Community nursing services for postdischarge chronically ill patients

A Retrospective Analysis of Internet-Based Sharing Nursing Service Appointment Data

Aims

To investigate the historical data of the "Internet+ Nursing" service platform and provide a theoretical basis to optimize the "Internet+ Nursing" service model by analyzing a population in need of nursing care services, service prices, services in demand, willingness to place orders, and feedback on use.

Methods

A retrospective analysis of data related to home care services on the "Jiuzhou Nursing Care" platform from April 2020 to August 2021, a total of 279 person-times, relevant information about the research subjects, and the status of home care services was conducted. SPSS 24.0 software was used for data analyses, such as calculating frequencies and percentages and conducting chi-square tests.

Results

The "Jiuzhou Online Nurse" primarily serves elderly patients, and the majority of these patients have lost their ability to care for themselves. The average cost of nursing services was ¥183.45, and the unit cost of services had no effect on the number of service items. This particular internet-based home nursing service has a high level of satisfaction. Patients aged 60 to 74 have the highest number of Internet-based home care service orders (χ 2 = 11.791, P < 0.05). Patients who reuse the platform are more willing to assign people to provide services (χ 2 = 238.078, P < 0.05). Patients who were unable to care for themselves had a higher rate of repeat order (χ 2 = 10.877, P < 0.05).

Conclusion

The "Internet+ Nursing" service platform specifically meets the individual needs of elderly patients, provides them with home nursing services, and improves local medical treatment and door-to-door services. This platform also provides convenience for elderly individuals who cannot care for themselves so that they can receive prompt treatment and assistance to improve their quality of life.

A mHealth-based nursing model for assessing the health outcomes of the discharged patients with nasopharyngeal carcinoma: a pilot RCT

Background

Nasopharyngeal carcinoma (NPC) is one of the most common head and neck malignancies, having a high incidence in Guangxi, China. Although chemoradiotherapy offers more effective cancer treatment, it also causes a variety of acute and chronic side effects, seriously affecting the quality of life. NPC has evolved into a chronic disease with most patients opting for home-based rehabilitation. Therefore, efforts on improving the home-based extended care services to improve the quality of life of patients are booming. The Chinese government encourages the use of internet technology for expanding the prospect of nursing. This study aimed to evaluate the impact of a mHealth-based care model on the health outcomes of discharged patients with nasopharyngeal carcinoma.

Methods

An experimental design was applied for this study. The study enrolled 116 discharged patients who were re-examined in the Radiotherapy Department of the First Affiliated Hospital of Guangxi Medical University from November 2019 to February 2020. These patients were randomized into control and intervention groups (n = 58 per group), but during the implementation of the project, there was one dropout in the control group due to the loss of follow-up, and one dropout in the intervention group due to distant metastasis. In the end, 57 patients in the control and intervention groups completed the trial. The control group was subjected to routine discharge guidance and follow-up, while the experimental group was implemented with a mobile health (mHealth)-based continuous nursing intervention model. The scores of the side effects, cancer fatigue, and quality of life were compared between the two groups of patients for 3, 6, and 12 months, respectively after discharge from the hospital.

Results

This study included 114 patients and there were no significant differences in the baseline data between the two groups. After 6 and 12 months of intervention, the severity of radiation toxicity and side effects, the scores of cancer-related fatigue, and quality of life (symptom field) of the patients in the interventional group were significantly lowered statistically compared to those in the control group.

Conclusion

This study is based on the mHealth continuous nursing intervention model, which can reduce the side effects of radiotherapy and cancer fatigue, and improve the quality of life.

Trial registration

This study was retrospectively registered as a randomized controlled trial in the Chinese Clinical Trial Center. Registration Date: January 12, 2021, Registration Number: ChiCTR2100042027.

Variables Determining Higher Home Care Effectiveness in Patients with Chronic Cardiovascular Disease

The aim of this cross-sectional study was to analyze the variables that influence the effectiveness of home care in patients with chronic cardiovascular disease and their informal caregivers. The study was conducted in 193 patients and their 161 informal caregivers. The study used the WHOQOL-BREF Quality of Life Questionnaire, the health behavior inventory questionnaire (HBI), the Camberwell assessment of need short appraisal schedule (CANSAS) and the hospital anxiety and depression scale–modified (HADS–M) version. Spearman’s rank correlation coefficient test and logistic regression were used for analyses. Analysis of patients revealed an association between home care effectiveness and the following variables (OR per unit): age (OR = 0.98, 95% CI: 0.95–0.99), educational level (OR = 1.45, 95% CI: 1.05–2.02), financial status (OR = 0.43, 95% CI: 0.21–0.83), medication irregularity (OR = 0.25, 95% CI: 0.07–0.72), presence of comorbidities (OR = 6.18, 95% CI: 1.83–23.78), health care services provided by a nurse (OR = 1.25, 95% CI: 1.03–1.64), and number of visits to a cardiology clinic (OR = 1.25, 95% CI: 1.02–1.59). There was no association between care effectiveness and sex (p = 0.28), place of residence (p = 0.757), duration of cardiovascular disease (p = 0.718), number of home visits (p = 0.154), nursing interventions (p = 0.16), and adherence to lifestyle change recommendations (p = 0.539) or proper dietary habits (p = 0.355). A greater chance of improved health care effectiveness was found in patients whose caregivers reported higher social (OR = 1.24, 95% CI: 1.09–1.44), psychological (OR = 1.68, 95% CI: 1.25–2.37), and physical (OR = 1.24, 95% CI: 1.05–1.49) quality of life. Patients with cardiovascular disease who were characterized by lower educational attainment, poorer financial status, fewer visits to cardiology clinics, lower utilization of medical services, poorer self-perception of mental and physical well-being, recent onset of disease symptoms, and irregular use of medications, were much more likely to have poorer health care effectiveness. Patients with cardiovascular disease and their caregivers can be well supported at home as long as the care model is tailored to the specific needs. This includes family care coordination in the health care team, home care, and general practice support.

Telehealth Education via WeChat Improves the Quality of Life of Parents of Children with Type-1 Diabetes Mellitus

OBJECTIVE

The purpose of this study was to explore the effect of telehealth education and care guidance via WeChat (Tencent Ltd., Shenzhen, China; a popular smartphone-based social media application) on improving the quality of life of parents of children with type-1 diabetes mellitus.

METHODS

A prospective randomized controlled study was conducted in our hospital from March 2019 to September 2020 to compare the quality of life of parents of children with type-1 diabetes mellitus in the intervention group and the control group.

RESULTS

Six months after discharge, the Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores of parents in the intervention group were significantly lower than those in the control group (p < 0.05). Compared with the SAS and SDS scores at discharge time, those scores of parents at 6 months after discharge time in intervention group were significantly lower (p < 0.05), while those scores of parents at 6 months after discharge time in control was similar (p > 0.05). Six months after discharge, the scores of the physiological field, psychological field, social relationship field, and environmental field in the intervention group were significantly higher than those of the control group according to the result of the World Health Organization Quality of Life Brief Scale (WHOQOL-BREF; p < 0.05).

CONCLUSION

Using WeChat to provide telehealth education and home care guidance to the parents of children with type-1 diabetes mellitus can effectively relieve the anxiety and depression of the parents and improve their quality of life.

The Evolving Roles of Nurses Providing Care at Home: A Qualitative Case Study Research of a Transitional Care Team

Purpose:

To examine the roles of transitional care nurses in an integrated healthcare system and how the integrated healthcare system influences their evolving roles.

Background:

Transitional care teams have been introduced to enable the seamless transfer of patients from acute-care to the home settings. A qualitative case study of the transitional care team was conducted to understand the changing roles of these nurses in an integrated Regional Health System (RHS) in Singapore.

Methods:

A hospital transitional team of an integrated RHS was studied. Purposive sampling was used. Non-participant observations and follow-up interviews were conducted with four nurses. Data were triangulated with the interviews of two managers and three healthcare professionals, and the analysis of documents. Within-case thematic analysis was carried out.

Results:

Three themes were identified: ‘Coming together to meet the needs of all’; ‘Standing strong amidst the stormy waves’; and ‘Searching for the right formula in handling complexity’. These themes have explained on the atypical roles taken on by nurses in their attempts to close the gaps and meet the patients’ needs. Various factors influencing the evolving roles were revealed.

Conclusion:

The roles of nurses have ‘emerged differently’ from their traditional counterparts. Various nursing roles have been undertaken to facilitate care integration. The findings emphasised the important balance between formal structural practices and informal processes in facilitating and supporting the nurses in their role development.

Home-based nursing care competencies: A scoping review

AIMS AND OBJECTIVES

To identify and consolidate the available evidence about nursing-related competencies for home-based care.

BACKGROUND

Over recent years, the demand for home-based nursing care has increased because of the need to meet the increasing need for chronic disease care to be delivered in patients' homes. However, knowledge is lacking about the expected competencies for home-based care nurses.

DESIGN

A scoping review was conducted in accordance with Arksey and O'Malley's six-step scoping review framework and the PRISMA-ScR guidelines. The review identified literature using five electronic databases (CINAHL, PubMed, Embase, Cochrane and Scopus) and a hand search for grey literature in relevant home-based care journals and online searches. Key search terms and inclusion and exclusion criteria were used as strategies to identify relevant articles.

RESULTS

Sixty-four articles were eligible for inclusion. Mapping and narrative synthesis of 116 elements related to home-based nursing care competencies identified the following 10 competencies: (1) care assessments; (2) performance of nursing procedures; (3) management of health conditions; (4) critical thinking and problem-solving skills; (5) interpersonal relationships and communication; (6) interdisciplinary collaboration; (7) leadership and resource management; (8) professional development; (9) technological literacy; (10) quality and safety.

CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE

This review provides insight into current knowledge about home-based nursing care competencies. These competencies could be used to evaluate nurses' competence level for home-based care or for development of appropriate professional education. The review also outlines the scope of nursing practice in home-based care, which provides support for some form of standardisation of home-based nursing care expectations across various stakeholders.

Barriers to accessing internet-based home Care for Older Patients: a qualitative study

Background

Due to the increasingly ageing society and the shortage of nursing human resources in China, the imbalance between the home care needs of older patients and the inadequate supply of nursing services is increasing. Based on this medical situation, China is implementing internet-based home care (with the nurses who provide this care called online nurses or sharing nurses) based on the concept of the sharing economy, internet technology and knowledge from the home care experience in other countries. Internet-based home care follows an online application/offline service model. Patients place orders through an app, nurses grab orders instantly, and managers dispatch orders through a web platform based on various factors such as nurses’ qualifications, professionalism and distance from the patient. In this way, home care is provided for patients with limited mobility, such as older or disabled patients, patients in rehabilitation and terminal patients. Only by fully understanding the barriers to accessing internet-based home care can we provide quality nursing services to older patients and achieve the sustainable development of internet-based home care.

Objective

The goal of this study was to use qualitative methods to explore barriers to accessing internet-based home care for older patients.

Methods

Based on Levesque’s access to health care framework, semi-structured personal interviews were conducted with 19 older patients in a descriptive qualitative study using directed content analysis.

Results

We identified four barriers to accessing internet-based home care for older patients: barriers to perceiving, seeking, paying for, and engaging in internet-based home care. Specific barriers included traditional perceptions, barriers to internet use, high payment costs, uneven quality of services, and concerns about privacy and patient safety.

