Continuity and utilization of health and community care in elderly patients with heart failure before and after hospitalization

Emma Säfström,Tiny Jaarsma,Anna Strömberg

doi:10.1186/s12877-018-0861-9

Abstract

BackgroundThe period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk. The transition from hospital to home is often problematic due to insufficient coordination of care, leading to a fragmentation of care rather than a seamless continuum of care. The aim was to describe health and community care utilization prior to and 30 days after hospitalization, and the continuity of care in patients hospitalized due to de novo or deteriorated HF from the patients’ perspective and from a medical chart review.MethodsThis was a cross-sectional study with consecutive inclusion of patients hospitalized at a county hospital in Sweden due to deteriorated HF during 2014. Data were collected by structured telephone interviews and medical chart review and analyzed with the Spearman’s rank correlation coefficient and Chi square. A P value of 0.05 was considered significant.ResultsA total of 121 patients were included in the study, mean age 82.5 (±6.8) and 49% were women. Half of the patients had not visited any health care facility during the month prior to the index hospital admission, and 79% of the patients visited the emergency room (ER) without a referral. Among these elderly patients, a total of 40% received assistance at home prior to hospitalization and 52% after discharge. A total of 86% received written discharge information, one third felt insecure after hospitalization and lacked knowledge of which health care provider to consult with and contact in the event of deterioration or complications. Health care utilization increased significantly after hospitalization.ConclusionMost patients had not visited any health care facility within 30 days before hospitalization. Health care utilization increased significantly after hospitalization. Flaws in the continuity of care were found; even though most patients received written information at discharge, one third of the patients lacked knowledge about which health care provider to contact in the event of deterioration and felt insecure at home after discharge.

Highlights

The period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk
Readmission rates are high after hospitalization due to HF deterioration, with about one quarter of patients being readmitted within one month [5]
This cross-sectional study, combining the perspective of elderly patients as well as data from the medical charts on health and community care, revealed novel aspects of the continuity of care in patients hospitalized due to HF

Summary

Introduction

The period after hospitalization due to deteriorated heart failure (HF) is characterized as a time of high generalized risk. The period post-discharge after hospitalization is characterized as a time of high generalized risk and instability [7]. Patients with HF have been found to visit the emergency room (ER), outpatient clinic and/or primary care multiple times every year [8,9,10] and 25% of the HF patients receive home care after hospitalization [11]. Patients with HF need a seamless chain of care across hospital and primary care. This can only be achieved through close collaboration between the healthcare providers so that the follow-up and management of every patient is optimal and integrated [7, 12]. A seamless continuity of care is most at risk during the patients’ transition from an institutional care setting to the home [13]

Results

Discussion

Conclusion