Skip Navigation
Skip to contents

JPMPH : Journal of Preventive Medicine and Public Health

OPEN ACCESS
SEARCH
Search

Articles

Page Path
HOME > J Prev Med Public Health > Volume 57(6); 2024 > Article
Original Article
Provider Perspectives, Barriers, and Improvement Strategies for Hospital Discharge Support Programs: A Focus Group Interview Study in Korea
Jae Woo Choi1orcid, Aejung Yoo1orcid, Hyojung Bang1orcid, Hyun-Kyung Park1orcid, Hyun-Ji Lee1orcid, Hyejin Lee2,3corresp_iconorcid
Journal of Preventive Medicine and Public Health 2024;57(6):572-585.
DOI: https://doi.org/10.3961/jpmph.24.275
Published online: October 4, 2024
  • 939 Views
  • 118 Download

1Health Insurance Research Institute, National Health Insurance Service, Wonju, Korea

2Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

3Department of Family Medicine, Seoul National University College of Medicine, Seoul, Korea

Corresponding author: Hyejin Lee, Department of Family Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173beon-gil, Bundang-gu, Seongnam 13620, Korea E-mail: jie2128@gmail.com
• Received: May 31, 2024   • Revised: August 16, 2024   • Accepted: August 19, 2024

Copyright © 2024 The Korean Society for Preventive Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

