Degree Name

DrPH (Doctor of Public Health)

Program

Public Health

Date of Award

8-2022

Committee Chair or Co-Chairs

Hadii M. Mamudu

Committee Members

Kate Beatty, David W. Stewart

Abstract

Introduction

Transition care clinics (TCCs) have proven to be effective in meeting the time-sensitive needs of patients in the post-discharge period and ensuring smooth transitions of patients from hospital to home. These clinics have led to lower readmissions, lower emergency department visits, cost savings, and lower rates of other adverse events following discharge. However, TCCs, including the East Tennessee State University Family Medicine (ETSU-FM) TCC have been facing high rates of patient no-shows.

Aim

The aim of this dissertation is to identify the different components and outcomes of TCC based on the literature. We further aim to analyze the TCC implementation process at the ETSU-FM clinic, identify gaps, and provide recommendations to address those gaps.

Methods

A scoping review was conducted using three databases (PubMed, Web of Science, and PsycINFO) searches while following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist to identify different components of TCCs and the associated outcomes. Additionally, a mixed-methods study was conducted using patients and providers from the ETSU-FM clinic to identify different factors associated with patients’ no-shows to scheduled TCC appointments.

Results

Eighteen studies were analyzed and TCC components and patients’ outcomes were assessed. Predischarge communication with patients and caregivers, early post-discharge contacts, etc. were identified as some of the effective components of TCC. Our review also highlighted that TCC resulted in lower readmissions, lower ED visits, and cost-effectiveness. For the mixed-methods study, we included 520 patients in our quantitative analysis and interviewed 10 providers for the qualitative analysis. Several patient-level and system-level factors were found to be associated with TCC no-shows. A few of the factors that were deemed modifiable by the clinic have been identified and recommendations provided accordingly.

Conclusion

TCCs play a vital role in ensuring smooth care transitions of patients following discharge. It is crucial to conduct context-level studies to identify factors that are associated with TCC no-shows and design interventions accordingly. Doing so could lead to pursuit of the triple aim of healthcare: improving patients’ experience of care, improving the health of populations, and reducing the per capita cost of health care.

Document Type

Dissertation - unrestricted

Copyright

Copyright by the authors.

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