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Henke RM, Karaca Z, Jackson P, Marder WD, Wong HS. Discharge Planning and Hospital Readmissions. Med Care Res Rev 2016; 74:345-368. [PMID: 27147642 DOI: 10.1177/1077558716647652] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examines the association between the quality of hospital discharge planning and all-cause 30-day readmissions and same-hospital readmissions. The sample included adults aged 18 years and older hospitalized in 16 states in 2010 or 2011 for acute myocardial infarction, heart failure, pneumonia, or total hip or joint arthroplasty. Data from the Hospital Consumer Assessment of Healthcare Providers and Systems measured discharge-planning quality at the hospital level. A generalized linear mixed model was used to estimate the contribution of patient and hospital characteristics to 30-day all-cause and same-hospital readmissions. Discharge-planning quality was associated with (a) lower rates of 30-day hospital readmissions and (b) higher rates of same-hospital readmissions for heart failure, pneumonia, and total hip or joint replacement. These results suggest that by improving inpatient discharge planning, hospitals may be able to influence their 30-day readmissions and increase the likelihood that readmissions will be to the same hospital.
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Affiliation(s)
| | - Zeynal Karaca
- 2 Agency for Healthcare Research and Quality, Rockville, MD, USA
| | - Paige Jackson
- 1 Truven Health Analytics, an IBM Company, Cambridge, MA, USA
| | | | - Herbert S Wong
- 2 Agency for Healthcare Research and Quality, Rockville, MD, USA
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102
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O'Connell Francischetto E, Damery S, Davies S, Combes G. Discharge interventions for older patients leaving hospital: protocol for a systematic meta-review. Syst Rev 2016; 5:46. [PMID: 26984024 PMCID: PMC4793488 DOI: 10.1186/s13643-016-0222-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increased need for additional care and support services for the elderly population. It is important to identify what support older people need once they are discharged from hospital and to ensure continuity of care. There is a large evidence base focusing on enhanced discharge services and their impact on patients. The services show some potential benefits, but there are inconsistent findings across reviews. Furthermore, it is unclear what elements of enhanced discharge interventions could be most beneficial to older people. This meta-review aims to identify existing systematic reviews of discharge interventions for older people, identify potentially effective elements of enhanced discharge services for this patient group and identify areas where further work may still be needed. METHODS/DESIGN The search will aim to identify English language systematic reviews that have assessed the effectiveness of discharge interventions for older people. The following databases will be searched: Medline, Embase, PsycINFO, HMIC, Social Policy and Practice, CINAHL, the Cochrane Library, ASSIA, Social Science Citation Index and the Grey Literature Report. The search strategy will comprise the keywords 'systematic reviews', 'older people' and 'discharge'. Discharge interventions must aim to support older patients before, during and/or after discharge from hospital. Outcomes of interest will include mortality, readmissions, length of hospital stay, patient health status, patient and carer satisfaction and staff views. Abstract, title and full text screening will be conducted independently by two reviewers. Data extracted from reviews will include review characteristics, patient population, review quality score, outcome measures and review findings, and a narrative synthesis will be conducted. DISCUSSION This review will identify existing reviews of discharge interventions and appraise how these interventions can impact outcomes in older people such as readmissions, health status, length of hospital stay and mortality. The review could inform practice and will help identify where further research is needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015025737.
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Affiliation(s)
- Elaine O'Connell Francischetto
- NIHR CLAHRC West Midlands - Theme 4 Chronic Diseases, School of Health & Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Sarah Damery
- NIHR CLAHRC West Midlands - Theme 4 Chronic Diseases, School of Health & Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sarah Davies
- Behavioural Brain Sciences Unit, Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
| | - Gill Combes
- NIHR CLAHRC West Midlands - Theme 4 Chronic Diseases, School of Health & Population Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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104
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Wariyapola C, Littlehales E, Abayasekara K, Fall D, Parker V, Hatton G. Improving the quality of vascular surgical discharge planning in a hub centre. Ann R Coll Surg Engl 2016; 98:275-9. [PMID: 26924480 DOI: 10.1308/rcsann.2016.0093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Discharge planning improves patient outcomes, reduces hospital stay and readmission rates, and should involve a multidisciplinary team (MDT) approach. The efficacy of MDT meetings in discharge planning was examined, as well as reasons for delayed discharge among vascular surgical inpatients. Methods Dedicated weekly MDT meetings were held on the vascular ward in Royal Derby Hospital for three months. Each patient was presented to the discharge planning meeting and an expected date of discharge was decided prospectively. Patients who were discharged after this date were considered 'delayed' and reasons for delay were explored at the next meeting. Results Overall, 193 patients were included in the study. Of these, 42 patients (22%) had a delayed discharge while 29 (15%) had an early discharge. The main reasons for delay were awaiting beds (30%), social (14%) and medical (45%). In 64%, the cause for delay was avoidable. Two-thirds (67%) of all delays were >24 hours. This totalled 115 bed days, of which 67 could have been avoided. However, 32 bed days were saved by early discharge. This equates to a net loss of 35 bed days, at a net cost of £2,936 per month or £35,235 per year. The MDT meetings also improved the quality of discharge planning; the variability between expected and actual discharge dates decreased after the first month. Conclusions Discharge planning meetings help prepare for patient discharge and are most effective with multidisciplinary input. The majority of delayed discharges from hospital are preventable. The main causes are awaiting transfers, social services input and medical reasons (eg falls). There is an obvious financial incentive to improve discharge planning. The efficiency of the MDT at discharge planning improves with time and this should therefore be continued for best results.
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Affiliation(s)
| | | | | | - D Fall
- Derby Teaching Hospitals NHS Foundation Trust , UK
| | - V Parker
- Derby Teaching Hospitals NHS Foundation Trust , UK
| | - G Hatton
- Derby Teaching Hospitals NHS Foundation Trust , UK
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105
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Abstract
BACKGROUND Discharge planning is a routine feature of health systems in many countries. The aim of discharge planning is to reduce hospital length of stay and unplanned readmission to hospital, and to improve the co-ordination of services following discharge from hospital.This is the third update of the original review. OBJECTIVES To assess the effectiveness of planning the discharge of individual patients moving from hospital. SEARCH METHODS We updated the review using the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 9), MEDLINE, EMBASE, CINAHL, the Social Science Citation Index (last searched in October 2015), and the US National Institutes of Health trial register (ClinicalTrials.gov). SELECTION CRITERIA Randomised controlled trials (RCTs) that compared an individualised discharge plan with routine discharge care that was not tailored to individual participants. Participants were hospital inpatients. DATA COLLECTION AND ANALYSIS Two authors independently undertook data analysis and quality assessment using a pre-designed data extraction sheet. We grouped studies according to patient groups (elderly medical patients, patients recovering from surgery, and those with a mix of conditions) and by outcome. We performed our statistical analysis according to the intention-to-treat principle, calculating risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous data using fixed-effect meta-analysis. When combining outcome data was not possible because of differences in the reporting of outcomes, we summarised the reported data in the text. MAIN RESULTS We included 30 trials (11,964 participants), including six identified in this update. Twenty-one trials recruited older participants with a medical condition, five recruited participants with a mix of medical and surgical conditions, one recruited participants from a psychiatric hospital, one from both a psychiatric hospital and from a general hospital, and two trials recruited participants admitted to hospital following a fall. Hospital length of stay and readmissions to hospital were reduced for participants admitted to hospital with a medical diagnosis and who were allocated to discharge planning (length of stay MD - 0.73, 95% CI - 1.33 to - 0.12, 12 trials, moderate certainty evidence; readmission rates RR 0.87, 95% CI 0.79 to 0.97, 15 trials, moderate certainty evidence). It is uncertain whether discharge planning reduces readmission rates for patients admitted to hospital following a fall (RR 1.36, 95% CI 0.46 to 4.01, 2 trials, very low certainty evidence). For elderly patients with a medical condition, there was little or no difference between groups for mortality (RR 0.99, 95% CI 0.79 to 1.24, moderate certainty). There was also little evidence regarding mortality for participants recovering from surgery or who had a mix of medical and surgical conditions. Discharge planning may lead to increased satisfaction for patients and healthcare professionals (low certainty evidence, six trials). It is uncertain whether there is any difference in the cost of care when discharge planning is implemented with patients who have a medical condition (very low certainty evidence, five trials). AUTHORS' CONCLUSIONS A discharge plan tailored to the individual patient probably brings about a small reduction in hospital length of stay and reduces the risk of readmission to hospital at three months follow-up for older people with a medical condition. Discharge planning may lead to increased satisfaction with healthcare for patients and professionals. There is little evidence that discharge planning reduces costs to the health service.
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Affiliation(s)
| | - Natasha A Lannin
- Alfred HealthOccupational TherapyThe Alfred55 Commercial RoadPrahranVictoriaAustralia3004
| | - Lindy M Clemson
- University of SydneyFaculty of Health SciencesJ005, East St. LidcombeLidcombeNSWAustralia1825
| | - Ian D Cameron
- Kolling Institute, Northern Sydney Local Health DistrictJohn Walsh Centre for Rehabilitation ResearchSt LeonardsNSWAustralia2065
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthOxfordUK
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Lewis Hunter AE, Spatz ES, Bernstein SL, Rosenthal MS. Factors Influencing Hospital Admission of Non-critically Ill Patients Presenting to the Emergency Department: a Cross-sectional Study. J Gen Intern Med 2016; 31:37-44. [PMID: 26084975 PMCID: PMC4700015 DOI: 10.1007/s11606-015-3438-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 04/03/2015] [Accepted: 05/29/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about the factors that influence physicians' admission decisions, especially among lower acuity patients. For the purpose of our study, non-medical refers to all of the factors-other than the patient's clinical condition-that could potentially influence admission decisions. OBJECTIVE To describe the influence of non-medical factors on physicians' decisions to admit non-critically ill patients presenting to the ED. DESIGN Cross-sectional study of hospital admissions at a single academic medical center. PARTICIPANTS Non-critically ill adult patients admitted to the hospital (n = 297) and the admitting emergency medicine physicians (n = 34). MAIN MEASURES A patient survey assessed non-medical factors, including primary care access and utilization. A physician survey assessed clinical and non-medical factors influencing the decision to admit. Based on physician responses, admissions were characterized as "strongly acuity-driven," "moderately acuity-driven," or "weakly acuity-driven." Among these admission types, we compared length of stay, cost, and readmission within 30 days to the hospital or ED. KEY RESULTS Based on the admitting physician's assessment, we categorized the motivation for admission as strongly acuity-driven in 185 (62 %) admissions, moderately acuity-driven in 92 (31 %), and weakly acuity-driven in 20 (7 %). Per the physician surveys, 51 % of hospitalizations were strongly or moderately influenced by one or more non-medical factors, including lack of information about baseline conditions (23 %); inadequate access to outpatient specialty care (14 %); need for a diagnostic testing or procedure (12 %); a recent ED visit (11 %); and inadequate access to primary care (10 %). Compared with strongly-acuity driven admissions, admissions that were moderately or weakly acuity-driven were shorter and less costly but were associated with similar rates of ED (35 %) and hospital (27 %) readmission. CONCLUSIONS Non-medical factors are influential in the admission decisions for many patients presenting to the emergency department. Moderately and weakly acuity-driven admissions may represent a feasible target for alternative care pathways.
