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Luo SA, Dahri K, Kwok J, Inglis C, Hong J, Legal M. What Patients Want: A Qualitative Study of Patients' Perspectives on Optimizing the Hospital Discharge Process. Can J Hosp Pharm 2024; 77:e3545. [PMID: 38720916 PMCID: PMC11060789 DOI: 10.4212/cjhp.3545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/05/2023] [Indexed: 05/12/2024]
Abstract
Background Poor discharge planning can lead to increases in adverse drug events, hospital readmissions, and costs. Prior research has identified the pharmacist as an integral part of the discharge process. Objectives To gain patients' perspectives on the discharge process and what they would like pharmacists to do to ensure a successful discharge. Methods Twenty patients discharged from tertiary care hospitals were interviewed after discharge. A phenomenological approach was used to conduct this qualitative study. Results Five main themes were identified from the patient interviews: interactions with health care professionals, importance of discharge documentation, importance of seamless care, comprehensive and patient-specific medication counselling, and patients' preference for involvement and communication at all stages of hospital stay. Conclusions Although participants generally reported positive interactions with health care providers at discharge, several areas for improvement were identified, particularly in terms of communication, discharge documentation, and continuity of care. A list of recommendations aligning with patient preferences is provided for clinicians.
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Affiliation(s)
- Shun Angel Luo
- , BScPharm, ACPR, is with Lower Mainland Pharmacy Services, Coquitlam, British Columbia
| | - Karen Dahri
- , BSc, BScPharm, PharmD, ACPR, FCSHP, is with the Faculty of Pharmaceutical Sciences, The University of British Columbia, and Lower Mainland Pharmacy Services, Vancouver, British Columbia
| | - Jacqueline Kwok
- , PharmD, ACPR, is with Lower Mainland Pharmacy Services, Vancouver, British Columbia
| | - Colleen Inglis
- , BSc, BScPharm, PharmD, is with Pharmacy Services, Island Health Authority, Courtenay, British Columbia, and the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Jenny Hong
- , BScPharm, PharmD, ACPR, is with Lower Mainland Pharmacy Services and the Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia
| | - Michael Legal
- , BScPharm, PharmD, ACPR, FCSHP, is with Lower Mainland Pharmacy Services, Vancouver, British Columbia
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Peter S, Oberröhrmann C, Pfaff H, Lehmann C, Schmidt-Hellerau K, Brandes V, Leisse C, Lindemann CH, Ihle P, Küpper-Nybelen J, Hagemeier A, Scholten N. Exploring patients' perspectives: a mixed methods study on Outpatient Parenteral Antimicrobial Therapy (OPAT) experiences. BMC Health Serv Res 2024; 24:544. [PMID: 38685017 PMCID: PMC11057129 DOI: 10.1186/s12913-024-11017-9] [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: 02/20/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Outpatient Parenteral Antimicrobial Therapy (OPAT), an alternative to inpatient intravenous antibiotic therapy, has shown benefits in international studies such as increased patient satisfaction. Because OPAT has been used only sporadically in Germany so far, no structured results on patients' experiences and concerns regarding OPAT have yet been available. This study therefore aims to explore the experiences of OPAT patients in a pilot region in Germany. METHODS This is an observational study in a German pilot region, including a survey of 58 patients on their experiences with OPAT, and in-depth interviews with 12 patients (explanatory-sequential mixed-methods design). RESULTS Patients reported that they were satisfied with OPAT. That a hospital discharge was possible and anti-infective therapy could be continued in the home environment was rated as being particularly positive. In the beginning, many patients in the interviews were unsure about being able to administer the antibiotic therapy at home on their own. However, healthcare providers (doctors and pharmacy service provider staff) were able to allay these concerns. Patients appreciated regular contact with care providers. There were suggestions for improvement, particularly concerning the organization of the weekly check-up appointments and the provision of information about OPAT. CONCLUSIONS Patients were generally satisfied with OPAT. However, the treatment structures in Germany still need to be expanded to ensure comprehensive and high-quality OPAT care. TRIAL REGISTRATION NCT04002453, https://www. CLINICALTRIALS gov/ , (registration date: 2019-06-21).
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Affiliation(s)
- Sophie Peter
- Chair of General Practice II and Patient-Centredness in Primary Care, Institute of General Practice and Primary Care, Faculty of Health, Witten/Herdecke University, Witten, Germany.
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany.
| | - Charlotte Oberröhrmann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
| | - Holger Pfaff
- University of Cologne, Faculty of Human Sciences and Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science Cologne, Cologne, Germany
- Center for Health Services Research Cologne, Cologne, Germany
| | - Clara Lehmann
- Department I of Internal Medicine, Medical Faculty, University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Bonn-Cologne, Germany
| | - Kirsten Schmidt-Hellerau
- Department I of Internal Medicine, Medical Faculty, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Vanessa Brandes
- Department I of Internal Medicine, Medical Faculty, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Charlotte Leisse
- Department I of Internal Medicine, Medical Faculty, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christoph Heinrich Lindemann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne (CMMC),, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Peter Ihle
- PMV forschungsgruppe, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jutta Küpper-Nybelen
- PMV forschungsgruppe, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Anna Hagemeier
- Institute of Medical Statistics and Computational Biology (IMSB), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nadine Scholten
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, Cologne, Germany
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Brown CL, Tittlemier BJ, Tiwari KK, Loewen H. Interprofessional Teams Supporting Care Transitions from Hospital to Community: A Scoping Review. Int J Integr Care 2024; 24:1. [PMID: 38618048 PMCID: PMC11012160 DOI: 10.5334/ijic.7623] [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: 03/30/2023] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Poor outcomes following the transition from hospital back to community living are common, especially for older adults with complex health and social care needs. Some health care systems now have multiple interprofessional teams (in hospital and community) to support care transitions. These teams will need to be well coordinated to improve care transition outcomes. Methods We conducted a scoping review to identify and map peer-reviewed literature on how interprofessional teams are working together to support older adults transitioning from hospital back to the community. We used the six-stage framework developed by Levac and colleagues (2010). Procedures were guided by the Joanna Briggs Institute scoping review guidelines. Results Our structured search and screening process resulted in 70 articles, published between 2000 and 2022, from 14 counties. Within these articles, 26 programs were described that used interprofessional teams in both the hospital and community. Discussion The qualitative articles suggested that effective teamwork is very important for promoting care transition quality, but the quantitative research did not report on team-related outcomes. Quantitative research has described, but not evaluated, strategies for promoting interprofessional collaboration. Conclusion Future research should focus on evaluating processes used to promote effective interprofessional teamwork in care transition interventions.