prev next
  • Objectives:
    Transitional periods, such as patient discharge, are notably challenging. This study aimed to explore the perceptions of providers involved in hospital discharge support programs, identify the primary obstacles, and propose strategies for improvement.
  • Methods:
    In this qualitative cross-sectional study, we interviewed 49 healthcare professionals, comprising doctors, nurses, and social workers, who participated in two pilot programs. We organized focus group interviews with 3-6 participants per group, segmented by the type of discharge support program and profession. For data analysis, we employed phenomenological analysis, a qualitative method.
  • Results:
    Participants recognized the importance of the discharge support program and anticipated its benefits. The Rehabilitation Hospital Discharge Patient Support program saw more active involvement from doctors than the Establishment of a Public Health-Medical Collaboration System program. Both programs highlighted the critical need for more staff and better compensation, as identified by the doctors. Nurses and social workers cited the heavy documentation burden, uncooperative attitudes from patients and local governments, and other issues. They also anticipated that program improvements could be achieved through the standardization of regional welfare services and better coordination by local governments serving as welfare service regulators. All groups—doctors, nurses, and social workers—underscored the significance of promoting these programs.
  • Conclusions:
    Discharge support programs are crucial for patients with functional impairments and severe illnesses, particularly in ensuring continuity of care. Policy support is essential for the successful implementation of these programs in Korea.
After hospitalization, patients can be admitted to long-term care facilities, experience a decline in daily living functions, and even die [1,2]. Transitional periods such as discharge pose significant challenges for patients due to numerous changes in medication, treatment, and medical staff [3]. The absence of proper coordination during this time can lead to preventable readmissions, complications, and increased healthcare costs, worsening daily living and treatment outcomes [4,5]. Transitional care, including discharge planning, is essential for patients with complex needs to ensure a successful return home [6,7]. In this context, various pilot studies on transitional care have been launched in several countries [4,8-10]. Unlike other countries where primary care physicians commonly coordinate integrated healthcare management, primary care in Korea is not well established. In Korea, there is no primary care physician system, and coordination between medical institutions is typically conducted solely through referral letters without direct communication between the institutions. This results in poor connections between individual medical institutions. Therefore, the Korean government has initiated pilot programs focused on transitional care during hospital discharge to fill this gap.
Current pilot programs include the establishment of a Public Health-Medical Collaboration System for patients discharged from acute care, an Acute Care Patient Discharge Support and Community Linkage program, and a Rehabilitation Hospital Discharge Patient Support program. The Public Health-Medical Collaboration System and the Acute Care Patient Discharge Support and Community Linkage programs are primarily implemented in tertiary and general hospitals [11]. The Public Health-Medical Collaboration System is a project where designated medical institutions strengthen linkage and collaboration among essential public health services within their respective regions to avoid gaps in critical healthcare. This initiative encompasses a wide range of areas, from establishing networks for collaboration between local medical institutions to covering pre-hospital, in-hospital, and community reintegration processes. The discharge support program is one of the key components of this project [11]. The Public Health-Medical Collaboration System ensures seamless health management of patients even after discharge. This includes an in-depth assessment of inpatient conditions, the establishment of care plans, and the integration of medical and welfare services along with health monitoring in the community post-discharge. The program targets diseases such as stroke, heart disease, respiratory diseases, fractures, cancer, rehabilitation needs, and chronic diseases. Each participating institution can select specific diseases to focus on as part of this program. The Rehabilitation Hospital Discharge Patient Support program aims to improve the effectiveness of rehabilitation treatment by managing residual disabilities of patients with mobility impairments through home-based rehabilitation after discharge from rehabilitation hospitals. This program targets patients who have received intensive treatment for acute conditions, such as stroke or spinal cord injuries, and are assessed as needing home-based rehabilitation post-discharge. A multidisciplinary team evaluates these patients to facilitate home-based rehabilitation and integration with community resources [12]. Although these 2 programs were initiated based on different social concerns, they have both implemented the most feasible policy—namely, the discharge support program—as part of the policy agenda of providing comprehensive and continuous services to patients after discharge (Table 1). In all these programs, multidisciplinary teams comprising doctors, nurses, and social workers collaborate to develop discharge plans and facilitate coordination. Despite these efforts, transitional care in Korea still faces significant challenges.
Although research has been conducted on discharge support programs [13], no studies have comprehensively captured the perspectives of all participating professions, often focusing solely on operational issues. Thus, there has been limited discussion regarding the overall perceptions, problems, and potential improvement strategies for these programs. To bridge this gap, we opted for qualitative research methods instead of surveys to initially understand the thoughts of the program participants.
This study aimed to explore the major issues and propose improvement strategies for discharge support programs within the context of transitional care at hospital discharge. We gathered feedback on these issues and potential improvements by interviewing program participants.
We conducted focus group interviews (FGIs) to assess the perceptions of current members involved in the discharge support program, as well as to identify major issues and potential improvements. FGIs help capture respondents’ thoughts, which can be challenging in quantitative research, and identifies commonalities through group discussions [14,15]. This study utilized FGIs to collect shared opinions from members across various institutions and to elicit diverse perspectives on problems faced by the program and strategies for improvement. This study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) [16].
Study Design and Participants
