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Choi DW, Kim SJ, Kim DJ, Chang YJ, Kim DW, Han KT. Does fragmented cancer care affect survival? Analysis of gastric cancer patients using national insurance claim data. BMC Health Serv Res 2022; 22:1566. [PMID: 36544140 PMCID: PMC9773508 DOI: 10.1186/s12913-022-08988-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to investigate the association between fragmented cancer care in the early phase after cancer diagnosis and patient outcomes using national insurance claim data. METHODS From a nationwide sampled cohort database, we identified National Health Insurance beneficiaries diagnosed with gastric cancer (ICD-10: C16) in South Korea during 2005-2013. We analyzed the results of a multiple logistic regression analysis using the generalized estimated equation model to investigate which patient and institution characteristics affected fragmented cancer care during the first year after diagnosis. Then, survival analysis using the Cox proportional hazard model was conducted to investigate the association between fragmented cancer care and five-year mortality. RESULTS Of 2879 gastric cancer patients, 11.9% received fragmented cancer care by changing their most visited medical institution during the first year after diagnosis. We found that patients with fragmented cancer care had a higher risk of five-year mortality (HR: 1.310, 95% CI: 1.023-1.677). This association was evident among patients who only received chemotherapy or radiotherapy (HR: 1.633, 95% CI: 1.005-2.654). CONCLUSIONS Fragmented cancer care was associated with increased risk of five-year mortality. Additionally, changes in the most visited medical institution occurred more frequently in either patients with severe conditions or patients who mainly visited smaller medical institutions. Further study is warranted to confirm these findings and examine a causal relationship between fragmented cancer care and survival.
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Affiliation(s)
- Dong-Woo Choi
- grid.410914.90000 0004 0628 9810Cancer Big Data Center, National Cancer Control Institute, National Cancer Center, Gyeonggi-do, Goyang-Si, Republic of Korea
| | - Sun Jung Kim
- grid.412674.20000 0004 1773 6524Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan-Si, Republic of Korea
| | - Dong Jun Kim
- grid.411947.e0000 0004 0470 4224Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon-Jung Chang
- grid.410914.90000 0004 0628 9810Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Gyeonggi-do, Goyang-Si, Republic of Korea
| | - Dong Wook Kim
- grid.256681.e0000 0001 0661 1492Department of Information and Statistics, RINS, Gyeongsang National University, 501 Jinju-daero, Jinju-si, Gyeongsangnam-do South Korea
| | - Kyu-Tae Han
- grid.410914.90000 0004 0628 9810Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Gyeonggi-do, Goyang-Si, Republic of Korea
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Killie P, Jakobsen R, Sørensen KE, Debesay J. A qualitative study of purchaser unit employees’ experiences of patient pathways from specialist healthcare to primary healthcare in Norway. INTERNATIONAL JOURNAL OF CARE COORDINATION 2022. [DOI: 10.1177/20534345221124711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Understanding the purchaser–provider split model in the patient pathway is important. The purchaser is a key player in managing the flow between specialist and municipal healthcare services. A smoother patient transfer has been a priority in Norway, but also challenging. Accordingly, this study aims to describe and explain how the purchasers operate as liaisons during patient transfers from specialist to primary healthcare services. Methods Eleven interviews were conducted with employees at purchaser units in primary healthcare in Norway. The interviewees’ professional backgrounds were in nursing and physiotherapy, as well as casework, and management. The interviews took place in 2018–2019 and analyzed with Graneheim and Lundman's content analysis strategy. Results The interviewees’ views reflected the changes they experienced in the wake of healthcare reforms in specialist healthcare services and municipal healthcare institutions. Three themes emerged from the analyses: (1) increased efficiency requirements after the Coordination Reform, (2) better reporting systems and the need for role clarifications in contact with hospitals, and (3) the need for good assessments for safe transfer to the municipality. Discussion Purchaser unit employees’ experiences with patient pathways point towards a need for certain changes. There is a need for increased efficiency requirements for purchasing units, even with new electronic tools, as well as a growing need for better reporting systems and a common understanding between the service levels about what patients can expect in the municipalities.
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Affiliation(s)
- Paul Killie
- Department of Nursing and Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Rita Jakobsen
- Department of Nursing, Lovisenberg Diaconal University College, Oslo, Norway
| | | | - Jonas Debesay
- Department of Nursing, Oslo Metropolitan University, Oslo, Norway
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Abraham J, Meng A, Tripathy S, Kitsiou S, Kannampallil T. Effect of health information technology (HIT)-based discharge transition interventions on patient readmissions and emergency room visits: a systematic review. J Am Med Inform Assoc 2022; 29:735-748. [PMID: 35167689 PMCID: PMC8922181 DOI: 10.1093/jamia/ocac013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/12/2022] [Accepted: 01/25/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To systematically synthesize and appraise the evidence on the effectiveness of health information technology (HIT)-based discharge care transition interventions (CTIs) on readmissions and emergency room visits. MATERIALS AND METHODS We conducted a systematic search on multiple databases (MEDLINE, CINAHL, EMBASE, and CENTRAL) on June 29, 2020, targeting readmissions and emergency room visits. Prospective studies evaluating HIT-based CTIs published as original research articles in English language peer-reviewed journals were eligible for inclusion. Outcomes were pooled for narrative analysis. RESULTS Eleven studies were included for review. Most studies (n = 6) were non-RCTs. Several studies (n = 9) assessed bridging interventions comprised of at least 1 pre- and 1 post-discharge component. The narrative analysis found improvements in patient experience and perceptions of discharge care. DISCUSSION Given the statistical and clinical heterogeneity among studies, we could not ascertain the cumulative effect of CTIs on clinical outcomes. Nevertheless, we found gaps in current research and its implications for future work, including the need for a HIT-based care transition model for guiding theory-driven design and evaluation of HIT-based discharge CTIs. CONCLUSIONS We appraised and aggregated empirical evidence on the cumulative effectiveness of HIT-based interventions to support discharge transitions from hospital to home, and we highlighted the implications for evidence-based practice and informatics research.
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Affiliation(s)
- Joanna Abraham
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA,Institute for Informatics, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA,Corresponding Author: Joanna Abraham, PhD, Department of Anesthesiology, Washington University School of Medicine, 660 South Euclid, Campus Box 8054, St. Louis, MO 63110, USA;
| | - Alicia Meng
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sanjna Tripathy
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Spyros Kitsiou
- Department of Biomedical and Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA,Institute for Informatics, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Nikbakht Nasrabadi A, Mardanian Dehkordi L, Taleghani F. Nurses’ Experiences of Transitional Care in Multiple Chronic Conditions. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/10848223211002166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transitional care is a designed plan to ensure the continuity of care received by patients as they transfer between different locations or levels of care. The aim of this paper is to explore nurses’ experiences of transitional care in multiple chronic conditions. A qualitative method with a conventional content analysis approach was utilized. The study was conducted at university hospitals in 2 big cities (Isfahan and Tehran) of Iran. This study is performed from November 2018 to December 2019 using deep, semi-structured, and face-to-face interviews which are focused on nurses’ experiences of transitional care. Data collection continued until saturation was reached. Finally, 15 nurses take part in this study. Data collection and data analysis were conducted concurrently. Data were analyzed using Graneheim and Lundman’s techniques. Two main themes providing a descriptive summary of the major elements of transitional care identified: “threat to patient safety” and “Care breakdown”. Findings showed an exclusive image of unsafe transitional care which was done unplanned without appropriate delegating care to family and threat patient safety. There is still a gap in the transition from hospital to home. Nursing managers can address this issue by creating a culture of teamwork, training competent nurses by continuum education, and more supervision of nursing care. Policymakers can ensure continuity of care by developing policies and programs about transitional care.
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Affiliation(s)
| | - Leila Mardanian Dehkordi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Taleghani
- Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Transitional care following a skilled nursing facility stay: Utilization of nurse practitioners to reduce readmissions in high risk older adults. Geriatr Nurs 2021; 42:1594-1596. [PMID: 34561109 DOI: 10.1016/j.gerinurse.2021.06.024] [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: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022]
Abstract
This quality improvement project's goal was to identify older adults who were at high risk for readmission following a skilled nursing facility (SNF) admission and evaluate the impact of a nurse practitioner (NP) visit within 72 hours of SNF discharge. The aims of this project were to reduce 30-day readmissions, identify gaps in care, and address care needs for patients recently discharged from a SNF. High readmission risk was estimated through use of readmission risk prediction and frailty tools. Results of the project revealed several gaps in care including medication discrepancies, delays in start of home health services, and lack of follow up with a primary care provider. Of the patients seen for a transitional care visit (TCV), none were readmitted. Project findings indicate there is value in seeing patients in their home soon after SNF discharge. Further work is indicated to improve care transitions in this area.
