Recommendations for improving care transitions for older adults with hip fracture.

Introduction: Falls among older adults are common, and frequently result in injuries such as hip fractures. Following a hip fracture, patients experience numerous transitions in care between providers and across sectors. These transitions have been noted as a vulnerable time for patients and families, with the potential for poor health outcomes, readmission to hospital, medication errors, decreased satisfaction, and confusion. Despite being known as a challenging and vulnerable time, there are limited recommendations on how to improve transitions in care for older adults with hip fracture. Objectives and Methods: The objective of this qualitative study was to explore recommendations for improving transitions in care for older adults with hip fracture from the perspectives of patients, caregivers, healthcare providers, and decision-makers. To achieve this objective, we conducted indepth, semi-structured interviews with all participants. Follow-up interviews were conducted with patients and caregivers as they transitioned along their care journey. All interviews were audiorecorded for transcription. The transcripts were coded by three team members and descriptive and interpretive approaches were used to analyze the data. Patients were involved as participants and are involved as co-leaders in the next phase of research. Results: A total of 48 participants (15 patients, 15 healthcare providers, 10 caregivers, and 8 decision-makers) took part in 66 interviews between August 2018 and July 2019. Recommendations to improve transitions were based within three main categories: (1) hospital-based recommendations; (2) community-based recommendations; and (3) cross-sectoral based recommendations. Hospital-based recommendations included improving communication between hospital providers and between providers and families, increasing staffing levels, and treating patients and families with respect. Community-based recommendations included identifying atrisk individuals early and increasing community-based prevention and educational programs. Cross-sectoral based recommendations were grounded in enhanced system navigation through the introduction of care navigators. Conclusions: We identified the importance of integrated care for older adults with hip fracture, with an enhanced focus on the integration of community-based providers (primary care). The recommendations outlined have the potential to improve experiences within the hospital, in the community, and during care transitions for older adults with hip fracture. Implications for applicability/transferability, sustainability, and limitations: The majority of patient and caregiver participants were English-speaking and White. It is possible that individuals who speak English as a second language or who are from different ethnic/cultural backgrounds have differing experiences and therefore, additional recommendations on how to improve care transitions. This requires future research. [ABSTRACT FROM AUTHOR]