1
|
Zhou H, Ngune I, Albrecht MA, Della PR. Risk factors associated with 30-day unplanned hospital readmission for patients with mental illness. Int J Ment Health Nurs 2023; 32:30-53. [PMID: 35976725 DOI: 10.1111/inm.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 01/14/2023]
Abstract
Unplanned hospital readmission rate is up to 43% in mental health settings, which is higher than in general health settings. Unplanned readmissions delay the recovery of patients with mental illness and add financial burden on families and healthcare services. There have been efforts to reduce readmissions with a particular interest in identifying patients at higher readmission risk after index admission; however, the results have been inconsistent. This systematic review synthesized risk factors associated with 30-day unplanned hospital readmissions for patients with mental illness. Eleven electronic databases were searched from 2010 to 30 September 2021 using key terms of 'mental illness', 'readmission' and 'risk factors'. Sixteen studies met the selection criteria for this review. Data were synthesized using content analysis and presented in narrative and tabular form because the extracted risk factors could not be pooled statistically due to methodological heterogeneity of the included studies. Consistently cited readmission predictors were patients with lower educational background, unemployment, previous mental illness hospital admission and more than 7 days of the index hospitalization. Results revealed the complexity of identifying unplanned hospital readmission predictors for people with mental illness. Policymakers need to specify the expected standards that written discharge summary must reach general practitioners concurrently at discharge. Hospital clinicians should ensure that discharge summary summaries are distributed to general practitioners for effective ongoing patient care and management. Having an advanced mental health nurse for patients during their transition period needs to be explored to understand how this role could ensure referrals to the general practitioner are eventuated.
Collapse
Affiliation(s)
- Huaqiong Zhou
- General Surgical Ward, Perth Children's Hospital, Western Australia, Australia.,Curtin School of Nursing, Curtin University, Western Australia, Australia
| | - Irene Ngune
- School of Nursing and Midwifery, Edith Cowan University, Western Australia, Australia
| | - Matthew A Albrecht
- Curtin School of Nursing, Curtin University, Western Australia, Australia
| | - Phillip R Della
- Curtin School of Nursing, Curtin University, Western Australia, Australia
| |
Collapse
|
2
|
Liu I, Cruz A, Gamcsik S, Harris SC. Reducing barriers to COVID-19 vaccine uptake through a culturally sensitive pharmacy-led patient medication education group in a behavioral health population. J Am Pharm Assoc (2003) 2023; 63:915-919. [PMID: 36754720 PMCID: PMC9891738 DOI: 10.1016/j.japh.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/22/2022] [Accepted: 01/19/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Hesitancy surrounding the coronavirus disease 2019 (COVID-19) vaccine is high in those with mental illnesses owing to intrapersonal barriers and barriers relating to social determinants of health. OBJECTIVES This study describes the implementation of a pharmacy-driven, culturally sensitive education program focused on COVID-19 vaccine hesitancy. METHODS This was an institutional review board-exempt, descriptive, quality improvement study held at a behavioral health facility. An education program dedicated to reduce COVID-19 vaccine hesitancy was developed. Each educator completed training on providing culturally sensitive care to behavioral health patients. Patients voluntarily attended pharmacist-led patient medication education groups (PMEGs) and were offered an anonymous survey. Participation was documented in the electronic health record (EHR). Vaccination status and perception of the education were collected through retrospective analysis of the EHR, survey results, and state COVID-19 vaccine registry. RESULTS Twenty PMEGs were provided and reached 90 individuals, with 47% identifying as black, indigenous, or person of color. Sixty of 90 patients received at least 1 vaccine. For participants who were eligible for a second dose of a 2-dose series, 62% completed their second vaccination after PMEGs. Vaccination rates were highest in white participants (73.9%) followed by 64.7% of black participants, both higher than state specific rates. Participants self-reported an increase in their likelihood to become vaccinated after PMEG attendance on surveys and rated the quality of education as high. CONCLUSION Patients who experience vaccine hesitancy had the opportunity to address their concerns on the COVID-19 vaccine. Overall, the program was well received and positively affected the patient's likelihood of obtaining and completing vaccination against COVID-19.