This qualitative cross-sectional study involved interviews with 49 healthcare professionals, including doctors, nurses, and social workers, who participated in two pilot programs: the Establishment of a Public Health-Medical Collaboration System and the Rehabilitation Hospital Discharge Patient Support program. The Acute Care Patient Discharge Support and Community Linkage program was excluded due to its overlap with the public health-medical collaboration system in terms of participating institutions and target patients.
We identified the medical institutions participating in the discharge support program using claim data from the National Health Insurance Service (NHIS) and the National Medical Center (NMC). The managers of the discharge support program at these institutions were identified through the institutions’ websites and the NMC, which oversees the program. We then sent emails to these managers, providing information about the study and requesting their cooperation. Following the emails, our internal research team contacted each manager by phone to further explain the study and request their cooperation.
The doctors, nurses, and social workers selected for interviews at each medical institution were recommended by the program managers.
Interview Methods
The guideline development process for conducting FGIs is as follows: Initially, we aimed to identify the key information we needed to gather from the survey. To achieve this, we reviewed the guidebooks for each discharge support project and conducted face-to-face interviews with the project managers. We carried out a preliminary survey focusing on the content, challenges, and future direction of the project as envisioned by the project manager. Subsequently, we crafted the primary questions to be explored through the FGI. These questions were developed by our internal researchers and were finalized after consulting with external experts.
Each FGI was conducted in 4 distinct stages: the warm-up stage, the bridge stage, the main stage, and the ending stage. During the warm-up stage, participants introduced themselves. In the bridge stage, they shared their opinions on the necessity of the discharge support project. The main stage involved discussing key questions, and the ending stage concluded with a summary of the discussions and provided an opportunity for further explanation.
We divided FGI participants into groups of 3-6 people based on their involvement in specific discharge support programs and their professional roles. In the Public Health and Medical Cooperation System Construction Project, we interviewed a total of 25 participants, divided into two groups of doctors (6 participants), one group of nurses (11 participants), and one group of social workers (8 participants). For the Rehabilitation Medical Institution Fee Pilot Project, we interviewed a total of 24 participants, comprising two groups of doctors (9 participants), one group of nurses (2 participants), and one group of social workers (13 participants) (Figure 1). Trained interviewers, under the supervision of researchers, conducted these sessions.
A tailored FGI questionnaire was administered to doctors, nurses, and social workers. For doctors, who often had limited knowledge of specific pilot programs, the questions addressed the necessity of discharge support programs, criteria for determining the need for support post-discharge, doctors’ roles, required post-discharge services, main issues with and improvement ideas for the program, and suggestions for increasing doctor participation. For nurses and social workers, who typically managed the programs, questions focused on the programs’ necessity, collaboration with doctors, key issues and suggestions for improvement within each program, problems related to community services and service coordination after discharge, and examples of successful and unsuccessful local coordination.
The survey was conducted from August 10, 2023 to August 29, 2023, using video conferencing as the method of interviewing. The same interviewer and researcher consistently applied the same methodology across all groups. Prior consent was obtained from the participants before videotaping the survey process. The interviews followed semi-structured guidelines and averaged 2 hours in duration (Supplemental Material 1).
The researcher who participated in the interview was a man with a doctorate in public health. The interviewer, a woman, held a degree in policy studies and had prior experience in conducting qualitative research, including focus group interviews and individual interviews. Neither the interviewer nor the researcher had any prior relationship with the study participants. The comprehensive transcript provided by the research company was summarized and organized by the internal researchers of this study to highlight key information.
Statistical Analysis
Data were analyzed using phenomenological analysis, which is a qualitative method. This approach aims to describe and interpret experiences to comprehend their underlying meanings. In phenomenological analysis, researchers identify key themes and subthemes and explore recurring themes across interviews to reveal the essence of the experiences [17]. We employed Van Kaam’s method, which typically involves repeatedly listening to and transcribing interview content verbatim. However, to minimize repetition, we used an automatic recording application [18]. Subsequently, meaningful statements were extracted from the recorded content, and a categorization process was conducted by grouping statements with common attributes into subthemes. These subthemes were then organized into broader themes, which were grouped into categories. To ensure objectivity, the co-authors independently analyzed the data. In instances where analysis results differed, discussions were held until a consensus was reached through repeated analysis cycles.
Ethics Statement
Individuals who were informed about the study and agreed to participate were enrolled. The study was ethically approved by the Institutional Review Board of the NHIS, with the approval number 2023-HR-04-002.
General Characteristics of Participants
The study included 17 male (34.7%) and 32 female (65.3%) participants. The largest age group was 30-39 years, which accounted for 38.8% of the participants. Regarding hospital affiliation, 15 participants (30.6%) were from tertiary hospitals, 10 (20.4%) from general hospitals, and 24 (49.0%) from rehabilitation hospitals. Twenty-five participants were involved in the Establishment of a Public Health-Medical Collaboration System program, and 24 participants were involved in the Rehabilitation Hospital Discharge Patient Support program. In the Establishment of a Public Health-Medical Collaboration System program, the work experience of doctors and nurses ranged from 3 years to 34 years, indicating generally high levels of experience, while social workers had more variability, with a range from 1.8 years to 11.0 years. Similarly, in the Rehabilitation Hospital Discharge Patient Support program, doctors and nurses had work experience ranging from 5 years to 45 years, and social workers’ experience ranged from 1.4 years to 15 years. The work experience in both programs ranged from 0.5 years to 4.0 years, showing no significant difference (Table 2, Supplemental Material 2).
Four themes emerged in the interviews: (1) perceptions of discharge support programs, (2) identifying patients and areas in need of discharge support, (3) obstacles to discharge support programs, and (4) recommendations for enhancing discharge support programs. A total of 11 sub-themes were identified for each program (Table 3).
Perceptions of the Discharge Support Programs

