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HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester

A cross-sectoral approach to high quality health care transitions for older people

Alternative title: Vertikal og horisontal samhandling om eldre personer som skrives ut fra sykehus

Awarded: NOK 19.0 mill.

WP 1 consists of 3 PhD projects. Two of the Phd projects will be completed in 2019 in line with the funding plan. One of these two PhD projects is funded by OsloMet, and one by the Research Council. The two PhD projects that will be completed in 2019 have the titles: 1) Nutritional care - older patients, family caregivers and healthcare professionals' perceptions on healthcare delivery: a qualitative study and 2) Patient Participation in Intermediate care services interactions of geriatric patients, their relatives and healthcare Professionals. 4 publications in each of the two PhD thesis With the PhD students as the first author. The third PhD Project funded by NFR will be completed in line with the previously signed agreement. "User perspective on quality in the transitional care for geriatric patients", two articles have been submitted, one is approved for publication and one is under review. In addition, an article will submitted November 2019. The candidates have presented their research at national and international Conferences. They had been invited as key-note speakers for researchers and in the clinic as well as several editions at research.no etc. WP 2 investigates vertical coordination between hospitals and municipal health- and care services in treating older patients. The work package has a particular focus at changes before and after The coordination Reform. Four articles were published in international scientific peer-reviewed journals in 2018. In 2018-2019, the researchers have presented paper on five scientific conferences, given two scientific presentations at Stanford University, and gave five presentations for stakeholders, and communicated findings in 8 national media. In 2018, one of the researches had a brief stay as a visiting scholar at the University of Kent, and another researcher had a one year stay as a visiting scholar at Stanford University (2018-2019). WP3 focusing on horizontal coordination when elderly people move between different municipal care services. In 2019 our focus has been analyzing data; 1) Qualitative analysis of observation and interviews of employees in municipal care services. Based on an Actor Network Theory approach we aim to describe and understand actors and coordination in play when elderly persons move between different care services. 2) Quantitative analysis of data from a questioner, distributed to nurses in care services, focusing on information sharing and actors in care coordination. Finally, we are analyzing register data to investigate care trajectories for elderly persons receiving municipal care services

National health and care reforms during recent years have increased municipalities' responsibility for developing integrated health and care services in collaboration with hospitals as well as individual users. One of the main concerns, a few years after the implementation of the Coordination Reform, is the impact of changed discharge practices for older patients' transition from specialized hospital care to municipal care services, and the potential increased fragmentation of health and care services for this particularly vulnerable group. So far, research on transitional care from hospital to municipal care settings continues to highlight individual patient factors, and fails to include a focus on macro- and meso levels. A study aimed at increased understanding of the role of cross-sectoral factors that constitute barriers for high quality care transitions for older people from hospital to municipal care is thus warranted. We propose an integrated three-way approach in developing a cross-sectoral model on 30-days transitional care in geriatric patients, by assessing (1) user perspectives on quality of transitional care; (2) vertical coordination between hospital and municipal health and care services ; and (3) horizontal coordination in transitional care- within and between municipalities. The empirical analyses will build upon a combination of data sources including register data (NPR, KOSTRA and IPLOS), a survey among nurses and coordinators at hospitals and municipalities, and qualitative interviews with patients, health professionals and municipal managers. Users contribute directly to the project by their involvement in the data collection and sampling of informants, and are represented through a user reference group that gives feedback on the milestones of the project. The project and its consortium will strengthen the foundation for knowledge-based education and professional practice by conducting practice-based and practice-oriented services research.

Publications from Cristin

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HELSEVEL-H-Gode og effektive helse-, omsorgs- og velferdstjenester