A review of patient-oriented care models as applied in transitional care of the elderly

In the health care quality literature patient experiences is recognized as a key area to attend to. Patient experiences can refer both to the quality of the patient’s experience as well as the clinical result, and can be measured in terms of prompt access, good relationships with service providers and efficient administration of health care services. Patient-centeredness, shared-decision making and patient participation are three models of care that incorporate user involvement and the patients’ experiences with care. Even though these care models are proven important to health care quality, limited knowledge exists as to their adaption to care for the elderly, and more specifically to the transitional care that most elderly patients are in need of. By transitional care we mean the assurance of coordination and continuity of health care as patients transfer between different levels of care within or between locations. The purpose of the paper is to give an overview of patient-oriented care models as applied in transitional care of the elderly, and to discuss their implementation in the health care system. The methodology used in the paper is a combination of document analysis of Norwegian policy documents and a review of the literature searching the electronic databases PubMed, Medline, Cinahl, Academic Search Elite and the Cochran Database of Systematic Reviews. The following search terms were used: “patient-centeredness”, “shared-decision making”, “patient involvement”, “patient participation”, “patient experience”, all concepts in combination with “elderly” AND/OR “health care quality” AND/OR “transitional care”, “handovers”, “patient transfer” AND/OR “discharge planning” AND/OR “admission”. Results show that policy documents to a large extent emphasize patients’ experiences and user involvement, cohesive services and continuity of care to ensure quality in the transitional care of the elderly. Family involvement is one of the most significant factors in successful discharge planning for elderly patients, and education of elderly shows promising results especially in relation to quality improvement of transitional care. This paper has documented that the role of elderly patients in transitional care and in activities to improve health care quality is highlighted as important in Norwegian policy documents, but has not been well explored in the research literature. The paper identifies key areas to address to ensure patient-oriented care when elderly patients transfer between different levels of the health care system. We furthermore suggest that these areas should be taken into consideration when implementing tools to support patient-oriented care and improve the quality of transitional care of the elderly.