Collapse
Affiliation(s)
- Ina Liu
- Correspondence: Ina Liu, PharmD, MS, BCPS, Department of Pharmacy, University of North Carolina Hospitals at WakeBrook, 111 Sunnybrook Rd., Raleigh, NC 27610
| | | | | | | |
Collapse
|
3
|
Skertich NJ, Lee TK, Grunvald MW, Sivakumar A, Tiglao RM, Madonna MB, Pillai S, Shah AN. The effect of standardized discharge instructions after gastrostomy tube placement on postoperative hospital utilization. J Pediatr Surg 2022; 57:418-423. [PMID: 33867152 DOI: 10.1016/j.jpedsurg.2021.03.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/02/2021] [Accepted: 03/15/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Gastrostomy tube (GT) placement is a common pediatric procedure with high postoperative resource utilization. We aimed to determine if standardized discharge instructions (SDI) reduced healthcare utilization rates. METHODS We performed a retrospective cohort study comparing postoperative hospital utilization of patients who underwent initial GT placement pre- and post-SDI protocol implementation from 2014-2019. Statistical analyses included Chi-square tests, multivariable adjusted logistic regression, adjusted Cox proportion hazard regression, and adjusted Poisson regression models when appropriate. RESULTS 197 patients were included, 102 (51.8%) before and 95 (48.2%) after protocol implementation. On primary analysis, SDI patients did not have significantly different total postoperative hospital utilization events at 30-days (48.0% vs. 38.9%, p = 0.25). On secondary analysis, SDI patients had lower rates of ED (8.4% vs. 19.6%, p = 0.026) and office visits (11.6% vs. 25.5%, p = 0.017) at 30-days. Non-SDIs patients had greater odds of ED visits (OR2.7, 95%CI 1.3-5.9, p = 0.01), office visits (OR3.7, 95%CI 1.7-8.1, p = 0.001) and phone calls (OR2.6, 95%CI 1.2-5.7, p = 0.016) at 1-year. The adjusted hazard ratio was 2.0 (95%CI 1.4-3.0, p < 0.001). Incident rate ratio were 1.8 (95%CI 1.2-2.5, p = 0.002) at 30-days and 1.9 (95%CI 1.5-2.4, p < 0.001) at 1-year post-discharge. CONCLUSIONS SDIs post-GT placement may reduce multiple aspects of postoperative hospital utilization.
Collapse
Affiliation(s)
- Nicholas J Skertich
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | | | - Miles W Grunvald
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | | | - Rona M Tiglao
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Mary Beth Madonna
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Srikumar Pillai
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Ami N Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, IL, 60612, USA.
| |
Collapse
|
4
|
Li J, Clouser JM, Brock J, Davis T, Jack B, Levine C, Mays GP, Mittman B, Nguyen H, Sorra J, Stromberg A, Du G, Dai C, Adu A, Vundi N, Williams MV. Effects of Different Transitional Care Strategies on Outcomes after Hospital Discharge-Trust Matters, Too. Jt Comm J Qual Patient Saf 2021; 48:40-52. [PMID: 34764025 DOI: 10.1016/j.jcjq.2021.09.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND As health systems shift toward value-based care, strategies to reduce readmissions and improve patient outcomes become increasingly important. Despite extensive research, the combinations of transitional care (TC) strategies associated with best patient-centered outcomes remain uncertain. METHODS Using an observational, prospective cohort study design, Project ACHIEVE sought to determine the association of different combinations of TC strategies with patient-reported and postdischarge health care utilization outcomes. Using purposive sampling, the research team recruited a diverse sample of short-term acute care and critical access hospitals in the United States (N = 42) and analyzed data on eligible Medicare beneficiaries (N = 7,939) discharged from their medical/surgical units. Using both hospital- and patient-reported TC strategy exposure data, the project compared patients "exposed" to each of five overlapping groups of TC strategies to their "control" counterparts. Primary outcomes included 30-day hospital readmissions, 7-day postdischarge emergency department (ED) visits and patient-reported physical and mental health, pain, and participation in daily activities. RESULTS Participants averaged 72.3 years old (standard deviation =10.1), 53.4% were female, and most were White (78.9%). Patients exposed to one TC group (Hospital-Based Trust, Plain Language, and Coordination) were less likely to have 30-day readmissions (risk ratio [RR], 0.72; 95% confidence interval [CI] = 0.57-0.92, p < 0.001) or 7-day ED visits (RR, 0.72; 95% CI, 0.55-0.93, p < 0.001) and more likely to report excellent physical and mental health, greater participation in daily activities, and less pain (RR ranged from 1.11 to 1.15, p < 0.01). CONCLUSION In concert with care coordination activities that bridge the transition from hospital to home, hospitals' clear communication and fostering of trust with patients were associated with better patient-reported outcomes and reduced health care utilization.
