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Clancy B, Bonevski B, English C, Guillaumier A. Healthcare provider perceptions of support provision for people with stroke: a qualitative study. Disabil Rehabil 2024:1-8. [PMID: 39259249 DOI: 10.1080/09638288.2024.2398135] [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: 02/27/2024] [Revised: 08/19/2024] [Accepted: 08/23/2024] [Indexed: 09/12/2024]
Abstract
PURPOSE This study aimed to explore healthcare providers' perceptions of support provision for people who have experienced stroke. MATERIALS AND METHODS A qualitative descriptive study was conducted. Snowball sampling was used to recruit Australian healthcare workers providing care to people with stroke. Semi-structured one-on-one interviews were audiotaped and transcribed. An inductive thematic analysis of all transcripts was undertaken by two authors. RESULTS Fourteen participants who worked across the care continuum in three Australian states were interviewed. Responses fit into three overarching themes: (1) attitudes to supports; (2) availability and accessibility of supports; and (3) awareness of supports. These themes encompassed perceptions of the support options available for people with stroke and the factors affecting support provision decision making among healthcare providers. CONCLUSIONS The healthcare providers in this study thought people with stroke would benefit from a greater range of available supports. Supports should take into account the diverse experiences and acute and long-term needs of people with stroke, as well as be accessible to people from all cultural, linguistic, and socioeconomic backgrounds. Healthcare providers and people who have experienced stroke may benefit from a roadmap for post-stroke support that clearly outlines where responsibility lies for support provision.
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Affiliation(s)
- Brigid Clancy
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Coralie English
- Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, NSW, Australia
- School of Health Sciences, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Ashleigh Guillaumier
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
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Seijas V, Maritz R, Fernandes P, Bernard RM, Lugo LH, Bickenbach J, Sabariego C. Rehabilitation delivery models to foster healthy ageing-a scoping review. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1307536. [PMID: 38660395 PMCID: PMC11041397 DOI: 10.3389/fresc.2024.1307536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/15/2024] [Indexed: 04/26/2024]
Abstract
Introduction Rehabilitation is essential to foster healthy ageing. Older adults have unique rehabilitation needs due to a higher prevalence of non-communicable diseases, higher susceptibility to infectious diseases, injuries, and mental health conditions. However, there is limited understanding of how rehabilitation is delivered to older adults. To address this gap, we conducted a scoping review to describe rehabilitation delivery models used to optimise older adults' functioning/functional ability and foster healthy ageing. Methods We searched Medline and Embase (January 2015 to May 2022) for primary studies published in English describing approaches to provide rehabilitation to older adults. Three authors screened records for eligibility and extracted data independently and in duplicate. Data synthesis included descriptive quantitative analysis of study and rehabilitation provision characteristics, and qualitative analysis to identify rehabilitation delivery models. Results Out of 6,933 identified records, 585 articles were assessed for eligibility, and 283 studies with 69,257 participants were included. We identified six rehabilitation delivery models: outpatient (24%), telerehabilitation (22%), home (18.5%), community (16.3%), inpatient (14.6%), and eldercare (4.7%). These models often involved multidisciplinary teams (31.5%) and follow integrated care principles (30.4%). Most studies used a disease-centred approach (59.0%), while studies addressing multimorbidity (6.0%) and prevalent health problems of older adults, such as pain, low hearing, and vision, or incontinence were scarce. The most frequently provided interventions were therapeutic exercises (54.1%), self-management education (40.1%), and assessment of person-centred goals (40%). Other interventions, such as assistive technology (8.1%) and environmental adaptations (7.4%) were infrequent. Conclusions Focusing on primary studies, this scoping review provides an overview of rehabilitation delivery models that are used to foster healthy ageing and highlights research gaps that require further attention, including a lack of systematic assessment of functioning/functional ability, a predominance of disease-centred rehabilitation, and a scarcity of programmes addressing prevalent issues like pain, hearing/vision loss, fall prevention, incontinence, and sexual dysfunctions. Our research can facilitate evidence-based decision-making and inspire further research and innovation in rehabilitation and healthy ageing. Limitations of our study include reliance on published research to infer practice and not assessing model effectiveness. Future research in the field is needed to expand and validate our findings.
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Affiliation(s)
- Vanessa Seijas
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Roxanne Maritz
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Patricia Fernandes
- Department of Clinical Medicine, Federal University of Parana, Parana, Brazil
| | | | - Luz Helena Lugo
- Rehabilitation in Health Research Group, University of Antioquia, Medellin, Colombia
| | - Jerome Bickenbach
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Carla Sabariego
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems (WHO Collaborating Center), Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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Carson DB, Messmer R, Leuf Fjällberg E. Creating 'good' hospital to home transfers in the rural north of Sweden: informal workarounds and opportunities for improvement. Home Health Care Serv Q 2024; 43:18-38. [PMID: 37439524 DOI: 10.1080/01621424.2023.2235321] [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] [Indexed: 07/14/2023]
Abstract
Hospital to home transfers for older people require effective communication, coordination and collaboration across multiple service settings. Rural Nursing Theory and the Beyond Periphery model explain why this is particularly difficult in rural areas, but there are few examples of how rural services respond. This paper presents a case study of the district of Tärnaby in the inland north of Sweden. Data are drawn from interviews with health and care staff in Tärnaby, observations, and experiences of the researchers. Data were analyzed thematically, with four main themes emerging - role clarity, communication, geography, and understanding of the rural context. Responses to challenges included increasing opportunities for communication between service providers and improving documentation. The paper concludes that informal "workarounds" run the risk of further disconnecting rural service settings from "the city". Rather, the aim needs to be to improve contextual understanding through formally incorporating "the rural" in service design.
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Affiliation(s)
| | - Ronja Messmer
- Department of Nursing, Umeå University, Umea, Sweden
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Reeves MJ, Boden-Albala B, Cadilhac DA. Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations. Stroke 2023; 54:386-395. [PMID: 36689590 DOI: 10.1161/strokeaha.122.039565] [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: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 01/24/2023]
Abstract
In many countries hospital length of stay after an acute stroke admission is typically just a few days, therefore, most of a person's recovery from stroke occurs in the community. Care transitions, which occur when there is a change in, or handoff between 2 different care settings or providers, represent an especially vulnerable period for patients and caregivers. For some patients with stroke the return home is associated with substantial practical, psychosocial, and health-related challenges leading to substantial burden for the individual and caregiver. Underserved and minority populations, because of their exposure to poor environmental, social, and economic conditions, as well as structural racism and discrimination, are especially vulnerable to the problems of complicated care transitions which in turn, can negatively impact stroke recovery. Overall, there remain significant unanswered questions about how to promote optimal recovery in the post-acute care period, particularly for those from underserved communities. Evidence is limited on how best to support patients after they have returned home where they are required to navigate the chronic stages of stroke with little direct support from health professionals.
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Affiliation(s)
- Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Bernadette Boden-Albala
- Department of Health Society and Behavior, Department of Epidemiology and Biostatistics, Program in Public Health, Department of Neurology, School of Medicine, University of California (B.B.-A.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (D.A.C.)
- Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (D.A.C.)
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Cadel L, Cimino SR, Bradley-Ridout G, Hitzig SL, Patel T, Ho CH, Packer TL, Lofters AK, Hahn-Goldberg S, McCarthy LM, Guilcher SJT. Medication self-management interventions for persons with stroke: A scoping review. PLoS One 2023; 18:e0285483. [PMID: 37200316 DOI: 10.1371/journal.pone.0285483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/25/2023] [Indexed: 05/20/2023] Open
Abstract
The use of multiple medications is common following a stroke for secondary prevention and management of co-occurring chronic conditions. Given the use of multiple medications post-stroke, optimizing medication self-management for this population is important. The objective of this scoping review was to identify and summarize what has been reported in the literature on interventions related to medication self-management for adults (aged 18+) with stroke. Electronic databases (Ovid Medline, Ovid Embase, EBSCO CINAHL, Ovid PsycINFO, Web of Science) and grey literature were searched to identify relevant articles. For inclusion, articles were required to include an adult population with stroke undergoing an intervention aimed at modifying or improving medication management that incorporated a component of self-management. Two independent reviewers screened the articles for inclusion. Data were extracted and summarized using descriptive content analysis. Of the 56 articles that met the inclusion criteria, the focus of most interventions was on improvement of secondary stroke prevention through risk factor management and lifestyle modifications. The majority of studies included medication self-management as a component of a broader intervention. Most interventions used both face-to-face interactions and technology for delivery. Behavioural outcomes, specifically medication adherence, were the most commonly targeted outcomes across the interventions. However, the majority of interventions did not specifically or holistically target medication self-management. There is an opportunity to better support medication self-management post-stroke by ensuring interventions are delivered across sectors or in the community, developing an understanding of the optimal frequency and duration of delivery, and qualitatively exploring experiences with the interventions to ensure ongoing improvement.
