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Torabzadeh SA, Tavakkoli-Moghaddam R, Samieinasab M, Hamid M. An intelligent algorithm to evaluate and improve the performance of a home healthcare center considering trust indicators. Comput Biol Med 2022; 146:105656. [PMID: 35751186 PMCID: PMC9126622 DOI: 10.1016/j.compbiomed.2022.105656] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/26/2022] [Accepted: 05/18/2022] [Indexed: 11/03/2022]
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Fields BE, Whitney RL, Bell JF. Home Oxygen Therapy: Assisting and educating caregivers and those receiving supplemental oxygen. Home Healthc Now 2022; 40:182-189. [PMID: 35777938 DOI: 10.1097/nhh.0000000000001085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
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Affiliation(s)
- Bronwyn E Fields
- Bronwyn E. Fields is an assistant professor in the School of Nursing at California State University, Sacramento; Robin L. Whitney is an assistant professor at the Valley Foundation School of Nursing at San Jose State University, San Jose, CA; and Janice F. Bell is a professor and associate dean for research at the Betty Irene Moore School of Nursing, University of California Davis, Sacramento. Contact author: Bronwyn E. Fields, . The authors have disclosed no potential conflicts of interest, financial or otherwise. A podcast with the authors is available at www.ajnonline.com
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LACE Score-Based Risk Management Tool for Long-Term Home Care Patients: A Proof-of-Concept Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031135. [PMID: 33525331 PMCID: PMC7908226 DOI: 10.3390/ijerph18031135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/21/2021] [Accepted: 01/25/2021] [Indexed: 12/13/2022]
Abstract
Background: Effectively predicting and reducing readmission in long-term home care (LTHC) is challenging. We proposed, validated, and evaluated a risk management tool that stratifies LTHC patients by LACE predictive score for readmission risk, which can further help home care providers intervene with individualized preventive plans. Method: A before-and-after study was conducted by a LTHC unit in Taiwan. Patients with acute hospitalization within 30 days after discharge in the unit were enrolled as two cohorts (Pre-Implement cohort in 2017 and Post-Implement cohort in 2019). LACE score performance was evaluated by calibration and discrimination (AUC, area under receiver operator characteristic (ROC) curve). The clinical utility was evaluated by negative predictive value (NPV). Results: There were 48 patients with 87 acute hospitalizations in Pre-Implement cohort, and 132 patients with 179 hospitalizations in Post-Implement cohort. These LTHC patients were of older age, mostly intubated, and had more comorbidities. There was a significant reduction in readmission rate by 44.7% (readmission rate 25.3% vs. 14.0% in both cohorts). Although LACE score predictive model still has room for improvement (AUC = 0.598), it showed the potential as a useful screening tool (NPV, 87.9%; 95% C.I., 74.2–94.8). The reduction effect is more pronounced in infection-related readmission. Conclusion: As real-world evidence, LACE score-based risk management tool significantly reduced readmission by 44.7% in this LTHC unit. Larger scale studies involving multiple homecare units are needed to assess the generalizability of this study.
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Home Oxygen Therapy. Am J Nurs 2020; 120:51-57. [PMID: 33105223 DOI: 10.1097/01.naj.0000721940.02042.99] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses.
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Su MC, Wang YJ, Chen TJ, Chiu SH, Chang HT, Huang MS, Hu LH, Li CC, Yang SJ, Wu JC, Chen YC. Assess the Performance and Cost-Effectiveness of LACE and HOSPITAL Re-Admission Prediction Models as a Risk Management Tool for Home Care Patients: An Evaluation Study of a Medical Center Affiliated Home Care Unit in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030927. [PMID: 32024309 PMCID: PMC7037289 DOI: 10.3390/ijerph17030927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 02/06/2023]
Abstract
The LACE index and HOSPITAL score models are the two most commonly used prediction models identifying patients at high risk of readmission with limited information for home care patients. This study compares the effectiveness of these two models in predicting 30-day readmission following acute hospitalization of such patients in Taiwan. A cohort of 57 home care patients were enrolled and followed-up for one year. We compared calibration, discrimination (area under the receiver operating curve, AUC), and net reclassification improvement (NRI) to identify patients at risk of 30-day readmission for both models. Moreover, the cost-effectiveness of the models was evaluated using microsimulation analysis. A total of 22 readmissions occurred after 87 acute hospitalizations during the study period (readmission rate = 25.2%). While the LACE score had poor discrimination (AUC = 0.598, 95% confidence interval (CI) = 0.488–0.702), the HOSPITAL score achieved helpful discrimination (AUC = 0.691, 95% CI = 0.582–0.785). Moreover, the HOSPITAL score had improved the risk prediction in 38.3% of the patients, compared with the LACE index (NRI = 0.383, 95% CI = 0.068–0.697, p = 0.017). Both prediction models effectively reduced readmission rates compared to an attending physician’s model (readmission rate reduction: LACE, 39.2%; HOSPITAL, 43.4%; physician, 10.1%; p < 0.001). The HOSPITAL score provides a better prediction of readmission and has potential as a risk management tool for home care patients.
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Affiliation(s)
- Mei-Chin Su
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-C.S.); (S.-H.C.); (M.-S.H.); (C.-C.L.); (L.-H.H.); (S.-J.Y.)
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan;
| | - Yi-Jen Wang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan (H.-T.C.)
- Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK
| | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan;
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan (H.-T.C.)
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan;
| | - Shiao-Hui Chiu
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-C.S.); (S.-H.C.); (M.-S.H.); (C.-C.L.); (L.-H.H.); (S.-J.Y.)
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan (H.-T.C.)
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan;
| | - Mei-Shu Huang
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-C.S.); (S.-H.C.); (M.-S.H.); (C.-C.L.); (L.-H.H.); (S.-J.Y.)
| | - Li-Hui Hu
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-C.S.); (S.-H.C.); (M.-S.H.); (C.-C.L.); (L.-H.H.); (S.-J.Y.)
| | - Chu-Chuan Li
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-C.S.); (S.-H.C.); (M.-S.H.); (C.-C.L.); (L.-H.H.); (S.-J.Y.)
| | - Su-Ju Yang
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (M.-C.S.); (S.-H.C.); (M.-S.H.); (C.-C.L.); (L.-H.H.); (S.-J.Y.)
| | - Jau-Ching Wu
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan;
- Department of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Yu-Chun Chen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 11221, Taiwan;
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan (H.-T.C.)
- School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan;
- Correspondence: ; Tel.: +886-28712121#7460
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