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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)

Sponsor Organization:
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.

Key Findings:
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; and
  • 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.

Evaluation Methodology:
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.

Resources Developed:
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: