Transitional Care for Improving Health Care Quality in Hospital: A Literature Review
Abstract
The transition of care from hospital to home is a critical period for patients, especially those with chronic conditions such as heart failure. During the transition period, patients often experience difficulties managing their disease, which can lead to an increased risk of rehospitalization. This literature review aims to analyze scientific evidence about the effectiveness of transitional care interventions in improving the quality of health care in hospitals, especially for patients with chronic conditions. The method of this study is a literature review. This study used electronic databases such as PubMed, ScienceDirect and Google Scholar. The selected articles are quantitative research articles published within the last 5 years available in full text and not the result of a review. The results of the review show that transitional care interventions have a significant positive impact on the quality of health care. This intervention can increase self-management, treatment adherence and patient satisfaction with heart failure. Some components of effective interventions include patient education, care coordination, outpatient follow up and social support. Transitional care interventions are an effective strategy to improve the quality of health care, especially in patients with chronic conditions. The implementation of a comprehensive transitional care program in hospitals needs to continue to be improved to achieve optimal results.
References
Albert, N. M., S. Barnason, A. Deswal, A. Hernandez, R. Kociol, E. Lee, S. Paul, C. J. Ryan, dan C. White-Williams. 2015. Transitions of care in heart failure: a scientific statement from the american heart association. Circulation: Heart Failure. 8(2):384–409.
Alcoberro, L., P. Moliner, J. Vime, S. Jiménez-Marrero, A. Garay, S. Yun, A. Pons-Riverola, R. Ramos-Polo, M. Ras-Jiménez, M. Tajes, E. Hidalgo, E. Calero, M. Ruiz, N. José-Bazán, C. Ferre, C. Delso, L. Alcober, C. Enjuanes, dan J. Comin-Colet. 2023. Breaking the 30-day barrier: long-term effectiveness of a nurse-led 7-step transitional intervention program in heart failure. PLoS ONE. 18(2 February):1–15.
Babamohamadi, H., H. Kadkhodaei-Elyaderani, A. Ebrahimian, dan R. Ghorbani. 2020. The effect of spiritual care based on the sound heart model on the spiritual health of patients with acute myocardial infarction. Journal of Religion and Health. 59(5):2638–2653.
Baecker, A., M. Meyers, S. Koyama, M. Taitano, H. Watson, M. Machado, dan H. Q. Nguyen. 2020. Evaluation of a transitional care program after hospitalization for heart failure in an integrated health care system. JAMA Network Open. 3(12):1–12.
Basso, I., E. Bassi, S. Caristia, A. Durante, C. Vairo, S. G. R. Patti, M. Pirisi, M. Campanini, M. Invernizzi, M. Bellan, A. Dal Molin, F. Caldera, D. D’amario, G. Dell’Era, I. Gomez, A. Lazzati, E. Massara, C. Milanese, A. Molon, M. Petteneo, S. Scaramuzzino, C. Torgano, dan P. Zumbo. 2024. A nurse-led coaching intervention with home telemonitoring for patients with heart failure: protocol for a feasibility randomized clinical trial. MethodsX. 13(March)
Blumer, V., A. Gayowsky, F. Xie, S. J. Greene, M. M. Graham, J. A. Ezekowitz, R. Perez, D. T. Ko, L. Thabane, F. Zannad, dan H. G. C. Van Spall. 2021. Effect of patient-centered transitional care services on patient-reported outcomes in heart failure: sex-specific analysis of the pact-hf randomized controlled trial. European Journal of Heart Failure. 23(9):1488–1498.
Coalition for evidence-based policy. 2010. Evidence-Based Reform: Key to major gains in education, economic mobility, crime prevention and other areas of social policy. evidencebasedpolicy.org
Coleman, E. A. dan C. Boult. 2003. Improving the quality of transitional care for persons with complex care needs. Journal of the American Geriatrics Society. 51(4):556–557.
Cui, X., X. Zhou, L. le Ma, T. W. Sun, L. Bishop, F. W. Gardiner, dan L. Wang. 2019. A nurse-led structured education program improves self-management skills and reduces hospital readmissions in patients with chronic heart failure: a randomized and controlled trial in china. Rural and Remote Health. 19(2)
Huynh, Q. L., K. Whitmore, K. Negishi, dan T. H. Marwick. 2019. Influence of risk on reduction of readmission and death by disease management programs in heart failure. Journal of Cardiac Failure. 25(5):330–339.
