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Associations between hospital structures, processes and patient experiences of preparation for discharge in breast cancer centers

A multilevel analysis

Nowak, Marina; Swora, Michael; Karbach, Ute; Pfaff, Holger; Ansmann, Lena

doi: 10.1097/HMR.0000000000000237
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Background Discharge management is a central task in hospital management. Mitchell's quality health outcomes model offers a contextual framework to derive expectations about the relationship between indicators of hospital structures and processes with patient experiences of preparation for discharge.

Purpose The aim is to analyze the association between hospital structures and processes with patient experiences of preparation for discharge in breast cancer centers.

Methodology The data were collected between February 1 and July 31, 2014–2016, with annual cross-sectional postal surveys on patient experiences of preparation for discharge in breast cancer center hospitals in Germany. These data were combined with secondary data on hospital structures, obtained from structured quality reports 2014 and the accreditation institution certifying breast cancer centers, constituting a hierarchical data structure. A total of 10,750 newly diagnosed breast cancer patients from 67 hospitals were analyzed. Following listwise deletion, 9,762 patients could be included in linear hierarchical regression analyses.

Results Patients felt better prepared for discharge in hospitals that communicate the discharge date timely to patients, with good coordinative processes, and which cooperate with two other breast cancer center hospitals. Hospital structures, size, teaching status, and ownership were not associated with the patient experiences of preparation for discharge.

Conclusion The results suggest that timely and informative communication, well-organized care processes, and the network structure of centers allow for an improvement of preparation for discharge. Current and future approaches for the improvement of hospital discharge should consider the identified hospital resources.

Practice Implications Hospital management should increase the focus on structured communication and coordination processes to improve the discharge process. Cooperating networks should be expanded to increase expertise and resources. Results can be generalized to other care domains with caution. Patients' characteristics should further be assessed in order to use resources efficiently.

Marina Nowak, MSc, is Research Associate, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany. E-mail: marina.nowak@uk-koeln.de.

Michael Swora, MSc, is Statistician and Research Associate, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany.

Ute Karbach, Dr, is Head, Department Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany.

Holger Pfaff, Prof Dr, is Professor and Director, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany.

Lena Ansmann, Prof Dr, is Professor for Organizational Health Services Research, Faculty of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.

The patient survey was financed by the participating hospitals. Preliminary results have been presented in autumn 2017 at the European Public Health Conference in Stockholm, Sweden, and at the German Conference for Health Services Research in Berlin, Germany.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

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