Category: Geriatric Rehabilitation; Health Services Research; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective : To compare transitions in care for patients with hip fracture in two contrasting health jurisdictions in Ontario, Canada.
Design : A qualitative multiple-case study.
Setting : The North East local health integration network (LHIN) health region and the Mississauga-Halton LHIN in Ontario, Canada.
Participants (or Animals, Specimens, Cadavers) : Qualitative interviews were conducted with hip fracture patients, their caregivers, clinicians and decision-makers in both LHINs. When possible, patients and caregivers were followed through their care journey by sequential interviews.
Interventions : Not applicable.
Main Outcome Measure(s) : Experiences of key stakeholders in transitions of care through the health care journey for individuals with hip fractures.
Results : 36 interviews were conducted: 23 with patients and caregivers and 13 with decision-makers and clinicians. Five main themes have been identified: 1) overall uncertainty about future care journey; 2) disruptive nature of injury and sudden instability; 3) caregiver involvement is critical but overlooked by system; 4) delayed discharge/waiting for rehabilitation beds; 5) care pathways often not following hip fracture guidelines/best practices.
Conclusions : Participants in both jurisdictions experienced similar challenges; however, the barriers and enabling factors that influenced optimal care transitions were unique to the local health system. This suggests that solutions and strategies to optimize transitions for these patients should be jurisdiction-specific at the individual, community and system levels.
Sara Guilcher– Assistant Professor, University of Toronto, Toronto, Ontario
Amanda Everall– Research Officer, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
Walter Wodchis– Professor (Tenure), University of Toronto, Toronto, Ontario
Joanna deGraaf-Dunlop– QI Specialist, Health Quality Ontario, Toronto, Ontario
Stacey Bar-Ziv– Manager, Quality Improvement Program Delivery, Health Quality Ontario Assistant Professor, University of Toronto, Faculty of Medicine, Dept of Pediatrics, Toronto, Ontario
Kerry Kuluski– Scientist and Assistant Professor, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario