Date Published: January 22, 2019
Publisher: Public Library of Science
Author(s): Chantal Backman, Sharon Johnston, Nelly D. Oelke, Katharina Kovacs Burns, Linda Hughes, Wendy Gifford, Jeanie Lacroix, Alan J. Forster, Rosemary Frey.
Research has shown that adverse events during care transitions from hospital to home can have a significant impact on patients’ outcomes, leading to readmission, delayed healing or even death. Gaps exist in the ways of monitoring care during transition periods and there is a need to help organizations better implement and monitor safe person-and family-centered care. Value statements are a way to obtain narratives in lay terms about how well care, treatment and support is organized to meet the needs and preferences of patients/families. The purpose of this study was to identify the value statements that are perceived by decision-makers and patients/families to best signify safe person- and family-centered care during transitions from hospital to home.
Between January and September 2017, a web-based Delphi was used to survey key stakeholders in acute care and home care organizations across Canada.
Decision-makers (n = 22) and patients/families (n = 24) from five provinces participated in the Delphi. Following Round 1, 45 perceived value statements were identified. In Round 2, consensus was received on 33/45 (73.3%) by decision-makers, and 30/45 (66.7%) by patients/families. In Round 3, additional value statements reached consensus in the decision-makers’ survey (3) and in the patients/families’ survey (2). A total of 30 high priority value statements achieved consensus derived from both the decision-makers’ and patients/families’ perspectives.
This study was an important first step in identifying key consensus-based priority value statements for monitoring care transitions from the perspective of both decision-makers and patients/families. Future research is needed to test their usability and to determine whether these value statements are actually suggestive of safe person-and family-centered care transition interventions from hospital to home.
Person- and-family-centered care (PFCC) allows the planning, delivery, and evaluation of health care to be grounded in mutually beneficial partnerships among health care providers, patients, and families. Providers who believe in PFCC will typically develop relationships, communicate, collaborate, share information and engage with patients and their families with regards to health care. Patient and family engagement is fundamental to both a PFCC approach to health delivery as well as to improving overall patient safety in our healthcare system[2–4]. This engagement process is defined as “patients, families, their representatives, and health professionals working in active partnership at various levels across the healthcare system—direct care, organizational design and governance, and policy making—to improve health and health care”, p. 224. It may encompass the complete spectrum of engagement, from understanding patients’ experiences and perspectives with the health system to fully involving patients and families in improving the health of their communities[3,5]. Research shows that patients who are more involved in the decision-making process related to their care are better able to manage complex chronic conditions,[6–8] have reduced anxiety and stress and have shorter lengths of stay in hospital. There is growing consensus that engaging patients and families can improve the quality of their care, particularly when transitioning from hospital to home.
We conducted a three-round, web-based Delphi technique to obtain consensus on potential value statements that best reflect safe person- and family-centered care transitions. We obtained ethics approval for our study from the University of Ottawa Research Ethics Board (uOttawa REB), and the Ottawa Health Science Network Research Ethics Board (OHSN REB).
Twenty-two decision-makers (n = 22) and twenty-four patients/families (n = 24) from five Canadian provinces participated in the Delphi survey. The demographic characteristics of the participants for the three Delphi rounds can be found in Table 2.
This study resulted in a consensus-based list of value statements associated with safe person- and family-centered care transitions from hospital to home, derived from both the decision-makers and patients/families’ perspectives. The high priority value statements which achieved consensus across both patients/families and decision-makers’ groups (n = 30) represent key elements of care transitions that could enable patients as well as decision-makers to determine if their transition was successful or not. These statements are foundational to building a learning system that can grow and improve with each patient care episode. The value statements that reached consensus (>90%) and were important (mean>4.0) in both groups spanned the full transition experience from hospital admission to post-discharge follow up.
The present study was an important first step in identifying key consensus-based priority value statements for monitoring care transitions from hospital to home from the perspective of both the decision-makers and the patients/families. Further research is needed to test their usability and to determine whether these value statements are actually suggestive of safe and effective person- and family-centered care transition interventions from hospital to home.