Journal article
Impact of Hospital Context on Transitioning Patients From Hospital to Skilled Nursing Facility: A Grounded Theory Study
The Gerontologist, Vol.58(3), pp.521-529
05/08/2018
DOI: 10.1093/geront/gnx012
PMCID: PMC5946923
PMID: 29746689
Abstract
Abstract
Background
Twenty-five percentage of patients who are transferred from hospital settings to skilled nursing facilities (SNFs) are rehospitalized within 30 days. One significant factor in poorly executed transitions is the discharge process used by hospital providers.
Objective
The objective of this study was to examine how health care providers in hospitals transition care from hospital to SNF, what actions they took based on their understanding of transitioning care, and what conditions influence provider behavior.
Design
Qualitative study using grounded dimensional analysis.
Participants
Purposive sample of 64 hospital providers (15 physicians, 31 registered nurses, 8 health unit coordinators, 6 case managers, 4 hospital administrators) from 3 hospitals in Wisconsin.
Approach
Open, axial, and selective coding and constant comparative analysis was used to identify variability and complexity across transitional care practices and model construction to explain transitions from hospital to SNF.
Key Results
Participants described their health care systems as being Integrated or Fragmented. The goal of transition in Integrated Systems was to create a patient-centered approach by soliciting feedback from other disciplines, being accountable for care provided, and bridging care after discharge. In contrast, the goal in Fragmented Systems was to move patients out quickly, resulting in providers working within silos with little thought as to whether or not the next setting could provide for patient care needs. In Fragmented Systems, providers achieved their goal by rushing to complete the discharge plan, ending care at discharge, and limiting access to information postdischarge.
Conclusions
Whether a hospital system is Integrated or Fragmented impacts the transitional care process. Future research should address system level contextual factors when designing interventions to improve transitional care.
Details
- Title: Subtitle
- Impact of Hospital Context on Transitioning Patients From Hospital to Skilled Nursing Facility: A Grounded Theory Study
- Creators
- Barbara J King - University of Wisconsin-Madison School of Nursing, WisconsinAndrea L Gilmore-Bykovskyi - University of Wisconsin-Madison School of Nursing, WisconsinTonya J Roberts - University of Wisconsin-Madison School of Nursing, WisconsinKorey A Kennelty - William S. Middleton Veterans Affairs Hospital, Geriatric Research Education and Clinical Center (GRECC), Madison, WisconsinJacquelyn F Mirr - William S. Middleton Veterans Affairs Hospital, Geriatric Research Education and Clinical Center (GRECC), Madison, WisconsinMichael B Gehring - William S. Middleton Veterans Affairs Hospital, Geriatric Research Education and Clinical Center (GRECC), Madison, WisconsinMelissa N Dattalo - William S. Middleton Veterans Affairs Hospital, Geriatric Research Education and Clinical Center (GRECC), Madison, WisconsinAmy J H Kind - University of Wisconsin-Madison School of Nursing, Wisconsin
- Resource Type
- Journal article
- Publication Details
- The Gerontologist, Vol.58(3), pp.521-529
- DOI
- 10.1093/geront/gnx012
- PMID
- 29746689
- PMCID
- PMC5946923
- NLM abbreviation
- Gerontologist
- ISSN
- 0016-9013
- eISSN
- 1758-5341
- Publisher
- Oxford University Press; US
- Grant note
- 2P50AG033514-06 / National Institute on Aging (10.13039/100000049) GRECC-Manuscript #2015-008 / Madison VA Geriatrics Research, Education and Clinical Center K23AG034551 / National Institute on Aging Beeson Career Development Award National Institute on Aging (10.13039/100000049) The American Federation for Aging Research The Atlantic Philanthropies University of Wisconsin School of Medicine and Public Health The John A. Hartford Foundation Wisconsin Partnership Program University of Wisconsin Hospitals and Clinics The Starr Foundation
- Alternative title
- In This Issue: Mental Health Technology Social Network
- Language
- English
- Date published
- 05/08/2018
- Academic Unit
- Family and Community Medicine; Pharmacy Practice and Science; Injury Prevention Research Center
- Record Identifier
- 9984065321002771
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