1
|
Improving In-Hospital Care For Older Adults: A Mixed Methods Study Protocol to Evaluate a System-Wide Sub-Acute Care Intervention in Canada. Int J Integr Care 2022; 22:25. [PMID: 35431701 PMCID: PMC8973798 DOI: 10.5334/ijic.5953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction: Acute care hospitals often inadequately prepare older adults to transition back to the community. Interventions that seek to improve this transition process are usually evaluated using healthcare use outcomes (e.g., hospital re-visit rates) only, and do not gather provider and patient perspectives about strategies to better integrate care. This protocol describes how we will use complementary research approaches to evaluate an in-hospital sub-acute care (SAC) intervention, designed to better prepare and transition older adults home. Methods: In three sequential research phases, we will assess (1) SAC transition pathways and effectiveness using administrative data, (2) provider fidelity to SAC core practices using chart audits, and (3) SAC implementation outcomes (e.g., facilitators and barriers to success, strategies to better integrate care) using provider and patient interviews. Results: Findings from each phase will be combined to determine SAC effectiveness and efficiency; to assess intervention components and implementation processes that ‘work’ or require modification; and to identify provider and patient suggestions for improving care integration, both while patients are hospitalized and to some extent after they transition back home. Discussion: This protocol helps to establish a blueprint for comprehensively evaluating interventions conducted in complex care settings using complementary research approaches and data sources.
Collapse
|
2
|
Moore J, Prentice D, Crawford J. Collaboration among nurses when transitioning older adults between hospital and community settings: a scoping review. J Clin Nurs 2021; 30:2769-2785. [PMID: 33870541 DOI: 10.1111/jocn.15789] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/10/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The transitioning of older patients between healthcare sectors requires the provision of high-quality nursing care. Collaboration among nurses is identified as an essential element of transitional care, yet nurse-nurse collaboration has received little attention. AIM The aim of this study was to examine the extent, range and nature of nurse-nurse collaboration when transitioning older patients between hospital and community settings, and to identify gaps in the literature. METHODS Arksey and O'Malley's (International Journal of Social Research Methodology, 8, 2005 and 19) framework was used to undertake a scoping review to answer the research questions: how do nurses collaborate together when transitioning older patients from hospital to community settings and what are the facilitators, barriers and outcomes of nurse-nurse collaboration when transitioning older patients between sectors? The Nurse-Nurse Collaboration Scale (NNCS) subdomains informed the identification of selected studies. RESULTS Twelve papers were included with most coming from Scandinavian countries and the majority using qualitative methodologies. Communication, coordination and professionalism were found to be both facilitators and barriers of nurse-nurse collaboration. Gaps in the literature included conflict management, and the outcomes of collaboration which was only reported in one study. CONCLUSIONS The findings indicate there is limited study of collaboration among nurses when transitioning older patients between hospital and community settings. Future research should address the impact of conflict on nurses working in collaborative practice as well as conducting intervention studies to examine the outcomes of nurse-nurse collaboration.
Collapse
Affiliation(s)
- Jane Moore
- Department of Nursing, Faculty of Applied Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Dawn Prentice
- Department of Nursing, Faculty of Applied Health Sciences, Brock University, St Catharines, Ontario, Canada
| | - Joanne Crawford
- Department of Nursing, Faculty of Applied Health Sciences, Brock University, St Catharines, Ontario, Canada
| |
Collapse
|
3
|
Fønss Rasmussen L, Grode LB, Lange J, Barat I, Gregersen M. Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review. BMJ Open 2021; 11:e040057. [PMID: 33419903 PMCID: PMC7799140 DOI: 10.1136/bmjopen-2020-040057] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To identify and synthesise available evidence on the impact of transitional care interventions with both predischarge and postdischarge elements on readmission rates in older medical patients. DESIGN A systematic review. METHOD Inclusion criteria were: medical patients ≥65 years or mean age in study population of ≥75 years; interventions were transitional care interventions between hospital and home with both predischarge and postdischarge components; outcome was hospital readmissions. Studies were excluded if they: included other patient groups than medical patients, included patients with only one diagnosis or patients with only psychiatric disorders. PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from January 2008 to August 2019. Study selection at title level was undertaken by one author; the remaining selection process, data extraction and methodological quality assessment were undertaken by two authors independently. A narrative synthesis was performed, and effect sizes were estimated. RESULT We identified 1951 records and included 11 studies: five randomised trials, four non-randomised controlled trials and two pre-post cohort studies. The 11 studies represent 15 different interventions and 29 outcome results measuring readmission rates within 7-182 days after discharge. Twenty-two of the 29 outcome results showed a drop in readmission rates in the intervention groups compared with the control groups. The most significant impact was seen when interventions were of high intensity, lasted at least 1 month and targeted patients at risk. The methodological quality of the included studies was generally poor. CONCLUSION Transitional care interventions reduce readmission rates among older medical patients although the impact varies at different times of outcome assessment. High-quality studies examining the impact of interventions are needed, preferably complimented by a process evaluation to refine and improve future interventions. PROSPERO REGISTRATION NUMBER CRD42019121795.
Collapse
Affiliation(s)
- Lisa Fønss Rasmussen
- Department of Research and Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Louise Bang Grode
- Department of Research and Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
| | - Jeppe Lange
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Department of Orthopedic Surgery, Regional Hospital Horsens, Horsens, Denmark
| | - Ishay Barat
- Department of Research and Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Merete Gregersen
- Departments of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
4
|
Bonakdari H, Pelletier JP, Martel-Pelletier J. Viewpoint on Time Series and Interrupted Time Series Optimum Modeling for Predicting Arthritic Disease Outcomes. Curr Rheumatol Rep 2020; 22:27. [PMID: 32435959 DOI: 10.1007/s11926-020-00907-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The propose of this viewpoint is to improve or facilitate the clinical decision-making in the management/treatment strategies of arthritis patients through knowing, understanding, and having access to an interactive process allowing assessment of the patient disease outcome in the future. RECENT FINDINGS In recent years, the time series (TS) concept has become the center of attention as a predictive model for making forecast of unseen data values. TS and one of its technologies, the interrupted TS (ITS) analysis (TS with one or more interventions), predict the next period(s) value(s) of a given patient based on their past and current information. Traditional TS/ITS methods involve segmented regression-based technologies (linear and nonlinear), while stochastic (linear modeling) and artificial intelligence approaches, including machine learning (complex nonlinear relationships between variables), are also used; however, each have limitations. We will briefly describe TS/ITS, provide examples of their application in arthritic diseases; describe their methods, challenges, and limitations; and propose a combined (stochastic and artificial intelligence) procedure in post-intervention that will optimize ITS modeling. This combined method will increase the accuracy of ITS modeling by profiting from the advantages of both stochastic and nonlinear models to capture all ITS deterministic and stochastic components. In addition, this combined method will allow ITS outcomes to be predicted as continuous variables without having to consider the time lag produced between the pre- and post-intervention periods, thus minimizing the prediction error not only for the given data but also for all possible future patterns in ITS. The use of reliable prediction methodologies for arthritis patients will permit treatment of not only the disease, but also the patient with the disease, ensuring the best outcome prediction for the patient.
Collapse
Affiliation(s)
- Hossein Bonakdari
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, R11.412, Montreal, QC, H2X 0A9, Canada.,Department of Soil and Agri-Food Engineering, Laval University, 2425 rue de l'Agriculture, Québec, QC, G1V 0A6, Canada
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, R11.412, Montreal, QC, H2X 0A9, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, R11.412, Montreal, QC, H2X 0A9, Canada.
| |
Collapse
|
5
|
Sempé L, Billings J, Lloyd-Sherlock P. Multidisciplinary interventions for reducing the avoidable displacement from home of frail older people: a systematic review. BMJ Open 2019; 9:e030687. [PMID: 31678943 PMCID: PMC6830674 DOI: 10.1136/bmjopen-2019-030687] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/04/2019] [Accepted: 09/03/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To synthesise existing literature on interventions addressing a new concept of avoidable displacement from home for older people with multimorbidity or frailty. The review focused on home-based interventions by any type of multidisciplinary team aimed at reducing avoidable displacement from home to hospital settings. A second objective was to characterise these interventions to inform policy. DESIGN A systematic search of the main bibliographic databases was conducted to identify studies relating to interventions addressing avoidable displacement from home for older people. Studies focusing on one specific condition or interventions without multidisciplinary teams were excluded. A narrative synthesis of data was conducted, and themes were identified by using an adapted thematic framework analysis approach. RESULTS The search strategy was performed using the following electronic databases: the American National Library of Medicine and the National Institutes of Health (PubMed), Scopus, Cochrane Library (Central and CDRS), CINAHL, Social Care Online, Web of Science as well as the database of the Latin American and Caribbean Health Sciences Literature. The database search was done in September 2018 and completed in October 2018. Overall 3927 articles were identified and 364 were retained for full text screening. Fifteen studies were included in the narrative review. Four themes were identified and discussed: (1) types of interventions, (2) composition of teams, (3) intervention effectiveness and (4) types of outcomes. Within intervention types, three categories of care types were identified; transitional care, case-management services and hospital at home. Each individual article was assessed in terms of risk of bias following Cochrane Collaboration guidelines. CONCLUSIONS The review identified some potential interventions and relevant topics to be addressed in order to develop effective and sustainable interventions to reduce the avoidable displacement from home of older people. However the review was not able to identify robust impact evidence, either in terms of quantity or quality from the studies presented. As such, the available evidence is not sufficiently robust to inform policy or interventions for reducing avoidable displacement from home. This finding reflects the complexity of these interventions and a lack of systematic data collection. PROSPERO REGISTRATION NUMBER CRD42018108116.
Collapse
Affiliation(s)
- Lucas Sempé
- School of International Development, University of East Anglia, Norwich, UK
| | - Jenny Billings
- Centre for Integrated Care Research, University of Kent, Canterbury, UK
| | | |
Collapse
|
6
|
|
7
|
Handley MA, Lyles CR, McCulloch C, Cattamanchi A. Selecting and Improving Quasi-Experimental Designs in Effectiveness and Implementation Research. Annu Rev Public Health 2018; 39:5-25. [PMID: 29328873 PMCID: PMC8011057 DOI: 10.1146/annurev-publhealth-040617-014128] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Interventional researchers face many design challenges when assessing intervention implementation in real-world settings. Intervention implementation requires holding fast on internal validity needs while incorporating external validity considerations (such as uptake by diverse subpopulations, acceptability, cost, and sustainability). Quasi-experimental designs (QEDs) are increasingly employed to achieve a balance between internal and external validity. Although these designs are often referred to and summarized in terms of logistical benefits, there is still uncertainty about (a) selecting from among various QEDs and (b) developing strategies to strengthen the internal and external validity of QEDs. We focus here on commonly used QEDs (prepost designs with nonequivalent control groups, interrupted time series, and stepped-wedge designs) and discuss several variants that maximize internal and external validity at the design, execution and implementation, and analysis stages.
Collapse
Affiliation(s)
- Margaret A Handley
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California 94110, USA;
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, California 94110, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, California 94110, USA
| | - Courtney R Lyles
- Department of Medicine, Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, California 94110, USA
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, California 94110, USA
| | - Charles McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California 94110, USA;
| | - Adithya Cattamanchi
- Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, California 94110, USA
- Department of Medicine, Division of Pulmonary and Critical Care Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, California 94110, USA
| |
Collapse
|
8
|
Hwang U, Hastings SN, Ramos K. Improving Emergency Department Discharge Care with Telephone Follow-Up. Does It Connect? J Am Geriatr Soc 2017; 66:436-438. [PMID: 29272032 DOI: 10.1111/jgs.15218] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ula Hwang
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.,Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY
| | - S Nicole Hastings
- Division of Geriatrics, Department of Medicine, School of Medicine, Duke University, Durham, NC.,Center for the Study of Aging and Human Development, Duke University, Durham, NC.,Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC
| | - Katherine Ramos
- Center for the Study of Aging and Human Development, Duke University, Durham, NC.,Geriatric Research, Education and Clinical Center, Durham Veterans Affairs Medical Center, Durham, NC
| |
Collapse
|
9
|
Heppenstall CP, Hanger HC, Wilkinson TJ, Dhanak M. Telephone discharge support for frail, vulnerable older people discharged from hospital: Impact on readmission rates - Participant and general practitioner feedback. Australas J Ageing 2017; 37:107-112. [PMID: 29143480 DOI: 10.1111/ajag.12477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the use and acceptability to older participants and general practitioners (GPs) of telephone support postdischarge to reduce readmissions. METHODS A prospective cohort study of older people after discharge from a specialist geriatric unit, and comparison with a previous cohort. Telephone follow-up calls were made fortnightly for three months. Structured questionnaires were used to obtain feedback from participants and GPs. RESULTS Readmission rates were high, 40%, despite the intervention. This rate had significantly increased since the earlier cohort. Almost one-fifth of the sample (19%) were readmitted before the first telephone call. Subsequent readmissions were not related to whether participants had reported deteriorating health during the preceding telephone call. Feedback on the intervention from both participants and GPs was supportive. CONCLUSIONS Telephone follow-up as we used it did not reduce readmission rates. However, it was well received and appreciated by participants. It is possible the telephone calls were not made early enough or frequently enough to achieve the desired outcome.
Collapse
Affiliation(s)
| | - Hugh C Hanger
- Canterbury District Health Board, Christchurch, New Zealand
| | | | | |
Collapse
|