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Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis

BACKGROUND: Older adults hospitalized following a fall often encounter preventable adverse events when transitioning from hospital to home. Discharge planning interventions developed to prevent these events do not all produce the expected effects to the same extent. This realist synthesis aimed to b...

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Autores principales: Provencher, Véronique, D’Amours, Monia, Menear, Matthew, Obradovic, Natasa, Veillette, Nathalie, Sirois, Marie-Josée, Kergoat, Marie-Jeanne
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844968/
https://www.ncbi.nlm.nih.gov/pubmed/33514326
http://dx.doi.org/10.1186/s12877-020-01980-3
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author Provencher, Véronique
D’Amours, Monia
Menear, Matthew
Obradovic, Natasa
Veillette, Nathalie
Sirois, Marie-Josée
Kergoat, Marie-Jeanne
author_facet Provencher, Véronique
D’Amours, Monia
Menear, Matthew
Obradovic, Natasa
Veillette, Nathalie
Sirois, Marie-Josée
Kergoat, Marie-Jeanne
author_sort Provencher, Véronique
collection PubMed
description BACKGROUND: Older adults hospitalized following a fall often encounter preventable adverse events when transitioning from hospital to home. Discharge planning interventions developed to prevent these events do not all produce the expected effects to the same extent. This realist synthesis aimed to better understand when, where, for whom, why and how the components of these interventions produce positive outcomes. METHODS: Nine indexed databases were searched to identify scientific papers and grey literature on discharge planning interventions for older adults (65+) hospitalized following a fall. Manual searches were also conducted. Documents were selected based on relevance and rigor. Two reviewers extracted and compiled data regarding intervention components, contextual factors, underlying mechanisms and positive outcomes. Preliminary theories were then formulated based on an iterative synthesis process. RESULTS: Twenty-one documents were included in the synthesis. Four Intervention-Context-Mechanism-Outcome configurations were developed as preliminary theories, based on the following intervention components: 1) Increase two-way communication between healthcare providers and patients/caregivers using a family-centered approach; 2) Foster interprofessional communication within and across healthcare settings through both standardized and unofficial information exchange; 3) Provide patients/caregivers with individually tailored fall prevention education; and 4) Designate a coordinator to manage discharge planning. These components should be implemented from patient admission to return home and be supported at the organizational level (contexts) to trigger knowledge, understanding and trust of patients/caregivers, adjusted expectations, reduced family stress, and sustained engagement of families and professionals (mechanisms). These optimal conditions improve patient satisfaction, recovery, functional status and continuity of care, and reduce hospital readmissions and fall risk (outcomes). CONCLUSIONS: Since transitions are critical points with potential communication gaps, coordinated interventions are vital to support a safe return home for older adults hospitalized following a fall. Considering the organizational challenges, simple tools such as pictograms and drawings, combined with computer-based communication channels, may optimize discharge interventions based on frail patients’ needs, habits and values. Empirically testing our preliminary theories will help to develop effective interventions throughout the continuum of transitional care to enhance patients’ health and reduce the economic burden of avoidable care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-020-01980-3.
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spelling pubmed-78449682021-02-01 Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis Provencher, Véronique D’Amours, Monia Menear, Matthew Obradovic, Natasa Veillette, Nathalie Sirois, Marie-Josée Kergoat, Marie-Jeanne BMC Geriatr Research Article BACKGROUND: Older adults hospitalized following a fall often encounter preventable adverse events when transitioning from hospital to home. Discharge planning interventions developed to prevent these events do not all produce the expected effects to the same extent. This realist synthesis aimed to better understand when, where, for whom, why and how the components of these interventions produce positive outcomes. METHODS: Nine indexed databases were searched to identify scientific papers and grey literature on discharge planning interventions for older adults (65+) hospitalized following a fall. Manual searches were also conducted. Documents were selected based on relevance and rigor. Two reviewers extracted and compiled data regarding intervention components, contextual factors, underlying mechanisms and positive outcomes. Preliminary theories were then formulated based on an iterative synthesis process. RESULTS: Twenty-one documents were included in the synthesis. Four Intervention-Context-Mechanism-Outcome configurations were developed as preliminary theories, based on the following intervention components: 1) Increase two-way communication between healthcare providers and patients/caregivers using a family-centered approach; 2) Foster interprofessional communication within and across healthcare settings through both standardized and unofficial information exchange; 3) Provide patients/caregivers with individually tailored fall prevention education; and 4) Designate a coordinator to manage discharge planning. These components should be implemented from patient admission to return home and be supported at the organizational level (contexts) to trigger knowledge, understanding and trust of patients/caregivers, adjusted expectations, reduced family stress, and sustained engagement of families and professionals (mechanisms). These optimal conditions improve patient satisfaction, recovery, functional status and continuity of care, and reduce hospital readmissions and fall risk (outcomes). CONCLUSIONS: Since transitions are critical points with potential communication gaps, coordinated interventions are vital to support a safe return home for older adults hospitalized following a fall. Considering the organizational challenges, simple tools such as pictograms and drawings, combined with computer-based communication channels, may optimize discharge interventions based on frail patients’ needs, habits and values. Empirically testing our preliminary theories will help to develop effective interventions throughout the continuum of transitional care to enhance patients’ health and reduce the economic burden of avoidable care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-020-01980-3. BioMed Central 2021-01-29 /pmc/articles/PMC7844968/ /pubmed/33514326 http://dx.doi.org/10.1186/s12877-020-01980-3 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Provencher, Véronique
D’Amours, Monia
Menear, Matthew
Obradovic, Natasa
Veillette, Nathalie
Sirois, Marie-Josée
Kergoat, Marie-Jeanne
Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis
title Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis
title_full Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis
title_fullStr Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis
title_full_unstemmed Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis
title_short Understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis
title_sort understanding the positive outcomes of discharge planning interventions for older adults hospitalized following a fall: a realist synthesis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844968/
https://www.ncbi.nlm.nih.gov/pubmed/33514326
http://dx.doi.org/10.1186/s12877-020-01980-3
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