Collapse
|
5
|
Singh G, Hu Y, Jacobs S, Brown J, George J, Bermudez M, Ho K, Green JA, Kirchner HL, Chang AR. Post-Discharge Mortality and Rehospitalization among Participants in a Comprehensive Acute Kidney Injury Rehabilitation Program. KIDNEY360 2021; 2:1424-1433. [PMID: 35373103 PMCID: PMC8786140 DOI: 10.34067/kid.0003672021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/13/2021] [Indexed: 02/04/2023]
Abstract
Background Hospitalization-associated AKI is common and is associated with markedly increased mortality and morbidity. This prospective cohort study examined the feasibility and association of an AKI rehabilitation program with postdischarge outcomes. Methods Adult patients hospitalized from September 1, 2019 to February 29, 2020 in a large health system in Pennsylvania with stage 2-3 AKI who were alive and not on dialysis or hospice at discharge were evaluated for enrollment. The intervention included patient education, case manager services, and expedited nephrology appointments starting within 1-3 weeks of discharge. We examined the association between AKI rehabilitation program participation and risks of rehospitalization or mortality in logistic regression analyses adjusting for comorbidities, discharge disposition, and sociodemographic and kidney parameters. Sensitivity analysis was performed using propensity score matching. Results Among the high-risk patients with AKI who were evaluated, 77 of 183 were suitable for inclusion. Out of these, 52 (68%) patients were enrolled and compared with 400 contemporary, nonparticipant survivors of stage 2/3 AKI. Crude postdischarge rates of rehospitalization or death were lower for participants versus nonparticipants at 30 days (15% versus 34%; P=0.01) and at 90 days (31% versus 51%; P=0.01). After multivariable adjustment, participation in the AKI rehabilitation program was associated with lower risk of rehospitalization or mortality at 30 days (OR, 0.41; 95% CI, 0.16 to 0.93), with similar findings at 90 days (OR, 0.52; 95% CI, 0.25 to 1.05). Due to small sample size, propensity-matched analyses were limited. The participants' rehospitalization or mortality was numerically lower but not statistically significant at 30 days (18% versus 31%; P=0.22) or at 90 days (47% versus 58%; P=0.4). Conclusions The AKI rehabilitation program was feasible and potentially associated with improved 30-day rehospitalization or mortality. Our interventions present a roadmap to improve enrollment in future randomized trials.
