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Boeng AC, Cechinel-Peiter C, da Costa MFBNA, Wachholz LF, dos Santos JLG, Lanzoni GMDM. Quality of Care Transition for COVID-19 Patients in a University Hospital in Southern Brazil. Rev Bras Enferm 2024; 77Suppl 1:e20230402. [PMID: 38958356 PMCID: PMC11213544 DOI: 10.1590/0034-7167-2023-0402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/14/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVE To assess the quality of care transition from hospital to home for COVID-19 patients. METHOD A cross-sectional study conducted at a University Hospital in Southern Brazil, involving 78 patients discharged after COVID-19 hospitalization. Data collection was performed via telephone using the Brazilian version of the Care Transitions Measure (CTM-15). Data were analyzed using descriptive and analytical statistics. RESULTS The mean quality of care transition was 70.8 on a scale ranging from zero to 100, indicating moderate quality of care transition. The highest score was attributed to factor 1, "Preparation for self-management," and the lowest to factor 4, "Care Plan." CONCLUSIONS It is important to enhance communication and support provided to patients during the transition process, especially regarding understanding prescribed medications and the development of clear care plans.
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Affiliation(s)
- Ana Cecilia Boeng
- Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil
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Marsall M, Hornung T, Bäuerle A, Weigl M. Measuring transitional patient safety: Adaptation and validation of the German version of the Care Transitions Measure. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 182-183:17-25. [PMID: 37951720 DOI: 10.1016/j.zefq.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 11/14/2023]
Abstract
INTRODUCTION The transition between different care contexts, especially during discharge from inpatient treatment to home, is associated with risks for patient safety. Internationally established, the Care Transitions Measure (CTM) is used to assess the quality and safety of this transition from the patients' perspective. A systematic and standardized assessment of quality and safety in the discharge process from the patients' perspective has not been possible in German-speaking countries due to the lack of a German adaptation and validation of the CTM. This study aims to translate, adapt, and validate the CTM for use in German-speaking countries METHODS: The German version of the CTM was developed based on internationally accepted recommendations for translating and adapting questionnaires. Patients of all departments (except pediatric departments) of a German university hospital who were discharged home after at least three days of inpatient treatment received the questionnaire by mail between May and August 2022. A total of 806 patients participated in the survey. The validity of the CTM was tested by factor analyses. For this purpose, different factor models were compared. In addition, the measurement invariance of the instrument was examined. RESULTS The construct validity of the long version of the CTM (15items) with a two-factorial model structure was confirmed with good model fit indices. The two subscales had excellent internal consistency. In addition, the one short version with four items achieved excellent model fit indices and high internal consistency. For the long version of the CTM, measurement invariance was confirmed for all sociodemographic, care-related, and survey response characteristics examined. The measurement invariance of the short version was only partially confirmed. DISCUSSION The validity and reliability of the German version of the CTM were confirmed. In its long version, the instrument is measurement invariant across various characteristics and thus allows valid interpretation of group differences. The short version is partially measurement invariant and is suitable as a screening instrument for assessing the quality and safety of discharge processes due to its high validity and reliability. CONCLUSIONS With a validated and standardized German version of the CTM, an instrument is now available to assess the quality and safety of the discharge process from the patients' perspective. Thus, this study provides an essential tool for systematically investigating and optimizing patient safety in the discharge process.
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Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany.
| | | | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany
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Seidenfeld J, Ramos K, Bruening RA, Sperber NR, Stechuchak KM, Hastings SN. Patient experiences of a care transition intervention for Veterans to reduce emergency department visits. Acad Emerg Med 2023; 30:388-397. [PMID: 36630213 DOI: 10.1111/acem.14661] [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: 09/02/2022] [Revised: 12/19/2022] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Care transition interventions (CTIs) are used to improve outcomes after an emergency department (ED) visit. A recent randomized controlled trial of a Veterans Health Administration (VHA) CTI titled Discharge Information and Support for Patients receiving Outpatient care in the ED (DISPO ED) demonstrated no difference in repeat ED visits. However, changes in health care utilization are not the only measures of a CTI worth evaluation, and there is interest in using patient-centered outcomes to assess CTIs as well. To inform future CTI design and outcome measure selection, the study aims were to understand how patients experienced the CTI and what elements they valued. METHODS This was a qualitative study of participants randomized to the intervention arm of the DISPO ED trial using semistructured interviews. The interview guide included questions about clinical health and other issues addressed by the study nurse, the most and least helpful aspects of the intervention, and impacts of the intervention on their perceptions of self-management. Interviews were analyzed using directed content analysis. RESULTS Our sample comprised 24 participants, with average age of 61 years, 58% male, and 50% Black or African American. We identified six major themes related to (1) experiences during the intervention and (2) elements they valued. Patients reported clinical health coaching recommendations covering a wide range of topics as well as care coordination actions such as appointment scheduling. Valuable elements of the intervention highlighted personal characteristics of the study nurse that promoted a sense of interpersonal connection and empathy in their interactions. CONCLUSIONS Intervention users described assistance with care coordination as well as clinical concerns. We identified aspects that were highly valued by the participants, such as interpersonal support and empathy from the interventionist. These findings suggest the need for more comprehensive nonutilization outcome measures for CTIs to capture the patient's perspective.
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Affiliation(s)
- Justine Seidenfeld
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Emergency Medicine, Durham VA Health Care System, Durham, North Carolina, USA.,Division of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Katherine Ramos
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for the Study of Human Aging and Development, Duke University School of Medicine, Durham, North Carolina, USA
| | - Rebecca A Bruening
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
| | - Nina R Sperber
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Karen M Stechuchak
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA
| | - Susan N Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, North Carolina, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA.,Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA.,Center for the Study of Human Aging and Development, Duke University School of Medicine, Durham, North Carolina, USA.,Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
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Shah VV, Villaflores CW, Chuong LH, Leuchter RK, Kilaru AS, Vangala S, Sarkisian CA. Association Between In-Person vs Telehealth Follow-up and Rates of Repeated Hospital Visits Among Patients Seen in the Emergency Department. JAMA Netw Open 2022; 5:e2237783. [PMID: 36282505 PMCID: PMC9597390 DOI: 10.1001/jamanetworkopen.2022.37783] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/30/2022] [Indexed: 11/14/2022] Open
Abstract
Importance For patients discharged from the emergency department (ED), timely outpatient in-person follow-up is associated with improved mortality, but the effectiveness of telehealth as follow-up modality is unknown. Objective To evaluate whether the rates of ED return visits and hospitalization differ between patients who obtain in-person vs telehealth encounters for post-ED follow-up care. Design, Setting, and Participants This retrospective cohort study included adult patients who presented to either of 2 in-system EDs of a single integrated urban academic health system from April 1, 2020, to September 30, 2021; were discharged home; and obtained a follow-up appointment with a primary care physician within 14 days of their index ED visit (15 total days). Exposures In-person vs telehealth post-ED discharge follow-up within 14 days. Main Outcomes and Measures Multivariable logistic regression was used to estimate the odds of ED return visits (primary outcome) or hospitalization (secondary outcome) within 30 days of an ED visit based on the modality of post-ED discharge follow-up. Models were adjusted for age, sex, primary language, race, ethnicity, Social Vulnerability Index, insurance type, distance to the ED, ambulatory billing codes for the index visit, and the time from ED discharge to follow-up. Results Overall, 12 848 patients with 16 987 ED encounters (mean [SD] age, 53 [20] years; 9714 [57%] women; 2009 [12%] Black or African American; 3806 [22%] Hispanic or Latinx; and 9858 [58%] White) were included; 11 818 (70%) obtained in-person follow-up, and 5169 (30%) obtained telehealth follow-up. Overall, 2802 initial ED encounters (17%) led to returns to the ED, and 676 (4%) led to subsequent hospitalization. In adjusted analyses, telehealth vs in-person follow-up visits were associated with increased rates of ED returns (28.3 [95% CI, 11.3-45.3] more ED returns per 1000 encounters) and hospitalizations (10.6 [95% CI, 2.9-18.3] more hospitalizations per 1000 encounters). Conclusions and Relevance In this cohort study of patients in an urban integrated health care system, those with telehealth follow-up visits after an ED encounter were more likely to return to the ED and be hospitalized than patients with in-person follow-up. The use of telehealth warrants further evaluation to examine its effectiveness as a modality for continuing care after an initial ED presentation for acute illness.