Ichihara, K., S. Ouchi, S. Okayama, F. Kinoshita, M. Miyashita, T. Morita, dan K. Tamura. 2019. Effectiveness of spiritual care using spiritual pain assessment sheet for advanced cancer patients: a pilot non-randomized controlled trial. Palliative and Supportive Care. 17(1):46–53.
Jepma, P., L. Verweij, B. M. Buurman, M. S. Terbraak, S. Daliri, C. H. M. Latour, G. Ter Riet, F. Karapinar - Çarkit, J. Dekker, J. L. Klunder, S. S. Liem, A. H. M. Moons, R. J. G. Peters, dan W. J. M. Scholte Op Reimer. 2021. The nurse-coordinated cardiac care bridge transitional care programme: a randomised clinical trial. Age and Ageing. 50(6):2105–2115.
Legallois, D., L. Chaufourier, K. Blanchart, J. J. Parienti, A. Belin, P. Milliez, dan R. Sabatier. 2019. Improving quality of care in patients with decompensated acute heart failure using a discharge checklist. Archives of Cardiovascular Diseases. 112(8–9):494–501.
Meleis, A.I., 2010. Transition theory: middle range and situation specific theories in nursing research and practice. Springer publishing company.
Mills, A. A., K. M. Rodeffer, dan S. L. Quick. 2021. Impact of heart failure transitions of care program: a prospective study of heart failure education and patient satisfaction. Hospital Pharmacy. 56(4):252–258.
Mora-López, G., C. Ferré-Grau, dan P. Montesó-Curto. 2016. Analysis of the transition process among family caregivers in a hospital in the region of catalonia in spain. Applied Nursing Research. 29:242–247.
Nakahara-Melo, M., A. P. da Conceição, D. de A. L. M. da Cruz, dan V. A. de A. Püschel. 2022. Transitional care from the hospital to the home in heart failure: implementation of best practices. Revista Brasileira de Enfermagem. 75(1):1–7.
Naylor, M. D., D. A. Brooten, R. L. Campbell, G. Maislin, K. M. McCauley, dan J. S. Schwartz. 2004. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. Journal of the American Geriatrics Society. 52(5):675–684.
Negarandeh, R., M. Zolfaghari, N. Bashi, dan M. Kiarsi. 2019. Evaluating the effect of monitoring through telephone (tele-monitoring) on self-care behaviors and readmission of patients with heart failure after discharge. Applied Clinical Informatics. 10(2):261–268.
Oscalices, M. I. L., M. F. P. Okuno, M. C. B. T. Lopes, C. R. V. Campanharo, dan R. E. A. Batista. 2019. Discharge guidance and telephone follow-up in the therapeutic adherence of heart failure: randomized clinical trial. Revista Latino-Americana de Enfermagem. 27
Prochaska, J. O. dan W. F. Velicer. 1997. The transtheoretical model of health behavior change. American Journal of Health Promotion. 12(1):38–48.
Schnipper, J. L., L. Samal, N. Nolido, C. Yoon, A. K. Dalal, C. Magny-Normilus, A. Bitton, R. Thompson, S. Labonville, dan G. Crevensten. 2021. The effects of a multifaceted intervention to improve care transitions within an accountable care organization: results of a stepped-wedge cluster-randomized trial. Journal of Hospital Medicine. 16(1):15–22.
Somsiri, V., U. Asdornwised, M. O’Connor, S. Suwanugsorn, dan N. Chansatitporn. 2021. Effects of a transitional telehealth program on functional status, rehospitalization, and satisfaction with care in thai patients with heart failure. Home Health Care Management and Practice. 33(2):72–80.
Veenis, J.F., Brugts,J.J. 2020. Remote monitoring of chronic heart failure patients: invasive versus non-invasive tools for optimising patient management. Vol. 28, issue 1: 3-13
Woodall, J., J. South, dan L. Warwick-booth. 2010. Empowerment and health & evidence review. Evidence Review. (September)
Yun, M. R., Song, M., Jung, K. H., Yu, B. J., & Lee, K. J. 2017. The effects of mind subtraction meditation on breast cancer survivors'psychological and spiritual wellbeing and sleep quality. Cancer Nursing, 40(5), 377–385. https://doi.org/10.1097/ NCC.0000000000000443
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