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Affiliation(s)
- Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Stephanie R Cimino
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | - Sander L Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tejal Patel
- University of Waterloo School of Pharmacy, Kitchener, ON, Canada
- Schlegel-University of Waterloo Research Institute of Aging, Waterloo, ON, Canada
| | - Chester H Ho
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Tanya L Packer
- Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, NS, Canada
- Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Aisha K Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Toronto, ON, Canada
| | - Shoshana Hahn-Goldberg
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- OpenLab, University Health Network, Toronto, ON, Canada
| | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Impact of Community Health Workers on Access to Care for Rural Populations in the United States: A Systematic Review. J Community Health 2021; 47:539-553. [PMID: 34817755 DOI: 10.1007/s10900-021-01052-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
Community Health Worker (CHW) interventions have shown potential to reduce inequities for underserved populations. However, there is a lack of support for CHW integration in the delivery of health care. This may be of particular importance in rural areas in the Unites States where access to care remains problematic. This review aims to describe CHW interventions and their outcomes in rural populations in the US. Peer reviewed literature was searched in PubMed and PsycINFO for articles published in English from 2015 to February 2021. Title and abstract screening was performed followed by full text screening. Quality of the included studies was assessed using the Downs and Black score. A total of 26 studies met inclusion criteria. The largest proportion were pre-post program evaluation or cohort studies (46.2%). Many described CHW training (69%). Almost a third (30%) indicated the CHW was integrated within the health care team. Interventions aimed to provide health education (46%), links to community resources (27%), or both (27%). Chronic conditions were the concern for most interventions (38.5%) followed by women's health (34.6%). Nearly all studies reported positive improvement in measured outcomes. In addition, studies examining cost reported positive return on investment. This review offers a broad overview of CHW interventions in rural settings in the United States. It provides evidence that CHW can improve access to care in rural settings and may represent a cost-effective investment for the healthcare system.
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Kass B, Dornquast C, Meisel A, Holmberg C, Rieckmann N, Reinhold T. Cost-effectiveness of patient navigation programs for stroke patients-A systematic review. PLoS One 2021; 16:e0258582. [PMID: 34653188 PMCID: PMC8519430 DOI: 10.1371/journal.pone.0258582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 09/30/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Stroke remains a leading cause of premature death, impairment and reduced quality of life. Its aftercare is performed by numerous different health care service providers, resulting in a high need for coordination. Personally delivered patient navigation (PN) is a promising approach for managing pathways through health care systems and for improving patient outcomes. Although PN in stroke care is evolving, no summarized information on its cost-effectiveness in stroke survivors is available. Hence, the aim of this systematic review is to analyze the level of evidence on the cost-effectiveness of PN for stroke survivors. METHODS A systematic literature search without time limitations was carried out in PubMed, EMBASE, CENTRAL, CINAHL as well as PsycINFO and supplemented by a manual search. Randomized controlled trials published prior to April 2020 in English or German were considered eligible if any results regarding the cost-effectiveness of PN for stroke survivors were reported. The review was conducted according to PRISMA guidelines. Quality of included studies was assessed with the RoB2 tool. Main study characteristics and cost-effectiveness results were summarized and discussed. RESULTS The search identified 1442 records, and two studies met the inclusion criteria. Quality of included studies was rated moderate and high. Programs, settings and cost-effectiveness results were heterogeneous, with one study showing a 90% probability of being cost-effective at a willingness to pay of $25600 per QALY (health/social care perspective) and the other showing similar QALYs and higher costs. CONCLUSIONS Since only two studies were eligible, this review reveals a large gap in knowledge regarding the cost-effectiveness of PN for stroke survivors. Furthermore, no conclusive statement about the cost-effectiveness can be made. Future attempts to evaluate PN for stroke survivors are necessary and should also involve cost-effectiveness issues.
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Affiliation(s)
- Benjamin Kass
- Institute for Social Medicine, Epidemiology and Health Economics, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Christina Dornquast
- Institute for Social Medicine, Epidemiology and Health Economics, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Meisel
- Department of Neurology with Experimental Neurology, Center for Stroke Research Berlin, Neurocure Clinical Research Center, Charité –Universitätsmedizin Berlin, Berlin, Germany
| | - Christine Holmberg
- Institute of Public Health, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Institute of Social Medicine and Epidemiology, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg an der Havel, Germany
| | - Nina Rieckmann
- Institute of Public Health, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Thomas Reinhold
- Institute for Social Medicine, Epidemiology and Health Economics, Charité –Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Lin DM, Arevalo YA, Lin C. Incidental Thyroid Nodules Found During Acute Stroke Angiography: Prevalence, Outcomes, and Suggested Management Guidelines. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021; 37:451-456. [PMID: 34458891 DOI: 10.1177/87564793211018459] [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] [Indexed: 11/17/2022]
Abstract
Objective In stroke patients, extensive interventions for incidental thyroid nodules can be burdensome and costly. It appears that the risk of malignancy has not been reported in angiographically detected nodules and outcomes have not yet been described in patients, receiving acute stroke work-up. Materials and Methods Incidental thyroid nodules were found on neck computerized tomography angiography or magnetic resonance angiography performed during inpatient stroke workup (January 2017 to September 2019). These patient cases were reviewed based on sonography reports, diagnosis, and follow-up care. Results Of the 13 563 patients, 192 had incidental thyroid nodules (prevalence 1.4%). Twenty-six died from comorbidities and 22 received thyroid sonography. Twelve nodules from 10 patients had sonographic characteristics for biopsy: 10 benign, 1 indeterminate, and 1 papillary thyroid cancer (risk of malignancy: 8%). The cancer patient underwent hemithyroidectomy and is disease-free. Follow-up of the remaining patients showed no worsening or suspicious nodules. The American College of Radiology (ACR) guidelines would have prevented 8 unnecessary sonograms and 1 biopsy without missing malignancy. Conclusion Although a small risk of malignancy was noted, 95% of patients undergoing additional diagnostic thyroid testing had clinically insignificant results. The ACR guidelines can prevent unnecessary interventions. Given the 14% mortality rate in the study cohort, it is proposed that a clinical evaluation of patients is important before undergoing further diagnostics, as comorbidities may be worse than a thyroid cancer.
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Affiliation(s)
- Diana M Lin
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yurany A Arevalo
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Chen Lin
- Department of Neurology, The University of Alabama at Birmingham, Birmingham, AL, USA
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Lannin NA, Clemson L, Drummond A, Stanley M, Churilov L, Laver K, O'Keefe S, Cameron I, Crotty M, Usherwood T, Andrew NE, Jolliffe L, Cadilhac DA. Effect of occupational therapy home visit discharge planning on participation after stroke: protocol for the HOME Rehab trial. BMJ Open 2021; 11:e044573. [PMID: 34226214 PMCID: PMC8258558 DOI: 10.1136/bmjopen-2020-044573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION After first stroke, the transition from rehabilitation to home can be confronting and fraught with challenges. Although stroke clinical practice guidelines recommend predischarge occupational therapy home visits to ensure safe discharge and provision of appropriate equipment, there is currently limited evidence to support this recommendation. METHODS AND ANALYSIS The HOME Rehab trial is a national, multicentre, phase III randomised controlled trial with concealed allocation, blinded assessment and intention-to-treat analysis being conducted in Australia. The trial aim is to determine the effect and potential cost-effectiveness of an enhanced occupational therapy discharge planning intervention that involves pre and postdischarge home visits, goal setting and occupational therapy in the home (the HOME programme) in comparison to an in-hospital predischarge planning intervention. Stroke survivors aged ≥45 years, admitted to a rehabilitation ward, expected to return to a community (private) dwelling after discharge, with no significant prestroke disability will be randomly allocated 1:1 to receive a standardised discharge planning intervention and the HOME programme or the standardised discharge planning intervention alone. The primary outcome is participation measured using the Nottingham Extended Activities of Daily Living. Secondary outcome areas include hospital readmission, disability, performance of instrumental activities of daily living, health-related quality of life, quality of care transition and carer burden. Resources used/costs will be collected for the cost-effectiveness analysis and hospital readmission. Recruitment commenced in 2019. Allowing for potential attrition, 360 participants will be recruited to detect a clinically important treatment difference with 80% power at a two-tailed significance level of 0.05. ETHICS AND DISSEMINATION This study is approved by the Alfred Health Human Research Ethics Committee and site-specific ethics approval has been obtained at all participating sites. Results of the main trial and the secondary endpoint of cost-effectiveness will be submitted for publication in peer-reviewed journalsTrial registration numberACTRN12618001360202.
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Affiliation(s)
- Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Lindy Clemson
- Sydney School of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Avril Drummond
- School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Mandy Stanley
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Leonid Churilov
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Brain Centre at Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Kate Laver
- Department of Rehabilitation, Aged and Extended Aged Care, College of Medicine and Public Heath, Flinders University, Adelaide, South Australia, Australia
| | - Sophie O'Keefe
- Occupational Therapy, School of Allied Heath, College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, The University of Sydney, Sydney, New South Wales, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Aged Care, College of Medicine and Public Heath, Flinders University, Adelaide, South Australia, Australia
- Flinders Clinical Effectiveness, School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of General Practice, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Nadine E Andrew
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Laura Jolliffe
- Alfred Health, Melbourne, Victoria, Australia
- Department of Occupational Therapy, Monash University, Melbourne, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health-Austin Campus, Heidelberg, Victoria, Australia
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van Zyl C, Badenhorst M, Hanekom S, Heine M. Unravelling 'low-resource settings': a systematic scoping review with qualitative content analysis. BMJ Glob Health 2021; 6:e005190. [PMID: 34083239 PMCID: PMC8183220 DOI: 10.1136/bmjgh-2021-005190] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The effects of healthcare-related inequalities are most evident in low-resource settings. Such settings are often not explicitly defined, and umbrella terms which are easier to operationalise, such as 'low-to-middle-income countries' or 'developing countries', are often used. Without a deeper understanding of context, such proxies are pregnant with assumptions, insinuate homogeneity that is unsupported and hamper knowledge translation between settings. METHODS A systematic scoping review was undertaken to start unravelling the term 'low-resource setting'. PubMed, Africa-Wide, Web of Science and Scopus were searched (24 June 2019), dating back ≤5 years, using terms related to 'low-resource setting' and 'rehabilitation'. Rehabilitation was chosen as a methodological vehicle due to its holistic nature (eg, multidisciplinary, relevance across burden of disease, and throughout continuum of care) and expertise within the research team. Qualitative content analysis through an inductive approach was used. RESULTS A total of 410 codes were derived from 48 unique articles within the field of rehabilitation, grouped into 63 content categories, and identified nine major themes relating to the term 'low-resource setting'. Themes that emerged relate to (1) financial pressure, (2) suboptimal healthcare service delivery, (3) underdeveloped infrastructure, (4) paucity of knowledge, (5) research challenges and considerations, (6) restricted social resources, (7) geographical and environmental factors, (8) human resource limitations and (9) the influence of beliefs and practices. CONCLUSION The emerging themes may assist with (1) the groundwork needed to unravel 'low-resource settings' in health-related research, (2) moving away from assumptive umbrella terms like 'low-to-middle-income countries' or 'low/middle-income countries' and (3) promoting effective knowledge transfer between settings.
