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Wallace AS, Bristol AA, Johnson EP, Elmore CE, Raaum SE, Presson A, Eppich K, Elliott M, Park S, Brooke BS, Park S, Weiss ME. Impact of Social Risk Screening on Discharge Care Processes and Postdischarge Outcomes: A Pragmatic Mixed-Methods Clinical Trial During the COVID-19 Pandemic. Med Care 2024; 62:639-649. [PMID: 39245813 PMCID: PMC11373892 DOI: 10.1097/mlr.0000000000002048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
BACKGROUND Social risk screening during inpatient care is required in new CMS regulations, yet its impact on inpatient care and patient outcomes is unknown. OBJECTIVES To evaluate whether implementing a social risk screening protocol improves discharge processes, patient-reported outcomes, and 30-day service use. RESEARCH DESIGN Pragmatic mixed-methods clinical trial. SUBJECTS Overall, 4130 patient discharges (2383 preimplementation and 1747 postimplementation) from general medicine and surgical services at a 528-bed academic medical center in the Intermountain United States and 15 attending physicians. MEASURES Documented family interaction, late discharge, patient-reported readiness for hospital discharge and postdischarge coping difficulties, readmission and emergency department visits within 30 days postdischarge, and coded interviews with inpatient physicians. RESULTS A multivariable segmented regression model indicated a 19% decrease per month in odds of family interaction following intervention implementation (OR=0.81, 95% CI=0.76-0.86, P<0.001), and an additional model found a 32% decrease in odds of being discharged after 2 pm (OR=0.68, 95% CI=0.53-0.87, P=0.003). There were no postimplementation changes in patient-reported discharge readiness, postdischarge coping difficulties, or 30-day hospital readmissions, or ED visits. Physicians expressed concerns about the appropriateness, acceptability, and feasibility of the structured social risk assessment. CONCLUSIONS Conducted in the immediate post-COVID timeframe, reduction in family interaction, earlier discharge, and provider concerns with structured social risk assessments likely contributed to the lack of intervention impact on patient outcomes. To be effective, social risk screening will require patient/family and care team codesign its structure and processes, and allocation of resources to assist in addressing identified social risk needs.
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Affiliation(s)
| | | | | | | | - Sonja E. Raaum
- University of Utah School of Medicine, Salt Lake City, UT
| | - Angela Presson
- University of Utah School of Medicine, Salt Lake City, UT
| | - Kaleb Eppich
- University of Utah School of Medicine, Salt Lake City, UT
| | | | - Sumin Park
- University of Utah College of Nursing, Salt Lake City, UT
| | | | - Sumin Park
- University of Utah College of Nursing, Salt Lake City, UT
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Smith J, Ashbrook C, Tew E, Smith B. Content validity index for the readiness for hospital discharge scale in the skilled nursing facility setting. Geriatr Nurs 2024; 59:346-350. [PMID: 39111067 DOI: 10.1016/j.gerinurse.2024.07.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/04/2024] [Accepted: 07/30/2024] [Indexed: 10/08/2024]
Abstract
OBJECTIVES The purpose of this study was to determine the appropriateness of using the Readiness for Hospital Discharge Scale (RHDS) in the skilled nursing facility (SNF) setting as a discharge outcome measure. METHODS Six experts consisting of nurses and physical therapists from two different SNFs in the Midwest were selected to participate in the study. The content validity of the scale was determined by using item and scale content validity index scores to determine the appropriateness of the scale in the SNF setting. RESULTS The scale content validity index score for the RHDS was 0.96 with an item content validity index score range of 0.83 to 1.0. Kendall's Coefficient of Concordance was 0.278 and the statistical significance had a p-value of 0.031. CONCLUSIONS The results of this study indicate that the RHDS has good content validity and is an appropriate measure to determine patient discharge readiness in the SNF setting.
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Affiliation(s)
- Justin Smith
- Department of Physical Therapy, Wichita State University, 213 N. Mead St, Wichita, KS 67202 USA.
| | - Christina Ashbrook
- Department of Physical Therapy, Wichita State University, 213 N. Mead St, Wichita, KS 67202 USA
| | - Elizabeth Tew
- Department of Physical Therapy, Wichita State University, 213 N. Mead St, Wichita, KS 67202 USA
| | - Barbara Smith
- Department of Physical Therapy, Wichita State University, 213 N. Mead St, Wichita, KS 67202 USA
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Mao W, Shalaby R, Owusu E, Elgendy HE, Agyapong B, Eboreime E, Silverstone P, Chue P, Li XM, Vuong W, Ohinmaa A, Taylor V, Greenshaw AJ, Agyapong VIO. Depression, anxiety, and poor well-being at discharge from psychiatric hospitals: prevalence and risk factors. Front Psychiatry 2024; 15:1408095. [PMID: 39056021 PMCID: PMC11269243 DOI: 10.3389/fpsyt.2024.1408095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/18/2024] [Indexed: 07/28/2024] Open
Abstract
Background Being ready for discharge is vital to successful hospital-to-home transitions. For many patients, however, the transition from psychiatric hospital care to outpatient care can be challenging. An in-depth understanding of the mental health conditions of patients at discharge is crucial and instructive for recovery research. Objective The purpose of this study was to determine the prevalence and risk factors of depression, anxiety, and poor well-being symptoms among patients who are about to be discharged from psychiatric units in Alberta, Canada. Our aim was to help determine the prevalence of anxiety, depression, and overall well-being among the general psychiatric inpatient population in Alberta before discharge and the potential factors which may influence this. Methods This epidemiological study used a cross-sectional quantitative survey from March 8, 2022, to November 5, 2023, to assess depression, anxiety, and well-being. Participants were invited to complete an online questionnaire that contained demographics, clinical information, and responses to the PHQ-9, GAD-7, and WHO-5 questionnaires. SPSS version 25 was used to analyze the data. Descriptive, univariate, and multivariate regression analyses were employed. Result The study found that the prevalence of likely depression, anxiety, and poor well-being among patients about to be discharged was 37.1%, 56.4%, and 48.3%, respectively. Based on a logistic regression model, there was a statistically significant association between anxiety, depression, and poor well-being diagnoses and multiple socio-demographic and clinical factors such as ethnicity, primary mental health diagnoses, education level, housing status, depression, anxiety, and well-being at baseline. Conclusion Mental health assessment at discharge is a critical step in the recovery and transition of care. There is still a need for further research to identify the underlying causes and robust predictors of mental health symptoms in patients about to be discharged and to provide appropriate interventions and supportive resources both before and following discharge. Future research utilizing these findings may help identify key opportunities to improve outcomes for patients after discharge.
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Affiliation(s)
- Wanying Mao
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Reham Shalaby
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Ernest Owusu
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | - Belinda Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Ejemai Eboreime
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Peter Silverstone
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Pierre Chue
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Xin-Min Li
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Wesley Vuong
- Alberta Health Services, Addiction and Mental Health Services, Edmonton, AB, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Valerie Taylor
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Vincent I. O. Agyapong
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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Li SQ, Luo CL, Qiu H, Liu YX, Chen JM. Effect of Orem's self-care model on discharge readiness of patients undergoing enterostomy: A randomized controlled trial. Eur J Oncol Nurs 2024; 70:102549. [PMID: 38692158 DOI: 10.1016/j.ejon.2024.102549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/18/2024] [Accepted: 03/03/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE To evaluate the effectiveness of Orem's self-care model in preparing hospitals for the discharge of patients with colorectal cancer who undergo enterostomy. METHODS 92 patients with enterostomy were recruited between February 2022 and February 2023 from a general tertiary hospital. The participants were assigned to either the intervention group or the control group randomly. The intervention group received Orem's self-care program and a three-month follow-up, whereas the control group received only routine care and a three-month follow-up. Discharge readiness, self-care ability, and stoma-quality-of-life data were collected at hospital discharge (T1), 30 days (T2), and 90 days (T3) after discharge. RESULTS The intervention group had substantially higher discharge readiness (knowledge, p < 0.001; coping ability, p = 0.006; personal status, p = 0.001; expected support, p = 0.021; total score, p < 0.001), better self-care ability at T1 (self-care knowledge, p < 0.001; self-care skills, p = 0.010), better total quality of life (QoL) at T1, T2, and T3 (p < 0.001; p = 0.006; p = 0.014); better stoma management and daily routine at T1 (p = 0.004; p < 0.001); and better daily routine at T2 (p = 0.009) than the control group. CONCLUSIONS The designed discharge readiness program based on Orem's self-care could promote effective patient discharge readiness, self-care knowledge, self-care skills, and QoL. TRIAL REGISTRATION The trial number ChiCTR2200056302 registered on ClinicalTrials.gov.
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Affiliation(s)
- Si-Qing Li
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Cui-Lian Luo
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Hong Qiu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Yu-Xia Liu
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
| | - Jian-Min Chen
- Department of Gastroenterology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, 51900, PR China.
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You S, Li N, Guo M, Ji H. Are patients ready for discharge from the hospital after fast-track total knee arthroplasty?-A qualitative study. PLoS One 2024; 19:e0303935. [PMID: 38809900 PMCID: PMC11135671 DOI: 10.1371/journal.pone.0303935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND The fast-track based on evidence-based medicine, has dramatically reduced the length of stay for patients undergoing total knee arthroplasty (TKA). Therefore, patients must assume the responsibility for self-functional exercise and care as early as possible. Also, higher standards and expectations of care delivery have been set. Studies into patients' experiences when faced with a discharge decision under a fast-track program are lacking. OBJECTIVES (1) Increase the knowledge about patients' experiences of discharged from hospital via a fast-track process after TKA. (2) Explore what gaps exist in the current discharge preparation care service for TKA under fast-track and what can be improved. METHODS A qualitative research design was chosen to conduct semi-structured face-to-face interviews with 21 patients from one Chinese hospital who successfully underwent TKA and received discharge orders. Interview data were meticulously analyzed, summarized and thematically distilled using Interpretative Phenomenological Analysis (IPA). RESULTS Three themes emerged from the structural analyses: a) Preparing for discharge despite concerns about symptoms-a sense of joy at discharge despite feelings of helplessness, stigmatisation, anxiety about prosthetic function. b) Managing the rehabilitation difficulties-vigilance is needed for medication management, environmental changes, and intimate relationships. c) Creating conditions for safe transition-compassionate bedside manner, listening to patients, and providing a humanized continuing care and referral services are important for safe transitions. CONCLUSION Findings suggest that patients undergoing fast-track TKA report good discharge preparation experiences. However, closer analysis reveals difficulties with this process and important directions in which discharge readiness care services can strive.
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Affiliation(s)
- Simeng You
- The affiliated hospital of Jiaxing University, The First Hospital of Jiaxing, Jiaxing, Zhejiang, China
| | - Na Li
- Nursing department, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
| | - Manjie Guo
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Hong Ji
- Nursing department, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong, China
- School of Nursing and Rehabilitation, Shandong University, Jinan, Shandong, China
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Yang J, Pu Y, Jiang X, Yao Q, Luo J, Wang T, Zhang X, Yang Z. Association between quality of discharge teaching and self-management in patients after percutaneous coronary intervention: A chain mediation model. J Clin Nurs 2024. [PMID: 38764246 DOI: 10.1111/jocn.17204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 05/21/2024]
Abstract
AIMS To examine chain mediating effect of discharge readiness and self-efficacy between quality of discharge teaching and self-management in patients after percutaneous coronary intervention (PCI). BACKGROUND Although self-management after PCI has significant benefits in controlling risk factors and delaying disease progression, the status of self-management remains unoptimistic. A large number of studies have explored the close relationship between the quality of discharge teaching and patients self-management, but little is known about the underlying mechanisms. METHODS The cross-sectional samples was collected from a tertiary hospital in China. Self-reported questionnaires were used to assess quality of discharge teaching, discharge readiness, self-efficacy and self-management. Pearson correlation analysis and mediation effect analysis were used for statistical analysis. REPORTING METHOD The study used the STROBE checklist for reporting. RESULTS A total of 198 patients with a mean age of 64.99 ± 11.32 (34-85) were included. The mean score of self-management was 88.41 ± 11.82. Quality of discharge teaching, discharge readiness, self-efficacy and self-management were all positively correlated. Mediation effect analysis showed that the mediating effects of discharge readiness, self-efficacy, discharge readiness and self-efficacy between quality of discharge teaching and self-management were 0.157, 0.177 and 0.049, respectively, accounting for 21.96%, 24.76% and 6.85% of the total effect. CONCLUSION The quality of discharge teaching for patients after PCI not only directly affects self-management, but also can indirectly affect self-management through discharge readiness and self-efficacy. RELEVANCE TO CLINICAL PRACTICE To improve the life quality of patients after PCI, medical staff should pay attention to the influence of self-management of quality of discharge teaching, and develop intervention strategies based on the path of discharge readiness and self-efficacy. PATIENT OR PUBLIC CONTRIBUTION Questionnaires filled out by patients were used to understand the association between quality of discharge teaching, discharge readiness, self-efficacy and self-management.
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Affiliation(s)
- Jin Yang
- Chengdu Medical College, Chengdu, China
- Department of Cardiology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - You Pu
- Department of Oncology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Xia Jiang
- Department of Cardiology, Sichuan Mianyang 404 Hospital, Mianyang, China
| | - Qian Yao
- Chengdu Medical College, Chengdu, China
| | - Jian Luo
- Chengdu Medical College, Chengdu, China
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Chen C, Sun Y, Chen C, Zhang M, Lin S, Dai T, Li R, Huang J, Zheng J, Chen Y. Development and Validation of a Patient Discharge Readiness Scale for Daytime Cataract Surgery (DRS-CAT). J Perianesth Nurs 2024; 39:195-201.e3. [PMID: 38099885 DOI: 10.1016/j.jopan.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 06/02/2023] [Accepted: 07/19/2023] [Indexed: 04/06/2024]
Abstract
PURPOSE To ensure the safety of patients discharged from the hospital, a nurse-assessed scale for outpatient cataract surgery patients was constructed to provide a special tool for cataract patients' discharge readiness evaluation. DESIGN This is a methodological study. METHODS The development of the tool was completed between 2021 and 2022. Based on the literature review and qualitative interviews, the initial entry pool of the discharge readiness scale was established. After consultation with Delphi experts, the preliminary scale was tested by 312 participants to screen items and test reliability and validity. The analysis included internal consistency, content validity, and construct validity. The Strengthening the Reporting of Observation studies in Epidemiology (STROBE) checklist was used as the reporting guideline for this study. FINDINGS The final Discharge Readiness Scale for Cataract surgery consists of 21 items in five dimensions: cognition of discharge readiness, personal status, mastery of health education knowledge, coping capacity, and social support. Five common factors were extracted from the exploratory factor analysis, and they explained 70.12% of the total variance. All of the indexes of the confirmatory factor analysis were within the theoretical allowable range. The Cronbach's α of the total scale was 0.903, and the scale-level content validity index/average variance extracted was 0.99. CONCLUSIONS The Discharge Readiness Scale for Cataract surgery, evaluated by nurses, has good reliability and validity and can be used to determine the discharge readiness of cataract patients undergoing day surgery.
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Affiliation(s)
- Chen Chen
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yiwen Sun
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Caifen Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mengyue Zhang
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shudan Lin
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Tingting Dai
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Rong Li
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jiali Huang
- Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jingwei Zheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Yanyan Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China.
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Feldbusch H, Schmidt M, Steeb EM, Paschek N, Nemesch M, Sartory Y, Brenner R, Nöst S. Theoretical concepts and instruments for measuring hospital discharge readiness: A scoping review. Heliyon 2024; 10:e26554. [PMID: 38439820 PMCID: PMC10909674 DOI: 10.1016/j.heliyon.2024.e26554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 02/09/2024] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
Background The Discharge Readiness of adult patients in a hospital setting is a multidimensional concept which is becoming increasingly important internationally as part of discharge planning. To date, there has been a lack of reviews of existing measurement instruments as well as theoretical concepts of discharge readiness. Objective To provide an overview of existing measurement instruments and theoretical concepts regarding readiness for hospital discharge in adult patients. Design and methods A scoping review was conducted in accordance with the Joanna Briggs Institute methodological manual and PRISMA ScR reporting principles. A literature search was conducted using the CINAHL and LIVIVO databases (including MEDLINE and PSYINDEX) in October 2021. After test screening, all identified articles were screened by two independent reviewers using predefined inclusion and exclusion criteria before the content was extracted and mapped. Results Of the 1823 records identified, 107 were included in this review. Of these, 30 studies were included as development or validation studies of measurement instruments assessing discharge readiness, 68 were included as empirical studies with readiness for hospital discharge as the primary outcome or key concept, and nine publications were included as theoretical papers or reviews. Five dimensions of readiness for hospital discharge were extracted:1) Physical, 2) Psychological, 3) Education and Knowledge, 4) Adequate Individual Support, and 5) Social and Organisational Determinants. Of the 47 instruments identified for measuring discharge readiness, 33 were validated. The Readiness for Hospital Discharge Scale (RHDS) was the most frequently used instrument. Conclusions The systematic measurement of readiness for hospital discharge, particularly from the patient's perspective combined with the nurse's perspective, might be useful in reducing negative outcomes such as readmissions. This review provides an overview of existing and validated instruments for the systematic assessment of discharge readiness in acute inpatient care, as well as an overview of the theoretical concepts of readiness for hospital discharge. Further research is needed on the relationship between organisational determinants and readiness for discharge.
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Affiliation(s)
- Hanna Feldbusch
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
- Robert Bosch Hospital, Stuttgart, Germany
| | - Marita Schmidt
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
| | | | | | | | | | | | - Stefan Nöst
- Baden-Württemberg Cooperative State University Stuttgart, School of Health Sciences and Management, Stuttgart, Germany
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Pogue CA, Schlak AE, McHugh MD. Effect of Discharge Readiness on 30-Day Readmissions Among Older Adults Living With Multiple Chronic Conditions. Med Care 2024; 62:205-212. [PMID: 38241081 PMCID: PMC10922299 DOI: 10.1097/mlr.0000000000001976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Despite decreases in readmissions among Medicare beneficiaries after the implementation of the Hospital Readmissions Reduction Program, older adults living with multiple chronic conditions (MCCs) continue to experience higher readmission rates. Few strategies leverage nursing to identify patients at risk for readmission. OBJECTIVES Examine the effect of nurse assessments of discharge readiness on 30-day readmissions. RESEARCH DESIGN Cross-sectional study linking 3 secondary data sources (ie, nurse survey, hospital survey, and Medicare claims data) representing 424 hospitals. SUBJECTS A total of 188,806 Medicare surgical patients with MCCs. MEASURES Discharge readiness was derived from the 2016 RN4CAST-US survey. Medicare claims data was used to determine the MCC count. The outcome was 30-day readmissions across the MCC count. RESULTS The average discharge readiness score was 0.45 (range=0-0.86) indicating that, in the average hospital, <50% of nurses were confident their patient or caregiver could manage their care after discharge. Nearly 8% of patients were readmitted within 30 days of discharge; the highest rates of readmissions were among individuals with ≥5 MCCs (4293, 13.50%). For each 10% increase in the proportion of nurses in a hospital who were confident in their patients' discharge readiness, the odds of 30-day readmission decreased by 2% (95% CI: 0.96-1.00; P =0.028) for patients with 2-4 MCCs and 3% (95% CI: 0.94-0.99; P =0.015) for patients with ≥5 MCCs, relative to patients with 0-1 MCCs. CONCLUSIONS Nurse assessments of discharge readiness may be a useful signal for hospitals to reduce readmissions and examine factors interfering with discharge processes.
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Affiliation(s)
- Colleen A Pogue
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
| | | | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
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Yakusheva O, Lee KA, Keller A, Weiss ME. Racial and Ethnic Disparities in Home Health Referral Among Adult Medicare Patients. Med Care 2024; 62:21-29. [PMID: 38060342 DOI: 10.1097/mlr.0000000000001945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Home health care (HHC) services following hospital discharge provide essential continuity of care to mitigate risks of posthospitalization adverse outcomes and readmissions, yet patients from racial and ethnic minority groups are less likely to receive HHC visits. OBJECTIVE To examine how the association of nurse assessments of patients' readiness for discharge with referral to HHC services at the time of hospital discharge differs by race and ethnic minority group. RESEARCH DESIGN Secondary data analysis from a multisite study of the implementation of discharge readiness assessments in 31 US hospitals (READI Randomized Clinical Trial: 09/15/2014-03/31/2017), using linear and logistic models adjusted for patient demographic/clinical characteristics and hospital fixed effects. SUBJECTS All Medicare patients in the study's intervention arm (n=14,684). MEASURES Patient's race/ethnicity and discharge disposition code for referral to HHC (vs. home) from electronic health records. Patient's Readiness for Hospital Discharge Scale (RHDS) score (0-10 scale) assessed by the discharging nurse on the day of discharge. RESULTS Adjusted RHDS scores were similar for non-Hispanic White (8.21; 95% CI: 8.18-8.24), non-Hispanic Black (8.20; 95% CI: 8.12-8.28), Hispanic (7.92; 95% CI: 7.81-8.02), and other race/ethnicity patients (8.09; 95% CI: 8.01-8.17). Non-Hispanic Black patients with low RHDS scores (6 or less) were less likely than non-Hispanic White patients to be discharged with an HHC referral (Black: 26.8%, 95% CI: 23.3-30.3; White: 32.6%, 95% CI: 31.1-34.1). CONCLUSIONS Despite similar RHDS scores, Black patients were less likely to be discharged with HHC. A better understanding of root causes is needed to address systemic structural injustice in health care settings.
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Affiliation(s)
- Olga Yakusheva
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI
| | - Kathryn A Lee
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
| | - Abiola Keller
- Marquette University College of Nursing, Milwaukee, WI
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Lei S, Sun J, Wang C, Zhang X, Han W, Wang X, Xie J. Nurse-to-patient ratios and readiness for hospital discharge: A moderated mediation model. Nurs Open 2024; 11:e2047. [PMID: 38268295 PMCID: PMC10697126 DOI: 10.1002/nop2.2047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/31/2023] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
AIM To explore whether and to what extent, nurse-patient assessment differences mediate the association between nurse-to-patient ratios and readiness for hospital discharge, and examine whether nurse-patient characteristics moderate the indirect and/or direct effect of mediation model. DESIGN A cross-sectional study was carried out from March 2021 to December 2022. METHODS A total of 523 pairs of gastrointestinal cancer patients with PICC and their nurses were recruited. All the participants were invited to complete the general information questionnaire and the Readiness for Hospital Discharge Scale. Outcome measure was patient-reported readiness for hospital discharge. This study was reported according to the STROBE checklist. RESULTS The patients reported a low level of readiness for hospital discharge. Nurse-patient assessment differences were positively associated with nurse-to-patient ratios but negatively associated with readiness for hospital discharge. Furthermore, nurse-patient assessment differences fully mediated the effect of nurse-to-patient ratios on readiness for hospital discharge, and age and gender of patients only moderated the indirect path of mediation model.