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Affiliation(s)
| | - Erica S Spatz
- Department of Medicine, Yale School of Medicine, New Haven, CT, USA.,Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA.,Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA
| | - Marjorie S Rosenthal
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA.,Robert Wood Johnson Clinical Scholars Program, Yale School of Medicine, New Haven, CT, USA
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Abstract
BACKGROUND A fragmented health care system leads to an increased demand for continuity of care across health care levels. Research indicates age-related differences during care transition, with the oldest patients having experiences and needs that differ from those of other patients. To meet the older patients' needs and preferences during care transition, professionals must understand their experiences. OBJECTIVE The purpose of the study was to explore how patients ≥80 years of age experienced the care transition from hospital to municipal health care services. METHODS The study has a descriptive, explorative design, using semistructured interviews. Fourteen patients aged ≥80 participated in the study. Qualitative content analysis was used to describe the individuals' experiences during care transition. RESULTS Two complementary themes emerged during the analysis: "Participation depends on being invited to plan the care transition" and "Managing continuity of care represents a complex and challenging process". DISCUSSION Lack of participation, insufficient information, and vague responsibilities among staff during care transition seemed to limit the continuity of care. The patients are the vulnerable part of the care transition process, although they possess important resources, which illustrate the importance of making their voice heard. Older patients are therefore likely to benefit from more intensive support. A tailored, patient-centered follow-up of each patient is suggested to ensure that patient preferences and continuity of care to adhere to the new situation.
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Affiliation(s)
- Else Cathrine Rustad
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway
- Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Haugesund, Norway
- Department of Clinical Medicine, Helse Fonna Local Health Authority, Haugesund, Norway
- Correspondence: Else Cathrine Rustad, Stord/Haugesund University College, Klingenbergvegen 8, N-5414 Stord, Norway, Email
| | - Bodil Furnes
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Berit Seiger Cronfalk
- Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway
- Palliative Research Center, Ersta Sköndal University College, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Elin Dysvik
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
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109
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The probability of readmission within 30 days of hospital discharge is positively associated with inpatient bed occupancy at discharge--a retrospective cohort study. BMC Emerg Med 2015; 15:37. [PMID: 26666221 PMCID: PMC4678651 DOI: 10.1186/s12873-015-0067-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous work has suggested that given a hospital's need to admit more patients from the emergency department (ED), high inpatient bed occupancy may encourage premature hospital discharges that favor the hospital's need for beds over patients' medical interests. We argue that the effects of such action would be measurable as a greater proportion of unplanned hospital readmissions among patients discharged when the hospital was full than when not. In response, the present study tested this hypothesis by investigating the association between inpatient bed occupancy at the time of hospital discharge and the 30-day readmission rate. METHODS The sample included all inpatient admissions from the ED at a 420-bed emergency hospital in southern Sweden during 2011-2012 that resulted in discharge before 1 December 2012. The share of unplanned readmissions within 30 days was computed for levels of inpatient bed occupancy of <95%, 95-100%, 100-105% and >105% at the hour of discharge. A binary logistic regression model was constructed to adjust for age, time of discharge, and other factors that could affect the outcome. RESULTS In all, 32,811 visits were included in the study, 9.9% of which resulted in an unplanned readmission within 30 days of discharge. The proportion of readmissions was 9.0% for occupancy levels of <95% at the patient's discharge, 10.2% for 95-100% occupancy, 10.8% for 100-105% occupancy, and 10.5% for >105% occupancy (p = 0.0001). Results from the multivariate models show that the OR (95% CI) of readmission was 1.11 (1.01-1.22) for patients discharged at 95-100% occupancy, 1.17 (1.06-1.29) at 100-105% occupancy, and 1.15 (0.99-1.34) at >105% occupancy. CONCLUSIONS Results indicate that patients discharged from inpatient wards at times of high inpatient bed occupancy experience an increased risk of unplanned readmission within 30 days of discharge.
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110
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Stover PR, Harpin S. Decreasing Psychiatric Admission Wait Time in the Emergency Department by Facilitating Psychiatric Discharges. J Psychosoc Nurs Ment Health Serv 2015; 53:20-7. [DOI: 10.3928/02793695-20151020-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/03/2015] [Indexed: 11/20/2022]
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Haga SB, Mills R. Nurses' communication of pharmacogenetic test results as part of discharge care. Pharmacogenomics 2015; 16:251-6. [PMID: 25712188 DOI: 10.2217/pgs.14.173] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
As pharmacogenetic (PGx) testing is becoming integrated into routine clinical procedures for admitted hospital patients, consideration is needed as to when test results will be communicated to patients and by whom. Given the implications of PGx test results for current and future care, we propose that if results are not promptly discussed with patients when testing is completed, results should be discussed with patients during discharge care when possible, included in the printed or electronic discharge summary and a copy of the results sent to their primary provider. Nurses play an important role in discharge planning and care by providing patients with the necessary information and support to transfer from the hospital setting to an outpatient setting or to return to home and work. To promote nurses' ability to fulfill the role of communicating PGx test results, revised curricula and interprofessional and clinical decision support are needed.
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Affiliation(s)
- Susanne B Haga
- Center for Applied Genomics & Precision Medicine, Duke University School of Medicine, 304 Research Drive, Box 90141, Durham, NC 27708, USA
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112
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Robinson TE, Zhou L, Kerse N, Scott JD, Christiansen JP, Holland K, Armstrong DE, Bramley D. Evaluation of a New Zealand program to improve transition of care for older high risk adults. Australas J Ageing 2015; 34:269-74. [PMID: 26525602 DOI: 10.1111/ajag.12232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Transition interventions aim to improve care and reduce hospital readmissions but evaluations of these interventions have reported inconsistent results. We report on the evaluation of an intervention implemented in Auckland, New Zealand. Participants were people over the age of 65 who had an acute medical admission and were at high risk of readmission. The intervention included an improved discharge process and nurse telephone follow-up soon after discharge. Outcomes were 28 day readmission rates and emergency attendances. The study is observational, using both interrupted times series and regression discontinuity designs. 5239 patients were treated over a one year period. There was no change in readmission rates or ED attendances or secondary outcomes. Not all patients received all components of the intervention. This transition intervention was not successful. Possible reasons for this and implications are discussed. Although non-experimental methods were used, we believe the results are robust.
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Affiliation(s)
| | - Lifeng Zhou
- Waitemata District Health Board, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - John Dr Scott
- Waitemata District Health Board, Auckland, New Zealand
| | - Jonathan P Christiansen
- Waitemata District Health Board, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karen Holland
- Waitemata District Health Board, Auckland, New Zealand
| | | | - Dale Bramley
- Waitemata District Health Board, Auckland, New Zealand
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Abstract
Quality care of vascular surgery patients extends to the postoperative coordination of care and long-term surveillance, including the medical management of vascular disease. This is particularly highlighted in contemporary modern vascular surgery practice, as tremendous focus is being placed on postoperative adverse events and hospital readmissions. The purpose of this review is to provide a contemporary perspective of transitions of care at discharge and long-term surveillance recommendations after vascular surgery interventions.
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Affiliation(s)
- Andrew W Hoel
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 650, Chicago, IL 60611.
| | - Kimberly C Zamor
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 650, Chicago, IL 60611; Division of General Surgery, Boston University School of Medicine, Boston, MA
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114
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Palonen M, Kaunonen M, Helminen M, Åstedt-Kurki P. Discharge education for older people and family members in emergency department: A cross-sectional study. Int Emerg Nurs 2015; 23:306-11. [DOI: 10.1016/j.ienj.2015.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 11/25/2022]
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115
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Bryant-Lukosius D, Carter N, Reid K, Donald F, Martin-Misener R, Kilpatrick K, Harbman P, Kaasalainen S, Marshall D, Charbonneau-Smith R, DiCenso A. The clinical effectiveness and cost-effectiveness of clinical nurse specialist-led hospital to home transitional care: a systematic review. J Eval Clin Pract 2015; 21:763-81. [PMID: 26135524 DOI: 10.1111/jep.12401] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2015] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Clinical nurse specialists (CNSs) are major providers of transitional care. This paper describes a systematic review of randomized controlled trials (RCTs) evaluating the clinical effectiveness and cost-effectiveness of CNS transitional care. METHODS We searched 10 electronic databases, 1980 to July 2013, and hand-searched reference lists and key journals for RCTs that evaluated health system outcomes of CNS transitional care. Study quality was assessed using the Cochrane Risk of Bias and Quality of Health Economic Studies tools. The quality of evidence for individual outcomes was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. We pooled data for similar outcomes. RESULTS Thirteen RCTs of CNS transitional care were identified (n = 2463 participants). The studies had low (n = 3), moderate (n = 8) and high (n = 2) risk of bias and weak economic analyses. Post-cancer surgery, CNS care was superior in reducing patient mortality. For patients with heart failure, CNS care delayed time to and reduced death or re-hospitalization, improved treatment adherence and patient satisfaction, and reduced costs and length of re-hospitalization stay. For elderly patients and caregivers, CNS care improved caregiver depression and reduced re-hospitalization, re-hospitalization length of stay and costs. For high-risk pregnant women and very low birthweight infants, CNS care improved infant immunization rates and maternal satisfaction with care and reduced maternal and infant length of hospital stay and costs. CONCLUSIONS There is low-quality evidence that CNS transitional care improves patient health outcomes, delays re-hospitalization and reduces hospital length of stay, re-hospitalization rates and costs. Further research incorporating robust economic evaluation is needed.
