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Bachmann N, Zumbrunn A, Bayer-Oglesby L. Social and Regional Factors Predict the Likelihood of Admission to a Nursing Home After Acute Hospital Stay in Older People With Chronic Health Conditions: A Multilevel Analysis Using Routinely Collected Hospital and Census Data in Switzerland. Front Public Health 2022; 10:871778. [PMID: 35615032 PMCID: PMC9126315 DOI: 10.3389/fpubh.2022.871778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/13/2022] [Indexed: 12/15/2022] Open
Abstract
If hospitalization becomes inevitable in the course of a chronic disease, discharge from acute hospital care in older persons is often associated with temporary or persistent frailty, functional limitations and the need for help with daily activities. Thus, acute hospitalization represents a particularly vulnerable phase of transient dependency on social support and health care. This study examines how social and regional inequality affect the decision for an institutionalization after acute hospital discharge in Switzerland. The current analysis uses routinely collected inpatient data from all Swiss acute hospitals that was linked on the individual level with Swiss census data. The study sample included 60,209 patients 75 years old and older living still at a private home and being hospitalized due to a chronic health condition in 199 hospitals between 2010 and 2016. Random intercept multilevel logistic regression was used to assess the impact of social and regional factors on the odds of a nursing home admission after hospital discharge. Results show that 7.8% of all patients were admitted directly to a nursing home after hospital discharge. We found significant effects of education level (compulsory vs. tertiary education OR = 1.16 (95% CI: 1.03-1.30), insurance class (compulsory vs. private insurance OR = 1.24 (95% CI: 1.09-1.41), living alone vs. living with others (OR = 1.64; 95% CI: 1.53-1.76) and language regions (French vs. German speaking part: OR = 0.54; 95% CI: 0.37-0.80) on the odds of nursing home admission in a model adjusted for age, gender, nationality, health status, year of hospitalization and hospital-level variance. The language regions moderated the effect of education and insurance class but not of living alone. This study shows that acute hospital discharge in older age is a critical moment of transient dependency especially for socially disadvantaged patients. Social and health care should work coordinated together to avoid unnecessary institutionalizations.
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Affiliation(s)
- Nicole Bachmann
- Institute for Social Work and Health, School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland
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2
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Yen HY, Lin SC, Chi MJ. Exploration of risk factors for high-risk adverse events in elderly patients after discharge and comparison of discharge planning screening tools. J Nurs Scholarsh 2021; 54:7-14. [PMID: 34841651 DOI: 10.1111/jnu.12705] [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: 12/02/2020] [Revised: 05/12/2021] [Accepted: 07/08/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Discharge planning is an effective strategy to prevent adverse health events and reduce medical expenditures. The high-risk target populations of discharged elderly patients and important predictors for the occurrence of adverse events are still not clear. Therefore, the purposes of this study were to examine the validity of discharge planning screening tools in sufficiently identifying high-risk adverse events to health after discharge and to compare two screening tools with our study model. DESIGN We conducted a prospective study and recruited elderly patients who had had no hospitalization within 3 months before admission to 13 general wards of a medical center in northern Taiwan from November 2018 to May 2020. METHODS Elderly patients were randomly selected during the study period. Within 24 h of admission, patients were asked to consent to join this study. After the patient was discharged, the patient's health and hospitalization for the next year were tracked by telephone interviews. RESULTS In total, 300 participants were recruited for this study. Incidences of high-risk adverse events within 30 days, 60 days, and 12 months after discharge were 20.3%, 25.7%, and 48.7% respectively. A logistic regression showed that an increased age, physical or mental disabilities or a major illness, a low body-mass index, and having been hospitalized in the past year were significantly related to the occurrence of high-risk events among elderly discharge patients. The pooled sensitivity of the Pra was 52% and the specificity was 72%; the pooled sensitivity of the LACE index was 67% and the specificity was 36%. The predictive model of this study had a higher discriminatory power than the Pra and LACE index for high-risk events after discharge. CONCLUSIONS Elderly patients are more vulnerable to high-risk adverse events after discharge. Both the LACE index and Pra are useful discharge planning screening tools to screen for high-risk adverse events after discharge. Elderly patients need more-active and complete continuity of care plans and discharge planning services to ensure that the overall quality of patient care can be improved and readmissions and mortality reduced. CLINICAL RELEVANCE The findings of this study can provide information for discharge planning managers to identify high-risk elderly patients during hospitalization and promptly offer care education or resources to improve care management.
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Affiliation(s)
- Hsin-Yen Yen
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Siou-Chun Lin
- Master Program in Long-term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Preventive and Community Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mei-Ju Chi
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan.,Master Program in Long-term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
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3
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Kondo K, Noguchi N, Teshima R, Tanaka K, Lee B. Effects of a nurse–occupational therapist meeting on function and motivation in hospitalized elderly patients: A pilot randomized control trial. Br J Occup Ther 2021. [DOI: 10.1177/03080226211008720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction This pilot randomized controlled trial assessed the effectiveness of a nurse–occupational therapist meeting on improving motor and social-cognitive functions, as well as motivation, in a subacute hospital setting. Methods Participants were randomized to a weekly multidisciplinary team meeting group (‘control’, n = 20) or a nurse–occupational therapist meeting group (‘intervention’, n = 18). Medical care plans in both groups were discussed in the weekly meeting. In addition, the details of daily life problems for the intervention patients were discussed in the nurse–occupational therapist meeting. Outcome measures included motor and social-cognitive functions assessed by the Functional Independence Measure and motivation assessed by the Vitality Index. Assessment time points were at admission and discharge. Results In the intervention group, additional improvements were found in the Functional Independence Measure cognitive ( p = 0.048, r = 0.32) and the Vitality Index ( p = 0.027, r = 0.36), whereas the Functional Independence Measure motor was improved in both groups ( p ≤ 0.018, r ≥ 0.52). Conclusion We found significant improvement in motor function in both groups and additional improvements in social-cognitive function and motivation in the intervention group. These observations suggest that collaborative practice between nurses and occupational therapists could improve functions underlying independent daily life in hospitalized elderly patients.
