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Ollonqvist K, Grönlund R, Karppi SL, Salmelainen U, Poikkeus L, Hinkka K. A network-based rehabilitation model for frail elderly people: development and assessment of a new model. Scand J Caring Sci 2007; 21:253-61. [PMID: 17559445 DOI: 10.1111/j.1471-6712.2007.00464.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND PURPOSE Living independently at home promotes the well-being of people aged 65 and over. In Finland, the municipalities are responsible for providing social and health services, including rehabilitation of the elderly. Rehabilitation is in practice carried out by independent rehabilitation centres. The Social Insurance Institution of Finland is a national agency responsible for financing and developing rehabilitation. Combining the efforts of these three agencies, a new network-based inpatient rehabilitation model was established to support the community living of frail elderly persons at high risk of institutionalization. This article describes the new model and evaluates the cooperation within the rehabilitation network, as well as the contents of the rehabilitation. MATERIAL AND METHODS The new model was evaluated in two phases using diverse methods. First, the networks were assessed as they were being established in 2000, and secondly, when they were operational in 2002. The first phase involved 53 networks operating in 46 municipalities and 12 rehabilitation centres, and the second 44 networks in 41 municipalities and seven rehabilitation centres. The data were collected by questionnaires, interviews and reports. RESULTS The rehabilitation networks were functional, although constant development and search for better working practices was time consuming. Two different approaches in the networks were found: the 'networks of creators' were able to carry out the new tasks highly successfully, while the 'networks of followers' only managed to do the minimum as instructed. Motivated network members and adequate resources appeared to be essential for a successful rehabilitation process. CONCLUSIONS It is possible to create a functional rehabilitation network involving different agencies. Further development work is necessary to make the network-based rehabilitation model more efficient.
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Bayliss EA, Bosworth HB, Noel PH, Wolff JL, Damush TM, Mciver L. Supporting self-management for patients with complex medical needs: recommendations of a working group. Chronic Illn 2007; 3:167-75. [PMID: 18083671 DOI: 10.1177/1742395307081501] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Increasing numbers of persons live with complex chronic medical needs and are at risk for poor health outcomes. These patients require unique self-management support, as they must manage many, often interacting, tasks. As part of a conference on Managing Complexity in Chronic Care sponsored by the Department of Veterans Affairs, a working group was convened to consider self-management issues specific to complex chronic care. In this paper, we assess gaps in current knowledge on self-management support relevant to this population, report on the recommendations of our working group, and discuss directions for future study. We conclude that this population requires specialized, multidimensional self-management support to achieve a range of patient-centred goals. New technologies and models of care delivery may provide opportunities to develop this support. Validation and quantification of these processes will require the development of performance measures that reflect the needs of this population, and research to prove effectiveness.
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Affiliation(s)
- E A Bayliss
- Clinical Research Unit, Kaiser Permanente, PO Box 378066, Denver, CO 80237-8066, USA.
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153
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Latour CHM, van der Windt DAWM, de Jonge P, Riphagen II, de Vos R, Huyse FJ, Stalman WAB. Nurse-led case management for ambulatory complex patients in general health care: a systematic review. J Psychosom Res 2007; 62:385-95. [PMID: 17324690 DOI: 10.1016/j.jpsychores.2006.10.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2006] [Revised: 08/09/2006] [Accepted: 10/17/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to summarize the available literature on the effectiveness of ambulatory nurse-led case management for complex patients in general health care. METHOD We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and Cinahl. We included randomized controlled trials, controlled clinical trials, controlled before/after study, and time series studies; identified references were screened by two reviewers. Two reviewers rated the quality of each article. Data extracted from the selected publications included design, characteristics of the participants, the intervention, type of outcome measures, and results. RESULTS We identified 10 relevant publications. Nine studies used readmission rate as primary outcome. Fewer studies investigated duration of hospital readmissions, emergency department (ED) visits, functional status, quality of life, or patient satisfaction. In general, results with regard to the effectiveness of case management were conflicting. CONCLUSION There is moderate evidence that case management has a positive effect on patient satisfaction and no effect on ED visits. It was not possible to draw firm conclusions on the other outcomes.
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Affiliation(s)
- Corine H M Latour
- Psychiatric Consultation and Liaison Service, VU University Medical Center, Amsterdam, The Netherlands
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154
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Wetzels R, Harmsen M, Van Weel C, Grol R, Wensing M. Interventions for improving older patients' involvement in primary care episodes. Cochrane Database Syst Rev 2007; 2007:CD004273. [PMID: 17253501 PMCID: PMC7197439 DOI: 10.1002/14651858.cd004273.pub2] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There is a growing expectation among patients that they should be involved in the delivery of medical care. Accumulating evidence from empirical studies shows that patients of average age who are encouraged to participate more actively in treatment decisions have more favourable health outcomes, in terms of both physiological and functional status, than those who do not. Interventions to encourage more active participation may be focused on different stages, including: the use of health care; preparation for contact with a care provider; contact with the care provider; or feedback about care. However, it is unclear whether the benefits of these interventions apply to the elderly as well. OBJECTIVES To assess the effects of interventions in primary medical care that improve the involvement of older patients (>=65 years) in their health care. SEARCH STRATEGY We searched: the Cochrane Consumers and Communication Review Group Specialised Register (May 2003); the Cochrane Central Register of Controlled Trials (CENTRAL), The Cochrane Library issue 1, 2004; MEDLINE (Ovid) (1966 to June 2004); EMBASE (1988 to June 2004); PsycINFO (1872 to June 2004); DARE, The Cochrane Library issue 1, 2004; ERIC (1966 to June 2004); CINAHL (1982 to June 2004); Sociological Abstracts (1963 to June 2004); Dissertation Abstracts International (1861 to June 2004); and reference lists of articles. SELECTION CRITERIA Randomised controlled trials or quasi-randomised trials of interventions to improve the involvement of older patients (>= 65 years) in single consultations or episodes of primary medical care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. Results are presented narratively as meta-analysis was not possible. MAIN RESULTS We identified three studies involving 433 patients. Overall, the quality of studies was not high, and there was moderate to high risk of bias. Interventions of a pre-visit booklet and a pre-visit session (either combined or pre-visit session alone) led to more questioning behaviour and more self-reported active behaviour in the intervention group (3 studies). One study (booklet and pre-visit session) showed no difference in consultation length and time engaged in talk between the intervention and control groups. The booklet and pre-visit session in one study was associated with more satisfaction with interpersonal aspects of care for the intervention group although no difference in overall satisfaction between intervention and control. There was no long-term follow up to see if effects were sustained. No studies measured outcomes relating to the use of health care, health status and wellbeing, or health behaviour. AUTHORS' CONCLUSIONS Overall this review shows some positive effects of specific methods to improve the involvement of older people in primary care episodes. Because the evidence is limited, however, we can not recommend the use of the reviewed interventions in daily practice. There should be a balance between respecting patients' autonomy and stimulating their active participation in health care. Face-to-face coaching sessions, whether or not complemented with written materials, may be the way forward. As this is impractical for the whole population, it could be worthwhile to identify a subgroup of older patients who might benefit the most from enhanced involvement, ie. those who want to be involved, but lack the necessary skills. This group could be coached either individually or, more practically, in group sessions.
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Affiliation(s)
- R Wetzels
- Radboud University Nijmegen Medical Centre, Centre for Quality of Care Research (WOK), (117 KWAZO), PO Box 9101, Nijmegen, Netherlands, 6500 HB.
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Counsell SR, Callahan CM, Buttar AB, Clark DO, Frank KI. Geriatric Resources for Assessment and Care of Elders (GRACE): A New Model of Primary Care for Low-Income Seniors. J Am Geriatr Soc 2006; 54:1136-41. [PMID: 16866688 DOI: 10.1111/j.1532-5415.2006.00791.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The majority of older adults receive health care in primary care settings, yet many fail to receive the recommended standard of care for preventive services, chronic disease management, and geriatric syndromes. The Geriatric Resources for Assessment and Care of Elders (GRACE) model of primary care for low-income seniors and their primary care physicians (PCPs) was developed to improve the quality of geriatric care so as to optimize health and functional status, decrease excess healthcare use, and prevent long-term nursing home placement. The catalyst for the GRACE intervention is the GRACE support team, consisting of a nurse practitioner and a social worker. Upon enrollment, the GRACE support team meets with the patient in the home to conduct an initial comprehensive geriatric assessment. The support team then meets with the larger GRACE interdisciplinary team (including a geriatrician, pharmacist, physical therapist, mental health social worker, and community-based services liaison) to develop an individualized care plan including activation of GRACE protocols for evaluating and managing common geriatric conditions. The GRACE support team then meets with the patient's PCP to discuss and modify the plan. Collaborating with the PCP, and consistent with the patient's goals, the support team then implements the plan. With the support of an electronic medical record and longitudinal tracking system, the GRACE support team provides ongoing care management and coordination of care across multiple geriatric syndromes, providers, and sites of care. The effectiveness of the GRACE intervention is being evaluated in a randomized, controlled trial.
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Affiliation(s)
- Steven R Counsell
- Indiana University Center for Aging Research, Indianapolis, Indiana 46202, USA.
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Pearson A, Porritt KA, Doran D, Vincent L, Craig D, Tucker D, Long L, Henstridge V. A comprehensive systematic review of evidence on the structure, process, characteristics and composition of a nursing team that fosters a healthy work environment. INT J EVID-BASED HEA 2006; 4:118-59. [DOI: 10.1111/j.1479-6988.2006.00039.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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A comprehensive systematic review of evidence on the structure, process, characteristics and composition of a nursing team that fosters a healthy work environment. INT J EVID-BASED HEA 2006. [DOI: 10.1097/01258363-200606000-00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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158
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Affiliation(s)
- Karl A Lorenz
- Veterans Administration Greater Los Angeles Healthcare System, Los Angeles, California 90073, USA.
