Executive summary on Adjustments to Transitions in Health Care Delivery

March 6, 2022

Executive summary on Adjustments to Transitions in Health Care Delivery

Executive summary on Adjustments to Transitions in Health Care Delivery

Executive summary on Adjustments to Transitions in Health Care Delivery

Write a brief, 2-page executive summary of the impact of the transition from volume-based to value-based health care. Specifically, address how this change in reimbursement methodology impacts operational requirements and how it can be implemented. Recommend at least two adjustments to operations which may position the organization for success under value-based health care.

Care transitions between health care settings are known to be hazardous. Twenty percent of patients develop an adverse event after discharge, that is, injury due to patient care, resulting in unnecessary worsening of symptoms, extended period of illness, or even readmission to the hospital.1–3 Failure of safe care transitions between settings is associated with untimely or insufficient communication regarding the current state of the patient’s health status or treatment plan with the next care clinician(s) or with the patient and any caregivers, and by insufficient follow-up and lack of communication with the patient, caregivers, and next care clinician(s) about care goals, developments to be expected and next steps in care (ie, comprehensive advance care planning).4–6

To target these safety problems with care transitions, many interventions have been developed in the past decade.7 Also, health care policy measures, such as readmission penalties for hospitals in the United States and innovation programs for care transitions were created to stimulate the health care system to improve the quality and safety of care transitions.8,9 Yet, although some trials have shown significant success of individual care transition interventions,10–12 scaling these appears to be laborious, and outcomes remain suboptimal.13,14 Indeed, the variability seen with implementing a care transition intervention in different environments, that is in different contexts, has consequences for its ability to improve outcomes.

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Such impact of context on the working of an intervention is well known for complex interventions, which are interventions composed

Executive summary on Adjustments to Transitions in Health Care Delivery

Executive summary on Adjustments to Transitions in Health Care Delivery

of interacting components.15 They are typically delivered by individuals, aimed at patient or clinician behavior, are dependent on intervention fidelity, and lead to heterogeneity across time and place and causal complexity.16 Care transition interventions (CTIs) between primary and secondary care represent particularly complex interventions because they inherently overarch different care settings, often contain bundles of several intervention components7,17 and usually include different organizational levels and several health care disciplines.

A better understanding of the contextual factors and working mechanisms of such complex CTIs may provide insight to understanding the inconsistent results of studies conducted to date, but they have not been systematically described. A realist approach for evaluating complex interventions describes how interventions might work differently in different contexts. In response to these different contexts, interventions trigger working mechanisms that generate outcomes.18 In this approach, it is not merely the intervention itself that generates the outcome, but rather the way in which the context shapes and responds to the intervention. Pawson and Tilly describe this thinking in terms of different components: context (C) + mechanism (M)=outcome (O), or, considering the centrality of (care transition) interventions in the current study, an extended version of the CMO configuration: the CIMO (Context-Intervention-Mechanism-Outcome) configuration. Disentangling the discrete components (the C, I, M, and O) will improve understanding of the working of CTIs in different contexts as it allows researchers to understand “what works for whom in what circumstances.”

This study aims to develop an understanding of the working of CTIs between hospital and home. Much has been written on specific components of CTIs (including complexity/medication management, care continuity, patient engagement, and caregiver education) and the outcomes that are used to evaluate them (including adherence and management, patient safety, clinician experience and costs) already, so the focus is on finding the (C)ontext elements and (M)echanisms that may have played a role in current CTIs.19,20 For this, we interviewed experts on CTI research and/or implementation in the United States. We report factors on the (C)ontext and (M)echanisms predominantly, along with some illustrative CIMO configurations to understand how (I)nterventions trigger (M)echanisms in response to the (C)ontext in order to achieve (O)utcomes, and a conceptual model of how these components relate to each other generally.

 

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Posted in nursing by Clarissa