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Monkong S, Krairit O, Ngamkala T, Chonburi JSN, Pussawiro W, Ratchasan P. Transitional care for older people from hospital to home: a best practice implementation project. JBI Evid Synth 2021; 18:357-367. [PMID: 32229738 DOI: 10.11124/jbisrir-d-19-00180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The objective of this implementation project was to promote evidence-based practice of transitional care for older people from hospital to home. INTRODUCTION The transition following hospitalization is a critical period of health risk for older people and their family caregivers. Older people need to learn how to take care of themselves at home safely, and caregivers play an important role in caring for them both in hospital and at home. METHODS A clinical audit was undertaken using evidence-based criteria regarding transitional care. Eight audit criteria that represented best-practice recommendations of transitional care for older people from hospital to home were used. A baseline audit was conducted, followed by the implementation of transitional care strategies, and the project was finalized with a follow-up audit to determine the change in practice. RESULTS Improvements in clinical practice were identified in relation to healthcare professional knowledge regarding transitional care, patient care needs during the transition and a multifaceted approach during the transition phase. CONCLUSIONS The project demonstrated positive changes in the transitional care for older people from hospital to home. A multifaceted approach, including patient-centered discharge instruction, telephone follow-up and family caregiver preparedness, is required for older adults to be successfully discharged from hospital to home.
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Affiliation(s)
- Supreeda Monkong
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Orapitchaya Krairit
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tipanatre Ngamkala
- Nursing Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Wipawee Pussawiro
- Nursing Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Penny Ratchasan
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Olsen CF, Bergland A, Bye A, Debesay J, Langaas AG. Crossing knowledge boundaries: health care providers' perceptions and experiences of what is important to achieve more person-centered patient pathways for older people. BMC Health Serv Res 2021; 21:310. [PMID: 33827714 PMCID: PMC8028726 DOI: 10.1186/s12913-021-06312-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/22/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Improving the transitional care of older people, especially hospital-to-home transitions, is a salient concern worldwide. Current research in the field highlights person-centered care as crucial; however, how to implement and enact this ideal in practice and thus achieve more person-centered patient pathways remains unclear. The aim of this study was to explore health care providers' (HCPs') perceptions and experiences of what is important to achieve more person-centered patient pathways for older people. METHODS This was a qualitative study. We performed individual semistructured interviews with 20 HCPs who participated in a Norwegian quality improvement collaborative. In addition, participant observation of 22 meetings in the quality improvement collaborative was performed. RESULTS A thematic analysis resulted in five themes which outline central elements of the HCPs' perceptions and experiences relevant to achieving more person-centered patient pathways: 1) Finding common ground through the mapping of the patient journey; 2) the importance of understanding the whole patient pathway; 3) the significance of getting to know the older patient; 4) the key role of home care providers in the patient pathway; and 5) ambiguity toward checklists and practice implementation. CONCLUSIONS The findings can assist stakeholders in understanding factors important to practicing person-centered transitional care for older people. Through collaborative knowledge sharing the participants developed a more shared understanding of how to achieve person-centered patient pathways. The importance of assuming a shared responsibility and a more holistic understanding of the patient pathway by merging different ways of knowing was highlighted. Checklists incorporating the What matters to you? question and the mapping of the patient journey were important tools enabling the crossing of knowledge boundaries both between HCPs and between HCPs and the older patients. Home care providers were perceived to have important knowledge relevant to providing more person-centered patient pathways implying a central role for them as knowledge brokers during the patient's journey. The study draws attention to the benefits of focusing on the older patients' way of knowing the patient pathway as well as to placing what matters to the older patient at the heart of transitional care.
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Affiliation(s)
- Cecilie Fromholt Olsen
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway.
| | - Astrid Bergland
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway
| | - Anne G Langaas
- Department of Physiotherapy, Faculty of Health Sciences, OsloMet- Oslo Metropolitan University, Oslo, Norway
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Sezgin D, O'Caoimh R, O'Donovan MR, Salem MA, Kennelly S, Samaniego LL, Carda CA, Rodriguez-Acuña R, Inzitari M, Hammar T, Holditch C, Bettger JP, Vernon M, Carroll Á, Gradinger F, Perman G, Wilson M, Vella A, Cherubini A, Tucker H, Fantini MP, Onder G, Roller-Wirnsberger R, Gutiérrez-Robledo LM, Cesari M, Bertoluci P, Kieliszek M, van der Vlegel-Brouwer W, Nelson M, Mañas LR, Antoniadou E, Barriere F, Lindblom S, Park G, Pérez I, Alguacil D, Lowdon D, Alkiza ME, Bouzon CA, Young J, Carriazo A, Liew A, Hendry A. Defining the characteristics of intermediate care models including transitional care: an international Delphi study. Aging Clin Exp Res 2020; 32:2399-2410. [PMID: 32430887 DOI: 10.1007/s40520-020-01579-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although there is growing utilisation of intermediate care to improve the health and well-being of older adults with complex care needs, there is no international agreement on how it is defined, limiting comparability between studies and reducing the ability to scale effective interventions. AIM To identify and define the characteristics of intermediate care models. METHODS A scoping review, a modified two-round electronic Delphi study involving 27 multi-professional experts from 13 countries, and a virtual consensus meeting were conducted. RESULTS Sixty-six records were included in the scoping review, which identified four main themes: transitions, components, benefits and interchangeability. These formed the basis of the first round of the Delphi survey. After Round 2, 16 statements were agreed, refined and collapsed further. Consensus was established for 10 statements addressing the definitions, purpose, target populations, approach to care and organisation of intermediate care models. DISCUSSION There was agreement that intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care. Models are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination. CONCLUSIONS This study identified key defining features of intermediate care to improve understanding and to support comparisons between models and studies evaluating them. More research is required to develop operational definitions for use in different healthcare systems.
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Affiliation(s)
- Duygu Sezgin
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway City, Ireland
| | - Rónán O'Caoimh
- Department of Geriatric Medicine, Mercy University Hospital Cork, Cork City, Ireland.
| | - Mark R O'Donovan
- Clinical Sciences Institute, National University of Ireland Galway, Galway City, Ireland
| | | | - Siobhán Kennelly
- Older Person's Programme, Health Service Executive, Dublin, Ireland
| | | | | | | | - Marco Inzitari
- Parc Sanitari Pere Virgili, Vall D'Hebrón Institute of Research (VHIR), and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teija Hammar
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | | | | | - Martin Vernon
- NHS England, London, England
- Manchester University NHS Foundation Trust, London, England
| | - Áine Carroll
- University College Dublin, Dublin, Ireland
- National Rehabilitation Hospital, Dún Laoghaire, County Dublin, Ireland
| | - Felix Gradinger
- University of Plymouth, Plymouth, England
- Torbay and South Devon NHS Foundation Trust, Torbay, England
| | - Gaston Perman
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martin Wilson
- Raigmore Hospital Inverness NHS Highland, Inverness, Scotland
| | - Antoine Vella
- Department of Geriatric Medicine, University of Malta, Msida, Malta
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di Ricerca Per L'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Helen Tucker
- Community Hospitals Association (UK), University of Winchester, Winchester, England
| | - Maria Pia Fantini
- Post-Graduate Medical School in Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università Degli Studi di Milano, Milan, Italy
| | - Paula Bertoluci
- Alves Pereira, Public Health School, University of São Paulo (FSP/USP), São Paulo, Brazil
| | - Magdalena Kieliszek
- Center for Innovation and Technology Transfer, Medical University of Lodz, Lodz, Poland
| | | | - Michelle Nelson
- Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | - François Barriere
- Pilote MAIA 13 Projets Parcours Pays Salonais, Pays Salonais, France
| | - Sebastian Lindblom
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Grace Park
- Fraser Health Authority, British Columbia, Canada
| | - Isidoro Pérez
- Regional Ministry of Health and Families of Andalusia (CSFJA), Seville, Spain
| | - Dolores Alguacil
- Andalusian Health Service (Servicio Andaluz de Salud, SAS), Seville, Spain
| | | | | | | | | | - Ana Carriazo
- Regional Ministry of Health and Families of Andalusia (CSFJA), Seville, Spain
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
- Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - Anne Hendry
- NHS Lanarkshire, Glasgow, Scotland
- University of the West of Scotland, Glasgow, Scotland
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Morkisch N, Upegui-Arango LD, Cardona MI, van den Heuvel D, Rimmele M, Sieber CC, Freiberger E. Components of the transitional care model (TCM) to reduce readmission in geriatric patients: a systematic review. BMC Geriatr 2020; 20:345. [PMID: 32917145 PMCID: PMC7488657 DOI: 10.1186/s12877-020-01747-w] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 08/31/2020] [Indexed: 01/19/2023] Open
Abstract
Background Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components’ role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes). Methods Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed. Results Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months). Conclusions Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, without increasing cost. Components such as type of staffing, assessing and managing symptoms, educating and promoting self-management, maintaining relationships and fostering coordination seem to have an important role in reducing the readmission rate. Research is needed to perform further investigations addressing geriatric patients well above 65 years old, to further understand the importance of individual components of the TCM in this population.
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Affiliation(s)
| | - Luz D Upegui-Arango
- Bundesverband Geriatrie e.V, Berlin, Germany.,Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Maria I Cardona
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany
| | | | - Martina Rimmele
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany
| | - Cornel Christian Sieber
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany.,Kantonspital Winterthur/Swiss, Winterthur, Switzerland
| | - Ellen Freiberger
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany.
