Abstract
Older adults requiring skilled home health care (SHHC) after hospital discharge are among those at highest risk of re-hospitalization and adverse events. SHHC agencies need strategies to provide safer SHHC transitions. Previously, we developed the “Index of SHHC Transition Quality”, including questions on 12 safe, individual and organizational transitions practices (ex: proper medication use, home safety, clear communication), and an overall care transition star rating: 1 (poor) to 5 (excellent). We conducted a pilot study with two objectives: 1) describe the incidence of care transitions threats from the researcher, SHHC provider, and older adult/caregiver perspectives; 2) compare ratings of care transition quality among these perspectives. During the study, researchers observed 50 hospital-to-SHHC transitions visits. After each visit, the researchers administered the Index to the SHHC provider (n=9) and older adult or caregiver (n=50), and completed the Index themselves to produce gold-standard responses. The greatest difference in overall quality of care transitions was evident in the frequency of five-star ratings. Researchers, SHHCP, and older adults/caregivers assigned five stars to 3, 17, and 6 visits, respectively. Transition threats were marked by the proportion of “no” answers to Index domains. Threats were identified 2–55% of the visits. Fisher tests evaluating differences in proportion of “transition threats” showed significant differences (p<0.05) among the three perspectives in 10/12 Index domains. In all 10 domains, the SHHC provider indicated less transition threats than the researcher and the older adult/caregiver. These results will inform research on improvement of SHHC workflow, and interventions addressing threats to patient safety.