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Affiliation(s)
- Shuang‐yan Lei
- Department of RadiotherapyShaanxi Provincial Cancer HospitalXi'anShaanxiChina
| | - Jia‐ru Sun
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Cai‐hua Wang
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Xiao‐fang Zhang
- Department of RadiotherapyShaanxi Provincial Cancer HospitalXi'anShaanxiChina
| | - Wen‐jin Han
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Xiao‐qin Wang
- Department of NursingXi'an Jiaotong University Health Science CenterXi'anShaanxiChina
| | - Juan Xie
- Department of NursingShaanxi Provincial Cancer HospitalXi'anShaanxiChina
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12
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Zhang R, Wang D, Zhu L, He Y, Cheng L, Ma J, Zhang T, Zhang J, Li L. Research trends in readiness for hospital discharge between 2002 and 2021: A bibliometric analysis. Nurs Open 2023; 10:7676-7693. [PMID: 37775985 PMCID: PMC10643845 DOI: 10.1002/nop2.2009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/16/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023] Open
Abstract
AIM This study aimed to undertake a bibliometric analysis to provide comprehensive information in demonstrating the current status and outline the overall trends in the area of readiness for hospital discharge (RHD). DESIGN A bibliometric and visual analysis of RHD literature was undertaken. METHODS Articles were retrieved from the Web of Science network from 2002 to 2021. VOSviewer was used to identify the co-authorship network of countries/institutions, co-authorship and co-citation analysis of authors, and co-citation analysis of references and citation analysis of documents. CiteSpace was used to identify the keyword co-occurrence network and perform cluster analysis, detecting the keywords with citation bursts and speculated frontiers in this research field. RESULTS A total of 512 articles were included in the final analysis. Key findings are: (1) There has been a continuous but somewhat fluctuating rise in the number of publications. (2) 56.05% of publications come from the USA with Marquette University making the highest contribution. (3) Most publications (17, 3.32%) in RHD research were from the Journal of Clinical Nursing, and Anaesthesia and Analgesia had the highest number of citations (584 citations). (4) Weiss ME (25, 4.88%) was the most productive author whose articles have been the most highly cited (646 citations). (5) Cited references from Weiss ME (2007) also made the largest contribution to co-citations, and the most cited reference was from Jack BW (2009) (1022 citations). (6) The 20 most frequent keywords and keywords with the strongest citation bursts were retrieved. There were seven research hotspots, and three emerging research frontiers were explored. CONCLUSIONS The bibliometric analysis of material published in the last 20 years indicates that there have been statistically significant gains in comprehensive information on RHD, including the knowledge mapping of the countries, institutions, authors, references and keywords. The hotspots and frontiers, which have been explored can give guidance to researchers as to new angles and directions to take. IMPLICATIONS FOR NURSING MANAGEMENT The effects of the implementation of ERAS on RHD-related risk for adverse post-discharge outcomes in surgical patients will be of increasing concern for healthcare professionals. It is important for patients and their relatives to be confident that on discharge they are sufficiently ready for hospital discharge to enable them to safely and smoothly make the transition to home. Improving the level of RHD in discharged patients can help nurse managers and researchers measure the effectiveness of discharge planning services.
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Affiliation(s)
- Rong Zhang
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Dongmei Wang
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Ling Zhu
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Yongdong He
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Ling Cheng
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Jifen Ma
- Department of Neuro‐Oncology Center, Taihe HospitalHubei University of MedicineShiyanChina
| | - Ting Zhang
- Department of Thoracic, Cardiac, and Great Vascular Surgery, Taihe HospitalHubei University of MedicineShiyanChina
| | - Jun Zhang
- School of NursingWuhan UniversityWuhanChina
| | - Longti Li
- Nursing Department, Taihe HospitalHubei University of MedicineShiyanChina
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13
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Wallace AS, Raaum SE, Johnson EP, Presson AP, Allen CM, Elliott M, Bristol AA, Elmore CE. Impact of COVID-19 visitation policies and hospital capacity on discharge readiness in medicine patients. DISCOVER HEALTH SYSTEMS 2023; 2:45. [PMID: 38045443 PMCID: PMC10689550 DOI: 10.1007/s44250-023-00060-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Abstract
Background COVID-19 impacted the experience of being hospitalized with the widespread adoption of strict visitation policies to ensure healthcare worker safety. One result was decreased time of caregivers at the bedside of hospitalized patients. Objective To understand the impact of pandemic-related system effects on patient-reported discharge preparation. Design This mixed methods study included interviews with a sample of discharged patients during April 2020, and quantitative hospital data from April 2020 to February 2021. Participants 616 patients completed a measure of discharge readiness on their day of discharge and 38 patients completed interviews about their discharge experiences. Main measures Readiness for discharge (RHDS), visitation policies, ward structure changes, COVID-19-unit census, time into the COVID-19 pandemic, patient characteristics (age, sex, race/ethnicity), admission type (planned/unplanned, for COVID-19), and discharge destination (home, home health, skilled nursing). Key results Adult patients aged 30-45 (vs. young and older adult patients) and those being discharged to places other than home (e.g., skilled nursing facility) or to out-of-state residences report lower readiness (p < 0.05) on RHDS. Patient interviews revealed some gaps in discharge communication but, overall, patients expressed high discharge readiness and few concerns about how COVID-19 system changes impacted their discharge preparation. Conclusions While there is some evidence that visitation policies and unit census may impact patient perceptions of discharge preparation, personal characteristics contributed more significantly to discharge readiness than system changes during COVID-19. Participant interviews demonstrated agreement, as most participants were discharged home and identified strong personal feelings of readiness for discharge.Clinical trials registration: ClinicalTrials.gov ID NCT04248738, https://clinicaltrials.gov/ct2/show/NCT04248738. Supplementary Information The online version contains supplementary material available at 10.1007/s44250-023-00060-8.
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Affiliation(s)
- Andrea S. Wallace
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Sonja E. Raaum
- University of Utah School of Medicine, Salt Lake City, USA
| | | | | | | | - Mackenzie Elliott
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Alycia A. Bristol
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
| | - Catherine E. Elmore
- The University of Utah College of Nursing, Annette Poulson Cumming Building Rm 5345, 10 South 2000 East, Salt Lake City, UT 84112-5880 USA
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14
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Tyler N, Hodkinson A, Planner C, Angelakis I, Keyworth C, Hall A, Jones PP, Wright OG, Keers R, Blakeman T, Panagioti M. Transitional Care Interventions From Hospital to Community to Reduce Health Care Use and Improve Patient Outcomes: A Systematic Review and Network Meta-Analysis. JAMA Netw Open 2023; 6:e2344825. [PMID: 38032642 PMCID: PMC10690480 DOI: 10.1001/jamanetworkopen.2023.44825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Importance Discharge from the hospital to the community has been associated with serious patient risks and excess service costs. Objective To evaluate the comparative effectiveness associated with transitional care interventions with different complexity levels at improving health care utilization and patient outcomes in the transition from the hospital to the community. Data Sources CENTRAL, Embase, MEDLINE, and PsycINFO were searched from inception until August 2022. Study Selection Randomized clinical trials evaluating transitional care interventions from hospitals to the community were identified. Data Extraction and Synthesis At least 2 reviewers were involved in all data screening and extraction. Random-effects network meta-analyses and meta-regressions were applied. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. Main Outcomes and Measures The primary outcomes were readmission at 30, 90, and 180 days after discharge. Secondary outcomes included emergency department visits, mortality, quality of life, patient satisfaction, medication adherence, length of stay, primary care and outpatient visits, and intervention uptake. Results Overall, 126 trials with 97 408 participants were included, 86 (68%) of which were of low risk of bias. Low-complexity interventions were associated with the most efficacy for reducing hospital readmissions at 30 days (odds ratio [OR], 0.78; 95% CI, 0.66 to 0.92) and 180 days (OR, 0.45; 95% CI, 0.30 to 0.66) and emergency department visits (OR, 0.68; 95% CI, 0.48 to 0.96). Medium-complexity interventions were associated with the most efficacy at reducing hospital readmissions at 90 days (OR, 0.64; 95% CI, 0.45 to 0.92), reducing adverse events (OR, 0.42; 95% CI, 0.24 to 0.75), and improving medication adherence (standardized mean difference [SMD], 0.49; 95% CI, 0.30 to 0.67) but were associated with less efficacy than low-complexity interventions for reducing readmissions at 30 and 180 days. High-complexity interventions were most effective for reducing length of hospital stay (SMD, -0.20; 95% CI, -0.38 to -0.03) and increasing patient satisfaction (SMD, 0.52; 95% CI, 0.22 to 0.82) but were least effective for reducing readmissions at all time periods. None of the interventions were associated with improved uptake, quality of life (general, mental, or physical), or primary care and outpatient visits. Conclusions and Relevance These findings suggest that low- and medium-complexity transitional care interventions were associated with reducing health care utilization for patients transitioning from hospitals to the community. Comprehensive and consistent outcome measures are needed to capture the patient benefits of transitional care interventions.
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Affiliation(s)
- Natasha Tyler
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Alexander Hodkinson
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Claire Planner
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Ioannis Angelakis
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- Institute of Population Health, Department of Primary Care & Mental Health, University of Liverpool, Liverpool, United Kingdom
| | | | - Alex Hall
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom
| | | | | | - Richard Keers
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
- Pharmacy Department, Pennine Care NHS Foundation Trust, Aston-Under-Lyne, United Kingdom
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Tom Blakeman
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
- National Institute for Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
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15
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Cukierman DS, Cata JP, Gan TJ. Enhanced recovery protocols for ambulatory surgery. Best Pract Res Clin Anaesthesiol 2023; 37:285-303. [PMID: 37938077 DOI: 10.1016/j.bpa.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION In the United States, ambulatory surgeries account for up to 87% of all surgical procedures. (1) It was estimated that 19.2 million ambulatory surgeries were performed in 2018 (https://www.hcup-us.ahrq.gov/reports/statbriefs/sb287-Ambulatory-Surgery-Overview-2019.pdf). Cataract procedures and musculoskeletal surgeries are the most common surgical interventions performed in ambulatory centers. However, more complex surgical interventions, such as sleeve gastrectomies, oncological, and spine surgeries, and even arthroplasties are routinely performed as day cases or in a model of an ambulatory extended recovery. (2-5) The ambulatory surgery centers industry has grown since 2017 by 1.1% per year and reached a market size of $31.2 billion. According to the Ambulatory Surgery Center Association, there is a potential to save $57.6 billion in Medicare costs over the next decade (https://www.ibisworld.com/industry-statistics/market-size/ambulatory-surgery-centers-united-states/). These data suggest an expected rise in the volume of ambulatory (same day) or extended ambulatory (23 h) surgeries in coming years. Similar increases are also observed in other countries. For example, 75% of elective surgeries are performed as same-day surgery in the United Kingdom. (6) To reduce costs and improve the quality of care after those more complex procedures, ambulatory surgery centers have started implementing patient-centered, high-quality, value-based practices. To achieve those goals, Enhanced Recovery After Surgery (ERAS) protocols have been implemented to reduce the length of stay, decrease costs, increase patients' satisfaction, and transform clinical practices. The ERAS fundamentals for ambulatory surgery are based on five pillars, including (1) preoperative patient counseling, education, and optimization; (2) multimodal and opioid-sparing analgesia; (3) nausea and vomiting, wound infection, and venous thromboembolism prophylaxis; (4) maintenance of euvolemia; and (5) encouragement of early mobility. Those pillars rely on interdisciplinary teamwork led by anesthesiologists, surgery-specific workgroups, and safety culture. (2) Research shows that a team of ambulatory anesthesiologists is crucial in improving postoperative nausea and vomiting (PONV) and pain control. (7) This review will summarize the current evidence on the elements and clinical importance of implementing ERAS protocol for ambulatory surgery.
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Affiliation(s)
- Daniel S Cukierman
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Juan P Cata
- Department of Anesthesiology and Perioperative Medicine, The University of Texas - MD Anderson Cancer Center, Houston, TX, USA; Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA
| | - Tong Joo Gan
- Anesthesiology and Surgical Oncology Research Group, Houston, TX, USA.