Conclusions

Internet-based home care brings new risks and challenges. In order to enable older patients to better enjoy it, it is necessary to strengthen publicity, optimize the network application process, improve the health insurance system, formulate unified nursing service standards, and address safety risks.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02474-6.

The use of mind mapping in health education in extended care for children with caries

Objective

To investigate the application of mind mapping-based health education in extended care for children with caries.

Methods

This was a prospective study of 159 eligible children with caries. Participants were randomly assigned to an observation group and a control group, and received extended health education and guidance. Patients in the observation group received health education with mind mapping. In the third month after the first visit, a questionnaire survey was conducted to assess knowledge of extended caries diagnosis and treatment in children and their parents. Children also underwent a bacterial plaque test.

Results

Caries knowledge was significantly greater in the observation group than in the control group. There was no significant between-group difference in debris index on the bacterial plaque test. The observation group had a significantly greater number of follow-up visits in 12 months than the control group.

Conclusions

Mind mapping was effective in the implementation of extended care. Mind mapping information was more accessible to children and their parents, increasing their compliance with health education. Thus, mind mapping is an appropriate health education tool for use in extended care for children with caries.

Medication interventions for African-American adults: Practice-based evidence from two nurse-led clinics

OBJECTIVE

This study was conducted to describe and examine the impact of medication intervention practices among African-American clients in two nurse-led community nursing centers (CNCs).

METHODS

This study used a retrospective-descriptive design. Omaha System data from visits of 196 African-American adults living with chronic disease and having two or more CNC visits in which medication regimen was an identified problem and the main reason for the visit was analyzed.

RESULTS

The sample had a mean age of 53.1 (6.67) and was primarily women (82%), uninsured, and with high school or less education. A total of 9,259 Medication regimen interventions were documented and implemented during 1,146 client CNC visits. A paired samples t test revealed statistically significant improvements in Knowledge (t = 2.434, p < .01). Behavior (t = 0.077, p = .94) and Status (t = 1.489, p = .14) remained unchanged, although the ratings trended toward improvement for each.

CONCLUSION

This study provides evidence that the nursing center model of care does improve the knowledge of medications among African-American clients. The study also demonstrated the Omaha System's utility to evaluate the impact of nursing interventions in community settings.

Nurses' experiences on the road during transition into community care: An exploratory descriptive qualitative study in Singapore

Healthcare systems are evolving to meet the demands of an ageing population whereby the provision of health care services in the community has increased to alleviate the burden faced by acute care health facilities. As the result, the number of community nurses are expected to increase in order to meet the demand. Several studies have identified the unique challenges faced by the growing responsibilities of community nurses. However, fewer studies focused on the experiences of nurses transitioning to become community nurses as they rise to meet the unique challenges of working in the community. This study aimed to explore the experiences of nurses' transitions into community care while gaining insight into the transition process. The study adopted the exploratory qualitative approach. Data collection was performed through semi-structured interviews with 14 community nurses in Singapore. Interview sessions were digitally recorded and transcribed into verbatim, and the thematic analysis approach was used for data analysis. Three major themes and nine subthemes were developed from the data of 14 interviews. The three major themes are: 'Changes in Dynamics in a Nurse-Patient Relationship', 'To Live Up to Expectations', and 'Negotiating the Landscape in the Community'. New community nurses are experiencing stress and struggling to adapt with performing nursing care in uncontrolled environments. Additionally, higher expectations have been set on them even when they are still in transition. It is important to provide support for nurses, including in-service talks, courses and formal orientation programs. The study findings highlighted the importance of adequately preparing new community nurses and provided insights on developing a customised formal orientation program. This study also contributed to the limited body of knowledge with respect to nurses' transition experiences into community care.

A Slovenian Model of Comprehensive Care for Patients with Difficulties Accessing Healthcare: A Step Towards Health Equity

Patients that cannot come to their family medicine practice (i.e. who have difficulties with access) do not receive the same preventive screening activities and management of their chronic diseases as those who can. Community nurses who provide healthcare to patients in their homes were trained in additional competencies, including screening for risk factors for selected diseases and the management of patients with selected chronic diseases. The presented model enables equal management of all registered patients, regardless of accessibility. It also fosters exchange of information within the team members and thus improves the quality of the team management of patients.