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Affiliation(s)
- Chanel van Zyl
- Division of Physiotherapy, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Marelise Badenhorst
- Institute of Sport and Exercise Medicine, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Susan Hanekom
- Division of Physiotherapy, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Martin Heine
- Institute of Sport and Exercise Medicine, Stellenbosch University, Faculty of Medicine and Health Sciences, Cape Town, South Africa
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Yang CL, Labbé D, Sakakibara BM, Vissers J, Bird ML. World Café- a community conversation: a Canadian perspective on stroke survivors needs for community integration. Top Stroke Rehabil 2021; 29:392-400. [PMID: 34057404 DOI: 10.1080/10749357.2021.1928839] [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: 10/21/2022]
Abstract
Background: Stroke is an acute condition that requires immediate care and long-term community-based chronic care supports. Communities vary in their ability to support the complex needs of this population.Objectives: To bring stroke recovery stakeholders together to discuss the needs of community-based stroke recovery and develop possible solutions across one province in Canada.Methods: The participatory research approach of the World Café was used to explore topics related to community-based stroke recovery. Three World Cafés were held in three communities, including rural, urban-multicultural, and indigenous communities. Sixty-one stakeholders participated in this study. The data was analyzed following an inductive approach for all three Word Cafés.Results: Four main themes were revealed from the data. First, Individual Needs, but Holistic Care encompassed the idea that stroke survivors' needs are complex and changing. Second, Whole of the Community indicated that all the people in stroke survivors' communities should be considered when designing solutions. Third, Transition in Care focused on the needs and solutions during the transition from hospital to community. Lastly, participants emphasized that better Connection, Collaboration, and Communication are needed among all stakeholders.Conclusions: While some similarities in needs and solutions were identified for stroke survivors across three diverse communities, differences between them were also reported. Approaches to enhance better communication among all stakeholders and facilitate a continuous transition from hospital to community are needed. Co-creating solutions with each local community should be considered as individual needs, and challenges are specific to each community.
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Affiliation(s)
- Chieh-Ling Yang
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Delphine Labbé
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,Disability and Human Development Department, University of Illinois, Chicago, IL, USA
| | - Brodie M Sakakibara
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada.,Centre for Chronic Disease Prevention and Management, University of British Columbia, Kelowna, BC, Canada
| | - Janneke Vissers
- Stroke Recovery Association of British Columbia, March of Dimes Canada, Vancouver, BC, Canada
| | - Marie-Louise Bird
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.,School of Health Sciences, University of Tasmania, Launceston, Australia
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12
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The value of caregiver inclusive practices in geriatric transitions of care: A systematic review. Health Policy 2021; 125:888-898. [PMID: 34034905 DOI: 10.1016/j.healthpol.2021.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 11/22/2022]
Abstract
Globally, hospital length of stay is decreasing, yet the number of aged patients requiring complex care is increasing. This causes more patients, and their informal caregivers, to self-manage in the community following acute care discharge. This study aims to assess whether transitional care programs that integrate caregivers provide better value care than routine care. In this systematic review, Medline Ovid, EMBASE Ovid, CINAHL EbscoHOST, Scopus, and Proquest were searched for any study design that investigated a caregiver inclusive transitional care intervention in a population of people with geriatric syndrome, enroled a comparator group, and assessed population health, experience, and/or cost related outcomes. Risk of bias was assessed by two reviewers using ROBINS I and RoB 2. The review included 23 studies and results were mixed. Consistently positive results occurred for patient and caregiver satisfaction. Cost tended to increase with caregiver inclusive practices. Most studies found no difference in population health outcomes. There was insufficient evidence on healthcare professional experience. Currently, there is insufficient evidence to determine whether caregiver inclusive transitions of care provide better value care than routine care. Studies that rigorously implement and evaluate caregiver inclusive care models are urgently required to inform future policy.
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13
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Stulberg EL, Twardzik E, Kim S, Hsu CW, Xu Y, Clarke P, Morgenstern LB, Lisabeth LD. Association of Neighborhood Socioeconomic Status With Outcomes in Patients Surviving Stroke. Neurology 2021; 96:e2599-e2610. [PMID: 33910941 DOI: 10.1212/wnl.0000000000011988] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 02/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine associations between neighborhood socioeconomic status (nSES) and 90-day poststroke outcomes. METHODS The Brain Attack Surveillance in Corpus Christi Project is a population-based surveillance study in Nueces County, Texas. Patients with strokes were identified between 2010 and 2016 via active and passive surveillance and enrolled in the study. nSES index is a standardized composite of 2010 Census tract-level income, wealth, education, and employment (median -4.56, interquartile range -7.48 to -0.46). The 90-day outcomes were ascertained via interview: functional status measured by the average of 22 activities of daily living/instrumental activities of daily living (range 1-4), biopsychosocial health by the Stroke-Specific Quality of Life scale (range 0-5), and depressive symptoms by the 8-item Patient Health Questionnaire (range 0-24). Associations between nSES and outcomes were estimated using confounder-adjusted generalized estimating equations with an nSES × NIH Stroke Scale score interaction term. RESULTS Seven hundred seventy-six survivors made up the analytical sample (52.96% male, 62.24% Mexican American, 52.96% ≥64 years old). Higher compared to lower nSES (mean difference comparing 75th to 25th percentile of nSES) was associated with better function (-0.27, 95% confidence interval [CI] -0.49 to -0.05), better biopsychosocial health (0.26, 95% CI 0.06-0.47), and fewer depressive symptoms (-1.77, 95% CI -3.306 to -0.48) among those with moderate to severe strokes. Among those with minor strokes, higher nSES was associated with better function (-0.13, 95% CI -0.24 to -0.02). CONCLUSIONS nSES may influence poststroke recovery. Studies should identify neighborhood characteristics that contribute to poststroke outcomes, particularly in moderate to severe stroke survivors.
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Affiliation(s)
- Eric L Stulberg
- From the Department of Neurology (E.L.S.), University of Utah School of Medicine, Salt Lake City; and Departments of Epidemiology (E.L.S., E.T., C.-W.H., P.C., L.B.M., L.D.L.) and Biostatistics (S.K., Y.X.), School of Public Health, School of Kinesiology (E.T.), Institute for Social Research (P.C.), and Department of Neurology (L.B.M., L.D.L.), Michigan Medicine, University of Michigan, Ann Arbor
| | - Erica Twardzik
- From the Department of Neurology (E.L.S.), University of Utah School of Medicine, Salt Lake City; and Departments of Epidemiology (E.L.S., E.T., C.-W.H., P.C., L.B.M., L.D.L.) and Biostatistics (S.K., Y.X.), School of Public Health, School of Kinesiology (E.T.), Institute for Social Research (P.C.), and Department of Neurology (L.B.M., L.D.L.), Michigan Medicine, University of Michigan, Ann Arbor
| | - Sehee Kim
- From the Department of Neurology (E.L.S.), University of Utah School of Medicine, Salt Lake City; and Departments of Epidemiology (E.L.S., E.T., C.-W.H., P.C., L.B.M., L.D.L.) and Biostatistics (S.K., Y.X.), School of Public Health, School of Kinesiology (E.T.), Institute for Social Research (P.C.), and Department of Neurology (L.B.M., L.D.L.), Michigan Medicine, University of Michigan, Ann Arbor
| | - Chia-Wei Hsu
- From the Department of Neurology (E.L.S.), University of Utah School of Medicine, Salt Lake City; and Departments of Epidemiology (E.L.S., E.T., C.-W.H., P.C., L.B.M., L.D.L.) and Biostatistics (S.K., Y.X.), School of Public Health, School of Kinesiology (E.T.), Institute for Social Research (P.C.), and Department of Neurology (L.B.M., L.D.L.), Michigan Medicine, University of Michigan, Ann Arbor
| | - Yuliang Xu
- From the Department of Neurology (E.L.S.), University of Utah School of Medicine, Salt Lake City; and Departments of Epidemiology (E.L.S., E.T., C.-W.H., P.C., L.B.M., L.D.L.) and Biostatistics (S.K., Y.X.), School of Public Health, School of Kinesiology (E.T.), Institute for Social Research (P.C.), and Department of Neurology (L.B.M., L.D.L.), Michigan Medicine, University of Michigan, Ann Arbor
| | - Philippa Clarke
- From the Department of Neurology (E.L.S.), University of Utah School of Medicine, Salt Lake City; and Departments of Epidemiology (E.L.S., E.T., C.-W.H., P.C., L.B.M., L.D.L.) and Biostatistics (S.K., Y.X.), School of Public Health, School of Kinesiology (E.T.), Institute for Social Research (P.C.), and Department of Neurology (L.B.M., L.D.L.), Michigan Medicine, University of Michigan, Ann Arbor
| | - Lewis B Morgenstern
- From the Department of Neurology (E.L.S.), University of Utah School of Medicine, Salt Lake City; and Departments of Epidemiology (E.L.S., E.T., C.-W.H., P.C., L.B.M., L.D.L.) and Biostatistics (S.K., Y.X.), School of Public Health, School of Kinesiology (E.T.), Institute for Social Research (P.C.), and Department of Neurology (L.B.M., L.D.L.), Michigan Medicine, University of Michigan, Ann Arbor
| | - Lynda D Lisabeth
- From the Department of Neurology (E.L.S.), University of Utah School of Medicine, Salt Lake City; and Departments of Epidemiology (E.L.S., E.T., C.-W.H., P.C., L.B.M., L.D.L.) and Biostatistics (S.K., Y.X.), School of Public Health, School of Kinesiology (E.T.), Institute for Social Research (P.C.), and Department of Neurology (L.B.M., L.D.L.), Michigan Medicine, University of Michigan, Ann Arbor.