Collapse
Affiliation(s)
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger Health, Danville, Pennsylvania
| | - Steven Jacobs
- Department of Medicine, Geisinger Health, Danville, Pennsylvania
| | - Jason Brown
- Department of Population Health Sciences, Geisinger Health, Danville, Pennsylvania
| | - Jason George
- Department of Nephrology, Geisinger Health, Danville, Pennsylvania
| | - Maria Bermudez
- Department of Nephrology, Geisinger Health, Danville, Pennsylvania
| | - Kevin Ho
- Department of Nephrology, Geisinger Health, Danville, Pennsylvania
| | - Jamie A. Green
- Department of Nephrology, Geisinger Health, Danville, Pennsylvania,Department of Population Health Sciences, Geisinger Health, Danville, Pennsylvania,Kidney Health Research Institute, Geisinger Health, Danville, Pennsylvania
| | - H. Lester Kirchner
- Department of Population Health Sciences, Geisinger Health, Danville, Pennsylvania
| | - Alex R. Chang
- Department of Nephrology, Geisinger Health, Danville, Pennsylvania,Department of Population Health Sciences, Geisinger Health, Danville, Pennsylvania,Kidney Health Research Institute, Geisinger Health, Danville, Pennsylvania
| |
Collapse
|
6
|
Examination of Post-discharge Follow-up Appointment Status and 30-Day Readmission. J Gen Intern Med 2021; 36:1214-1221. [PMID: 33469750 PMCID: PMC8131454 DOI: 10.1007/s11606-020-06569-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 12/29/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Post-hospital discharge follow-up appointments are intended to evaluate patients' recovery following a hospitalization, but it is unclear how appointment statuses are associated with readmissions. OBJECTIVE To examine the association between post-discharge ambulatory follow-up status, (1) having a scheduled appointment and (2) arriving to said appointment, and 30-day readmission. DESIGN AND SETTING A retrospective cohort study of patients hospitalized at 12 hospitals in an Integrated Delivery Network and their ambulatory appointments in that same network. PATIENTS AND MAIN MEASURES We included 50,772 patients who had an ambulatory appointment within 18 months of an inpatient admission in 2018. Primary outcome was readmission within 30 days post-discharge. KEY RESULTS There were 32,108 (63.2%) patients with scheduled follow-up appointments and 18,664 (36.8%) patients with no follow-up; 28,313 (88.2%) patients arrived, 3149 (9.8%) missed, and 646 (2.0%) were readmitted prior to their scheduled appointments. Overall 30-day readmission rate was 7.3%; 6.0% [5.75-6.31] for those who arrived, 8.8% [8.44-9.25] for those without follow-up, and 10.3% [9.28-11.40] for those who missed a scheduled appointment (p < 0.001). After adjusting for covariates, patients who arrived at their appointment in the first week following discharge were significantly less likely to be readmitted than those not having any follow-up scheduled (medical adjusted hazard ratio (aHR) 0.57 [0.47-0.69], p < 0.001; surgical aHR 0.58 [0.44-0.75], p < 0.001) There was an increased risk at weeks 3 and 4 for medical patients who arrived at a follow-up compared to those with no follow-up scheduled (week 3 aHR 1.29 [1.10-1.51], p = 0.001; week 4 aHR 1.46 [1.26-1.70], p < 0.001). CONCLUSIONS The benefit of patients arriving to their post-discharge appointments compared with patients who missed their follow-up visits or had no follow-up scheduled, is only significant during first week post-discharge, suggesting that coordination within 1 week of discharge is critical in reducing 30-day readmissions.
Collapse
|
7
|
Messerli AW, Deutsch C. Implementation of Institutional Discharge Protocols and Transition of Care Following Acute Coronary Syndrome. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1180-1188. [DOI: 10.1016/j.carrev.2020.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 10/25/2022]
|
8
|
Yang MM, Liang W, Zhao HH, Zhang Y. Quality analysis of discharge instruction among 602 hospitalized patients in China: a multicenter, cross-sectional study. BMC Health Serv Res 2020; 20:647. [PMID: 32652990 PMCID: PMC7353724 DOI: 10.1186/s12913-020-05518-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to understand the quality of discharge guidance for patients with chronic diseases, to clarify the gap between patient needs and the content of discharge guidance, and to provide a reference for health education and clinical path management of patients with chronic diseases in the future. METHODS A total of 602 inpatients with stroke, coronary heart disease, cancer, chronic obstructive pulmonary disease and diabetes from the chronic disease-related departments of 7 tertiary general hospitals in China were selected by convenience sampling. Measures included a demographic questionnaire and the Quality of Discharged Teaching Scale(QDTS). Descriptive analysis ANOVA and paired t-test were completed by SPSS 22.0 software. RESULTS The overall average score of QDTS in this survey was 155.79 ± 23.29. The total score of QDTS in chronic obstructive pulmonary disease was lower than coronary heart disease (P < 0.001) and cancer (P = 0.02). While coronary heart disease was higher than stroke (P = 0.01) and diabetes (P = 0.01). And the scores of patients on discharge guidance skills and effects were higher than 8.50. CONCLUSIONS The level of the patients' perception of quality of discharge insrtuction is middle to high. Managers should understand the characteristics of various departments, give corresponding guidance and help, and clinical nurses should understand the characteristics of ward patients and pay more attention to individual guidance.