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Sezgin D, O'Caoimh R, Liew A, O'Donovan MR, Illario M, Salem MA, Kennelly S, Carriazo AM, Lopez-Samaniego L, Carda CA, Rodriguez-Acuña R, Inzitari M, Hammar T, Hendry A. The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review. Eur Geriatr Med 2020; 11:961-974. [PMID: 32754841 PMCID: PMC7402396 DOI: 10.1007/s41999-020-00365-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/11/2020] [Indexed: 11/30/2022]
Abstract
Aim This scoping review examined the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Findings While some studies report positive outcomes on hospital utilisation, the evidence is limited for their effectiveness on emergency department attendances, institutionalisation, function, and cost-effectiveness. Message Intermediate care including transitional care interventions were associated with reduced hospital stay but this finding was not universal. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users. Background and aim Intermediate care describes services, including transitional care, that support the needs of middle-aged and older adults during care transitions and between different settings. This scoping review aimed to examine the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Design A scoping review of the literature was conducted including studies published between 2002 and 2019 with a transitional care and/or intermediate care intervention for adults aged ≥ 50. Searches were performed in CINAHL, Cochrane Library, EMBASE, Open Grey and PubMed databases. Qualitative and quantitative approaches were employed for data synthesis. Results In all, 133 studies were included. Interventions were grouped under four models of care: (a) Hospital-based transitional care (n = 8), (b) Transitional care delivered at discharge and up to 30 days after discharge (n = 70), (c) Intermediate care at home (n = 41), and (d) Intermediate care delivered in a community hospital, care home or post-acute facility (n = 14). While these models were associated with a reduced hospital stay, this was not universal. Intermediate including transitional care services combined with telephone follow-up and coaching support were reported to reduce short and long-term hospital re-admissions. Evidence for improved ADL function was strongest for intermediate care delivered by an interdisciplinary team with rehabilitation at home. Study design and types of interventions were markedly heterogenous, limiting comparability. Conclusions Although many studies report that intermediate care including transitional care models reduce hospital utilisation, results were mixed. There is limited evidence for the effectiveness of these services on function, institutionalisation, emergency department attendances, or on cost-effectiveness. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duygu Sezgin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.
| | - Rónán O'Caoimh
- Department of Geriatric Medicine, Mercy University Hospital Cork, Cork, Ireland.,Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland.,Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | | | - Maddelena Illario
- Campania Region Health Innovation Unit, and Federico II Department of Public Health, Naples, Italy
| | | | - Siobhán Kennelly
- Royal College of Surgeons in Ireland Connolly Hospital, Dublin and Health Service Executive, Dublin, Ireland
| | | | | | - Cristina Arnal Carda
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall D'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Marco Inzitari
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall D'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teija Hammar
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anne Hendry
- NHS Lanarkshire, Bothwell, UK.,School of Health and Life Sciences, University of the West of Scotland, Hamilton, UK
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Sezgin D, Hendry A, Liew A, O'Donovan M, Salem M, Carriazo AM, López-Samaniego L, Rodríguez-Acuña R, Kennelly S, Illario M, Arnal Carda C, Inzitari M, Hammar T, O'Caoimh R. Transitional palliative care interventions for older adults with advanced non-malignant diseases and frailty: a systematic review. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-02-2020-0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PurposeTo identify transitional palliative care (TPC) interventions for older adults with non-malignant chronic diseases and complex conditions.Design/methodology/approachA systematic review of the literature was conducted. CINAHL, Cochrane Library, Embase and Pubmed databases were searched for studies reporting TPC interventions for older adults, published between 2002 and 2019. The Crowe Critical Appraisal Tool was used for quality appraisal.FindingsA total of six studies were included. Outcomes related to TPC interventions were grouped into three categories: healthcare system-related outcomes (rehospitalisation, length of stay [LOS] and emergency department [ED] visits), patient-related outcomes and family/carer important outcomes. Overall, TPC interventions were associated with lower readmission rates and LOS, improved quality of life and better decision-making concerning hospice care among families. Outcomes for ED visits were unclear.Research limitations/implicationsPositive outcomes related to healthcare services (including readmissions and LOS), patients (quality of life) and families (decision-making) were reported. However, the number of studies supporting the evidence were limited.Originality/valueStudies examining the effectiveness of existing care models to support transitions for those in need of palliative care are limited. This systematic literature review identified and appraised interventions aimed at improving transitions to palliative care in older adults with advanced non-malignant diseases or frailty.
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12
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Olsen CF, Debesay J, Bergland A, Bye A, Langaas AG. What matters when asking, "what matters to you?" - perceptions and experiences of health care providers on involving older people in transitional care. BMC Health Serv Res 2020; 20:317. [PMID: 32299424 PMCID: PMC7164237 DOI: 10.1186/s12913-020-05150-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/24/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Transitional care for older chronically ill people is an important area for healthcare quality improvement. A central goal is to involve older people more in transitional care and make care more patient-centered. Recently, asking, "What matters to you?" (WMTY) has become a popular way of approaching the implementation of patient-centered care. The aim of this study was to explore health care providers' perceptions and experiences regarding the question of WMTY in the context of improving transitional care for older, chronically ill persons. METHODS The data comprise semi-structured individual interviews with 20 health care providers (HCPs) who took part in a Norwegian quality improvement collaborative, three key informant interviews, and observations of meetings in the quality improvement collaborative. We used a thematic analysis approach. RESULTS Three interrelated themes emerged from the analysis: WMTY is a complex process that needs to be framed competently; framing WMTY as a functional approach; and framing WMTY as a relational approach. There was a tension between the functional and the relational approach. This tension seemed to be based in different understandings of the purpose of asking the WMTY question and the responsibility that comes with asking it. CONCLUSIONS WMTY may appear as a simple question, but using it in everyday practice is a complex process, which requires professional competence. When seen in terms of a patient-centered goal process, the challenge of competently eliciting older people's personal goals and transferring these goals into professional action becomes evident. An important factor seems to be how HCPs regard the limits of their responsibility in relation to giving care within the larger frame of the patient's life project. Factors in the organizational and political context also seem to influence substantially how HCPs approach older patients with the WMTY question.
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Affiliation(s)
| | - Jonas Debesay
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Anne G Langaas
- Department of Physiotherapy, OsloMet - Oslo Metropolitan University, Oslo, Norway
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13
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Chase JAD, Russell D, Huang L, Hanlon A, O'Connor M, Bowles KH. Relationships Between Race/Ethnicity and Health Care Utilization Among Older Post-Acute Home Health Care Patients. J Appl Gerontol 2020; 39:201-213. [PMID: 29457521 PMCID: PMC6344331 DOI: 10.1177/0733464818758453] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Few studies have explored racial/ethnic differences in health care outcomes among patients receiving home health care (HHC), despite known differences in other care settings. We conducted a retrospective cohort study examining racial/ethnic disparities in rehospitalization and emergency room (ER) use among post-acute patients served by a large northeastern HHC agency between 2013 and 2014 (N = 22,722). We used multivariable binomial logistic regression to describe the relationship between race/ethnicity and health care utilization outcomes, adjusting for individual-level factors that are conceptually related to health service use. Overall rates of rehospitalization and ER visits were 10% and 13%, respectively. African American and Hispanic patients experienced higher odds of ER visits or rehospitalization during their HHC episode. Racial/ethnic differences in utilization were mediated by enabling factors, such as caregiver availability, and illness-level factors, such as illness severity, functional status, and symptoms. Intervention targets may include early risk assessment, proactive management of clinical conditions, rehabilitative therapy, and caregiver training.