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Affiliation(s)
- Denise Bryant-Lukosius
- School of Nursing and Department of Oncology, McMaster University, Hamilton, Ontario, Canada.,Affiliate Faculty, Canadian Centre for Advanced Practice Nursing Research, Hamilton, Ontario, Canada
| | - Nancy Carter
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Affiliate Faculty, Canadian Centre for Advanced Practice Nursing Research, Hamilton, Ontario, Canada
| | - Kim Reid
- KJResearch, Rosemere, Quebec, Canada
| | - Faith Donald
- Affiliate Faculty, Canadian Centre for Advanced Practice Nursing Research, Hamilton, Ontario, Canada.,Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | - Ruth Martin-Misener
- Affiliate Faculty, Canadian Centre for Advanced Practice Nursing Research, Hamilton, Ontario, Canada.,School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kelley Kilpatrick
- Affiliate Faculty, Canadian Centre for Advanced Practice Nursing Research, Hamilton, Ontario, Canada.,Faculty of Nursing, Université de Montreal, Montréal, Quebec, Canada
| | - Patricia Harbman
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Affiliate Faculty, Canadian Centre for Advanced Practice Nursing Research, Hamilton, Ontario, Canada.,Health Interventions Research Centre, Ryerson University, Toronto, Ontario, Canada
| | | | - Deborah Marshall
- Health Services and Systems Research, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Alba DiCenso
- School of Nursing and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Nalder EJ, Clark AJ, Anderson ND, Dawson DR. Clinicians’ perceptions of the clinical utility of the Multiple Errands Test for adults with neurological conditions. Neuropsychol Rehabil 2015; 27:685-706. [DOI: 10.1080/09602011.2015.1067628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Emily J. Nalder
- March of Dimes, Paul J.J. Martin Early Career Professor, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy & Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Rotman Research Institute, Baycrest, Toronto, Canada
| | - Amanda J. Clark
- Department of Psychology, University of Tennessee at Chattanooga, Chattanooga, USA
| | - Nicole D. Anderson
- Rotman Research Institute, Baycrest, Toronto, Canada
- Departments of Psychiatry & Psychology, University of Toronto, Toronto, Canada
| | - Deirdre R. Dawson
- Department of Occupational Science & Occupational Therapy & Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
- Rotman Research Institute, Baycrest, Toronto, Canada
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Toye C, Moorin R, Slatyer S, Aoun SM, Parsons R, Hegney D, Maher S, Hill KD. Protocol for a randomised controlled trial of an outreach support program for family carers of older people discharged from hospital. BMC Geriatr 2015; 15:70. [PMID: 26108207 PMCID: PMC4479237 DOI: 10.1186/s12877-015-0065-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Presentations to hospital of older people receiving family care at home incur substantial costs for patients, families, and the health care system, yet there can be positive carer outcomes when systematically assessing/addressing their support needs, and reductions in older people's returns to hospital attributed to appropriate discharge planning. This study will trial the Further Enabling Care at Home program, a 2-week telephone outreach initiative for family carers of older people returning home from hospital. Hypotheses are that the program will (a) better prepare families to sustain their caregiving role and (b) reduce patients' re-presentations/readmissions to hospital, and/or their length of stay; also that reduced health system costs attributable to the program will outweigh costs of its implementation. METHODS/DESIGN In this randomised controlled trial, family carers of older patients aged 70+ discharged from a Medical Assessment Unit in a Western Australian tertiary hospital, plus the patients themselves, will be recruited at discharge (N = 180 dyads). Carers will be randomly assigned (block allocation, assessors blinded) to receive usual care (control) or the new program (intervention). The primary outcome is the carer's self-reported preparedness for caregiving (Preparedness for Caregiving Scale administered within 4 days of discharge, 2-3 weeks post-discharge, 6 weeks post-discharge). To detect a clinically meaningful change of two points with 80 % power, 126 carers need to complete the study. Patients' returns to hospital and subsequent length of stay will be ascertained for a minimum of 3 months after the index admission. Regression analyses will be used to determine differences in carer and patient outcomes over time associated with the group (intervention or control). Data will be analysed using an Intention to Treat approach. A qualitative exploration will examine patients' and their family carers' experiences of the new program (interviews) and explore the hospital staff's perceptions (focus groups). Process evaluation will identify barriers to, and facilitators of, program implementation. A comprehensive economic evaluation will determine cost consequences. DISCUSSION This study investigates a novel approach to identifying and addressing family carers' needs following discharge from hospital of the older person receiving care. If successful, the program has potential to be incorporated into routine post-discharge support. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry: ACTRN12614001174673 .
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Affiliation(s)
- Christine Toye
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, WA, 6845, Australia. .,School of Population Health, The University of Western Australia, Perth, WA, 6009, Australia. .,Department of Research, Silver Chain Group, Osborne Park, Perth, WA, 6017, Australia.
| | - Susan Slatyer
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia. .,Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Richard Parsons
- School of Pharmacy, Curtin University, Perth, WA, 6845, Australia.
| | - Desley Hegney
- School of Nursing and Midwifery, The University of Southern Queensland, Toowoomba, QLD, 4350, Australia. .,School of Nursing, The University of Adelaide, Adelaide, South Australia, 5005, Australia.
| | - Sean Maher
- Department of Rehabilitation and Aged Care, Sir Charles Gairdner Hospital, Perth, WA, 6009, Australia.
| | - Keith D Hill
- School of Physiotherapy and Exercise Science, Curtin University, Perth, WA, 6845, Australia.
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Unnewehr M, Schaaf B, Marev R, Fitch J, Friederichs H. Optimizing the quality of hospital discharge summaries--a systematic review and practical tools. Postgrad Med 2015; 127:630-9. [PMID: 26074128 DOI: 10.1080/00325481.2015.1054256] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Although doctors' discharge summaries (DS) are important forms of communication between the physicians in patient care, deficits in the quality of DS are common. This review aims to answer the following question: according to the literature, how can the quality of DS be improved by (1) interventions; (2) reviews and guidelines of regulatory bodies; and (3) other practical recommendations? METHODS Systematic review of the literature. RESULTS The scientific papers on optimizing the quality of DS (n = 234) are heterogeneous and do not allow any meta-analysis. The interventional studies revealed that a structured approach of writing, educational training including feedback and the use of a checklist are effective methods. Guidelines are helpful for outlining the key characteristics of DS. Additionally, the articles in the literature provided practical proposals on improving form, structure, clinical content, treatment recommendations, follow-up plan, medications and changes, addressees, patient data, length, language, dictation, electronic processing and timeliness of DS. CONCLUSION The literature review revealed various possibilities for improving the quality of DS.
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Affiliation(s)
- Markus Unnewehr
- Klinikum Dortmund gGmbH, Respiratory Medicine, Infectious Diseases, Intensive Care Medicine , Dortmund , Germany
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119
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Zhu QM, Liu J, Hu HY, Wang S. Effectiveness of nurse-led early discharge planning programmes for hospital inpatients with chronic disease or rehabilitation needs: a systematic review and meta-analysis. J Clin Nurs 2015; 24:2993-3005. [PMID: 26095175 DOI: 10.1111/jocn.12895] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To compare the effectiveness of nurse-led early discharge planning programmes to standard care for inpatients with chronic disease or rehabilitation needs. BACKGROUND Nurse-directed early discharge planning could shorten inpatient stays and reduce medical costs; however, it is not known whether the development of discharge planning programmes is effective for inpatients with chronic disease nor how such programmes might be optimally organised. DESIGN Systematic review and meta-analysis. METHODS The PubMed, MEDLINE, EMBASE, CINAHL and Cochrane Library were searched for randomized controlled trials assessing nurse-directed discharge planning for inpatients with chronic disease or rehabilitation needs. Two reviewers independently extracted data and assessed risk of bias. Meta-analyses were conducted for the eligible studies by RevMan 5.2.6. Data were pooled using a fixed-effect or random effects model. Where meta-analysis was not possible, narrative analysis was reported. RESULTS Ten randomized controlled trials and 3438 participants were included. Meta-analysis demonstrated that, compared to standard care, early discharge planning programmes are effective in reducing hospital readmission rates, duration of inpatient readmissions and all-cause mortality. However, no reduction in the length of stay of the index admission was demonstrated. Narrative analysis suggested that discharge planning may reduce total and readmission costs, as well as improving patients' satisfaction and overall quality of life. CONCLUSIONS Compared to standard care, nurse-led early discharge planning programmes have a positive impact on several aspects of care for inpatients with chronic disease and rehabilitation requirements, including reducing readmission, readmission length of stay and mortality and improving quality of life. These findings should be taken into account in future health service policy development. RELEVANCE TO CLINICAL PRACTICE These findings are relevant to clinical and managerial staff in formulating and implementing discharge planning programmes for inpatients with chronic disease or rehabilitation needs.
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Affiliation(s)
- Qin-Mei Zhu
- Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Jia Liu
- Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Hong-Yi Hu
- Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Su Wang
- Clinical Medical College of Yangzhou University, Yangzhou, Jiangsu Province, China
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120
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Lithner M, Klefsgard R, Johansson J, Andersson E. The significance of information after discharge for colorectal cancer surgery-a qualitative study. BMC Nurs 2015; 14:36. [PMID: 26045695 PMCID: PMC4456055 DOI: 10.1186/s12912-015-0086-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 05/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim was to explore patients' experiences of information and their information needs after discharge for colorectal cancer surgery. METHODS Thirty one interviews were performed with sixteen patients during the first seven weeks at home after discharge. Patients were included from three hospitals in the south of Sweden, two of which used an enhanced recovery programme. RESULTS Trying to regain control in life by using information was the overall theme emerging from the interviews. Patients experienced the bodily changes after surgery and the emotional impact of the cancer disease, and these combined experiences seriou/sly affected their ability to manage their daily lives. They both needed, and were in search of, information to increase participation in their own cancer trajectory and to facilitate the regaining of some measure of control in their lives. Waiting for different kinds of information increased the anguish and fear in the face of an unknown future. CONCLUSIONS This study showed that receiving information was vital when patients tried to regain control in life after colorectal cancer surgery. The information was necessary in order to facilitate and manage the transition from hospital to home, and the need varied between different transitions. Patients needed more information to manage the daily life at home, but also to understand what the cancer disease really meant to them. This suggests a need for patients to participate more actively in the information and the discharge planning.