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Affiliation(s)
- Vivek V. Shah
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Chad W. Villaflores
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Linh H. Chuong
- Fielding School of Public Health, Department of Health Policy and Management, University of California, Los Angeles
| | - Richard K. Leuchter
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Austin S. Kilaru
- Perelman School of Medicine, Center for Emergency Care Policy and Research, Department of Emergency Medicine, University of Pennsylvania, Philadelphia
- Leonard Davis Institute for Health Economics, Wharton School, University of Pennsylvania, Philadelphia
| | - Sitaram Vangala
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Catherine A. Sarkisian
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- VA Greater Los Angeles Healthcare System, Los Angeles, California
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Gettel CJ, Voils CI, Bristol AA, Richardson LD, Hogan TM, Brody AA, Gladney MN, Suyama J, Ragsdale LC, Binkley CL, Morano CL, Seidenfeld J, Hammouda N, Ko KJ, Hwang U, Hastings SN, Bellolio MF, Biese K, Binkley C, Bott N, Brody A, Carpenter C, Clark S, Dresden MS, Forrester S, Gerson L, Gettel C, Goldberg E, Greenberg A, Hammouda N, Han J, Hastings SN, Hogan T, Hung W, Hwang U, Kayser J, Kennedy M, Ko K, Lesser A, Linton E, Liu S, Malsch A, Matlock D, McFarland F, Melady D, Morano C, Morrow‐Howell N, Nassisi D, Nerbonne L, Nyamu S, Ohuabunwa U, Platts‐Mills T, Ragsdale L, Richardson L, Ringer T, Rosen A, Rosenberg M, Shah M, Skains R, Skees S, Souffront K, Stabler L, Sullivan C, Suyama J, Vargas S, Camille Vaughan E, Voils C, Wei D, Wexler N. Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement. Acad Emerg Med 2021; 28:1430-1439. [PMID: 34328674 DOI: 10.1111/acem.14360] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Individual-level social needs have been shown to substantially impact emergency department (ED) care transitions of older adults. The Geriatric Emergency care Applied Research (GEAR) Network aimed to identify care transition interventions, particularly addressing social needs, and prioritize future research questions. METHODS GEAR engaged 49 interdisciplinary stakeholders, derived clinical questions, and conducted searches of electronic databases to identify ED discharge care transition interventions in older adult populations. Informed by the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) framework, data extraction and synthesis of included studies included the degree that intervention components addressed social needs and their association with patient outcomes. GEAR convened a consensus conference to identify topics of highest priority for future care transitions research. RESULTS Our search identified 248 unique articles addressing care transition interventions in older adult populations. Of these, 17 individual care transition intervention studies were included in the current literature synthesis. Overall, common care transition interventions included coordination efforts, comprehensive geriatric assessments, discharge planning, and telephone or in-person follow-up. Fourteen of the 17 care transition intervention studies in older adults specifically addressed at least one social need within the PRAPARE framework, most commonly related to access to food, medicine, or health care. No care transition intervention addressing social needs in older adult populations consistently reduced subsequent health care utilization or other patient-centered outcomes. GEAR stakeholders identified that determining optimal outcome measures for ED-home transition interventions was the highest priority area for future care transitions research. CONCLUSIONS ED care transition intervention studies in older adults frequently address at least one social need component and exhibit variation in the degree of success on a wide array of health care utilization outcomes.