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16
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Wiens MO, Bone JN, Kumbakumba E, Businge S, Tagoola A, Sherine SO, Byaruhanga E, Ssemwanga E, Barigye C, Nsungwa J, Olaro C, Ansermino JM, Kissoon N, Singer J, Larson CP, Lavoie PM, Dunsmuir D, Moschovis PP, Novakowski S, Komugisha C, Tayebwa M, Mwesigwa D, Zhang C, Knappett M, West N, Nguyen V, Mugisha NK, Kabakyenga J. Mortality after hospital discharge among children younger than 5 years admitted with suspected sepsis in Uganda: a prospective, multisite, observational cohort study. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:555-566. [PMID: 37182535 PMCID: PMC10543357 DOI: 10.1016/s2352-4642(23)00052-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Substantial mortality occurs after hospital discharge in children younger than 5 years with suspected sepsis, especially in low-income countries. A better understanding of its epidemiology is needed for effective interventions to reduce child mortality in these countries. We evaluated risk factors for death after discharge in children admitted to hospital for suspected sepsis in Uganda, and assessed how these differed by age, time of death, and location of death. METHODS In this prospective, multisite, observational cohort study, we recruited and consecutively enrolled children aged 0-60 months admitted with suspected sepsis from the community to the paediatric wards of six Ugandan hospitals. Suspected sepsis was defined as the need for admission due to a suspected or proven infectious illness. At admission, trained study nurses systematically collected data on clinical variables, sociodemographic variables, and baseline characteristics with encrypted study tablets. Participants were followed up for 6 months after discharge by field officers who contacted caregivers at 2 months and 4 months after discharge by telephone and at 6 months after discharge in person to measure vital status, health-care seeking after discharge, and readmission details. We assessed 6-month mortality after hospital discharge among those discharged alive, with verbal autopsies conducted for children who had died after hospital discharge. FINDINGS Between July 13, 2017, and March 30, 2020, 16 991 children were screened for eligibility. 6545 children (2927 [44·72%] female children and 3618 [55·28%] male children) were enrolled and 6191 were discharged from hospital alive. 6073 children (2687 [44·2%] female children and 3386 [55·8%] male children) completed follow-up. 366 children died in the 6-month period after discharge (weighted mortality rate 5·5%). Median time from discharge to death was 28 days (IQR 9-74). For the 360 children for whom location of death was documented, deaths occurred at home (162 [45·0%]), in transit to care (66 [18·3%]), or in hospital (132 [36·7%]) during a subsequent readmission. Death after hospital discharge was strongly associated with weight-for-age Z scores less than -3 (adjusted risk ratio [aRR] 4·7, 95% CI 3·7-5·8 vs a Z score of >-2), discharge or referral to a higher level of care (7·3, 5·6-9·5), and unplanned discharge (3·2, 2·5-4·0). Hazard ratios (HRs) for severe anaemia (<7g/dL) increased with time since discharge, from 1·7 (95% CI 0·9-3·0) for death occurring in the first time tertile to 5·2 (3·1-8·5) in the third time tertile. HRs for some discharge vulnerabilities decreased significantly with increasing time since discharge, including unplanned discharge (from 4.5 [2·9-6·9] in the first tertile to 2·0 [1·3-3·2] in the third tertile) and poor feeding status (from 7·7 [5·4-11·0] to 1·84 [1·0-3·3]). Age interacted with several variables, including reduced weight-for-age Z score, severe anaemia, and reduced admission temperature. INTERPRETATION Paediatric mortality following hospital discharge after suspected sepsis is common, with diminishing, although persistent, risk during the first 6 months after discharge. Efforts to improve outcomes after hospital discharge are crucial to achieving Sustainable Development Goal 3.2 (ending preventable childhood deaths under age 5 years). FUNDING Grand Challenges Canada, Thrasher Research Fund, BC Children's Hospital Foundation, and Mining4Life.
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Affiliation(s)
- Matthew O Wiens
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada; Walimu, Kampala, Uganda.
| | - Jeffrey N Bone
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Elias Kumbakumba
- Department of Paediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Abner Tagoola
- Department of Paediatrics, Jinja Regional Referral Hospital, Jinja City, Uganda
| | | | | | | | | | - Jesca Nsungwa
- Ministry of Health for the Republic of Uganda, Kampala, Uganda
| | - Charles Olaro
- Ministry of Health for the Republic of Uganda, Kampala, Uganda
| | - J Mark Ansermino
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Niranjan Kissoon
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Charles P Larson
- School of Population and Global Health, McGill University, Montreal, QC, Canada
| | - Pascal M Lavoie
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada; Department of Paediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Dustin Dunsmuir
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada; BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Peter P Moschovis
- Division of Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Stefanie Novakowski
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada; Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Cherri Zhang
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | - Martina Knappett
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | - Nicholas West
- BC Children's Hospital Research Institute, BC Children's Hospital, Vancouver, BC, Canada
| | - Vuong Nguyen
- Centre for International Child Health, BC Children's Hospital, Vancouver, BC, Canada
| | | | - Jerome Kabakyenga
- Maternal Newborn and Child Health Institute, Mbarara University of Science and Technology, Mbarara, Uganda; Department of Community Health, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Yoshimura M, Kawamura M, Hasegawa S, Ito YM, Takahashi K, Sumi N. Development and validation of the Care Transitions Scale for Patients with Heart Failure: A tool for nurses to assess patients' readiness for hospital discharge. Jpn J Nurs Sci 2023; 20:e12522. [PMID: 36755473 DOI: 10.1111/jjns.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/06/2022] [Accepted: 12/22/2022] [Indexed: 02/10/2023]
Abstract
AIM This study aimed to develop and assess the validity and reliability of the Care Transitions Scale for Patients with Heart Failure (CTS-HF) as a nurse-reported measure for evaluating patients' readiness for hospital discharge. METHODS We conducted a cross-sectional study of cardiovascular ward nurses from 163 hospitals across Japan. Structural validity was assessed using exploratory factor analysis with development participants and confirmatory factor analysis with validation participants. Convergent validity was assessed by correlation with the Discharge Planning of Ward Nurses scale (DPWN). Hypotheses testing for construct validity was performed as comparisons between subgroups of transitional care practice. RESULTS Valid responses were obtained from 704 nurses (development participants, n = 352; validation participants, n = 352). The final scale comprised 21 items divided into six factors: "Clear preparation for how to manage health at home," "Adjusting to home care/support system," "Transitions of medication management from hospital to home," "Dealing with patients' concerns and questions," "Transitions of disease management from hospital to home," and "Family support." Indices of fit supported these results (comparative fit index = 0.944, root mean square error of approximation = 0.057). The CTS-HF was significantly correlated with the DPWN. The nurses' subgroup with higher transitional care practice had higher CTS-HF scores. Cronbach's alpha was .93 for the CTS-HF. CONCLUSIONS The CTS-HF showed sufficient reliability and validity for use in evaluating discharge care. Further studies are needed regarding the usefulness of this scale in nursing practice.
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Affiliation(s)
- Mai Yoshimura
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Masumi Kawamura
- Department of Nursing, Sapporo-Kosei General Hospital, Sapporo, Japan
| | - Satoko Hasegawa
- Department of Nursing, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Keita Takahashi
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Naomi Sumi
- Department of Fundamental Nursing, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Tobiano G, Roberts S, Muir R, Jerofke-Owen T, Ting C, Thorning S, Heyland DK, Marshall AP. Patient-mediated interventions in hospital: A systematic review. J Adv Nurs 2023; 79:418-441. [PMID: 36408930 DOI: 10.1111/jan.15500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/13/2022] [Accepted: 11/06/2022] [Indexed: 11/22/2022]
Abstract
AIMS To describe the characteristics of hospital-based, patient-mediated interventions and their impact on patient, clinician and organization outcomes. DESIGN Systematic review. DATA SOURCES Health literature databases (MEDLINE, CINAHL and EMBASE) were searched in August 2021. Backward and forward citation searching was conducted. REVIEW METHODS Studies investigating patient-mediated interventions, targeted at adult hospitalized patients were eligible. Data were extracted related to study and intervention characteristics. Narrative synthesis was used to understand intervention impact on patient, clinician and organization outcomes (as per a framework). Methodological quality was assessed using the Mixed Methods Assessment Tool. RESULTS Thirty-three studies, reporting 18 interventions, were included. Twelve interventions prompted patients to report health information about their own health/needs/concerns and six interventions encouraged patients to provide feedback about clinical practice. Across all interventions, there was evidence that patients used patient-mediated interventions and that they may improve patient communication. Healthcare professional outcomes were mixed for actual/intended use, acceptability and usefulness of interventions; yet there was some evidence of healthcare professional behaviour change. Interventions that encouraged patients to report health information about their own health/needs/concerns appeared more successful than other types of interventions. CONCLUSIONS There is some evidence that hospital-based patient-mediated interventions may influence patient communication and healthcare professional behaviour. Patient-mediated interventions that encourage patients to report patient data before a clinical encounter may be more impactful than interventions that encourage patient feedback during or post-encounter. IMPACT To date, most patient-mediated intervention research has been conducted in primary care settings; we uncovered the types of patient-mediated interventions that have been trialled in hospitals. We found that patient communication and healthcare professional behaviour may be influenced by these patient-mediated interventions. Future researchers could explore the suitability and effectiveness of a wider range of hospital-based patient-mediated interventions. NO PATIENT OR PUBLIC CONTRIBUTION There was no funding to remunerate a patient/member of the public for this review.
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Affiliation(s)
- Georgia Tobiano
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,NHMRC CRE in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Shelley Roberts
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Rachel Muir
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | | | - Christine Ting
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Sarah Thorning
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Daren K Heyland
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.,Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
| | - Andrea P Marshall
- Gold Coast University Hospital, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
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Lerret SM, Schiffman R, White-Traut R, Medoff-Cooper B, Ahamed SI, Adib R, Liegl M, Alonso E, Mavis A, Jensen K, Peterson CG, Neighbors K, Riordan MK, Semp MC, Vo T, Stendahl G, Chapman S, Unteutsch R, Simpson P. Feasibility and Acceptability of a mHealth Self-Management Intervention for Pediatric Transplant Families. West J Nurs Res 2022; 44:955-965. [PMID: 34154460 PMCID: PMC8688578 DOI: 10.1177/01939459211024656] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Families of pediatric solid organ transplant recipients need ongoing education and support in the first 30 days following hospital discharge for the transplantation. The purpose of this report is to describe the feasibility, acceptability, and preliminary efficacy of a mHealth family-self management intervention, (myFAMI), designed to improve post-discharge outcomes of coping, family quality of life, self-efficacy, family self-management, and utilization of health care resources. We enrolled 46 primary family members. myFAMI was feasible and acceptable; 81% (n=17/21) of family members completed the app at least 24/30 days (goal 80% completion rate). Family members generated 134 trigger alerts and received a nurse response within the goal timeframe of < 2 h 99% of the time. Although there were no significant differences between groups, primary outcomes were in the expected direction. The intervention was well received and is feasible for future post-discharge interventions for families of children who receive an organ transplant.
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Affiliation(s)
- Stacee M Lerret
- Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Schiffman
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Rosemary White-Traut
- Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Barbara Medoff-Cooper
- College of Nursing, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sheikh Iqbal Ahamed
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, WI, USA
| | - Riddhiman Adib
- Department of Mathematics, Statistics, and Computer Science, Marquette University, Milwaukee, WI, USA
| | - Melodee Liegl
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Estella Alonso
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Alisha Mavis
- Pediatric Gastroenterology, Hepatology and Nutrition, Duke University Medical Center, Durham, NC
| | - Kyle Jensen
- Pediatric Gastroenterology, Hepatology and Nutrition, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Caitlin G Peterson
- Pediatric Nephrology and Hypertension, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Katie Neighbors
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Mary K Riordan
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Melissa C Semp
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Truc Vo
- Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Gail Stendahl
- Pediatric Heart Transplant Program, Children's Wisconsin, Milwaukee, WI, USA
| | - Shelley Chapman
- Pediatric Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel Unteutsch
- Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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20
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Post-Hospital Availability of Instrumental Support May Influence Patients' Readiness for Discharge. Prof Case Manag 2022; 27:194-202. [PMID: 35617535 DOI: 10.1097/ncm.0000000000000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY Evaluate the relationship between unplanned acute care utilization after discharge from an index hospital admission and registered nurse and patient perceptions of available instrumental support the patient would have after discharge. PRIMARY PRACTICE SETTING Three hospitals in a large regional hospital system in the southeastern United States. METHODOLOGY AND SAMPLE Retrospective, secondary quantitative analysis of 13,361 patient records (mean age 58.4 years; 51% female) from index hospitalizations evaluating patient and nurse responses to 2 questions that specifically address instrumental support on both the patient and nurse versions of the Readiness for Hospital Discharge Survey (RHDS) and subsequent unexpected care received (emergency department [ED] visit, observation stay, hospital readmission) in the acute care setting within 60 days of discharge. Logistic regression was used to evaluate the relationship between RHDS scores and unplanned care received. RESULTS Patients who required hospital-based acute care within 60 days after discharge had lower average RN-RHDS scores than those who did not require hospital-based acute care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Including a nursing assessment of potential postdischarge expected instrumental support may be helpful in identifying patients who are at a higher risk of experiencing postdischarge acute care utilization. Monitoring ED visits and observation stays in addition to readmissions will facilitate capturing significantly more points of care received after discharge and provide additional information regarding postdischarge care utilization.