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Affiliation(s)
- Ken Kondo
- Gunma University Graduate School of Health Sciences, Gunma, Japan
| | - Naoto Noguchi
- Gunma University Graduate School of Health Sciences, Gunma, Japan
| | - Ryoto Teshima
- Division of Rehabilitation Service, Geriatrics Research Institute and Hospital, Gunma, Japan
| | - Koji Tanaka
- Gunma University Graduate School of Health Sciences, Gunma, Japan
| | - Bumsuk Lee
- Gunma University Graduate School of Health Sciences, Gunma, Japan
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Sezgin D, O'Caoimh R, Liew A, O'Donovan MR, Illario M, Salem MA, Kennelly S, Carriazo AM, Lopez-Samaniego L, Carda CA, Rodriguez-Acuña R, Inzitari M, Hammar T, Hendry A. The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review. Eur Geriatr Med 2020; 11:961-974. [PMID: 32754841 PMCID: PMC7402396 DOI: 10.1007/s41999-020-00365-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/11/2020] [Indexed: 11/30/2022]
Abstract
Aim This scoping review examined the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Findings While some studies report positive outcomes on hospital utilisation, the evidence is limited for their effectiveness on emergency department attendances, institutionalisation, function, and cost-effectiveness. Message Intermediate care including transitional care interventions were associated with reduced hospital stay but this finding was not universal. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users. Background and aim Intermediate care describes services, including transitional care, that support the needs of middle-aged and older adults during care transitions and between different settings. This scoping review aimed to examine the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Design A scoping review of the literature was conducted including studies published between 2002 and 2019 with a transitional care and/or intermediate care intervention for adults aged ≥ 50. Searches were performed in CINAHL, Cochrane Library, EMBASE, Open Grey and PubMed databases. Qualitative and quantitative approaches were employed for data synthesis. Results In all, 133 studies were included. Interventions were grouped under four models of care: (a) Hospital-based transitional care (n = 8), (b) Transitional care delivered at discharge and up to 30 days after discharge (n = 70), (c) Intermediate care at home (n = 41), and (d) Intermediate care delivered in a community hospital, care home or post-acute facility (n = 14). While these models were associated with a reduced hospital stay, this was not universal. Intermediate including transitional care services combined with telephone follow-up and coaching support were reported to reduce short and long-term hospital re-admissions. Evidence for improved ADL function was strongest for intermediate care delivered by an interdisciplinary team with rehabilitation at home. Study design and types of interventions were markedly heterogenous, limiting comparability. Conclusions Although many studies report that intermediate care including transitional care models reduce hospital utilisation, results were mixed. There is limited evidence for the effectiveness of these services on function, institutionalisation, emergency department attendances, or on cost-effectiveness. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duygu Sezgin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.
| | - Rónán O'Caoimh
- Department of Geriatric Medicine, Mercy University Hospital Cork, Cork, Ireland.,Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland.,Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | | | - Maddelena Illario
- Campania Region Health Innovation Unit, and Federico II Department of Public Health, Naples, Italy
| | | | - Siobhán Kennelly
- Royal College of Surgeons in Ireland Connolly Hospital, Dublin and Health Service Executive, Dublin, Ireland
| | | | | | - Cristina Arnal Carda
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall D'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Marco Inzitari
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall D'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teija Hammar
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anne Hendry
- NHS Lanarkshire, Bothwell, UK.,School of Health and Life Sciences, University of the West of Scotland, Hamilton, UK
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5
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Huion A, Decalf V, Kumps C, De Witte N, Everaert K. Smart diapers for nursing home residents with dementia: a pilot study. Acta Clin Belg 2019; 74:258-262. [PMID: 30146971 DOI: 10.1080/17843286.2018.1511279] [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] [Indexed: 10/28/2022]
Abstract
Objectives: The objective of the study is to evaluate the use of an experimental smart diaper as an indicator of saturation for diaper change in persons with dementia living in nursing homes. Methods: A multicenter prospective study was conducted in 3 nursing homes amongst 18 residents with dementia. For each resident, a frequency-volume urine chart (FVUC) was kept for 24 h including voided volume and diaper weights, wearing smart diapers. A comparative study was set up between results obtained by smart diapers and data registered in FVUCs. Results: Analysis based on quantification of the agreement between saturation calculated by smart diaper and determined by FVUC indicates that measurements reported by sensor do not correspond with measurements based on FVUC. For the regular diaper, the saturation measured by sensor may be 26% below or 39% above saturation based on FVUC and for the super diaper, respectively, 34% below or 30% above. Discussion: This study indicates that the sensor detects and notifies wetness but is not sensitive enough for using it as an indicator for diaper change in people with severe dementia.
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Affiliation(s)
- Anja Huion
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
| | - Veerle Decalf
- Department of Medical Sciences, Ghent University, Ghent, Belgium
| | - Candy Kumps
- Department of Medical Sciences, Ghent University, Ghent, Belgium
| | - Nico De Witte
- Department of Education, Health and Social Work, University College Ghent, Ghent, Belgium
- Department of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Karel Everaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
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6
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Jeon MS, Jeong YM, Yee J, Lee E, Kim KI, Lee BK, Rhie SJ, Chung JE, Gwak HS. Association of pre-operative medication use with unplanned 30-day hospital readmission after surgery in oncology patients receiving comprehensive geriatric assessment. Am J Surg 2019; 219:963-968. [PMID: 31255260 DOI: 10.1016/j.amjsurg.2019.06.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 05/27/2019] [Accepted: 06/18/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study aimed to determine whether pre-operative medication use is associated with unplanned 30-day readmission in elderly people undergoing cancer surgery. METHODS Patients aged 65 years or older who were scheduled for cancer surgery and presented for comprehensive geriatric assessment were included. Comparisons of variables between patients with readmission and those without readmission were performed by univariate and multivariate analyses. RESULTS A total of 473 patients were included. Multivariate analysis showed that pre-operative discontinuation-requiring medications (PDRMs) and gastrointestinal/hepato-pancreato-biliary (GI/HPB) cancer were significant factors for 30-day readmission. PDRM increased the risk of readmission by about 2.2-fold. Attributable risk of PDRM to readmission was around 55%. The adjusted odds ratio and attributable risk for GI/HPB surgery was 3.4 (95% CI 1.0-11.5) and 70.8%, respectively. CONCLUSIONS Medication use has an impact on unplanned 30-day readmission in geriatric oncology patients, further highlighting the importance of medication optimization for elderly patients with cancer surgery.
