teter, Christine Schaeffer, and Angela Rogers. 2018. “A Qualitative Study of Urban Hospital Transitional Care”. Qualitative Research in Medicine and Healthcare 2 (2). https://doi.org/10.4081/qrmh.2018.7216.