1
|
Jesus TS, Stern BZ, Lee D, Zhang M, Struhar J, Heinemann AW, Jordan N, Deutsch A. Systematic review of contemporary interventions for improving discharge support and transitions of care from the patient experience perspective. PLoS One 2024; 19:e0299176. [PMID: 38771768 PMCID: PMC11108181 DOI: 10.1371/journal.pone.0299176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/03/2024] [Indexed: 05/23/2024] Open
Abstract
AIM To synthesize the impact of improvement interventions related to care coordination, discharge support and care transitions on patient experience measures. METHOD Systematic review. Searches were completed in six scientific databases, five specialty journals, and through snowballing. Eligibility included studies published in English (2015-2023) focused on improving care coordination, discharge support, or transitional care assessed by standardized patient experience measures as a primary outcome. Two independent reviewers made eligibility decisions and performed quality appraisals. RESULTS Of 1240 papers initially screened, 16 were included. Seven studies focused on care coordination activities, including three randomized controlled trials [RCTs]. These studies used enhanced supports such as improvement coaching or tailoring for vulnerable populations within Patient-Centered Medical Homes or other primary care sites. Intervention effectiveness was mixed or neutral relative to standard or models of care or simpler supports (e.g., improvement tool). Eight studies, including three RCTs, focused on enhanced discharge support, including patient education (e.g., teach back) and telephone follow-up; mixed or neutral results on the patient experience were also found and with more substantive risks of bias. One pragmatic trial on a transitional care intervention, using a navigator support, found significant changes only for the subset of uninsured patients and in one patient experience outcome, and had challenges with implementation fidelity. CONCLUSION Enhanced supports for improving care coordination, discharge education, and post-discharge follow-up had mixed or neutral effectiveness for improving the patient experience with care, compared to standard care or simpler improvement approaches. There is a need to advance the body of evidence on how to improve the patient experience with discharge support and transitional approaches.
Collapse
Affiliation(s)
- Tiago S. Jesus
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, Ohio, United States of America
- Center for Education in Health Science, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Brocha Z. Stern
- Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Dongwook Lee
- Center for Child Development & Research, Sensory EL, ROK, Dept. of Physical Medicine and Rehabilitation Medicine, Korehab Clinic, Dubai, UAE
| | - Manrui Zhang
- Center for Education in Health Science, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Jan Struhar
- Nerve, Muscle and Bone Innovation Center & Oncology Innovation Center, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
| | - Allen W. Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Neil Jordan
- Department of Psychiatry and Behavioral Sciences, Dept. of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Illinois, United States of America
| | - Anne Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, United States of America
- Department of Physical Medicine and Rehabilitation Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
- Center for Health Care Outcomes, RTI International, Chicago, Illinois, United States of America
| |
Collapse
|
2
|
Jošt M, Kerec Kos M, Kos M, Knez L. Effectiveness of pharmacist-led medication reconciliation on medication errors at hospital discharge and healthcare utilization in the next 30 days: a pragmatic clinical trial. Front Pharmacol 2024; 15:1377781. [PMID: 38606174 PMCID: PMC11007427 DOI: 10.3389/fphar.2024.1377781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/07/2024] [Indexed: 04/13/2024] Open
Abstract
Transitions of care often lead to medication errors and unnecessary healthcare utilization. Medication reconciliation has been repeatedly shown to reduce this risk. However, the great majority of evidence is limited to the provision of medication reconciliation within clinical trials and countries with well-established clinical pharmacy. Thus, this pragmatic, prospective, controlled trial evaluated the effectiveness of routine pharmacist-led medication reconciliation compared to standard care on medication errors and unplanned healthcare utilization in adult general medical patients hospitalized in a teaching hospital in Slovenia. All patients hospitalized in a ward where medication reconciliation was integrated into routine clinical practice were included in the intervention group and received admission and discharge medication reconciliation, coupled with patient counselling. The control group consisted of randomly selected patients from the remaining medical wards. The primary study outcome was unplanned healthcare utilization within 30 days of discharge, and the secondary outcomes were clinically important medication errors at hospital discharge and serious unplanned healthcare utilization within 30 days of discharge. Overall, 414 patients (53.4% male, median 71 years) were included-225 in the intervention group and 189 in the control group. In the intervention group, the number of patients with clinically important medication errors at discharge was significantly lower (intervention vs control group: 9.3% vs 61.9%). Multiple logistic regression revealed that medication reconciliation reduced the likelihood of a clinically important medication error by 20-fold, while a higher number of medications on admission was associated with an increased likelihood. However, no significant differences were noted in any and serious unplanned healthcare utilization (intervention vs control group: 33.9% vs 27.8% and 20.3% vs 14.6%, respectively). The likelihood of serious healthcare utilization increased with the age of the patient, the number of medications on admission and being hospitalized for an acute medical condition. Our pragmatic trial confirmed that medication reconciliation, even when performed as part of routine clinical practice, led to a substantial reduction in the risk of clinically important medication errors at hospital discharge but not to a reduction in healthcare utilization. Medication reconciliation is a fundamental, albeit not sufficient, element to ensure patient safety after hospital discharge. Clinical Trial Registration: https://clinicaltrials.gov/search?id=NCT06207500, identifier NCT06207500.
Collapse
Affiliation(s)
- Maja Jošt
- University Clinic Golnik, Golnik, Slovenia
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Mojca Kerec Kos
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Mitja Kos
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| | - Lea Knez
- University Clinic Golnik, Golnik, Slovenia
- University of Ljubljana, Faculty of Pharmacy, Ljubljana, Slovenia
| |
Collapse
|
3
|
Terrana A, Viglione C, Rhee K, Rabin B, Godino J, Aarons GA, Chapman J, Melendrez B, Holguin M, Osorio L, Gidwani P, Juarez Nunez C, Firestein G, Hekler E. The core functions and forms paradigm throughout EPIS: designing and implementing an evidence-based practice with function fidelity. FRONTIERS IN HEALTH SERVICES 2024; 3:1281690. [PMID: 38292916 PMCID: PMC10826509 DOI: 10.3389/frhs.2023.1281690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
There are numerous frameworks for implementing evidence-based practices (EBPs) in novel settings to achieve "fidelity." However, identifying appropriate referents for fidelity poses a challenge. The Core Functions and Forms paradigm offers a model that can inform adaptation decisions throughout all phases of the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. We applied the Core Functions-Forms paradigm throughout the Exploration and Preparation phases of EPIS in the design of two EBPs targeting family protective factors among Latinos in San Diego, as well as describe plans for its use in Implementation and Sustainment. We employed a distinct approach for each intervention element to contrast adaptation decisions that prioritize adherence to either form or function fidelity. We describe our application of the functions-forms paradigm within the EPIS framework, focusing on the Preparation phase. We also provide functions-forms matrices that map out the relationship between individual intervention components (forms) and the essential processes (functions) by which components are theorized to exert their impact. This case study of how the core functions-forms framework can be mapped onto EPIS can support a conceptual shift from prioritizing form fidelity to also focusing on function fidelity. This might allow interventionists to target appropriate fidelity referents when adapting an EBP, rather than defaulting to maintaining fidelity to forms as described in the protocol. We see great promise for using this framework for guiding actions throughout all EPIS phases and informing future applications of this paradigm to foster more robust fidelity to function.
