title: The Family Perspective on Hospital to Home Transitions: A Qualitative Study.
abstract: OBJECTIVE
  Transitions from the hospital to home can be difficult for patients and families. Family-informed characterization of this vulnerable period may facilitate the identification of interventions to improve transitions home. Our objective was to develop a comprehensive understanding of hospital-to-home transitions from the family perspective.
  
  
  METHODS
  Using qualitative methods, focus groups and individual interviews were held with caregivers of children discharged from the hospital in the preceding 30 days. Focus groups were stratified based upon socioeconomic status. The open-ended, semistructured question guide included questions about communication and understanding of care plans, transition home, and postdischarge events. Using inductive thematic analysis, investigators coded the transcripts, resolving differences through consensus.
  
  
  RESULTS
  Sixty-one caregivers participated across 11 focus groups and 4 individual interviews. Participants were 87% female and 46% nonwhite; 38% were the only adult in their household, and 56% resided in census tracts with ≥15% of residents living in poverty. Responses from participants yielded a conceptual model depicting key elements of families' experiences with hospital-to-home transitions. Four main concepts resulted: (1) "In a fog" (barriers to processing and acting on information), (2) "What I wish I had" (desired information and suggestions for improvement), (3) "Am I ready to go home?" (discharge readiness), and (4) "I'm home, now what?" (confidence and postdischarge care).
  
  
  CONCLUSIONS
  Transitions from hospital to home affect the lives of families in ways that may affect patient outcomes postdischarge. The caregiver is key to successful transitions, and the family perspective can inform interventions that support families and facilitate an easier re-entry to the home.
authors.affiliation: Division of Pediatric Hospital Medicine, University of Rochester Medical Center, Rochester, New York; lauren_solan@urmc.rochester.edu.
authors.forename: Lauren G
authors.initials: LG
authors.lastname: Solan
authors.affiliation: Divisions of General and Community Pediatrics, Hospital Medicine, and.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Beck
authors.affiliation: Hospital Medicine, and.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Brunswick
authors.affiliation: Hospital Medicine, and.
authors.forename: Hadley S
authors.initials: HS
authors.lastname: Sauers
authors.affiliation: Home Care Services, and.
authors.forename: Susan
authors.initials: S
authors.lastname: Wade-Murphy
authors.affiliation: Hospital Medicine, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Simmons
authors.affiliation: Hospital Medicine, and Infectious Diseases.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: SNS Research, Cincinnati, Ohio.
authors.forename: Susan N
authors.initials: SN
authors.lastname: Sherman
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D002648:Child; D005195:Family Relations / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010290:Parents / Q000523:psychology*; D010351:Patient Discharge; D018802:Patient-Centered Care; D036301:Qualitative Research; D013315:Stress, Psychological; D000069341:Transitional Care; D055815:Young Adult