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21
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Li W, Zhang Y, Wei L. Postdischarge coping difficulties and influencing factors of pregnant women with gestational diabetes mellitus: A cross-sectional study. Nurs Open 2022; 9:1625-1634. [PMID: 35240006 PMCID: PMC8994934 DOI: 10.1002/nop2.1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/01/2021] [Accepted: 01/09/2022] [Indexed: 11/29/2022] Open
Abstract
Aims and objectives To identify coping difficulties after discharge and influencing factors of pregnant women with gestational diabetes mellitus. Design A cross‐sectional descriptive survey was conducted with gestational diabetes mellitus women from four tertiary hospitals in the Shandong Peninsula in China. Methods The study consists of 252 gestational diabetes mellitus women. Survey measures included demographic information, quality of discharge teaching scale, readiness for hospital discharge scale and postdischarge coping difficulty scale. Multiple linear regression analysis was used to explore the factors of coping difficulties after discharge. Results The situation of coping difficulties in pregnant women with gestational diabetes mellitus after discharge is not optimistic. Age, education level, type of birth, parity, quality of discharge teaching and discharge readiness are six factors that significantly influence postdischarge coping difficulties.
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Affiliation(s)
- Wen Li
- Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Yan Zhang
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Lili Wei
- The Affiliated Hospital of Qingdao University, Qingdao, China
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22
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Yoshimura M, Sumi N. Measurement tools that assess the quality of transitional care from patients' perspective: A literature review. Jpn J Nurs Sci 2022; 19:e12472. [PMID: 35132783 DOI: 10.1111/jjns.12472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/06/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
AIM Transitional care is important for improving the quality of life of patients discharged from hospitals. Patient-reported experience measures help improve transitional care quality. Thus, this literature review aimed to identify and appraise measurement tools that assess transitional care quality from the patient's perspective and identify its components. METHODS Development and validation studies were systematically searched in the PubMed and CINAHL databases. The review team appraised the methodological quality and statistical results of measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. RESULTS A total of 30 studies and seven instruments were identified. The target population was patients discharged from hospital to a home or nursing home (mean age = 52-84 years). The measurement time was before or after the discharge. The number of items in the original versions of the measures ranged from eight to 41, with short versions ranging from three to 12. The overall methodological quality of structural validity, internal consistency, and hypotheses testing was mostly "very good or adequate," according to COSMIN criteria. However, content validity and development were mostly "inadequate or doubtful" or not reported. The main components of included measures comprised "self-care after discharge," "providing information to the patient," "patient engagement in the care plan," and "dealing with patient's concerns." CONCLUSION The quality appraisal results and identified components are useful for choosing measurement tools in clinical practice and research. The Care Transitions Measure is the most widely validated measurement tool.
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Affiliation(s)
- Mai Yoshimura
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Naomi Sumi
- Department of Fundamental Nursing, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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23
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Schultz BE, Corbett CF, Hughes RG, Bell N. Scoping review: Social support impacts hospital readmission rates. J Clin Nurs 2021; 31:2691-2705. [PMID: 34866259 DOI: 10.1111/jocn.16143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 12/21/2022]
Abstract
AIMS AND OBJECTIVES To review and synthesise the current literature on social support and hospital readmission rates. BACKGROUND Hospital readmission rates have not declined significantly since 2010 despite efforts to identify and implement strategies to reduce readmissions. After discharge, patients often report the need for help at home with personal care, medical care and/or transportation. Social factors can positively or negatively affect the transition from hospital to home and the extended recovery period experienced by patients. METHODS Published primary studies in peer-reviewed journals, written in English, assessing the adult medical/surgical population and discussing social support and hospital readmission rates were included. A Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) was completed for this scoping review. RESULTS The search resulted in 2919 articles. After removing duplicates and reviewing content for the inclusion and exclusion criteria, 23 articles were selected for review. Social support is provided by those within one's social circle. There are several types of social support and depending on the needs to the patient, the type of social required and provided is different. CONCLUSIONS The most common form of social support needed at home for people recovering after a hospitalisation was instrumental support, tangible care in the form of assistance with daily personal and medical care, and transportation. Patients who lacked adequate social support after discharge were at an increased risk of hospital readmission. RELEVANCE TO CLINICAL PRACTICE Identifying factors, such as social support, that may impact hospital readmission rates is important for quality hospital to home care transitions. Assessing patients' needs and available social support to meet those needs may be an essential part of the discharge planning process to decrease the risk of hospital readmission.
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Affiliation(s)
- Beth E Schultz
- University of South Carolina, Columbia, South Columbia, USA
| | | | - Ronda G Hughes
- University of South Carolina, Columbia, South Columbia, USA
| | - Nathaniel Bell
- University of South Carolina, Columbia, South Columbia, USA
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24
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Cassidy CE, Harrison MB, Godfrey C, Nincic V, Khan PA, Oakley P, Ross-White A, Grantmyre H, Graham ID. Use and effects of implementation strategies for practice guidelines in nursing: a systematic review. Implement Sci 2021; 16:102. [PMID: 34863220 PMCID: PMC8642950 DOI: 10.1186/s13012-021-01165-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 10/12/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Practice guidelines can reduce variations in nursing practice and improve patient care. However, implementation of guidelines is complex and inconsistent in practice. It is unclear which strategies are effective at implementing guidelines in nursing. This review aimed to describe the use and effects of implementation strategies to facilitate the uptake of guidelines focused on nursing care. METHODS We conducted a systematic review of five electronic databases in addition to the Cochrane Effective Practice and Organization of Care (EPOC) Group specialized registry. Studies were included if implementation of a practice guideline in nursing and process or outcome of care provided by nurses were reported. Two reviewers independently screened studies, assessed study quality, extracted data, and coded data using the EPOC taxonomy of implementation strategies. For those strategies not included in the EPOC taxonomy, we inductively categorized these strategies and generated additional categories. We conducted a narrative synthesis to analyze results. RESULTS The search identified 46 papers reporting on 41 studies. Thirty-six studies used a combination of educational materials and educational meetings. Review findings show that multicomponent implementation strategies that include educational meetings, in combination with other educational strategies, report positive effects on professional practice outcomes, professional knowledge outcomes, patient health status outcomes, and resource use/expenditures. Twenty-three of the 41 studies employed implementation strategies not listed within the EPOC taxonomy, including adaptation of practice guidelines to local context (n = 9), external facilitation (n = 14), and changes to organizational policy (n = 3). These implementation strategies also corresponded with positive trends in patient, provider, and health system outcomes. CONCLUSIONS Nursing guideline implementation may benefit from using the identified implementation strategies described in this review, including participatory approaches such as facilitation, adaptation of guidelines, and organizational policy changes. Further research is needed to understand how different implementation strategy components work in a nursing context and to what effect. As the field is still emerging, future reviews should also explore guideline implementation strategies in nursing in quasi or non-experimental research designs and qualitative research studies.
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Affiliation(s)
- Christine E. Cassidy
- School of Nursing, Dalhousie University, 5860 University Ave., Halifax, NS B3H 4R2 Canada
| | - Margaret B. Harrison
- School of Nursing, Queen’s University, 92 Barrie Street, Kingston, ON K7L 3J9 Canada
| | - Christina Godfrey
- School of Nursing, Queen’s University, 92 Barrie Street, Kingston, ON K7L 3J9 Canada
| | - Vera Nincic
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Paul A. Khan
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, 209 Victoria Street, Toronto, ON M5B 1W8 Canada
| | - Patricia Oakley
- National Research Council Canada, Institute for Information Technology, 46 Dineen Drive, Fredericton, NB E3B 9W4 Canada
| | - Amanda Ross-White
- Queen’s University Library, Queen’s University, 18 Stuart Street, Kingston, ON K7L 3N6 Canada
| | - Hilary Grantmyre
- School of Nursing, Dalhousie University, 5860 University Ave., Halifax, NS B3H 4R2 Canada
| | - Ian D. Graham
- School of Epidemiology and Public HealthSchool of Nursing, University of Ottawa, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
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25
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Kamau EB, Foronda C, Hernandez VH, Walters BA. Reducing Length of Stay and Hospital Readmission for Orthopedic Patients: A Quality Improvement Project. J Dr Nurs Pract 2021; 15:JDNP-D-20-00060. [PMID: 34716277 DOI: 10.1891/jdnp-d-20-00060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transitioning patients from the hospital to home after a total hip or knee arthroplasty is challenging. Severe pain, comorbidities and complex medication regimes have the potential to delay readiness for discharge, increase length of stay (LOS), and cause readmissions. OBJECTIVE The goal of this practice improvement project was to improve patient readiness for discharge after total joint arthroplasty to reduce LOS, prevent emergency department (ED) visits, and prevent hospital readmissions. METHODS This quality improvement project was guided by the Iowa Model and implemented a prepost program implementation evaluation design. Nurses incorporated the Registered Nurse Assessment of Readiness for Hospital Discharge Scale (RN-RHDS) to guide and evaluate discharge education efforts. RESULTS The focused education cohort demonstrated significantly decreased LOS and decreased readmissions compared to the cohort receiving standard education efforts. ED visits were not significantly different amongst cohorts. CONCLUSION This practice improvement project demonstrates successful translation of research into practice. IMPLICATIONS FOR NURSING The use of focused education and the RN-RHDS tool is recommended for nursing to improve patient readiness for discharge and patient outcomes.
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Affiliation(s)
- Emma Betty Kamau
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida
| | - Cynthia Foronda
- University of Miami School of Nursing and Health Studies, Coral Gables, Florida
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26
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Seip RL, Lee S, McLaughlin T, Staff I, Nsereko A, Thompson S, Santana C, Tishler DS, Papasavas P. Utility of a Novel Scale to Assess Readiness for Discharge After Bariatric Surgery. World J Surg 2021; 46:172-179. [PMID: 34668048 DOI: 10.1007/s00268-021-06324-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The safe release of a patient from hospital care after bariatric surgery depends upon the achievement of satisfactory health status. Here, we describe a new objective scale (the Readiness for Discharge, RFD Scale) to measure the patient's suitability for hospital discharge after bariatric surgery. METHODS We conducted a retrospective, observational analysis of data collected in a randomized clinical trial of an enhanced recovery after surgery protocol for laparoscopic sleeve gastrectomy from 3/15/2018 to 1/12/2019. Nursing staff assessed 122 patients every 4-8 h after surgery using a checklist to document 5 components: ambulation, vital signs, pain, nausea, and oral intake of clear fluid. Satisfaction of each component was scored as "1" (satisfactory) or "0" (not satisfactory). Scores were summed and analyzed for patterns. RFD = 5 marked the patient as ready for discharge. RESULTS Sufficient intake of clear liquid was the last RFD component satisfied in 87% of patients. Two overall response patterns emerged: "Steady Progressors" (n = 51) whose RFD score rose steadily from 0 to 5 without reversion to a lower score; and "Oscillators" (n = 71) who had at least one temporary decrease in RFD score on the way to attaining 5, or showed a simultaneous oscillation of components without change in RFD. CONCLUSIONS The RFD checklist allows objective scoring of medical readiness for discharge after LSG and has the potential to improve clinical communication.
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Affiliation(s)
- Richard L Seip
- Hartford Hospital Surgical Weight Loss Program, Hartford Hospital, Hartford, CT, 06102, US
| | - Samantha Lee
- Hartford Hospital Surgical Weight Loss Program, Hartford Hospital, Hartford, CT, 06102, US
| | - Tara McLaughlin
- Hartford Hospital Department of Surgery, Hartford Hospital, Hartford, CT, 06102, US
| | - Ilene Staff
- Hartford Hospital Research Program, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06106, US
| | - Aloys Nsereko
- Hartford Hospital Surgical Weight Loss Program, Hartford Hospital, Hartford, CT, 06102, US
| | - Stephen Thompson
- Hartford Hospital Research Program, Hartford Hospital, 80 Seymour Street, Hartford, CT, 06106, US
| | - Connie Santana
- Hartford Hospital Surgical Weight Loss Program, Hartford Hospital, Hartford, CT, 06102, US
| | - Darren S Tishler
- Hartford Hospital Surgical Weight Loss Program, Hartford Hospital, Hartford, CT, 06102, US
| | - Pavlos Papasavas
- Hartford Hospital Surgical Weight Loss Program, Hartford Hospital, Hartford, CT, 06102, US.
