Literature Review: Transition care
Introduction
The term transition of care implies the continuous provision of healthcare services to patient through different settings for instance, from hospital to a nursing home, higher level of care or back to the hospital. Researches have established that poorly managed system of care can expose the patient to health risk, and sometimes accelerate the need for hospital readmission. Several models have come up to explore the concept of transitional of care. Two of such models include The Transitional Care Model or Project BOOST (I) and the handover communication techniques such as SBAR(C). This study reviews three literatures on the two, to synthesize what is known and unknown about the models.
Allen et al (2014) explored the quality of care outcomes during transitional care for older people when patients are moved from hospital to home care. The study found significant gaps in terms of quality, equity, efficiency and effectiveness in symptoms management. Laugalanda, Aase & Barach (2012) reviewed evidence to explore the intervention models that improve patient safety during a case of transitional care. The research discovered that when patients move from one level of care to another under sub-optimal condition, significant risk are involved which might even lead to mortality. Feltner et al, 2014 purposed to explore the effectiveness of transitional care intervention in preventing readmission for patients with heart failure. The research found that heart failure accounts for the greatest proportion of hospital reimbursement in the US; however, hospitals can improve their transition model to reduce maximize patient safety. All the research focused on the effectiveness of care during transition, the studies share a common conclusion that in presence of a transition care model, there is low risk of readmission as compared to handover communication such as SBAR.
Sample Population
Allen et al (2014) used a systematic review of data on the elements that affect the quality of care. The secondary research involved studiesthat evaluated the effectiveness of care in patients older than 60 year living in their home but are in the process of care transition. The information gathered from the identified articles were reviewed by two independent reviewers. Laugalanda, Aase & Barach (2012) did a secondary research by sampling of publication on the different models of transitional care, the publications provides relevant knowledge on the application of the different technique and the outcome. The articles selected were based on evaluation of patients older than 65 years. The results of the findings are presented in a systematic way that shows the structure of each approach and how it can impact care. Feltner et al, 2014 conducted a literature review to answer the research question. The sample sources were gathered from online search in medical databases. The samples consisted of books published not earlier than 2013 and publications were human-only. The sources used consisted publication based on primary research on the implication of different care practices in during transition
Limitations
Allen et al (2014) findings are limited in the sense that data used in answering the research questions were based on secondary information which is liable to biasness. Mistakes in the original research may affect the conclusive remarks. Laugalanda, Aase & Barach (2012) research is based on secondary sources, the research does not document clear eligibility criteria observed in the selection of the sources. In addition, it does compare the different models against each other, the findings presented in the research. There is also the fact that the study does not have a system of eliminating bias and might be flawed by author’s shortcomings; hence, have little credibility and limited application in informed decision making. Feltner et al, 2014 research is based on secondary sources, while the research has measures to reduce the influence of biases, it might be swayed by mistake committed in the original publication. The evidence utilized in the research was sufficient to make conclusive remarks on the research question. Additionally, there was an insufficiency of direct evidence, thus reducing the applicability of the research findings. Many trials utilized in answering the research question had methodological limitation and room for bias which may negatively affect the conclusions. Some of the sources used did not give clear methodology of how the research was conducted. Other limitation included sample size and heterogeneous outcome across the trials.
Conclusion
From the literature review, volumes of research have been done on the effectiveness of different transition models. Most of the research was based on secondary data and there is limited primary research on the subject. Additionally, the majority of researches are reviews of previously documented studies. While the research is majorly secondary in nature, they reveal that readmission rates are directly related to the method of care. Care models that allow for continued contact with the healthcare provider show better results than the handover approach. The fact that most of these researches are based on patient history omits knowledge on what happen during the process and only focus on the outcome. Future research should consider doing primary research on different models to ascertain their effectiveness while still in progress. Factors such as immediate patient feedback, the caregiver takes and the role of environment cues in dictating the outcome can be understood from such investigations. The information gained from the primary research critical knowledge care practices during the process, which is inadequately researched.
References
Allen, J., Hutchinson, A., Brown, R., & Livingston, P. (2014). Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Health Services Research, 14(1). https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-14-346
Feltner, C., Jones, C., Cené, C., Zheng, Z., Sueta, C., & Coker-Schwimmer, E. et al. (2014). Transitional Care Interventions to Prevent Readmissions for Persons With Heart Failure. Annals Of Internal Medicine, 160(11), 774. https://www.ncbi.nlm.nih.gov/books/NBK209233/
Laugalanda, K., Aase, K., & Barach, P. (2012). Interventions to improve patient safety in transitional care – a review of the evidence. Work, 41, 2915-2924. https://www.researchgate.net/publication/224974647_Interventions_to_improve_patient_safety_in_transitional_care_-_a_review_of_evidence