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159
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Mukamel DB, Temkin-Greener H, Delavan R, Peterson DR, Gross D, Kunitz S, Williams TF. Team Performance and Risk-Adjusted Health Outcomes in the Program of All-Inclusive Care for the Elderly (PACE). THE GERONTOLOGIST 2006; 46:227-37. [PMID: 16581887 DOI: 10.1093/geront/46.2.227] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE The Program of All-Inclusive Care for the Elderly (PACE) is a community-based program providing primary, acute, and long-term care to frail elderly individuals. A central component of the PACE model is the interdisciplinary care team, which includes both professionals and non-professionals. The purpose of this study was to examine the association between the team's overall performance and the risk-adjusted health outcomes of program enrollees. DESIGN AND METHODS The study included interdisciplinary teams in 26 PACE programs and 3,401 individuals enrolled in them. We combined information about individuals' health, functional, and mental status from DataPACE with an overall measure of team performance. We used multivariate regression techniques to test the hypothesis that better team performance is associated with better risk-adjusted health outcomes: survival and short-term (within 3 months of enrollment) and long-term (within 12 months of enrollment) improvements in functional status and in urinary incontinence. RESULTS Team performance was significantly associated with better functional outcomes (both short and long term) and with better long-term urinary incontinence outcomes. There was no significant association with survival. IMPLICATIONS This study provides empirical evidence for the relationship between team performance and patient outcomes in long-term care. It suggests that PACE programs can improve patient outcomes by improving the functioning of care teams.
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Affiliation(s)
- Dana B Mukamel
- University of California, Irvine, 111 Academy Way, Suite 220, Irvine, CA 92697, USA.
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160
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Pearson A, Porritt KA, Doran D, Vincent L, Craig D, Tucker D, Long L, Henstridge V. A comprehensive systematic review of evidence on the structure, process, characteristics and composition of a nursing team that fosters a healthy work environment. JBI LIBRARY OF SYSTEMATIC REVIEWS 2006; 4:1-69. [PMID: 27819880 DOI: 10.11124/01938924-200604020-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES The overall aim of this comprehensive systematic review was to identify the best available evidence on the effect of team characteristics, processes, structure and composition within the context of collaborative practice among nursing teams that create a healthy work environment. SEARCH STRATEGY The search strategy sought to find both published and unpublished studies and papers written in the English language. An initial limited search of Medline and CINAHL databases was undertaken to identify optimal search terms. A second extensive search using all identified keywords and index terms was then undertaken. METHODOLOGICAL QUALITY Two independent reviewers assessed the methodological quality of retrieved papers using the corresponding checklist from the System for the Unified Management, Assessment and Review of Information (SUMARI) package. RESULTS The papers included in the review included nine experimental or quasi-experimental studies, 11 descriptive studies and four qualitative studies. A variety of different team structures such as interdisciplinary teams, primary nursing, team nursing, multidisciplinary models of care delivery and the use of a Partner in Patient Care model were investigated. Team characteristics should include accountability, commitment, enthusiasm and motivation. Social support within a team from a supervisor or colleague increased satisfaction levels of staff. CONCLUSION The results of the review lead to the development of a number of recommendations for practice that could assist with creating a health work environment.
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Affiliation(s)
- Alan Pearson
- 1The Joanna Briggs Institute, Royal Adelaide Hospital, 2School of Population Health and Clinical Practice, Faculty of Health Sciences, The University of Adelaide, Adelaide, South Australia, Australia; 3Faculty of Nursing, University of Toronto, 4RNAO, Toronto, Ontario, Canada; and 5Nursing and Patient Care Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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161
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Tanaka M, Yokode M. Attitudes of medical students and residents toward multidisciplinary team approach. MEDICAL EDUCATION 2005; 39:1255-6. [PMID: 16313586 DOI: 10.1111/j.1365-2929.2005.02340.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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García-Morillo JS, Bernabeu-Wittel M, Ollero-Baturone M, Aguilar-Guisad M, Ramírez-Duque N, González de la Puente MA, Limpo P, Romero-Carmona S, Cuello-Contreras JA. Incidencia y características clínicas de los pacientes con pluripatología ingresados en una unidad de medicina interna. Med Clin (Barc) 2005; 125:5-9. [PMID: 15960937 DOI: 10.1157/13076399] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Our objective was to assess the incidence and clinical features of patients with numerous disorders--comorbidity patients (CP)--and to clinically validate the CP criteria defined by a panel of experts (patients with 2 or more chronic diseases, distributed into seven categories). PATIENTS AND METHOD Prospective observational study of all patients, attended in internal medicine areas of a tertiary teaching hospital, during June 2003. Patients were stratified in 3 cohorts: CP, palliative, and general (GE). Incidence of CP, functional evaluation (at baseline, at admission, and at discharge), and burden of hospital care (by means of urgent and programmed visits, as well as episodes of hospitalization) in the last 12 months were analyzed. A multivariate analysis of predictors of survival and functional deterioration (fall in Barthel's scale > or = 10 points between baseline-discharge values) was performed in the CP cohort. RESULTS 339 patients (CP cohort: 132; palliative: 52; GE: 155) were included. The overall incidence was 38.9/100 admissions/month. CP were older (75 [11] vs 67 [16]); had higher mortality (19.3% vs 6.1%; relative risk [RR]: 3.66 [95% confidence interval [CI], 1.65-8.13]; lower functional ability at baseline (45 vs 95), at admission (20 vs 75), and at discharge (20 vs 95); higher rates of significant functional deterioration (16% vs 7%; RR = 2.47 [95% CI, 1.15-5.35]); and required more burden of hospital care by means of urgent care (3.6 [3.4] episodes vs 2.4 [1.9]), and hospitalizations (1.9 [1.3] vs 1.5 [1]) than GE patients. Chronic digestive/hepatic diseases (odds ratio [OR] = 48.3 [2.4-980.9], peripheric vascular disease/diabetes with visceral involvement (OR = 5.6 [CI 95%, 1.1-28.6]), and better functional ability at admission were associated with survival. Female gender (OR ) 46.6 [CI 95%, 4.5-486.9]), chronic lung disease (OR = 8.9 [CI 95%, 1.2-64]), and neurologic disease with disability (OR = 8 [CI 95%, 1.1-58.9]), were associated with significant functional deterioration during hospital stay. CONCLUSIONS The defined CP criteria were highly accurate in detecting a population of patients with high attention in Internal Medicine areas, high mortality rates, clinical frailty (more need of hospital care), and significant functional deterioration. Barthel's scale identified correctly this group of patients, and was independently associated with survival.
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Affiliation(s)
- José Salvador García-Morillo
- Unidad Clínica de Atención Médica Integral, Servicio de Medicina Interna, Hospitales Universitarios Virgen del Rocío, 41013 Sevilla, España.
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Østbye T, Yarnall KSH, Krause KM, Pollak KI, Gradison M, Michener JL. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005; 3:209-14. [PMID: 15928223 PMCID: PMC1466884 DOI: 10.1370/afm.310] [Citation(s) in RCA: 471] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 01/10/2005] [Accepted: 02/03/2005] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Despite the availability of national practice guidelines, many patients fail to receive recommended chronic disease care. Physician time constraints in primary care are likely one cause. METHODS We applied guideline recommendations for 10 common chronic diseases to a panel of 2,500 primary care patients with an age-sex distribution and chronic disease prevalences similar to those of the general population, and estimated the minimum physician time required to deliver high-quality care for these conditions. The result was compared with time available for patient care for the average primary care physician. RESULTS Eight hundred twenty-eight hours per year, or 3.5 hours a day, were required to provide care for the top 10 chronic diseases, provided the disease is stable and in good control. We recalculated this estimate based on increased time requirements for uncontrolled disease. Estimated time required increased by a factor of 3. Applying this factor to all 10 diseases, time demands increased to 2,484 hours, or 10.6 hours a day. CONCLUSIONS Current practice guidelines for only 10 chronic illnesses require more time than primary care physicians have available for patient care overall. Streamlined guidelines and alternative methods of service delivery are needed to meet recommended standards for quality health care.
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Affiliation(s)
- Truls Østbye
- Department of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Reed J, Cook G, Childs S, McCormack B. A literature review to explore integrated care for older people. Int J Integr Care 2005; 5:e17. [PMID: 16773170 PMCID: PMC1395528 DOI: 10.5334/ijic.119] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2004] [Revised: 11/17/2004] [Accepted: 12/20/2004] [Indexed: 11/21/2022] Open
Abstract
PURPOSE This paper reports on some of the findings of a literature review commissioned to explore integrated care for older people. METHODS The process of revising included finding and selecting literature from multidisciplinary sources, and encompassed both published papers and 'grey' literature, i.e. material which had not been reviewed for publication. RESULTS The study found that thinking has moved on from a focus on the problems of accessing services to exploring ways in which they may function in an integrated way. CONCLUSIONS The study shows how thinking on integrated care for older people has developed, and knowledge of micro, mezzo and macro strategies is now more available.
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Affiliation(s)
- Jan Reed
- Centre for Care of Older People, Northumbria University, H017 Coach Lane East, Northumbria University, Newcastle upon Tyne, UK, NE7 7XA.
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165
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Hope JM, Lugassy D, Meyer R, Jeanty F, Myers S, Jones S, Bradley J, Mitchell R, Cramer E. Bringing interdisciplinary and multicultural team building to health care education: the downstate team-building initiative. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2005; 80:74-83. [PMID: 15618100 DOI: 10.1097/00001888-200501000-00020] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE To evaluate the impact of the Downstate Team-Building Initiative (DTBI), a model multicultural and interdisciplinary health care team-building program for health professions students. METHOD A total of 65 students representing seven health disciplines participated in DTBI's first three years (one cohort per year since implementation). During the 18-session curriculum, students self-evaluated their group's progress through Tuckman's four team-development stages (FORMING, STORMING, NORMING, PERFORMING) on an 11-point scale. Students completed matched pre- and postintervention program evaluations assessing five variables: interdisciplinary understanding, interdisciplinary attitudes, teamwork skills, multicultural skills, and team atmosphere. After participation, students completed narrative follow-up questionnaires investigating impact one and two years after program completion. RESULTS Each year's team development curve followed a similar logarithmic trajectory. Cohort 1 remained in team development stage 3 (NORMING) while Cohorts 2 and 3 advanced into the final stage-PERFORMING. A total of 34 matched pre- and postintervention evaluations showed significant change in all major variables: Team atmosphere and group teamwork skills improved most (48% and 44%, respectively). Interdisciplinary understanding improved 42%. Individual multicultural skills (defined by ability to address racism, homophobia, and sexism) started at the highest baseline and improved the least (13%). Group multicultural skills improved 36%. Of 23 responses to the follow-up surveys, 22 (96%) stated DTBI was a meaningful educational experience applicable to their current clinical surroundings. CONCLUSIONS DTBI successfully united students across health discipline, ethnicity, socioeconomic class, gender, and sexual orientation into functioning teams. The model represents an effective approach to teaching health care team building and demonstrates benefits in both preclinical and clinical years of training.