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Gibbons C, Porter I, Gonçalves-Bradley DC, Stoilov S, Ricci-Cabello I, Tsangaris E, Gangannagaripalli J, Davey A, Gibbons EJ, Kotzeva A, Evans J, van der Wees PJ, Kontopantelis E, Greenhalgh J, Bower P, Alonso J, Valderas JM. Routine provision of feedback from patient-reported outcome measurements to healthcare providers and patients in clinical practice. Cochrane Database Syst Rev 2021; 10:CD011589. [PMID: 34637526 PMCID: PMC8509115 DOI: 10.1002/14651858.cd011589.pub2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patient-reported outcomes measures (PROMs) assess a patient's subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision-making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. OBJECTIVES To assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient-reported health outcomes and processes of care. SEARCH METHODS We searched MEDLINE, Embase, CENTRAL, two other databases and two clinical trial registries on 5 October 2020. We searched grey literature and consulted experts in the field. SELECTION CRITERIA Two review authors independently screened and selected studies for inclusion. We included randomised trials directly comparing the effects on outcomes and processes of care of PROMs feedback to healthcare professionals and patients, or both with the impact of not providing such information. DATA COLLECTION AND ANALYSIS Two groups of two authors independently extracted data from the included studies and evaluated study quality. We followed standard methodological procedures expected by Cochrane and EPOC. We used the GRADE approach to assess the certainty of the evidence. We conducted meta-analyses of the results where possible. MAIN RESULTS We identified 116 randomised trials which assessed the effectiveness of PROMs feedback in improving processes or outcomes of care, or both in a broad range of disciplines including psychiatry, primary care, and oncology. Studies were conducted across diverse ambulatory primary and secondary care settings in North America, Europe and Australasia. A total of 49,785 patients were included across all the studies. The certainty of the evidence varied between very low and moderate. Many of the studies included in the review were at risk of performance and detection bias. The evidence suggests moderate certainty that PROMs feedback probably improves quality of life (standardised mean difference (SMD) 0.15, 95% confidence interval (CI) 0.05 to 0.26; 11 studies; 2687 participants), and leads to an increase in patient-physician communication (SMD 0.36, 95% CI 0.21 to 0.52; 5 studies; 658 participants), diagnosis and notation (risk ratio (RR) 1.73, 95% CI 1.44 to 2.08; 21 studies; 7223 participants), and disease control (RR 1.25, 95% CI 1.10 to 1.41; 14 studies; 2806 participants). The intervention probably makes little or no difference for general health perceptions (SMD 0.04, 95% CI -0.17 to 0.24; 2 studies, 552 participants; low-certainty evidence), social functioning (SMD 0.02, 95% CI -0.06 to 0.09; 15 studies; 2632 participants; moderate-certainty evidence), and pain (SMD 0.00, 95% CI -0.09 to 0.08; 9 studies; 2386 participants; moderate-certainty evidence). We are uncertain about the effect of PROMs feedback on physical functioning (14 studies; 2788 participants) and mental functioning (34 studies; 7782 participants), as well as fatigue (4 studies; 741 participants), as the certainty of the evidence was very low. We did not find studies reporting on adverse effects defined as distress following or related to PROM completion. AUTHORS' CONCLUSIONS PROM feedback probably produces moderate improvements in communication between healthcare professionals and patients as well as in diagnosis and notation, and disease control, and small improvements to quality of life. Our confidence in the effects is limited by the risk of bias, heterogeneity and small number of trials conducted to assess outcomes of interest. It is unclear whether many of these improvements are clinically meaningful or sustainable in the long term. There is a need for more high-quality studies in this area, particularly studies which employ cluster designs and utilise techniques to maintain allocation concealment.
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Affiliation(s)
| | - Ian Porter
- Health Services & Policy Research, University of Exeter Medical School, Exeter, UK
| | - Daniela C Gonçalves-Bradley
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Stanimir Stoilov
- College of Medicine and Health, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ignacio Ricci-Cabello
- Primary Care Research Unit, Instituto de Investigación Sanitaria Illes Balears, Palma de Mallorca, Spain
| | | | | | - Antoinette Davey
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Elizabeth J Gibbons
- PROM Group, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Anna Kotzeva
- Health Technology Assessment Department, Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain
| | - Jonathan Evans
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
| | - Philip J van der Wees
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands
| | - Evangelos Kontopantelis
- Centre for Health Informatics, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Jordi Alonso
- CIBER Epidemiologia y Salud Publica (CIBERESP), IMIM-Hospital del mar, Barcelona, Spain
| | - Jose M Valderas
- Health Services & Policy Research, Exeter Collaboration for Academic Primary Care (APEx), NIHR School for Primary Care Research, NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK
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28
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Saunders S, Weiss ME, Meaney C, Killackey T, Varenbut J, Lovrics E, Ernecoff N, Hsu AT, Stern M, Mahtani R, Wentlandt K, Isenberg SR. Examining the course of transitions from hospital to home-based palliative care: A mixed methods study. Palliat Med 2021; 35:1590-1601. [PMID: 34472398 DOI: 10.1177/02692163211023682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hospital-to-home transitions in palliative care are fraught with challenges. To assess transitions researchers have used patient reported outcome measures and qualitative data to give unique insights into a phenomenon. Few measures examine care setting transitions in palliative care, yet domains identified in other populations are likely relevant for patients receiving palliative care. AIM Gain insight into how patients experience three domains, discharge readiness, transition quality, and discharge-coping, during hospital-to-home transitions. DESIGN Longitudinal, convergent parallel mixed methods study design with two data collection visits: in-hospital before and 3-4 weeks after discharge. Participants completed scales assessing discharge readiness, transition quality, and post discharge-coping. A qualitative interview was conducted at both visits. Data were analyzed separately and integrated using a merged transformative methodology, allowing us to compare and contrast the data. SETTING AND PARTICIPANTS Study was set in two tertiary hospitals in Toronto, Canada. Adult inpatients (n = 25) and their caregivers (n = 14) were eligible if they received a palliative care consultation and transitioned to home-based palliative care. RESULTS Results were organized aligning with the scales; finding low discharge readiness (5.8; IQR: 1.9), moderate transition quality (66.7; IQR: 33.33), and poor discharge-coping (5.0; IQR: 2.6), respectively. Positive transitions involved feeling well supported, managing medications, feeling well, and having healthcare needs met. Challenges in transitions were feeling unwell, confusion over medications, unclear healthcare responsibilities, and emotional distress. CONCLUSIONS We identified aspects of these three domains that may be targeted to improve transitions through intervention development. Identified discrepancies between the data types should be considered for future research exploration.
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Affiliation(s)
- Stephanie Saunders
- Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Chris Meaney
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Jaymie Varenbut
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada
| | - Emily Lovrics
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada
| | - Natalie Ernecoff
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Amy T Hsu
- Bruyère Research Institute, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Ramona Mahtani
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada
| | - Kirsten Wentlandt
- Division of Palliative Care, University Health Network, Toronto, ON, Canada
| | - Sarina R Isenberg
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
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29
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Manges KA, Wallace AS, Groves PS, Schapira MM, Burke RE. Ready to Go Home? Assessment of Shared Mental Models of the Patient and Discharging Team Regarding Readiness for Hospital Discharge. J Hosp Med 2021; 16:326-332. [PMID: 33357321 PMCID: PMC8025658 DOI: 10.12788/jhm.3464] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 05/08/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND A critical task of the inpatient interprofessional team is readying patients for discharge. Assessment of shared mental model (SMM) convergence can determine how much team members agree about patient discharge readiness and how their mental models align with the patient's self-assessment. OBJECTIVE Determine the convergence of interprofessional team SMMs of hospital discharge readiness and identify factors associated with these assessments. DESIGN We surveyed interprofessional discharging teams and each team's patient at time of hospital discharge using validated tools to capture their SMMs. PARTICIPANTS Discharge events (N = 64) from a single hospital consisting of the patient and their team (nurse, coordinator, physician). MEASURES Clinician and patient versions of the validated Readiness for Hospital Discharge Scales/Short Form (RHDS/SF). We measured team convergence by comparing the individual clinicians' scores on the RHDS/SF, and we measured team-patient convergence as the absolute difference between the Patient-RHDS/SF score and the team average score on the Clinician-RHDS/SF. RESULTS Discharging teams assessed patients as having high readiness for hospital discharge (mean score, 8.5 out of 10; SD, 0.91). The majority of teams had convergent SMMs with high to very high interrater agreement on discharge readiness (mean r*wg(J), 0.90; SD, 0.10). However, team-patient SMM convergence was low: Teams overestimated the patient's self-assessment of readiness for discharge in 48.4% of events. We found that teams reporting higher-quality teamwork (P = .004) and bachelor's level-trained nurses (P < .001) had more convergent SMMs with the patient. CONCLUSION Measuring discharge teams' SMM of patient discharge readiness may represent an innovative assessment tool and potential lever to improve the quality of care transitions.
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Affiliation(s)
- Kirstin A Manges
- National Clinician Scholars Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Andrea S Wallace
- Division of Health Systems and Community Based Care, College of Nursing, University of Utah, Salt Lake City, Utah
| | | | - Marilyn M Schapira
- Center for Health Equity Promotion and Research, Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert E Burke
- Center for Health Equity Promotion and Research, Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
- Division of General Internal Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Bettencourt AP, Schondelmeyer AC. Are You Thinking What I'm Thinking? The Case for Shared Mental Models in Hospital Discharges. J Hosp Med 2021; 16:383. [PMID: 34129492 PMCID: PMC8191767 DOI: 10.12788/jhm.3606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Amanda P Bettencourt
- University of Michigan School of Nursing, Department of Systems, Populations, and Leadership, Ann Arbor, Michigan
| | - Amanda C Schondelmeyer
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
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Stichler JF, Pelletier LR. Psychometric Testing of a Patient Empowerment, Engagement, and Activation Survey. J Nurs Care Qual 2021; 35:E49-E57. [PMID: 31821184 DOI: 10.1097/ncq.0000000000000452] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patient or person-centered care has become a widely used philosophical framework and yet has varying definitions and characteristics. Person-centered care has recently been conceptualized as patient empowerment, engagement, and activation with studies citing positive outcomes. PURPOSE This study reports the psychometric properties of the Patient Empowerment, Engagement, and Activation Survey. METHODS An instrument development and testing approach was used. RESULTS A 21-item survey was developed demonstrating respectable Cronbach α coefficients for the total scale (α = 0.88) and for each subscale: Empowerment (α = 0.71), Engagement (α = 0.81), and Activation (α = 0.76). A regression analysis with 1 item, "I am ready to be discharged" as the dependent variable and all other items as independent variables explained 65% of the variance in readiness for discharge (P < .001). DISCUSSION The Patient Empowerment, Engagement, and Activation Survey can be used to evaluate patients' perspectives of care quality (empowerment and engagement) and readiness for discharge (activation).
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Affiliation(s)
- Jaynelle F Stichler
- Research & Professional Development, Sharp Center of Nursing Excellence, San Diego, California (Dr Stichler); San Diego State University, San Diego, California (Dr Stichler); and Sharp Mesa Vista Hospital, San Diego, California (Mr Pelletier)
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Siclovan DM, Bang JT, Yakusheva O, Hamilton M, Bobay KL, Costa LL, Hughes RG, Miles J, Bahr SJ, Weiss ME. Effectiveness of home health care in reducing return to hospital: Evidence from a multi-hospital study in the US. Int J Nurs Stud 2021; 119:103946. [PMID: 33957500 DOI: 10.1016/j.ijnurstu.2021.103946] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Home health care, a commonly used bridge strategy for transitioning from hospital to home-based care, is expected to contribute to readmission avoidance efforts. However, in studies using disease-specific samples, evidence about the effectiveness of home health care in reducing readmissions is mixed. OBJECTIVE To examine the effectiveness of home health care in reducing return to hospital across a diverse sample of patients discharged home following acute care hospitalization. RESEARCH DESIGN Secondary analysis of a multi-site dataset from a study of discharge readiness assessment and post-discharge return to hospital, comparing matched samples of patients referred and not referred for home health care at the time of hospital discharge. SETTING Acute care, Magnet-designated hospitals in the United States PARTICIPANTS: The available sample (n = 18,555) included hospitalized patients discharged from medical-surgical units who were referred (n = 3,579) and not referred (n = 14,976) to home health care. The matched sample included 2767 pairs of home health care and non- home health care patients matched on patient and hospitalization characteristics using exact and Mahalanobis distance matching. METHODS Unadjusted t-tests and adjusted multinomial logit regression analyses to compare the occurrence of readmissions and Emergency Department/Observation visits within 30 and 60-days post-discharge. RESULTS No statistically significant differences in readmissions or Emergency Department /Observation visits between home health care and non-home health care patients were observed. CONCLUSIONS Home health care referral was not associated with lower rates of return to hospital within 30 and 60 days in this US sample matched on patient and clinical condition characteristics. This result raises the question of why home health care services did not produce evidence of lower post-discharge return to hospital rates. Focused attention by home health care programs on strategies to reduce readmissions is needed.