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Lobo EH, Frølich A, Rasmussen LJ, Livingston PM, Grundy J, Abdelrazek M, Kensing F. Understanding the Methodological Issues and Solutions in the Research Design of Stroke Caregiving Technology. Front Public Health 2021; 9:647249. [PMID: 33937175 PMCID: PMC8085388 DOI: 10.3389/fpubh.2021.647249] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
The rise in the number of cases of stroke has resulted in a significant burden on the healthcare system. As a result, the majority of care for the person living with stroke occurs within the community, resulting in caregivers being a central and challenged agent in care. To better support caregivers during the recovery trajectory poststroke, we investigated the role of health technologies to promote education and offer various kinds of support. However, the introduction of any new technology comes with challenges due to the growing need for more user-centric systems. The integration of user-centric systems in stroke caregiving has the potential to ensure long-term acceptance, success, and engagement with the technology, thereby ensuring better care for the person living with stroke. We first briefly characterize the affordances of available technologies for stroke caregiving. We then discuss key methodological issues related to the acceptance to such technologies. Finally, we suggest user-centered design strategies for mitigating such challenges.
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Affiliation(s)
- Elton H Lobo
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, VIC, Australia.,Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Lene J Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - John Grundy
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, VIC, Australia
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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15
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Hewner S, Chen C, Anderson L, Pasek L, Anderson A, Popejoy L. Transitional Care Models for High-Need, High-Cost Adults in the United States: A Scoping Review and Gap Analysis. Prof Case Manag 2021; 26:82-98. [PMID: 32467513 PMCID: PMC10576263 DOI: 10.1097/ncm.0000000000000442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose of Study: This scoping review explored research literature on the integration and coordination of services for high-need, high-cost (HNHC) patients in an attempt to answer the following questions: What models of transitional care are utilized to manage HNHC patients in the United States ? and How effective are they in reducing low-value utilization and in improving continuity ? Primary Practice Settings: U.S. urban, suburban, and rural health care sites within primary care, veterans’ services, behavioral health, and palliative care. Methodology and Sample: Utilizing the Joanna Briggs Institute and PRISMA guidelines for scoping reviews, a stepwise method was applied to search multiple databases for peer-reviewed published research on transitional care models serving HNHC adult patients in the United States from 2008 to 2018. All eligible studies were included regardless of quality rating. Exclusions were foreign models, studies published prior to 2008, review articles, care reports, and studies with participants younger than 18 years. The search returned 1,088 studies, of which 19 were included. Results: Four studies were randomized controlled trials and other designs included case reports and observational, quasi-experimental, cohort, and descriptive studies. Studies focused on Medicaid, Medicare, dual-eligible patients, veterans, and the uninsured or underinsured. High-need, high-cost patients were identified on the basis of prior utilization patterns of inpatient and emergency department visits, high cost, multiple chronic medical diagnoses, or a combination of these factors. Tools used to identify these patients included the hierarchical condition category predictive model, the Elder Risk Assessment, and the 4-year prognostic index score. The majority of studies combined characteristics of multiple case management models with varying levels of impact. Implications for Case Management Practice:
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Affiliation(s)
- Sharon Hewner
- Sharon Hewner, PhD, RN, FAAN, is a faculty in the Department of the Family, Community and Health Systems Science Department in the University at Buffalo School of Nursing. Her research focuses on implementing technology-supported care management interventions to improve transitional care for persons with social needs and multiple chronic conditions
- Chiahui Chen, MS, RN, FNP-BC, is a University at Buffalo School of Nursing PhD candidate. Her research interests are concerned with the development of a comprehensive understanding of end-of-life care in the intensive care unit and the improvement of nursing care to enhance the quality of end of life
- Linda Anderson, BSN, RN, is a PhD student in Sinclair School of Nursing at the University of Missouri-Columbia. Her doctoral research focuses on exploring functional status, health care experiences, and health-related quality of life in older women with chronic illness and disability
- Lana Pasek, EdM, MSN, ANP-BC, CCRN, CNRN, is a University at Buffalo Nursing doctoral student. She is an adult nurse practitioner with experience managing high-need, high-cost patients in a county hospital and an inner-city clinic. Her research interest is the development of patient-reported outcome measures for chronic diseases
- Amanda Anderson, MSN, MPA, RN, is a University at Buffalo Nursing doctoral student. Amanda develops care transitions programs utilizing nurses and telehealth, and she is a contributing editor for the American Journal of Nursing . Her research looks at gaps homeless patients face when transitioning between community-based and acute care institutions
- Lori Popejoy, PhD, RN, FAAN, is the Associate Dean for Innovation and Partnerships in Sinclair School of Nursing at the University of Missouri. She is a health system researcher focused on understanding the complex issues surrounding care to older adults across the continuum and implementation of evidence-based approaches to care coordination
| | - Chiahui Chen
- Sharon Hewner, PhD, RN, FAAN, is a faculty in the Department of the Family, Community and Health Systems Science Department in the University at Buffalo School of Nursing. Her research focuses on implementing technology-supported care management interventions to improve transitional care for persons with social needs and multiple chronic conditions
- Chiahui Chen, MS, RN, FNP-BC, is a University at Buffalo School of Nursing PhD candidate. Her research interests are concerned with the development of a comprehensive understanding of end-of-life care in the intensive care unit and the improvement of nursing care to enhance the quality of end of life
- Linda Anderson, BSN, RN, is a PhD student in Sinclair School of Nursing at the University of Missouri-Columbia. Her doctoral research focuses on exploring functional status, health care experiences, and health-related quality of life in older women with chronic illness and disability
- Lana Pasek, EdM, MSN, ANP-BC, CCRN, CNRN, is a University at Buffalo Nursing doctoral student. She is an adult nurse practitioner with experience managing high-need, high-cost patients in a county hospital and an inner-city clinic. Her research interest is the development of patient-reported outcome measures for chronic diseases
- Amanda Anderson, MSN, MPA, RN, is a University at Buffalo Nursing doctoral student. Amanda develops care transitions programs utilizing nurses and telehealth, and she is a contributing editor for the American Journal of Nursing . Her research looks at gaps homeless patients face when transitioning between community-based and acute care institutions
- Lori Popejoy, PhD, RN, FAAN, is the Associate Dean for Innovation and Partnerships in Sinclair School of Nursing at the University of Missouri. She is a health system researcher focused on understanding the complex issues surrounding care to older adults across the continuum and implementation of evidence-based approaches to care coordination
| | - Linda Anderson
- Sharon Hewner, PhD, RN, FAAN, is a faculty in the Department of the Family, Community and Health Systems Science Department in the University at Buffalo School of Nursing. Her research focuses on implementing technology-supported care management interventions to improve transitional care for persons with social needs and multiple chronic conditions
- Chiahui Chen, MS, RN, FNP-BC, is a University at Buffalo School of Nursing PhD candidate. Her research interests are concerned with the development of a comprehensive understanding of end-of-life care in the intensive care unit and the improvement of nursing care to enhance the quality of end of life
- Linda Anderson, BSN, RN, is a PhD student in Sinclair School of Nursing at the University of Missouri-Columbia. Her doctoral research focuses on exploring functional status, health care experiences, and health-related quality of life in older women with chronic illness and disability
- Lana Pasek, EdM, MSN, ANP-BC, CCRN, CNRN, is a University at Buffalo Nursing doctoral student. She is an adult nurse practitioner with experience managing high-need, high-cost patients in a county hospital and an inner-city clinic. Her research interest is the development of patient-reported outcome measures for chronic diseases
- Amanda Anderson, MSN, MPA, RN, is a University at Buffalo Nursing doctoral student. Amanda develops care transitions programs utilizing nurses and telehealth, and she is a contributing editor for the American Journal of Nursing . Her research looks at gaps homeless patients face when transitioning between community-based and acute care institutions
- Lori Popejoy, PhD, RN, FAAN, is the Associate Dean for Innovation and Partnerships in Sinclair School of Nursing at the University of Missouri. She is a health system researcher focused on understanding the complex issues surrounding care to older adults across the continuum and implementation of evidence-based approaches to care coordination
| | - Lana Pasek
- Sharon Hewner, PhD, RN, FAAN, is a faculty in the Department of the Family, Community and Health Systems Science Department in the University at Buffalo School of Nursing. Her research focuses on implementing technology-supported care management interventions to improve transitional care for persons with social needs and multiple chronic conditions
- Chiahui Chen, MS, RN, FNP-BC, is a University at Buffalo School of Nursing PhD candidate. Her research interests are concerned with the development of a comprehensive understanding of end-of-life care in the intensive care unit and the improvement of nursing care to enhance the quality of end of life
- Linda Anderson, BSN, RN, is a PhD student in Sinclair School of Nursing at the University of Missouri-Columbia. Her doctoral research focuses on exploring functional status, health care experiences, and health-related quality of life in older women with chronic illness and disability