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Affiliation(s)
- Cara L. Brown
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | | | | | - Hal Loewen
- Health Sciences Librarian, Neil John Maclean Health Science Library, Winnipeg, MB, Canada
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Strumann C, Pfau L, Wahle L, Schreiber R, Steinhäuser J. Designing and Implementation of a Digitalized Intersectoral Discharge Management System and Its Effect on Readmissions: Mixed Methods Approach. J Med Internet Res 2024; 26:e47133. [PMID: 38530343 PMCID: PMC11005442 DOI: 10.2196/47133] [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: 03/09/2023] [Revised: 06/13/2023] [Accepted: 01/31/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Digital transformation offers new opportunities to improve the exchange of information between different health care providers, including inpatient, outpatient and care facilities. As information is especially at risk of being lost when a patient is discharged from a hospital, digital transformation offers great opportunities to improve intersectoral discharge management. However, most strategies for improvement have focused on structures within the hospital. OBJECTIVE This study aims to evaluate the implementation of a digitalized discharge management system, the project "Optimizing instersectoral discharge management" (SEKMA, derived from the German Sektorübergreifende Optimierung des Entlassmanagements), and its impact on the readmission rate. METHODS A mixed methods design was used to evaluate the implementation of a digitalized discharge management system and its impact on the readmission rate. After the implementation, the congruence between the planned (logic model) and the actual intervention was evaluated using a fidelity analysis. Finally, bivariate and multivariate analyses were used to evaluate the effectiveness of the implementation on the readmission rate. For this purpose, a difference-in-difference approach was adopted based on routine data of hospital admissions between April 2019 and August 2019 and between April 2022 and August 2022. The department of vascular surgery served as the intervention group, in which the optimized discharge management was implemented in April 2022. The departments of internal medicine and cardiology formed the control group. RESULTS Overall, 26 interviews were conducted, and we explored 21 determinants, which can be categorized into 3 groups: "optimization potential," "barriers," and "enablers." On the basis of these results, 19 strategies were developed to address the determinants, including a lack of networking among health care providers, digital information transmission, and user-unfriendliness. On the basis of these strategies, which were prioritized by 11 hospital physicians, a logic model was formulated. Of the 19 strategies, 7 (37%; eg, electronic discharge letter, providing mobile devices to the hospital's social service, and generating individual medication plans in the format of the national medication plan) have been implemented in SEKMA. A survey on the fidelity of the application of the implemented strategies showed that 3 of these strategies were not yet widely applied. No significant effect of SEKMA on readmissions was observed in the routine data of 14,854 hospital admissions (P=.20). CONCLUSIONS This study demonstrates the potential of optimizing intersectoral collaboration for patient care. Although a significant effect of SEKMA on readmissions has not yet been observed, creating a digital ecosystem that connects different health care providers seems to be a promising approach to ensure secure and fast networking of the sectors. The described intersectoral optimization of discharge management provides a structured template for the implementation of a similar local digital care networking infrastructure in other care regions in Germany and other countries with a similarly fragmented health care system.
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Affiliation(s)
- Christoph Strumann
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Lisa Pfau
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Laila Wahle
- Lacanja GmbH Health Innovation Port, Hamburg, Germany
| | - Raphael Schreiber
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Medical Centre Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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Ingram L, Pitt R, Shrubsole K. Health professionals' practices and perspectives of post-stroke coordinated discharge planning: a national survey. BRAIN IMPAIR 2024; 25:IB23092. [PMID: 38566295 DOI: 10.1071/ib23092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/08/2024] [Indexed: 04/04/2024]
Abstract
Background It is best practice for stroke services to coordinate discharge care plans with primary/community care providers to ensure continuity of care. This study aimed to describe health professionals' practices in stroke discharge planning within Australia and the factors influencing whether discharge planning is coordinated between hospital and primary/community care providers. Methods A mixed-methods survey informed by the Theoretical Domains Framework was distributed nationally to stroke health professionals regarding post-stroke discharge planning practices and factors influencing coordinated discharge planning (CDP). Data were analysed using descriptive statistics and content analysis. Results Data from 42 participants working in hospital-based services were analysed. Participants reported that post-stroke CDP did not consistently occur across care providers. Three themes relating to perceived CDP needs were identified: (1) a need to improve coordination between care providers, (2) service-specific management of the discharge process, and (3) addressing the needs of the stroke survivor and family . The main perceived barriers were the socio-political context and health professionals' beliefs about capabilities . The main perceived facilitators were health professionals' social/professional role and identity, knowledge, and intentions . The organisation domain was perceived as both a barrier and facilitator to CDP. Conclusion Australian health professionals working in hospital-based services believe that CDP promotes optimal outcomes for stroke survivors, but experience implementation challenges. Efforts made by organisations to ensure workplace culture and resources support the CDP process through policies and procedures may improve practice. Tailored implementation strategies need to be designed and tested to address identified barriers.