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Affiliation(s)
| | - James T Bang
- Department of Economics, St. Ambrose University, McMullen Hall 124A 518 W. Locust St.Davenport, IA 52803, USA.
| | - Olga Yakusheva
- University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109-5482, USA.
| | - Morris Hamilton
- Abt Associates, 5001 S Miami Blvd #210, Durham, NC 27703, USA.
| | - Kathleen L Bobay
- Marcella Niehoff School of Nursing, Loyola University Chicago, 2160 S. 1st Ave., Maywood, Illinois, 60153, USA.
| | - Linda L Costa
- University of Maryland School of Nursing, 655 W. Lombard St., Baltimore, MD, 21201, USA
| | - Ronda G Hughes
- University of South Carolina College of Nursing, 1601 Greene Street, Room 405, Columbia, SC, 29208, USA.
| | - Jane Miles
- Marquette University College of Nursing, PO Box 1881, Milwaukee, WI, 53201-1881, USA.
| | - Sarah J Bahr
- Marquette University College of Nursing, PO Box 1881, Milwaukee, WI, 53201-1881, USA.
| | - Marianne E Weiss
- Marquette University College of Nursing, PO Box 1881, Milwaukee, WI, 53201-1881, USA.
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Wang M, Lv L, Yu Z, Gao L, Lu Q, Ou J, Luo S. A cross-sectional study of readiness for discharge, chronic illness resources and postdischarge outcomes in patients with diabetic foot ulcer. Nurs Open 2021; 8:2645-2654. [PMID: 33730433 PMCID: PMC8363364 DOI: 10.1002/nop2.813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/25/2021] [Accepted: 01/31/2021] [Indexed: 11/30/2022] Open
Abstract
Aim To investigate the correlation of readiness for hospital discharge, the chronic illness resources, and postdischarge outcomes of diabetic foot ulcer patients, which can be help for discharged patient rehabilitation. Design A cross‐sectional study. Methods One hundred and seventy‐nine patients were recruited from the Endocrinology units of two tertiary hospitals between November 2018–September 2019, in Guangdong, China. The methods used were Readiness for Hospital Discharge Scale, The Chronic Illness Resources Survey and one‐on‐one telephone interviews. Results Pearson correlation coefficients indicated moderate correlation between the readiness for discharge and resource availability for chronic illnesses (r = .446, p < .001). Multiple linear regression analysis showed that Chronic Illness Resources Survey, self‐care ability, methods of wound treatments after discharge, and living alone were the main predictors of readiness for hospital discharge among diabetic foot ulcer patients (F = 12.272, p < .001, R2 = .621, Rad2 = .571). The study was limited by location, patient's recall bias and lack of BADL scale, which can be further improved in subsequent studies by developing multi‐centre clinical study and adopting more objective assessment tools.
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Affiliation(s)
- Mingzhu Wang
- Department of Nursing, Nanhai People's Hospital/The Second School of Clinical Medicine, Southern Medical University, Foshan, China.,Department of Endocrinology, Nanhai People's Hospital/The Second School of Clinical Medicine, Southern Medical University, Foshan, China
| | - Lixue Lv
- Department of Endocrinology, Traditional Chinese Medicine of Foshan Hospital, Foshan, China
| | - Zhaohong Yu
- Department of Endocrinology, Traditional Chinese Medicine of Foshan Hospital, Foshan, China
| | - Limei Gao
- Department of Nursing, Nanhai People's Hospital/The Second School of Clinical Medicine, Southern Medical University, Foshan, China
| | - Qiaocong Lu
- Department of Nursing, Nanhai People's Hospital/The Second School of Clinical Medicine, Southern Medical University, Foshan, China
| | - Jiefen Ou
- Department of Nursing, Nanhai People's Hospital/The Second School of Clinical Medicine, Southern Medical University, Foshan, China
| | - Shaozhuang Luo
- Department of Endocrinology, Nanhai People's Hospital/The Second School of Clinical Medicine, Southern Medical University, Foshan, China
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Wong CH, Cheung WK, Zhong CC, Yeoh EK, Hung CT, Yip BH, Wong EL, Wong SY, Chung VC. Effectiveness of nurse-led peri-discharge interventions for reducing 30-day hospital readmissions: Network meta-analysis. Int J Nurs Stud 2021; 117:103904. [PMID: 33691220 DOI: 10.1016/j.ijnurstu.2021.103904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Existing systematic reviews have compared the effectiveness of nurse-led peri-discharge interventions comprising different components with usual care on reducing all-cause 30-day hospital readmissions. However, conflicting results were reported. OBJECTIVE We conducted a network meta-analysis to evaluate the comparative effectiveness of different nurse-led peri-discharge interventions, compared with usual care, for reducing all-cause 30-day hospital readmissions. DESIGN Network meta-analysis. METHODS A total of five international databases were searched for systematic reviews of randomized controlled trials. Additional searches for most updated randomized controlled trials published between 2014 to 2019 were conducted. Data from included randomized controlled trials were extracted for random-effect pairwise meta-analyses. Pooled risk ratios with 95% confidence interval were used to quantify impact of nurse-led peri-discharge interventions on all-cause 30-day hospital readmissions. Network meta-analysis was used to evaluate the comparative effectiveness of different interventions. RESULTS From two systematic reviews and additional randomized controlled trial searches, 12 eligible randomized controlled trials (n=150,840) assessing 15 different nurse-led peri-discharge interventions were included. For reducing all-cause 30-day hospital readmissions, pairwise meta-analysis showed that there was no significant difference between nurse-led peri-discharge interventions and usual care (pooled risk ratios = 0.86, 95% confidence interval: 0.71-1.04, moderate quality of evidence). Network meta-analysis indicated no significant difference across different interventions despite variation in complexity. CONCLUSIONS Our results indicated that nurse-led peri-discharge interventions were not significantly different from usual care for reducing all-cause 30-day hospital readmissions. Simpler nurse-led peri-discharge interventions are on par with more complex interventions in terms of effectiveness. Benefits of nurse-led peri-discharge interventions may vary across health system context. Therefore, careful consideration is required prior to implementation. REGISTRATION DETAILS The protocol for this study has been registered in PROSPERO (Registration No. CRD42020186938). Tweetable abstract: This study suggested that nurse-led peri-discharge interventions do not differ from usual care for reducing all-cause 30-day hospital readmissions.
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Affiliation(s)
- Charlene Hl Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - William Kw Cheung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Claire Cw Zhong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Eng-Kiong Yeoh
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chi Tim Hung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Benjamin Hk Yip
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eliza Ly Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Samuel Ys Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent Ch Chung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong; School of Chinese Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
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Hamadi HY, Martinez D, Palenzuela J, Spaulding AC. Magnet Hospitals and 30-Day Readmission and Mortality Rates for Medicare Beneficiaries. Med Care 2021; 59:6-12. [PMID: 32925454 DOI: 10.1097/mlr.0000000000001427] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND US hospitals are penalized for excess 30-day readmissions and mortality for select conditions. Under the Centers for Medicare and Medicaid Services policy, readmission prevention is incentivized to a greater extent than mortality reduction. A strategy to potentially improve hospital performance on either measure is by improving nursing care, as nurses provide the largest amount of direct patient care. However, little is known as to whether achieving nursing excellence, such as Magnet status, is associated with improved hospital performance on readmissions and mortality. OBJECTIVE The purpose of this study was to examine the relationship between hospitals' Magnet status and performance on readmission and mortality rates for Medicare beneficiaries. RESEARCH DESIGN This is a cross-sectional analysis of Medicare readmissions and mortality reduction programs from 2013 to 2016. A propensity score-matching approach was used to take into account differences in baseline characteristics when comparing Magnet and non-Magnet hospitals. SUBJECTS The sample was comprised of 3877 hospitals. MEASURES The outcome measures were 30-day risk-standardized readmission and mortality rates. RESULTS Following propensity score matching on hospital characteristics, we found that Magnet hospitals outperformed non-Magnet hospitals in reducing mortality; however, Magnet hospitals performed worse in reducing readmissions for acute myocardial infarction, coronary artery bypass grafting, and stroke. CONCLUSIONS Magnet hospitals performed better on the Hospital Value-Based Purchasing Mortality Program than the Hospital Readmissions Reduction Program. The results of this study suggest the need for The Magnet Recognition Program to examine the role of nurses in postdischarge activities as a component of its evaluation criteria.
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Affiliation(s)
- Hanadi Y Hamadi
- Department of Health Administration, Brooks College of Health, University of North Florida
| | - Dayana Martinez
- Department of Health Administration, Brooks College of Health, University of North Florida
| | - Julia Palenzuela
- Department of Health Administration, Brooks College of Health, University of North Florida
| | - Aaron C Spaulding
- Department of Health Sciences Research, Division of Health Care Policy and Research, Mayo Clinic Robert D. and Patricia E. Kern, Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, FL
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Costa LL, Bobay K, Hughes R, Bahr SJ, Siclovan D, Nuccio S, Weiss M. Using the consolidated framework for implementation research to evaluate clinical trials: An example from multisite nursing research. Nurs Outlook 2020; 68:769-783. [DOI: 10.1016/j.outlook.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/28/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
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Bobay KL, Conway-Phillips R, Hughes RG, Costa L, Bahr SJ, Siclovan D, Nuccio S, Weiss M. Clinical nurses' perspectives on discharge practice changes from participating in a translational research study. J Nurs Manag 2020; 29:553-561. [PMID: 33025695 DOI: 10.1111/jonm.13171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/23/2020] [Accepted: 09/30/2020] [Indexed: 12/01/2022]
Abstract
AIM To describe clinical nurses' experiences with practice change associated with participation in a multi-site nursing translational research study implementing new protocols for hospital discharge readiness assessment. BACKGROUND Nurses' participation in translational research studies provides an opportunity to evaluate how implementation of new nursing interventions affects care processes within a local context. These insights can provide information that leads to successful adoption and sustainability of the intervention. METHODS Semi-structured focus groups from 30 of 33 participating study hospitals lead by team nurse researchers. RESULTS Nurses reported improved and earlier awareness of patients' discharge needs, changes in discharge practices, greater patient/family involvement in discharge, synergy and enhanced discharge processes, and implementation challenges. Participating nurses related the benefits of participation in nursing research. CONCLUSION Participation in a unit-level translational research project was a successful strategy for engaging nurses in practice change to improve hospital discharge. IMPLICATIONS FOR NURSING MANAGEMENT Leading unit-based implementation of a structured discharge readiness assessment including nurse assessment and patient self-assessment encourages earlier awareness of patients' discharge needs, improved patient assessment and greater patient/family involvement in discharge preparation. Integrating discharge readiness assessments into existing discharge care promotes communication between health team members that facilitates a timely, coordinated discharge.