Collapse
Affiliation(s)
- Alec Terrana
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Clare Viglione
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Kyung Rhee
- School of Medicine, University of California San Diego, San Diego, CA, United States
| | - Borsika Rabin
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, United States
| | - Job Godino
- Family Health Centers of San Diego, San Diego, CA, United States
| | - Gregory A. Aarons
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Jessica Chapman
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Blanca Melendrez
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | | | - Liliana Osorio
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | | | | | - Gary Firestein
- Altman Clinical and Translational Research Institute, School of Medicine, University of California, San Diego, CA, United States
| | - Eric Hekler
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, United States
| |
Collapse
|
4
|
Jordan J, Tume L, Clarke M, McAuley D, McDowell C, McIlmurray L, Morris K, Peters M, Walsh T, Blackwood B. Delivery of a novel intervention to facilitate liberation from mechanical ventilation in paediatric intensive care: A process evaluation. PLoS One 2023; 18:e0293063. [PMID: 38011103 PMCID: PMC10681213 DOI: 10.1371/journal.pone.0293063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 10/04/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Prolonged mechanical ventilation increases the risk of mortality and morbidity. Optimising sedation and early testing for possible liberation from invasive mechanical ventilation (IMV) has been shown to reduce time on the ventilator. Alongside a multicentre trial of sedation and ventilation weaning, we conducted a mixed method process evaluation to understand how the intervention content and delivery was linked to trial outcomes. METHODS 10,495 children admitted to 18 paediatric intensive care units (ICUs) in the United Kingdom participated in a stepped-wedge, cluster randomised controlled trial, with 1955 clinical staff trained to deliver the intervention. The intervention comprised assessment and optimisation of sedation levels, and bedside screening of respiratory parameters to indicate readiness for a spontaneous breathing trial prior to liberation from ventilation. 193 clinical staff were interviewed towards the end of the trial. Interview data were thematically analysed, and quantitative adherence data were analysed using descriptive statistics. RESULTS The intervention led to a reduced duration of IMV (adjusted median difference- 7.1 hours, 95% CI -9.6 to -5.3, p = 0.01). Overall intervention adherence was 75% (range 59-85%). Ease and flexibility of the intervention promoted it use; designated responsibilities, explicit pathways of decision-making and a shared language for communication fostered proactivity and consistency towards extubation. Delivery of the intervention was hindered by established hospital and unit organisational and patient care routines, clinician preference and absence of clinical leadership. CONCLUSIONS The SANDWICH trial showed a significant, although small, reduction in duration of IMV. Findings suggest that greater direction in decision-making pathways, robust embedment of new practice in unit routine, and capitalising on the skills of Advanced Nurse Practitioners and physiotherapists would have contributed to greater intervention effect. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN16998143.
Collapse
Affiliation(s)
- Joanne Jordan
- School of Health, Wellbeing and Social Care, Open University, Milton Keynes, England
| | - Lyvonne Tume
- Faculty of Heath, Social Care & Medicine, Edge Hill University, Ormskirk, England
- PICU, Alder Hey Children’s NHS Trust, Liverpool, England
| | - Mike Clarke
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland
| | - Danny McAuley
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - Cliona McDowell
- Northern Ireland Clinical Trials Unit, Royal Hospitals, Belfast, Northern Ireland
| | - Lisa McIlmurray
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - Kevin Morris
- Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, England
- Institute of Applied Health Research, University of Birmingham, Birmingham, England
| | - Mark Peters
- Great Ormond Street Institute of Child Health, NIHR Biomedical Research Centre, University College London, London, England
- Great Ormond Street Hospital, London, England
| | - Timothy Walsh
- Institute of Population Health Sciences, University of Edinburgh, Edinburgh, Scotland
| | - Bronagh Blackwood
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| |
Collapse
|
5
|
Lau EY, Small SS, Butcher K, Cragg A, Loh GW, Shalansky S, Hohl CM. An external facilitation intervention to increase uptake of an adverse drug event reporting intervention. FRONTIERS IN HEALTH SERVICES 2023; 3:1106586. [PMID: 37332530 PMCID: PMC10272762 DOI: 10.3389/frhs.2023.1106586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/09/2023] [Indexed: 06/20/2023]
Abstract
Background Adverse drug events (ADEs) are a leading cause of emergency department visits and hospital admissions in Canada. ActionADE prevents repeat ADEs by enabling clinicians to document and communicate standardized ADE information across care settings. We used an external facilitation intervention to promote the uptake of ActionADE in four hospitals in British Columbia, Canada. This study examined whether, how and in what context external facilitation influenced the uptake of ActionADE. Methods In this convergent-parallel mixed-methods study, an external facilitator used a four-step iterative process to support site champions using context-specific implementation strategies to increase the ADE reporting rate at their sites. We extracted archival data to assess implementation determinants before and after the implementation of the external facilitation and implementation strategies. We also retrieved data on the mean monthly counts of reported ADEs for each user from the ActionADE server. Zero-inflated Poisson models were used to examine changes in mean monthly counts of reported ADEs per user between pre-intervention (June 2021 to October 2021) and intervention (November 2021 to March 2022) periods. Results The external facilitator and site champions co-created three functions: (1) educate pharmacists about what and how to report in ActionADE, (2) educate pharmacists about the impact of ActionADE on patient outcomes, and (3) provide social support for pharmacists to integrate ADE reporting into clinical workflows. Site champions used eight forms to address the three functions. Peer support and reporting competition were the two common strategies used by all sites. Sites' responses to external facilitation varied. The rate of mean monthly counts of reported ADEs per user significantly increased during the intervention period compared to the pre-intervention period at LGH (RR: 3.74, 95% CI 2.78 to 5.01) and RH (RR: 1.43, 95% CI 1.23 to 1.94), but did not change at SPH (RR: 0.68, 95% CI: 0.43 to 1.09) and VGH (RR: 1.17, 95% CI 0.92 to 1.49). Leave of absence of the clinical pharmacist champion and failure to address all identified functions were implementation determinants that influenced the effectiveness of external facilitation. Conclusion External facilitation effectively supported researchers and stakeholders to co-create context-specific implementation strategies. It increased ADE reporting at sites where clinical pharmacist champions were available, and where all functions were addressed.