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Affiliation(s)
- Lara Ingram
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Rachelle Pitt
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; and Office of the Chief Allied Health Officer, Queensland Health, Qld, Australia
| | - Kirstine Shrubsole
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia; and Queensland Aphasia Research Centre, The University of Queensland, Herston, Australia; and Speech Pathology Department, Princess Alexandra Hospital, Metro South Health, Brisbane, Qld, Australia; and Centre for Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Bundoora, Vic., Australia
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Abel B, Bongartz M, Rapp K, Roigk P, Peiter J, Metz B, Finger B, Büchele G, Wensing M, Roth C, Schmidberger O, König HH, Gottschalk S, Dams J, Deuster O, Immel D, Micol W, Bauer JM, Benzinger P. Multimodal home-based rehabilitation intervention after discharge from inpatient geriatric rehabilitation (GeRas): study protocol for a multicenter randomized controlled trial. BMC Geriatr 2024; 24:69. [PMID: 38233746 PMCID: PMC10795216 DOI: 10.1186/s12877-023-04634-2] [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: 08/07/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Geriatric rehabilitation aims to maintain the functional reserves of older adults in order to optimize social participation and prevent disability. After discharge from inpatient geriatric rehabilitation, patients are at high risk for decreased physical capacity, increased vulnerability, and limitations in mobility. As a result, ageing in place becomes uncertain for a plethora of patients after discharge from geriatric rehabilitation and effective strategies to prevent physical decline are required. Collaboration between different health-care providers is essential to improve continuity of care after discharge from inpatient geriatric rehabilitation. The aim of this study is to evaluate the effectiveness of a multi-professional home-based intervention program (GeRas) to improve functional capacity and social participation in older persons after discharge from inpatient geriatric rehabilitation. METHODS The study is a multicenter, three-arm, randomized controlled trial with a three-month intervention period. Two hundred and seventy community-dwelling older people receiving inpatient geriatric rehabilitation will be randomized with a 1:1:1 ratio to one of the parallel intervention groups (conventional IG or tablet IG) or the control group (CG). The participants of both IGs will receive a home-based physical exercise program supervised by physical therapists, a nutritional recommendation by a physician, and social counseling by social workers of the health insurance company. The collaboration between the health-care providers and management of participants will be realized within a cloud environment based on a telemedicine platform and supported by multi-professional case conferences. The CG will receive usual care, two short handouts on general health-related topics, and facultative lifestyle counseling with general recommendations for a healthy diet and active ageing. The primary outcomes will be the physical capacity measured by the Short Physical Performance Battery and social participation assessed by the modified Reintegration to Normal Living Index, three months after discharge. DISCUSSION The GeRas program is designed to improve the collaboration between health-care providers in the transition from inpatient geriatric rehabilitation to outpatient settings. Compared to usual care, it is expected to improve physical capacity and participation in geriatric patients after discharge from inpatient geriatric rehabilitation. TRIAL REGISTRATION German Clinical Trials Register (DRKS00029559). Registered on October 05, 2022.
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Grants
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- 01NVF20017 German Innovation Fund ('New Forms of Care') coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- German Innovation Fund (‘New Forms of Care’) coordinated by the Innovation Committee of the Federal Joint Committee, Berlin, Germany
- Universitätsklinikum Heidelberg (8914)
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Affiliation(s)
- Bastian Abel
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Martin Bongartz
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Patrick Roigk
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Janine Peiter
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Brigitte Metz
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Benjamin Finger
- Department of Telemedicine, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Gisela Büchele
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Oliver Schmidberger
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sophie Gottschalk
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Dams
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Oliver Deuster
- Interdisciplinary Center for Clinical Trials (IZKS) at the University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Désirée Immel
- AOK Baden-Württemberg, Statutory Health Insurance Company, Stuttgart, Germany
| | - William Micol
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen M Bauer
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany
| | - Petra Benzinger
- Center for Geriatric Medicine, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Heidelberg, Germany.
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Tarsney PS, Kondrat A, Watters K, Kirschner KL, Mukherjee D. Ethical aspects of the disfavored discharge. PM R 2024; 16:92-101. [PMID: 37846433 DOI: 10.1002/pmrj.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Preya S Tarsney
- Donnelley Ethics Program at the Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Andy Kondrat
- Clinical Ethicist, Center for Healthcare Ethics, Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Kelsey Watters
- Occupational Therapist and Clinical Practice Leader for Occupational Therapy, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - Kristi L Kirschner
- Departments of Medical Education, Neurology & Rehabilitation, and Academic Internal Medicine, and the Director of Undergraduate Education, University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Debjani Mukherjee
- Medical Ethics in Clinical Medicine and Clinical Rehabilitation Medicine, Weill Cornell Medicine and Senior Clinical Ethicist, New York Presbyterian Weill Cornell Medical Center, New York, New York, USA
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de Groot AJ, Wattel EM, van Balen R, Hertogh CM, van der Wouden JC. Association of Vulnerability Screening on Hospital Admission with Discharge to Rehabilitation-Oriented Care after Acute Hospital Stay. Ann Geriatr Med Res 2023; 27:301-309. [PMID: 37691483 PMCID: PMC10772331 DOI: 10.4235/agmr.23.0068] [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: 05/13/2023] [Revised: 08/18/2023] [Accepted: 09/03/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND We assessed the vulnerability of patients aged ≥70 years during hospital admission based on the Short Dutch Safety Management Screening (DSMS). Screening of four geriatric domains aims to prevent adverse outcomes and may support targeted discharge planning for post-acute care. We explored whether the DSMS criteria for acutely admitted patients were associated with rehabilitation-oriented care needs. METHODS This retrospective cohort study included community-dwelling patients aged ≥70 years acutely admitted to a tertiary hospital. We recorded patient demographics, morbidity, functional status, malnutrition, fall risk, and delirium and used descriptive analysis to calculate the risks by comparing the discharge destination groups. RESULTS Among 491 hospital discharges, 349 patients (71.1%) returned home, 60 (12.2%) were referred for geriatric rehabilitation, and 82 (16.7%) to other inpatient post-acute care. Non-home referrals increased with age from 21% (70-80 years) to 61% (>90 years). A surgical diagnosis (odds ratio [OR]=4.92; 95% confidence interval [CI], 2.03-11.95), functional decline represented by Katz-activities of daily living positive screening (OR=3.79; 95% CI, 1.76-8.14), and positive fall risk (OR=2.87; 95% CI, 1.31-6.30) were associated with non-home discharge. The Charlson Comorbidity Index did not differ significantly between the groups. CONCLUSION Admission diagnosis and vulnerability screening outcomes were associated with discharge to rehabilitation-oriented care in patients >70 years of age. The usual care data from DSMS vulnerability screening can raise awareness of discharge complexity and provide opportunities to support timely and personalized transitional care.
