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Evaluations of postoperative transitions in care for older adults: a scoping review

BACKGROUND: Most people having major surgery are over the age of 65. The transition out of hospital is a vulnerable time for older adults, particularly after major surgery. Research on postoperative transitions in care is growing, but it is not clear how postoperative transitions are being evaluated...

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Autores principales: Hladkowicz, Emily, Dumitrascu, Flavia, Auais, Mohammad, Beck, Andrew, Davis, Sascha, McIsaac, Daniel I., Miller, Jordan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9013054/
https://www.ncbi.nlm.nih.gov/pubmed/35428193
http://dx.doi.org/10.1186/s12877-022-02989-6
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author Hladkowicz, Emily
Dumitrascu, Flavia
Auais, Mohammad
Beck, Andrew
Davis, Sascha
McIsaac, Daniel I.
Miller, Jordan
author_facet Hladkowicz, Emily
Dumitrascu, Flavia
Auais, Mohammad
Beck, Andrew
Davis, Sascha
McIsaac, Daniel I.
Miller, Jordan
author_sort Hladkowicz, Emily
collection PubMed
description BACKGROUND: Most people having major surgery are over the age of 65. The transition out of hospital is a vulnerable time for older adults, particularly after major surgery. Research on postoperative transitions in care is growing, but it is not clear how postoperative transitions are being evaluated. The objective of this scoping review was to synthesize processes and outcomes used to evaluate postoperative transitions in care for older adults. METHODS: We conducted a scoping review that included articles evaluating a postoperative transition in care among adults aged > 65 having major elective surgery. We searched Medline (Ovid), EMBASE (Ovid), CINHAL, and Cochrane Central Register of Controlled Trials (CENTRAL) from their respective inception dates to April 6, 2021. We also searched The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov from their respective inception dates to April 6, 2021. Screening and data extraction was completed by reviewers in duplicate. Data relevant to study design and objective, intervention description, and process or outcome evaluations were extracted. Process evaluations were categorized using the Ideal Transitions in Care Framework, and outcome evaluations were categorized using the Institute for Healthcare Improvement Triple Aim Framework. RESULTS: After screening titles and abstracts and full-text article review, we included 20 articles in our final synthesis. There was variability in the processes and outcomes used to evaluate postoperative transitions in care. The most common outcomes evaluated were health service utilization (n = 9), including readmission and Emergency Department visits, experiential outcomes (n = 9) and quality of life (n = 7). Process evaluations included evaluating the education provided to patients to promote self-management (n = 6), coordination of care among team members (n = 3) and outpatient follow-up (n = 3). Only two articles measured frailty, one article used theory to guide their evaluations and no articles engaged knowledge users. CONCLUSIONS: There is inconsistency in how postoperative transitions in care were evaluated. There is a need to use theories and to engage key stakeholders involved in postoperative transitions in care, including older adults and their caregivers, to identify the most appropriate approaches for developing and evaluating interventions to meaningfully improve care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-02989-6.
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spelling pubmed-90130542022-04-17 Evaluations of postoperative transitions in care for older adults: a scoping review Hladkowicz, Emily Dumitrascu, Flavia Auais, Mohammad Beck, Andrew Davis, Sascha McIsaac, Daniel I. Miller, Jordan BMC Geriatr Research BACKGROUND: Most people having major surgery are over the age of 65. The transition out of hospital is a vulnerable time for older adults, particularly after major surgery. Research on postoperative transitions in care is growing, but it is not clear how postoperative transitions are being evaluated. The objective of this scoping review was to synthesize processes and outcomes used to evaluate postoperative transitions in care for older adults. METHODS: We conducted a scoping review that included articles evaluating a postoperative transition in care among adults aged > 65 having major elective surgery. We searched Medline (Ovid), EMBASE (Ovid), CINHAL, and Cochrane Central Register of Controlled Trials (CENTRAL) from their respective inception dates to April 6, 2021. We also searched The World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov from their respective inception dates to April 6, 2021. Screening and data extraction was completed by reviewers in duplicate. Data relevant to study design and objective, intervention description, and process or outcome evaluations were extracted. Process evaluations were categorized using the Ideal Transitions in Care Framework, and outcome evaluations were categorized using the Institute for Healthcare Improvement Triple Aim Framework. RESULTS: After screening titles and abstracts and full-text article review, we included 20 articles in our final synthesis. There was variability in the processes and outcomes used to evaluate postoperative transitions in care. The most common outcomes evaluated were health service utilization (n = 9), including readmission and Emergency Department visits, experiential outcomes (n = 9) and quality of life (n = 7). Process evaluations included evaluating the education provided to patients to promote self-management (n = 6), coordination of care among team members (n = 3) and outpatient follow-up (n = 3). Only two articles measured frailty, one article used theory to guide their evaluations and no articles engaged knowledge users. CONCLUSIONS: There is inconsistency in how postoperative transitions in care were evaluated. There is a need to use theories and to engage key stakeholders involved in postoperative transitions in care, including older adults and their caregivers, to identify the most appropriate approaches for developing and evaluating interventions to meaningfully improve care. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12877-022-02989-6. BioMed Central 2022-04-15 /pmc/articles/PMC9013054/ /pubmed/35428193 http://dx.doi.org/10.1186/s12877-022-02989-6 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/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/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://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
Hladkowicz, Emily
Dumitrascu, Flavia
Auais, Mohammad
Beck, Andrew
Davis, Sascha
McIsaac, Daniel I.
Miller, Jordan
Evaluations of postoperative transitions in care for older adults: a scoping review
title Evaluations of postoperative transitions in care for older adults: a scoping review
title_full Evaluations of postoperative transitions in care for older adults: a scoping review
title_fullStr Evaluations of postoperative transitions in care for older adults: a scoping review
title_full_unstemmed Evaluations of postoperative transitions in care for older adults: a scoping review
title_short Evaluations of postoperative transitions in care for older adults: a scoping review
title_sort evaluations of postoperative transitions in care for older adults: a scoping review
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9013054/
https://www.ncbi.nlm.nih.gov/pubmed/35428193
http://dx.doi.org/10.1186/s12877-022-02989-6
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