The care delivery experience of hospitalized patients with complex chronic disease

OBJECTIVE: This study investigated what is important in care delivery from the perspective of hospital inpatients with complex chronic disease, a currently understudied population. PARTICIPANTS AND SETTING: One‐on‐one semi‐structured interviews were conducted with inpatients at a continuing care/rehabilitation hospital (n = 116) in Canada between February and July 2011. DESIGN: The study design was mixed methods and reports on patient characteristics and care delivery experiences. Basic descriptive statistics were run using SPSS version 17, and thematic analysis on the transcripts was conducted using NVivo9 software. RESULTS: Patients had an average of 5 morbidities and several illness symptoms including activity of daily living impairments, physical pain and emotional disturbance. Three broad themes (each with one or more subthemes) were generated from the data representing important components of care delivery: components of the care plan (a comprehensive assessment, supported transitions and a bio‐psycho‐social care package); care capacity and quality (optimal staff to patient ratios, quicker response times, better patient–provider communication and consistency between providers) and the patient–provider relationships (characterized by respect and dignity). CONCLUSIONS: As health systems throughout the industrialized world move to sustain health budgets while optimizing quality of care, it is critical to better understand this population, so that appropriate metrics, services and policies can be developed. The study has generated a body of evidence on the important components of care delivery from the perspectives of a diverse group of chronically ill individuals who have spent a considerable amount of time in the health‐care system. Moving forward, exploration around the appropriate funding models and skill mix is needed to move the evidence into changed practice.