Collapse
Affiliation(s)
- Miao-Miao Yang
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Wei Liang
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| | - Hui Hua Zhao
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China.
| | - Ying Zhang
- Department of nursing, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, 200032, China
| |
Collapse
|
9
|
Berger RE, Yang S, Weiner J, Gace D, Finn K. Measuring Patient Preferences and Clinic Follow-Up Utilizing an Embedded Discharge Appointment Scheduler: A Pilot Study. Jt Comm J Qual Patient Saf 2019; 45:580-585. [PMID: 31281091 DOI: 10.1016/j.jcjq.2019.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 05/16/2019] [Accepted: 05/17/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Scheduling timely outpatient follow-up appointments is part of a high-quality discharge process. In many centers, residents and hospitalists schedule follow-up appointments, often without patient input due to time constraints. METHODS A needs assessment was conducted to quantify clinician time spent making discharge appointments and to identify barriers to successful appointment scheduling. A four-week pilot intervention subsequently embedded a discharge scheduler responsible for scheduling discharge appointments into five house staff teams. The goals of the pilot were to incorporate patients' scheduling preferences when making appointments, to improve appointment attendance, and to reduce administrative burden on residents. Results were analyzed using chi-square and Fisher's exact tests. RESULTS Patients expressed a strong preference to be involved in scheduling follow-up appointments. In the intervention, there was a statistically significant increase in successfully scheduled appointments (66.7% vs. 87.7%; p < 0.0001) and attendance at follow-up appointments (43.9% baseline vs. 62.9% intervention; p = 0.011), a statistically significant reduction in rescheduled appointments (16.7% baseline vs. 4.9% intervention; p = 0.008), a nonsignificant trend toward increased number of canceled appointments (7.6% baseline vs. 17.5% intervention; p = 0.088), and no significant difference in no-show rates (18.2% baseline vs. 14.7% intervention; p = 0.544). Of residents involved in the pilot, 100% reported that the scheduler improved their ability to care for patients. CONCLUSION This pilot suggests that adding a nonclinical team member tasked with scheduling discharge appointments improved alignment of the discharge process with patients' preferences and may be of value to residents, hospitalists, and the health care system.
Collapse
|
10
|
Reengineering Skilled Nursing Facility Discharge: Analysis of Reengineered Discharge Implementation. J Nurs Care Qual 2019; 35:158-164. [PMID: 31145185 DOI: 10.1097/ncq.0000000000000413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a need to adopt evidence-based approaches to discharge planning in the skilled nursing facility (SNF) short stay population. PURPOSE This article describes implementation of the Reengineered Discharge (RED) process in SNFs and makes recommendations for its future implementation. METHODS The methods included a pre- and postanalysis of an 18-month RED implementation with a contemporaneous comparison of 4 Midwestern SNFs randomly assigned to 2 different RED implementation strategies. The Standard facilities received less implementation than Enhanced facilities. RESULTS Standard SNFs made more improvements and were more satisfied with the improved process than Enhanced SNFs. Field notes revealed that corporate willingness to make process changes impacted the Standard group's capacity for change; both groups were heavily influenced by external forces, and turnover was an impediment to RED implementation. CONCLUSION This research revealed that discharge processes are similar across settings and that evidence-based programs such as RED can be adapted to the SNF setting.
