Addressing social disconnection among frequent users of community hospital emergency departments: A statewide implementation evaluation

We conducted a qualitative exploration and implementation evaluation of a Massachusetts policy initiative, the Community Hospital Acceleration, Revitalization, and Transformation (CHART) investment program, to examine how CHART innovations aimed at reducing unnecessary emergency department (ED) visi...

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Autores principales:	A. Rani Elwy, Elisa Koppelman, Victoria Parker, Chris Louis
Formato:	article
Lenguaje:	EN
Publicado:	The Beryl Institute 2020
Materias:	social disconnection qualitative research community hospitals stakeholders implementation evaluation Medicine (General) R5-920 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/f843735cf0204346bc411468c67ddd35
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spelling	oai:doaj.org-article:f843735cf0204346bc411468c67ddd352021-11-15T04:31:28ZAddressing social disconnection among frequent users of community hospital emergency departments: A statewide implementation evaluation2372-0247https://doaj.org/article/f843735cf0204346bc411468c67ddd352020-11-01T00:00:00Zhttps://pxjournal.org/journal/vol7/iss3/22https://doaj.org/toc/2372-0247We conducted a qualitative exploration and implementation evaluation of a Massachusetts policy initiative, the Community Hospital Acceleration, Revitalization, and Transformation (CHART) investment program, to examine how CHART innovations aimed at reducing unnecessary emergency department (ED) visits also addressed patients’ social disconnection problems according to a social connection framework (structural, functional, quality or multilevel). We performed interviews with 236 stakeholders (hospital managers, CHART providers, staff, and community partners) one-year post CHART implementation. Interviews were analyzed using a directed content analysis approach. Data were then mapped to levels of the social connection framework. Our results support that social disconnection, described as “loneliness” and “social isolation” by stakeholders, met the definition of a structural social connection problem according to our framework. These structural problems led patients to the ED for reasons not always related to their physical health. CHART innovations involving home visit programs, elder services interventions, work flow changes in the ED, and regular telephone follow-ups provided functional level emotional and tangible support to meet these structural problems. We did not find substantive support for mapping interview data to the quality and multi-level dimensions of the framework. Innovations to address high ED use, according to stakeholders, provided functional level emotional and tangible support to address structural level problems of social disconnection. Future work should examine the sustainability of innovations in a value-based healthcare climate, and the effectiveness of these programs on reducing ED utilization. <strong>Experience Framework</strong> This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (<a href="http://bit.ly/ExperienceFramework">http://bit.ly/ExperienceFramework</a>) <ul> <li><a href="https://www.theberylinstitute.org/page/PXSEARCH#resource-list-all/?view_28_page=1&view_28_filters=%5B%7B%22field%22%3A%22field_38%22%2C%22operator%22%3A%22in%22%2C%22value%22%3A%5B%22PXJ%20Article%22%5D%7D%2C%7B%22field%22%3A%22field_20%22%2C%22operator%22%3A%22is%22%2C%22value%22%3A%5B%22%22%5D%7D%2C%7B%22field%22%3A%22field_40%22%2C%22operator%22%3A%22is%22%2C%22value%22%3A%5B%22%22%2C%22Policy%20%26%20Measurement%22%5D%7D%2C%7B%22field%22%3A%22field_41%22%2C%22operator%22%3A%22is%22%2C%22value%22%3A%5B%22%22%5D%7D%5D">Access other PXJ articles</a> related to this lens.</li> <li><a href="https://www.theberylinstitute.org/page/Ecosystem-PolicyMeasurement">Access other resources</a> related to this lens.</li> </ul>A. Rani ElwyElisa KoppelmanVictoria ParkerChris LouisThe Beryl Institutearticlesocial disconnectionqualitative researchcommunity hospitalsstakeholdersimplementation evaluationMedicine (General)R5-920Public aspects of medicineRA1-1270ENPatient Experience Journal (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	social disconnection qualitative research community hospitals stakeholders implementation evaluation Medicine (General) R5-920 Public aspects of medicine RA1-1270
spellingShingle	social disconnection qualitative research community hospitals stakeholders implementation evaluation Medicine (General) R5-920 Public aspects of medicine RA1-1270 A. Rani Elwy Elisa Koppelman Victoria Parker Chris Louis Addressing social disconnection among frequent users of community hospital emergency departments: A statewide implementation evaluation