Collapse
Affiliation(s)
- Erica Y. Lau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Serena S. Small
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Kate Butcher
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
- Pharmaceutical Science, Vancouver General Hospital, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Amber Cragg
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| | - Gabriel W. Loh
- Richmond Hospital Pharmacy Department, Lower Mainland Pharmacy Services, Richmond, BC, Canada
| | - Steve Shalansky
- Pharmacy Department, St. Paul’s Hospital, Providence Health Care, Vancouver, BC, Canada
| | - Corinne M. Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver Coastal Health Research Centre, Centre for Clinical Epidemiology andEvaluation, Vancouver, BC, Canada
| |
Collapse
|
6
|
Abbott JH. Delivering exercise therapy in practice: a lot to consider, and much still to work out. Osteoarthritis Cartilage 2023; 31:292-294. [PMID: 36509331 DOI: 10.1016/j.joca.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Affiliation(s)
- J Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago Medical School, Dunedin, New Zealand.
| |
Collapse
|
7
|
LaBedz SL, Prieto-Centurion V, Mutso A, Basu S, Bracken NE, Calhoun EA, DiDomenico RJ, Joo M, Pickard AS, Pittendrigh B, Williams MV, Illendula S, Krishnan JA. Pragmatic Clinical Trial to Improve Patient Experience Among Adults During Transitions from Hospital to Home: the PArTNER study. J Gen Intern Med 2022; 37:4103-4111. [PMID: 35260961 PMCID: PMC9708982 DOI: 10.1007/s11606-022-07461-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/04/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Minority-serving hospitals (MSHs) need evidence-based strategies tailored to the populations they serve to improve patient-centered outcomes after hospitalization. METHODS We conducted a pragmatic randomized clinical trial (RCT) from October 2014 to January 2017 at a MSH comparing the effectiveness of a stakeholder-supported Navigator intervention vs. Usual care on post-hospital patient experience, outcomes, and healthcare utilization. Community health workers and peer coaches delivered the intervention which included (1) in-hospital visits to assess barriers to health/healthcare and to develop a personalized Discharge Patient Education Tool (DPET); (2) a home visit to review the DPET; and (3) telephone-based peer coaching. The co-primary outcomes were between-group comparisons of 30-day changes in Patient-Reported Outcomes Measurement Information System (PROMIS) measures of anxiety and informational support (minimum important difference is 2 to 5 units change); a p-value <0.025 was considered significant using intention-to-treat analysis. Secondary outcomes included death, ED visits, or readmissions and measures of emotional, social, and physical health at 30 and 60 days. RESULTS We enrolled 1029 adults hospitalized with heart failure (28%), pneumonia (22%), MI (10%), COPD (11%), or sickle cell disease (29%). Over 80% were non-Hispanic Black. Overall, there were no significant between-group differences in the 30-day change in anxiety (adjusted difference: -1.6, 97.5% CI -3.3 to 0.1, p=0.03), informational support (adjusted difference: -0.01, 97.5% CI -2.0 to 1.9, p=0.99), or any secondary outcomes. Exploratory analyses suggested the Navigator intervention improved anxiety among participants with COPD, a primary care provider, a hospitalization in the past 12 months, or higher baseline anxiety; among participants without health insurance, the intervention improved informational support (all p-values <0.05). CONCLUSIONS In this pragmatic RCT at a MSH, the Navigator intervention did not improve post-hospital anxiety, informational support, or other outcomes compared to Usual care. Benefits observed in participant subgroups should be confirmed in future studies. TRIAL REGISTRATION Clinicaltrials.gov identifier: NCT02114515.