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Affiliation(s)
- Min Sun Jeon
- College of Pharmacy & Division of Life Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea; Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 13620, South Korea
| | - Young Mi Jeong
- College of Pharmacy & Division of Life Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea; Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 13620, South Korea
| | - Jeong Yee
- College of Pharmacy & Division of Life Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea
| | - Eunsook Lee
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, 13620, South Korea
| | - Kwang-Il Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, 13620, South Korea
| | - Byung Koo Lee
- College of Pharmacy & Division of Life Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea
| | - Sandy Jeong Rhie
- College of Pharmacy & Division of Life Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea
| | - Jee Eun Chung
- College of Pharmacy, Hanyang University, Ansan, 15588, South Korea.
| | - Hye Sun Gwak
- College of Pharmacy & Division of Life Pharmaceutical Sciences, Ewha Womans University, Seoul, 03760, South Korea.
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Hernández-Zambrano SM, Mesa-Melgarejo L, Carrillo-Algarra AJ, Castiblanco-Montañez RA, Chaparro-Diaz L, Carreño-Moreno SP, Rico-Salas RG, Marles-Salazar MA, Diaztagle-Fernández JJ, Ardila-Rodriguez HM. Effectiveness of a case management model for the comprehensive provision of health services to multi-pathological people. J Adv Nurs 2018; 75:665-675. [PMID: 30375026 DOI: 10.1111/jan.13892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 08/19/2018] [Accepted: 09/12/2018] [Indexed: 11/27/2022]
Abstract
AIM To determine the effectiveness of a case management model for approaching multi-pathological people in a health promoting entity of the contributory healthcare scheme in Bogotá, Colombia between 2018 - . DESIGN Mixed methods research. METHOD The study contemplates two components: a quantitative component using a quasi-experimental analytical design before and after longitudinal intervention to determine the effectiveness of the case management model and a qualitative descriptive design to understand the experience of the participants about the model. The Administrative Department of Science, Technology and Innovation of Colombia (Colciencias) funded this project by means of call 777-November 2017, under the financing agreement No. 848-December 2017. DISCUSSION Addressing problems deriving from the structure of the Colombian healthcare system is crucial for implementing case management models. Furthermore, the effectiveness of such models may be affected by power relations and market failures, but the proved potential of a model may represent a generalized benefit for the Colombian health system. IMPACT In Colombia, considering complications and management of chronic non-communicable diseases as isolated cases is considered as the highest cost events in healthcare provision, since an average of 12.8 million pesos is invested in each patient. This has led to rethink the management in these patients by means of a comprehensive model that guarantees the effectiveness of healthcare delivery, in the framework of a healthcare system heavily affected by payment capacity, where the market has a strong predominance, such as the case of Colombia. TRIAL REGISTRATION NUMBER RPCEC00000293.
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Affiliation(s)
| | | | | | | | - Lorena Chaparro-Diaz
- Nursing Care for Chronic Patients Research Group, Faculty of Nursing, Universidad Nacional de Colombia, Bogotá, Colombia
| | | | | | | | - Juan José Diaztagle-Fernández
- Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia.,Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud, Bogotá, Colombia
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8
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Choi KS, Jeong YM, Lee E, Kim KI, Yee J, Lee BK, Chung JE, Rhie SJ, Gwak HS. Association of pre-operative medication use with post-surgery mortality and morbidity in oncology patients receiving comprehensive geriatric assessment. Aging Clin Exp Res 2018; 30:1177-1185. [DOI: 10.1007/s40520-018-0904-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/27/2018] [Indexed: 12/13/2022]
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9
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Scheepmans K, Dierckx de Casterlé B, Paquay L, Van Gansbeke H, Milisen K. Restraint Use in Older Adults Receiving Home Care. J Am Geriatr Soc 2017; 65:1769-1776. [PMID: 28369736 DOI: 10.1111/jgs.14880] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To determine the prevalence, types, frequency, and duration of restraint use in older adults receiving home nursing care and to determine factors involved in the decision-making process for restraint use and application. DESIGN Cross-sectional survey of restraint use in older adults receiving home care completed by primary care nurses. SETTING Homes of older adults receiving care from a home nursing organization in Belgium. PARTICIPANTS Randomized sample of older adults receiving home care (N = 6,397; mean age 80.6; 66.8% female). MEASUREMENTS For each participant, nurses completed an investigator-constructed and -validated questionnaire collecting information demographic, clinical, and behavioral characteristics and aspects of restraint use. A broad definition of restraint was used that includes a range of restrictive actions. RESULTS Restraints were used in 24.7% of the participants, mostly on a daily basis (85%) and often for a long period (54.5%, 24 h/d). The most common reason for restraint use was safety (50.2%). Other reasons were that the individual wanted to remain at home longer, which necessitated the use of restraints (18.2%) and to provide respite for the informal caregiver (8.6%). The latter played an important role in the decision and application process. The physician was less involved in the process. In 64.5% of cases, there was no evaluation after restraint use was initiated. CONCLUSION Use of restraints is common in older adults receiving home care nursing in Belgium. These results contribute to a better understanding of the complexity of use of restraints in home care, a situation that may be even more complex than in nursing homes and acute hospital settings.