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Affiliation(s)
- Maria Lithner
- />Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
| | | | - Jan Johansson
- />Department of Surgery, Skåne University Hospital, SUS Lund, 221 85 Lund, Sweden
| | - Edith Andersson
- />Department of Health Sciences, Faculty of Medicine, Lund University, Box 157, 221 00 Lund, Sweden
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121
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Nakanishi M, Niimura J, Tanoue M, Yamamura M, Hirata T, Asukai N. Association between length of hospital stay and implementation of discharge planning in acute psychiatric inpatients in Japan. Int J Ment Health Syst 2015; 9:23. [PMID: 26029254 PMCID: PMC4449576 DOI: 10.1186/s13033-015-0015-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/20/2015] [Indexed: 11/17/2022] Open
Abstract
Background Japan has introduced an acute psychiatric care unit to the public healthcare insurance program, but its requirement of a shorter length of stay could lead to discharges without proper discharge planning. The aim of this study was to examine the association between the implementation of discharge planning and the length of stay of acute psychiatric inpatients in Japan. Methods This retrospective cross-sectional study included 449 patients discharged from the ‘psychiatric emergency ward’ of 66 hospitals during a two-week period from March 7 to 20, 2011. The assigned nurse or nursing assistant for each patient provided information on the implementation of discharge planning in the hospital stay. Results Approximately one quarter of the 449 patients (n = 122) received no support for coordination with post-discharge community care resources. The 122 patients who had received no support for community care coordination had a significantly lower mean age at admission, a shorter length of stay, and a higher rate of either no follow-up or unidentified post-discharge outpatient service than the other 327 patients. Multilevel linear regression analysis demonstrated a significantly greater length of stay among patients who were older, those who had a primary diagnosis of schizophrenia, those who were admitted compulsorily, those who received hospital outpatient services, and those who received community care coordination support from the assigned nurse or nursing assistant. The implementation of support for community care coordination did not indicate a significant association with these factors, which have been related to an increased risk of psychiatric readmission. Conclusion Patients to whom the assigned nurse or nursing assistant provided support on community care coordination experienced a significantly greater length of hospital stay. The implementation of support for community care coordination did not indicate a significant association with these factors, which have been related to an increased risk of psychiatric readmission. The mental health policy should increase focus on discharge planning in the acute psychiatric setting to enhance a link between psychiatric inpatient care and post-discharge community care resources.
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Affiliation(s)
- Miharu Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Junko Niimura
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
| | - Michika Tanoue
- Mental Health and Psychiatric Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Motoe Yamamura
- Division of Nursing Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Arakawa-ku, Tokyo, Japan
| | - Toyoaki Hirata
- Chiba Psychiatric Medical Centre, Chiba-shi, Chiba Japan
| | - Nozomu Asukai
- Research Project for Mental Health Promotion, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Tokyo, Japan
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122
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Chang W, Goopy S, Lin CC, Barnard A, Liu HE, Han CY. Registered Nurses and Discharge Planning in a Taiwanese ED: A Neglected Issue? Clin Nurs Res 2015; 25:512-31. [PMID: 25940582 DOI: 10.1177/1054773815584138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Published research on discharge planning is written from the perspective of hospital wards and community services. Limited research focuses on discharge planning in the emergency department (ED). The objective of this study was to identify ED nurses' perceptions of factors influencing the implementation of discharge planning. This qualitative study collected data from 25 ED nurses through in-depth interviews and a drawing task in which participants were asked to depict on paper the implementation of discharge planning in their practice. Factors influencing discharge planning were grouped into three categories: discharge planning as a neglected issue in the ED, heavy workload, and the negative attitudes of ED patients and their families. The study highlighted a need for effective discharge planning to be counted as an essential clinical competency for ED nurses and factored into their everyday workload. Nurses perceived that organizational culture, and parents' and relatives' attitudes were barriers to implementing discharge teaching in the ED.
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Affiliation(s)
- Wen Chang
- Chang Gung University of Science and Technology, Taiwan, Republic of China
| | | | - Chun-Chih Lin
- Chang Gung University of Science and Technology, Taiwan, Republic of China
| | - Alan Barnard
- Queensland University of Technology, Brisbane, Australia
| | | | - Chin-Yen Han
- Chang Gung University of Science and Technology, Taiwan, Republic of China
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123
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Waring TS, Alexander M. Innovations in inpatient flow and bed management. INTERNATIONAL JOURNAL OF OPERATIONS & PRODUCTION MANAGEMENT 2015. [DOI: 10.1108/ijopm-06-2013-0275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to address a gap in operations management empirical research through the use of diffusion of innovation (DOI) theory to develop further insight into patient flow and bed management, a problem that has been taxing healthcare organizations across the world.
Design/methodology/approach
– The study used an action research (AR) approach and was conducted over an 18-month period within an acute hospital in the north east of England. Data were generated through enacting AR cycles, interviews, participant observation, document analysis, diaries, meetings, questionnaires and statistical analysis.
Findings
– The research conducted within this study has not only led to practical outcomes for the hospital in terms of the successful adoption of a new patient flow system but has also led to new knowledge about the determinants of diffusion for technological and process innovations in healthcare organizations which are complex and highly political.
Research limitations/implications
– AR is not suited to all organizations and is most appropriate within those that are culturally attuned to participative and democratic ways of working. The results from this study are not generalizable but some similar organizations may see merits in this approach.
Social implications
– The AR approach has supported the hospital in adopting the new system, PFMS. This system is helping to improve the quality of patient care, providing facilities to support the work of clinicians, aiding timely discharge of well patients back into the community and saving the hospital money in terms of not needing to open emergency “winter” wards.
Originality/value
– From an operations management perspective this work has demonstrated the potential to bring theory, in this case DOI theory, and practice closer together as well as show how academic research can impact organizations. Local-H intends to continue developing its AR approach and take it into other systems projects.
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Capsule commentary on Baier et al., A qualitative study of choosing home health care after hospitalization: the unintended consequences of 'patient choice' requirements. J Gen Intern Med 2015; 30:654. [PMID: 25623302 PMCID: PMC4395614 DOI: 10.1007/s11606-015-3189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
SummaryThe majority of hospital in-patients are older people, and many of these are at increased risk of readmission, which can be an adverse outcome for the patient. Currently there is poor understanding as to how best to reduce the risk of readmission. We searched MEDLINE, EMBASE and the Cochrane library for high quality review articles about readmissions. Each review was quality assessed by two reviewers. Grouped data and evidence from original papers is cited with 95% confidence intervals when possible. Nine review studies of sufficient quality were included. Two addressed risk factors for readmission, which included: age, poor functional status prior to admission, length of stay during the index admission, depression, cognitive impairment, malnutrition, social support and social networks/support. The seven other reviews addressed interventions to reduce readmission, which included: discharge planning, post-discharge support, post-discharge case management, and nutritional supplementation. It is possible to identify older people at risk of readmission using well-established risk factors; discharge planning, post-discharge support and nutritional interventions appear to be effective in reducing readmission. Combined interventions appear to be more effective than isolated interventions.
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126
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Stewart GB, Higgins JPT, Schünemann H, Meader N. The use of Bayesian networks to assess the quality of evidence from research synthesis: 1. PLoS One 2015; 10:e0114497. [PMID: 25837450 PMCID: PMC4383525 DOI: 10.1371/journal.pone.0114497] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 11/10/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The grades of recommendation, assessment, development and evaluation (GRADE) approach is widely implemented in systematic reviews, health technology assessment and guideline development organisations throughout the world. A key advantage to this approach is that it aids transparency regarding judgments on the quality of evidence. However, the intricacies of making judgments about research methodology and evidence make the GRADE system complex and challenging to apply without training. METHODS We have developed a semi-automated quality assessment tool (SAQAT) l based on GRADE. This is informed by responses by reviewers to checklist questions regarding characteristics that may lead to unreliability. These responses are then entered into the Bayesian network to ascertain the probabilities of risk of bias, inconsistency, indirectness, imprecision and publication bias conditional on review characteristics. The model then combines these probabilities to provide a probability for each of the GRADE overall quality categories. We tested the model using a range of plausible scenarios that guideline developers or review authors could encounter. RESULTS Overall, the model reproduced GRADE judgements for a range of scenarios. Potential advantages over standard assessment are use of explicit and consistent weightings for different review characteristics, forcing consideration of important but sometimes neglected characteristics and principled downgrading where small but important probabilities of downgrading are accrued across domains. CONCLUSIONS Bayesian networks have considerable potential for use as tools to assess the validity of research evidence. The key strength of such networks lies in the provision of a statistically coherent method for combining probabilities across a complex framework based on both belief and evidence. In addition to providing tools for less experienced users to implement reliability assessment, the potential for sensitivity analyses and automation may be beneficial for application and the methodological development of reliability tools.
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Affiliation(s)
- Gavin B. Stewart
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Julian P. T. Higgins
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Holger Schünemann
- Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, Hamilton, ON, Canada
| | - Nick Meader
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
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Jeong O, Kyu Park Y, Ran Jung M, Yeop Ryu S. Analysis of 30-day postdischarge morbidity and readmission after radical gastrectomy for gastric carcinoma: a single-center study of 2107 patients with prospective data. Medicine (Baltimore) 2015; 94:e259. [PMID: 25789945 PMCID: PMC4602494 DOI: 10.1097/md.0000000000000259] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PD morbidity and readmission pose a substantial clinical and economic burden to the healthcare system. Comprehensive PD complications and readmission data are essential for developing initiatives to improve patient care. No previous studies have extensively investigated PD complications after gastric cancer surgery.We investigated the incidence, types, treatment, and risk factors of 30-day postdischarge (PD) complications after gastric cancer surgery.Between 2010 and 2013, data concerning complications and readmission within 30 days of hospital discharge were prospectively collected in 2107 patients undergoing gastric cancer surgery.In total, 1642 patients (77.9%) underwent distal gastrectomy, 418 (19.8%) total gastrectomy, and 47 (2.3%) other procedures. Postoperative morbidity and mortality were 17.4% and 0.6%, respectively, with a mean 8.8-day hospital stay. Sixty-one patients (2.9%) developed 30-day PD morbidity (58 local and 3 systemic complications), accounting for 16.6% of overall morbidity; 47 (2.2%) were readmitted; and 7 (0.3%) underwent a reoperation. The mean time to PD complications was 9.5 days after index hospital discharge. The most common complication was intra-abdominal abscess (n = 14), followed by wound, ascites, and anastomosis leakage. No mortality occurred resulting from PD complications. In the univariate and multivariate analyses, underlying comorbidity (hypertension and liver cirrhosis) and obesity were independent risk factors for developing PD complications.The early PD period is a vulnerable time for surgical patients with substantial risk of complication and readmission. Tailored discharge plans along with appropriate PD patient support are essential for improving the quality of patient care.
