Provider and health care team member insights for implementing a transitions of care clinic in a federally qualified health center

Abstract

Objectives: To identify medical professionals' specific insights to implementing a transitions of care (TOC) clinic in a federally qualified health center (FQHC).

Design: The investigators conducted focus groups during the structured 1-hour provider meetings that take place at each clinic. Each meeting was split into two 30-minute group sessions that consisted of licensed providers and of other health care team members. During the focus groups, investigators explored past experiences of care provided to patients recently discharged from hospitalizations, and the perceived benefits, barriers, and workflow for a TOC clinic. Questions used were based on the consolidated framework for implementation research (CFIR). Transcriptions were coded with the use of qualitative research data analysis software by 2 investigators independently. Initial codes were based on the CFIR constructs to identify themes in responses while remaining adaptable for any themes or discussion that the participants found important.

Setting and participants: Participants were selected via purposive sampling within FQHCs of northwest Indiana. Participants included physicians, nurse practitioners, team care nurses, pharmacists, and behavioral health consultants.

Results: A total of 40 participants took part in 8 focus groups. Major themes identified were inaccessibility to patient information, apprehension about implementation, lack of familiarity with transitions of care service, and FQHC patient-centered factors. Aspects of each of the 5 CFIR constructs are discussed.

Conclusion: Participants provided numerous factors that may affect the success of this patient care intervention in an FQHC. Proper external communication with other health care providers, comprehensive assessment of patient access to necessary resources, and collaboration at the site are the most crucial factors. Many FQHCs work with scarce resources and high patient volumes; being able to develop appropriate processes for a patient care service as encompassing and important as a TOC will affect both patient and provider experience in primary care.