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Affiliation(s)
- Kristien Scheepmans
- Nursing Department, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium
| | | | - Louis Paquay
- Nursing Department, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium
| | | | - Koen Milisen
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Leuven, Belgium.,Division of Geriatric Medicine, Department of Internal Medicine, Leuven University Hospitals, Leuven, Belgium
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10
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Geriatric preinjury activities of daily living function is associated with glasgow coma score and discharge disposition: a retrospective, consecutive cohort study. J Trauma Nurs 2016; 22:6-13. [PMID: 25584447 DOI: 10.1097/jtn.0000000000000095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The primary objective was to evaluate the associations of the Injury Severity Score (ISS), age, Glasgow Coma Score (GCS), preexisting medical conditions (PEMC), and preinjury activities of daily living (ADL) Katz score with discharge disposition in surviving geriatric trauma patients.Data were obtained from the trauma registry. The preinjury Katz ADL score was prospectively ascertained.Of 184 consecutive surviving geriatric trauma patients with an ISS of 4 to 30, age was 80 ± 8 years and 75% fell. A PEMC was present in 93%. Preinjury ADL limitation occurred in 33%. The Katz score had inverse associations with the number of PEMCs (P< .01) and dementia (P < .01). Preinjury residence was home in 93% and nursing home in 7%. Katz scores by discharge disposition were as follows: home (36%) 5.5 ± 1; nursing home (15%) 3.6 ± 2; rehabilitation (44%) 5.6 ± 1; long-term acute care (5%) 4.0 ± 3 (P < .01). Nursing home/long-term acute care discharge was independently associated (P< .01) withlower Katz score, higher age, and lower discharge GCS; dementia and the number of PEMCs had P > .05. The discharge GCS was associated with the Katz score (P < .01), head injury score (P < .01), dementia (P < .01), and admission GCS (P < .01). The discharge GCS was independently associated (P < .01) with the Katz score and admission GCS. The admission GCS was associated with the Katz score (P = .02), ISS (P < .01), head injury score (P < .01), and dementia (P < .01). The admission GCS was independently associated (P < .05) with the Katz score and ISS.The majority of geriatric trauma survivors with an ISS of 4 to 30 are not discharged home. Lower preinjury ADL function is associated with the lower admission and discharge GCS and greater care needs at discharge. Dementia and the number of PEMCs are not independent predictors of discharge disposition.
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11
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Stegemann S. Defining Patient Centric Drug Product Design and Its Impact on Improving Safety and Effectiveness. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-43099-7_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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12
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Stevens AB, Hochhalter AK, Basu R, Smith ER, Thorud JL, Jo C, McGhee R. A Model Program of Community-Based Supports for Older Adults at Risk of Nursing Facility Placement. J Am Geriatr Soc 2015; 63:2601-2609. [DOI: 10.1111/jgs.13831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alan B. Stevens
- Baylor Scott & White Health; Temple Texas
- Texas A&M Health Science Center; College Station Texas
| | | | | | - Emily R. Smith
- Department of Epidemiology; Gillings School of Global Public Health; University of North Carolina; Chapel Hill North Carolina
| | | | - Chanhee Jo
- Baylor Scott & White Health; Temple Texas
| | - Richard McGhee
- Central Texas Area Agency on Aging and Disability Resource Center; Belton Texas
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13
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De Vliegher K, Aertgeerts B, Declercq A, Moons P. Exploring the activity profile of health care assistants and nurses in home nursing. Br J Community Nurs 2015; 20:608-614. [PMID: 26636895 DOI: 10.12968/bjcn.2015.20.12.608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Are home nurses (also known as community nurses) ready for their changing role in primary care? A quantitative study was performed in home nursing in Flanders, Belgium, to explore the activity profile of home nurses and health care assistants, using the 24-hour recall instrument for home nursing. Seven dates were determined, covering each day of the week and the weekend, on which data collection would take place. All the home nurses and health care assistants from the participating organisations across Flanders were invited to participate in the study. All data were measured at nominal level. A total of 2478 home nurses and 277 health care assistants registered 336 128 (47 977 patients) and 36 905 (4558 patients) activities, respectively. Home nurses and health care assistants mainly perform 'self-care facilitation' activities in combination with 'psychosocial care' activities. Health care assistants also support home nurses in the 'selfcare facilitation' of patients who do not have a specific nursing indication.
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Affiliation(s)
- Kristel De Vliegher
- Research Associate at Nursing Department, Wit-Gele Kruis van Vlaanderen, Brussels, and Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Bert Aertgeerts
- Professor, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Anja Declercq
- Professor, Department of Public Health and Primary Care, KU Leuven, Belgium
| | - Philip Moons
- Professor at Department of Public Health and Primary Care, KU Leuven, The Heart Centre, Copenhagen University Hospital, Denmark, and The Institute of Health and Care Science, Centre for Person-Centred Care, University of Gothenburg, Sweden
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14
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De Vliegher K, Declercq A, Aertgeerts B, Moons P. Health Care Assistants in Home Nursing. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2015. [DOI: 10.1177/1084822315589563] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
What are the experiences of home health care workers with regard to the delegation of nursing activities, the supervision of health care assistants (HCAs), and the impact of these changes on the work of home nurses (HNs). In-depth interviews were performed with 12 HNs, 12 HCAs, and eight managers in home nursing. HCAs take care of a less care dependent patient population, allowing the HNs to spend more time on more complex, technical nursing care. However, the analysis revealed some barriers, such as a knowledge gap and insecurity felt by HCAs leading to unnecessary patient visits by HNs, unfamiliarity of HNs with the role of delegating activities and supervising HCAs, and poor face-to-face communication between HNs and HCAs.
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Affiliation(s)
| | | | | | - Philip Moons
- KU Leuven, Belgium
- Copenhagen University Hospital, Denmark
- University of Gothenburg, Sweden
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Burke RE, Guo R, Prochazka AV, Misky GJ. Identifying keys to success in reducing readmissions using the ideal transitions in care framework. BMC Health Serv Res 2014; 14:423. [PMID: 25244946 PMCID: PMC4180324 DOI: 10.1186/1472-6963-14-423] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 09/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Systematic attempts to identify best practices for reducing hospital readmissions have been limited without a comprehensive framework for categorizing prior interventions. Our research aim was to categorize prior interventions to reduce hospital readmissions using the ten domains of the Ideal Transition of Care (ITC) framework, to evaluate which domains have been targeted in prior interventions and then examine the effect intervening on these domains had on reducing readmissions. METHODS Review of literature and secondary analysis of outcomes based on categorization of English-language reports published between January 1975 and October 2013 into the ITC framework. RESULTS 66 articles were included. Prior interventions addressed an average of 3.5 of 10 domains; 41% demonstrated statistically significant reductions in readmissions. The most common domains addressed focused on monitoring patients after discharge, patient education, and care coordination. Domains targeting improved communication with outpatient providers, provision of advanced care planning, and ensuring medication safety were rarely included. Increasing the number of domains included in a given intervention significantly increased success in reducing readmissions, even when adjusting for quality, duration, and size (OR per domain, 1.5, 95% CI 1.1 - 2.0). The individual domains most associated with reducing readmissions were Monitoring and Managing Symptoms after Discharge (OR 8.5, 1.8 - 41.1), Enlisting Help of Social and Community Supports (OR 4.0, 1.3 - 12.6), and Educating Patients to Promote Self-Management (OR 3.3, 1.1 - 10.0). CONCLUSIONS Interventions to reduce hospital readmissions are frequently unsuccessful; most target few domains within the ITC framework. The ITC may provide a useful framework to consider when developing readmission interventions.