Interventions to Promote Early Discharge and Avoid Inappropriate Hospital (Re)Admission: A Systematic Review

Increasing pressure on limited healthcare resources has necessitated the development of measures promoting early discharge and avoiding inappropriate hospital (re)admission. This systematic review examines the evidence for interventions in acute hospitals including (i) hospital-patient discharge to home, community services or other settings, (ii) hospital discharge to another care setting, and (iii) reduction or prevention of inappropriate hospital (re)admissions. Academic electronic databases were searched from 2005 to 2018. In total, ninety-four eligible papers were included. Interventions were categorized into: (1) pre-discharge exclusively delivered in the acute care hospital, (2) pre- and post-discharge delivered by acute care hospital, (3) post-discharge delivered at home and (4) delivered only in a post-acute facility. Mixed results were found regarding the effectiveness of many types of interventions. Interventions exclusively delivered in the acute hospital pre-discharge and those involving education were most common but their effectiveness was limited in avoiding (re)admission. Successful pre- and post-discharge interventions focused on multidisciplinary approaches. Post-discharge interventions exclusively delivered at home reduced hospital stay and contributed to patient satisfaction. Existing systematic reviews on tele-health and long-term care interventions suggest insufficient evidence for admission avoidance. The most effective interventions to avoid inappropriate re-admission to hospital and promote early discharge included integrated systems between hospital and the community care, multidisciplinary service provision, individualization of services, discharge planning initiated in hospital and specialist follow-up.

Optimal Timing of Physician Visits after Hospital Discharge to Reduce Readmission

OBJECTIVE

To identify the optimal timing of in-person physician visit after hospital discharge to yield the largest reduction in readmission among elderly or chronically ill patients.

DATA SOURCES/STUDY SETTING/EXTRACTION METHODS

We extracted insurance billing data on 620,656 admissions for any cause from 2002 to 2009 in Quebec, Canada.

STUDY DESIGN

We used flexible survival models to estimate inverse probability weights for the precise timing (days) of in-person physician visit after discharge and weighted competing risk outcome models.

PRINCIPAL FINDINGS

Readmission reduction associated with in-person physician visits (compared to none) was seen early after discharge, with 67.8 fewer readmissions per 1,000 discharges if physician visit occurred within 7 days (95 percent CI: 66.7-69.0), and 110.0 fewer readmissions within 21 days (95 percent CI: 108.2-111.7). The period of largest contribution to readmission reduction was seen in the first 10 days, while physician visits occurring later than 21 days after discharge did not further contribute to reducing hospital readmissions. Larger risk reductions were observed among patients in the highest morbidity level and for in-person follow-up with a primary care physician rather than a medical specialist.

CONCLUSIONS

When provided promptly, postdischarge in-person physician visit can prevent many readmissions. The benefits appear optimal when such visit occurs within the first 10 days, or at least within the first 21 days of discharge.

Nursing care in multifunctional small group homes providing day, visiting and overnight services for older people living at home

Home care programs for older people have been developed around the world. Nurses are key to these programs. The aim of this study is to explore details of the nursing activities used in group homes to provide a basis for describing effective nursing practices in such facilities. A self-administered questionnaire was sent to 240 randomly selected facilities throughout Japan in 2013. Responses indicated that the activities of nurses in managing the health of older people included determining the need for medical consultations, dealing with emergencies, and making arrangements for the use of flexible care services. Nursing activities were directly related to the percentage of older people in each facility with diagnoses such as dementia or heart disease. Nurses reported low general self-efficacy for some of the more specialized nursing activities they performed. Nursing activities are performed with the aim of supporting older people with high health care needs to continue living at home; are tailored to the characteristics of residents and contribute to the provision of timely health examinations and flexible arrangement of services. Findings indicate that it might be advantageous to increase the nursing staffing at these facilities, to provide care guidelines and training opportunities to increase nurse self-efficacy.

