title: Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study.
abstract: BACKGROUND
  Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services.
  
  
  METHODS
  The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n = 17); focus groups (n = 9) with ward staff (n = 36); interviews with frail older people (n = 4). The data were analysed using the framework approach.
  
  
  RESULTS
  THREE THEMES ARE PRESENTED: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions.
  
  
  CONCLUSIONS
  A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other's roles and build relationships and trust.
authors.affiliation: Faculty of Health and Social Care, Florence Nightingale Foundation Chair of Clinical Nursing Practice, London South Bank University and University College London Hospitals, London, UK.
authors.forename: Lesley
authors.initials: L
authors.lastname: Baillie
authors.affiliation: Nursing for the Hospital of St John & St Elizabeth, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Gallini
authors.affiliation: Nursing and Clinical Services, CareUK, Reading, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Corser
authors.affiliation: University of Bedfordshire, Oxford House Campus, Aylesbury, UK.
authors.forename: Gina
authors.initials: G
authors.lastname: Elworthy
authors.affiliation: University of Bedfordshire, Oxford House Campus, Aylesbury, UK.
authors.forename: Ann
authors.initials: A
authors.lastname: Scotcher
authors.affiliation: University of Bedfordshire, Butterfield Campus, Luton, UK.
authors.forename: Annabelle
authors.initials: A
authors.lastname: Barrand
keywords: acute hospital wards; care transitions; community healthcare; frail older people; integrated care; vertical integration