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Affiliation(s)
- Aafke J. de Groot
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Elizabeth M. Wattel
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Romke van Balen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - Cees M.P.M. Hertogh
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Johannes C. van der Wouden
- Department of Medicine for Older People, Amsterdam University Medical Center, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later Life, Amsterdam Public Health, Amsterdam, The Netherlands
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9
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Liu S, Xiong XY, Chen H, Liu MD, Wang Y, Yang Y, Zhang MJ, Xiang Q. Transitional Care in Patients with Heart Failure: A Concept Analysis Using Rogers' Evolutionary Approach. Risk Manag Healthc Policy 2023; 16:2063-2076. [PMID: 37822727 PMCID: PMC10563773 DOI: 10.2147/rmhp.s427495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
Objective The purpose of this study was to clarify the concept of transitional care in patients with heart failure. Background Transitional care is increasingly being applied in patients with heart failure, but the concept of transitional care in heart failure patients is not uniform and confused with other definitions, which limits further research and practice on transitional care for these patients. Design Rodgers' evolutionary concept analysis. Methods A comprehensive literature search was conducted using the PUBMED, EMBASE, EBSCO, Chinese Biological Medicine (CBM), CNKI, and WANFANG databases (up to January 26, 2023). We used Rodgers' evolutionary concept analysis method to identify related concepts, attributes, antecedents, and consequences of transitional care in patients with heart failure. Results A total of 33 articles were included. The following attributes belonging to transitional care in patients with heart failure were extracted from the literature: self-care, multidisciplinary collaboration, and information transmission. The antecedents were patients' health status, the health literacy of patients and caregivers, the role functions of the main implementer and social and medical resources. Consequences were separated into two categories: patient-centered health outcomes (all-cause mortality, health-related quality of life, discharge preparedness, self-care behaviors, satisfaction of patients) and healthcare utilization outcomes (hospital readmission, length of hospital stay, emergency department visits). Conclusion This study found that transitional care in heart failure patients is a systemic care process during a vulnerable period that improves patient self-management and coordination between hospital resources and social support systems for continuous management to promote smooth patient transitions between different locations. This concept analysis will inform healthcare providers in designing evidence-based interventions and quality improvement strategies to ensure that transition processes lead to desired outcomes. In addition, this study will also be helpful for developing specific assessment tools to identify patients with HF who need transitional care.
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Affiliation(s)
- Si Liu
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
- Nursing Department, the Second Affiliated Hospital of Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Xiao-yun Xiong
- Nursing Department, the Second Affiliated Hospital of Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Hua Chen
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Meng-die Liu
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Ying Wang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Ying Yang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Mei-jun Zhang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
| | - Qin Xiang
- School of Nursing, Nan Chang University, Nan Chang, Jiang Xi, People’s Republic of China
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10
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Evangelista A, Camussi E, Corezzi M, Gilardetti M, Fonte G, Scarmozzino A, La Valle G, Angelone L, Olivero E, Ciccone G, Corsi D. Routine vs. On-Demand Discharge Planning Strategy in Intermediate-Risk Patients for Complex Discharge: a Cluster-Randomized, Multiple Crossover Trial. J Gen Intern Med 2023; 38:2749-2754. [PMID: 37170018 PMCID: PMC10506972 DOI: 10.1007/s11606-023-08186-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/22/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Early hospital discharge planning can help to reduce the length of stay and unplanned readmission in high-risk patients. Therefore, it is important to select patients who can benefit from a personalized discharge planning based on validated tools. The modified Blaylock Risk Assessment Screening Score (BRASS) is routinely used in the Molinette Hospital (Turin, Italy) to screen patients at high risk for discharge, but the effectiveness of the discharge planning is uncertain in intermediate-risk patients. OBJECTIVE To evaluate the best strategy for discharge planning by the Continuity of Care Hospital Unit (CCHU) in intermediate-risk patients according to modified BRASS. DESIGN Cluster-randomized, multiple crossover trial. PARTICIPANTS Adult patients admitted in the Medicine and Neurology departments of the Molinette Hospital in Turin, Italy, between June 2018 and May 2019 with a BRASS intermediate risk. INTERVENTIONS A routine discharge planning strategy (RDP, Routine Discharge Plan), which involved the management of all intermediate-risk patients, was compared to an on-demand discharge planning strategy (DDP, on-Demand Discharge Planning), which involved only selected patients referred to the CCHU by ward staff. MAIN MEASURES The primary outcome was the 90-day hospital readmission for any cause (HR90). Secondary outcomes included the prolonged length of stay (pLOS). KEY RESULTS Eight hundred two patients (median age 79 years) were included (414 RDP and 388 DDP). Comparing RDP vs. DDP periods, HR90 was 27.6% and 27.3% (OR 1.01, 90%CI 0.76-1.33, p = 0.485); and pLOS was 47 (11.4%) and 40 (10.3%) (OR 1.24, 95%CI 0.72-2.13, p = 0.447), respectively. CONCLUSIONS This is one of the largest randomized study conducted to compare the effectiveness of two different hospital discharge planning strategies. In patients with intermediate risk of hospital discharge, a RDP offers no advantage over a DDP and results in an unnecessary increase in staff workload. TRIAL REGISTRATION Clinicaltrials.gov: NCT03436940.
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Affiliation(s)
- Andrea Evangelista
- Unit of Clinical Epidemiology, AOU Città Della Salute E Della Scienza Di Torino and CPO Piemonte, Via Santena, 7 10126, Turin, Italy.
| | - Elisa Camussi
- Unit of Screening Epidemiology, AOU Città Della Salute E Della Scienza Di Torino and CPO Piemonte, Turin, Italy
| | - Michele Corezzi
- Quality and Safety of Care Department, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Marco Gilardetti
- Unit of Clinical Epidemiology, AOU Città Della Salute E Della Scienza Di Torino and CPO Piemonte, Via Santena, 7 10126, Turin, Italy
| | - Gianfranco Fonte
- Unit of Screening Epidemiology, AOU Città Della Salute E Della Scienza Di Torino and CPO Piemonte, Turin, Italy
| | - Antonio Scarmozzino
- Hospital Medical Direction, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Giovanni La Valle
- Hospital Medical Direction, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Lorenzo Angelone
- Hospital Medical Direction, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Elena Olivero
- Hospital Medical Direction, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, AOU Città Della Salute E Della Scienza Di Torino and CPO Piemonte, Via Santena, 7 10126, Turin, Italy
| | - Daniela Corsi
- Hospital Medical Direction, AOU Città Della Salute E Della Scienza Di Torino, Turin, Italy
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11
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Roos R, Pepping RMC, van Aken MO, Labots G, Lahdidioui A, van den Berg JMW, Kolfschoten NE, Pasha SM, Ten Holder JT, Mollink SM, van den Bos F, Kant J, Kroon I, Vos RC, Numans ME, van Nieuwkoop C. Evaluation of an integrated care pathway for out-of-hospital treatment of older adults with an acute moderate-to-severe lower respiratory tract infection or pneumonia: protocol of a mixed methods study. BMJ Open 2023; 13:e073126. [PMID: 37591644 PMCID: PMC10441079 DOI: 10.1136/bmjopen-2023-073126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/04/2023] [Indexed: 08/19/2023] Open
Abstract
INTRODUCTION Older adults with an acute moderate-to-severe lower respiratory tract infection (LRTI) or pneumonia are generally treated in hospitals causing risk of iatrogenic harm such as functional decline and delirium. These hospitalisations are often a consequence of poor collaboration between regional care partners, the lack of (acute) diagnostic and treatment possibilities in primary care, and the presence of financial barriers. We will evaluate the implementation of an integrated regional care pathway ('The Hague RTI Care Bridge') developed with the aim to treat and coordinate care for these patients outside the hospital. METHODS AND ANALYSIS This is a prospective mixed methods study. Participants will be older adults (age≥65 years) with an acute moderate-to-severe LRTI or pneumonia treated outside the hospital (care pathway group) versus those treated in the hospital (control group). In addition, patients, their informal caregivers and treating physicians will be asked about their experiences with the care pathway. The primary outcome of this study will be the feasibility of the care pathway, which is defined as the percentage of patients treated outside the hospital, according to the care pathway, whom fully complete their treatment without the need for hospitalisation within 30 days of follow-up. Secondary outcomes include the safety of the care pathway (30-day mortality and occurrence of complications (readmissions, delirium, falls) within 30 days); the satisfaction, usability and acceptance of the care pathway; the total number of days of bedridden status or hospitalisation; sleep quantity and quality; functional outcomes and quality of life. ETHICS AND DISSEMINATION The Medical Research Ethics Committee Leiden The Hague Delft (reference number N22.078) has confirmed that the Medical Research Involving Human Subjects Act does not apply to this study. The results will be published in international peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN68786381.
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Affiliation(s)
- Rick Roos
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands
| | - Rianne M C Pepping
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands
| | - Maarten O van Aken
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands
| | - Geert Labots
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Ali Lahdidioui
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | | | - Nikki E Kolfschoten
- Department of Emergency Medicine, Haga Teaching Hospital, The Hague, The Netherlands
| | - Sharif M Pasha
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Joris T Ten Holder
- Department of Pulmonology, Haaglanden Medical Center, The Hague, The Netherlands
| | - Susan M Mollink
- Department of Emergency Medicine, Haaglanden Medical Center, The Hague, The Netherlands
| | - Frederiek van den Bos
- Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ingrid Kroon
- Kroon Elderly Care Physician, The Hague, The Netherlands
| | - Rimke C Vos
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands
| | - Mattijs E Numans
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, The Netherlands
- Health Campus The Hague/Department of Public Health and Primary Care, Leiden University Medical Center, The Hague, The Netherlands
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12
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Gallo LC, Fortmann AL, Clark TL, Roesch SC, Bravin JI, Spierling Bagsic SR, Sandoval H, Savin KL, Gilmer T, Talavera GA, Philis-Tsimikas A. Mi Puente (My Bridge) Care Transitions Program for Hispanic/Latino Adults with Multimorbidity: Results of a Randomized Controlled Trial. J Gen Intern Med 2023; 38:2098-2106. [PMID: 36697929 PMCID: PMC9876654 DOI: 10.1007/s11606-022-08006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/23/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Multimorbidity frequently co-occurs with behavioral health concerns and leads to increased healthcare costs and reduced quality and quantity of life. Unplanned readmissions are a primary driver of high healthcare costs. OBJECTIVE We tested the effectiveness of a culturally appropriate care transitions program for Latino adults with multiple cardiometabolic conditions and behavioral health concerns in reducing hospital utilization and improving patient-reported outcomes. DESIGN Randomized, controlled, single-blind parallel-groups. PARTICIPANTS Hispanic/Latino adults (N=536; 75% of those screened and eligible; M=62.3 years (SD=13.9); 48% women; 73% born in Mexico) with multiple chronic cardiometabolic conditions and at least one behavioral health concern (e.g., depression symptoms, alcohol misuse) hospitalized at a hospital that serves a large, mostly Hispanic/Latino, low-income population. INTERVENTIONS Usual care (UC) involved best-practice discharge processes (e.g., discharge instructions, assistance with appointments). Mi Puente ("My Bridge"; MP) was a culturally appropriate program of UC plus inpatient and telephone encounters with a behavioral health nurse and community mentor team who addressed participants' social, medical, and behavioral health needs. MAIN MEASURES The primary outcome was 30- and 180-day readmissions (inpatient, emergency, and observation visits). Patient-reported outcomes (quality of life, patient activation) and healthcare use were also examined. KEY RESULTS In intention-to-treat models, the MP group evidenced a higher rate of recurrent hospitalization (15.9%) versus UC (9.4%) (OR=1.91 (95% CI 1.09, 3.33)), and a greater number of recurrent hospitalizations (M=0.20 (SD=0.49) MP versus 0.12 (SD=0.45) UC; P=0.02) at 30 days. Similar trends were observed at 180 days. Both groups showed improved patient-reported outcomes, with no advantage in the Mi Puente group. Results were similar in per protocol analyses. CONCLUSIONS In this at-risk population, the MP group experienced increased hospital utilization and did not demonstrate an advantage in improved patient-reported outcomes, relative to UC. Possible reasons for these unexpected findings are discussed. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02723019. Registered on 30 March 2016.
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Affiliation(s)
- Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, USA.
- South Bay Latino Research Center, San Diego State University, 780 Bay Blvd. Suite 200, Chula Vista, CA, 91910, USA.
| | - Addie L Fortmann
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Taylor L Clark
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Scott C Roesch
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Julia I Bravin
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | | | - Haley Sandoval
- Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA, USA
| | - Kimberly L Savin
- SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA
| | - Todd Gilmer
- Family Medicine and Public Health, University of California, San Diego, San Diego, CA, USA
| | - Gregory A Talavera
- Department of Psychology, San Diego State University, San Diego, CA, USA
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13
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Yeung HM. Pyramid of Discharge Needs: A Simple Framework on Discharge Planning for Medical Students and Residents. J Community Hosp Intern Med Perspect 2023; 13:6-9. [PMID: 37877045 PMCID: PMC10593166 DOI: 10.55729/2000-9666.1188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 10/26/2023] Open
Abstract
Medical students and residents often have difficulty with discharge planning and determining appropriate post-hospitalization level of care. As the discharge planning process can be complex, physicians in-training often do not engage until late into the hospitalization or near day of discharge. This paper offers a simple pyramid construct that categorizes common discharge needs into 4 areas or tiers. As the topic of discharge planning is not formally taught in medical education, most trainees learn through experience and by trial and error. Using a simple pyramid and a basic flow chart to guide students and residents, the discharge planning process can be introduced as soon as possible during the hospitalization.
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Affiliation(s)
- Ho-Man Yeung
- Section in Hospital Medicine, Department of Medicine, Temple University Hospital, PA, 19104,
USA
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14
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Lee CR, Taggert E, Coe NB, Chatterjee P. Patient Experience at US Hospitals Following the Caregiver Advise, Record, Enable (CARE) Act. JAMA Netw Open 2023; 6:e2311253. [PMID: 37126344 PMCID: PMC10152302 DOI: 10.1001/jamanetworkopen.2023.11253] [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: 11/17/2022] [Accepted: 03/19/2023] [Indexed: 05/02/2023] Open
Abstract
Importance Communication with caregivers is often not established or standardized during hospitalization. The Caregiver Advise, Record, Enable (CARE) Act is a state-level policy designed to facilitate communication among patients, caregivers, and clinical care teams during hospitalization to improve patient experience; 42 states have passed this policy since 2014, but whether it was associated with achieving these goals remains unknown. Objective To determine whether passage of the CARE Act was associated with improvements in patient experience. Design, Setting, and Participants This cohort study used a difference-in-differences analysis of short-term, acute-care US hospitals from 2013 to 2019 to analyze changes in patient experience before vs after CARE Act implementation in hospitals located in states that passed the CARE Act compared with those in states that did not. Analyses were performed between September 1, 2021, and July 31, 2022. Exposure Time-varying indicators for whether a hospital was in a state that passed the CARE Act. Main Outcomes and Measures Patient-reported experience via the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Results A total of 2763 hospitals were included, with 2188 hospitals in CARE Act states and 575 in non-CARE Act states. There were differential improvements in patient experience in the measures of communication with nurses (unadjusted mean [SD] score, 78.40% [0.42%]; difference, 0.18 percentage points; 95% CI, 0.07-0.29 percentage points; P = .002), communication with physicians (mean [SD] score, 80.00% [0.19%]; difference, 0.17 percentage points; 95% CI, 0.06-0.28 percentage points; P = .002), and receipt of discharge information (mean [SD] score, 86.40% [0.22%]; difference, 0.11 percentage points; 95% CI, 0.02-0.21 percentage points; P = .02) among CARE Act states compared with non-CARE Act states after policy passage. In subgroup analyses, improvements were larger among hospitals with lower baseline Hospital Consumer Assessment of Healthcare Providers and Systems performance on measures of communication with nurses, communication with physicians, and overall hospital rating. Conclusions and Relevance These findings suggest that implementation of the CARE Act was associated with improvements in several measures of patient experience. Policies that formally incorporate caregivers into patient care during hospitalization may improve patient outcomes.
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Affiliation(s)
- Courtney R. Lee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medicine, Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Elizabeth Taggert
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
| | - Norma B. Coe
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia
| | - Paula Chatterjee
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Department of Medicine, Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
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15
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Tyler N, Angelakis I, Keers RN, Planner C, Hodkinson A, Giles SJ, Grundy A, Kapur N, Armitage C, Blakeman T, Campbell SM, Robinson C, Leather J, Panagioti M. Evaluating a co-designed care bundle to improve patient safety at discharge from adult and adolescent mental health services (SAFER-MH and SAFER-YMH): protocol for a non-randomised feasibility study. BMJ Open 2023; 13:e069216. [PMID: 37041053 PMCID: PMC10106061 DOI: 10.1136/bmjopen-2022-069216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023] Open
Abstract
INTRODUCTION Patients being discharged from inpatient mental wards often describe safety risks in terms of inadequate information sharing and involvement in discharge decisions. Through stakeholder engagement, we co-designed, developed and adapted two versions of a care bundle intervention, the SAFER Mental Health care bundle for adult and youth inpatient mental health settings (SAFER-MH and SAFER-YMH, respectively), that look to address these concerns through the introduction of new or improved processes of care. METHODS AND ANALYSIS Two uncontrolled before-and-after feasibility studies, where all participants will receive the intervention. We will examine the feasibility and acceptability of the SAFER-MH in inpatient mental health settings in patients aged 18 years or older who are being discharged and the feasibility and acceptability of the SAFER-YMH intervention in inpatient mental health settings in patients aged between 14 and 18 years who are being discharged. The baseline period and intervention periods are both 6 weeks. SAFER-MH will be implemented in three wards and SAFER-YMH in one or two wards, ideally across different trusts within England. We will use quantitative (eg, questionnaires, completion forms) and qualitative (eg, interviews, process evaluation) methods to assess the acceptability and feasibility of the two versions of the intervention. The findings will inform whether a main effectiveness trial is feasible and, if so, how it should be designed, and how many patients/wards should be included. ETHICS AND DISSEMINATION Ethical approval was obtained from the National Health Service Cornwall and Plymouth Research Ethics Committee and Surrey Research Ethics Committee (reference: 22/SW/0096 and 22/LO/0404). Research findings will be disseminated with participating sites and shared in various ways to engage different audiences. We will present findings at international and national conferences, and publish in open-access, peer-reviewed journals.
