From hospital to home: Analysis of transition processes in a national sample

Chronic disease is challenging today's societies. There is an increasing part of the population with chronic diseases, partly due to an ageing population. Seniors are more often and longer hospitalised than a younger population, and hospital readmission rates are higher, thus leading to an increase of healthcare relatedcosts. To provide effective treatment to this group, healthcare professionals need to work together. Transitioning from hospital to home has been identified as a central moment to ensure continuity of care. With the aim to face these challenges, transitional care has been conceptualised and introduced. Studies evaluating its effectiveness use often patients' readmission rates. Yet, very little is known about how healthcare transition is organised within different Swiss Cantons, how institutions organise these transition processes, how healthcare professionals collaborate and put guidelines into action and how transition is experienced by participants involved in these processes. This study aims to investigate what transitional care guidelines are used in the Swiss healthcare system, how they are enacted in their specific (Cantonal) context and what are the participants' experiences with the proposed transitional care. We will focus on three levels: the health policy level (macro level), the healthcare institutions and community level (meso level), and the professionals', patients' and informal caregivers' experiences (micro level), using a triangulation method to better understand the complexity of transitional care.

• Schoeb Mezzanotte Veronika, Directrice de la recherche, HESAV
• Ribeiro Carla Alexandra, Adjointe scientifique, HESAV
• Weber Sabrina, Assistante doctorante, HESAV

• FNS - Fonds National Suisse - DORE