Choose one of the following chronic diseases to address in this component: Chapter 2 pages 44-47 in Fundamentals of Case Management Practice De Regge, M., Pourcq, K. D., Meijboom, B., Trybou, J., Mortier, E., & Eeckloo, K. (2017). . BMC Health Services Research, 17 Davis, M. M., Devoe, M., Kansagara, D., Nicolaidis, C., & Englander, H. (2012). ” ” healthcare professional views on hospital to home care transitions. Journal of General Internal Medicine, 27(12), 1649-56. Paper

Title: Healthcare Professional Views on Hospital to Home Care Transitions

Introduction:
Hospital to home care transitions are critical for patients with chronic diseases as it involves the transfer of care and responsibility from the hospital setting to the patient’s home. Ensuring smooth and effective transitions is essential to improve patient outcomes and reduce readmission rates. The study conducted by Davis et al. (2012) titled “Healthcare Professional Views on Hospital to Home Care Transitions” provides valuable insights into this aspect of chronic disease management. This paper aims to critically analyze the study and discuss its implications for case management practice.

Summary of the Study:
The study by Davis et al. (2012) utilized a qualitative research design to explore healthcare professionals’ perspectives on hospital to home care transitions. The data was collected through semi-structured interviews with physicians, nurses, and care coordinators involved in the transition process. The participants were asked about their experiences, challenges, and suggestions for improving care transitions. The study included a diverse range of healthcare professionals from different healthcare settings.

Findings of the Study:
The study identified several key themes related to hospital to home care transitions. First, communication challenges emerged as a prominent issue. Healthcare professionals highlighted the need for effective communication among care teams, patients, and family members to ensure continuity of care. Additionally, participants emphasized the importance of timely and accurate transmission of information, including medication reconciliation and discharge instructions.

Second, coordination and collaboration emerged as crucial factors in successful transitions. Participants stressed the need for interdisciplinary care teams, clear care plans, and designated care coordinators to facilitate coordination and seamless transitions. They also identified the importance of involving patients and their families in the care planning and decision-making process.

Third, healthcare professionals highlighted the impact of the healthcare system on care transitions. Participants identified systemic barriers, such as limited resources, time constraints, and fragmented care, as challenges that impede optimal transitions. They emphasized the need for system-level changes to support care coordination and enhance the transition process.

Implications for Case Management Practice:
The findings of the study have significant implications for case management practice in the management of chronic diseases. Firstly, the study highlights the central role of effective communication in care transitions. Case managers can facilitate communication among the care team, patients, and family members by establishing clear channels for information sharing and using technology to enhance communication efficiency.

Furthermore, the study emphasizes the importance of coordination and collaboration in care transitions. Case managers can play a pivotal role in facilitating coordination among different healthcare professionals involved in the transition process. This includes ensuring interdisciplinary care team involvement, promoting care planning meetings, and advocating for the inclusion of patients and their families in care decisions.

Moreover, the study underscores the need for system-level changes to support optimal care transitions. Case managers can advocate for improvements in healthcare systems and policies to address systemic barriers and enhance care coordination. This may involve advocating for adequate resources, streamlined processes, and comprehensive care plans to support the transition process.

Conclusion:
The study by Davis et al. (2012) provides valuable insights into healthcare professionals’ perspectives on hospital to home care transitions. The findings emphasize the importance of effective communication, coordination, and system-level changes in facilitating successful transitions. Case managers can apply these findings to their practice by focusing on improving communication channels, facilitating coordination, and advocating for system-level changes. By addressing these key areas, case managers can enhance the quality of hospital to home care transitions and ultimately improve patient outcomes in chronic disease management.