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Affiliation(s)
- Joanie Mayer Hope
- Department of OB/GYN, New York University, 462-1st Ave, Office 9E2, New York, NY 10002, USA
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Goodlin S, Boult C, Bubolz T, Chiang L. Who Will Need Long-Term Care?: Creation and Validation of an Instrument that Identifies Older People at Risk. ACTA ACUST UNITED AC 2004; 7:267-74. [PMID: 15671784 DOI: 10.1089/dis.2004.7.267] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this study was to create and measure the predictive validity of a screening instrument that identifies older people who are at risk for developing a need for long-term care within a year. This was an observational study, with participants allocated to either a derivation cohort or a validation cohort, in the United States. A nationally representative sample of older community-dwelling Medicare beneficiaries (n = 6,538) participated in the Medicare Current Beneficiary Survey. Questions addressed sociodemographic, functional, health-related, and utilization characteristics in 1991 and 1992, linked to records of Medicare payments for health services during 1991-1992. In the derivation cohort, 14 self-reported characteristics were significant predictors of developing a need for long-term care within 1 year. In the validation cohort, these 14 characteristics identified a high-risk subgroup (18%) that, during the following year, developed a need for long-term care at six times the rate of the low-risk majority. This brief survey instrument identifies a high-risk minority of older people that will, during the following year, develop a need for long-term care at six times the rate of the low-risk majority. This instrument may be useful for targeting at-risk subgroups of older populations to receive interventions designed to preserve functional independence and avert the need for long-term care.
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Affiliation(s)
- Sarah Goodlin
- Institute for Health Care Delivery Research, Salt Lake City, Utah 84111, USA.
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Halcomb E, Davidson P, Daly J, Yallop J, Tofler G. Australian nurses in general practice based heart failure management: implications for innovative collaborative practice. Eur J Cardiovasc Nurs 2004; 3:135-47. [PMID: 15234318 DOI: 10.1016/j.ejcnurse.2004.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2003] [Revised: 12/05/2003] [Accepted: 02/11/2004] [Indexed: 11/27/2022]
Abstract
BACKGROUND The growing global burden of heart failure (HF) necessitates the investigation of alternative methods of providing co-ordinated, integrated and client-focused primary care. Currently, the models of nurse-coordinated care demonstrated to be effective in randomized controlled trials are only available to a relative minority of clients and their families with HF. This current gap in service provision could prove fertile ground for the expansion of practice nursing [The Nurse in Family Practice: Practice Nurses and Nurse Practitioners in primary health care. 1988, Scutari Press, London: Impact of rural living on the experience of chronic illness. Australian Journal of Rural Health, 2001. 9: 235-240]. AIM This paper aims to review the published literature describing the current and potential role of the practice nurse in HF management in Australia. METHODS Searches of electronic databases, the reference lists of published materials and the internet were conducted using key words including 'Australia', 'practice nurse', 'office nurse', 'nurs*', 'heart failure', 'cardiac' and 'chronic illness'. Inclusion criteria for this review were English language literature; nursing interventions for heart failure (HF) and the role of practice nurses in primary care. RESULTS There is currently a paucity of data evaluating the potential role for practice nurses in a reconfigured, collaborative health care system. Those studies that were identified were, largely, of a descriptive nature. In addition to identifying the practice nurse as a largely unexplored resource, key themes that emerged from the review include: (1) current general practice services face significant barriers to the implementation of evidence-based HF practice; (2) there is considerable variation in the practice nurse role between general practices; (3) there are significant barriers to the expansion of the practice nurse role; (4) multidisciplinary interventions can effectively deliver secondary prevention strategies; (5) practice nurses can potentially facilitate these multidisciplinary interventions; and (6) practice nurses are favorably perceived by consumers although there is some confusion about the nature of their role. CONCLUSION On the basis of this literature review, practice nurses represent a potentially useful adjunct to current models of service provision in HF management. Further research needs to comprehensively investigate the role of the practice nurse in the Australian context with a view to developing effective and sustainable frameworks for clinical practice. In particular, high-level evidence is required to evaluate the efficacy of the practice nurse role compared to current disease management strategies.
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Affiliation(s)
- Elizabeth Halcomb
- School of Nursing, Family and Community Health (SNFCH), College of Social and Health Sciences (CSHS), University of Western Sydney, Locked Bag 1797, Penrith DC 1797, NSW, Sydney, Australia.
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Gantert TW, McWilliam CL. Interdisciplinary Team Processes Within an In-Home Service Delivery Organization. Home Health Care Serv Q 2004; 23:1-17. [PMID: 15451713 DOI: 10.1300/j027v23n03_01] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Interdisciplinary teamwork is particularly difficult to achieve in the community context where geographical separateness and solo practices impede face to face contact and collaborative practice. Understanding the processes that occur within interdisciplinary teams is imperative, since client outcomes are influenced by interdisciplinary teamwork. The purpose of this exploratory study was to describe the processes that occur within interdisciplinary teams that deliver in-home care. Applying grounded theory methodology, the researcher conducted unstructured in-depth interviews with a purposeful sample of healthcare providers and used constant comparative analysis to elicit the findings. Findings revealed three key team processes: networking, navigating, and aligning. The descriptions afford several insights that are applicable to in-home healthcare agencies attempting to achieve effective interdisciplinary team functioning.
