Patient-level barriers, related facilitators, and proposed strategies for timely home health care and outpatient appointments for sepsis survivors: Perspectives from healthcare system and home health care informants

Abstract

Objective: This study explored the perspectives of healthcare system and home health care (HHC) informants - including leaders, managers, clinicians, sepsis coordinators, and care coordinators - on patient-level barriers, related facilitators, and proposed strategies related to timely HHC nursing visits and outpatient appointments among sepsis survivors. This work is part of a larger qualitative needs assessment within Improving TRansitions ANd outcomeS oF sEpsis suRvivors (I-TRANSFER), which aims to implement a sepsis survivor hospital-to-home care transition protocol across five healthcare system-affiliated HHC agency dyads.

Methods: Semi-structured interviews informed by the Consolidated Framework for Implementing Research were conducted with informants as part of the I-TRANSFER qualitative needs assessment. Interviews were analyzed via a deductive-inductive coding approach, resulting in 32 themes and subthemes. A targeted query was done to extract data from themes and subthemes relevant to patient engagement in follow-up care.

Results: Sixty-one interviews were conducted with 91 informants. The four themes included Patient Behaviors, Decisions, and Preferences; Care Coordination; Patient Education; and Access to Care. Patient-level barriers include refusal or delay of HHC, missed outpatient appointments, scheduling difficulties, low health literacy, language barriers, competing health priorities, transportation issues, financial difficulties, and not having an outpatient provider. Facilitators and proposed strategies include proactive patient education, building clinician-patient trust, leveraging technology, implementing dedicated scheduler and sepsis patient education roles, building population health programs, and partnering with community organizations.

Conclusion: Findings highlight common challenges and offer actionable strategies to engage sepsis survivors in their follow-up care. They have important implications for patient education delivery, discharge planning, social determinants of health, and technology to enhance hospital-to-home care transitions.

Practice implications: Recommendations include hiring dedicated schedulers, early screening for patient learning barriers, expanding sepsis coordinator roles, using telehealth and text-messaging, and strengthening community partnerships.

Keywords: Care transitions; Healthcare delivery; Home health care; Implementation science; Patient engagement; Qualitative; Sepsis survivors.

Fig. 1.. Themes and Subthemes