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Substudy 15 Fact Sheet
An Analysis of Blockage to the Effective Transfer of Clients from
Acute Care to Home Care (NA101-15)
Canadian Policy Research Networks Inc., Ottawa
This project is one of fifteen sub-studies of the National Evaluation
of the Cost Effectiveness of Home Care Project (NA101). As hospitals are
subjected to financial pressures, early discharge policies, emergency
backlogs, and admission waiting lists, quality home care becomes critically
important. This has put pressure on the home care system as a whole and
in particular on the discharge relationships and processes between the
two sectors. This study was designed to identify the key problems or blockages
in this process by investigating how roles, relationships and structural
boundaries between the home care and hospital sectors affect patient discharge.
Interviews and focus groups were conducted with hospital and home care
practitioners in seven jurisdictions in Canada. These included care providers
and managers, community representatives, and administrators. As well,
the study was informed by an Expert Panel, representing a range of professions,
organizations and interests.
The project leaders identified a range of barriers that impeded effective
patient discharge. These included:
- systems barriers relating to definitions of roles and responsibilities,
and the scheduling, availability and assignment of human resources;
- family/caregiver/patient barriers relating to resistance to change,
lack of education/awareness of benefits of early discharge, and lack
of family or caregiver capacity to provide support to discharged patients;
- geographic barriers relating to rural access to services, supports,
equipment and supplies. Interjurisdictional barriers were also evident
in "out of region" patient discharge.
Systems management and control, resources and constant system change
were also identified as issues.
The project leaders indicated that their findings are important because,
in their view, lack of system resources is a significant barrier to more
effective discharge. Cost shifting between acute care and home care sectors
is also complicating the relationship, as is cost shifting between long
term care home supports to acute care home care supports. This is anticipated
to lead to greater demand on acute and institutional care, and to competition
for resources within the community sector. The community sector in general
is not resourced to support increasing numbers of post-acute patients
discharged from hospital. Finally, costs are shifting to the patient and
caregivers as the types and hours of service are reduced.
A systems framework developed by Minstzberg and Glouberman was valuable
in focussing attention on the boundaries between the home care and hospital
sectors and at the system level where they interact. The authors argue
that the current way of thinking about the elements of the system overlooks
this differentiation and ignores the dynamic nature of the system. The
study also synthesized relevant literature, conducted focus groups and
interviews, and undertook site visits.
This report provides a list of best practices for streamlining the movement
of clients between hospitals and home care.
HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)
Language of Report: