Introduction: Oncology patients often experience breakdowns in care when transitioning between care settings.
Aims and objectives: To examine the experience of oncology patients at the transition between hospital and community care and identify factors
which affect fragmentation.
Methods: We used a complementary mixed method approach. Qualitative phase: semi-structured interviews and focus groups were conducted
with patients and their caregivers, nurses, social workers, physicians and medical administrators. Quantitative phase: a survey
was administered to 400 oncology patients of a large tertiary medical center in Northern Israel. Patients who were discharged
from the hospital completed a validated questionnaire on their transition from the hospital to the community and on their
perceptions of the quality of their primary care. The surveys were administered in Hebrew, Arabic, and Russian.
Results: From the preliminary analysis of the qualitative data four broad themes emerged: (1) responsibility for care, (2) administrative
and bureaucratic burden, (3) informal routes of communication, and (4) cultural barriers. The regression analyses examined
the effect of patient characteristics (gender, age, education, income, health status, and language group) and showed that
patients' language accounted for most of the variance in quality scores. Russian speaking patients reported poorer quality
of care and Arabic speaking patients reported better quality of care, than Hebrew speakers, in all primary care domains. Both
Arabic and Russian speakers scored significantly higher on the Care Transition Measure than Hebrew speakers.
Conclusions: The differences between sub-groups found here suggest that avoidable variations in care exist. To enable a more streamlined
process, cultural issues need to be addressed at the interface between care settings. Further research should examine the
causes for such differences.
Presentation slides available from: http://www.integratedcarenetwork.org/Sweden2008/slides/02-06-shadmi.ppt