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Affiliation(s)
- Thomas W Gantert
- School of Nursing, Faculty of Health Sciences, The University of Western Ontario, London, Canada.
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169
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Algera M, Francke AL, Kerkstra A, van der Zee J. Home care needs of patients with long-term conditions: literature review. J Adv Nurs 2004; 46:417-29. [PMID: 15117353 DOI: 10.1111/j.1365-2648.2004.03031.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a widely felt need to improve the match between long-term patients' care needs and actual use of home care. As this match is not always adequate, it is important to know what factors influence it. AIM The aim of this paper is to provide insight into long-term patients' need and actual use of home care, and the factors influencing these. METHOD A literature review was carried out, based on database searches in PubMed, CINAHL and the Nivel online library catalogue. A total of 114 papers were retrieved, but only 13 clearly dealt with use of professional home care (rather than informal home care or residential care) by people with long-term conditions. RESULTS There is a dearth of publications on factors influencing the match between care need and actual use of professional home care among people with long-term conditions. Most of the 13 publications reviewed concerned determinants of professional home care use, rather than the match between patients' felt needs and the home care delivered. From these studies, a profile of people with long-term conditions who used home care emerged. In general, older, non-white women, with multiple chronic diseases and impairments, and who had recently had inpatient care, tended to make more use of professional home care. CONCLUSION Future research in this field is recommended, particularly into system- and patient-related characteristics that may be responsible for the mismatch between care need and use.
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Affiliation(s)
- Marco Algera
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands.
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170
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Abstract
Three overlapping initiatives can be found in the effort to improve the management of chronic illness: the report card initiative, the disease management industry, and "Improving Chronic Illness Care." The third of these initiatives proposes the Chronic Care Model to assist provider organizations in chronic care improvement. The Chronic Care Model is made up of six major elements: community resources, the health care system surrounding the provider organization, patient self-management, decision support, delivery system redesign, and clinical information systems. Within these elements are a number of components, for example, clinical practice guidelines, reminder prompts, disease registries, provider feedback systems, primary care teams, planned chronic care visits, and case management. A literature review is provided to summarize the effectiveness of these Chronic Care Model components.
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Affiliation(s)
- Thomas Bodenheimer
- Department of Family and Community Medicine, University of California at San Francisco, Building 80-83, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110, USA.
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171
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172
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Billings JA, Dahlin C, Dungan S, Greenberg D, Krakauer EL, Lawless N, Montgomery P, Reid C. Psychosocial Training in a Palliative Care Fellowship. J Palliat Med 2003; 6:355-63. [PMID: 14509481 DOI: 10.1089/109662103322144673] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We present a description of a one-year palliative care fellowship training program for physicians at the Massachusetts General Hospital. We provide background information on the Palliative Care Service, and offer an overview of the educational content and methods for fellowship training, focusing especially on psychosocial aspects of care. The medical background and post-training positions of fellows are described. This document is meant to assist other palliative care fellowship programs in developing their curricula and possibly to serve as an initial template for creating educational standards and for identifying outcome measures for educational evaluation of such programs.
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Affiliation(s)
- J Andrew Billings
- Palliative Care Service, Massachusetts General Hospital, Harvard Medical School Center for Palliative Care, Boston, Massachusetts 02114, USA.
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173
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Gosling AS, Westbrook JI, Braithwaite J. Clinical team functioning and IT innovation: a study of the diffusion of a point-of-care online evidence system. J Am Med Inform Assoc 2003; 10:244-51. [PMID: 12626379 PMCID: PMC342047 DOI: 10.1197/jamia.m1285] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2002] [Accepted: 12/28/2002] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the association between clinical team functioning and diffusion (awareness, use, and impact) of a 24-hour online evidence retrieval system. To examine the relationships between clinical team characteristics and the adoption of the online evidence system. DESIGN 18 clinical teams, consisting of 180 clinicians from three Australian hospitals, were identified and studied. Teams were categorized as small ( 15). MEASUREMENTS Clinical team functioning was assessed using the Team Climate Inventory (TCI). Awareness, use, and impact of an online evidence retrieval system were measured using a self-administered questionnaire. The relationships between TCI scores and awareness, use, and impact were examined using t-tests and one-way ANOVAs. Chi square analyses were used to examine differences between small and large teams. RESULTS were interpreted within a diffusion of innovations framework. RESULTS Clinical team functioning was not related to awareness or use of the online evidence retrieval system. However, clinical team functioning was significantly associated with the impact of online evidence in terms of reported experience of improved patient care following system use. Clinicians in small teams ( 15) teams. CONCLUSIONS Team functioning had the greatest impact on the fourth stage of innovation diffusion, the effective use of online evidence for clinical care. This supports Rogers' diffusion of innovation theory, to the effect that different types of communication about an innovation are important at different stages in the diffusion process. Members of small teams were more aware of the system than members of large teams. Team functioning is amenable to improvement through interventions. The findings suggest that the role of team climate in the diffusion of information systems is a promising area for future research.
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Affiliation(s)
- A Sophie Gosling
- Centre for Health Informatics, Faculty of Medicine, University of New South Wales, Sydney, Australia.