Collapse
Affiliation(s)
- Stephanie L LaBedz
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA.
| | - Valentin Prieto-Centurion
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Amelia Mutso
- Department of Pharmacology & Regenerative Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Sanjib Basu
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Nina E Bracken
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth A Calhoun
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Robert J DiDomenico
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Min Joo
- Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Mark V Williams
- Division of Hospital Medicine, Department of Internal Medicine, Washington University, St. Louis, MO, USA
| | - Sai Illendula
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
| | - Jerry A Krishnan
- Breathe Chicago Center, Division of Pulmonary, Critical Care, Sleep, and Allergy, University of Illinois at Chicago, Chicago, IL, USA
- Population Health Sciences Program, University of Illinois Hospital & Health Sciences System, University of Illinois at Chicago, Chicago, IL, USA
| |
Collapse
|
8
|
Fernandes CDS, Lima MMDS, Araújo DVD, Galindo Neto NM, Caetano JÁ, Barros LM. Construction and validation of a serial album for companions of patients with stroke. Rev Bras Enferm 2022; 75:e20210843. [PMID: 36228292 DOI: 10.1590/0034-7167-2021-0843] [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: 11/19/2021] [Accepted: 06/29/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES to construct and validate a serial album, to be used in hospital discharge planning of patients with stroke. METHODS a methodological study, with construction of a serial album, validity by 22 judges and assessment by 22 companions. Data were collected from the Health Education Content Validity Instrument, with the companions, from the Suitability Assessment of Materials. RESULTS the serial album has 21 pages. The overall Content Validity Index was equal to 0.87 among expert judges and 1.0 among companions. CONCLUSIONS the educational technology constructed was considered valid by the judges and assessed as understandable by the companions so that it presented itself as a viable technological resource for use in the health education of companions of patients with stroke.
Collapse
Affiliation(s)
| | | | | | | | | | - Lívia Moreira Barros
- Universidade da Integração Internacional da Lusofonia Afro-Brasileira. Redenção, Ceará, Brazil
| |
Collapse
|
9
|
Balancing standardisation and individualisation in transitional care pathways: a meta-ethnography of the perspectives of older patients, informal caregivers and healthcare professionals. BMC Health Serv Res 2022; 22:430. [PMID: 35365140 PMCID: PMC8974038 DOI: 10.1186/s12913-022-07823-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transitional care implies the transfer of patients within or across care settings in a seamless and safe way. For frail, older patients with complex health issues, high-quality transitions are especially important as these patients typically move more frequently within healthcare settings, requiring treatment from different providers. As transitions of care for frail people are considered risky, securing the quality and safety of these transitions is of great international interest. Nevertheless, despite efforts to improve quality in transitional care, research indicates that there is a lack of clear guidance to deal with practical challenges that may arise. The aim of this article is to synthesise older patients, informal caregivers and healthcare professionals' experiences of challenges to achieving high-quality transitional care. METHODS We used the seven-step method for meta-ethnography originally developed by Noblit and Hare. In four different but connected qualitative projects, the authors investigated the challenges to transitional care for older people in the Norwegian healthcare system from the perspectives of older patients, informal caregivers and healthcare professionals. In this paper, we highlight and discuss the cruciality of these challenging issues by synthesising the results from twelve articles. RESULTS The analysis resulted in four themes: i) balancing person-centred versus efficient care, ii) balancing everyday patient life versus the treatment of illness, iii) balancing user choice versus "What Matters to You", and iv) balancing relational versus practical care. These expressed challenges represent tensions at the system, organisation and individual levels based on partial competing assumptions on person-centred-care-inspired individualisation endeavours and standardisation requirements in transitional care. CONCLUSIONS There is an urgent need for a clearer understanding of the tension between standardisation and individualisation in transitional care pathways for older patients to ensure better healthcare quality for patients and more realistic working environments for healthcare professionals. Incorporating a certain professional flexibility within the wider boundary of standardisation may give healthcare professionals room for negotiation to meet patients' individual needs, while at the same time ensuring patient flow, equity and evidence-based practice.