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Affiliation(s)
- Jo-Ana D. Chase
- University of Pennsylvania, 338G School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104, Assistant Professor, University of Missouri – Columbia,
| | - David Russell
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, 1250 Broadway, 7th Floor, New York, NY 10001,
| | - Liming Huang
- 418 Curie Blvd, Suite 479L, Claire M. Fagin Hall, School of Nursing, University of Pennsylvania,
| | - Alexandra Hanlon
- 418 Curie Blvd, Suite 479L, Claire M. Fagin Hall, School of Nursing, University of Pennsylvania,
| | - Melissa O'Connor
- National Hartford Center for Gerontological Nursing Excellence, Assistant Professor, College of Nursing, Villanova University, Driscoll Hall, Office #316, 800 Lancaster Avenue, Villanova, PA 19085,
| | - Kathryn H. Bowles
- University of Pennsylvania, 418 Curie Boulevard Room 340, Philadelphia, PA 19104; Director of the Center for Home Care Policy and Research, Visiting Nurse Service of New York,
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14
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Where are the family caregivers? Finding family caregiver-related content in foundational nursing documents. J Prof Nurs 2020; 36:76-84. [DOI: 10.1016/j.profnurs.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 05/13/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022]
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15
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Hestevik CH, Molin M, Debesay J, Bergland A, Bye A. Hospital nurses and home care providers’ experiences of participation in nutritional care among older persons and their family caregivers: a qualitative study. J Hum Nutr Diet 2019; 33:198-206. [DOI: 10.1111/jhn.12729] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- C. H. Hestevik
- Department of Physiotherapy Faculty of Health Sciences OsloMet–Oslo Metropolitan University Oslo Norway
| | - M. Molin
- Department of Nursing and Health Promotion Faculty of Health Sciences OsloMet – Oslo Metropolitan University Oslo Norway
- Bjorknes University College Oslo Norway
| | - J. Debesay
- Department of Nursing and Health Promotion Faculty of Health Sciences OsloMet – Oslo Metropolitan University Oslo Norway
| | - A. Bergland
- Department of Physiotherapy Faculty of Health Sciences OsloMet–Oslo Metropolitan University Oslo Norway
| | - A. Bye
- Department of Nursing and Health Promotion Faculty of Health Sciences OsloMet – Oslo Metropolitan University Oslo Norway
- Regional Advisory Unit in Palliative Care Department of Oncology Oslo University Hospital Oslo Norway
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16
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Aronow H, Fila S, Martinez B, Sosna T. Depression and Coleman Care Transitions Intervention. SOCIAL WORK IN HEALTH CARE 2018; 57:750-761. [PMID: 30015601 DOI: 10.1080/00981389.2018.1496514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The Coleman Care Transitions Intervention (CTI) is a "Patient Activation Model." Depression can be a barrier to activation and may challenge CTI. This study addressed whether CTI coaches modified the intervention for older adults who screened positive for depression. Over 4,500 clients in a Centers for Medicare and Medicaid Services demonstration completed screening for depression with the PHQ-9; one in five screened positive (score = 9+). Our findings suggest that coaches modified CTI and played a more directive role for clients who screened positive for depression, resulting in similar 30-day readmission rates among patients who screened positive for depression risk and those who did not. That finding stands in contrast to the widely reported higher readmission rates among people screening positive for depression.
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Affiliation(s)
- Harriet Aronow
- a Department of Nursing Research , Cedars-Sinai Medical Center , Los Angeles , USA
| | - Susan Fila
- b Santa Monica College , Department of Health and Wellbeing Services , Los Angeles , CA , USA
| | - Bibiana Martinez
- a Department of Nursing Research , Cedars-Sinai Medical Center , Los Angeles , USA
| | - Todd Sosna
- c Jewish Family Service of Los Angeles , Los Angeles , USA
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Waterson P, Wooldridge A, Wooldridge A, Sesto M, Gurses A, Holden R, Werner N, Fray M, Carman EM, Waterson P. Improving Care Transitions in Healthcare: A Human Factors/Ergonomics (HFE) Approach. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/1541931218621126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Delivering safe healthcare often involves multi-disciplinary teams working across multiple locations. Care transitions are required to provide continuity of care and are often fail due to this type of complexity. Care transitions occur in numerous settings, for example: during shift changes, transfer between wards, or during discharge to the patient’s home (WHO Collaborating Centre for Patient Safety Solutions 2007). The aim of the panel will be to discuss different types of care transitions and how HFE can assist in improving patient safety and efficiency of the process. The panel will discuss and share lessons learnt from a range of projects involving care transitions for pediatric trauma care (Woolridge), and barriers and facilitators to follow-up care for bone marrow transplant survivors (Sesto). In addition, the work system elements for care transitions for elective orthopedic patients (Carman), elderly patients after heart failure hospitalization (Holden) and risks to elderly patients’ safe medication management (Gurses) when transitioning from hospital to home will be discussed.
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Affiliation(s)
| | | | | | - Mary Sesto
- University of Wisconsin-Madison, Madison, WI, USA
| | - Ayse Gurses
- Johns Hopkins University, Baltimore, MD, USA
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18
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Post-Hospital Medication Discrepancies at Home: Risk Factor for 90-Day Return to Emergency Department. J Nurs Care Qual 2018; 33:180-186. [PMID: 29466262 DOI: 10.1097/ncq.0000000000000278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the occurrence of medication discrepancies during transitional care home visits and the association with emergency department (ED) visits. Using secondary data analysis, the relationships between in-home medication discrepancies and 30- and 90-day ED utilization were examined. For every in-home medication discrepancy, the odds of being admitted to the ED within 90 days increased by 31%. This brief intervention could add a valuable component to post-hospital transition management.
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19
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Banerjee D, Thompson C, Kell C, Shetty R, Vetteth Y, Grossman H, DiBiase A, Fowler M. An informatics-based approach to reducing heart failure all-cause readmissions: the Stanford heart failure dashboard. J Am Med Inform Assoc 2017; 24:550-555. [PMID: 28011593 DOI: 10.1093/jamia/ocw150] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/26/2016] [Indexed: 11/13/2022] Open
Abstract
Background Reduction of 30-day all-cause readmissions for heart failure (HF) has become an important quality-of-care metric for health care systems. Many hospitals have implemented quality improvement programs designed to reduce 30-day all-cause readmissions for HF. Electronic medical record (EMR)-based measures have been employed to aid in these efforts, but their use has been largely adjunctive to, rather than integrated with, the overall effort. Objectives We hypothesized that a comprehensive EMR-based approach utilizing an HF dashboard in addition to an established HF readmission reduction program would further reduce 30-day all-cause index hospital readmission rates for HF. Methods After establishing a quality improvement program to reduce 30-day HF readmission rates, we instituted EMR-based measures designed to improve cohort identification, intervention tracking, and readmission analysis, the latter 2 supported by an electronic HF dashboard. Our primary outcome measure was the 30-day index hospital readmission rate for HF, with secondary measures including the accuracy of identification of patients with HF and the percentage of patients receiving interventions designed to reduce all-cause readmissions for HF. Results The HF dashboard facilitated improved penetration of our interventions and reduced readmission rates by allowing the clinical team to easily identify cohorts with high readmission rates and/or low intervention rates. We significantly reduced 30-day index hospital all-cause HF readmission rates from 18.2% at baseline to 14% after implementation of our quality improvement program ( P = .045). Implementation of our EMR-based approach further significantly reduced 30-day index hospital readmission rates for HF to 10.1% ( P for trend = .0001). Daily time to screen patients decreased from 1 hour to 15 minutes, accuracy of cohort identification improved from 83% to 94.6% ( P = .0001), and the percentage of patients receiving our interventions, such as patient education, also improved significantly from 22% to 100% over time ( P < .0001). Conclusions In an institution with a quality improvement program already in place to reduce 30-day readmission rates for HF, an EMR-based approach further significantly reduced 30-day index hospital readmission rates.
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Affiliation(s)
| | | | | | | | | | | | - Aria DiBiase
- Palo Alto Medical Foundation, Palo Alto, CA, USA
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20
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Huber TP, Shortell SM, Rodriguez HP. Improving Care Transitions Management: Examining the Role of Accountable Care Organization Participation and Expanded Electronic Health Record Functionality. Health Serv Res 2016; 52:1494-1510. [PMID: 27549015 DOI: 10.1111/1475-6773.12546] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Examine the extent to which physician organization participation in an accountable care organization (ACO) and electronic health record (EHR) functionality are associated with greater adoption of care transition management (CTM) processes. DATA SOURCES/STUDY SETTING A total of 1,398 physician organizations from the third National Study of Physician Organization survey (NSPO3), a nationally representative sample of medical practices in the United States (January 2012-May 2013). STUDY DESIGN We used data from the third National Study of Physician Organization survey (NSPO3) to assess medical practice characteristics, including CTM processes, ACO participation, EHR functionality, practice type, organization size, ownership, public reporting, and pay-for-performance participation. DATA COLLECTION/EXTRACTION METHODS Multivariate linear regression models estimated the extent to which ACO participation and EHR functionality were associated with greater CTM capabilities, controlling for practice size, ownership, public reporting, and pay-for-performance participation. PRINCIPAL FINDINGS Approximately half (52.4 percent) of medical practices had a formal program for managing care transitions in place. In adjusted analyses, ACO participation (p < .001) and EHR functionality (p < .001) were independently associated with greater use of CTM processes among medical practices. CONCLUSIONS The growth of ACOs and similar provider risk-bearing arrangements across the country may improve the management of care transitions by physician organizations.
