How to bridge the gap between hospital and home?
Many countries have separate organizations for delivering nursing care to patients in the hospital and to patients at home in the community. This separation creates extra difficulties in organizing continuous care for patients discharged from hospital who need nursing aftercare (in The Netherlands, at a rough estimate, 10% of all hospital patients). Special arrangements have to be made to prevent these patients missing out completely. By means of a questionnaire sent to all Dutch regional community nursing organizations, this study makes an inventory of the organizational measures that have been taken in this field in The Netherlands and analyses a model of the effects these measures (and also the effects on contextual factors) have on the number of problems reported by the community in respect of continuity of care. In The Netherlands, the initiative in arranging continuity of care is taken by the regional community nursing organizations or by their operational teams. In most cases, they have been able to make arrangements with the hospitals about the selection of aftercare patients and the transfer of information by transfer forms. Sometimes special continuity nurses are appointed by the community, among other things to organize regular consultation with the hospitals. An eight-item Likert scale was developed to measure the extent of continuity problems. Analysis of the effect of several factors in the model by a stepwise multiple regression analysis, revealed that the consistent use of transfer forms by hospitals was an important tool in reducing the problems. Furthermore, regional community nursing organizations themselves had fewer problems compared with the operational teams to whom arranging continuity is sometimes delegated. Increased personnel capacity within the community is also beneficial. The effect of these last two factors (organizational level and personnel capacity) is, however, overruled, by the negative effect of the size of the regional community nursing organization: the more inhabitants, the more problems there are.
Kersten
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Netherlands Institute of Primary Health Care, Ultrecht.
Hackenitz
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D000359:Aftercare / Q000458:organization & administration / Q000592:standards*; D003142:Communication; D003152:Community Health Nursing / Q000458:organization & administration / Q000592:standards*; D003159:Community-Institutional Relations; D003266:Continuity of Patient Care / Q000592:standards*; D006801:Humans; D016294:Models, Nursing; D009426:Netherlands; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000592:standards; D010351:Patient Discharge; D011795:Surveys and Questionnaires