Establishment of a Public Health-Medical Collaboration System program

Participants in the Establishment of a Public Health-Medical Collaboration System program unanimously agreed on the necessity of the discharge support program. Doctors, nurses, and social workers involved in the program indicated that the discharge support program is essential, as it alleviates the burden on caregivers and aids patients with limited caregiver support, enabling them to receive care at home rather than in hospitals.
Elderly patients often need a lot of attention after their diseases are treated, but hospitals have almost no services for the elderly, so a linkage program is necessary.” (Doctor A)
Even if there are welfare systems, it’s often hard to connect them, and many patients can’t find services that meet their needs, so we need to actively find them.” (Nurse A)
Regarding the efficacy of the program, doctors acknowledged that providing information and linking services could be beneficial; however, they expressed uncertainty about whether these measures were actually implemented. Nurses and social workers noted the program’s benefits but pointed out that due to patient reluctance, strict eligibility criteria for services, and changes in conditions from service providers, only 30-50% of the linkages were successful. This suggests that the program requires further improvement. Doctors typically played a crucial role in deciding on the final support for identified subjects and in managing consultative bodies. Nurses and social workers, whose roles varied by institution, were involved in the entire process, from identifying subjects to evaluation, planning, and linkage.

Rehabilitation Hospital Discharge Patient Support program

All participants in the Rehabilitation Hospital Discharge Patient Support program, including doctors, nurses, and social workers, concurred on the necessity of the program, emphasizing its role in facilitating patients’ return to the community.
Even if simulated training is done in a hospital environment, it’s different from the real environment, so it’s very necessary to help with activities of daily living and health maintenance.” (Doctor B)
I think the discharge support program is necessary, and through it, we can establish a discharge plan and help reduce patients’ and caregivers’ anxiety about returning to the community.” (Social Worker A)
Most participants recognized that linking essential services enhances patient satisfaction and provides benefits; however, when services such as home repairs are challenging to secure, the perceived effectiveness of the discharge support program diminishes.
There was a high demand for structural modifications like home repairs, but it seemed difficult to provide those services.” (Doctor C)
Patients and Areas Needing Discharge Support

Establishment of a Public Health-Medical Collaboration System program

Doctors primarily indicated that patients requiring discharge support typically have specific diseases or conditions, including stroke, respiratory diseases, heart diseases, and frailty. Conversely, nurses and social workers suggested that discharge support is also necessary for patients who live alone or have families that struggle to provide care.
Most stroke patients need discharge support because they are often discharged with residual symptoms.” (Doctor D)
With the increase in single-person households, managing medication and performing rehabilitation and exercises at home becomes difficult after discharge. There’s also a lack of social welfare information and initial post-discharge management (within 1-2 weeks) for these patients. Even if they have family members, they are often unable to provide actual care due to work.” (Social Worker B)
Doctors ranked housekeeping support, housing support, and visiting nursing as their top priorities, in that order. Conversely, nurses and social workers prioritized housekeeping support, mobility support, and visiting nursing, highlighting differences in their priorities.

Rehabilitation Hospital Discharge Patient Support program

Doctors indicated that the program is necessary for patients who need training for themselves or their caregivers, as well as for those facing non-medical discharge challenges. Nurses and social workers have pointed out that the current selection criteria, including restrictions based on the length of inpatient stay, are unreasonable. They recommended broadening the target audience of the program.
I thought the 30-day hospitalization criterion for conditions like hip fractures was too short. Especially when guiding patients for long-term care applications, those discharged within a month often get rejected, so the duration needs to be extended.” (Social Worker C)
Doctors identified home rehabilitation or house repair as the most necessary services, whereas nurses and social workers prioritized housekeeping support, indicating variations in perceived needs.
Barriers of the Discharge Support Programs

Establishment of a Public Health-Medical Collaboration System program

The main barriers identified for the program included a lack of resources and services, the burden of documentation and operational challenges, and low participation of doctors. Doctors suggested increasing resources such as manpower and budget, and creating incentive systems linked to hospital profits and doctors’ willingness to participate. Nurses and social workers noted that unclear and diverse welfare or health resources in the region complicate the planning process. They also highlighted that patients who do not meet certain income thresholds or are not already welfare beneficiaries often cannot access services. Challenges such as early patient discharge, frequent consultations within hospitals, and varying documentation requirements across administrative districts were also reported.
Having nurses and social workers as full-time dedicated staff would be beneficial.” (Doctor E)
If we institutionalize this with health insurance, hospitals will see profit increases, which would motivate hospital management to promote participation from doctors by offering incentives.” (Doctor F)
A lack of prior explanation to caregivers about discharge often leads to complaints when we contact them.” (Social Worker D)
Nurses and social workers mostly establish the plans because doctors find it hard to participate during working hours, so doctors’ input is often limited to final suggestions.” (Nurse B)