Nurse-led clinics for patients with chronic diseases in hospital and transmural care organizations

OBJECTIVES

The objectives of this study were to elucidate the purpose, content, and organization of nurse-led clinics for patients with chronic diseases and to explore whether there are differences in the content and context of the nurse-led clinics and attention for the home situation between a transmural and a hospital setting.

SETTINGS

Transmural setting by which nurses work in both primary and secondary care and hospital setting where nurses are employed by a local hospital. Within the transmural setting, 4 nurse-led clinics were studied: heart failure, rheumatoid arthritis, Parkinson disease, and multiple sclerosis. Within the hospital setting, 3 nurse-led clinics were studied: heart failure, rheumatoid arthritis, and Parkinson disease.

METHODS

A multiple-case embedded design was used to investigate the content and context of the nurse-led clinics for patients with heart failure, rheumatoid arthritis, Parkinson disease, and multiple sclerosis in the transmural and hospital setting.

SAMPLE

One hundred twenty-one patient records, bimonthly telephone interviews with 218 patients, and face-to-face interviews with 7 nurses.

RESULTS

Nurses focus on disease itself, treatment, and the everyday life of the patient. In addition, nurses maintain contacts with colleagues and other disciplines both inside and outside the hospital. No influence of setting was found on the execution of nurse-led clinics.

CONCLUSIONS

Nurse-led clinics for chronically ill patients focus on all aspects of living with a chronic disease. The organizational context does not seem to contribute to the execution of the nurse-led clinics. Instead, this seems to be driven by patient needs, the definition of nursing and nursing competencies, and general developments in the nursing profession.

IMPLICATIONS

To improve nursing care for patients with chronic illnesses, changing the organizational context might not be useful.

An Interrupted Time-Series Analysis to Assess Impact of Introduction of Co-Payment on Emergency Room Visits in Cyprus

INTRODUCTION

A co-payment fee of EUR10 was introduced in Cyprus, in order to cope with overcrowding of emergency room services. The scope of this paper is the assessment of the short-term impact of this measure.

METHODS

We used an interrupted time-series autoregressive integrated moving average model, and we analyzed official data from Cyprus' largest emergency room facility for three years.

RESULTS

Co-payment is associated with a 16% statistically significant reduction of emergency room visits. No impact was observed in categories of teenagers, children, infants, and people over 70 years old.

CONCLUSIONS

Co-payment was proven to be effective in Cyprus' emergency room setting and is expected to lessen congestion in the emergency room. The price insensitivity of people aged over 70 years, teenagers, children and infants, merits additional research for the identification of the underlying reasons.

The Omaha System: a systematic review of the recent literature

BACKGROUND

The Omaha System (OS) is one of the oldest of the American Nurses Association recognized standardized terminologies describing and measuring the impact of healthcare services. This systematic review presents the state of science on the use of the OS in practice, research, and education.

AIMS

(1) To identify, describe and evaluate the publications on the OS between 2004 and 2011, (2) to identify major trends in the use of the OS in research, practice, and education, and (3) to suggest areas for future research.

METHODS

Systematic search in the largest online healthcare databases (PUBMED, CINAHL, Scopus, PsycINFO, Ovid) from 2004 to 2011. Methodological quality of the reviewed research studies was evaluated.

RESULTS

56 publications on the OS were identified and analyzed. The methodological quality of the reviewed research studies was relatively high. Over time, publications' focus shifted from describing clients' problems toward outcomes research. There was an increasing application of advanced statistical methods and a significant portion of authors focused on classification and interoperability research. There was an increasing body of international literature on the OS. Little research focused on the theoretical aspects of the OS, the effective use of the OS in education, or cultural adaptations of the OS outside the USA.

