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Defining quality outcomes for complex-care patients transitioning across the continuum using a structured panel process
  1. Lianne Jeffs1,2,3,
  2. Madelyn P Law4,
  3. Sharon Straus5,6,7,8,
  4. Roberta Cardoso1,
  5. Renee F Lyons9,10,
  6. Chaim Bell11,12,13,14
  1. 1St. Michael's Hospital, Toronto, Ontario, Canada
  2. 2Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
  3. 3Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Community Health Sciences, Brock University, St. Catharines, Ontario, Canada
  5. 5Knowledge Translation Program, Li Ka Shing Institute, St Michael's Hospital, Toronto, Ontario, Canada
  6. 6Department of Medicine, University of Calgary,
  7. 7Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  8. 8Department of Geriatric Medicine, University of Toronto, Toronto, Ontario, Canada
  9. 9Complex Chronic Disease Research, Bridgepoint Collaboratory for Research and Innovation, Toronto, Ontario, Canada
  10. 10Professor Dalla Lana School of Public Health and Institute of Health Policy, Management and Evaluation, University of Toronto, Bridgepoint Health, Toronto, Ontario, Canada
  11. 11Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
  12. 12Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  13. 13Institute for Clinical Evaluative Sciences (ICES) of Ontario, Toronto, Ontario, Canada
  14. 14Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Lianne Jeffs, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8; jeffsl{at}smh.ca

Abstract

Background No standardised set of quality measures associated with transitioning complex-care patients across the various healthcare settings and home exists. In this context, a structured panel process was used to define quality measures for care transitions involving complex-care patients across healthcare settings.

Methods A modified Delphi consensus technique based on the RAND method was used to develop measures of quality care transitions across the continuum of care. Specific stages included a literature review, individual rating of each measure by each of the panelists (n=11), a face-to-face consensus meeting, and final ranking by the panelists.

Results The literature review produced an initial set of 119 measures. To advance to rounds 1 and 2, an aggregate rating of >75% of the measure was required. This analysis yielded 30/119 measures in round 1 and 11/30 measures in round 2. The final round of scoring yielded the following top five measures: (1) readmission rates within 30 days, (2) primary care visit within 7 days postdischarge for high-risk patients, (3) medication reconciliation completed at admission and prior to discharge, (4) readmission rates within 72 h and (5) time from discharge to homecare nursing visit for high-risk patients.

Conclusions The five measures identified through this research may be useful as indicators of overall care quality related to care transitions involving complex-care patients across different healthcare settings. Further research efforts are called for to explore the applicability and feasibility of using the quality measures to drive quality improvement across the healthcare system.

  • Adverse events, epidemiology and detection
  • Transitions in care
  • Quality measurement
  • Performance measures
  • Health services research

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