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Reconceptualizing children's complex discharge with health systems theory: novel integrative review with embedded
Jane Noyes1, Maria Brenner, Patricia Fox
1Centre for Health-Related Research, School of Healthcare Sciences, Bangor University, UK.
Insights
Developing a health systems model for children with complex needs is crucial for successful hospital-to-home transitions. This review identifies seven critical factors for effective discharge planning and integrated care pathways.
Area of Science:
- Health Systems Science
- Pediatric Healthcare Management
- Transition of Care
Background:
- Children with complex healthcare needs often face prolonged, ineffective hospital discharge processes.
- Extended hospitalization offers no benefits and poses significant risks to children.
- A lack of research hinders intervention development and health system-wide process evaluation.
Purpose of the Study:
- To develop a health systems model for the successful transition of children with complex healthcare needs from hospital to home.
- To address the limitations of current nurse-led discharge processes.
Main Methods:
- A novel mixed-method integrative review informed by health systems theory.
- Data sources included CINAHL, PsychInfo, EMBASE, PubMed, citation searching, and expert consultation.
- Framework synthesis and iterative theory development were employed.
Main Results:
- Seven critical factors were identified across five health system levels, explaining successful discharge.
- An integrated care pathway with a dynamic communication loop is essential for effective discharge.
- Current health system responses are often static, lacking critical success factors and leading to ineffectual discharge.
Conclusions:
- A novel, evidence-based model reconceptualizes discharge as a complex, longitudinal health system intervention.
- This model contributes significantly to global knowledge for practice development in pediatric care transitions.
- Further research is needed for process/outcome measures and trials of integrated health system discharge models.
Aim:
To report a novel review to develop a health systems model of successful transition of children with complex healthcare needs from hospital to home.
Background:
Children with complex healthcare needs commonly experience an expensive, ineffectual and prolonged nurse-led discharge process. Children gain no benefit from prolonged hospitalization and are exposed to significant harm. Research to enable intervention development and process evaluation across the entire health system is lacking.
Design:
Novel mixed-method integrative review informed by health systems theory. DATA
Sources:
CINAHL, PsychInfo, EMBASE, PubMed, citation searching, personal contact. REVIEW
Methods:
Informed by consultation with experts. English language studies, opinion/discussion papers reporting research, best practice and experiences of children, parents and healthcare professionals and purposively selected policies/guidelines from 2002-December 2012 were abstracted using Framework synthesis, followed by iterative theory development.
Results:
Seven critical factors derived from thirty-four sources across five health system levels explained successful discharge (new programme theory). All seven factors are required in an integrated care pathway, with a dynamic communication loop to facilitate effective discharge (new programme logic). Current health system responses were frequently static and critical success factors were commonly absent, thereby explaining ineffectual discharge.
Conclusion:
The novel evidence-based model, which reconceptualizes 'discharge' as a highly complex longitudinal health system intervention, makes a significant contribution to global knowledge to drive practice development. Research is required to develop process and outcome measures at different time points in the discharge process and future trials are needed to determine the effectiveness of integrated health system discharge models.
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