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Affiliation(s)
- Natasha Tyler
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Ioannis Angelakis
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Richard Neil Keers
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety Research, University of Manchester, Manchester, UK
| | - Claire Planner
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | | | - Sally J Giles
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Andrew Grundy
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Navneet Kapur
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Centre for Suicide Prevention, University of Manchester, Manchester, UK
| | - Chris Armitage
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Tom Blakeman
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Catherine Robinson
- Division of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK
| | - Jessica Leather
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
| | - Maria Panagioti
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, UK
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
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16
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Whitehead L, Palamara P, Babatunde-Sowole OO, Boak J, Franklin N, Quinn R, George C, Allen J. Nurses' experience of managing adults living with multimorbidity: A qualitative study. J Adv Nurs 2023. [PMID: 36861787 DOI: 10.1111/jan.15600] [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: 08/17/2022] [Revised: 01/09/2023] [Accepted: 02/05/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND The number of adults living with two or more chronic conditions is increasing worldwide. Adults living with multimorbidity have complex physical, psychosocial and self-management care needs. AIM This study aimed to describe Australian nurses' experience of care provision for adults living with multimorbidity, their perceived education needs and future opportunities for nurses in the management of multimorbidity. DESIGN Qualitative exploratory. METHODS Nurses providing care to adults living with multimorbidity in any setting were invited to take part in a semi-structured interview in August 2020. Twenty-four registered nurses took part in a semi-structured telephone interview. RESULTS Three main themes were developed: (1) The care of adults living with multimorbidity requires skilled collaborative and holistic care; (2) nurses' practice in multimorbidity care is evolving; and (3) nurses value education and training in multimorbidity care. CONCLUSION Nurses recognize the challenge and the need for change in the system to support them to respond to the increasing demands they face. IMPACT The complexity and prevalence of multimorbidity creates challenges for a healthcare system configured to treat individual disease. Nurses are key in providing care for this population, but little is known about nurses' experiences and perceptions of their role. Nurses believe a person-centred approach is important to address the complex needs of adults living with multimorbidity. Nurses described their role as evolving in response to the growing demand for quality care and believed inter-professional approaches achieve the best outcomes for adults living with multimorbidity. The research has relevance for all healthcare providers seeking to provide effective care for adults living with multimorbidity. Understanding how best to equip and support the workforce to meet the issues and demands of managing the care of adults living with multimorbidity has the potential to improve patient outcomes. PATIENT OR PUBLIC CONTRIBUTION There was no patient or public contribution. The study only concerned the providers of the service.
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Affiliation(s)
- Lisa Whitehead
- Centre for Nursing, Midwifery & Health Services Research, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Australian College of Nursing, Parramatta, New South Wales, Australia
| | - Peter Palamara
- Centre for Nursing, Midwifery & Health Services Research, School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Olutoyin Oluwakemi Babatunde-Sowole
- Australian College of Nursing, Parramatta, New South Wales, Australia.,Faculty of Health, School of Nursing and Midwifery, University of Technology, Sydney, New South Wales, Australia.,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, North Sydney, New South Wales, Australia
| | - Jennifer Boak
- Australian College of Nursing, Parramatta, New South Wales, Australia.,Bendigo Health, Bendigo, Victoria, Australia
| | - Natasha Franklin
- Australian College of Nursing, Parramatta, New South Wales, Australia.,Australian Catholic University, Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Blacktown, New South Wales, Australia
| | - Robyn Quinn
- Australian College of Nursing, Parramatta, New South Wales, Australia
| | - Cobie George
- Australian College of Nursing, Parramatta, New South Wales, Australia
| | - Jacqueline Allen
- Australian College of Nursing, Parramatta, New South Wales, Australia.,School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
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17
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Valente R, Santori G, Stanton L, Abraham A, Thaha MA. Introducing a structured daily multidisciplinary board round to safely enhance surgical ward patient flow in the bed shortage era: a quality improvement research report. BMJ Open Qual 2023; 12:bmjoq-2021-001669. [PMID: 36972925 PMCID: PMC10069591 DOI: 10.1136/bmjoq-2021-001669] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 03/12/2023] [Indexed: 03/29/2023] Open
Abstract
Hospital bed shortage is a worldwide concern. Their unavailability has caused elective surgery cancellations at our hospital peaking in spring 2016 at over 50%. This is often due to difficult patient step-down from intensive care (ICU) and high-dependency units (HDU). In our general/digestive surgery service admitting approximately 1000 patients yearly, ward rounds were run on a consultant firm basis.We report quality improvement (ISRCTN13976096) after we introduced a structured daily multidisciplinary board round framework (SAFER Surgery R2G) adapted from the 'SAFER patient flow bundle' and the 'Red to Green days' approaches to enhance flow. We compare 2016-2017, when our framework was applied for 12 months.We used a Plan-Do-Study-Act (PDSA) methodology. Our intervention consisted in (1) systematically communicating the key care plan after the afternoon ward rounds to the nurse in charge; (2) 30' 10:00 hours Monday-to-Friday multidisciplinary board rounds, attended daily by the senior team and weekly by hospital and site managers, revising the key care plan to aim at safe, early discharges, assessing the appropriateness of each inpatient day and tackling any cause of delay. We measured patient flow by average length of stay (LOS), ICU/HDU step-downs and operation cancellations count, monitoring safety through early 30-day readmissions. Compliance was assessed by board round attendance and staff satisfaction rate surveys.After 12 months of intervention (PDSA-1-2, N=1032), compared with baseline (PDSA-0, N=954) average LOS significantly decreased from 7.2 (8.9) to 6.3 (7.4) days (p=0.003); ICU/HDU bed step-down flow increased by 9.3% from 345 to 375 (p=0.197), surgery cancellations dropped from 38 to 15 (p=0.100). 30-day readmissions increased from 0.9% (N=9) to 1.3% (N=14)(p=0.390). Average cross-specialty attendance was 80%. Satisfaction rates were >75%, regarding enhanced teamwork and faster decisions.The SAFER Surgery R2G framework has increased patient flow in the context of an enhanced multidisciplinary approach, requiring senior staff commitment to remain sustainable.
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Affiliation(s)
- Roberto Valente
- University College London, London, UK
- Barts and The London NHS Trust, London, UK
| | - Gregorio Santori
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genova, Italy
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18
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García-Hernández M, González de León B, Barreto-Cruz S, Vázquez-Díaz JR. Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program. Front Med (Lausanne) 2022; 9:1033689. [PMID: 36507542 PMCID: PMC9729702 DOI: 10.3389/fmed.2022.1033689] [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: 08/31/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022] Open
Abstract
Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program.