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Affiliation(s)
- Thomas P Huber
- School of Public Health, University of California Berkeley, Berkeley, CA
| | - Stephen M Shortell
- School of Public Health, University of California Berkeley, Berkeley, CA
| | - Hector P Rodriguez
- School of Public Health, University of California Berkeley, Berkeley, CA
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21
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Palonen M, Kaunonen M, Helminen M, Åstedt-Kurki P. Discharge education for older people and family members in emergency department: A cross-sectional study. Int Emerg Nurs 2015; 23:306-11. [DOI: 10.1016/j.ienj.2015.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 02/11/2015] [Accepted: 02/11/2015] [Indexed: 11/25/2022]
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22
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Powers JS, Cox Z, Young J, Howell M, DiSalvo T. Critical pathways: implementation of the Coleman Care Transitions Program in individuals hospitalized with congestive heart failure. J Am Geriatr Soc 2015; 62:2442-4. [PMID: 25516044 DOI: 10.1111/jgs.13174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- James S Powers
- Center for Quality in Aging, School of Medicine, Vanderbilt University, Nashville, Tennessee; Tennessee Valley Healthcare System, Geriatric Education Research and Clinical Center, Nashville, Tennessee
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23
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Allen J, Hutchinson AM, Brown R, Livingston PM. Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Health Serv Res 2014; 14:346. [PMID: 25128468 PMCID: PMC4147161 DOI: 10.1186/1472-6963-14-346] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/01/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Provision of high quality transitional care is a challenge for health care providers in many western countries. This systematic review was conducted to (1) identify and synthesise research, using randomised control trial designs, on the quality of transitional care interventions compared with standard hospital discharge for older people with chronic illnesses, and (2) make recommendations for research and practice. METHODS Eight databases were searched; CINAHL, Psychinfo, Medline, Proquest, Academic Search Complete, Masterfile Premier, SocIndex, Humanities and Social Sciences Collection, in addition to the Cochrane Collaboration, Joanna Briggs Institute and Google Scholar. Results were screened to identify peer reviewed journal articles reporting analysis of quality indicator outcomes in relation to a transitional care intervention involving discharge care in hospital and follow-up support in the home. Studies were limited to those published between January 1990 and May 2013. Study participants included people 60 years of age or older living in their own homes who were undergoing care transitions from hospital to home. Data relating to study characteristics and research findings were extracted from the included articles. Two reviewers independently assessed studies for risk of bias. RESULTS Twelve articles met the inclusion criteria. Transitional care interventions reported in most studies reduced re-hospitalizations, with the exception of general practitioner and primary care nurse models. All 12 studies included outcome measures of re-hospitalization and length of stay indicating a quality focus on effectiveness, efficiency, and safety/risk. Patient satisfaction was assessed in six of the 12 studies and was mostly found to be high. Other outcomes reflecting person and family centred care were limited including those pertaining to the patient and carer experience, carer burden and support, and emotional support for older people and their carers. Limited outcome measures were reported reflecting timeliness, equity, efficiencies for community providers, and symptom management. CONCLUSIONS Gaps in the evidence base were apparent in the quality domains of timeliness, equity, efficiencies for community providers, effectiveness/symptom management, and domains of person and family centred care. Further research that involves the person and their family/caregiver in transitional care interventions is needed.
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Affiliation(s)
- Jacqueline Allen
- />Deakin University, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Alison M Hutchinson
- />Deakin University, School of Nursing and Midwifery; Centre for Nursing Research – Deakin University and Monash Health Partnership, Monash Health, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Rhonda Brown
- />Deakin University, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Patricia M Livingston
- />Faculty of Health & School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood, 3125 Vic Australia
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Integrated interdisciplinary care for patients with chronic obstructive pulmonary disease reduces emergency department visits, admissions and costs: a quality assurance study. Can Respir J 2014; 20:351-6. [PMID: 24093114 DOI: 10.1155/2013/187059] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Dedicated programs for the management of chronic obstructive pulmonary disease (COPD) can reduce hospitalizations and improve quality of life. OBJECTIVE To investigate whether health care utilization could be reduced by a newly developed integrated, interdisciplinary initiative that included a COPD nurse navigator who educates patients and families, transitions patients through various points of care and integrates services. METHODS The present quality assurance, pre-post study included patients followed by a COPD nurse navigator from January 25, 2010 to November 5, 2011. Information regarding emergency department visits and hospitalizations, including lengths of stay, were obtained from hospital databases. Diagnoses were classified as respiratory or nonrespiratory, and used primary and secondary hospitalization diagnoses to identify acute exacerbations of COPD (AECOPD). Paired sign tests were performed. RESULTS The sample consisted of 202 patients. Following nurse navigator intervention, significantly more patients experienced a decrease in the number of respiratory-cause emergency department visits (P<0.05), number of respiratory hospitalizations (P<0.001), total hospital days for respiratory admissions (P<0.001), number of hospitalizations with AECOPD (P<0.001) and total hospital days for admissions with AECOPD (P<0.001). Financial modelling estimated annual savings in excess of $260,000. CONCLUSION The present quality assurance study indicated that the implementation of an integrated interdisciplinary program for the care of patients with COPD can improve patient outcomes despite the tendency of COPD to worsen over time.
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Islam T, O'Connell B, Hawkins M. Factors associated with transfers from healthcare facilities among readmitted older adults with chronic illness. AUST HEALTH REV 2014; 38:354-62. [PMID: 24670934 DOI: 10.1071/ah13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 01/09/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Because chronic illness accounts for a considerable proportion of Australian healthcare expenditure, there is a need to identify factors that may reduce hospital readmissions for patients with chronic illness. The aim of the present study was to examine a range of factors potentially associated with transfer from healthcare facilities among older adults readmitted to hospital within a large public health service in Melbourne, Australia. METHODS Data on readmitted patients between June 2006 and June 2011 were extracted from hospital databases and medical records. Adopting a retrospective case-control study design, a sample of 51 patients transferred from private residences was matched by age and gender with 55 patients transferred from healthcare facilities (including nursing homes and acute care facilities). Univariate and multivariate logistic regression analyses were used to compare the two groups, and to determine associations between 46 variables and transfer from a healthcare facility. RESULTS Univariate analysis indicated that patients readmitted from healthcare facilities were significantly more likely to experience relative socioeconomic advantage, disorientation on admission, dementia diagnosis, incontinence and poor skin integrity than those readmitted from a private residence. Three of these variables remained significantly associated with admission from healthcare facilities after multivariate analysis: relative socioeconomic advantage (odds ratio (OR) 11.30; 95% confidence interval (CI) 2.62-48.77), incontinence (OR 7.18; 95% CI 1.19-43.30) and poor skin integrity (OR 18.05; 95% CI 1.85-176.16). CONCLUSIONS Older adults with chronic illness readmitted to hospital from healthcare facilities are significantly more likely to differ from those readmitted from private residences in terms of relative socioeconomic advantage, incontinence and skin integrity. The findings direct efforts towards addressing the apparent disparity in management of patients admitted from a facility as opposed to a private residence.
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Affiliation(s)
- Tasneem Islam
- Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Beverly O'Connell
- Deakin University, 221 Burwood Highway, Burwood, Vic. 3125, Australia
| | - Mary Hawkins
- Centre for Nursing Research, Deakin University and Monash Health Partnership, Locked Bag 29, Clayton South, Vic. 3169, Australia.
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Wysocki A, Kane RL, Dowd B, Golberstein E, Lum T, Shippee T. Hospitalization of elderly Medicaid long-term care users who transition from nursing homes. J Am Geriatr Soc 2014; 62:71-8. [PMID: 24383662 DOI: 10.1111/jgs.12614] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare hospitalizations of dually eligible older adults who had an extended Medicaid nursing home (NH) stay and transitioned out to receive Medicaid home- and community-based services (HCBS) with hospitalizations of those who remained in the NH. DESIGN Retrospective matched cohort study using Medicaid and Medicare claims and NH assessment data. SETTING Community (receiving Medicaid HCBS) or NH. PARTICIPANTS Dually eligible fee-for-service beneficiaries aged 65 and older in Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont, and Washington from 2003 to 2005. Individuals who had a Medicaid NH stay of at least 90 days and transitioned to Medicaid HCBS (N = 1,169) were matched to individuals who had a Medicaid NH stay of at least 90 days and remained in the NH (N = 1,169). MEASUREMENTS Potentially preventable hospitalizations (defined according to ambulatory-care-sensitive conditions) and all hospitalizations were examined. RESULTS Cox proportional hazards models were used to compare the risk of hospitalization between the groups, accounting for the differing time at risk and censoring. Being a NH transitioner increased the hazard of experiencing a potentially preventable hospitalization by 40% (95% confidence interval (CI) = 1.01-1.93) over remaining in the NH. NH transitioners had a 58% (95% CI = 1.32-1.91) greater risk of experiencing any type of hospitalization than NH stayers. CONCLUSION Individuals who transitioned from the NH to HCBS had a greater risk of hospitalization. Most of the attention in long-term care transition programs has been focused on NH readmission, but programs encouraging NH transition should recognize that individuals may be at greater risk for hospitalization after returning to the community. Planning for the medical needs of individuals who transition from an extended NH stay may improve their posttransition outcomes.
