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      An alternate level of care plan: Co‐designing components of an intervention with patients, caregivers and providers to address delayed hospital discharge challenges

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          Abstract

          Objective

          To engage with patients, caregivers and care providers to co‐design components of an intervention that aims to improve delayed hospital discharge experiences.

          Design

          This is a qualitative study, which entailed working groups and co‐design sessions utilizing World Café and deliberative dialogue techniques to continually refine the intervention.

          Setting and Participants

          Our team engaged with 61 participants (patients, caregivers and care providers) in urban and rural communities across Ontario, Canada. A 7‐member Patient and Caregiver Advisory Council participated in all stages of the research.

          Results

          Key challenges experienced during a delayed discharge by patients, caregivers and care providers were poor communication and a lack of care services. Participants recommended a communication guide to support on‐going conversation between care providers, patients and caregivers. The guide included key topics to cover and questions to ask during initial and on‐going conversations to manage expectations and better understand the priorities and goals of patients and caregivers. Service recommendations included getting out of bed and dressed each day, addressing the psycho‐social needs of patients through tailored activities and having a storyboard at the bedside to facilitate on‐going engagement.

          Discussion and Conclusions

          Our findings outline ways to meaningfully engage patients and caregivers during a delayed hospital discharge. Combining this with a minimal basket of services can potentially facilitate a better care experience and outcomes for patients, their care providers and families.

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          Most cited references54

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          Shared Decision Making: A Model for Clinical Practice

          The principles of shared decision making are well documented but there is a lack of guidance about how to accomplish the approach in routine clinical practice. Our aim here is to translate existing conceptual descriptions into a three-step model that is practical, easy to remember, and can act as a guide to skill development. Achieving shared decision making depends on building a good relationship in the clinical encounter so that information is shared and patients are supported to deliberate and express their preferences and views during the decision making process. To accomplish these tasks, we propose a model of how to do shared decision making that is based on choice, option and decision talk. The model has three steps: a) introducing choice, b) describing options, often by integrating the use of patient decision support, and c) helping patients explore preferences and make decisions. This model rests on supporting a process of deliberation, and on understanding that decisions should be influenced by exploring and respecting “what matters most” to patients as individuals, and that this exploration in turn depends on them developing informed preferences.
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            A systematic review of evidence on the links between patient experience and clinical safety and effectiveness

            Objective To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. Design Systematic review. Setting A wide range of settings within primary and secondary care including hospitals and primary care centres. Participants A wide range of demographic groups and age groups. Primary and secondary outcome measures A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. Results This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. Conclusions The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the ‘real’ clinical work of measuring safety and effectiveness.
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              Engaging patients to improve quality of care: a systematic review

              Background To identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services. Methods We searched MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, PsychINFO, Social Science Abstracts, EBSCO, and ISI Web of Science from 1990 to 2016 for empirical studies addressing the active participation of patients, caregivers, or families in the design, delivery and evaluation of health services to improve quality of care. Thematic analysis was used to identify (1) strategies and contextual factors that enable optimal engagement of patients, (2) outcomes of patient engagement, and (3) patients’ experiences of being engaged. Results Forty-eight studies were included. Strategies and contextual factors that enable patient engagement were thematically grouped and related to techniques to enhance design, recruitment, involvement and leadership action, and those aimed to creating a receptive context. Reported outcomes ranged from educational or tool development and informed policy or planning documents (discrete products) to enhanced care processes or service delivery and governance (care process or structural outcomes). The level of engagement appears to influence the outcomes of service redesign—discrete products largely derived from low-level engagement (consultative unidirectional feedback)—whereas care process or structural outcomes mainly derived from high-level engagement (co-design or partnership strategies). A minority of studies formally evaluated patients’ experiences of the engagement process (n = 12; 25%). While most experiences were positive—increased self-esteem, feeling empowered, or independent—some patients sought greater involvement and felt that their involvement was important but tokenistic, especially when their requests were denied or decisions had already been made. Conclusions Patient engagement can inform patient and provider education and policies, as well as enhance service delivery and governance. Additional evidence is needed to understand patients’ experiences of the engagement process and whether these outcomes translate into improved quality of care. Registration N/A (data extraction completed prior to registration on PROSPERO). Electronic supplementary material The online version of this article (10.1186/s13012-018-0784-z) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Kerry.Kuluski@thp.ca
                Journal
                Health Expect
                Health Expect
                10.1111/(ISSN)1369-7625
                HEX
                Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
                John Wiley and Sons Inc. (Hoboken )
                1369-6513
                1369-7625
                30 June 2020
                October 2020
                : 23
                : 5 ( doiID: 10.1111/hex.v23.5 )
                : 1155-1165
                Affiliations
                [ 1 ] Institute for Better Health Trillium Health Partners Mississauga ON Canada
                [ 2 ] Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health Toronto ON Canada
                [ 3 ] Leslie Dan Faculty of Pharmacy University of Toronto Toronto ON Canada
                [ 4 ] Rehabilitative Care Alliance / GTA Rehab Network / Toronto ABI Network Toronto ON Canada
                [ 5 ] Edson College of Nursing and Health Innovation Arizona State University Tempe AZ USA
                Author notes
                [*] [* ] Correspondence

                Kerry Kuluski, Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada.

                Email: Kerry.Kuluski@ 123456thp.ca

                Author information
                https://orcid.org/0000-0002-6377-6653
                https://orcid.org/0000-0002-0730-5742
                https://orcid.org/0000-0002-9552-9139
                Article
                HEX13094
                10.1111/hex.13094
                7696114
                32602628
                9db68b41-0175-4d8f-bbd2-4a635197c024
                © 2020 The Authors Health Expectations published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 March 2020
                : 13 May 2020
                : 07 June 2020
                Page count
                Figures: 0, Tables: 3, Pages: 11, Words: 8972
                Funding
                Funded by: Canadian Institutes of Health Research: , open-funder-registry 10.13039/501100000037;
                Award ID: 157054
                Funded by: Ontario Strategy for Patient Oriented Research (SPOR) SUPPORT Unit EMPOWER Award
                Funded by: Sinai Health System
                Funded by: Toronto‐Central Local Health Integration Network
                Categories
                Original Research Paper
                Original Research Papers
                Custom metadata
                2.0
                October 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.4 mode:remove_FC converted:28.11.2020

                Health & Social care
                canada,co‐design,delayed hospital discharge,patient engagement,qualitative,transitions in care

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