Rehabilitation Hospital Discharge Patient Support program

Major barriers in this program included insufficient reimbursement, operational challenges, and lack of coordination. Doctors emphasized the need for adequate reimbursement to cover the time and person-hours required.
The reimbursement is too low compared to the personnel and time required, so very few hospitals implement it properly.” (Doctor G)
To promote on-site visits and management, financial incentives should be increased.” (Doctor H)
Operationally, doctors emphasized the need for objective selection criteria and guidelines. Nurses and social workers pointed out challenges in communicating with patients due to cognitive impairments, differing opinions between patients and caregivers, and patients’ reluctance to disclose sensitive information.
It’s challenging when patients or caregivers feel uncomfortable with sensitive questions during evaluations.” (Social Worker E)
All groups agreed that the lack of coordination was a barrier, highlighting the absence of a central control tower for the program and the varying information requirements from municipalities and government agencies.
Even though we know a lot, linking services across municipalities is difficult due to varying requirements and inconsistent information from different officials.” (Social Worker F)
Recommendations to Improve the Discharge Support Programs

Establishment of a Public Health-Medical Collaboration System program

Participants identified 3 key areas for improvement: team restructuring, enhancement of the reimbursement system, and process improvement. They advocated for an increase in nursing and social worker staff, as well as a reorganization of overlapping roles within hospital teams. Doctors highlighted the need for guaranteed hospital profits and incentives for participating physicians, whereas nurses and social workers focused on improvements in health insurance reimbursements. Additionally, they suggested the creation of a coordination function to integrate local resources via a unified portal.

Rehabilitation Hospital Discharge Patient Support program

Participants suggested standardizing services across regions, enhancing the reimbursement system, and improving processes. Nurses and social workers advocated for the standardization of welfare services across different regions, whereas doctors called for higher reimbursement fees. Proposed process improvements involved promoting the program via academic societies and medical associations, as well as coordinating fragmented local services with municipalities serving as facilitators (Table 4).
Our study results revealed unanimous agreement among all participants on the necessity of discharge support programs. However, a significant challenge identified was the lack of interest and participation from doctors, who are the final decision-makers. Addressing this issue is crucial for the successful activation of these programs, as doctors play a key role in formulating discharge plans essential for effective discharge management. Additionally, if doctors do not provide prior explanations or if patients are not well-informed about the programs, patients may exhibit uncooperative attitudes. This can lead to increased time investment and coordination failures. Therefore, it is essential to improve the preliminary explanations provided by the medical staff. From the patient’s perspective, explanations about discharge support may seem complex, necessitating clear and simple introductions to the program and efforts to build relationships [19]. Previous research suggests that increasing medical staff participation requires an understanding of the program’s necessity, along with incentives and motivation, and clear role assignments within the program [20]. Therefore, to enhance the program’s activation, improving doctors’ compensation and incentives to increase their participation will be necessary.
In our study, the participants identified as the target population for discharge support programs included individuals hospitalized for diseases that cause functional impairment, those with diminished functionality, and those in need of training or care. This indicates a need to broaden the current target population of discharge support programs to encompass patients with more complex needs. Previous research on transitional care programs has predominantly focused on specific patient groups, including those with heart failure, mental illness, stroke, hip fractures, as well as older adults and frail individuals with complex issues [21-23]. Meta-analyses involving these populations have shown associations with reduced readmission rates, fewer adverse reactions, and improved medication adherence, particularly when interventions incorporated medication reviews, post-discharge phone follow-ups, and other monitoring services [21]. The expert consensus also recognizes individuals with complex needs as the primary target for transitional care [24]. Therefore, it is necessary to expand the target population for transitional care to include those with complex needs and to continuously refine criteria such as income level and length of hospital stay to adapt to local contexts and enhance program effectiveness.
It is also important to develop comprehensive services tailored to the needs of the target population [9]. Service providers have consistently highlighted a shortage of resources and services. If the program continues to concentrate solely on evaluation without expanding these resources and services, delivering high-quality services that patients genuinely value will remain challenging. Previous studies have similarly reported this lack of resources and services [13,19,25]. There is a need to standardize local welfare services and broaden the range of options available to patients in discharge support programs.
Effective resource allocation is crucial for managing transitional care [26], and it is vital to establish collaborative relationships among patients, healthcare professionals, and local communities [27]. However, the reluctance of local governments to cooperate has been identified as a significant barrier. Numerous studies have highlighted substantial challenges in forming effective community linkages [13,24,28]. Participants in the discharge support program expect local governments to serve not only as cooperative partners but also as coordinators of welfare services. Consequently, it is essential for local governments to engage as stakeholders, define their roles clearly, and enhance their coordination capabilities [9,21]. In Korea, a pilot program integrating medical and social care support is being implemented to improve the coordination functions of local governments for discharged patients [29]. Evaluating the effectiveness of these initiatives is crucial. Additionally, to cultivate a collaborative environment, physicians, nurses, and social workers emphasize the importance of public awareness. They point out the need for initiatives aimed at altering patients’ perceptions.
In terms of reimbursement, the discharge support program faces challenges in providing appropriate compensation due to the varying amounts of time required for each patient. To address this issue, it is recommended to enhance outcome-based incentives, adjust reimbursement costs based on the average personnel time invested, and implement differential reimbursement that reflects the complexity of cases. A multidisciplinary team is a fundamental prerequisite for the success of a discharge support program. The formation of multidisciplinary teams for transitional care management has been shown to contribute to shorter patient length of stay and improved satisfaction. Additionally, it increases the satisfaction of service providers [30]. For the successful implementation of a discharge support program, it is crucial to ensure that compensation is adequate to sustain a multidisciplinary team.
Community integration involves collaboration among doctors. However, the persistent lack of coordination among medical institutions continues to be a significant problem. In Korea, communication between these entities usually happens only through documentation, which must be enhanced to guarantee the safe reintegration of patients into the community [24,28].
If the discharge plan is unclear, proper post-discharge management may not be achieved [24,31]. Currently, there are no accredited training programs for developing discharge plans. In addition to encouraging the formulation of discharge plans, it is essential to establish educational programs that include training on discharge planning during residency programs [32].
Our research extensively covered various occupations involved in different discharge support programs across Korea, and we encouraged broad participation by contacting all participating hospitals. Unlike previous studies that focused primarily on coordinators of public health and medical cooperation pilot programs [13], our study encompassed a broader array of programs and included a diverse group of service providers, not limited to coordinators. By emphasizing the perspectives of study participants through phenomenological analysis and incorporating solutions proposed by field personnel for identified issues, this research is expected to contribute to future improvements in these programs. However, the participation in interviews was limited to those who agreed to participate, which may have introduced selection bias. The phenomenological methodology relies heavily on the researcher’s interpretation and derives content through interactions with participants. Consequently, it is challenging to assert that the interview results are representative of all program participants [33,34]. Additionally, variations in the composition of personnel and resources involved in discharge support programs at each hospital could have influenced the responses; however, our study did not explore specific differences among hospitals.
In conclusion, the need for discharge support programs is well acknowledged, yet their effectiveness is hindered by several challenges. These include limited human and financial resources, inadequate awareness of the programs, the burdens associated with their implementation, and a lack of coordination functions. Addressing these issues could involve establishing suitable reimbursement and incentive structures that support the creation and sustained operation of multidisciplinary teams. Additionally, augmenting networks with community organizations and strengthening the coordinating role of local governments may help overcome these challenges.
Supplemental material is available at https://doi.org/10.3961/jpmph.24.275.
Supplementary Material 1.
Interview guidelines for doctors, nurses, and social workers
jpmph-24-275-Supplementary-Material-1.docx
Supplementary Material 2.
Characteristics of study participants by programs
jpmph-24-275-Supplementary-Material-2.docx

