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Children with Medical Complexities (CMC) often require 24/7 expert care, which frequently necessitates prolonged (re)admissions to a university medical centre (UMC), thereby impeding discharge to home. The transition from hospital to home for CMC is a multifaceted process with numerous challenges and obstacles. This protocol describes the evaluation of an innovative transitional care unit (TCU), where families can stay together in a home-like environment between hospital and home. Under the supervision of healthcare professionals, parents are supported in preparing for a sustainable home situation. We hypothesise that an intermediate stay at the Jeroen Pit Huis (JPH) will have a favourable effect on healthcare consumption, patient, parent and family-relevant outcomes in comparison to discharge directly from a hospital ward to home. Therefore, the purpose of this study is to compare the transition via the TCU JPH versus transition from hospital ward to home as provided elsewhere for CMC patients in the Netherlands.
This observational prospective cohort study compares patients who transition directly from hospital to home with those who transition via the TCU. The control group comprises five UMCs in the Netherlands. Data will be collected by extracting information from electronic health records and through online questionnaires. Parents complete questionnaires at three time points: on discharge home, 3 months and 12 months postdischarge. Bayesian inverse probability weighting will be used to control for confounding effects and analyse the results.
Ethical approval was granted by the Amsterdam UMC Medical Ethics Committee (W20_220#20.007). The need for ethical approval was waived by all other participating UMCs. Results will be disseminated through peer-reviewed scientific journals and conference presentations. The insights gained from this study will contribute to the development of a national care pathway to enhance transitional care for CMC and their families in the future.
NCT06599398 (ClinicalTrials.gov) - Bridging Hospital to Home for CMC and Their Families.
To provide an in-depth insight into the barriers, facilitators and needs of district nurses and nurse assistants on using patient outcomes in district nursing care.
As healthcare demands grow, particularly in district nursing, there is a significant need to understand how to systematically measure and improve patient outcomes in this setting. Further investigation is needed to identify the barriers and facilitators for effective implementation.
A multi-method qualitative study.
Open-ended questions of a survey study (N = 132) were supplemented with in-depth online focus group interviews involving district nurses and nurse assistants (N = 26) in the Netherlands. Data were analysed using thematic analysis.
Different barriers, facilitators and needs were identified and compiled into 16 preconditions for using outcomes in district nursing care. These preconditions were summarised into six overarching themes: follow the steps of a learning healthcare system; provide patient-centred care; promote the professional's autonomy, attitude, knowledge and skills; enhance shared responsibility and collaborations within and outside organisational boundaries; prioritise and invest in the use of outcomes; and boost the unity and appreciation for district nursing care.
The preconditions identified in this study are crucial for nurses, care providers, policymakers and payers in implementing the use of patient outcomes in district nursing practice. Further exploration of appropriate strategies is necessary for a successful implementation.
This study represents a significant step towards implementing the use of patient outcomes in district nursing care. While most research has focused on hospitals and general practitioner settings, this study focuses on the needs for district nursing care. By identifying 16 key preconditions across themes such as patient-centred care, professional autonomy and unity, the findings offer valuable guidance for integrating a learning healthcare system that prioritises the measurement and continuous improvement of patient outcomes in district nursing.
Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.
No patient or public contribution.
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