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Affiliation(s)
- Oh Jeong
- From the Department of Surgery, Chonnam National University Hwasun Hospital, South Korea (OJ, YKP, MRJ, SYR)
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128
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Tarrant C, Windridge K, Baker R, Freeman G, Boulton M. 'Falling through gaps': primary care patients' accounts of breakdowns in experienced continuity of care. Fam Pract 2015; 32:82-7. [PMID: 25411422 PMCID: PMC5926435 DOI: 10.1093/fampra/cmu077] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Experienced continuity is important for good quality primary care but may be challenging to achieve. Little is known about how discontinuities or gaps in care may arise, how they impact on patients' experiences and how best to understand them so that they can be avoided or managed. OBJECTIVES Using the theoretical framework of candidacy, we aim to explore patients' experiences of discontinuities in care and to gain insight into how gaps come to be bridged and why they might remain unresolved. METHODS A secondary analysis was undertaken of interview data from a large study into continuity in primary care, involving a diverse sample of 50 patients, recruited from 15 general practices, one walk-in centre and community settings in Leicestershire, UK. Analysis was conducted using a constant comparative approach. RESULTS Experiences of gaps in care were common, arising from failures in communication and coordination of care. Although some gaps were easily bridged, many patients described 'falling through gaps' because of difficulties establishing their candidacy for ongoing care when gaps occurred. These patients commonly had complex, chronic conditions and multi-morbidity. Bridging gaps required resources; relationship continuity was a valuable resource for preventing and repairing gaps in care. When gaps were not bridged, distress and dysfunctional use of health services followed. CONCLUSION This study demonstrates that some patients with complex chronic conditions and multi-morbidity may be unable to get the continuity they need and highlights the potential for relationship continuity to help prevent vulnerable patients falling through gaps in care.
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Affiliation(s)
- Carolyn Tarrant
- Department of Health Sciences, University of Leicester, Leicester,
| | - Kate Windridge
- Department of Health Sciences, University of Leicester, Leicester
| | - Richard Baker
- Department of Health Sciences, University of Leicester, Leicester
| | - George Freeman
- Department of Primary Care and Public Health, Imperial College London, London and
| | - Mary Boulton
- Department of Clinical Health Care, Oxford Brookes University, Oxford, UK
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129
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Dahl U, Johnsen R, Sætre R, Steinsbekk A. The influence of an intermediate care hospital on health care utilization among elderly patients--a retrospective comparative cohort study. BMC Health Serv Res 2015; 15:48. [PMID: 25638151 PMCID: PMC4323014 DOI: 10.1186/s12913-015-0708-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 01/19/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND An intermediate care hospital (ICH) was established in a municipality in Central Norway in 2007 to improve the coordination of services and follow-up among elderly and chronically ill patients after hospital discharge. The aim of this study was to compare health care utilization by elderly patients in a municipality with an ICH to that of elderly patients in a municipality without an ICH. METHODS This study was a retrospective comparative cohort study of all hospitalized patients aged 60 years or older in two municipalities. The data were collected from the national register of hospital use from 2005 to 2012, and from the local general hospital and two primary health care service providers from 2008 to 2012 (approx. 1,250 patients per follow-up year). The data were analyzed using descriptive statistics and analysis of covariance (ANCOVA). RESULTS The length of hospital stay decreased from the time the ICH was introduced and remained between 10% and 22% lower than the length of hospital stay in the comparative municipality for the next five years. No differences in the number of readmissions or admissions during one year follow-up after the index stay at the local general hospital or changes in primary health care utilization were observed. In the year after hospital discharge, the municipality with an ICH offered more hour-based care to elderly patients living at home (estimated mean = 234 [95% CI 215-252] versus 175 [95% CI 154-196] hours per person and year), while the comparative municipality had a higher utilization of long-term stays in nursing homes (estimated mean = 33.3 [95% CI 29.0-37.7] versus 21.9 [95% CI 18.0-25.7] days per person and year). CONCLUSIONS This study indicates that the introduction of an ICH rapidly reduces the length of hospital stay without exposing patients to an increased health risk. The ICH appears to operate as an extension of the general hospital, with only a minor impact on the pattern of primary health care utilization.
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Affiliation(s)
- Unni Dahl
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
- Central Norway Health Authority, 7500, Stjørdal, Norway.
| | - Roar Johnsen
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
| | - Rune Sætre
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
| | - Aslak Steinsbekk
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Medisinsk teknisk forskningssenter, Post box 8905 , 7491, Trondheim, Norway.
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Tsui K, Fleig L, Langford DP, Guy P, MacDonald V, Ashe MC. Exploring older adults' perceptions of a patient-centered education manual for hip fracture recovery: "everything in one place". Patient Prefer Adherence 2015; 9:1637-45. [PMID: 26604713 PMCID: PMC4655952 DOI: 10.2147/ppa.s86148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe older adults' perspectives on a new patient education manual for the recovery process after hip fracture. MATERIALS AND METHODS The Fracture Recovery for Seniors at Home (FReSH) Start manual is an evidence-based manual for older adults with fall-related hip fracture. The manual aims to support the transition from hospital to home by facilitating self-management of the recovery process. We enrolled 31 community-dwelling older adults with previous fall-related hip fracture and one family member. We collected data using a telephone-based questionnaire with eight five-point Likert items and four semi-structured open-ended questions to explore participants' perceptions on the structure, content, and illustration of the manual. The questionnaire also asked participants to rate the overall utility (out of 10 points) and length of the manual. We used content analysis to describe main themes from responses to the open-ended interview questions. RESULTS Participants' ratings for structure, content, and illustrations ranged from 4 to 5 (agree to highly agree), and the median usefulness rating was 9 (10th percentile: 7, 90th percentile: 10). Main themes from the content analysis included: ease of use and presentation; health literacy; illustration utility; health care team delivery; general impression, information support from hospital to home; emotional and decision-making support; and the novelty of the manual. CONCLUSION The FReSH Start manual was perceived as comprehensive in content and acceptable for use with older adults post-fall-related hip fracture. Participants expressed a need for delivery and explanation of the manual by a health care team member.
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Affiliation(s)
- Karen Tsui
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, The University of British Columbia, Vancouver, BC, Canada
| | - Lena Fleig
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
- Health Psychology, Freie Universität Berlin, Berlin, Germany
| | - Dolores P Langford
- Vancouver Coastal Health, The University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
| | - Pierre Guy
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health, The University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, The University of British Columbia, Vancouver, BC, Canada
| | - Valerie MacDonald
- School of Nursing, The University of British Columbia, Vancouver, BC, Canada
- Fraser Health Authority, Surrey, BC, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, The University of British Columbia, Vancouver, BC, Canada
- Department of Family Practice, The University of British Columbia, Vancouver, BC, Canada
- Correspondence: Maureen C Ashe, Centre for Hip Health and Mobility, 7F – 2635 Laurel St, Vancouver, BC, Canada V5Z 1M9, Tel +1 604 675 2574, Fax +1 604 675 2576, Email
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131
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Rennke S, Ranji SR. Transitional care strategies from hospital to home: a review for the neurohospitalist. Neurohospitalist 2015; 5:35-42. [PMID: 25553228 PMCID: PMC4272352 DOI: 10.1177/1941874414540683] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hospitals are challenged with reevaluating their hospital's transitional care practices, to reduce 30-day readmission rates, prevent adverse events, and ensure a safe transition of patients from hospital to home. Despite the increasing attention to transitional care, there are few published studies that have shown significant reductions in readmission rates, particularly for patients with stroke and other neurologic diagnoses. Successful hospital-initiated transitional care programs include a "bridging" strategy with both predischarge and postdischarge interventions and dedicated transitions provider involved at multiple points in time. Although multicomponent strategies including patient engagement, use of a dedicated transition provider, and facilitation of communication with outpatient providers require time and resources, there is evidence that neurohospitalists can implement a transitional care program with the aim of improving patient safety across the continuum of care.
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Affiliation(s)
- Stephanie Rennke
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sumant R. Ranji
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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132
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Sheehy TJ, Thygeson NM. Physician organization care management capabilities associated with effective inpatient utilization management: a fuzzy set qualitative comparative analysis. BMC Health Serv Res 2014; 14:582. [PMID: 25467603 PMCID: PMC4263202 DOI: 10.1186/s12913-014-0582-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 11/05/2014] [Indexed: 02/03/2023] Open
Abstract
Background We studied the relationship between physician organization (PO) care management capabilities and inpatient utilization in order to identify PO characteristics or capabilities associated with low inpatient bed-days per thousand. Methods We used fuzzy-set qualitative comparative analysis (fsQCA) to conduct an exploratory comparative case series study. Data about PO capabilities were collected using structured interviews with medical directors at fourteen California POs that are delegated to provide inpatient utilization management (UM) for HMO members of a California health plan. Health plan acute hospital claims from 2011 were extracted from a reporting data warehouse and used to calculate inpatient utilization statistics. Supplementary analyses were conducted using Fisher’s Exact Test and Student’s T-test. Results POs with low inpatient bed-days per thousand minimized length of stay and surgical admissions by actively engaging in concurrent review, discharge planning, and surgical prior authorization, and by contracting directly with hospitalists to provide UM-related services. Disease and case management were associated with lower medical admissions and readmissions, respectively, but not lower bed-days per thousand. Conclusions Care management methods focused on managing length of stay and elective surgical admissions are associated with low bed-days per thousand in high-risk California POs delegated for inpatient UM. Reducing medical admissions alone is insufficient to achieve low bed-days per thousand. California POs with high bed-days per thousand are not applying care management best practices. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0582-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas J Sheehy
- Children First for Oregon, Portland, Oregon, USA (formerly Goldman School of Public Policy, University of California, Berkeley, California, USA.
| | - N Marcus Thygeson
- Healthcare Services Department, Blue Shield of California, San Francisco, California, USA.