- Lana Pasek, EdM, MSN, ANP-BC, CCRN, CNRN, is a University at Buffalo Nursing doctoral student. She is an adult nurse practitioner with experience managing high-need, high-cost patients in a county hospital and an inner-city clinic. Her research interest is the development of patient-reported outcome measures for chronic diseases
- Amanda Anderson, MSN, MPA, RN, is a University at Buffalo Nursing doctoral student. Amanda develops care transitions programs utilizing nurses and telehealth, and she is a contributing editor for the American Journal of Nursing . Her research looks at gaps homeless patients face when transitioning between community-based and acute care institutions
- Lori Popejoy, PhD, RN, FAAN, is the Associate Dean for Innovation and Partnerships in Sinclair School of Nursing at the University of Missouri. She is a health system researcher focused on understanding the complex issues surrounding care to older adults across the continuum and implementation of evidence-based approaches to care coordination
| | - Amanda Anderson
- Sharon Hewner, PhD, RN, FAAN, is a faculty in the Department of the Family, Community and Health Systems Science Department in the University at Buffalo School of Nursing. Her research focuses on implementing technology-supported care management interventions to improve transitional care for persons with social needs and multiple chronic conditions
- Chiahui Chen, MS, RN, FNP-BC, is a University at Buffalo School of Nursing PhD candidate. Her research interests are concerned with the development of a comprehensive understanding of end-of-life care in the intensive care unit and the improvement of nursing care to enhance the quality of end of life
- Linda Anderson, BSN, RN, is a PhD student in Sinclair School of Nursing at the University of Missouri-Columbia. Her doctoral research focuses on exploring functional status, health care experiences, and health-related quality of life in older women with chronic illness and disability
- Lana Pasek, EdM, MSN, ANP-BC, CCRN, CNRN, is a University at Buffalo Nursing doctoral student. She is an adult nurse practitioner with experience managing high-need, high-cost patients in a county hospital and an inner-city clinic. Her research interest is the development of patient-reported outcome measures for chronic diseases
- Amanda Anderson, MSN, MPA, RN, is a University at Buffalo Nursing doctoral student. Amanda develops care transitions programs utilizing nurses and telehealth, and she is a contributing editor for the American Journal of Nursing . Her research looks at gaps homeless patients face when transitioning between community-based and acute care institutions
- Lori Popejoy, PhD, RN, FAAN, is the Associate Dean for Innovation and Partnerships in Sinclair School of Nursing at the University of Missouri. She is a health system researcher focused on understanding the complex issues surrounding care to older adults across the continuum and implementation of evidence-based approaches to care coordination
| | - Lori Popejoy
- Sharon Hewner, PhD, RN, FAAN, is a faculty in the Department of the Family, Community and Health Systems Science Department in the University at Buffalo School of Nursing. Her research focuses on implementing technology-supported care management interventions to improve transitional care for persons with social needs and multiple chronic conditions
- Chiahui Chen, MS, RN, FNP-BC, is a University at Buffalo School of Nursing PhD candidate. Her research interests are concerned with the development of a comprehensive understanding of end-of-life care in the intensive care unit and the improvement of nursing care to enhance the quality of end of life
- Linda Anderson, BSN, RN, is a PhD student in Sinclair School of Nursing at the University of Missouri-Columbia. Her doctoral research focuses on exploring functional status, health care experiences, and health-related quality of life in older women with chronic illness and disability
- Lana Pasek, EdM, MSN, ANP-BC, CCRN, CNRN, is a University at Buffalo Nursing doctoral student. She is an adult nurse practitioner with experience managing high-need, high-cost patients in a county hospital and an inner-city clinic. Her research interest is the development of patient-reported outcome measures for chronic diseases
- Amanda Anderson, MSN, MPA, RN, is a University at Buffalo Nursing doctoral student. Amanda develops care transitions programs utilizing nurses and telehealth, and she is a contributing editor for the American Journal of Nursing . Her research looks at gaps homeless patients face when transitioning between community-based and acute care institutions
- Lori Popejoy, PhD, RN, FAAN, is the Associate Dean for Innovation and Partnerships in Sinclair School of Nursing at the University of Missouri. She is a health system researcher focused on understanding the complex issues surrounding care to older adults across the continuum and implementation of evidence-based approaches to care coordination
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Community-Based Interventions for Stroke Provided by Nurses and Community Health Workers: A Review of the Literature. J Neurosci Nurs 2021; 52:152-159. [PMID: 32341258 DOI: 10.1097/jnn.0000000000000512] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Community-based interventions are vital for facilitating poststroke recovery, increasing community participation, and raising awareness about stroke survivors. To optimize recovery and community reintegration, there is a need to understand research findings on community-based interventions that focus on stroke survivors and their caregivers. Although nurses and community health workers (CHWs) are commonly involved in community-based interventions, less is known about their roles relative to other poststroke rehabilitation professionals (physical therapists, occupational therapists, and speech-language pathologists). Thus, the purpose of this review is to explore research focused on improving community-based stroke recovery for adult stroke survivors, caregivers, or both when delivered by nurses or CHWs. METHODS A systematic review using Scopus, PubMed, EBSCOhost, MEDLINE, CINAHL Complete, and PsycInfo was completed to identify community-based poststroke intervention studies using nurses or CHWs through August 2018. RESULTS Eighteen studies meeting inclusion criteria from 9 countries were identified. Details regarding nurses' and CHWs' roles were limited or not discussed. Interventions emphasized stroke survivor self-care and caregiver support and were offered face-to-face and in group sessions in the community and home. A wide range of instruments were used to measure outcomes. The results of the interventions provided were mixed. Improvements were observed in perceptions of health, quality of life, knowledge, self-efficacy, self-management, and caregiver support. CONCLUSION Nurses and CHWs play a pivotal role in community-based care. Evidence suggests community-based interventions facilitate the necessary support for stroke survivors, caregivers, families, and communities to optimize stroke recovery. Data from this review illustrate a continued need for comprehensive programs designed to address the complex needs of stroke survivors and families when they return to their homes and communities.
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17
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Betz CL, Zalon ML, Caramanica L, Arslanian-Engoren C. Nurse competencies for transitions of care: Implications for education and practice. Nurs Forum 2020; 56:358-364. [PMID: 33373047 DOI: 10.1111/nuf.12544] [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: 10/22/2020] [Revised: 11/24/2020] [Accepted: 12/13/2020] [Indexed: 11/27/2022]
Abstract
Although there are a number of transitions of care initiatives that address specific needs as patients move across healthcare settings, adverse events still occur during handoffs. Transitions of care create periods of vulnerability for populations with complex needs that include communication gaps, medication changes, and poorly coordinated treatment plans, often without involving patients and their families. This paper outlines what nurses need to know to provide for safe transitions of care across the healthcare continuum. The theoretical basis for transitions of care at the macro level, examples of nurse-led models for transitions of care, and key activities and implications for nursing education and practice are described. A holistic framework for effective transitions of care across healthcare settings can guide nursing educators in the development of specific nursing competencies for transitions of care.
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Affiliation(s)
- Cecily L Betz
- University of Southern California Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Margarete L Zalon
- University of Scranton Department of Nursing, Scranton, Pennsylvania, USA
| | - Laura Caramanica
- Tanner Health System School of Nursing, University of West Georgia, Carrollton, Georgia, USA
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18
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Unscheduled Care Access in the United States-A Tale of Two Emergency Departments. Am J Emerg Med 2020; 45:374-377. [PMID: 33143957 DOI: 10.1016/j.ajem.2020.08.095] [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: 07/22/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Rural communities face challenges in accessing healthcare services due to physician shortages and limited unscheduled care capabilities in office settings. As a result, rural hospital-based Emergency Departments (ED) may disproportionately provide acute, unscheduled care needs. We sought to examine differences in ED utilization and the relative role of the ED in providing access to unscheduled care between rural and urban communities. METHODS Using a 20% sample of the 2012 Medicare Chronic Condition Warehouse, we studied the overall ED visit rate and the unscheduled care rate by geography using the Dartmouth Atlas' hospital referral regions (HRR). We calculated HRR urbanicity as the proportion of beneficiaries residing in an urban zip code within each HRR. We report descriptive statistics and utilize K-means clustering based on the ED visit rates and unscheduled care rates. RESULTS We found rural ED use is more common and disproportionately the site of unscheduled care delivery when compared to urban communities. The ED visit and. unscheduled care proportions were negatively correlated with increased urbanicity (r =. -0.48, p < 0.001; r = -0.58, p < 0.001). CONCLUSION The use and role of EDs by Medicare beneficiaries appears to be substantially different between urban and rural areas. This suggests that the ED may play a distinct role within the healthcare delivery system of rural communities that face disproportionate barriers to care access.
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19
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van Niekerk SM, Inglis-Jassiem G, Kamalakannan S, Fernandes S, Webster J, English R, Smythe T, Louw QA. Achieving universal health coverage for people with stroke in South Africa: protocol for a scoping review. BMJ Open 2020; 10:e041221. [PMID: 33046479 PMCID: PMC7552861 DOI: 10.1136/bmjopen-2020-041221] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Stroke is the second most common cause of death after HIV/AIDS and a significant health burden in South Africa. The extent to which universal health coverage (UHC) is achieved for people with stroke in South Africa is unknown. Therefore, a scoping review to explore the opportunities and challenges within the South African health system to facilitate the achievement of UHC for people with stroke is warranted. METHODS AND ANALYSIS The scoping review will follow the approach recommended by Levac, Colquhoun and O'Brien, which includes five steps: (1) identifying the research question, (2) identifying relevant studies, (3) selecting the studies, (4) charting the data, and (5) collating, summarising and reporting the results. Health Systems Dynamics Framework and WHO Framework on integrated people-centred health services will be used to map, synthesise and analyse data thematically. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review, as it will only include published and publicly available data. The findings of this review will be published in an open-access, peer-reviewed journal and we will develop an accessible summary of the results for website posting and stakeholder meetings.
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Affiliation(s)
- Sjan-Mari van Niekerk
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gakeemah Inglis-Jassiem
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sureshkumar Kamalakannan
- SACDIR, Public Health Foundation of India, Gurgaon, India
- International Center for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Silke Fernandes
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jayne Webster
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, Stellenbosch University, Cape Town, South Africa
| | - Rene English
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, London, UK
| | - Tracey Smythe
- International Center for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Q A Louw
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Stellenbosch University, Cape Town, South Africa
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20
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Wang N, Albaroudi A, Chen J. Decomposing Urban and Rural Disparities of Preventable ED Visits Among Patients With Alzheimer's Disease and Related Dementias: Evidence of the Availability of Health Care Resources. J Rural Health 2020; 37:624-635. [PMID: 32613666 DOI: 10.1111/jrh.12465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to examine the urban and rural differences in the frequency of preventable Emergency Department (ED) visits among Alzheimer's Disease and Related Dementias (ADRD) patients, with a focus on the availability of health care resources in urban and rural areas. METHODS Linked datasets of 2015 State Emergency Department Databases from the Healthcare Cost and Utilization Project and the Area Health Resource File were used. ED discharges of 7 states were included in our analysis. We performed a state fixed-effect multivariable logistic regression to estimate the variation of preventable EDs by urban and rural areas. Individual characteristics and county-level health care resources were included in the estimation. The Oaxaca decomposition was used to quantify the association of county-level health care resources and urban/rural disparities. FINDINGS Rural patients with ADRD had 1.23 higher adjusted odds (P < .001) of going to the ED for a preventable visit compared to urban counterparts. The decomposition results showed that the model specification explained 49.2% of the differences between urban and rural patients. Patient residence in a mental health professional shortage area is one of the driving factors (contributing to 27%-48%) that explained the urban and rural disparities. CONCLUSIONS Our study demonstrates the importance of improving health care resources in rural areas to improve health care quality and outcomes among ADRD patients who reside in rural areas. Future research and data collection on unobserved factors, such as health care quality, will be helpful in explaining the geographic differences.
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Affiliation(s)
- Nianyang Wang
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
| | - Asmaa Albaroudi
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, Maryland
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21
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Sutton KM, Hunter EG, Logsdon B, Santella B, Kitzman PH. The Role of Physical Therapy in Multiple Risk Factor Management Poststroke: A Scoping Review. J Geriatr Phys Ther 2020; 44:165-174. [PMID: 32511115 DOI: 10.1519/jpt.0000000000000248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Individuals after stroke often have multiple chronic conditions, such as hypertension, diabetes, dyslipidemia, obesity, and tobacco use. These comorbidities not only are commonly found in individuals with stroke, but also negatively affect functional outcomes and increase risk for hospital readmission and overall mortality. It is important for physical therapists to address the whole person during treatment after stroke, including comorbidities, not just the problems resulting from the stroke itself. However, it is unclear how common it is for physical therapists to address multiple diagnoses at once using a wellness model. Therefore, the purpose of this scoping review was to examine current evidence regarding the role of physical therapy in addressing modifiable risk factors for individuals after stroke, to identify gaps in research associated with physical therapy management of related comorbid diagnoses during treatment for stroke. METHODS A scoping review methodology was utilized searching PubMed and CINAHL databases to identify interventional research studies specifically addressing multiple modifiable risk factors utilizing physical therapy for individuals after stroke. RESULTS The initial search yielded 5358 articles and 12 articles met full inclusion criteria. Only 2 studies included participants with significant mobility impairments, and none included individuals with communication impairments. Only 4 of the 12 studies provided education in their design. Eight studies did not include any patient-reported outcome measures. Only 3 studies included long-term follow-up assessments. DISCUSSION Secondary stroke risk factors can be positively addressed using physical therapy interventions; however, more research is needed regarding individuals with moderate to severe mobility or communication deficits. Opportunities for physical therapy research to address stroke risk factors in this complex population include expanding follow-up periods, improving educational interventions, and including caregivers in study design. CONCLUSIONS This review highlights the need for better integration of clinical considerations into stroke rehabilitation research as a whole, along with the need for additional research regarding the role physical therapy can play in addressing multimorbidity in individuals with stroke.
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Affiliation(s)
| | | | - Brooke Logsdon
- Department of Physical Therapy, University of Kentucky, Lexington
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22
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Hartley T, Burger M, Esterhuizen TM, Inglis-Jassiem G. Functional outcome of stroke inpatients according to human immunodeficiency virus status: A feasibility study. Afr J Disabil 2020; 9:618. [PMID: 32284924 PMCID: PMC7136685 DOI: 10.4102/ajod.v9i0.618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 01/27/2020] [Indexed: 11/24/2022] Open
Abstract
Background Stroke in human immunodeficiency virus positive (HIV+) individuals is becoming an increasing concern. Being significantly younger than typical stroke patients, the impact of functional challenges on quality of life and burden on society becomes more eminent. Objectives This feasibility study aims to determine the requirements for a large descriptive cohort, to adequately describe the functional outcome of stroke patients with varying HIV status. Method All stroke patients meeting the inclusion criteria were recruited over a 6-month period at a South African inpatient rehabilitation centre. Data were collected on admission and discharge using outcome measures including the Barthel Index (BI), Berg Balance Scale (BBS) and the use of assistive devices used to describe independence with activities of daily living (ADL), mobility and safety post-stroke. Statistical analysis was performed using Stata version 14.2. Results The feasibility study identified appropriate procedures and barriers to a successful study in addition to describing preliminary data on participant demographics, relevant medical history and functional outcomes post-stroke. Limitations that affected feasibility included minimal recruitment sites, length of data collection period, timely communication of participant discharge plans and dates, and confirmation of participant HIV status. An appropriate comparison between sub-groups could not be made because of disproportionate group sizes, median age differences and no assessor blinding. Conclusion To increase generalisability and the understanding of the unique HIV+ stroke profile, multiple recruitment sites, longer data collection periods, assessor blinding and age-matched groups with HIV status confirmation are recommended.
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Affiliation(s)
- Tasneem Hartley
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marlette Burger
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tonya M Esterhuizen
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gakeemah Inglis-Jassiem
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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23
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Harrington RA, Califf RM, Balamurugan A, Brown N, Benjamin RM, Braund WE, Hipp J, Konig M, Sanchez E, Joynt Maddox KE. Call to Action: Rural Health: A Presidential Advisory From the American Heart Association and American Stroke Association. Circulation 2020; 141:e615-e644. [PMID: 32078375 DOI: 10.1161/cir.0000000000000753] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Understanding and addressing the unique health needs of people residing in rural America is critical to the American Heart Association's pursuit of a world with longer, healthier lives. Improving the health of rural populations is consistent with the American Heart Association's commitment to health equity and its focus on social determinants of health to reduce and ideally to eliminate health disparities. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders to make rural populations a priority in programming, research, and policy. This advisory first summarizes existing data on rural populations, communities, and health outcomes; explores 3 major groups of factors underlying urban-rural disparities in health outcomes, including individual factors, social determinants of health, and health delivery system factors; and then proposes a set of solutions spanning health system innovation, policy, and research aimed at improving rural health.
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Chen Y, Patel MB, McNaughton CD, Malin BA. Interaction patterns of trauma providers are associated with length of stay. J Am Med Inform Assoc 2019; 25:790-799. [PMID: 29481625 DOI: 10.1093/jamia/ocy009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/26/2018] [Indexed: 01/08/2023] Open
Abstract
Background Trauma-related hospitalizations drive a high percentage of health care expenditure and inpatient resource consumption, which is directly related to length of stay (LOS). Robust and reliable interactions among health care employees can reduce LOS. However, there is little known about whether certain patterns of interactions exist and how they relate to LOS and its variability. The objective of this study is to learn interaction patterns and quantify the relationship to LOS within a mature trauma system and long-standing electronic medical record (EMR). Methods We adapted a spectral co-clustering methodology to infer the interaction patterns of health care employees based on the EMR of 5588 hospitalized adult trauma survivors. The relationship between interaction patterns and LOS was assessed via a negative binomial regression model. We further assessed the influence of potential confounders by age, number of health care encounters to date, number of access action types care providers committed to patient EMRs, month of admission, phenome-wide association study codes, procedure codes, and insurance status. Results Three types of interaction patterns were discovered. The first pattern exhibited the most collaboration between employees and was associated with the shortest LOS. Compared to this pattern, LOS for the second and third patterns was 0.61 days (P = 0.014) and 0.43 days (P = 0.037) longer, respectively. Although the 3 interaction patterns dealt with different numbers of patients in each admission month, our results suggest that care was provided for similar patients. Discussion The results of this study indicate there is an association between LOS and the extent to which health care employees interact in the care of an injured patient. The findings further suggest that there is merit in ascertaining the content of these interactions and the factors that induce these differences in interaction patterns within a trauma system.