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Affiliation(s)
- Robert E Burke
- Department of Veterans Affairs Medical Center, Eastern Colorado Health Care System, 1055 Clermont St, Denver, CO 80220, USA.
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Flesch LD, Araujo TCCFD. Alta hospitalar de pacientes idosos: necessidades e desafios do cuidado contínuo. ESTUDOS DE PSICOLOGIA (NATAL) 2014. [DOI: 10.1590/s1413-294x2014000300008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
No Brasil, o crescimento da longevidade tem aumentado a prevalência de doenças crônico-degenerativas, as quais podem ocasionar dependência funcional e exigir hospitalizações repetitivas. Especificamente, esta investigação visou conhecer e analisar a percepção de idosos sobre a alta hospitalar, definida como transição hospital-domicílio. A amostra foi constituída por 30 pacientes idosos recrutados em um hospital da rede pública. Antes da alta (internação) e após a alta (domicílio), aplicou-se o Questionário de Continuidade de Cuidado do Paciente, traduzido e adaptado. Verificaram-se correlações significativas entre as subescalas do instrumento. Os resultados reafirmaram a importância do planejamento e da coordenação da alta hospitalar para assegurar continuidade dos cuidados e propiciar atenção integral no campo da Saúde do Idoso. Recomenda-se a validação do instrumento adotado, no intuito de possibilitar estudos multicêntricos.
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Allen J, Hutchinson AM, Brown R, Livingston PM. Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Health Serv Res 2014; 14:346. [PMID: 25128468 PMCID: PMC4147161 DOI: 10.1186/1472-6963-14-346] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/01/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Provision of high quality transitional care is a challenge for health care providers in many western countries. This systematic review was conducted to (1) identify and synthesise research, using randomised control trial designs, on the quality of transitional care interventions compared with standard hospital discharge for older people with chronic illnesses, and (2) make recommendations for research and practice. METHODS Eight databases were searched; CINAHL, Psychinfo, Medline, Proquest, Academic Search Complete, Masterfile Premier, SocIndex, Humanities and Social Sciences Collection, in addition to the Cochrane Collaboration, Joanna Briggs Institute and Google Scholar. Results were screened to identify peer reviewed journal articles reporting analysis of quality indicator outcomes in relation to a transitional care intervention involving discharge care in hospital and follow-up support in the home. Studies were limited to those published between January 1990 and May 2013. Study participants included people 60 years of age or older living in their own homes who were undergoing care transitions from hospital to home. Data relating to study characteristics and research findings were extracted from the included articles. Two reviewers independently assessed studies for risk of bias. RESULTS Twelve articles met the inclusion criteria. Transitional care interventions reported in most studies reduced re-hospitalizations, with the exception of general practitioner and primary care nurse models. All 12 studies included outcome measures of re-hospitalization and length of stay indicating a quality focus on effectiveness, efficiency, and safety/risk. Patient satisfaction was assessed in six of the 12 studies and was mostly found to be high. Other outcomes reflecting person and family centred care were limited including those pertaining to the patient and carer experience, carer burden and support, and emotional support for older people and their carers. Limited outcome measures were reported reflecting timeliness, equity, efficiencies for community providers, and symptom management. CONCLUSIONS Gaps in the evidence base were apparent in the quality domains of timeliness, equity, efficiencies for community providers, effectiveness/symptom management, and domains of person and family centred care. Further research that involves the person and their family/caregiver in transitional care interventions is needed.
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Affiliation(s)
- Jacqueline Allen
- />Deakin University, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Alison M Hutchinson
- />Deakin University, School of Nursing and Midwifery; Centre for Nursing Research – Deakin University and Monash Health Partnership, Monash Health, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Rhonda Brown
- />Deakin University, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Patricia M Livingston
- />Faculty of Health & School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood, 3125 Vic Australia
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Rayan N, Admi H, Shadmi E. Transitions from hospital to community care: the role of patient-provider language concordance. Isr J Health Policy Res 2014; 3:24. [PMID: 25075273 PMCID: PMC4114088 DOI: 10.1186/2045-4015-3-24] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 06/26/2014] [Indexed: 11/19/2022] Open
Abstract
Background Cultural and language discordance between patients and providers constitutes a significant challenge to provision of quality healthcare. This study aims to evaluate minority patients’ discharge from hospital to community care, specifically examining the relationship between patient–provider language concordance and the quality of transitional care. Methods This was a multi-method prospective study of care transitions of 92 patients: native Hebrew, Russian or Arabic speakers, with a pre-discharge questionnaire and structured observations examining discharge preparation from a large Israeli teaching hospital. Two weeks post-discharge patients were surveyed by phone, on the transition from hospital to community care (the Care Transition Measure (CTM-15, 0–100 scale)) and on the primary-care post-discharge visit. Results Overall, ratings on the CTM indicated fair quality of the transition process (scores of 51.8 to 58.8). Patient–provider language concordance was present in 49% of minority patients’ discharge briefings. Language concordance was associated with higher CTM scores among minority groups (64.1 in language-concordant versus 49.8 in non-language-concordant discharges, P <0.001). Other aspects significantly associated with CTM scores: extent of discharge explanations (P <0.05), quality of discharge briefing (P <0.001), and post-discharge explanations by the primary care physician (P <0.01). Conclusion Language-concordant care, coupled with extensive discharge briefings and post-discharge explanations for ongoing care, are important contributors to the quality of care transitions of ethnic minority patients.