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133
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Miani C, Ball S, Pitchforth E, Exley J, King S, Roland M, Fuld J, Nolte E. Organisational interventions to reduce length of stay in hospital: a rapid evidence assessment. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02520] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAvailable evidence on effective interventions to reduce length of stay in hospital is wide-ranging and complex, with underlying factors including those acting at the health system, organisational and patient levels, and the interface between these. There is a need to better understand the diverse literature on reducing the length of hospital stay.ObjectivesThis study sought to (i) describe the nature of interventions that have been used to reduce length of stay in acute care hospitals; (ii) identify the factors that are known to influence length of stay; and (iii) assess the impact of interventions on patient outcomes, service outcomes and costs.Data sourcesWe searched MEDLINE (Ovid), EMBASE, the Health Management Information Consortium and System for Information on Grey Literature in Europe for the period January 1995 to January 2013 with no limitation of publication type.MethodsWe conducted a rapid evidence synthesis of the peer-reviewed literature on organisational interventions set in or initiated from acute hospitals. We considered evidence published between 2003 and 2013. Data were analysed drawing on the principles of narrative synthesis. We also carried out interviews with eight NHS managers and clinical leads in four sites in England.ResultsA total of 53 studies met our inclusion criteria, including 19 systematic reviews and 34 primary studies. Although the overall evidence base was varied and frequently lacked a robust study design, we identified a range of interventions that showed potential to reduce length of stay. These were multidisciplinary team working, for example some forms of organised stroke care; improved discharge planning; early supported discharge programmes; and care pathways. Nursing-led inpatient units were associated with improved outcomes but, if anything, increased length of stay. Factors influencing the impact of interventions on length of stay included contextual factors and the population targeted. The evidence was mixed with regard to the extent to which interventions seeking to reduce length of stay were associated with cost savings.LimitationsWe only considered assessments of interventions which provided a quantitative estimate of the impact of the given organisational intervention on length of hospital stay. There was a general lack of robust evidence and poor reporting, weakening the conclusions that can be drawn from the review.ConclusionsThe design and implementation of an intervention seeking to reduce (directly or indirectly) the length of stay in hospital should be informed by local context and needs. This involves understanding how the intervention is seeking to change processes and behaviours that are anticipated, based on the available evidence, to achieve desired outcomes (‘theory of change’). It will also involve assessing the organisational structures and processes that will need to be put in place to ensure that staff who are expected to deliver the intervention are appropriately prepared and supported. With regard to future research, greater attention should be given to the theoretical underpinning of the design, implementation and evaluation of interventions or programmes. There is a need for further research using appropriate methodology to assess the effectiveness of different types of interventions in different settings. Different evaluation approaches may be useful, and closer relationships between researchers and NHS organisations would enable more formative evaluation. Full economic costing should be undertaken where possible, including considering the cost implications for the wider local health economy.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
| | | | | | | | | | - Martin Roland
- Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Ellen Nolte
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and the London School of Hygiene & Tropical Medicine, London, UK
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Dharmarajan K, Krumholz HM. Strategies to Reduce 30-Day Readmissions in Older Patients Hospitalized with Heart Failure and Acute Myocardial Infarction. CURRENT GERIATRICS REPORTS 2014; 3:306-315. [PMID: 25431752 PMCID: PMC4242430 DOI: 10.1007/s13670-014-0103-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Readmission within 30 days after hospital discharge for common cardiovascular conditions such as heart failure and acute myocardial infarction is extremely common among older persons. To incentivize investment in reducing preventable rehospitalizations, the United States federal government has directed increasing financial penalties to hospitals with higher-than-expected 30-day readmission rates. Uncertainty exists, however, regarding the best approaches to reducing these adverse outcomes. In this review, we summarize the literature on predictors of 30-day readmission, the utility of risk prediction models, and strategies to reduce short-term readmission after hospitalization for heart failure and acute myocardial infarction. We report that few variables have been found to consistently predict the occurrence of 30-day readmission and that risk prediction models lack strong discriminative ability. We additionally report that the literature on interventions to reduce 30-day rehospitalization has significant limitations due to heterogeneity, susceptibility to bias, and lack of reporting on important contextual factors and details of program implementation. New information is characterizing the period after hospitalization as a time of high generalized risk, which has been termed the post-hospital syndrome. This framework for characterizing inherent post-discharge instability suggests new approaches to reducing readmissions.
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Affiliation(s)
- Kumar Dharmarajan
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; Department of Health Policy and Management, Yale University School of Public Health, New Haven, CT
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Parina RP, Chang DC, Rose JA, Talamini MA. Is a low readmission rate indicative of a good hospital? J Am Coll Surg 2014; 220:169-76. [PMID: 25529903 DOI: 10.1016/j.jamcollsurg.2014.10.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Revised: 10/27/2014] [Accepted: 10/29/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hospital readmissions are an increasing focus of health care policy. This study explores the association between 30-day readmissions and 30-day mortality for surgical procedures. STUDY DESIGN California longitudinal statewide data from 1995 to 2009 were analyzed for 7 complex procedures: abdominal aortic aneurysm repair, aortic valve replacement, bariatric surgery, coronary artery bypass grafting, esophagectomy, pancreatectomy, and percutaneous coronary intervention. Hospitals were categorized based on observed-to-expected (O/E) ratios for 30-day mortality and 30-day readmissions. Hospitals were considered "high" or "low" outliers if the 95% confidence intervals of their O/E ratios excluded 1 and "expected" if they included 1. Hospitals that were outliers in at least 1 metric were classified as "discordant" if their readmission and mortality rates were not both "high" or both "low," and "poorly discordant" in the particular scenario of high mortality with "expected" or "low" readmission rates. RESULTS A total of 1,090,071 patients and 299 hospitals were analyzed for 7 procedures, representing a total of 1,150 clinical encounters. The overall 30-day mortality was 3.79% and the 30-day readmission was 12.69%. Of the total, 729 (63.3%) had "expected" O/E ratios for both outcomes. Among outliers, 358 (85.0%) were "discordant" and 100 (23.8%) were "poorly discordant." CONCLUSIONS Hospital readmission rate alone is a limited measure of quality given the poor correlation between hospital readmission and mortality rates. In this study, 85% of hospital outliers were "discordant" for readmission and mortality. Furthermore, almost a quarter of these discordant hospitals had "expected" or "low" readmission but "high" mortality rates. Quality metrics that focus exclusively on readmission rates overlook these discrepancies.
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Affiliation(s)
| | - David C Chang
- Department of Surgery, University of California, San Diego, CA.
| | - John A Rose
- Department of Surgery, University of California, San Diego, CA
| | - Mark A Talamini
- Department of Surgery, University of California, San Diego, CA; Department of Surgery, State University of New York, Stony Brook, NY
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Fischer C, Lingsma HF, Marang-van de Mheen PJ, Kringos DS, Klazinga NS, Steyerberg EW. Is the readmission rate a valid quality indicator? A review of the evidence. PLoS One 2014; 9:e112282. [PMID: 25379675 PMCID: PMC4224424 DOI: 10.1371/journal.pone.0112282] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 10/03/2014] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Hospital readmission rates are increasingly used for both quality improvement and cost control. However, the validity of readmission rates as a measure of quality of hospital care is not evident. We aimed to give an overview of the different methodological aspects in the definition and measurement of readmission rates that need to be considered when interpreting readmission rates as a reflection of quality of care. METHODS We conducted a systematic literature review, using the bibliographic databases Embase, Medline OvidSP, Web-of-Science, Cochrane central and PubMed for the period of January 2001 to May 2013. RESULTS The search resulted in 102 included papers. We found that definition of the context in which readmissions are used as a quality indicator is crucial. This context includes the patient group and the specific aspects of care of which the quality is aimed to be assessed. Methodological flaws like unreliable data and insufficient case-mix correction may confound the comparison of readmission rates between hospitals. Another problem occurs when the basic distinction between planned and unplanned readmissions cannot be made. Finally, the multi-faceted nature of quality of care and the correlation between readmissions and other outcomes limit the indicator's validity. CONCLUSIONS Although readmission rates are a promising quality indicator, several methodological concerns identified in this study need to be addressed, especially when the indicator is intended for accountability or pay for performance. We recommend investing resources in accurate data registration, improved indicator description, and bundling outcome measures to provide a more complete picture of hospital care.
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Affiliation(s)
- Claudia Fischer
- Department of Public Health, Centre for Medical Decision Making, Erasmus MC, Rotterdam, the Netherlands
| | - Hester F. Lingsma
- Department of Public Health, Centre for Medical Decision Making, Erasmus MC, Rotterdam, the Netherlands
| | | | - Dionne S. Kringos
- Department of Public Health, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - Niek S. Klazinga
- Department of Public Health, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - Ewout W. Steyerberg
- Department of Public Health, Centre for Medical Decision Making, Erasmus MC, Rotterdam, the Netherlands
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Abstract
Readmission is a large problem after both medical and surgical admissions. Recent policy changes that include substantial financial penalties have made readmission an important, if not the most important, pay-for-performance program for health care in the United States. The CMS Hospital Readmissions Reduction Program currently applies only to patients with certain medical diagnoses, but it is expanding into orthopedic surgery in 2014, and will likely involve more surgical procedures in the future. Accordingly, hospitals and researchers will increasingly be focused on understanding and preventing readmission. Definitions of readmission must be standardized between organizations to allow for comparison. The accepted definition for any organization tracking rehospitalization should be 30-day all-cause readmission. In addition, any hospital profiling applications or studies comparing readmission rates between hospitals should use hierarchical rather than standard logistic regression modeling. Rather than relying on findings from medical patients, further studies on the specific causes of readmission after surgery should be conducted. Predictive modeling has some utility in focusing readmission prevention efforts on high-risk patients, but understanding the underlying causes of readmission is key to designing effective prevention interventions. Current evidence suggests that postoperative complications play a key role in surgical readmission, but efforts on improving discharge planning and coordination of care developed in medical patients will also be critical in decreasing unnecessary readmissions in the future.
