How Do Care Transitions Work
Unraveling the Working Mechanisms of Care Transition Interventions
Bibliographic Data
| ID | 9097962 |
|---|---|
| Authors | Dorien L M Zwart (Harkness Fellowship Program in Health Care Policy and Practice, The Commonwealth Fund, New York, NY), Dorien Zwart (0000-0003-0098-4882, Harvard University, corresponding author), Jeffrey L Schnipper (0000-0001-7072-0781, Harvard Medical School, Boston, MA), Debbie Vermond (0000-0002-9552-2340, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands), David W Bates (0000-0001-5440-6039, Harvard Medical School, Boston, MA) |
| Year | 2021 |
| Volume | 59 |
| Issue | Suppl 4 |
| Pages | S387-S397 |
| Publication date | 2021-08-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0000000000001581 |
| PMID | 34228021 |
| OpenAlex | W3177873229 |
| Language | EN |
| Citations received | 4 |
| References cited | 35 |
BACKGROUND: Failure of safe care transitions after hospital discharge results in unnecessary worsening of symptoms, extended period of illness or readmission to the hospital. OBJECTIVE: The objective of this study was to add to the understanding of the working of care transition interventions between hospital and home through unraveling the contextual elements and mechanisms that may have played a role in the success of these interventions, and by developing a conceptual model of how these components relate to each other. RESEARCH DESIGN: This was a qualitative study using in-person, semi-structured interviews, based on realist evaluation methods. SUBJECTS: A total of 26 researchers, designers, administrators, and/or practitioners of both current "leading" care transitions interventions and of less successful care transition intervention studies or practices. MEASURES: The contextual elements and working mechanisms of the different care transition intervention studies or practices. RESULTS: Three main contextual factors (internal environment, external environment, and patient population) and 7 working mechanisms (simplifiying, verifiying, connecting, translating, coaching, monitoring, and anticipating) were found to be relevant to the outcome of care transition interventions. Context, Intervention, Mechanism, and Outcome (CIMO) configurations revealed that, in response to these contextual factors, care transition interventions triggered one or several of the mechanisms, in turn generating outcomes, including a safer care transition. CONCLUSION: We developed a conceptual model which explains the working of care transition interventions within different contexts, and believe it can help support future successful implementation of care transition interventions
Coaching · Context (archaeology) · Health care · Intervention (counseling) · Political science · Psychological intervention · Psychotherapist · Qualitative research · SAFER · Sociology · Transition (genetics) · Transitional care · Chronic Disease Management Strategies · Computer Science · Heart Failure Treatment and Management · Hospital Admissions and Outcomes · Medicine · Nursing · Psychology
Exploring Patient and Caregiver Work and Continuity of Care During Hospital‐to‐Home Transitions of Care in the Canadian Context
Caregiver Engagement Enhances Outcomes Among Randomized Control Trials of Transitional Care Interventions
Patient-Centered Approaches to Transitional Care Research and Implementation
Transição e continuidade do cuidado do pós-alta hospitalar à atenção primária
Risk Prediction Models for Hospital Readmission
The Care Transitions Intervention
Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians
Fostering implementation of health services research findings into practice
Consolidated criteria for reporting qualitative research (Coreq)
Developing and evaluating complex interventions
On the Reliability of Unitizing Continuous Data
Qualitative Data Analysis for Health Services Research
Coding In-depth Semistructured Interviews
| Citations per year | 0.8 |
|---|---|
| Citation span | 2021 - 2026 (6) |
| Highly cited | No |