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Affiliation(s)
- Nosaiba Rayan
- School of Public Health, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel
| | - Hanna Admi
- Rambam Medical Campus: Nursing Division, Haifa 31096, Israel
| | - Efrat Shadmi
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, Haifa University, Mount Carmel 31905, Israel
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García-Fernández FP, Arrabal-Orpez MJ, Rodríguez-Torres MDC, Gila-Selas C, Carrascosa-García I, Laguna-Parras JM. Effect of hospital case-manager nurses on the level of dependence, satisfaction and caregiver burden in patients with complex chronic disease. J Clin Nurs 2014; 23:2814-21. [DOI: 10.1111/jocn.12543] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 11/29/2022]
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The Cancelling of Elective Surgical Operations Causes Emotional Trauma and a Lack of Confidence: Study from a Urological Department. Urologia 2013; 81:242-5. [DOI: 10.5301/urologia.5000050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2013] [Indexed: 11/20/2022]
Abstract
Objectives Cancellation of elective surgical procedures is inconvenient and stressful on patients, causing loss of working days and disruption of daily life. Furthermore, it causes significant emotional trauma to the patients and their families. The purpose of this study was to analyze the number of elective surgery cancellations, as well as to identify and compare potential emotional trauma and satisfaction between older (≥65 years) and younger (<65 years) patients. Methods 157 patients whose surgeries were scheduled and then cancelled were divided in two groups: Group A (62 younger patients, age <65) and Group B (95 older patients, age ≥65). The Hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety. Patient satisfaction was collected from the Healthcare Providers and Systems Survey (HCAHPS). Results All groups with higher HADS score demonstrated markedly reduced satisfaction scores (with a mean score of 38%, p<0.001). In fact, patient satisfaction scores varied widely across the surveyed groups. Patient overall satisfaction scores after surgery ranged from 39% to 82%, with a mean of 68.5%, and from 28% to 73%, with a mean of 47.3% in Group A and B, respectively. These results point out a significantly lower satisfaction in elderly patients with depression (p<0.001) and with anxiety than in younger patients (p<0.002). Conclusions The study goal was to point out the importance of satisfying patients’ expectations to offer a better assistance, in order to ensure a comforting and friendly experience, especially when the patients are weak and not young anymore.
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Lindpaintner LS, Gasser JT, Schramm MS, Cina-Tschumi B, Müller B, Beer JH. Discharge intervention pilot improves satisfaction for patients and professionals. Eur J Intern Med 2013; 24:756-62. [PMID: 24075842 DOI: 10.1016/j.ejim.2013.08.703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 08/17/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The risk of adverse events and information loss following hospital discharge is particularly high for vulnerable multimorbid patients. Poor coordination of care at discharge increases the burden upon patients, caregivers and professionals, and can lead to increased morbidity and costs. Targeted programs can improve efficiency and health outcomes, but the ideal organization of hospital discharge remains to be specified. METHODS This single-blind, randomized, controlled interprofessional pilot on two internal medicine wards in a teaching hospital in Baden, Switzerland tested a discharge management intervention using nurse care managers. Patients (n=60) were at high risk for adverse events, fulfilling criteria such as polypharmacy, therapy with anticoagulants or insulin, plus secondary criteria indicating vulnerability. Primary composite endpoint was fulfilled by any of the following: death, rehospitalization, urgent physician visit within five days of discharge or adverse medicine reaction. Secondary endpoints evaluated patient quality-of-life, caregiver burden, adequacy of information provided to primary care physicians and home care nurses, and satisfaction with discharge for all groups. Endpoint evaluation was via telephone interviews on days 5 and 30 post-discharge. Design was critically evaluated in anticipation of a larger trial. RESULTS Intervention acceptance was high. In the intervention group, satisfaction was higher among patients (p=0.027) and caregivers (p=0.008), and primary care physicians rated discharge information higher (p=0.031). Primary endpoint showed no significant difference between groups. Necessary design modifications were identified. CONCLUSION Discharge coordination and follow-up care by nurse care managers significantly improved subjective endpoints. A modified design is planned to test effectiveness in a well-powered study.
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Wellens NIH, Flamaing J, Moons P, Deschodt M, Boonen S, Milisen K. Translation and adaption of the interRAI Suite to local requirements in Belgian hospitals. BMC Geriatr 2012; 12:53. [PMID: 22958520 PMCID: PMC3492186 DOI: 10.1186/1471-2318-12-53] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 08/31/2012] [Indexed: 12/02/2022] Open
Abstract
Background The interRAI Suite contains comprehensive geriatric assessment tools designed for various healthcare settings. Although each instrument is developed for a particular population, together they form an integrated health evaluation system. The interRAI Acute Care Minimum Data Set (interRAI AC) is tailored for hospitalized older persons. Our aim in this study was to translate and adapt the interRAI AC to the Belgian hospital context, where it can be used together with the interRAI Home Care (HC) and the interRAI Long Term Care Facility (LTCF). Methods A systematic, comprehensive, and rigorous 10-step approach was used to adapt the interRAI AC to local requirements. After linguistic translation by an official translator, five researchers assessed the translation for appropriate hospital jargon. Three researchers double-checked for translation accuracy and proposed additional items. A provisional version was converted into the three official languages of Belgium—Flemish, French, and German. Next, a multidisciplinary panel of nine experts judged item relevance to the Belgian care context and advised which country-specific items should be added. After these suggestions were incorporated into the interRAI AC, hospital staff from nine Flemish hospitals field-tested the tool in their practice. After evaluating field-test results, we compared the interRAI AC with Belgian versions of the interRAI HC and interRAI LTCF. Next, the Flemish, French, and German versions of the Belgian interRAI portfolio were harmonized. Finally, we submitted the Belgian interRAI AC to the interRAI organization for ratification. Results Eighteen administrative items of the interRAI AC were adapted to the Belgian healthcare context (e.g., usual residence, formal community services prior to admission). Fourteen items assessing the ‘informal caregiver’, and 17 items, including country-specific items, were added (e.g., advanced directive for euthanasia). Conclusions The interRAI AC was adapted to local requirements using a meticulous and recursive 10-step approach. As use of the interRAI Suite continues to grow worldwide and as it continues to expand to other care settings and populations, this procedure can guide future translations. This procedure might also be used by others facing similar challenges of complex translation and adaptation situations, where multidimensional instruments are used across multiple care settings in multiple languages.
