Understanding and improving transitions of care from hospital to community for older adults with multiple long-term conditions
Supervisors:
Prof Susan D Shenkin, Ageing and Health, Usher Institute, University of Edinburgh
Dr Stella Arakelyan, Advanced Care Research Centre (ACRC), Usher Institute, University of Edinburgh
Prof John Vines, School of Informatics, University of Edinburgh
Dr Jennifer K Burton (Jenni Burton), School of Cardiovascular & Metabolic Health, University of Glasgow
Summary:
Older adults with multiple long-term conditions (MLTC) often need to move between care settings (in and out of hospital to home or care home). These ‘care transitions’ are weak points in the system, and every move increases the risk of needing to return to hospital as an emergency, or other poor outcomes. We don’t yet know the best way to provide coordinated care and share information at these care transitions.
This multidisciplinary PhD programme offers the opportunity to co-develop a transitional care intervention to improve care experience and outcomes for older adults with MLTC. It will include evidence synthesis of existing literature relating to interventions at care transitions, qualitative inquiry to understand the current and potential interventions to improve care transitions from the perspective of a wide range of stakeholders, and co-development and feasibility testing of a transitional care intervention. It has a focus on participatory research methods, with co-design with stakeholders throughout, and a systems thinking approach. This work will generate evidence and practical solutions to improve transitional care and align with national priorities to reduce avoidable hospital readmission, improve communication between primary, secondary and social care, and support older adults with MLTC to live well in their communities.