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Affiliation(s)
- Miguel García-Hernández
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Beatriz González de León
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Silvia Barreto-Cruz
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - José Ramón Vázquez-Díaz
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain,*Correspondence: José Ramón Vázquez-Díaz
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Gridley K, Baxter K, Birks Y, Newbould L, Allan S, Roland D, Malisauskaite G, Jones K. Social care causes of delayed transfer of care (DTOC) from hospital for older people: Unpicking the nuances of 'provider capacity' and 'patient choice'. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4982-e4991. [PMID: 35841589 PMCID: PMC10084034 DOI: 10.1111/hsc.13911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/19/2022] [Accepted: 07/04/2022] [Indexed: 06/15/2023]
Abstract
Unnecessarily prolonged stays in hospitals can have negative impacts on patients and present avoidable costs to health and social care systems. This paper presents the qualitative findings of a multi-methods study of the social care causes of delayed transfers of care (DTOC) for older people in England. The quantitative strand of this study found that DTOC are significantly affected by homecare supply. In this paper, we explore in depth how and why social care capacity factors lead to delays, from the perspectives of those working within the system. We examined the local transfer arrangements in six English local authority (LA) sites that were purposively sampled to include a range of DTOC performance and LA characteristics. Between March and December 2018, 52 professionals involved in arranging or facilitating discharge from hospitals in these sites provided qualitative data, primarily through semi-structured interviews. Topics included discharge teams and processes, strategic issues and perceived causes of delays. The thematic analysis uncovered the nuances behind the causes of DTOC previously categorised broadly as 'provider capacity' and 'patient choice'. In particular, our analysis highlights the lack of fit between available provision and the needs of people leaving hospital (theme 1); workforce inconsistencies (theme 2) and a myth of patient choice (theme 3). We are now at a turning point in the development of policy to reduce DTOC in the English system, with the full implications of a new national discharge to assess programme yet to be seen. Our research shows the significance of the alignment of service capacity, including the type and location of provision, with the needs and preferences of those leaving hospital. As the new system becomes established, attendance to such nuances behind blockages in the system will be more important than ever.
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Affiliation(s)
- Kate Gridley
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Kate Baxter
- Social Policy Research UnitUniversity of YorkYorkUK
| | - Yvonne Birks
- Social Policy Research UnitUniversity of YorkYorkUK
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Allen J, Lobchuk M, Livingston PM, Layton N, Hutchinson AM. Informal carers' support needs, facilitators and barriers in the transitional care of older adults: A qualitative study. Health Expect 2022; 25:2876-2892. [PMID: 36069335 DOI: 10.1111/hex.13596] [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: 06/08/2022] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Inclusion of informal carers in transitional care is challenging because of fast throughput and service fragmentation. This study aimed to understand informal carers' needs during the care transitions of older adults from inpatient care to the community. METHODS A qualitative exploratory design was used with mixed-methods data collection. Seventeen semi-structured telephone interviews were conducted with family carers; one focus group was conducted by videoconference with two family carers and three community-based advocacy and aged care providers; and eight semi-structured telephone interviews were undertaken with healthcare practitioners from rehabilitation services. Data were thematically analysed. FINDINGS All carers described the main social challenge that they needed to address in transitional care as 'Needing to sustain family'. Carers reported their social needs across five solutions: 'Partnering with carers', 'Advocating for discharge', 'Accessing streamlined multidisciplinary care', 'Knowing how to care' and 'Accessing follow-up care in the community'. Focus group participants endorsed the findings from the carer interviews and added the theme 'Putting responsibility back onto carers'. All healthcare practitioners described the main social challenge that they needed to address as 'Needing to engage carers'. They reported their social solutions in three themes: 'Communicating with carers', 'Planning with carers' and 'Educating carers'. DISCUSSION Findings highlight the importance of reconstructing the meaning of transitional care and relevant outcomes to be inclusive of carers' experiences and their focus on sustaining family. Transitional care that includes carers should commence at the time of hospital admission of the older adult. CONCLUSIONS Future sustainable and high-quality health services for older adults will require transitional care that includes carers and older adults and efficient use of inpatient and community care resources. Healthcare professionals will require education and skills in the provision of transitional care that includes carers. To meet carers' support needs, models of transitional care inclusive of carers and older adults should be developed, implemented and evaluated. PUBLIC CONTRIBUTION This study was conducted with the guidance of a Carer Advisory Group comprising informal carers with experience of care transitions of older adults they support and community-based organizations providing care and advocacy support to informal carers.
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Affiliation(s)
- Jacqueline Allen
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Michelle Lobchuk
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Patricia M Livingston
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Natasha Layton
- Rehabilitation, Ageing and Independent Living Research Centre, Peninsula Campus, Monash University, Frankston, Victoria, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Rattray M, Roberts S. Dietitians’ Perspectives on the Coordination and Continuity of Nutrition Care for Malnourished or Frail Clients: A Qualitative Study. Healthcare (Basel) 2022; 10:healthcare10060986. [PMID: 35742038 PMCID: PMC9223016 DOI: 10.3390/healthcare10060986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Abstract
Malnutrition and frailty are common conditions that impact overall health and function. There is limited research exploring the barriers and enablers to providing coordinated nutrition care to malnourished or frail clients in the community (including transitions from hospital). This study aimed to explore dietitians’ experiences and perspectives on providing coordinated nutrition care for frail and malnourished clients identified in the community or being discharged from hospital. Semi-structured interviews with clinical/acute, community, and aged care dietitians across Australia and New Zealand were conducted. Interviews were 23–61 min long, audio recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. Eighteen dietitians participated in interviews, including five clinical, eleven community, and two residential aged care dietitians. Three themes, describing key factors influencing the transition and coordination of nutrition care, emerged from the analysis: (i) referral and discharge planning practices, processes, and quality; (ii) dynamics and functions within the multidisciplinary team; and (iii) availability of community nutrition services. Guidelines advising on referral pathways for malnourished/frail clients, improved communication between acute and community dietitians and within the multidisciplinary team, and solutions for community dietetic resource shortages are required to improve the delivery of coordinated nutrition care to at-risk clients.
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Affiliation(s)
- Megan Rattray
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
- College of Medicine & Public Health, Flinders University, Adelaide 5042, Australia
- Correspondence:
| | - Shelley Roberts
- School of Health Sciences and Social Work, Griffith University, Gold Coast 4222, Australia;
- Allied Health Research, Gold Coast Hospital and Health Service, Gold Coast 4215, Australia
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