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Affiliation(s)
- Nathalie I H Wellens
- Center for Health Services and Nursing Research, Kapucijnenvoer 35 - PB 7001/4, B-3000, Leuven, Belgium
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Linertová R, García-Pérez L, Vázquez-Díaz JR, Lorenzo-Riera A, Sarría-Santamera A. Interventions to reduce hospital readmissions in the elderly: in-hospital or home care. A systematic review. J Eval Clin Pract 2011; 17:1167-75. [PMID: 20630005 DOI: 10.1111/j.1365-2753.2010.01493.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Unplanned hospital readmissions of elderly people represent an increasing burden on health care systems. This burden could theoretically be reduced by adequate preventive interventions, although there is uncertainty about the effectiveness of different types of interventions. The objective of this systematic review was to identify interventions that effectively reduce the risk of hospital readmissions in patients of 75 years and older, and to assess the role of home follow-up. METHODS We searched studies in MEDLINE, CINAHL, CENTRAL and seven other electronic databases up to October 2007, and we updated the MEDLINE search in October 2009. Clinical trials (randomized or controlled) evaluating the effectiveness of an intervention aimed at reducing readmissions in elderly patients were selected. Quality was assessed using the SIGN tool and the information extracted is presented in text and tables. RESULTS Thirty-two clinical trials were included and they were divided into two groups: in-hospital interventions (17 studies) and interventions with home follow-up (15 studies). A positive effect of the intervention evaluated on the readmission outcome was found in three studies from the first group and in seven from the second group. CONCLUSIONS Most of the interventions evaluated did not have any effect on the readmission of elderly patients. However, those interventions that included home care components seem to be more likely to reduce readmissions in the elderly.
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Affiliation(s)
- Renata Linertová
- Canary Islands Foundation for Health and Research (FUNCIS), Santa Cruz de Tenerife, Spain.
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Tomura H, Yamamoto-Mitani N, Nagata S, Murashima S, Suzuki S. Creating an agreed discharge: discharge planning for clients with high care needs. J Clin Nurs 2011; 20:444-53. [DOI: 10.1111/j.1365-2702.2010.03556.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scott IA. Preventing the rebound: improving care transition in hospital discharge processes. AUST HEALTH REV 2010; 34:445-51. [DOI: 10.1071/ah09777] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 02/15/2010] [Indexed: 11/23/2022]
Abstract
Background.Unplanned readmissions of recently discharged patients impose a significant burden on hospitals with limited bed capacity. Deficiencies in discharge processes contribute to such readmissions, which have prompted experimentation with multiple types of peridischarge interventions. Objective.To determine the relative efficacy of peridischarge interventions categorised into two groups: (1) single component interventions (sole or predominant) implemented either before or after discharge; and (2) integrated multicomponent interventions which have pre- and postdischarge elements. Design.Systematic metareview of controlled trials. Data collection.Search of four electronic databases for controlled trials or systematic reviews of trials published between January 1990 and April 2009 that reported effects on readmissions. Data synthesis.Among single-component interventions, only four (intense self-management and transition coaching of high-risk patients and nurse home visits and telephone support of patients with heart failure) were effective in reducing readmissions. Multicomponent interventions that featured early assessment of discharge needs, enhanced patient (and caregiver) education and counselling, and early postdischarge follow-up of high-risk patients were associated with evidence of benefit, especially in populations of older patients and those with heart failure. Conclusion.Peridischarge interventions are highly heterogenous and reported outcomes show considerable variation. However, multicomponent interventions targeted at high-risk populations that include pre- and postdischarge elements seem to be more effective in reducing readmissions than most single-component interventions, which do not span the hospital–community interface. What is known about this topic?Unplanned readmissions within 30 days of hospital discharge are common and may reflect deficiencies in discharge processes. Various peridischarge interventions have been evaluated, mostly single-component interventions that occur either before or after discharge, but failing to yield consistent evidence of benefit in reducing readmissions. More recent trials have assessed multicomponent interventions which involve pre- and postdischarge periods, but no formal review of such studies has been undertaken. What does this paper add?With the exception of intense self-management and transition coaching of high-risk patients, and nurse home visits and telephonic support for patients with heart failure, single-component interventions were ineffective in reducing readmissions. Multicomponent interventions demonstrated evidence of benefit in reducing readmissions by as much as 28%, with best results achieved in populations of older patients and those with heart failure. What are the implications for practitioners and managers?Hospital clinicians and managers should critically review and, where appropriate, modify their current discharge processes in accordance with these findings and negotiate the extra funding and personnel required to allow successful implementation of multicomponent discharge processes that transcend organisational boundaries.
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Braes T, Flamaing J, Pelemans W, Milisen K. Geriatrics on the run: rationale, implementation, and preliminary findings of a Belgian internal liaison team. Acta Clin Belg 2009; 64:384-92. [PMID: 19999385 DOI: 10.1179/acb.2009.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This article describes the rationale, implementation, interventions and preliminary findings of a Belgian interdisciplinary internal liaison team in a 1470-bed teaching hospital. The motive to start the team was threefold: the ageing of the inhospital population, the conclusion that health care professionals working on non-geriatric wards often lack the necessary skills to deal with older patients' needs and Belgian law, obliging each general hospital to set up an internal liaison team. Our team aims at detecting geriatric patients at risk, assisting health care professionals in caring for older patients and sensitizing them regarding optimal geriatric care. The article explains the underlying philosophy and strategy for implementation, focusing on the concepts of reciprocity, flexibility and cooperation. The preliminary results are based on a process evaluation of 719 consultations carried out from November 2004 to November 2006, a time registration, and a Strengths, Weaknesses, Opportunities, and Threats analysis (SWOT). Although our data are preliminary and the implementation of the team was pragmatic rather than research driven, they provide insight into the development, implementation, functioning and interventions of a Belgian interdisciplinary internal liaison team.