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Affiliation(s)
- Cameron J. Gettel
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- National Clinician Scholars Program Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA
| | - Corrine I. Voils
- William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Lynne D. Richardson
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
- Department of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York New York USA
- Institute for Health Equity Research Icahn School of Medicine at Mount Sinai New York New York USA
| | - Teresita M. Hogan
- Department of Medicine Section of Emergency Medicine The University of Chicago School of Medicine Chicago Illinois USA
| | - Abraham A. Brody
- Hartford Institute for Geriatric Nursing New York University Rory Meyers College of Nursing New York New York USA
| | - Micaela N. Gladney
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
| | - Joe Suyama
- Department of Emergency Medicine University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Luna C. Ragsdale
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
- Department of Emergency Medicine Durham VA Health Care System Durham North Carolina USA
| | - Christine L. Binkley
- Department of Emergency Medicine University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Carmen L. Morano
- School of Social Welfare University at AlbanyState University of New York Albany New York USA
| | - Justine Seidenfeld
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
| | - Nada Hammouda
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Kelly J. Ko
- West Health Institute La Jolla California USA
| | - Ula Hwang
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- Geriatrics Research, Education, and Clinical Center James J. Peters VAMC Bronx New York USA
| | - Susan N. Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
- Department of Medicine Duke University School of Medicine Durham NC USA
- Geriatric Research, Education, and Clinical Center Durham VA Health Care System Durham North Carolina USA
- Center for the Study of Human Aging and Development Duke University School of Medicine Durham North Carolina USA
- Department of Population Health Sciences Duke University School of Medicine Durham North Carolina USA
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Jaffe TA, Wang D, Loveless B, Lai D, Loesche M, White B, Raja AS, He S. A Scoping Review of Emergency Department Discharge Risk Stratification. West J Emerg Med 2021; 22:1218-1226. [PMID: 34787544 PMCID: PMC8597698 DOI: 10.5811/westjem.2021.6.52969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/25/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Although emergency department (ED) discharge presents patient-safety challenges and opportunities, the ways in which EDs address discharge risk in the general ED population remains disparate and largely uncharacterized. In this study our goal was to conduct a review of how EDs identify and target patients at increased risk at time of discharge. METHODS We conducted a literature search to explore how EDs assess patient risk upon discharge, including a review of PubMed and gray literature. After independently screening articles for inclusion, we recorded study characteristics including outcome measures, patient risk factors, and tool descriptions. Based on this review and discussion among collaborators, major themes were identified. RESULTS PubMed search yielded 384 potentially eligible articles. After title and abstract review, we screened 235 for potential inclusion. After full text and reference review, supplemented by Google Scholar and gray literature reviews, we included 30 articles for full review. Three major themes were elucidated: 1) Multiple studies include retrospective risk assessment, whereas the use of point-of-care risk assessment tools appears limited; 2) of the point-of-care tools that exist, inputs and outcome measures varied, and few were applicable to the general ED population; and 3) while many studies describe initiatives to improve the discharge process, few describe assessment of post-discharge resource needs. CONCLUSION Numerous studies describe factors associated with an increased risk of readmission and adverse events after ED discharge, but few describe point-of-care tools used by physicians for the general ED population. Future work is needed to investigate standardized tools that assess ED discharge risk and patients' needs upon ED discharge.
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Affiliation(s)
- Todd A Jaffe
- Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts
| | - Daniel Wang
- Kansas City University School of Medicine, Kansas City, Missouri
| | - Bosten Loveless
- Rocky Vista University College of Osteopathic Medicine, Ivins, Utah
| | - Debbie Lai
- University College of London, Division of Psychology and Language Sciences, London, England
| | - Michael Loesche
- Massachusetts General Hospital and Brigham and Women's Hospital, Harvard Affiliated Emergency Medicine Residency, Boston, Massachusetts
| | - Benjamin White
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Ali S Raja
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Shuhan He
- Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts.,Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
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