Collapse
|
10
|
Schnipper JL. Improving care transitions: Is readmission reduction possible? Or even desirable? J Hosp Med 2022; 17:229-230. [PMID: 35504590 DOI: 10.1002/jhm.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Jeffrey L Schnipper
- Hospital Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
11
|
On Gesell Evaluation System for Disabled Children in Minority Areas. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:4210116. [PMID: 35126922 PMCID: PMC8808213 DOI: 10.1155/2022/4210116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/02/2021] [Accepted: 12/17/2021] [Indexed: 11/17/2022]
Abstract
This paper takes 105 disabled children from the Disabled Rehabilitation Research Center of the South China minority autonomous region as the survey objects. Based on the Gesell scale, it collects health data such as exercise ability and health status of disabled children, analyzes the data in accordance with SPSS software, and constructs comprehensive disease analysis model of 105 disabled children. Moreover, according to five indicator data collected and tested for disabled children (adaptability, big movements, fine movements, language, and personal-social) in Gesell scale, comprehensive disease indicators of the disabled children are calculated and statistically analyzed together with age and gender information. This study analyzed comprehensive diseases and the correlation among various indicators, concluding that most disabled children aged 3–7 are diagnosed with moderate and severe developmental retardation, and retardation level is in obvious normal distribution. At the same time, there is a significant correlation between indicators of ability test interval and measurement indicators with age. This study suggests that targeted treatment and rehabilitation plans should be implemented for disabled children of different ages according to different indicators of ability test interval, which has reference value and significance for improving the treatment level of disabled children and realizing targeted rehabilitation.
Collapse
|
12
|
Practice What We Preach: Beginning a Journey to Embrace Patient-Centered Outcomes Research. NURSING REPORTS 2021; 11:728-740. [PMID: 34968346 PMCID: PMC8608128 DOI: 10.3390/nursrep11030068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Patient-centered outcomes research seeks to answer patient-centered questions. The process includes varied locations and individuals throughout the care continuum to address individual differences and constraints in implementation and dissemination. Problem: This paper intends to answer this question: do academic nurses practice what they preach by assisting patient-centered outcomes research and researchers through their engagement with patients, caregivers, and other community stakeholder partners in nursing research? Approach: This paper provides an overview of how academic nurses in a single institution (the University of Texas Medical Branch at Galveston School of Nursing) began to embrace patient-centered outcomes research. Conclusion: Whether academic nurses are practicing what they preach in terms of patient-centered outcomes research remains uncertain. More examples from academia are required to make that determination. Academic nurses worldwide have embarked on a steep learning curve to embrace patient-centered outcomes research. This journey will require patience and a systematic strategy.
Collapse
|
13
|
Parry C, Johnston-Fleece M, Johnson MC, Shifreen A, Clauser SB. Patient-Centered Approaches to Transitional Care Research and Implementation: Overview and Insights From Patient-Centered Outcomes Research Institute's Transitional Care Portfolio. Med Care 2021; 59:S330-S335. [PMID: 34228014 PMCID: PMC8263147 DOI: 10.1097/mlr.0000000000001593] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This Special Issue, Future Directions in Transitional Care Research, focuses on the approaches used and lessons learned by researchers conducting care transitions studies funded by the Patient-Centered Outcomes Research Institute (PCORI). PCORI's approach to transitional care research augments prior research by encouraging researchers to focus on head-to-head comparisons of interventions, the use of patient-centered outcomes, and the engagement of stakeholders throughout the research process. OBJECTIVES This paper introduces the themes and topics addressed by the articles that follow, which are focused on opportunities and challenges involved in conducting patient-centered clinical comparative effectiveness research in transitional care. It provides an overview of the state of the care transitions field, a description of PCORI's programmatic objectives, highlights of the patient and stakeholder engagement activities that have taken place during the course of these studies, and a brief overview of PCORI's Transitional Care Evidence to Action Network, a learning community designed to foster collaboration between investigators and their research teams and enhance the collective impact of this body of work. CONCLUSIONS The papers in this Special Issue articulate challenges, lessons learned, and new directions for measurement, stakeholder engagement, implementation, and methodological and design approaches that reflect the complexity of transitional care comparative effectiveness research and seek to move the field toward a more holistic understanding of transitional care that integrates social needs and lifespan development into our approaches to improving care transitions.
Collapse
Affiliation(s)
- Carly Parry
- Patient-Centered Outcomes Research Institute, Washington, DC
| | | | | | - Aaron Shifreen
- Patient-Centered Outcomes Research Institute, Washington, DC
| | | |
Collapse
|