CONCLUSIONS

The OS has a high potential to provide meaningful and high quality information about complex healthcare services. Further research on the OS should focus on its applicability in healthcare education, theoretical underpinnings and international validity. Researchers analyzing the OS data should address how they attempted to mitigate the effects of missing data in analyzing their results and clearly present the limitations of their studies.

Can participation in documentation influence experiences of involvement in care decision-making?

Introduction:

Patients have the right to influence the care they receive, but their wish to participate in care decision-making is unclear.

Aim:

This study investigates whether participation in nursing documentation influences patient participation in care decision-making, mastery, self-esteem, empowerment and depressive feelings among adult in-patients with chronic disease.

Materials and Methodology:

Adult patients (n=39) with chronic diseases were randomized. The intervention group participated in nursing documentation. Upon departure, patients filled in questionnaires about participation in care decision-making, mastery, self-esteem, empowerment and depressive feelings.

Results:

The majority of the patients preferred a collaborative or passive role regarding care decision-making. Lack of knowledge was one reason for non-participation. Having been diagnosed more than five years previously meant stronger empowerment.

Conclusion:

It is a challenge for nurses to find strategies to assess patients’ wishes regarding participation in care decision-making. Nurses must support patients’ knowledge of their disease and empowerment.

Risk factors for 30-day readmission in general medical patients admitted from the emergency department: a single centre study

BACKGROUND

Overcrowding in emergency departments (ED) around the world is an increasingly serious problem with an adverse impact on both patient flow and patient outcomes. A significant contributing factor to ED overcrowding is possibly due to readmission. Risk factors for readmission in patients admitted from ED are rarely studied, particularly in Asian countries where the length of stay is reportedly longer.

METHODS

A retrospective study of patients admitted to general medical wards from the ED of a referral centre in northern Taiwan from November 2009 to April 2010 was conducted. The primary outcome was 30-day hospital readmission and clinical characteristics were analysed for predictors of readmission.

RESULTS

Of the recruited 2698 patients, 451 (16.7%) were readmitted within 30 days after discharge. Age, gender, marital status and the activities of daily living (Barthel's score) were not associated with 30-day readmission. Higher Charlson score ((score 2-4) hazard ratio (HR): 1.42, 95% confidence interval (CI): 1.07-1.89; (score >4) HR: 1.93, 95% CI: 1.37-2.73), longer hospital stay ((8-14 days) HR: 1.51, 95% CI: 1.17-1.95; (15-28 days) HR: 1.64, 95% CI: 1.22-2.19; (>28 days) HR: 1.97, 95% CI: 1.43-2.71), and presence of underlying active malignancy (HR: 1.66, 95% CI: 1.27-2.16) and anaemia (HR: 1.26, 95% CI: 1.02-1.55) were independently associated with readmission.

CONCLUSION

Medical patients admitted from the ED of a referral centre have a 30-day readmission rate of 16.7%. Post-discharge care should focus on patients with higher Charlson score, longer hospitalisation, anaemia and underlying active malignancy, which are independent predictive factors for 30-day readmission.

Work Limitations and Their Relationship to Morbidity Burden among Academic Health Center Employees with Diabetes

The objective of this study was to determine the prevalence of work limitations and their relationship to morbidity burden among academic health center employees with diabetes. Employees with diabetes were surveyed via Internet and mail using the Work Limitations Questionnaire. Morbidity burden was measured using the Adjusted Clinical Groups methodology. Seventy-two percent of the employees with diabetes had a work limitation. Adjusted odds ratios for overall, physical, time, and output limitations were 1.81, 2.27, 2.13, and 2.14, respectively. Morbidity burden level is an indicator of work limitations in employees with diabetes and can be used to identify employees who may benefit from specialized services aimed at addressing their work limitations associated with diabetes.