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Affiliation(s)
- Andrea Wysocki
- Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island
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Dale B, Hvalvik S. Administration of care to older patients in transition from hospital to home care services: home nursing leaders' experiences. J Multidiscip Healthc 2013; 6:379-89. [PMID: 24124378 PMCID: PMC3794989 DOI: 10.2147/jmdh.s51947] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes. METHODS A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway participated in individual interviews. The interview texts were audio taped, transcribed verbatim and analyzed by use of a phenomenological-hermeneutic approach. RESULTS Three main themes and seven subthemes were deduced from the data. The first main theme was that the home nursing leaders felt challenged by the organization of home care services. Two subthemes were identified related to this. The first was that the leaders lacked involvement in the transitional process, and the second was that they were challenged by administration of care being decided at another level in the municipality. The second main theme found was that the leaders felt that they were acting in a shifting and unsettled context. Related to this, they had to adjust internal resources to external demands and expectations, and experienced lack of communication with significant others. The third main theme identified was that the leaders endeavored to deliver care in accordance with professional values. The two related subthemes were, first, that they provided for appropriate internal systems and routines, and, second, that they prioritized available professional competence, and made an effort to promote a professional culture. CONCLUSION To meet the complex needs of the patients in a professional way, the home nursing leaders needed to be flexible and pragmatic in their administration of care. This involved utilizing available professional competence appropriately. The coordination and communication between the different organizational levels and units were pointed out as major factors requiring improvement.
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Affiliation(s)
- Bjørg Dale
- Centre for Caring Research - Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway
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Heeke S, Wood F, Schuck J. Improving care transitions from hospital to home: standardized orders for home health nursing with remote telemonitoring. J Nurs Care Qual 2013; 29:E21-8. [PMID: 23938358 DOI: 10.1097/ncq.0b013e3182a520b6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A task force at a multihospital health care system partnered with home health agencies to improve gaps during the discharge transition process. A standardized order template for home health nursing and remote telemonitoring was developed to decrease discrepancies in communication between hospital health care providers and home health nurses caring for patients with heart failure. Pilot results showed significantly improved communication with no readmissions, using the order template.
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Affiliation(s)
- Sheila Heeke
- Cardiology (Dr Heeke) and Care Coordination (Ms Schuck), Emory Healthcare, Inc, Atlanta, Georgia; Capstone College of Nursing, University of Alabama, Tuscaloosa (Dr Wood); and Wesley Woods Geriatric Hospital, Atlanta, Georgia (Ms Schuck). Dr Heeke is now with Neurological Surgery, Emory Healthcare, Inc, Atlanta, Georgia
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Navarro AE, Enguídanos S, Wilber KH. Identifying risk of hospital readmission among Medicare aged patients: an approach using routinely collected data. Home Health Care Serv Q 2012; 31:181-95. [PMID: 22656916 DOI: 10.1080/01621424.2012.681561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Readmission provisions in the Patient Protection and Affordable Care Act of March 2010 have created urgent fiscal accountability requirements for hospitals, dependent upon a better understanding of their specific populations, along with development of mechanisms to easily identify these at-risk patients. Readmissions are disruptive and costly to both patients and the health care system. Effectively addressing hospital readmissions among Medicare aged patients offers promising targets for resources aimed at improved quality of care for older patients. Routinely collected data, accessible via electronic medical records, were examined using logistic models of sociodemographic, clinical, and utilization factors to identify predictors among patients who required rehospitalization within 30 days. Specific comorbidities and discharge care orders in this urban, nonprofit hospital had significantly greater odds of predicting a Medicare aged patient's risk of readmission within 30 days.
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Affiliation(s)
- Adria E Navarro
- Azusa Pacific University, Department of Graduate Social Work, School of Behavioral and Applied Sciences, Azusa, California 91702-7000, USA.
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Gershon RRM, Dailey M, Magda LA, Riley HEM, Conolly J, Silver A. Safety in the home healthcare sector: development of a new household safety checklist. J Patient Saf 2012; 8:51-9. [PMID: 22543362 DOI: 10.1097/pts.0b013e31824a4ad6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Unsafe household conditions could adversely affect safety and quality in home health care. However, risk identification tools and procedures that can be readily implemented in this setting are lacking. To address this need, we developed and tested a new household safety checklist and accompanying training program. METHODS A 50-item, photo-illustrated, multi-hazard checklist was designed as a tool to enable home healthcare paraprofessionals (HHCPs) to conduct visual safety inspections in patients' homes. The checklist focused on hazards presenting the greatest threat to the safety of seniors. A convenience sample of 57 HHCPs was recruited to participate in a 1-hour training program, followed by pilot testing of the checklist in their patients' households. Checklist data from 116 patient homes were summarized using descriptive statistics. Qualitative feedback on the inspection process was provided by HHCPs participating in a focus group. RESULTS Pretesting and posttesting determined that the training program was effective; participating HHCPs' ability to identify household hazards significantly improved after training (P<0.001). Using the checklist, HHCPs were able to identify unsafe conditions, including fire safety deficiencies, fall hazards, unsanitary conditions, and problems with medication management. Home healthcare paraprofessionals reported that the checklist was easy to use and that inspections were well accepted by patients. Inspections took roughly 20 minutes to conduct. CONCLUSIONS Home healthcare paraprofessionals can be effectively trained to identify commonplace household hazards. Using this checklist as a guide, visual household inspections were easily performed by trained HHCPS. Additional studies are needed to evaluate the reliability of the checklist and to determine if hazard identification leads to interventions that improve performance outcomes.
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Affiliation(s)
- Robyn R M Gershon
- Department of Epidemiology and Biostatistics, Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, School of Medicine, San Francisco, California 94118, USA.
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Dossa A, Bokhour B, Hoenig H. Care transitions from the hospital to home for patients with mobility impairments: patient and family caregiver experiences. Rehabil Nurs 2012; 37:277-85. [PMID: 23212952 DOI: 10.1002/rnj.047] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE Our study described patient and caregiver experiences with care transitions following hospital discharge to home for patients with mobility impairments receiving physical and occupational therapy. METHODS The study was a qualitative longitudinal interview study. Interviews were conducted at 2 weeks, 1 month, and 2 months post discharge. Participants were men, Caucasian, between 70 and 88 years old, and had either a medical or surgical diagnosis. RESULTS Breakdowns in communication in four domains impacted continuity of care and patient recovery: (a) Poor communication between patients and providers regarding ongoing care at home, (b) Whom to contact post discharge, (c) Provider response to phone calls following discharge, and (d) Provider-provider communication. DISCUSSION AND CONCLUSIONS Improved systems are needed to address patient concerns after discharge from the hospital, specifically for patients with mobility impairments. Better communication between patients, hospital providers, and home care providers is needed to improve care coordination, facilitate recovery at home, and prevent potential adverse outcomes.
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Affiliation(s)
- Almas Dossa
- Center for Health Quality, Outcomes and Economic Research, Bedford, VA, USA.
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Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax 2012; 67:957-63. [PMID: 22684094 PMCID: PMC3505864 DOI: 10.1136/thoraxjnl-2011-201518] [Citation(s) in RCA: 479] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The long-term natural history of chronic obstructive pulmonary disease (COPD) in terms of successive severe exacerbations and mortality is unknown. Methods The authors formed an inception cohort of patients from their first ever hospitalisation for COPD during 1990–2005, using the healthcare databases from the province of Quebec, Canada. Patients were followed until death or 31 March 2007, and all COPD hospitalisations occurring during follow-up were identified. The hazard functions of successive hospitalised COPD exacerbations and all-cause mortality over time were estimated, and HRs adjusted for age, sex, calendar time and comorbidity. Results The cohort included 73 106 patients hospitalised for the first time for COPD, of whom 50 580 died during the 17-year follow-up, with 50% and 75% mortality at 3.6 and 7.7 years respectively. The median time from the first to the second hospitalised exacerbation was around 5 years and decreased to <4 months from the 9th to the 10th. The risk of the subsequent severe exacerbation was increased threefold after the second severe exacerbation and 24-fold after the 10th, relative to the first. Mortality after a severe exacerbation peaked to 40 deaths per 10 000 per day in the first week after admission, dropping gradually to 5 after 3 months. Conclusions The course of COPD involves a rapid decline in health status after the second severe exacerbation and high mortality in the weeks following every severe exacerbation. Two strategic targets for COPD management should include delaying the second severe exacerbation and improving treatment of severe exacerbations to reduce their excessive early mortality.
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Affiliation(s)
- Samy Suissa
- Center for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.
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Gray LC, Peel NM, Crotty M, Kurrle SE, Giles LC, Cameron ID. How effective are programs at managing transition from hospital to home? A case study of the Australian Transition Care Program. BMC Geriatr 2012; 12:6. [PMID: 22416921 PMCID: PMC3314563 DOI: 10.1186/1471-2318-12-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 03/14/2012] [Indexed: 11/10/2022] Open
Abstract
Background An increasing demand for acute care services due in part to rising proportions of older people and increasing rates of chronic diseases has led to new models of post-acute care for older people that offer coordinated discharge, ongoing support and often a focus on functional restoration. Overall, review of the literature suggests there is considerable uncertainty around the effectiveness and resource implications of the various model configurations and delivery approaches. In this paper, we review the current evidence on the efficacy of such programs, using the Australian Transition Care Program as a case study. Discussion The Australian Transition Care Program was established at the interface of the acute and aged care sectors with particular emphasis on transitions between acute and community care. The program is intended to enable a significant proportion of care recipients to return home, rather than prematurely enter residential aged care, optimize their functional capacity, and reduce inappropriate extended lengths of hospital stay for older people. Broadly, the model is configured and targeted in accordance with programs reported in the international literature to be effective. Early evaluations suggest good acceptance of the program by hospitals, patients and staff. Ultimately, however, the program's place in the array of post-acute services should be determined by its demonstrated efficacy relative to other services which cater for similar patient groups. Summary Currently there is a lack of robust evaluation to provide convincing evidence of efficacy, either from a patient outcome or cost reduction perspective. As the program expands and matures, there will be opportunity to scrutinise the systematic effects, with lessons for both Australian and international policy makers and clinical leaders.