description	We conducted a qualitative exploration and implementation evaluation of a Massachusetts policy initiative, the Community Hospital Acceleration, Revitalization, and Transformation (CHART) investment program, to examine how CHART innovations aimed at reducing unnecessary emergency department (ED) visits also addressed patients’ social disconnection problems according to a social connection framework (structural, functional, quality or multilevel). We performed interviews with 236 stakeholders (hospital managers, CHART providers, staff, and community partners) one-year post CHART implementation. Interviews were analyzed using a directed content analysis approach. Data were then mapped to levels of the social connection framework. Our results support that social disconnection, described as “loneliness” and “social isolation” by stakeholders, met the definition of a structural social connection problem according to our framework. These structural problems led patients to the ED for reasons not always related to their physical health. CHART innovations involving home visit programs, elder services interventions, work flow changes in the ED, and regular telephone follow-ups provided functional level emotional and tangible support to meet these structural problems. We did not find substantive support for mapping interview data to the quality and multi-level dimensions of the framework. Innovations to address high ED use, according to stakeholders, provided functional level emotional and tangible support to address structural level problems of social disconnection. Future work should examine the sustainability of innovations in a value-based healthcare climate, and the effectiveness of these programs on reducing ED utilization. <strong>Experience Framework</strong> This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (<a href="http://bit.ly/ExperienceFramework">http://bit.ly/ExperienceFramework</a>) <ul> <li><a href="https://www.theberylinstitute.org/page/PXSEARCH#resource-list-all/?view_28_page=1&view_28_filters=%5B%7B%22field%22%3A%22field_38%22%2C%22operator%22%3A%22in%22%2C%22value%22%3A%5B%22PXJ%20Article%22%5D%7D%2C%7B%22field%22%3A%22field_20%22%2C%22operator%22%3A%22is%22%2C%22value%22%3A%5B%22%22%5D%7D%2C%7B%22field%22%3A%22field_40%22%2C%22operator%22%3A%22is%22%2C%22value%22%3A%5B%22%22%2C%22Policy%20%26%20Measurement%22%5D%7D%2C%7B%22field%22%3A%22field_41%22%2C%22operator%22%3A%22is%22%2C%22value%22%3A%5B%22%22%5D%7D%5D">Access other PXJ articles</a> related to this lens.</li> <li><a href="https://www.theberylinstitute.org/page/Ecosystem-PolicyMeasurement">Access other resources</a> related to this lens.</li> </ul>
format	article
author	A. Rani Elwy Elisa Koppelman Victoria Parker Chris Louis
author_facet	A. Rani Elwy Elisa Koppelman Victoria Parker Chris Louis
author_sort	A. Rani Elwy
title	Addressing social disconnection among frequent users of community hospital emergency departments: A statewide implementation evaluation
title_short	Addressing social disconnection among frequent users of community hospital emergency departments: A statewide implementation evaluation
title_full	Addressing social disconnection among frequent users of community hospital emergency departments: A statewide implementation evaluation
title_fullStr	Addressing social disconnection among frequent users of community hospital emergency departments: A statewide implementation evaluation
title_full_unstemmed	Addressing social disconnection among frequent users of community hospital emergency departments: A statewide implementation evaluation
title_sort	addressing social disconnection among frequent users of community hospital emergency departments: a statewide implementation evaluation
publisher	The Beryl Institute
publishDate	2020
url	https://doaj.org/article/f843735cf0204346bc411468c67ddd35
work_keys_str_mv	AT aranielwy addressingsocialdisconnectionamongfrequentusersofcommunityhospitalemergencydepartmentsastatewideimplementationevaluation AT elisakoppelman addressingsocialdisconnectionamongfrequentusersofcommunityhospitalemergencydepartmentsastatewideimplementationevaluation AT victoriaparker addressingsocialdisconnectionamongfrequentusersofcommunityhospitalemergencydepartmentsastatewideimplementationevaluation AT chrislouis addressingsocialdisconnectionamongfrequentusersofcommunityhospitalemergencydepartmentsastatewideimplementationevaluation
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Addressing social disconnection among frequent users of community hospital emergency departments: A statewide implementation evaluation

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