Optimizing Health Information Exchange during Patient Transitions into Long-term Care

Abstract

Background: Older adults are the highest healthcare users, and their rapidly growing population mounts increasing pressures on the healthcare system, including the demand for long-term care (LTC) beds. Most older adults lose contact with their family physicians on entering LTC as new providers assume responsibility for their care. System fragmentation, including impacts of policies like Bill 7 – permitting temporary placement in LTC facilities nearly 150km away from one’s preferred location – exacerbates this problem. Disruption of care continuity creates challenges for the healthcare workforce and patient care outcomes. This dissertation aims to describe the information exchange activities that occur during primary care to LTC transition, and to explore opportunities to leverage policy to optimize informational continuity during the transition process. Methods: This work includes a three-stage research program comprising a scoping review of the literature pertaining to continuity of care during LTC transition in Canada, followed by a multiple case study design to elicit insights from various LTC providers on the information continuity discourse. The third study was a qualitative descriptive study on family physicians’ perspectives concerning informational continuity practices during LTC transitions. Results: Informational continuity is perceived as a valuable and viable solution to mitigating disrupted relational continuity. However, the information shared currently is inadequate to support informational continuity. Systemic barriers (e.g., document designs, time constraints) and provider perception about the information shared (e.g., redundancy, obsoleteness) contribute to suboptimal information exchange. Health professions education interventions, document revision, the automation of form completion, collaborative documentation practice, warm handoff standards, and efforts to better empower patient families would be needed to optimize informational continuity. Conclusion: Informational continuity remains a promising means to address disrupted continuity. This work calls on policymakers, practitioners, and educators to address practices and systemic issues hindering informational continuity. It encourages further research into digital solutions, stakeholder perspectives, and context-specific continuity frameworks.