Collapse
|
11
|
Noordman J, van Vliet L, Kaunang M, van den Muijsenbergh M, Boland G, van Dulmen S. Towards appropriate information provision for and decision-making with patients with limited health literacy in hospital-based palliative care in Western countries: a scoping review into available communication strategies and tools for healthcare providers. BMC Palliat Care 2019; 18:37. [PMID: 30979368 PMCID: PMC6461806 DOI: 10.1186/s12904-019-0421-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Person-centred palliative care poses high demands on professionals and patients regarding appropriate and effective communication and informed decision-making. This is even more so for patients with limited health literacy, as they lack the necessary skills to find, understand and apply information about their health and healthcare. Recognizing patients with limited health literacy and adapting the communication, information provision and decision-making process to their skills and needs is essential to achieve desired person-centred palliative care. The aim of this study is to summarize available strategies and tools for healthcare providers towards successful communication, information provision and/or shared decision-making in supporting patients with limited health literacy in hospital-based palliative care in Western countries. METHODS A scoping review was conducted. First, databases PubMed, Embase, CINAHL, and PsycINFO were searched. Next, grey literature was examined using several online databases and by contacting national experts. In addition, all references of included studies were checked. RESULTS Five studies were included that showed that there are face-to-face, written as well as online strategies available for healthcare providers to support communication, information provision and, to a lesser extent, (shared) decision-making in palliative care for patients with limited health literacy. Strategies that were mentioned several times were: teach-back method, jargon-free communication and developing and testing materials with patients with limited health literacy, among others. Two supporting tools were found: patient decision aids and question prompt lists. CONCLUSIONS To guarantee high quality person-centred palliative care, the role of health literacy should be considered. Although there are several strategies available for healthcare providers to facilitate such communication, only few tools are offered. Moreover, the strategies and tools appear not specific for the setting of palliative care, but seem helpful for providers to support the communication, information provision and decision making with patients with limited health literacy in general. Future research should focus on which strategies or tools are (most) effective in supporting patients with limited health literacy in palliative care, and the implementation of these strategies and tools in practice.
Collapse
Affiliation(s)
- Janneke Noordman
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands. .,Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - Liesbeth van Vliet
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.,Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Menno Kaunang
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Sandra van Dulmen
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| |
Collapse
|
12
|
Popejoy LL, Vogelsmeier AA, Wakefield BJ, Galambos CM, Lewis AM, Huneke D, Mehr DR. Adapting Project RED to Skilled Nursing Facilities. Clin Nurs Res 2018; 29:149-156. [PMID: 30556413 DOI: 10.1177/1054773818819261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes our recommendation for adapting hospital-based RED (Reengineered Discharge) processes to skilled nursing facilities (SNFs). Using focus groups, the SNFs' discharge processes were assessed twice additionally, research staff then recorded field notes documenting discussions about facility discharge processes as they related to RED processes. Data were systematically analyzed using thematic analysis to identify recommendations for adapting RED to the SNF setting including (a) rapidly identifying, involving, and preparing family/caregivers to implement a patient focused SNF discharge plan; (b) reconnecting patients quickly to primary care providers; and (c) educating patients at discharge about their target health condition, medications, and impact of changes on other chronic health needs. Limited SNF staff capacity and corporate-level policies limited adoption of some key RED components. Transitional care processes such as RED, developed to avoid discharge problems, can be adapted for SNFs to improve their discharges.
Collapse
|
13
|
Vasquez RA, Chotai S, Freeman TH, Kay HF, Cheng JS, McGirt MJ, Devin CJ. Impact of Discharge Disposition on 30-Day Readmissions Following Elective Spine Surgery. Neurosurgery 2017; 81:772-778. [PMID: 28605552 DOI: 10.1093/neuros/nyx114] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 05/31/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Readmissions are a significant economic burden on the health care system and increasingly being utilized as a metric of quality. Patients discharged to home vs an inpatient facility have different characteristics, which might influence the readmissions following spine surgery. OBJECTIVE To determine the effect of discharge disposition on readmission rates and causes of readmission after spine surgery. METHODS Patients enrolled in a prospective registry and undergoing elective spine surgery were analyzed. Readmissions (30 d), demographic, clinical variables, and baseline patient-reported outcomes were recorded. Patients were dichotomized as discharged home vs inpatient facility. RESULTS Of total 1631 patients, 1444 (89%) patients were discharged home and 187 (11%) discharged to an inpatient facility. Sixty-five (4%) patients were readmitted at 30 d. There was no significant difference in readmissions between patients discharged to a facility 10 (5%) vs home 55 (4%; P = .210). In a multivariable analysis, adjusting for all the comorbidities, the discharge destination was not associated with readmission within 30 d. The medical complications (80%) were the most common cause of readmission in those discharged to a facility. Patients discharged home had significantly higher readmissions related to surgical wound issues (67%; P = .034). CONCLUSION Despite the older age and higher comorbidities in patients discharged to an inpatient facility, the proportion of readmissions was comparable to those discharged home. Patients discharged home had a higher proportion of readmissions related to surgical wound complications and those discharged to facility had higher readmissions associated with medical complications. Understanding causes of readmission based on discharge destination may allow targeted intervention to reduce the readmission rates following spine surgery.