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Affiliation(s)
- Leonard C Gray
- Centre for Research in Geriatric Medicine, The University of Queensland, Level 2, Building 33, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia
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Allen J, Ottmann G, Roberts G. Multi-professional communication for older people in transitional care: a review of the literature. Int J Older People Nurs 2012; 8:253-69. [PMID: 22309308 DOI: 10.1111/j.1748-3743.2012.00314.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS AND OBJECTIVES To synthesise research-reporting literature about multi-professional communication between health and social care professionals within transitional care for older people, with particular attention on outcomes, enabling contextual factors and constraints. BACKGROUND Older adults experience high rates of morbidity and health care usage, and frequently transit between health services, and community and social care providers. These transition episodes place elders at increased risk of adverse incidents due to poor communication of information. Integrated multi-professional models of care built on enhanced communication have been widely promoted as a strategy to improve transitional care for older people. However, a range of findings exist in the literature to guide service providers and researchers. DESIGN Comprehensive literature search and review strategies were employed to identify, describe and synthesise relevant studies. Ten databases were searched in addition to Google Scholar. CONCLUSIONS Specified discharge worker roles, multi-professional care coordination teams, and information technology systems promote better service satisfaction and subjective quality of life for older people when compared with standard hospital discharge. Improved multi-professional communication reduces rates of re-admission and length of stay indicating greater cost effectiveness and efficiency for the health and social care systems. Systems of care emphasizing information exchange, education and negotiation between stakeholders facilitate communication in transitional care contexts for older adults. Conversely, lack of dialogue and lack of understanding of others' roles are barriers to communication in transitional care. IMPLICATIONS FOR PRACTICE Enhanced multi-professional communication, transitional pathways, and role clarity are required to improve the quality, sustainability and responsiveness of aged care into the future. Recommendations for further research include: (i) Investigation of pathways promoting person-centred care planning including the older person, their family and relevant practitioners; (ii) Development of interventions aimed at improving multi-professional communication and transitional aged care with marginalised and socially disadvantaged elders on indicators of equity and access; (iii) Investigation of changing roles for practitioners in multi-professional teams with a focus on community-based teams including nurses specialising in aged care and general practice.
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Affiliation(s)
- Jacqui Allen
- Lecturer, School of Nursing, Deakin University, Burwood, Vic., AustraliaSenior Research Fellow, School of Nursing, Deakin University, Burwood, Vic., AustraliaResearch Fellow, School of Nursing, Deakin University, Burwood, Vic., Australia
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Ramsay P, Huby G, Rattray J, Salisbury LG, Walsh TS, Kean S. A longitudinal qualitative exploration of healthcare and informal support needs among survivors of critical illness: the RELINQUISH protocol. BMJ Open 2012; 2:bmjopen-2012-001507. [PMID: 22802422 PMCID: PMC3400070 DOI: 10.1136/bmjopen-2012-001507] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND BACKGROUND Survival following critical illness is associated with a significant burden of physical, emotional and psychosocial morbidity. Recovery can be protracted and incomplete, with important and sustained effects upon everyday life, including family life, social participation and return to work. In stark contrast with other critically ill patient groups (eg, those following cardiothoracic surgery), there are comparatively few interventional studies of rehabilitation among the general intensive care unit patient population. This paper outlines the protocol for a sub study of the RECOVER study: a randomised controlled trial evaluating a complex intervention of enhanced ward-based rehabilitation for patients following discharge from intensive care. METHODS AND ANALYSIS The RELINQUISH study is a nested longitudinal, qualitative study of family support and perceived healthcare needs among RECOVER participants at key stages of the recovery process and at up to 1 year following hospital discharge. Its central premise is that recovery is a dynamic process wherein patients' needs evolve over time. RELINQUISH is novel in that we will incorporate two parallel strategies into our data analysis: (1) a pragmatic health services-oriented approach, using an a priori analytical construct, the 'Timing it Right' framework and (2) a constructivist grounded theory approach which allows the emergence of new themes and theoretical understandings from the data. We will subsequently use Qualitative Health Needs Assessment methodology to inform the development of timely and responsive healthcare interventions throughout the recovery process. ETHICS AND DISSEMINATION The protocol has been approved by the Lothian Research Ethics Committee (protocol number HSRU011). The study has been added to the UK Clinical Research Network Database (study ID. 9986). The authors will disseminate the findings in peer reviewed publications and to relevant critical care stakeholder groups.
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Affiliation(s)
- Pam Ramsay
- Department of Anaesthesia and Critical Care (Research), Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Guro Huby
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Janice Rattray
- School of Nursing and Midwifery, University of Dundee, Dundee, UK
| | - Lisa G Salisbury
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Timothy Simon Walsh
- Critical Care Medicine, Centre for Inflammation Research, Edinburgh University, Edinburgh, UK
| | - Susanne Kean
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Abstract
PURPOSE OF REVIEW Adherence to proven, effective medications remains low, resulting in high rates of clinical complications, hospital readmissions, and death. The use of technology to identify patients at risk and to target interventions for poor adherence has increased. This review focuses on research that tests these emerging technologies and evaluates the effect of technology-based adherence interventions on cardiovascular outcomes. RECENT FINDINGS Recent studies have evaluated technology-based interventions to improve medication adherence by using pharmaceutical databases, tailoring educational information to individual patient needs, delivering technology-driven reminders to patients and providers, and integrating in-person interventions with electronic alerts. Cellular phone reminders and in-home electronic technology used to communicate reminder messages have shown mixed results. Only one study has shown improvement in both adherence and clinical outcome. Current trials suggest that increasing automated reminders will complement but not replace the benefits seen with in-person communication for medication taking. SUMMARY Integration of in-person contacts with technology-driven medication adherence reminders, electronic medication reconciliation, and pharmaceutical databases may improve medication adherence and have a positive effect on cardiovascular clinical outcomes. Opportunities for providers to monitor the quality of care based on new adherence research are evolving and may be useful as standards for quality improvement emerge.
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Russell D, Rosati RJ, Sobolewski S, Marren J, Rosenfeld P. Implementing a Transitional Care Program for High-Risk Heart Failure Patients: Findings from a Community-Based Partnership Between a Certified Home Healthcare Agency and Regional Hospital. J Healthc Qual 2011; 33:17-23; quiz 23-4. [DOI: 10.1111/j.1945-1474.2011.00167.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bednash G, Mezey M, Tagliareni E. The Hartford Geriatric Nursing Initiative experience in geriatric nursing education: looking back, looking forward. Nurs Outlook 2011; 59:228-35. [PMID: 21757080 DOI: 10.1016/j.outlook.2011.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 05/03/2011] [Accepted: 05/15/2011] [Indexed: 10/18/2022]
Abstract
This article traces the impact of the John A. Hartford Foundation's (JAHF) Hartford Geriatric Nursing Initiative (HGNI) on the geriatric preparation of nursing students. With over 2.6 million practitioners, nurses play a critical role in assuring the health care of older adults. Older adults make up the majority of patient days in hospitals, home care, and nursing homes. Yet, when the JAHF began its investment in geriatric nursing, specific content on care of older adults was woefully absent in academic programs preparing entry- and graduate-level nurses. Clearly, the JAHF HGNI investment in nursing education has paid huge dividends. Baccalaureate nursing students are now likely to graduate with competencies in care of older adults. In the next 5 years, ongoing JAHF HGNI initiatives should yield similar outcomes in associate degree-prepared graduates and in advanced practice registered nurse graduates. This article traces the impact of the JAHF HGNI on nursing education.
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Skolarus TA, Zhang Y, Hollenbeck BK. Understanding fragmentation of prostate cancer survivorship care: implications for cost and quality. Cancer 2011; 118:2837-45. [PMID: 22370955 DOI: 10.1002/cncr.26601] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 08/16/2011] [Accepted: 08/29/2011] [Indexed: 01/06/2023]
Abstract
BACKGROUND Cancer survivors are particularly prone to the effects of a fragmented health care delivery system. The implications of fragmented cancer care across providers likely include greater spending and worse quality of care. For this reason, the authors measured relations between increasing fragmentation of cancer care, expenditures, and quality of care among prostate cancer survivors. METHODS A total of 67,736 patients diagnosed with prostate cancer between 1992 and 2005 were identified using Surveillance, Epidemiology, and End Results (SEER)-Medicare data. Using the Herfindahl-Hirschman Index and a measure of the average number of prostate cancer providers over time, patients were sorted into 3 fragmentation groups (low, intermediate, and high). The authors then examined annual per capita survivorship expenditures and a measure of quality (ie, repetitive prostate-specific antigen [PSA] testing within 30 days) according to their fragmentation exposure using multinomial logistic regression. RESULTS Patients with highly fragmented cancer care tended to be younger, white, and of higher socioeconomic status (all P < .001). Prostate cancer survivorship interventions were most common among patients with the highest fragmentation of care across providers (P < .001). After adjustment for clinical characteristics and prostate cancer survivorship interventions, higher degrees of fragmentation continued to be associated with repetitive PSA testing (13.6% for high vs 7.0% for low fragmentation; P < .001) and greater spending, particularly among patients not treated with androgen deprivation therapy. CONCLUSIONS Fragmented prostate cancer survivorship care is expensive and associated with potentially unnecessary services. Efforts to improve care coordination via current policy initiatives, electronic medical records, and the implementation of cancer survivorship tools may help to decrease fragmentation of care and mitigate downstream consequences for prostate cancer survivors.