Intervening conditions of hospital-based home care for people with severe mental illness

OBJECTIVE

This study discusses the intervening conditions of hospital-based home care (HBHC) for people with severe mental illness in Taiwan.

DESIGN AND SAMPLE

Grounded theory of the Strauss and Corbin approach was used. Participants were selected from six hospitals in Central Taiwan, including 21 clients, 19 caregivers, and 25 professionals.

MEASURES

Semi-structured one-on-one interviews were used to collect data. Data analysis consisted of three stages: open, axial, and selective coding. Data analysis, data collection, and sampling were conducted through the constant comparative analysis process.

RESULTS

Two categories were generated as positive and negative intervening conditions of HBHC services. Eight positive effects and nine negative effects were generated from the data.

CONCLUSIONS

Several positive and negative intervening conditions were found in this study to affect the delivery of HBHC. Government support and several limitations regarding HBHC services quality should be noticed and improved.

Continuous quality improvement of nursing care: case study of a clinical pathway revision for cardiac catheterization

BACKGROUND

: Taiwan's Bureau of National Health Insurance (BNHI) has been gradually introducing Taiwan diagnosis related groups (Tw-DRGs) for inpatient cases since 2010. Challenged to adapt to payment system changes, hospitals must implement necessary management control systems or measures to maintain both fiscal soundness and medical care quality.

PURPOSE

: This study investigated the outcome of management participation in work to revise cardiac catheterization clinical pathway operating procedures.

METHODS

: BNHI-qualified cases for Tw-DRGs 125 payment principles were recruited as study subjects to revise the cardiac catheterization clinical pathway. Researchers compared pre- and postrevision values in terms of mean medical care fees, patient volumes, healthcare quality, and length of hospital stay, as well as financial risk.

RESULTS

: Significant differences were observed in precardiac catheterization nursing care completion rates, mean lengths of hospital stay, diagnosis numbers, surgical treatment numbers, and numbers of complications or comorbidities. Medical utilization was also significantly lower (p < .05) after revision implementation.

CONCLUSIONS

: Clinical pathway revision involves organization, procedural flows, and performance management. The revision successfully improved hospital finances and promoted medical care quality.

Integrated postdischarge transitional care in a hospitalist system to improve discharge outcome: an experimental study

BACKGROUND

The postdischarge period is a vulnerable time for patients, with high rates of adverse events that may cause unnecessary readmissions, especially in the elderly. Because postdischarge care continuity is often interrupted after hospitalist care, close follow-up may decrease patient readmission. In this study, we aimed to investigate the impact of a quality improvement program, integrated postdischarge transitional care (PDTC), in Taiwan's hospitalist system.

METHODS

From December 2009 to May 2010, patients admitted to the hospitalist ward of a medical center in Taiwan and later discharged alive to home care were included. Efforts to improve the quality of interventions in the PDTC program, including a disease-specific care plan, telephone monitoring, hotline counseling and referral to a hospitalist-run clinic, were implemented in the latter four months in the intervention group, while the control group was recruited during the first two months of the study period. The primary end point was unplanned readmission or death within 30 days after discharge.

RESULTS

There were 94 and 219 patients in the control and intervention groups, respectively. Both groups had similar characteristics at the time of admission and at discharge. In the intervention group, 18 patients with worsening disease-specific indicators recorded during telephone monitoring and 21 patients with new or worsening symptoms recorded during hotline counseling had higher rates of unplanned readmission than those without worsening disease-specific indicators (P = 0.031) and worsening symptoms (P = 0.019), respectively. Patients who received PDTC had lower rates of readmission and death than the control group within 30 days after discharge (15% vs. 25%; P = 0.021). Nonuse of a hospitalist-run clinic and presence of underlying malignancy were other independent risk factors for readmission and death within 30 days after discharge.

CONCLUSION

Integrated PDTC using disease-specific care, telephone monitoring, hotline counseling and a hospitalist-run clinic can reduce rates of postdischarge readmission and death.