(Boston)– Hospitals are continuously working to improve care transitions, the time when patients are discharged from the hospital and moved to post-acute care facilities or brought home, but there is little known about what patients and caregivers value during this time. For the first time on a large scale, researchers have investigated what patients and caregivers want from providers during a care transition. A new study from Boston Medical Center (BMC) found caring attitudes, accountability from the health system, and continuity of care were the most sought after outcomes.
Researchers, led by Suzanne Mitchell, MD, a family medicine and palliative care physician at BMC, looked at patient and caregiver responses after hospital stays to determine what values and what health services they desired most during the hospital discharge process.
The researchers designed the qualitative study to identify the care transitions outcomes most important to patients and caregivers in a clinical setting. They accomplished this by interviewing 248 patients and caregivers individually and in groups across six U.S. medical centers who had been discharged from a medical setting in the previous 90 days. Using that information, the team created a conceptual model for how care transition services and provider behavior are linked to achieve these outcomes.
Accountability, care continuity and caring attitudes were found to be the most important outcomes for patients and caregivers. When achieved, care was perceived as excellent and trustworthy, but when providers failed to meet these outcomes, care was seen as unsafe or transactional and left patients and caregivers feeling abandoned. Poor outcomes could lead to mistrust, anxiety, and confusion and can precipitate conflict, avoidable health care use and delayed or worse outcomes.
Mitchell, who is also an assistant professor of family medicine at Boston University School of Medicine, believes serious gaps exist between the services needed and the services provided during these transitions, saying "Health systems must learn how to better prepare patients and caregivers for care at home and design accessible channels for ongoing support in order to ensure the journey from hospital to home is safe and supports each person's recovery."
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These findings appear in the Annals of Family Medicine. Funding for the study was supported by the Patient-Centered Outcomes Research Institute (PCORI) Award Contract #TC-1403-14049.
About Boston Medical Center
Boston Medical Center is a private, not-for-profit, 487-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. Boston Medical Center offers specialized care for complex health problems and is a leading research institution, receiving more than $116 million in sponsored research funding in fiscal year 2017. It is the 15th largest recipient of funding in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in the Boston HealthNet – 14 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit http://www.bmc.org.
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