Conflict of Interest

The authors have no conflicts of interest associated with the material presented in this paper.

Funding

None.

Author Contributions

Conceptualization: Choi JW, Yoo A, Lee H. Data curation: Choi JW, Yoo A, Bang H, Park HK, Lee H. Formal analysis: Choi JW, Lee H. Funding acquisition: None. Methodology: Choi JW, Yoo A, Bang H, Park HK, Lee HJ, Lee H. Project administration: Yoo A. Visualization: Choi JW, Lee H. Writing – original draft: Choi JW, Lee H. Writing – review & editing: Choi JW, Yoo A, Bang H, Park HK, Lee HJ, Lee H.

None.
Figure. 1.
Research framework diagram.
jpmph-24-275f1.jpg
jpmph-24-275f2.jpg
Table 1.
Policy framework for discharge support programs
Framework Establishment of a Public Health-Medical Collaboration System program Rehabilitation Hospital Discharge Patient Support program
Social issue Gaps in essential health care within regions because of the lack of continuity between medical institutions Challenges in providing continuous care for patients who need rehabilitation post-discharge
Agenda setting Establishing continuous and comprehensive healthcare for patients after discharge Establishing continuous and comprehensive healthcare for patients who need rehabilitation after discharge
Problem definition Fragmented services leading to inefficiencies and poor health outcomes High readmission rates and lack of resources for discharged patients who need rehabilitation
Alternative exploration Introduction of a primary care physician system and establishment of an information-sharing system between hospitals and clinics Community rehabilitation service, tele-rehabilitation, education
Policy decision Providing a comprehensive discharge assessment, planning and post-discharge service Providing a structured discharge plan with follow-up home-based rehabilitation
Policy implementation Conducting pilot programs targeting hospitals with regional responsibility Conducting pilot programs targeting rehabilitation hospitals
Policy evaluation Monitoring health outcomes, patient satisfaction, and system efficiency Monitoring health outcomes, patient satisfaction, and system efficiency
Table 2.
Characteristics of participants
Characteristics Group n Profession Age (y) Professional experience (y) Work experience in discharge support programs (y)
Establishment of a Public Health-Medical Collaboration System program A 1 Doctor 44 21.0 N/A
A 2 Doctor 53 28.0 4.0
A 3 Doctor 42 15.0 N/A
B 4 Doctor 37 3.0 3.0
B 5 Doctor 43 3.0 3.0
B 6 Doctor 46 6.0 3.0
C 7 Nurse 40 15.0 2.0
C 8 Nurse 28 5.0 2.0
C 9 Nurse 56 34.0 1.3
C 10 Nurse 57 34.0 3.0
C 11 Nurse 34 12.0 4.0
C 12 Nurse 58 34.0 0.7
D 13 Nurse 28 3.0 2.0
D 14 Nurse 51 30.0 3.0
D 15 Nurse 45 23.0 3.0
D 16 Nurse 44 25.0 2.0
D 17 Nurse 57 21.0 3.0
E 18 Social worker 36 2.5 2.5
E 19 Social worker 30 1.8 1.8
E 20 Social worker 35 N/A 5.0
E 21 Social worker 50 2.6 2.6
F 22 Social worker 40 N/A 2.5
F 23 Social worker 27 3.5 2.5
F 24 Social worker 37 N/A 1.3
F 25 Social worker 36 11.0 4.0
Rehabilitation Hospital Discharge Patient Support program A 1 Doctor 33 5.0 0.5
A 2 Doctor 42 N/A N/A
A 3 Doctor 39 8.0 4.0
A 4 Doctor 39 N/A 1.0
A 5 Doctor 33 3.0 0.4
B 6 Doctor 41 10.0 0.4
B 7 Doctor 60 45.0 0.4
B 8 Doctor 38 5.0 4.0
B 9 Doctor 47 15.0 3.0
C 10 Nurse 44 20.0 3.0
C 11 Nurse 50 23.0 0.5
C 12 Social worker 25 1.4 1.4
C 13 Social worker 34 9.0 6.0
C 14 Social worker 52 15.0 3.0
D 15 Social worker 40 10.0 3.0
D 16 Social worker 30 9.0 1.3
D 17 Social worker 32 8.2 0.5
D 18 Social worker 24 0.4 0.4
D 19 Social worker 42 5.0 5.0
E 20 Social worker 30 2.0 1.0
E 21 Social worker 28 2.0 N/A
E 22 Social worker 32 6.0 4.0
E 23 Social worker 37 3.5 3.5
E 24 Social worker 34 N/A 2.0
Table 3.
Themes extracted from the interviews
Main theme Sub-theme
Establishment of a Public Health-Medical Collaboration System program Rehabilitation Hospital Discharge Patient Support program
Perceptions of the discharge support programs The necessity of the discharge support program The necessity of the discharge support program
The efficacy of the discharge support program The efficacy of the discharge support program
Role in the discharge support program Role in the discharge support program
Patients and areas needing discharge support Patients requiring discharge support programs Patients requiring discharge support programs
Essential services to be included in discharge support programs Essential services to be included in discharge support programs
Barriers of discharge support programs Lack of resources and services Insufficient reimbursement
Operational challenges leading to burdens Operational challenges leading to burdens
Low patient and team member participation Lack of coordination
Recommendations to improve discharge support programs Team restructuring Standardization
Improvement of the reimbursement system Improvement of the reimbursement system
Process and awareness improvement Process and awareness improvement
Table 4.
Interview results by profession
Programs Theme Doctors Nurses Social workers
Establishment of a Public Health-Medical Collaboration System program Perceptions of the discharge support programs
 (1) The necessity of the discharge support program Necessary for vulnerable groups with weak caregiver support Necessary as the probability of receiving care at home is higher than hospital admissions Necessary to reduce caregiver burden and provide appropriate care
 (2) The efficacy of the discharge support program Information provision and service linkage are helpful, but unsure if linkage is actually implemented Only 30-50% are successful due to patient reluctance, strict service eligibility, and changes in service provider conditions
 (3) Role in discharge support programs Final decision on plan for identified subjects and running consultative bodies Varies by medical institution, identification of subjects, program guidance, initial evaluation, health education, and discharge planning in nursing Varies by medical institution, program explanation, initial evaluation, medical expense support, and consultative body meetings
Patients and areas needing discharge support
 Patients requiring discharge support programs Patients with diseases like stroke, respiratory diseases, heart diseases, and frail patients Older patients living alone, older couples who have difficulty managing health or using welfare services after discharge Patients with social changes such as those who live alone, patients who lack information about community welfare resources or who have lost social connections
 Essential services to be included in discharge support programs Necessary in the following order: housekeeping support, housing support, and visiting nursing Necessary in the following order: housekeeping support, mobility support, and visiting nursing
Barriers of discharge support programs
 Lack of resources and services Lack of nurses and social workers in charge and insufficient promotion and institutionalization of the program Unclear and diverse welfare or health resources in the region, making it difficult to establish plans, services cannot be provided if needed based on income level
 Operational challenges leading to burdens Burden of documentation, difficulty in linkage due to a lack of understanding of the program by private hospitals Suspicions of being insurance company staff and refusal of consultation without prior notice from doctors or ward nurses, difficulty communicating with older patients, lack of privacy during consultations, high workload per person, early patient discharge
 Low participation of doctors Difficult to participate without incentives related to hospital profits and doctors’ willingness to participate Only specific doctors actively participate, doctors are rarely involved in planning
Recommendations to improve discharge support programs
 Team restructuring Increase staffing of nurses and social workers Restructure hospital teams with overlapping roles with discharge support program teams
 Improvement of the reimbursement system Incentives related to hospital profits and doctors’ willingness to participate Need for health insurance coverage and standardized guidelines
 Process improvement N/A Coordinate fragmented local services with a focus on municipalities and promote awareness of the program
Rehabilitation Hospital Discharge Patient Support program Perceptions of the discharge support programs
 The necessity of the discharge support program Necessary to shorten the hospital stay and assist in returning to daily life Reduces anxiety about returning to the community and helps in discharge preparation
 The efficacy of the discharge support program Participation increases patient motivation for treatment and reduces vague fear of discharge, but limitations exist in actual rehabilitation and linking care resources Only 20-30% successful due to patient reluctance, service eligibility, and changes in service provider conditions
 Role in discharge support programs Guidance on discharge support program, helpful in treatment and discharge planning Identify the need for linkage and monitor post-discharge medical management Identify the welfare needs of the discharged patients and link appropriate welfare resources
Patients and areas needing discharge support
 Patients requiring discharge support programs Patients who are moderately independent but need training for themselves or their caregivers, patients with non-medical discharge difficulties Need to expand program target, remove or expand inpatient period restrictions, program needed more for patients outside the target
 Essential services to be included in discharge support programs Home rehabilitation or house repair, housekeeping support, or mobility support Necessary in the following order: housekeeping support, visiting nursing, and home rehabilitation
Barriers of discharge support programs
 Insufficient reimbursement Low incentives and fees N/A
 Operational challenges leading to burdens Difficult to focus due to multiple responsibilities of the person in charge, need objective criteria for selecting subjects and guidelines for welfare support, practical difficulties in field visits or home management due to workforce or cost issues Difficulties due to reduced communication ability and cognitive function of patients, differences in opinions between patients and caregivers, reluctance to disclose sensitive information
 Lack of coordination No control tower for the program Different criteria and information requirements depending on the municipality or person in charge
Recommendations to improve discharge support programs
 Standardization N/A Need to standardize service variations across regions
 Improvement of the reimbursement system Increase fees N/A
 Process improvement Promote through academic societies and medical associations Coordinate fragmented local services with a focus on municipalities and promote awareness of the program

