TY - JOUR

T1 - Opportunities for transitional care and care continuity following hospital discharge of older people in three Nordic cities

T2 - A comparative study

AU - Liljas, Ann E. M.

AU - Pulkki, Jutta

AU - Jensen, Natasja K.

AU - Jamsen, Esa

AU - Burstrom, Bo

AU - Andersen, Ingelise

AU - Keskimaki, Ilmo

AU - Agerholm, Janne

PY - 2024

Y1 - 2024

N2 - Aim: To outline and discuss care transitions and care continuity following hospital discharge of older people with complex care needs in three Nordic cities: Copenhagen, Tampere and Stockholm. Methods: Data on potential pathways following hospital discharge of older people were obtained from existing literature and expert consultations. The pathways for each system were outlined and presented in three figures. The hospital discharge process of the systems was then compared. Results: In all three care systems, the main care path from hospital is to home. Short-term intermediate healthcare can be provided in all three systems, possibly creating additional care transitions; however, once home, extensive home healthcare may prevent further care transitions. Opportunities for continuity of care include needs assessments (all cities) and meetings with the patient about care upon return home (Copenhagen, Stockholm). Yet this is challenged by lack of transfer of information (Tampere) and patients' having to apply for some services themselves (Tampere, Stockholm). Conclusions: Comparisons of the discharge processes studied suggest that despite individual care planning and short- and long-term care options, transitional care and care continuity are challenged by limited access as some services need to be applied for by the older person themselves.

AB - Aim: To outline and discuss care transitions and care continuity following hospital discharge of older people with complex care needs in three Nordic cities: Copenhagen, Tampere and Stockholm. Methods: Data on potential pathways following hospital discharge of older people were obtained from existing literature and expert consultations. The pathways for each system were outlined and presented in three figures. The hospital discharge process of the systems was then compared. Results: In all three care systems, the main care path from hospital is to home. Short-term intermediate healthcare can be provided in all three systems, possibly creating additional care transitions; however, once home, extensive home healthcare may prevent further care transitions. Opportunities for continuity of care include needs assessments (all cities) and meetings with the patient about care upon return home (Copenhagen, Stockholm). Yet this is challenged by lack of transfer of information (Tampere) and patients' having to apply for some services themselves (Tampere, Stockholm). Conclusions: Comparisons of the discharge processes studied suggest that despite individual care planning and short- and long-term care options, transitional care and care continuity are challenged by limited access as some services need to be applied for by the older person themselves.

KW - Ageing

KW - care continuity

KW - care transitions

KW - care systems

KW - hospital discharge

KW - older adults

KW - health services research

U2 - 10.1177/14034948221122386

DO - 10.1177/14034948221122386

M3 - Journal article

C2 - 36113132

VL - 52

SP - 5

EP - 9

JO - Scandinavian Journal of Public Health, Supplement

JF - Scandinavian Journal of Public Health, Supplement

SN - 1403-4956

IS - 1

ER -