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174
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Sidorov J, Paulick P, Sobel L. What is the Return on Investment Associated with Diabetes Disease Management? ACTA ACUST UNITED AC 2003. [DOI: 10.2165/00115677-200311090-00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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175
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Flaherty E, Hyer K, Kane R, Wilson N, Whitelaw N, Fulmer T. Using case studies to evaluate students' ability to develop a geriatric interdisciplinary care plan. GERONTOLOGY & GERIATRICS EDUCATION 2003; 24:63-74. [PMID: 15871931 DOI: 10.1300/j021v24n02_06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The Geriatric Interdisciplinary Team Training (GITT) program, an educational intervention funded by The John A. Hartford Foundation of New York City, has trained more than 1800 health care professions students and clinicians throughout the United States. Evaluating the effectiveness of this training intervention has proven to be quite a challenge. Core measures were collected pre- and post-GITT training to evaluate student development as a result of GITT. This paper focuses on one of these core measures, the Test of Geriatric Interdisciplinary Care Planning (TGICP). This instrument, developed for the GITT program, is one mechanism created to test trainees' ability to develop an interdisciplinary plan of care. Using a case study methodology, this two-part instrument provides an innovative approach to quantifying and correlating responses from an interdisciplinary cohort of students. This paper will describe the development of the TGICP, including the creation and validation of the case studies, the framework for the questionnaire, and the coding and scoring mechanism created to evaluate trainee responses.
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Affiliation(s)
- Ellen Flaherty
- Geriatric Nurse Practioner/Adult Nurse Practioner Program, New York University, NY 10003, USA
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176
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Speer DC, Schneider MG. Mental health needs of older adults and primary care: Opportunity for interdisciplinary geriatric team practice. ACTA ACUST UNITED AC 2003. [DOI: 10.1093/clipsy.10.1.85] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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177
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Takemura Y, Kanda K, Matsumoto A, Yamagishi M. Role expectations of nurses in health service facilities for the elderly. Nurs Health Sci 2002; 4:73-83. [PMID: 12153404 DOI: 10.1046/j.1442-2018.2002.00107.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In order to investigate nurses' roles in health service facilities for the elderly in Japan, questionnaires were mailed to institutional managers, nurse managers and care work leaders of all registered facilities. Among 2244 facilities, responses were received from 479. Role expectations of nursing personnel were largely similar among the managers of the three fields. They regarded medical treatment, medication administration, health status monitoring and general care management as within the domain of nursing, whereas they regarded environmental regulation, recreational activities and rehabilitation as less suited to nursing personnel. Although there was basic agreement, care work leaders were more likely to expect nursing personnel to participate in matters of personal care, and nurse managers were more likely to view matters related to admission/discharge, which were actually shared with support counselors, as belonging to the domain of nursing. Role expectations of nursing personnel will change especially at the margins of other professions, as the other professions develop.
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Affiliation(s)
- Yukie Takemura
- Department of Nursing Administration, Graduate School of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo 113-0033, Japan.
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178
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Jiwa M, Gerrish K, Gibson A, Scott H. Preventing avoidable hospital admission of older people. Br J Community Nurs 2002; 7:426-31. [PMID: 12192347 DOI: 10.12968/bjcn.2002.7.8.10650] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The National Service Framework for Older People (Department of Health, 2001) stresses the importance of preventing unnecessary hospital admissions for older people. Such admissions arise when there is inadequate health and social support available in the community to meet the needs of this age group. This article reports on a study designed to evaluate the effectiveness of a programme of enhanced primary care support intended to reduce the risk of hospital admission for people aged 75 years and above. Nineteen patients out of a possible 322 in one GP practice were judged by GPs and district nurses to be "at risk" of avoidable hospital admission. All at-risk patients were visited by a GP or district nurse to review their needs for enhanced support, six patients subsequently accepting a referral for additional support. No statistically significant difference in the number of hospital admissions in the intervention group was observed compared with a group of patients with similar demographic characteristics but deemed not to be at such high risk, suggesting that the intervention might have been effective in reducing the number of avoidable hospital admissions.
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Affiliation(s)
- Moyez Jiwa
- Institute of General Practice and Primary Care, University of Sheffield, Sheffield, Yorkshire, UK
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179
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Leipzig RM, Hyer K, Ek K, Wallenstein S, Vezina ML, Fairchild S, Cassel CK, Howe JL. Attitudes toward working on interdisciplinary healthcare teams: a comparison by discipline. J Am Geriatr Soc 2002; 50:1141-8. [PMID: 12110079 DOI: 10.1046/j.1532-5415.2002.50274.x] [Citation(s) in RCA: 159] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Interdisciplinary teams are important in providing care for older patients, but interdisciplinary teamwork is rarely a teaching focus, and little is known about trainees' attitudes towards it. To determine the attitudes of second-year post-graduate (PGY-2) internal medicine or family practice residents, advanced practice nursing (NP), and masters-level social work (MSW) students toward the value and efficiency of interdisciplinary teamwork and the physician's role on the team, a baseline survey was administered to 591 Geriatrics Interdisciplinary Team Training participants at eight U.S. academic medical centers from January 1997 to July 1999. Most students in each profession agreed that the interdisciplinary team approach benefits patients and is a productive use of time, but PGY-2s consistently rated their agreement lower than NP or MSW students. Interprofessional differences were greatest for beliefs about the physician's role; 73% of PGY-2s but only 44% to 47% of MSW and NP trainees agreed that a team's primary purpose was to assist physicians in achieving treatment goals for patients. Approximately 80% of PGY-2s but only 35% to 40% of MSW or NP trainees agreed that physicians have the right to alter patient care plans developed by the team. Although students from all three disciplines were positively inclined toward medical interdisciplinary teamwork, medical residents were the least so. Exposure to interdisciplinary teamwork may need to occur at an earlier point in medical training than residency. The question of who is ultimately responsible for the decisions of the team may be an "Achilles heel," interfering with shared decision-making.