N/A, not available.

Figure & Data

References

    Citations

    Citations to this article as recorded by  

      Figure
      • 0
      • 1
      Provider Perspectives, Barriers, and Improvement Strategies for Hospital Discharge Support Programs: A Focus Group Interview Study in Korea
      Image Image
      Figure. 1. Research framework diagram.
      Graphical abstract
      Provider Perspectives, Barriers, and Improvement Strategies for Hospital Discharge Support Programs: A Focus Group Interview Study in Korea
      Framework Establishment of a Public Health-Medical Collaboration System program Rehabilitation Hospital Discharge Patient Support program
      Social issue Gaps in essential health care within regions because of the lack of continuity between medical institutions Challenges in providing continuous care for patients who need rehabilitation post-discharge
      Agenda setting Establishing continuous and comprehensive healthcare for patients after discharge Establishing continuous and comprehensive healthcare for patients who need rehabilitation after discharge
      Problem definition Fragmented services leading to inefficiencies and poor health outcomes High readmission rates and lack of resources for discharged patients who need rehabilitation
      Alternative exploration Introduction of a primary care physician system and establishment of an information-sharing system between hospitals and clinics Community rehabilitation service, tele-rehabilitation, education
      Policy decision Providing a comprehensive discharge assessment, planning and post-discharge service Providing a structured discharge plan with follow-up home-based rehabilitation
      Policy implementation Conducting pilot programs targeting hospitals with regional responsibility Conducting pilot programs targeting rehabilitation hospitals
      Policy evaluation Monitoring health outcomes, patient satisfaction, and system efficiency Monitoring health outcomes, patient satisfaction, and system efficiency
      Characteristics Group n Profession Age (y) Professional experience (y) Work experience in discharge support programs (y)
      Establishment of a Public Health-Medical Collaboration System program A 1 Doctor 44 21.0 N/A
      A 2 Doctor 53 28.0 4.0
      A 3 Doctor 42 15.0 N/A
      B 4 Doctor 37 3.0 3.0
      B 5 Doctor 43 3.0 3.0
      B 6 Doctor 46 6.0 3.0
      C 7 Nurse 40 15.0 2.0
      C 8 Nurse 28 5.0 2.0
      C 9 Nurse 56 34.0 1.3
      C 10 Nurse 57 34.0 3.0
      C 11 Nurse 34 12.0 4.0
      C 12 Nurse 58 34.0 0.7
      D 13 Nurse 28 3.0 2.0
      D 14 Nurse 51 30.0 3.0
      D 15 Nurse 45 23.0 3.0
      D 16 Nurse 44 25.0 2.0
      D 17 Nurse 57 21.0 3.0
      E 18 Social worker 36 2.5 2.5
      E 19 Social worker 30 1.8 1.8
      E 20 Social worker 35 N/A 5.0
      E 21 Social worker 50 2.6 2.6
      F 22 Social worker 40 N/A 2.5
      F 23 Social worker 27 3.5 2.5
      F 24 Social worker 37 N/A 1.3
      F 25 Social worker 36 11.0 4.0
      Rehabilitation Hospital Discharge Patient Support program A 1 Doctor 33 5.0 0.5
      A 2 Doctor 42 N/A N/A
      A 3 Doctor 39 8.0 4.0
      A 4 Doctor 39 N/A 1.0
      A 5 Doctor 33 3.0 0.4
      B 6 Doctor 41 10.0 0.4
      B 7 Doctor 60 45.0 0.4
      B 8 Doctor 38 5.0 4.0
      B 9 Doctor 47 15.0 3.0
      C 10 Nurse 44 20.0 3.0
      C 11 Nurse 50 23.0 0.5
      C 12 Social worker 25 1.4 1.4
      C 13 Social worker 34 9.0 6.0
      C 14 Social worker 52 15.0 3.0
      D 15 Social worker 40 10.0 3.0
      D 16 Social worker 30 9.0 1.3
      D 17 Social worker 32 8.2 0.5
      D 18 Social worker 24 0.4 0.4
      D 19 Social worker 42 5.0 5.0
      E 20 Social worker 30 2.0 1.0
      E 21 Social worker 28 2.0 N/A
      E 22 Social worker 32 6.0 4.0
      E 23 Social worker 37 3.5 3.5
      E 24 Social worker 34 N/A 2.0
      Main theme Sub-theme
      Establishment of a Public Health-Medical Collaboration System program Rehabilitation Hospital Discharge Patient Support program
      Perceptions of the discharge support programs The necessity of the discharge support program The necessity of the discharge support program
      The efficacy of the discharge support program The efficacy of the discharge support program
      Role in the discharge support program Role in the discharge support program
      Patients and areas needing discharge support Patients requiring discharge support programs Patients requiring discharge support programs
      Essential services to be included in discharge support programs Essential services to be included in discharge support programs
      Barriers of discharge support programs Lack of resources and services Insufficient reimbursement
      Operational challenges leading to burdens Operational challenges leading to burdens
      Low patient and team member participation Lack of coordination
      Recommendations to improve discharge support programs Team restructuring Standardization
      Improvement of the reimbursement system Improvement of the reimbursement system
      Process and awareness improvement Process and awareness improvement
      Programs Theme Doctors Nurses Social workers
      Establishment of a Public Health-Medical Collaboration System program Perceptions of the discharge support programs
       (1) The necessity of the discharge support program Necessary for vulnerable groups with weak caregiver support Necessary as the probability of receiving care at home is higher than hospital admissions Necessary to reduce caregiver burden and provide appropriate care
       (2) The efficacy of the discharge support program Information provision and service linkage are helpful, but unsure if linkage is actually implemented Only 30-50% are successful due to patient reluctance, strict service eligibility, and changes in service provider conditions