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Pioli G, Barone A, Mussi C, Tafaro L, Bellelli G, Falaschi P, Trabucchi M, Paolisso G. The management of hip fracture in the older population. Joint position statement by Gruppo Italiano Ortogeriatria (GIOG). Aging Clin Exp Res 2014; 26:547-53. [PMID: 24566982 DOI: 10.1007/s40520-014-0198-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/16/2014] [Indexed: 10/25/2022]
Abstract
This document is a Joint Position Statement by Gruppo Italiano di OrtoGeriatria (GIOG) supported by Società Italiana di Gerontologia e Geriatria (SIGG), and Associazione Italiana Psicogeriatria (AIP) on management of hip fracture older patients. Orthogeriatric care is at present the best model of care to improve results in older patients after hip fracture. The implementation of orthogeriatric model of care, based on the collaboration between orthopaedic surgeons and geriatricians, must take into account the local availability of resources and facilities and should be integrated into the local context. At the same time the programme must be based on the best available evidences and planned following accepted quality standards that ensure the efficacy of the intervention. The position paper focused on eight quality standards for the management of hip fracture older patients in orthogeriatric model of care. The GIOG promotes the development of a clinic database with the aim of obtaining a qualitative improvement in the management of hip fracture.
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Volpato S, Bazzano S, Fontana A, Ferrucci L, Pilotto A. Multidimensional Prognostic Index predicts mortality and length of stay during hospitalization in the older patients: a multicenter prospective study. J Gerontol A Biol Sci Med Sci 2014; 70:325-31. [PMID: 25209253 DOI: 10.1093/gerona/glu167] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The Multidimensional Prognostic Index (MPI) is a validated predictive tool for long-term mortality based on information collected in a standardized Comprehensive Geriatric Assessment. We investigated whether the MPI is an effective predictor of intrahospital mortality and length of hospital stay after admission to acute geriatric wards. METHODS Prospective study of 1,178 older patients (702 women and 476 men, 85.0±6.8 years) admitted to 20 geriatrics units. Within 48 hours from admission, the MPI, according to an earlier validated algorithm, was calculated. Subjects were divided into three groups of MPI score, low-risk (MPI-1 value ≤ 0.33), moderate-risk (MPI-2 value 0.34-0.66), and severe-risk of mortality (MPI-3 value ≥ 0.67), on the basis of earlier established cut-offs. Associations with in-hospital mortality and length of stay were examined using multivariable Cox regression models and adjusted Poisson linear mixed-effects models, respectively. RESULTS At admission, 23.6% subjects had a MPI-1 score, 33.8% had a MPI-2 score, and 42.6% had a MPI-3 score. Subjects with higher MPI score at admission were older (p < .001), more frequently women (p < .001) and had higher prevalence of common chronic conditions. After adjustment for age, gender, and diseases, patients included in the MPI-2 and MPI-3 groups had a significantly higher risk for intrahospital mortality (hazard ratio: 3.48, 95% confidence intervals: 1.02-11.88, p = .047; hazard ratio: 8.31, 95% confidence intervals: 2.54-27.19, p < .001) than patients included in the MPI-1 group, respectively. In multivariable model, length of stay significantly increased across the three MPI groups (11.29 [0.5], 13.73 [1.3], and 15.30 [1.4] days, respectively [p < .0001]). CONCLUSIONS In older acute care inpatients, MPI score assessed at hospital admission is an independent predictor of in-hospital mortality and the length of hospital stay.
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Affiliation(s)
- Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Italy.
| | - Salvatore Bazzano
- Geriatrics Unit, Azienda ULSS 16 Padova, Italy. Geriatric-Gerontology Research Unit and
| | - Andrea Fontana
- Unit of Biostatistics, Scientific Institute for Research and Care, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Luigi Ferrucci
- Longitudinal Studies Section, Clinical Research Branch, National Institute on Aging, Baltimore, Maryland
| | - Alberto Pilotto
- Geriatrics Unit, Azienda ULSS 16 Padova, Italy. Geriatric-Gerontology Research Unit and
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Waring J, Marshall F, Bishop S, Sahota O, Walker M, Currie G, Fisher R, Avery T. An ethnographic study of knowledge sharing across the boundaries between care processes, services and organisations: the contributions to ‘safe’ hospital discharge. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02290] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundHospital discharge is a vulnerable stage in the patient pathway. Research highlights communication failures and the problems of co-ordination as resulting in delayed, poorly timed and unsafe discharges. The complexity of hospital discharge exemplifies the threats to patient safety found ‘between’ care processes and organisations. In developing this perspective, safe discharge is seen as relying upon enhanced knowledge sharing and collaboration between stakeholders, which can mitigate system complexity and promote safety.AimTo identify interventions and practices that support knowledge sharing and collaboration in the processes of discharge planning and care transition.SettingThe study was undertaken between 2011 and 2013 in two English health-care systems, each comprising an acute health-care provider, community and primary care providers, local authority social services and social care agencies. The study sites were selected to reflect known variations in local population demographics as well as in the size and composition of the care systems. The study compared the experiences of stroke and hip fracture patients as exemplars of acute care with complex discharge pathways.DesignThe study involved in-depth ethnographic research in the two sites. This combined (a) over 180 hours of observations of discharge processes and knowledge-sharing activities in various care settings; (b) focused ‘patient tracking’ to trace and understand discharge activities across the entire patient journey; and (c) qualitative interviews with 169 individuals working in health, social and voluntary care sectors.FindingsThe study reinforces the view of hospital discharge as a complex system involving dynamic and multidirectional patterns of knowledge sharing between multiple groups. The study shows that discharge planning and care transitions develop through a series of linked ‘situations’ or opportunities for knowledge sharing. It also shows variations in these situations, in terms of the range of actors, forms of knowledge shared, and media and resources used, and the wider culture and organisation of discharge. The study also describes the threats to patient safety associated with hospital discharge, as perceived by participants and stakeholders. These related to falls, medicines, infection, clinical procedures, equipment, timing and scheduling of discharge, and communication. Each of these identified risks are analysed and explained with reference to the observed patterns of knowledge sharing to elaborate how variations in knowledge sharing can hinder or promote safe discharge.ConclusionsThe study supports the view of hospital discharge as a complex system involving tightly coupled and interdependent patterns of interaction between multiple health and social care agencies. Knowledge sharing can help to mitigate system complexity through supporting collaboration and co-ordination. The study suggests four areas of change that might enhance knowledge sharing, reduce system complexity and promote safety. First, knowledge brokers in the form of discharge co-ordinators can facilitate knowledge sharing and co-ordination; second, colocation and functional proximity of stakeholders can support knowledge sharing and mutual appreciation and alignment of divergent practices; third, local cultures should prioritise and value collaboration; and finally, organisational resources, procedures and leadership should be aligned to fostering knowledge sharing and collaborative working. These learning points provide insight for future interventions to enhance discharge planning and care transition. Future research might consider the implementation of interviews to mediate system complexity through fostering enhanced knowledge sharing across occupational and organisational boundaries. Research might also consider in more detail the underlying complexity of both health and social care systems and how opportunities for knowledge sharing might be engendered to promote patient safety in other areas.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Justin Waring
- Centre for Heath Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, UK
| | - Fiona Marshall
- Centre for Heath Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, UK
| | - Simon Bishop
- Centre for Heath Innovation, Leadership and Learning, Nottingham University Business School, Nottingham, UK
| | - Opinder Sahota
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Marion Walker
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Graeme Currie
- Warwick Business School, University of Warwick, Coventry, UK
| | - Rebecca Fisher
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Tony Avery
- Community Health Sciences, University of Nottingham, Nottingham, UK
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Allen J, Hutchinson AM, Brown R, Livingston PM. Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Health Serv Res 2014; 14:346. [PMID: 25128468 PMCID: PMC4147161 DOI: 10.1186/1472-6963-14-346] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/01/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Provision of high quality transitional care is a challenge for health care providers in many western countries. This systematic review was conducted to (1) identify and synthesise research, using randomised control trial designs, on the quality of transitional care interventions compared with standard hospital discharge for older people with chronic illnesses, and (2) make recommendations for research and practice. METHODS Eight databases were searched; CINAHL, Psychinfo, Medline, Proquest, Academic Search Complete, Masterfile Premier, SocIndex, Humanities and Social Sciences Collection, in addition to the Cochrane Collaboration, Joanna Briggs Institute and Google Scholar. Results were screened to identify peer reviewed journal articles reporting analysis of quality indicator outcomes in relation to a transitional care intervention involving discharge care in hospital and follow-up support in the home. Studies were limited to those published between January 1990 and May 2013. Study participants included people 60 years of age or older living in their own homes who were undergoing care transitions from hospital to home. Data relating to study characteristics and research findings were extracted from the included articles. Two reviewers independently assessed studies for risk of bias. RESULTS Twelve articles met the inclusion criteria. Transitional care interventions reported in most studies reduced re-hospitalizations, with the exception of general practitioner and primary care nurse models. All 12 studies included outcome measures of re-hospitalization and length of stay indicating a quality focus on effectiveness, efficiency, and safety/risk. Patient satisfaction was assessed in six of the 12 studies and was mostly found to be high. Other outcomes reflecting person and family centred care were limited including those pertaining to the patient and carer experience, carer burden and support, and emotional support for older people and their carers. Limited outcome measures were reported reflecting timeliness, equity, efficiencies for community providers, and symptom management. CONCLUSIONS Gaps in the evidence base were apparent in the quality domains of timeliness, equity, efficiencies for community providers, effectiveness/symptom management, and domains of person and family centred care. Further research that involves the person and their family/caregiver in transitional care interventions is needed.
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Affiliation(s)
- Jacqueline Allen
- />Deakin University, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Alison M Hutchinson
- />Deakin University, School of Nursing and Midwifery; Centre for Nursing Research – Deakin University and Monash Health Partnership, Monash Health, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Rhonda Brown
- />Deakin University, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Patricia M Livingston
- />Faculty of Health & School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood, 3125 Vic Australia
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Dementia considered? Safety-relevant communication between health care settings: a systematic review. J Public Health (Oxf) 2014. [DOI: 10.1007/s10389-014-0630-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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143
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Hospital discharge of elderly patients to primary health care, with and without an intermediate care hospital - a qualitative study of health professionals' experiences. Int J Integr Care 2014; 14:e011. [PMID: 24868194 PMCID: PMC4027887 DOI: 10.5334/ijic.1156] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 02/14/2014] [Accepted: 03/11/2014] [Indexed: 12/05/2022] Open
Abstract
Introduction Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital. Methods A qualitative study with data collected through semi-structured focus groups and individual interviews. Results Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients. Conclusions The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.