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Affiliation(s)
- Kathleen L Bobay
- Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | | | - Ronda G Hughes
- Center for Nursing Leadership, University of South Carolina College of Nursing, Columbia, SC, USA
| | - Linda Costa
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Sarah J Bahr
- Marquette University College of Nursing, Milwaukee, WI, USA
| | - Danielle Siclovan
- Risk Management Services, Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Susan Nuccio
- Marquette University College of Nursing, Milwaukee, WI, USA
| | - Marianne Weiss
- Marquette University College of Nursing, Milwaukee, WI, USA
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Naseri C, McPhail SM, Haines TP, Morris ME, Shorr R, Etherton-Beer C, Netto J, Flicker L, Bulsara M, Lee DCA, Francis-Coad J, Waldron N, Boudville A, Hill AM. Perspectives of older adults regarding barriers and enablers to engaging in fall prevention activities after hospital discharge. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1710-1722. [PMID: 32337796 PMCID: PMC7513672 DOI: 10.1111/hsc.12996] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/04/2020] [Accepted: 03/18/2020] [Indexed: 05/05/2023]
Abstract
Older adults recently discharged from hospital are at high risk of functional decline and falls. A tailored fall prevention education provided at hospital discharge aimed to improve the capacity of older adults to engage in falls prevention activities. What remains unknown are the factors affecting behaviour change after hospital discharge. This study identified the perceived barriers and enablers of older adults to engagement in fall prevention activities during the 6-month period post-discharge. An exploratory approach using interpretative phenomenological analysis focused on the lived experience of a purposive sample (n = 30) of participants. All were recruited as a part of an RCT (n = 390) that delivered a tailored fall prevention education program at three hospital rehabilitation wards in Perth, Australia. Data were collected at 6-month post-discharge using semi-structured telephone surveys. Personal stories confirmed that some older adults have difficulty recovering functional ability after hospital discharge. Reduced physical capability, such as experiences of fatigue, chronic pain and feeling unsteady when walking were barriers for participants to safely return to their normal daily activities. Participants who received the tailored fall education program reported positive effects on knowledge and motivation to engage in fall prevention. Participants who had opportunities to access therapy or social supports described more positive experiences of recovery compared to individuals who persevered without assistance. A lack of physical and social support was associated with apprehension and fear toward adverse events such as falls, injuries, and hospital readmission. The lived experience of participants following hospital discharge strongly suggested that they required more supports from both healthcare professionals and caregivers to ensure that their needs were met. Further research that evaluates how to assist this population to engage in programs that will mitigate the high risk of falls and hospital readmissions is required.
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Affiliation(s)
- Chiara Naseri
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, WA, Australia
| | - Steven M. McPhail
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, QLD, Australia
| | - Terry P. Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, VC, Australia
| | - Meg E. Morris
- Healthscope & La Trobe Centre for Sport & Exercise Medicine Research, La Trobe University, Melbourne, VC, Australia
| | - Ronald Shorr
- Malcom Randall VA Medical Center, Geriatric Research Education and Clinical Center (GRECC), Gainesville, FL, USA
- College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christopher Etherton-Beer
- Western Australian Centre for Health & Ageing, University of Western Australia, Royal Perth Hospital Unit, Perth, WA, Australia
| | - Julie Netto
- School of Occupational Therapy and Social Work, Faculty of Health Science, Curtin University, Perth, WA, Australia
| | - Leon Flicker
- Western Australian Centre for Health & Ageing, Centre for Medical Research, University of Western Australia, Perth, WA, Australia
| | - Max Bulsara
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Den-Ching A. Lee
- School of Primary and Allied Health Care, Monash University, Melbourne, VC, Australia
| | - Jacqueline Francis-Coad
- School of Physiotherapy, Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Nicholas Waldron
- Department of Geriatric Rehabilitation, Department of Health, Armadale Health Service, Perth, WA, Australia
| | - Amanda Boudville
- Department of Aged Care and Rehabilitation, St John of God Health Care, Midland, WA, Australia
| | - Anne-Marie Hill
- School of Physiotherapy and Exercise Sciences, Faculty of Health Science, Curtin University, Perth, WA, Australia
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Meng N, Liu R, Wong M, Liao J, Feng C, Li X. The association between patient-reported readiness for hospital discharge and outcomes in patients diagnosed with anxiety disorders: A prospective and observational study. J Psychiatr Ment Health Nurs 2020; 27:380-392. [PMID: 31943521 DOI: 10.1111/jpm.12592] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 02/05/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Readiness for hospital discharge (RHD) has been an important topic for nurses. RHD can be measured by the Readiness for Hospital Discharge Scale (RHDS), including 4 subscales: personal status, knowledge, coping ability and expected support. There are few studies that focus on RHD in patients diagnosed with mental disorders. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Improving patient-reported RHD can decrease the risks of unscheduled post-discharge clinic visits, readmission and poor quality of life (QOL) in patients diagnosed with anxiety disorders. Improving patient-reported personal status can decrease the risk of poor QOL in patients diagnosed with anxiety disorders. Improving patient-reported knowledge can decrease the risks of unscheduled post-discharge clinic visits and readmission in patients diagnosed with anxiety disorders. Improving patient-reported expected support can decrease the risk of unscheduled post-discharge clinic visits in patients diagnosed with anxiety disorders. Improving the methods of discharge teaching and anxiety severity can enhance RHD in patients diagnosed with anxiety disorders. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses could enhance patient-reported RHD to reduce unscheduled post-discharge medical resource utilization or improve QOL by facilitating knowledge acquisition and skill development and improving social support systems. Nurse managers could add RHD assessment to patients' discharge process and train nurses in the methods of discharge education. Nurses could advance their methods of discharge education, such as listening to and answering patients' questions, choosing a convenient time and engaging in online education. ABSTRACT: Introduction The association between readiness for hospital discharge (RHD) and post-discharge outcomes remains unclear in individuals with anxiety disorders. Aim To explore the factors of RHD and the effect of patient-reported RHD on post-discharge outcomes. Method In the observational study, 373 patients diagnosed with anxiety disorders completed the self-administered Readiness for Hospital Discharge Scale (RHDS) on discharge. After 30 days, phone interviews were conducted to collect data on post-discharge outcomes, including self-reported unscheduled medical service utilization, symptom severity and quality of life (QOL). Multiple logistic regression models were built to explore the relationships among sociodemographic characteristics, the RHDS and its subscales, and post-discharge outcomes. Results The unscheduled clinic visits were significantly associated with low RHD, knowledge and expected support. Readmission was significantly associated with low RHD and knowledge. Poor QOL was significantly associated with low RHD and personal status. Delivery, received content and anxiety severity were the predictors of RHD. Discussion Improved RHD is associated with fewer unscheduled clinic visits and readmissions and better QOL. Enhancing discharge education can improve RHD. Implications for practice Nurses should enhance patient-reported RHD to improve post-discharge outcomes by advancing the quality of discharge education in patients diagnosed with anxiety disorders.
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Affiliation(s)
- Na Meng
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Ruian Liu
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Mengmeng Wong
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Jingping Liao
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Chi Feng
- Department of Rehabilitation Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiaolin Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
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Sessine MS, Weizer A, Kirk PS, Borza T, Jacobs BL, Qin Y, Oerline M, Li B, Modi PK, Lavieri MS, Gilbert SM, Montgomery JS, Hollenbeck BK, Urish K, Helm JE, Skolarus TA. Reframing Financial Incentives Around Reducing Readmission After Radical Cystectomy. Urology 2020; 142:99-105. [PMID: 32413517 DOI: 10.1016/j.urology.2020.03.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/29/2020] [Accepted: 03/29/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To better understand the financial implications of readmission after radical cystectomy, an expensive surgery coupled with a high readmission rate. Currently, whether hospitals benefit financially from readmissions after radical cystectomy remains unclear, and potentially obscures incentives to invest in readmission reduction efforts. MATERIALS AND METHODS Using a 20% sample of national Medicare beneficiaries, we identified 3544 patients undergoing radical cystectomy from January 2010 to November 2014. We compared price-standardized Medicare payments for index admissions and readmissions after surgery. We also examined the variable financial impact of length of stay and the proportion of Medicare payments coming from readmissions based on overall readmission rate. RESULTS Medicare patients readmitted after cystectomy had higher index hospitalization payments ($19,164 readmitted vs $18,146 non-readmitted, P = .03) and an average readmission payment of $7356. Adjusted average Medicare readmission payments and length of stay varied significantly across hospitals, ranging from $2854 to $15,605, and 2.0 to 17.1 days, respectively (both P <.01), with longer length of stay associated with increased payments. After hospitals were divided into quartiles based on overall readmission rates, the percent of payments coming from readmissions ranged from 5% to 13%. CONCLUSION Readmissions following radical cystectomy were associated with increased Medicare payments for the index hospitalization, and the readmission payment, potentially limiting incentives for readmission reduction programs. Our findings highlight opportunities to reframe efforts to support patients, caregivers, and providers through improving the discharge and readmission processes to create a patient-centered experience, rather than for fear of financial penalties.
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Affiliation(s)
- Michael S Sessine
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Alon Weizer
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Peter S Kirk
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Tudor Borza
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Urology, William S. Middleton Memorial Veterans Hospital, Madison, WI
| | - Bruce L Jacobs
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Yongmei Qin
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Mary Oerline
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Benjamin Li
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Parth K Modi
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Mariel S Lavieri
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI
| | - Scott M Gilbert
- Department of Urology, H. Lee Moffitt Cancer Center, Tampa, FL
| | - Jeffrey S Montgomery
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Ken Urish
- Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jonathan E Helm
- Department of Operations and Decision Technologies, Kelley School of Business, Indiana University, Bloomington, IN
| | - Ted A Skolarus
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI; VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
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Individual Nurse Productivity in Preparing Patients for Discharge Is Associated With Patient Likelihood of 30-Day Return to Hospital. Med Care 2020; 57:688-694. [PMID: 31335757 PMCID: PMC6693983 DOI: 10.1097/mlr.0000000000001170] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Supplemental Digital Content is available in the text. Objective: Applied to value-based health care, the economic term “individual productivity” refers to the quality of an outcome attributable through a care process to an individual clinician. This study aimed to (1) estimate and describe the discharge preparation productivities of individual acute care nurses and (2) examine the association between the discharge preparation productivity of the discharging nurse and the patient’s likelihood of a 30-day return to hospital [readmission and emergency department (ED) visits]. Research Design: Secondary analysis of patient-nurse data from a cluster-randomized multisite study of patient discharge readiness and readmission. Patients reported discharge readiness scores; postdischarge outcomes and other variables were extracted from electronic health records. Using the structure-process-outcomes model, we viewed patient readiness for hospital discharge as a proximal outcome of the discharge preparation process and used it to measure nurse productivity in discharge preparation. We viewed hospital return as a distal outcome sensitive to discharge preparation care. Multilevel regression analyses used a split-sample approach and adjusted for patient characteristics. Subjects: A total 522 nurses and 29,986 adult (18+ y) patients discharged to home from 31 geographically diverse medical-surgical units between June 15, 2015 and November 30, 2016. Measures: Patient discharge readiness was measured using the 8-item short form of Readiness for Hospital Discharge Scale (RHDS). A 30-day hospital return was a categorical variable for an inpatient readmission or an ED visit, versus no hospital return. Results: Variability in individual nurse productivity explained 9.07% of variance in patient discharge readiness scores. Nurse productivity was negatively associated with the likelihood of a readmission (−0.48 absolute percentage points, P<0.001) and an ED visit (−0.29 absolute percentage points, P=0.042). Conclusions: Variability in individual clinician productivity can have implications for acute care quality patient outcomes.
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Hodgins MJ, Filiatreault S, Keeping‐Burke L, Logan SM. Patterns of patient coping following hospital discharge from medical and surgical units: A pilot study. Nurs Health Sci 2019; 22:118-125. [DOI: 10.1111/nhs.12658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 08/26/2019] [Accepted: 09/18/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Marilyn J. Hodgins
- Faculty of NursingUniversity of New Brunswick (UNB) Fredericton Fredericton Canada
| | - Sarah Filiatreault
- Faculty of NursingUniversity of New Brunswick (UNB) Fredericton Fredericton Canada
| | - Lisa Keeping‐Burke
- Department of Nursing & Health SciencesUniversity of New Brunswick Saint John Saint John Canada
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Ryan P, Weiss M, Papanek P. A Substruction Approach to Assessing the Theoretical Validity of Measures. J Nurs Meas 2019; 27:126-145. [PMID: 31068496 DOI: 10.1891/1061-3749.27.1.126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Validity is about the logic, meaningfulness, and evidence used to defend inferences made when interpreting results. Substruction is a heuristic or process that visually represent the hierarchical structure between theory and measures. PURPOSE To describe substruction as a method for assessing the toretical validity of research measures. METHODS Using Fawcett's Conceptual-Theoretical-Empirical Structure. an exemplar is presented of substruction from the Individual and Family Self-Management Theory to the Striving to be strong study concepts and empirical measures. RESULTS Substruction tables display evidence supporting theoretical validity of the instruments used in the study. CONCLUSION A high degree of congruence between theory and measure is critical to support the validity of the theory and to support attributions made about moderating, mediating, causal relationships, and intervention effects.
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Affiliation(s)
- Polly Ryan
- University of Wisconsin, Madison, School of Nursing, WI
| | | | - Paula Papanek
- Marquette University, College of Health Science, Milwaukee, WI
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