{"id":{"repo_id":"buffalo","oai_identifier":"oai:ubir.buffalo.edu:10477/80038"},"canonical_url":"https://search.dev.ndltd.org/etd/buffalo/oai:ubir.buffalo.edu:10477/80038","repository":{"repo_id":"buffalo","name":"Buffalo","base_url":"https://ubir.buffalo.edu/oai/request"},"display":{"title":"Transitional Care Planning: A Pilot Study to Explore Patient, Hospital and Primary Care Perspectives","abstract":"M.Eng.","abstract_html":"M.Eng.","abstract_has_math":false,"creators":["Hall, Kara; 0000-0001-5529-0170"],"institution":"State University of New York at Buffalo","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":["Chen, Huei-Yen (Winnie)","Industrial and Systems Engineering"],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2019,"date_issued":"2019-07-30T15:12:01Z","date_published":"2019-07-30T15:12:01Z","updated_at":"2026-07-27T19:05:23Z","subjects":["industrial engineering"],"languages":["eng"],"rights":["Users of works found in University at Buffalo Institutional Repository (UBIR) are responsible for identifying and contacting the copyright owner for permission to reuse. University at Buffalo Libraries do not manage rights for copyright-protected works and cannot assist with permissions.","Copyright retained by author."],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/10477/80038","outbound_label":"Handle","outbound_source":"dc:identifier"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:contributor","label":"Contributor","values":["Chen, Huei-Yen (Winnie)","Industrial and Systems Engineering"]},{"key":"dc:creator","label":"Author","values":["Hall, Kara; 0000-0001-5529-0170"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2019-07-30T15:12:01Z","2019","2019-05-17 20:50:02"]},{"key":"dc:publisher","label":"Institution","values":["State University of New York at Buffalo"]},{"key":"dc:type","label":"Dc Type","values":["Text","Thesis"]}]},{"id":"subjects_keywords","label":"Subjects and Keywords","entries":[{"key":"dc:subject","label":"Dc Subject","values":["industrial engineering"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["eng"]},{"key":"dc:rights","label":"Dc Rights","values":["Users of works found in University at Buffalo Institutional Repository (UBIR) are responsible for identifying and contacting the copyright owner for permission to reuse. University at Buffalo Libraries do not manage rights for copyright-protected works and cannot assist with permissions.","Copyright retained by author."]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier","label":"Identifier","values":["http://hdl.handle.net/10477/80038"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description","label":"Description","values":["M.Eng.","“The care plan is a holistic, dynamic and integrated plan that documents important disease prevention, treatment goals and plans of care” (Dykes, 2013). This thesis reports an exploratory study that used a qualitative approach, which included field observations and semi-structured interviews, to understand the barriers and current process of care planning. A thematic analysis identified barriers at the system, care-team, and patient levels. Specific themes included limited time and resources to establish value-based care, inconsistent/vague role definitions across settings, disconnections in care team communication, inconsistent care planning definitions and goals, Current processes/strategies, patients’ lack of knowledge of care planning, and social behavioral determinants that prevent patients from engaging in their care planning. While the barriers identified in this study provide opportunities for human factors in the redesign of process and support tools; further research is necessary to fully understand the care plan process."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["Transitional Care Planning: A Pilot Study to Explore Patient, Hospital and Primary Care Perspectives"]}]}],"canonical_facts":{"dc:contributor":["Chen, Huei-Yen (Winnie)","Industrial and Systems Engineering"],"dc:creator":["Hall, Kara; 0000-0001-5529-0170"],"dc:date":["2019-07-30T15:12:01Z","2019","2019-05-17 20:50:02"],"dc:description":["M.Eng.","“The care plan is a holistic, dynamic and integrated plan that documents important disease prevention, treatment goals and plans of care” (Dykes, 2013). This thesis reports an exploratory study that used a qualitative approach, which included field observations and semi-structured interviews, to understand the barriers and current process of care planning. A thematic analysis identified barriers at the system, care-team, and patient levels. Specific themes included limited time and resources to establish value-based care, inconsistent/vague role definitions across settings, disconnections in care team communication, inconsistent care planning definitions and goals, Current processes/strategies, patients’ lack of knowledge of care planning, and social behavioral determinants that prevent patients from engaging in their care planning. 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