Exploring the complexities involved in bridging the gap between hospital and community care for older people

O'Connell Francischetto, Elaine (2022). Exploring the complexities involved in bridging the gap between hospital and community care for older people. University of Birmingham. Ph.D.

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Abstract

Introduction: The UK has an ageing population and there is an increasing need for additional care and support services for older patients discharged from hospital. Despite a large evidence base on different discharge services, there are inconsistent findings on their effectiveness and a lack of research on factors that impact service implementation. This research: identified different types of discharge interventions and evaluated the impact of these discharge interventions on older people leaving hospital to aid the understanding of factors that impact implementation into practice.

Methods: This convergent parallel mixed method research has two main methods: a systematic review of reviews and a qualitative case study (comprising a stakeholder mapping exercise and semi-structured interviews with service stakeholders). For the review, ten databases were searched for discharge intervention for people aged over 60 using multiple key search terms related to ‘systematic reviews’, ‘older people’ and ‘discharge’. Outcomes of interest included mortality, readmissions, length of hospital stay, patient health status and costs. A narrative data synthesis was conducted. The case study of a supported integrated hospital discharge service involved, process mapping to understand the service from different perspectives alongside qualitative interviews to explore stakeholders’ experiences. Semi-structured interviews were undertaken with service staff (hospital, community and social care), patients and carers. Data were analysed using thematic analysis and by generating/reviewing process maps. The two elements of the case study were triangulated using an implementation framework.

Results: As part of the review, 8,748 title and abstracts were reviewed and 859 full texts were assessed for eligibility. Of these, 91 were taken forward to quality assessment and 66 reviews were included in the final synthesis. As part of the case study, staff in a variety of roles (n=14), patients (n=11) and their informal carers (n=4) were interviewed. The evidence included in the review highlighted that: readmissions and length of hospital stay could be significantly reduced, costs reduced and patient health significantly improved by elements of discharge services (e.g. patient assessments and discharge planning) but there was no impact on mortality. The case study found that providing transitional support in the gap between hospital and community care was important, along with equipment aids and collaborative working across health, community, and social care (including admission prevention services). A number of factors should be considered when implementing discharge services, including service (and resource) coordination and access to records across key partners, identifying development needs of staff and ensuring regular data collection, monitoring and review.

Conclusions: This study has identified multiple types and formats of discharge support for older people. The findings deepen the understanding of the impact of discharge services, key stakeholders and outcomes. The findings from this research provide practical insights to help inform the design and delivery of discharge services and the direction of future research.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):