Heterogeneity and misaligned incentives in discharge transition programs: Insights from a multisite rapid qualitative...

Area of Science:

• Healthcare delivery research
• Patient safety initiatives
• Health services research

Background:

• Transitions of care (ToC) programs are crucial for patient safety but exhibit variable success in US hospitals.
• Multimorbidity and health-related social needs (HRSNs) present unique challenges for ToC program implementation.
• Hospitalists are key stakeholders in discharge planning and identify barriers to effective ToC.

Purpose of the Study:

• To investigate hospitalists' views on the successes, failures, and implementation obstacles of ToC programs.
• To understand challenges in transitions from hospital to community settings.

Main Methods:

• A rapid qualitative study design was employed.
• Virtual focus groups were conducted with participants from the Hospital Medicine Reengineering Network (HOMERuN).
• A mixed inductive-deductive framework facilitated data analysis and theme identification.

Main Results:

• Twenty-two hospitalists from 19 organizations participated; no comprehensive ToC programs were universally offered.
• Key themes included: diagnosis-specific programs causing fragmentation, post-discharge follow-up barriers (appointments, insurance, geography), and inadequate attention to patient preferences, HRSNs, health literacy, resources, and leadership.
• Successful programs necessitate institutional commitment, funding, interprofessional collaboration, and community engagement, with a focus on patient-centered care over financial ROI.

Conclusions:

• Current ToC programs are fragmented, compromising safe and equitable patient transitions.
• Addressing HRSNs, securing leadership support, and prioritizing patient-centered care are vital for enhancing ToC outcomes.
• Moving beyond short-term financial goals towards patient well-being is essential for effective transitions of care.