       (3) Role in discharge support programs Final decision on plan for identified subjects and running consultative bodies Varies by medical institution, identification of subjects, program guidance, initial evaluation, health education, and discharge planning in nursing Varies by medical institution, program explanation, initial evaluation, medical expense support, and consultative body meetings
      Patients and areas needing discharge support
       Patients requiring discharge support programs Patients with diseases like stroke, respiratory diseases, heart diseases, and frail patients Older patients living alone, older couples who have difficulty managing health or using welfare services after discharge Patients with social changes such as those who live alone, patients who lack information about community welfare resources or who have lost social connections
       Essential services to be included in discharge support programs Necessary in the following order: housekeeping support, housing support, and visiting nursing Necessary in the following order: housekeeping support, mobility support, and visiting nursing
      Barriers of discharge support programs
       Lack of resources and services Lack of nurses and social workers in charge and insufficient promotion and institutionalization of the program Unclear and diverse welfare or health resources in the region, making it difficult to establish plans, services cannot be provided if needed based on income level
       Operational challenges leading to burdens Burden of documentation, difficulty in linkage due to a lack of understanding of the program by private hospitals Suspicions of being insurance company staff and refusal of consultation without prior notice from doctors or ward nurses, difficulty communicating with older patients, lack of privacy during consultations, high workload per person, early patient discharge
       Low participation of doctors Difficult to participate without incentives related to hospital profits and doctors’ willingness to participate Only specific doctors actively participate, doctors are rarely involved in planning
      Recommendations to improve discharge support programs
       Team restructuring Increase staffing of nurses and social workers Restructure hospital teams with overlapping roles with discharge support program teams
       Improvement of the reimbursement system Incentives related to hospital profits and doctors’ willingness to participate Need for health insurance coverage and standardized guidelines
       Process improvement N/A Coordinate fragmented local services with a focus on municipalities and promote awareness of the program
      Rehabilitation Hospital Discharge Patient Support program Perceptions of the discharge support programs
       The necessity of the discharge support program Necessary to shorten the hospital stay and assist in returning to daily life Reduces anxiety about returning to the community and helps in discharge preparation
       The efficacy of the discharge support program Participation increases patient motivation for treatment and reduces vague fear of discharge, but limitations exist in actual rehabilitation and linking care resources Only 20-30% successful due to patient reluctance, service eligibility, and changes in service provider conditions
       Role in discharge support programs Guidance on discharge support program, helpful in treatment and discharge planning Identify the need for linkage and monitor post-discharge medical management Identify the welfare needs of the discharged patients and link appropriate welfare resources
      Patients and areas needing discharge support
       Patients requiring discharge support programs Patients who are moderately independent but need training for themselves or their caregivers, patients with non-medical discharge difficulties Need to expand program target, remove or expand inpatient period restrictions, program needed more for patients outside the target
       Essential services to be included in discharge support programs Home rehabilitation or house repair, housekeeping support, or mobility support Necessary in the following order: housekeeping support, visiting nursing, and home rehabilitation
      Barriers of discharge support programs
       Insufficient reimbursement Low incentives and fees N/A
       Operational challenges leading to burdens Difficult to focus due to multiple responsibilities of the person in charge, need objective criteria for selecting subjects and guidelines for welfare support, practical difficulties in field visits or home management due to workforce or cost issues Difficulties due to reduced communication ability and cognitive function of patients, differences in opinions between patients and caregivers, reluctance to disclose sensitive information
       Lack of coordination No control tower for the program Different criteria and information requirements depending on the municipality or person in charge
      Recommendations to improve discharge support programs
       Standardization N/A Need to standardize service variations across regions
       Improvement of the reimbursement system Increase fees N/A
       Process improvement Promote through academic societies and medical associations Coordinate fragmented local services with a focus on municipalities and promote awareness of the program
      Table 1. Policy framework for discharge support programs

      Table 2. Characteristics of participants

      Table 3. Themes extracted from the interviews

      Table 4. Interview results by profession

      N/A, not available.


      JPMPH : Journal of Preventive Medicine and Public Health
      TOP