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Salles N, Floccia M, Videau MN, Diallo L, Guérin D, Valentin V, Rainfray M. Avoiding Emergency Department Admissions Using Telephonic Consultations Between General Practitioners and Hospital Geriatricians. J Am Geriatr Soc 2014; 62:782-4. [DOI: 10.1111/jgs.12757] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Nathalie Salles
- Pôle de Gérontologie Clinique; Hôpital Xavier-Arnozan; Centre Hospitalier Universitaire de Bordeaux; Pessac France
| | - Marie Floccia
- Pôle de Gérontologie Clinique; Hôpital Xavier-Arnozan; Centre Hospitalier Universitaire de Bordeaux; Pessac France
| | - Marie-Neige Videau
- Pôle de Gérontologie Clinique; Hôpital Xavier-Arnozan; Centre Hospitalier Universitaire de Bordeaux; Pessac France
| | - Leila Diallo
- Pôle de Gérontologie Clinique; Hôpital Xavier-Arnozan; Centre Hospitalier Universitaire de Bordeaux; Pessac France
| | - Dany Guérin
- Regional Union of General Practitioners Aquitaine; Bordeaux France
| | | | - Muriel Rainfray
- Pôle de Gérontologie Clinique; Hôpital Xavier-Arnozan; Centre Hospitalier Universitaire de Bordeaux; Pessac France
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Ubbink DT, Tump E, Koenders JA, Kleiterp S, Goslings JC, Brölmann FE. Which reasons do doctors, nurses, and patients have for hospital discharge? A mixed-methods study. PLoS One 2014; 9:e91333. [PMID: 24625666 PMCID: PMC3953385 DOI: 10.1371/journal.pone.0091333] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 02/07/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The decision to discharge a patient from a hospital is a complex process governed by many medical and non-medical factors, while the actual reasons for discharge frequently remain ill-defined. AIM To define relevant discharge criteria as perceived by doctors, nurses and patients for the development of a standard hospital discharge policy, we collected actual reasons and most pivotal medical and organisational criteria for discharge among all stakeholders. SETTING A tertiary referral university teaching hospital. METHODS We conducted a mixed methods analysis, using patient questionnaires, interviews and a focus group with caregivers, and observations during the daily rounds of doctors, nurses and patients during their hospital stay. Fourteen wards of the Surgery, Paediatrics and Neurology departments contributed. RESULTS We observed 426 patients during their hospital stay. Forty doctors and nurses were interviewed, and 7 senior nurses attended a focus group. The most commonly used discharge criteria were clinical factors, organisational discharge issues and patient-related factors. A total of 269 patients returned their questionnaires. About one third of the adult patients and nearly half of the children (or their parents) felt their personal situation and assistance needed at home was insufficiently taken into account before discharge. Patients were least satisfied with the information given about what they were allowed to do or should avoid after discharge and their involvement in the planning of their discharge. Thus, besides obvious medical reasons for discharge, several non-medical reasons were signalled by all stakeholders as important issues to be improved. CONCLUSIONS A set of discharge criteria could be defined that is useful for a more uniform hospital discharge policy that may help reduce unnecessary length of stay and improve patient satisfaction.
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Affiliation(s)
- Dirk T. Ubbink
- Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, The Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Evelien Tump
- Department of Paediatrics, Academic Medical Center, Amsterdam, The Netherlands
| | - Josje A. Koenders
- Department of Quality Assurance and Process Innovation, Academic Medical Center, Amsterdam, The Netherlands
| | - Sieta Kleiterp
- Department of Obstetrics and Gynaecology, Academic Medical Center, Amsterdam, The Netherlands
| | - J. Carel Goslings
- Department of Trauma Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Fleur E. Brölmann
- Department of Plastic, Reconstructive and Hand Surgery, St Lucas Andreas Hospital, Amsterdam, The Netherlands
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146
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Philis-Tsimikas A, Gallo LC. Implementing community-based diabetes programs: the scripps whittier diabetes institute experience. Curr Diab Rep 2014; 14:462. [PMID: 24390404 PMCID: PMC3946451 DOI: 10.1007/s11892-013-0462-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diabetes affects a large and growing segment of the US population. Ethnic and racial minorities are at disproportionate risk for diabetes, with Hispanics and non-Hispanic Blacks showing a near doubling of risk relative to non-Hispanic Whites. There is an urgent need to identify low cost, effective, and easily implementable primary and secondary prevention approaches, as well as tertiary strategies that delay disease progression, complications, and associated deterioration in function in patients with diabetes. The Chronic Care Model provides a well-accepted framework for improving diabetes and chronic disease care in the community and primary care medical home. A number of community-based diabetes programs have incorporated this model into their infrastructure. Diabetes programs must offer accessible information and support throughout the community and must be delivered in a format that is understood, regardless of literacy and socioeconomic status. This article will discuss several successful, culturally competent community-based programs and the key elements needed to implement the programs at a community or health system level. Health systems together with local communities can integrate the elements of community-based programs that are effective across the continuum of the care to enhance patient-centered outcomes, enable patient acceptability and ultimately lead to improved patient engagement and satisfaction.
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Affiliation(s)
- Athena Philis-Tsimikas
- Scripps Whittier Diabetes Institute, 9894 Genesee Ave, Suite 316, La Jolla, CA 92037, Telephone : 858-626-5628, Fax : 858-626-5680
| | - Linda C. Gallo
- San Diego State University, Department of Psychology, 9245 Sky Park Court Suite 115, San Diego, CA 92123, Telephone: (619) 594-4833, Fax: (619) 594-6780
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147
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Krell RW, Girotti ME, Fritze D, Campbell DA, Hendren S. Hospital readmissions after colectomy: a population-based study. J Am Coll Surg 2014; 217:1070-9. [PMID: 24246621 DOI: 10.1016/j.jamcollsurg.2013.07.403] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/11/2013] [Accepted: 07/29/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND Surgical readmissions will be targeted for reimbursement cuts in the near future. We sought to understand differences between hospitals with high and low readmission rates in a statewide surgical collaborative to identify potential quality improvement targets. STUDY DESIGN We studied 5,181 patients undergoing laparoscopic or open colectomy at 24 hospitals participating in the Michigan Surgical Quality Collaborative between May 2007 and January 2011. We first calculated hospital risk-adjusted 30-day readmission rates. We then compared reasons for readmission, risk-adjusted complication rates, risk-adjusted inpatient length of stay, and composite process compliance across readmission rate quartiles. RESULTS Hospitals with the lowest 30-day readmission rates averaged 5.1%, compared with 10.3% in hospitals with the highest rates (p < 0.01). Despite wide variability in readmission rates, reasons for readmission were similar between hospitals. Compared with hospitals with low readmission rates, hospitals with high readmission rates had higher risk-adjusted complication rates (29% vs 22%, p = 0.03), but similar median lengths of stay (5.5 days vs 5.6 days, p = 0.61). Although measures to reduce complications were associated with lower surgical site infection rates, they were not associated with reduced overall complication or readmission rates. There was wide variation in complication rates among hospitals with similar readmission rates. CONCLUSIONS There is wide variation in hospital readmission rates after colectomy that correlates with overall complication rates. However, the wide variation in complication rates among hospitals with similar readmission rates suggests that hospital complication rates explain little about their readmission rates. Preventing readmissions after colectomy in hospitals with high readmission rates will require more attention to different care processes currently unmeasured in many clinical registries as well as complication prevention.
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Affiliation(s)
- Robert W Krell
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
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148
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Hashimoto M, Matsuzaki Y, Kawahara K, Matsuda H, Nishimura G, Hatae T, Kimura Y, Arai K. Medication-Related Factors Affecting Discharge to Home. Biol Pharm Bull 2014; 37:1228-33. [DOI: 10.1248/bpb.b14-00251] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Masako Hashimoto
- Faculty of Pharmacy, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University
- Temari Pharmacy
| | - Yu Matsuzaki
- Faculty of Pharmacy, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University
| | | | | | | | | | - Yoshiaki Kimura
- Faculty of Pharmacy, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University
- Suisen Pharmacy, Fukui Pharmaceutical Association
| | - Kunizo Arai
- Faculty of Pharmacy, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University
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149
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Almagro P, Castro A. Helping COPD patients change health behavior in order to improve their quality of life. Int J Chron Obstruct Pulmon Dis 2013; 8:335-45. [PMID: 23901267 PMCID: PMC3726303 DOI: 10.2147/copd.s34211] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is one of the most prevalent and debilitating diseases in adults worldwide and is associated with a deleterious effect on the quality of life of affected patients. Although it remains one of the leading causes of global mortality, the prognosis seems to have improved in recent years. Even so, the number of patients with COPD and multiple comorbidities has risen, hindering their management and highlighting the need for futures changes in the model of care. Together with standard medical treatment and therapy adherence--essential to optimizing disease control--several nonpharmacological therapies have proven useful in the management of these patients, improving their health-related quality of life (HRQoL) regardless of lung function parameters. Among these are improved diagnosis and treatment of comorbidities, prevention of COPD exacerbations, and greater attention to physical disability related to hospitalization. Pulmonary rehabilitation reduces symptoms, optimizes functional status, improves activity and daily function, and restores the highest level of independent physical function in these patients, thereby improving HRQoL even more than pharmacological treatment. Greater physical activity is significantly correlated with improvement of dyspnea, HRQoL, and mobility, along with a decrease in the loss of lung function. Nutritional support in malnourished COPD patients improves exercise capacity, while smoking cessation slows disease progression and increases HRQoL. Other treatments such as psychological and behavioral therapies have proven useful in the treatment of depression and anxiety, both of which are frequent in these patients. More recently, telehealthcare has been associated with improved quality of life and a reduction in exacerbations in some patients. A more multidisciplinary approach and individualization of interventions will be essential in the near future.
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Affiliation(s)
- Pere Almagro
- Acute Geriatric Care Unit, Internal Medicine Department, University Hospital Mútua de Terrassa, Barcelona, Spain.
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150
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Dodds C, Foo I, Jones K, Singh SK, Waldmann C. Peri-operative care of elderly patients - an urgent need for change: a consensus statement to provide guidance for specialist and non-specialist anaesthetists. Perioper Med (Lond) 2013; 2:6. [PMID: 24472108 PMCID: PMC3964338 DOI: 10.1186/2047-0525-2-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/20/2013] [Indexed: 11/25/2022] Open
Affiliation(s)
- Chris Dodds
- James Cook University Hospital, Middleborough, UK
| | - Irwin Foo
- Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK
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