JMIR Publications

ABSTRACT

Background:

Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies aimed to support hospital-to-home transitions.

Objective:

In order to guide the development of digital health intervention to support transitions from hospital-to-home (the Digital Bridge intervention), this review aimed to: 1) understand the various roles and functions of healthcare providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; 2) describe the types of digital health interventions used to facilitate the transition from hospital-to-home for older adults and how these interventions support the roles and functions of providers; 3) describe the lessons learned from the design and implementation of these interventions; and 4) identify opportunities to improve the fit between technology and provider functions within the Digital Bridge Project and other transition focused digital health interventions.

Methods:

This two-phase rapid review involved a selective review of providers’ roles and their functions during hospital-to-home transitions (Phase 1) and a structured literature review on digital health interventions used to support older adults’ hospital-to-home transition. The technology functions identified in Phase 2 were linked to the provider roles and functions identified in Phase 1 during the analysis.

Results:

In Phase 1, various provider roles were identified as facilitating hospital-to-home transitions, including navigation-specific roles, nurses and physicians. The key transition functions performed by providers related to providing information, management, and relational continuity. In Phase 2, 142 articles reporting digital health interventions targeting various population groups were included. Most digital health interventions supported management continuity functions (e.g. follow-up, assessment, monitoring patients’ status after hospital discharge), while informational and relational continuity were least supported. The lessons learned from the interventions were categorized into 1) technology- and 2) research-related challenges and opportunities and informed several recommendations to guide the design of transition focused digital health interventions.

Conclusions:

This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults and examine multi-level outcomes.