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Affiliation(s)
- Tom Braes
- Center for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium
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Mould-Quevedo JF, García-Peña C, Contreras-Hernández I, Juárez-Cedillo T, Espinel-Bermúdez C, Morales-Cisneros G, Sánchez-García S. Direct costs associated with the appropriateness of hospital stay in elderly population. BMC Health Serv Res 2009; 9:151. [PMID: 19698130 PMCID: PMC2744673 DOI: 10.1186/1472-6963-9-151] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 08/22/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ageing of Mexican population implies greater demand of hospital services. Nevertheless, the available resources are used inadequately. In this study, the direct medical costs associated with the appropriateness of elderly populations hospital stay are estimated. METHODS Appropriateness of hospital stay was evaluated with the Appropriateness Evaluation Protocol (AEP). Direct medical costs associated with hospital stay under the third-party payer's institutional perspective were estimated, using as information source the clinical files of 60 years of age and older patients, hospitalized during year 2004 in a Regional Hospital from the Mexican Social Security Institute (IMSS), in Mexico City. RESULTS The sample consisted of 724 clinical files, with a mean of 5.3 days (95% CI = 4.9-5.8) of hospital stay, of which 12.4% (n = 90) were classified with at least one inappropriate patient day, with a mean of 2.2 days (95% CI = 1.6-2.7). The main cause of inappropriateness days was the inexistence of a diagnostic and/or treatment plan, 98.9% (n = 89). The mean cost for an appropriate hospitalization per patient resulted in US$1,497.2 (95% CI = US$323.2-US$4,931.4), while the corresponding mean cost for an inappropriate hospitalization per patient resulted in US$2,323.3 (95% CI = US$471.7-US$6,198.3), (p < 0.001). CONCLUSION Elderly patients who were inappropriately hospitalized had a higher rate of inappropriate patient days. The average of inappropriate patient days cost is considerably higher than appropriate days. In this study, inappropriate hospital-stay causes could be attributable to physicians and current organizational management.
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Affiliation(s)
- Joaquín F Mould-Quevedo
- Departamento de Negocios Internacionales, Instituto Tecnológico y de Estudios Superiores de Monterrey, México, D.F., México.
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Abstract
BACKGROUND Each year, more than 13 million post acute referral decisions are made for Medicare recipients, yet there are no national, empirically derived decision support tools to assist in making these important decisions. OBJECTIVES The aim of this study was to elicit expert knowledge about factors important to referral decision making and identify the characteristics of hospitalized patients who need a post acute referral. METHODS This was a retrospective and prospective mixed-methods study of the referral decisions made by discharge planning experts for 355 hospitalized older adults. Variables included sociodemographics, living arrangement, insurance, diagnosis, comorbid conditions, adverse events, medications, home care use, hospitalization in last 30 days or 6 months, patients' perception of need for and use of assistive devices or post acute services, length of stay, cognition, self-rated health, depression, functional status, and post acute referral decision. RESULTS The final model identified six factors associated with the need for a post acute referral. A cutpoint was derived with a sensitivity and specificity of 87.6% and 63.2%, respectively. Experts were more likely to refer patients who had no or intermittent help available (odds ratio [OR] = 3.0), major walking restrictions (OR = 6.5), less than excellent self-rated health (3.1 and 4.0 times more likely with good and fair-poor health, respectively), remained in the hospital longer (OR = 1.2), and had higher depression scores (OR = 1.1) or number of comorbidities (OR = 1.2). DISCUSSION This study begins to identify information useful to clinicians caring for hospitalized older adults who may benefit from post acute services. By assuring the systematic, valid, and reliable collection of these items, the multidisciplinary team is alerted to patients who may benefit from post acute services. Further work is needed to increase the specificity and generalizability of the model and to test its effects on patient and clinician outcomes.
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Hammar T, Perälä ML, Rissanen P. The effects of integrated home care and discharge practice on functional ability and health-related quality of life: a cluster-randomised trial among home care patients. Int J Integr Care 2007; 7:e29. [PMID: 17786178 PMCID: PMC1963470 DOI: 10.5334/ijic.200] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 05/25/2007] [Accepted: 06/19/2007] [Indexed: 11/20/2022] Open
Abstract
Objectives The aim was to evaluate the effects of integrated home care and discharge practice on the functional ability (FA) and health-related quality of life (HRQoL) of home care patients. Methods A cluster randomised trial (CRT) with Finnish municipalities (n=22) as the units of randomisation. At baseline the sample included 669 patients aged 65 years or over. Data consisted of interviews (at discharge, and at 3-week and 6-month follow-up), medical records and care registers. The intervention was a generic prototype of care/case management-practice (IHCaD-practice) that was tailored to municipalities needs. The aim of the intervention was to standardize practices and make written agreements between hospitals and home care administrations, and also within home care and to name a care/case manager pair for each home care patient. The main outcomes were HRQoL—as measured by a combination of the Nottingham Health Profile (NHP) and the EQ-5D instrument for measuring health status—and also Activities of Daily Living (ADL). All analyses were based on intention-to-treat. Results At baseline over half of the patient population perceived their FA and HRQoL as poor. At the 6-month follow-up there were no improvements in FA or in EQ-5D scores, and no differences between groups. In energy, sleep, and pain the NHP improved significantly in both groups at the 3-week and at 6-month follow-up with no differences between groups. In the 3-week follow-up, physical mobility was higher in the trial group. Conclusions Although the effects of the new practice did not improve the patients' FA and HRQoL, except for physical mobility at the 3-week follow-up, the workers thought that the intervention worked in practice. The intervention standardised practices and helped to integrate services. The intervention was focused on staff activities and through the changed activities also had an effect on patients. It takes many years to achieve permanent changes in every worker's individual practice and it is also likely that changes in working practices would be visible before effects on patients. The use of other outcome measures, such as the use of services, may be clearer in showing a positive impact of the intervention rather than FA or HRQoL.
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Affiliation(s)
- Teija Hammar
- National Research and Development Centre for Welfare and Health, Finland.
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