Design of a tool for transferring patient care from hospital to home in Iran

Abstract

Abstract Introduction: Care transfer is the basic concept for providing quality patient care, continuity of health care and is an integral part of the care path. It is a complex process of evaluating the patient upon admission to the hospital, providing education to the patient, his family, follow-up after discharge and evaluation. Studies show that a major part of the rate of re-hospitalization can be prevented through the model of education, pre-discharge preparations and care provided at home. The transfer of care improves the quality of services, the quality of life of patients and ultimately leads to the improvement of their health. The purpose of this study is to design a care transfer tool for patients from hospital to home in Iran so that care transfer can be organized more coherently using this tool.

Objective: Designing a tool to transfer patient care from hospital to home in Iran.

Methods: The current research was a multi-stage study that used extensive review and qualitative study. At first, extensive scoping review was conducted in the field of identification of tools, methods, challenges and requirements for transfer of patient care from hospital to home in PubMed, Scopus, Science Web of databases, related sites as well as manual search of information sources. The experts were examined using a questionnaire and the primary tool was developed by the research team. In the final phase of the validation of the initial tool using the Delphi technique and a panel of experts who were selected through the snowball sampling method and their final comments regarding the proposed tool were applied and the tool was finalized.

Results: Research findings show that there are 8 models for the implementation of care transfer process in the world, 5 models are designed for the elderly and 3 models for chronic patients. The tools needed to transfer care are 3 categories, which include patient awareness measurement, process control, and medication management, each of which includes subcategories. As the tool for measuring the level of patient awareness includes the subcategory of discharge and patient risk assessment, process control includes the review of care transfer methods and the necessary coordination checklist, and drug management also includes the subcategory of drug control and drug problems. Discharge components also include physical, mental and health literacy assessment of the patient. Transfer requirements include five themes (education, collaboration and communication coordination, improving the quality of care transfer, planning and policy making, and use of information technology) and 39 subcategories. The identified challenges are also categorized into five main categories, including challenges of the institution, treatment staff, transfer process, insurance and other challenges. In Nizamand's review, practical solutions for implementing and improving care transfer including planning and policy making, treatment follow-up, training, collaboration, communication and needs assessment were presented. The findings of the interview with the experts have classified the transfer challenges into four main categories: systemic, infrastructural, cultural-social barriers, and behavioral-psychological barriers, as well as the requirements into four main categories including process, infrastructural, incentive and supervision. In the following, the designed tool has examined all the required items in a proper care transfer model in three phases before transfer, during transfer and after transfer through 44 information items.

Conclusion: The tool designed in this research is based on the review of texts, views and experiences of people involved and experts in this process (experts in the field of care and care transfer). Evaluating the level of readiness of the transferring organization, the receiving organization of the patient and the patient himself as well as all the people involved in the transfer of care can be done well using this tool. This tool can monitor the level of readiness of all items involved in the transfer of care and inform the transferors of possible problems and challenges. Considering the major weaknesses in the care transfer process, the use of such tools can give a more structured form to this process and also improve the efficiency and productivity of people and organizations involved in care transfer by using it correctly. The results of this study can provide a care tool for hospitals and medical centers and lead to the coherence of providing services for discharged patients, improving the quality of services provided to patients, reducing re-visits, improving the condition of patients, and satisfying patients and their families. Also, designing a specific tool for these services can help policymakers and health system managers in making decisions and provide a suitable platform for improving the quality and quantity of hospital services for patients discharged home.