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Affiliation(s)
- Ted A Skolarus
- Division of Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan 48109-5330, USA.
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Foust JB, Vuckovic N, Henriquez E. Hospital to home health care transition: patient, caregiver, and clinician perspectives. West J Nurs Res 2011; 34:194-212. [PMID: 21427451 DOI: 10.1177/0193945911400448] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Increasing national attention is focused on improving posthospital transitions. Home health patients are in an opportune position to provide insight into this transition as they resume care for themselves with informal caregivers and home health professionals. This qualitative study describes the experiences of patients, informal caregivers, and home health clinicians during the posthospital transition. A total of 40 patients, 35 informal caregivers, and 15 clinicians participated in this study. Patients recalled receiving discharge instructions but with few details and limited information about follow-up actions if they had problems. Discharge instructions were a versatile means of communication. Home health clinicians used these instructions to guide discussions with patients and their caregivers. Both informal caregivers and home health care clinicians emphasized the inadequate preparation of caregivers during the discharge process. More attention is needed to proactively engage informal caregivers and involve home health clinicians who can facilitate the implementation of discharge plans to improve patient outcomes.
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Abstract
The people of the United States sent a clear message in November 2008 that they wanted a change in the nation's priorities, including healthcare. The question is whether healthcare reform will extend to the care of older adults, especially in the face of complex needs in the last years of their lives. This article addresses this question by examining the demographics of the older adult population, the eldercare workforce, and the current inadequate patchwork of financing. Some aging issues, such as chronic care, are being addressed in the broad context of healthcare reform, whereas health information technology and others remain marginal. The window of opportunity for a clear and coherent voice in a reformed/reshaped healthcare system is narrow. Now is the time for the "trusted" profession to advocate for meaningful change that will meet the current and future needs of older adults. The article concludes with strategies and Web-based resources for nurses to bring aging issues to the healthcare reform debate at both the national and local levels.
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Gill L, White L, Cameron I. Transitional aged care and the patient's view of quality. QUALITY IN AGEING AND OLDER ADULTS 2010. [DOI: 10.5042/qiaoa.2010.0285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Meier DE, Beresford L. Palliative care seeks its home in national health care reform. J Palliat Med 2009; 12:593-7. [PMID: 19594342 DOI: 10.1089/jpm.2009.9596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Diane E Meier
- Center to Advance Palliative Care at Mount Sinai School of Medicine, New York City, USA
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Van Vuuren P, Kagan SH, Chalian AA. Geriatric Otolaryngology Toolbox: What you and your Nurse can do to Improve Outcomes for Older Adults. EAR, NOSE & THROAT JOURNAL 2009. [DOI: 10.1177/014556130908801007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Interest in addressing the health needs of older adults and improving their outcomes is burgeoning in otolaryngology, but the availability of practical strategies to achieve these aims is limited. In this article, we describe how otolaryngologists can capitalize on collaboration with nurses to create a toolbox of quick and effective strategies that can be incorporated into outpatient otolaryngology practice. The toolbox was compiled by a collaborative team of three: an otolaryngologist—head and neck surgeon who specializes in microvascular reconstruction, a geriatrician completing a second residency in otolaryngology, and a gerontologic clinical nurse. We selected and developed these strategies to fit within the framework of standard otolaryngology practice based on evidence we gathered from the geriatric literature and our own collective academic and clinical experience. We review our criteria for selecting each of the 10 items in our toolbox, and we discuss the potential benefits of each.
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Affiliation(s)
| | - Sarah H. Kagan
- University of Pennsylvania School of Nursing, Philadelphia
| | - Ara A. Chalian
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia
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Rother J, Lavizzo-Mourey R. Addressing the nursing workforce: a critical element for health reform. Health Aff (Millwood) 2009; 28:w620-4. [PMID: 19525288 DOI: 10.1377/hlthaff.28.4.w620] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Fundamental health reform is integral to putting the country on the path to economic recovery. These goals-health reform and economic recovery-will not be met unless we build, empower, and deploy a twenty-first-century health care workforce. A reformed health care system must include an adequate supply of well-trained professionals who can deliver care to all Americans. Nurses are at the center of this discussion. It is nurses-of every stripe-who will deliver, coordinate, and direct care in hospitals, clinics, and physicians' offices, and it is these same most necessary nurses who are in short supply.
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Coye MJ, Haselkorn A, DeMello S. Remote Patient Management: Technology-Enabled Innovation And Evolving Business Models For Chronic Disease Care. Health Aff (Millwood) 2009; 28:126-35. [DOI: 10.1377/hlthaff.28.1.126] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Prediction of early readmission in medical inpatients using the Probability of Repeated Admission instrument. Nurs Res 2008; 57:406-15. [PMID: 19018215 DOI: 10.1097/nnr.0b013e31818c3e06] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the absence of an instrument to predict risk of early readmission, examination of the well-validated probability of repeated admission (Pra) for this new purpose is indicated. OBJECTIVE The objective of this study was to examine the use of the Pra in accurately identifying and predicting adult medical inpatients at risk of early readmission. METHODS Over 20 months, 1,077 consecutively admitted medical patients were enrolled in this prospective cohort study at a Midwestern tertiary care medical center. Pra score values were calculated within 2 days of discharge. Databases at the index medical center and other institutions were queried to identify readmission within 41 days. RESULTS Prevalence of readmission was 14% (confidence interval = 12.4%-15.6%). Pra score values ranged from .16 to .75. Indices to identify and predict readmission for a range of cut points were reported to minimize loss of information. The likelihood ratio for patients with a Pra score value > or = .53 was 1.67. Using a Pra cut point of > or = .45, readmission of patients with a high Pra was 2.3 times more likely than that of patients with a low Pra (p < .001, confidence interval = 1.63-3.27). Comparisons between cohorts indicated that differences existed with four of the eight variables used to calculate the Pra score: diabetes (p = .01), self-rated health status (p = .007), and number of doctor visits (p < .001) and hospitalizations (p < .001) in the past year. DISCUSSION Within this heterogeneous sample, prediction of readmission using the Pra was better than chance. These findings may facilitate development of a better predictive model by combining select Pra variables with other variables associated with early readmission.
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Abstract
PACE and state-based payment for in-home supportive services.
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Balaban RB, Weissman JS, Samuel PA, Woolhandler S. Redefining and redesigning hospital discharge to enhance patient care: a randomized controlled study. J Gen Intern Med 2008; 23:1228-33. [PMID: 18452048 PMCID: PMC2517968 DOI: 10.1007/s11606-008-0618-9] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2007] [Revised: 02/27/2008] [Accepted: 03/20/2008] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients are routinely ill-prepared for the transition from hospital to home. Inadequate communication between Hospitalists and primary care providers can further compromise post-discharge care. Redesigning the discharge process may improve the continuity and the quality of patient care. OBJECTIVES To evaluate a low-cost intervention designed to promptly reconnect patients to their "medical home" after hospital discharge. DESIGN Randomized controlled study. Intervention patients received a "user-friendly" Patient Discharge Form, and upon arrival at home, a telephone outreach from a nurse at their primary care site. PARTICIPANTS A culturally and linguistically diverse group of patients admitted to a small community teaching hospital. MEASUREMENTS Four undesirable outcomes were measured after hospital discharge: (1) no outpatient follow-up within 21 days; (2) readmission within 31 days; (3) emergency department visit within 31 days; and (4) failure by the primary care provider to complete an outpatient workup recommended by the hospital doctors. Outcomes of the intervention group were compared to concurrent and historical controls. RESULTS Only 25.5% of intervention patients had 1 or more undesirable outcomes compared to 55.1% of the concurrent and 55.0% of the historical controls. Notably, only 14.9% of the intervention patients failed to follow-up within 21 days compared to 40.8% of the concurrent and 35.0% of the historical controls. Only 11.5% of recommended outpatient workups in the intervention group were incomplete versus 31.3% in the concurrent and 31.0% in the historical controls. CONCLUSIONS A low-cost discharge-transfer intervention may improve the rates of outpatient follow-up and of completed workups after hospital discharge.
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Affiliation(s)
- Richard B Balaban
- Department of Medicine, Cambridge Health Alliance, Cambridge, MA, USA.
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