Patient engagement in the development of best practices for transitions from hospital to home: a scoping review

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Abstract

Objectives

To explore the extent of patient engagement in the development of best practice reports related to transitions from hospital to home.

Design

Scoping review.

Data sources

Electronic databases (MEDLINE, EMBASE, CINAHL, Scopus, Trip Database, DynaMed Plus and Public Health Plus) and multiple provincial regulatory agency and healthcare organisation websites.

Eligibility criteria

We included best practice reports related to the transition from hospital to a long-term care facility, community dwelling or rehabilitation centre. We included documents disseminated in English between 1947 and 2019.

Data extraction and synthesis

Two independent reviewers screened for eligibility and one extracted and analysed data using a data extraction tool we developed based on established patient engagement frameworks. Only records actively engaging patients were analysed (n=11). The methodological quality of actively engaging patients was assessed using domain 2 (item 5) of stakeholder involvement from the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.

Results

The search yielded 1921 citations of which 23 met the inclusion criteria and were included for narrative synthesis. These were disseminated between 1995 and 2019, with 18 (78%) published after 2010. Most were conducted in North America (USA 43%, Canada 22%), Europe (UK 30%) and Australia (4%). Eleven (48%) actively involved patients, of which only two involved patients across all stages of development. Most involved patients through direct or indirect consultation. The mean AGREE II domain 2 item 5 score (of those that actively engaged patients) was 5.9 out of 7.

Conclusions

Only half of existing best practice reports related to the transition from hospital to home actively involved patients in report development. However, the extent of patient engagement has been increasing over time. More organisations should strive to engage patients throughout the best practice development process and provide patients with opportunities for shared leadership.

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Most cited references 29

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AGREE II: advancing guideline development, reporting and evaluation in health care.

M. Brouwers, M E Kho, G P Browman … (2010)

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Patient engagement in research: a systematic review

Juan Pablo Domecq, Gabriela Prutsky, Tarig Elraiyah … (2014)

Background A compelling ethical rationale supports patient engagement in healthcare research. It is also assumed that patient engagement will lead to research findings that are more pertinent to patients’ concerns and dilemmas. However; it is unclear how to best conduct this process. In this systematic review we aimed to answer 4 key questions: what are the best ways to identify patient representatives? How to engage them in designing and conducting research? What are the observed benefits of patient engagement? What are the harms and barriers of patient engagement? Methods We searched MEDLINE, EMBASE, PsycInfo, Cochrane, EBSCO, CINAHL, SCOPUS, Web of Science, Business Search Premier, Academic Search Premier and Google Scholar. Included studies were published in English, of any size or design that described engaging patients or their surrogates in research design. We conducted an environmental scan of the grey literature and consulted with experts and patients. Data were analyzed using a non-quantitative, meta-narrative approach. Results We included 142 studies that described a spectrum of engagement. In general, engagement was feasible in most settings and most commonly done in the beginning of research (agenda setting and protocol development) and less commonly during the execution and translation of research. We found no comparative analytic studies to recommend a particular method. Patient engagement increased study enrollment rates and aided researchers in securing funding, designing study protocols and choosing relevant outcomes. The most commonly cited challenges were related to logistics (extra time and funding needed for engagement) and to an overarching worry of a tokenistic engagement. Conclusions Patient engagement in healthcare research is likely feasible in many settings. However, this engagement comes at a cost and can become tokenistic. Research dedicated to identifying the best methods to achieve engagement is lacking and clearly needed.

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The care span: The importance of transitional care in achieving health reform.

Andrew Olds, Karen Hirschman, Mary Naylor … (2011)

Under the Affordable Care Act of 2010, a variety of transitional care programs and services have been established to improve quality and reduce costs. These programs help hospitalized patients with complex chronic conditions-often the most vulnerable-transfer in a safe and timely manner from one level of care to another or from one type of care setting to another. We conducted a systematic review of the research literature and summarized twenty-one randomized clinical trials of transitional care interventions targeting chronically ill adults. We identified nine interventions that demonstrated positive effects on measures related to hospital readmissions-a key focus of health reform. Most of the interventions led to reductions in readmissions through at least thirty days after discharge. Many of the successful interventions shared similar features, such as assigning a nurse as the clinical manager or leader of care and including in-person home visits to discharged patients. Based on these findings, we recommend several strategies to guide the implementation of transitional care under the Affordable Care Act, such as encouraging the adoption of the most effective interventions through such programs as the Community-Based Care Transitions Program and Medicare shared savings and payment bundling experiments.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2019

Publication date (Electronic): 5 August 2019

Volume: 9

Issue: 8

Electronic Location Identifier: e029693

Affiliations

[1 ] departmentMD Program, Faculty of Medicine , University of Toronto , Toronto, Ontario, Canada

[2 ] departmentQuality Standards, Evidence Development and Standards , Health Quality Ontario , Toronto, Ontario, Canada

[3 ] departmentDepartment of Medicine , University Health Network and University of Toronto , Toronto, Ontario, Canada

[4 ] departmentDepartment of Family and Community Medicine , St. Michael’s Hospital and University of Toronto , Toronto, Ontario, Canada

[5 ] departmentCentre for Urban Health Solutions , Li Ka Shing Knowledge Institute , Toronto, Ontario, Canada

Author notes

[Correspondence to ] Ms Grace Zhao; grace.zhao@ 123456mail.utoronto.ca

Author information

Grace Zhao https://orcid.org/0000-0002-8819-8490

Article

Publisher ID: bmjopen-2019-029693

DOI: 10.1136/bmjopen-2019-029693

PMC ID: 6687029

PubMed ID: 31383707

SO-VID: c9e09292-09a2-43a3-8134-273b4a6d2517

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 6 February 2019

Date revision received : 13 June 2019

Date accepted : 14 June 2019

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ScienceOpen disciplines: Medicine

Keywords: transitions of care,patient engagement,best practices,quality in health care

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ScienceOpen disciplines: Medicine

Keywords: transitions of care, patient engagement, best practices, quality in health care

Patient engagement in the development of best practices for transitions from hospital to home: a scoping review

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Abstract

Objectives

Design

Data sources

Eligibility criteria

Data extraction and synthesis

Results

Conclusions

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Radiology and Natural Language Processing

Most cited references 29

AGREE II: advancing guideline development, reporting and evaluation in health care.

Patient engagement in research: a systematic review

The care span: The importance of transitional care in achieving health reform.

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