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Affiliation(s)
- You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mayur B Patel
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Emergency General Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Candace D McNaughton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bradley A Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biostatistics, School of Medicine, Vanderbilt University, Nashville, TN, USA.,Department of Electrical Engineering and Computer Science, School of Engineering, Vanderbilt University, Nashville, TN, USA
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The Prevalence of Multiple Comorbidities in Stroke Survivors in Rural Appalachia and the Clinical Care Implications. J Stroke Cerebrovasc Dis 2019; 28:104358. [PMID: 31519456 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 08/09/2019] [Accepted: 08/14/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The majority of studies on multimorbidity have been in aging populations and there is a paucity of data on individuals following stroke. OBJECTIVE In order to better understand the overall complexity of the stroke population in rural Kentucky, we examined the prevalence of multimorbidity that impact the overall long-term health and health care for these individuals. METHODS A secondary analysis examined whether there are gender or age differences in this stroke population related to the prevalence of multimorbidity. A total of 5325 individuals, 18 years of age and older, seen at an academic medical center for the primary diagnosis of acute ischemic stroke or transient ischemic attack between the years of 2010-2017 were identified using the Kentucky Appalachian Stroke Registry. Descriptive analysis was used to report the prevalence of each comorbidity in the rural population by age group, gender, and level of multimorbidity by looking at concurrent frequencies. RESULTS Overall, hypertension, dyslipidemia, tobacco use, diabetes, and obesity were the comorbidities with the highest prevalence in our population irrespective of gender. Over 78% (n = 4153) of the individuals had 3 or more comorbidities while 61% (n = 3285) had at least 3 out of the top 5 comorbidities (hypertension, hyperlipidemia, tobacco, obesity, diabetes). With respect to age, 15% (n = 795) of the sample was under the age of 50, while 32% (n = 1704) were between the age of 50 and 64 and 53% (n = 2826) of the sample were 65 years or older. CONCLUSIONS The results of this study indicate the majority of individuals affected by stroke in rural Appalachia Kentucky have multimorbidity. In addition, almost half of these individuals are having their strokes at a younger age, which will require a shift in the focus for therapeutic interventions (eg, reintegration into the workforce versus just community reintegration).
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26
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McInnis RP, Lee AJ, Schwartz B, Fazal M, Hohler A. A quality improvement curriculum for the neurology clerkship: A practice-based approach to discharge education. eNeurologicalSci 2019; 16:100196. [PMID: 31341991 PMCID: PMC6630082 DOI: 10.1016/j.ensci.2019.100196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 06/13/2019] [Indexed: 01/02/2023] Open
Abstract
In the Neurology Clerkship at our institution, we introduced a medical education curriculum to increase student competency in providing discharge education to patients with neurologic disease, and to increase knowledge of QI principles. The curriculum was peer-based, in that it was developed by medical students, experienced by medical student clerks, and modified over time with their feedback, which was tracked using exit surveys. Patients counseled were predominantly male (67%) and white (55%), with stroke or TIA together representing the most common diagnoses (58%). A high proportion of students (>85%) agreed that the clerkship project was effective in teaching discharge education, the risk factors for readmission, and increased confidence in providing discharge education. We conclude that medical students are poised to learn QI principals through practice-based curricula, and through practice may improve the quality and safety of care for patients with neurologic disease. This curriculum can be implemented within other services, and with different learners.
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Affiliation(s)
- Robert P. McInnis
- Brigham and Women's Hospital, Massachusetts General Hospital, Departments of Neurology, United States of America
| | - Andrew J. Lee
- Boston University School of Medicine, Department of Neurology, United States of America
- New York University Langone, Department of Neurology, United States of America
| | - Brian Schwartz
- Boston University School of Medicine, Department of Neurology, United States of America
| | - Muhammad Fazal
- Boston University School of Medicine, Department of Neurology, United States of America
| | - Anna Hohler
- St. Elizabeth's Medical Center, Department of Neurology, United States of America
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27
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Ross KH, Patzer RE, Goldberg D, Osborne NH, Lynch RJ. Rural-Urban Differences in In-Hospital Mortality Among Admissions for End-Stage Liver Disease in the United States. Liver Transpl 2019; 25:1321-1332. [PMID: 31206223 DOI: 10.1002/lt.25587] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 06/10/2019] [Indexed: 02/07/2023]
Abstract
Access to quality hospital care is a persistent problem for rural patients. Little is known about disparities between rural and urban populations regarding in-hospital outcomes for end-stage liver disease (ESLD) patients. We aimed to determine whether rural ESLD patients experienced higher in-hospital mortality than urban patients and whether disparities were attributable to the rurality of the patient or the center. This was a retrospective study of patient admissions in the National Inpatient Sample, a population-based sample of hospitals in the United States. Admissions were included if they were from adult patients who had an ESLD-related admission defined by codes from the International Classification of Diseases, Ninth Revision, between January 2012 and December 2014. The primary exposures of interest were patient-level rurality and hospital-level rurality. The main outcome was in-hospital mortality. We stratified our analysis by disease severity score. After accounting for patient- and hospital-level covariates, ESLD admissions to rural hospitals in every category of disease severity had significantly higher odds of in-hospital mortality than patient admissions to urban hospitals. Those with moderate or major risk of dying had more than twice the odds of in-hospital mortality (odds ratio [OR] for moderate risk, 2.41; 95% confidence interval [CI], 1.62-3.59; OR for major risk, 2.49; 95% CI, 1.97-3.14). There was no association between patient-level rurality and mortality in the adjusted models. In conclusion, ESLD patients admitted to rural hospitals had increased odds of in-hospital mortality compared with those admitted to urban hospitals, and the differences were not attributable to patient-level rurality. Our results suggest that interventions to improve outcomes in this population should focus on the level of the health system.
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Affiliation(s)
- Katherine H Ross
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Emory University, Atlanta, GA
| | - Rachel E Patzer
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Emory University, Atlanta, GA.,Division of Transplantation, Department of Surgery, Emory University School of Medicine, Emory University, Atlanta, GA
| | - David Goldberg
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Nicolas H Osborne
- Division of Vascular Surgery, Department of Surgery, School of Medicine, University of Michigan, Ann Arbor, MI
| | - Raymond J Lynch
- Department of Epidemiology, Rollins School of Public Health, Emory University School of Medicine, Emory University, Atlanta, GA.,Division of Transplantation, Department of Surgery, Emory University School of Medicine, Emory University, Atlanta, GA
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28
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Ma C, Bao S, Dull P, Wu B, Yu F. Hospital readmission in persons with dementia: A systematic review. Int J Geriatr Psychiatry 2019; 34:1170-1184. [PMID: 31087373 DOI: 10.1002/gps.5140] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 05/05/2019] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Hospital readmission in persons with dementia is becoming a critical safety and cost issue. The purpose of this review is to systematically assess published evidence on hospital readmissions in persons with dementia, including rate, clinical reasons, risk factors, and prevention programs. METHODS A systematic review of relevant literature was conducted. Literature were searched in PubMed, CINAHL, PsycINFO, and Embase as well as hand searching. Quality of reviewed studies were assessed independently by reviewers using quality assessment checklists. RESULTS Nineteen studies met the inclusion criteria and were reviewed. In persons with dementia, all-cause 30-day readmission rate was most frequently reported and ranged from 7% to 35%. Compared with those without dementia, persons with dementia had significantly higher rate of readmission. Reported risk factors of readmission varied across studies from patient sociodemographic and clinical status, history of health care utilization, to family caregivers. Reasons for readmission were rarely documented. Programs of home-based individualized care and interdisciplinary team care were used for preventing readmissions. Findings from some of the studies were limited by small sample sizes, single data source, and other methodologic flaws. CONCLUSIONS Persons with dementia are at high risk for hospital readmission, but many of the readmissions are potentially preventable. Multiple strategies such like identifying high-risk individuals and the clinical reasons for index admission and readmission and implementing home-based individualized care by interdisciplinary team can reduce preventable hospital readmissions. Future studies should use multiple national data sources and advanced methodology to identify risk factors and clinical reasons of hospital readmissions.
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Affiliation(s)
- Chenjuan Ma
- New York University Rory Meyers College of Nursing, New York, NY
| | - Silin Bao
- New York University Rory Meyers College of Nursing, New York, NY
| | - Peter Dull
- New York University Rory Meyers College of Nursing, New York, NY
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, NY
| | - Fang Yu
- University of Minnesota School of Nursing, Minneapolis, MN
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Community Health Workers in the Emergency Department-Can they Help with Chronic Hypertension Care. Curr Hypertens Rep 2019; 21:49. [PMID: 31115736 DOI: 10.1007/s11906-019-0955-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
PURPOSE OF REVIEW To review community health worker (CHW) interventions tailored for hypertension management and to determine if the emergency department (ED) population would benefit from such interventions. RECENT FINDINGS When working with patients who have one or more chronic diseases, CHW interventions have been very successful in improving health outcomes and are cost-effective. CHWs use a variety of techniques to address social determinants that patients may face that effect how they manage their chronic disease(s). Current CHW interventions in the ED have targeted the "super-user" population. CHW-based interventions help address social determinants of patients in a variety of settings, especially in the ED where the physicians have limited resources and time. There is limited information about how CHWs can improve community health outcomes outside of the ED "super-user" population. Future research needs to determine if creating a data-driven CHW intervention for the ED would be effective.
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30
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Ruiz-Pérez I, Bastos Á, Serrano-Ripoll MJ, Ricci-Cabello I. Effectiveness of interventions to improve cardiovascular healthcare in rural areas: a systematic literature review of clinical trials. Prev Med 2019; 119:132-144. [PMID: 30597226 DOI: 10.1016/j.ypmed.2018.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 12/16/2022]
Abstract
The objective of this systematic literature review is to examine the impact of interventions to improve cardiovascular disease healthcare provided to people living in rural areas. Systematic electronic searches were conducted in Medline, CINAHL, Embase, Scopus, and Web of Knowledge in July 2018. We included clinical trials assessing the effectiveness of interventions to improve cardiovascular disease healthcare in rural areas. Study eligibility assessment, data extraction, and critical appraisal were undertaken by two reviewers independently. We identified 18 trials (18 interventions). They targeted myocardial infarction (five interventions), stroke (eight), and heart failure (five). All the interventions for myocardial infarction were based on organizational changes (e.g. implementation of mobile coronary units). They consistently reduced time to treatment and decreased mortality. All the interventions for heart failure were based on the provision of patient education. They consistently improved patient knowledge and self-care behaviour, but mortality reductions were reported in only some of the trials. Among the interventions for stroke, those based on the implementation of telemedicine (tele-stroke systems or tele-consultations) improved monitoring of stroke survivors; those based on new or enhanced rehabilitation services did not consistently improve mortality or physical function; whereas educational interventions effectively improved patient knowledge and behavioural outcomes. In conclusion, a number of different strategies (based on enhancing structures and providing patient education) have been proposed to improve cardiovascular disease healthcare in rural areas. Although available evidence show that these interventions can improve healthcare processes, their impact on mortality and other important health outcomes still remains to be established.
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Affiliation(s)
- Isabel Ruiz-Pérez
- Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011 Granada, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Ibs. Instituto de Investigación Biosanitaria de Granada, Spain.
| | - Ángel Bastos
- Andalusian School of Public Health, Cuesta del Observatorio, 4, 18011 Granada, Spain
| | - Maria Jesús Serrano-Ripoll
- Balearic Islands Health Research Institute (IdISBa), Spain; Atención Primaria Mallorca, IB-Salut, Spain; Universitat de les Illes Balears (UIB), Departament de Psicologia, Spain
| | - Ignacio Ricci-Cabello
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Balearic Islands Health Research Institute (IdISBa), Spain; Atención Primaria Mallorca, IB-Salut, Spain
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31
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Miller KK, Lin SH, Neville M. From Hospital to Home to Participation: A Position Paper on Transition Planning Poststroke. Arch Phys Med Rehabil 2018; 100:1162-1175. [PMID: 30465739 DOI: 10.1016/j.apmr.2018.10.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/18/2018] [Accepted: 10/27/2018] [Indexed: 12/25/2022]
Abstract
Based on a review of the evidence, members of the American Congress of Rehabilitation Medicine Stroke Group's Movement Interventions Task Force offer these 5 recommendations to help improve transitions of care for patients and their caregivers: (1) improving communication processes; (2) using transition specialists; (3) implementing a patient-centered discharge checklist; (4) using standardized outcome measures; and (5) establishing partnerships with community wellness programs. Because of changes in health care policy, there are incentives to improve transitions during stroke rehabilitation. Although transition management programs often include multidisciplinary teams, medication management, caregiver education, and follow-up care management, there is a lack of a comprehensive and standardized approach to implement transition management protocols during poststroke rehabilitation. This article uses the Transitions of Care (TOC) model to conceptualize how to facilitate a comprehensive patient-centered hand off at discharge to maximize patient functioning and health. Specifically, this article reviews current guidelines and provides an evidence summary of several commonly cited approaches (Early Supported Discharge, planned predischarge home visits, discharge checklists) to manage TOC, followed by a description of documented barriers to effective transitions. Patient-centered and standardized transition management may improve community integration, activities of daily living performance, and quality of life for stroke survivors while also decreasing hospital readmission rates during the transition from hospital to home to community.
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Affiliation(s)
- Kristine K Miller
- Department of Physical Therapy, Indiana University, Indianapolis, IN.
| | - Susan H Lin
- Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA
| | - Marsha Neville
- School of Occupational Therapy, Texas Woman's University, Dallas, TX
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Hay-McCutcheon MJ, Hyams A, Yang X, Parton J. Hearing loss and social support in urban and rural communities. Int J Audiol 2018; 57:610-617. [PMID: 29671659 DOI: 10.1080/14992027.2018.1461262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Perceived social support and hearing handicap were assessed in adults with and without hearing loss who lived in different geographical regions of Alabama. DESIGN The Hearing Handicap Inventory for Adults (HHIA) assessed emotional and social consequences of hearing loss. The Medical Outcomes Study (MOS) Social Support Survey and the Social Functioning, Role Emotional and Mental Health scales of the SF-36 were administered. STUDY SAMPLE Data were collected from 71 study participants with hearing loss and from 45 adults without hearing loss. RESULTS Degree of hearing loss and outcomes from the HHIA did not differ between adults who lived in rural or urban settings. Tangible support was poorer for adults with hearing loss who lived in rural settings compared to those who lived in urban settings. For adults without hearing loss, residency was not associated with tangible support. For these adults, income was associated with other types of social support (i.e. informational support, affection, positive social interaction). CONCLUSIONS Adults with hearing loss living in rural areas had poor perceived tangible support. The provision of support to address a hearing loss could be worse for these adults compared to adults who lived in urban settings.
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Affiliation(s)
| | - Adriana Hyams
- b Department of Psychology , The University of Alabama , Tuscaloosa , AL , USA.,c Department of Psychiatry , Rhode Island Hospital , Providence , RI , USA
| | - Xin Yang
- d Department of Information Systems, Statistics and Management Science , The University of Alabama , Tuscaloosa , AL , USA
| | - Jason Parton
- d Department of Information Systems, Statistics and Management Science , The University of Alabama , Tuscaloosa , AL , USA
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Kurpas D, Szwamel K, Lenarcik D, Guzek M, Prusaczyk A, Żuk P, Michalowska J, Grzeda A, Mroczek B. Effectiveness of Healthcare Coordination in Patients with Chronic Respiratory Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1040:47-62. [PMID: 28801791 DOI: 10.1007/5584_2017_84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Coordination of healthcare effectively prevents exacerbations and reduces the number of hospitalizations, emergency visits, and the mortality rate in patients with chronic respiratory diseases. The purpose of this study was to determine clinical effectiveness of ambulatory healthcare coordination in chronic respiratory patients and its effect on the level of healthcare services as an indicator of direct medical costs. We conducted a retrospective health record survey, using an online database of 550 patients with chronic respiratory diseases. There were decreases in breathing rate, heart rate, and the number of cigarettes smoked per day, and forced vital capacity (FVC) and forced expired volume in 1 s (FEV1) increased after the implementation of the coordinated healthcare structure. These benefits were accompanied by increases in the number of visits to the pulmonary outpatient clinic (p < 0.001), diagnostic costs (p < 0.001), and referrals to other outpatient clinics (p < 0.003) and hospitals (p < 0.001). The advantageous effects of healthcare coordination on clinical status of respiratory patients above outlined persisted over a 3-year period being reviewed.
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Affiliation(s)
- Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, 1 Syrokomli St., 51-141, Wroclaw, Poland.
- Opole Medical School, 68 Katowicka Street, 45-060, Opole, Poland.
| | - Katarzyna Szwamel
- Department of Family Medicine, Wroclaw Medical University, 1 Syrokomli St., 51-141, Wroclaw, Poland
- Opole Medical School, 68 Katowicka Street, 45-060, Opole, Poland
| | - Dorota Lenarcik
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Marika Guzek
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Artur Prusaczyk
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Paweł Żuk
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | | | - Agnieszka Grzeda
- Medical and Diagnostic Center, 2 Kleeberg Street, 08-110, Siedlce, Poland
| | - Bożena Mroczek
- Department of Humanities in Medicine, Pomeranian Medical University, 11 Generała Chlapowskiego Street, 70-204, Szczecin, Poland
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Fausto MCR, Campos EMS, Almeida PF, Medina MG, Giovanella L, Bousquat A, Carneiro A, Jerônimo AS, Aleluia ÍRS, Borges GA, Mota PHDS. Therapeutic itineraries for patients with cerebrovascular accident: fragmentation of care in a regionalized health network. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2017. [DOI: 10.1590/1806-9304201700s100004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to analyze the itineraries of patients with cerebrovascular accident (CVA) in the Interstate health region in San Francisco Valley. Methods: this study uses the qualitative approach through the construction of Therapeutic Itineraries (IT). In the IT mapping the observation was prioritized on the different points and forms to access health service in search of care. Results: sixteen semi-structured interviews with healthcare users were conducted. There were diverse forms to access and provide services at the Rede Interestadual de Atenção à Saúde do Vale do Médio São Francisco-PEBA (Interstate Healthcare Network Region in the San Francisco Valley), which could be characterized by disorganized and uncoordinated care in the analyzed cases, despite the guarantee of hospital care. The Primary Health Care (APS) teams are present at a care point with most of the patients' itineraries, however, little integration to the regionalized network and they were unable to perform their functions and coordinate the care. It is observed pilgrimage assistance, fragmented care and difficulties in receiving care after post hospitalization which is essential for the patients’ rehabilitation. Conclusions: traces of fragments of the regional health system are important warning signs that points out fragility in PEBA and demonstrate persistent gaps in the public health system to fulfil the responsibility and guarantee individuals’ right for health.
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