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Barriers and Facilitators to Best Practices in Microtransitions in Care in Post-acute and Long-Term Care: A
Aval-Na'Ree S Green1, Sing T Palat2, Kenneth S Boockvar3
1Department of Medicine, Baylor Scott and White Health, Central Texas Division, Temple, TX, USA; Department of Medicine, Baylor College of Medicine, Temple, TX, USA; Texas A&M University Health Science System College of Medicine, College Station, TX, USA.
Objectives:
Microtransitions are brief, nonurgent transitions in care, such as room changes, recreational outings, and outpatient medical visits. Microtransitions occur at least as frequently as major transitions (eg, hospitalizations, discharges, etc.) and carry similar risks for adverse clinical outcomes if not properly managed. Post-acute and long-term care (PALTC) staff may be challenged to implement certain best practice recommendations for microtransitions. The objective of this study was to explore barriers and facilitators to successful execution of these recommendations in PALTC.
Design:
Mixed-methods study.
Setting And Participants:
A total of 39 panelists from the PALTmed modified Delphi study on best practices for microtransitions in care.
Methods:
Through 3 surveys and a focus group, panelists described implementation of best practice recommendations for microtransitions within PALTC settings. Panelist feedback was thematically analyzed to identify barriers and facilitators of successful microtransitions at patient, staff, and systems levels. Panelists' views on regulations related to microtransitions were explored using content analysis and a four-question quantitative survey.
Results:
Patient-level themes included safety and resident rights. Panelists emphasized that many microtransition-related standards of care are inconsistently implemented. Staff-level themes included burden, importance of communication, and training. Systems-level themes included staffing, regulation, material resource, and liability concerns, as well as "already standard of care." Most panelists agreed that microtransition needs vary by facility characteristics and patient-specific needs and would not benefit from federal (71.4%) or state regulations (74.3%). There was consensus (91.4%) that regularly updated best-practice recommendations are advisable.
Conclusions And Implications:
The care coordination required for successful execution of a microtransition is complex. Using best practice recommendations during microtransitions for PALTC residents may mitigate adverse event risk. However, ethical, liability, and regulatory barriers may limit effective implementation. Regulations around microtransitions may do more harm than good when it comes to improving patient care. Future research on interventions to facilitate adoption of best practices are needed.
Insights
Implementing best practices for microtransitions in post-acute and long-term care (PALTC) is complex. Barriers include staff burden and regulatory concerns, hindering patient safety during care transitions.
Area of Science:
- Healthcare Management
- Patient Safety
- Gerontology
Background:
- Microtransitions, brief care changes, occur frequently in post-acute and long-term care (PALTC).
- These transitions pose risks similar to major ones if not managed properly.
- PALTC staff face challenges implementing best practices for microtransitions.
Purpose of the Study:
- To explore barriers and facilitators to implementing best practice recommendations for microtransitions in PALTC.
- To identify patient, staff, and systems-level factors influencing microtransition success.
Main Methods:
- Mixed-methods study involving 39 panelists from a modified Delphi study.
- Data collected through 3 surveys and a focus group.
- Thematic analysis of feedback for barriers/facilitators; content analysis and survey for regulatory views.
Main Results:
- Patient-level themes: safety, resident rights. Staff-level themes: burden, communication, training.
- Systems-level themes: staffing, regulation, resources, liability.
- Most panelists found federal/state regulations unnecessary but favored updated best-practice recommendations.
Conclusions:
- Successful microtransition execution requires complex care coordination.
- Best practices can mitigate risks, but ethical, liability, and regulatory barriers exist.
- Current regulations may impede rather than improve patient care; further research on interventions is needed.
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