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Affiliation(s)
- Rosanne M Leipzig
- Brookdale Department of Geriatrics and Adult Development, The Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA.
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180
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Abstract
BACKGROUND With the reorganization of the financing of health care and creation of systems of care, it is possible to design and implement organizational interventions to improve the care of older persons beyond the services that can be provided by an individual provider. OBJECTIVES To review the effectiveness of organizational interventions for older persons, describe barriers to dissemination of success models into practice settings, and identify future directions for such interventions. METHODS Selective review of organizational interventions that have been aimed primarily at the geriatric population and have been formally evaluated using conventional research designs, usually randomized clinical trials. RESULTS Organizational interventions can be classified into two groups: component models and systems changes. The former can be superimposed upon an intact system but do not fundamentally change the system of care whereas the latter modify the basic structure of primary care. A variety of organizational interventions have been implemented in diverse settings, but the evidence supporting the effectiveness of these interventions is inconsistent. Even when such interventions have been effective in research settings, these interventions rarely reduce health care costs. Moreover, there have been formidable barriers to implementation of successful interventions into practice. CONCLUSIONS Organizational interventions are potentially powerful methods to influence health care and maintain health status of older persons. Nevertheless, gaps between knowledge and practice and unanswered questions about the effectiveness of organizational interventions currently limit the potential value of this approach to improving health care of older persons.
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Affiliation(s)
- David B Reuben
- Division of Geriatrics, University of California, Los Angeles 90095-1687, USA.
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181
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Billings JA. Vicissitudes of the clinician-patient relationship in end-of-life care: recognizing the role for teams. J Palliat Med 2002; 5:295-9. [PMID: 12006232 DOI: 10.1089/109662102753641296] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J Andrew Billings
- Palliative Care Service, Massachusetts General Hospital and Harvard Medical School, FND 600, 55 Fruit Street, Boston, MA 02114, USA.
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182
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Lee JS. Social work services in home health care: challenges for the new prospective payment system era. SOCIAL WORK IN HEALTH CARE 2002; 35:23-36. [PMID: 12371790 DOI: 10.1300/j010v35n03_02] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The implementation of the Prospective Payment System (PPS) provides a unique opportunity for social workers to be better integrated into home health care. To do so, it is important for social workers to define their roles and eliminate any barriers to providing social workers services, which may improve patient outcomes. Two focus groups with home health nurses (n = 10) and social workers (n = 8) were conducted in a large urban home health agency to define social work roles and identify barriers to providing social work services. This paper categorizes the barriers to providing social work services into informational, systems/organizational, and inter-professional barriers and presents possible solutions to these barriers as home health agencies strive to provide care under PPS.
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Affiliation(s)
- Ji Seon Lee
- Fordham University, Graduate School of Social Service, New York, NY 10023, USA
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183
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Abstract
During a single illness episode, the sickest, frailest older patients are often treated in multiple distinct sites, including the emergency room, the intensive care unit, a general medical floor, and a skilled nursing facility. Such frequent transfers involve changes in physician, changes in nursing care, the rewriting of orders, and physical dislocation, all of which can adversely affect outcomes. This system, although efficient, increases the chance of medical errors, promotes delirium, and undermines the doctor-patient relationship. Partial solutions include a team approach to care, an electronic medical record, and substitution of home for hospital care. A more comprehensive solution is to create a geriatric hospital for treatment of the most common medical and surgical problems and for provision of rehabilitative or skilled nursing care. Designing new institutions for geriatric care will require new legislation and a new set of regulations but should be considered for the oldest and frailest patients.
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Affiliation(s)
- Muriel R Gillick
- Hebrew Rehabilitation Center for Aged, Department of Medicine, Boston, MA 02131, USA
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184
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Sidorov J, Fisher FJ, Girolami S, Wolke O. An HMO-Sponsored Primary Care-Based Disease Management and Case Management Initiative. ACTA ACUST UNITED AC 2002. [DOI: 10.2165/00115677-200210010-00002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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185
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Montenegro-Torres BF, Engelhardt T, Thamer M, Anderson G. Are Fortune 100 companies responsive to chronically ill workers? Health Aff (Millwood) 2001; 20:209-19. [PMID: 11463078 DOI: 10.1377/hlthaff.20.4.209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We conducted a survey of Fortune 100 companies to determine their response to the growing number of employees with chronic conditions. We found that although all companies cover some services that are particularly beneficial to persons with chronic conditions, gaps in coverage remain. We also found large variations in cost-sharing mechanisms, number of covered visits, and lifetime maximum benefit provisions, which are especially important to persons with chronic conditions. In general, for persons with chronic conditions the benefits offered by these Fortune 100 companies are superior to those offered by Medicare.
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Affiliation(s)
- B F Montenegro-Torres
- Partnership for Solutions: Better Lives for People with Chronic Conditions, Johns Hopkins University, Baltimore, USA
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