Collapse
Affiliation(s)
- Raul A Vasquez
- Department of Neurosurgery, University of Kentucky, Lexington, Kentucky
| | - Silky Chotai
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas H Freeman
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Harrison F Kay
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joseph S Cheng
- Department of Neurosurgery, Yale University, New Haven, Connecticut
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina
| | - Clinton J Devin
- Department of Orthopedics and Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
14
|
Cancino RS, Manasseh C, Kwong L, Mitchell SE, Martin J, Jack BW. Project RED Impacts Patient Experience. J Patient Exp 2017; 4:185-190. [PMID: 29276765 PMCID: PMC5734517 DOI: 10.1177/2374373517714454] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Hospitalized patients are frequently unprepared to care for themselves after discharge often leading to unplanned hospital readmission. One strategy to reduce readmission rates is improving the quality of patient education and preparation before hospital discharge. The ReEngineered Discharge (RED) is a standardized hospital-based program designed to provide patients and caregivers the information they need to continue care at home. Objectives: We sought to study the impact of the RED intervention on posthospitalization adult patient experience scores in an urban academic safety-net hospital. Methods: We conducted a descriptive study of a pilot program that compared posthospitalization survey responses to the Press Ganey survey item “Instructions were given about how to care for yourself at home.” We compared the survey results for 3 groups of adult patients: those receiving the RED program, those receiving a standard discharge on the same hospital unit, and those receiving a standard discharge on other hospital units. Results: A greater percentage of adult patients who received the RED discharge program rated the quality of their discharge as “very good” as compared to those receiving a standard discharge on the same hospital unit and those receiving a standard discharge on other hospital units (61%, 35%, and 41%, respectively, P = .0001). Conclusion: Delivery of a standardized hospital discharge program resulted in a larger proportion of top-box “very good” responses on a Press Ganey posthospitalization survey. Future research should examine whether hospital-based transition programs can sustain improvement in patient experience measures and whether these improvements can be observed in other patient populations.
Collapse
Affiliation(s)
- Ramon S Cancino
- Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, Joe R. & Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | | | - Lana Kwong
- Torrance Memorial Health System, Torrance, CA, USA
| | | | | | | |
Collapse
|
15
|
Piepoli MF, Corrà U, Dendale P, Frederix I, Prescott E, Schmid JP, Cupples M, Deaton C, Doherty P, Giannuzzi P, Graham I, Hansen TB, Jennings C, Landmesser U, Marques-Vidal P, Vrints C, Walker D, Bueno H, Fitzsimons D, Pelliccia A. Challenges in secondary prevention after acute myocardial infarction: A call for action. Eur J Cardiovasc Nurs 2017; 16:369-380. [DOI: 10.1177/1474515117702594] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Massimo F Piepoli
- Cardiac Department, Guglielmo da Saliceto Polichirurgico Hospital AUSL Piacenza, Italy
| | - Ugo Corrà
- Cardiology Rehabilitation Division, Scientific Institute of Veruno, Italy
| | - Paul Dendale
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Ines Frederix
- Heart Centre Hasselt, University of Hasselt, Belgium
| | - Eva Prescott
- Department of Cardiology, University of Copenhagen, Denmark
| | | | - Margaret Cupples
- Department of General Practice and Primary Care, Queen’s University Belfast, UK
| | - Christi Deaton
- Florence Nightingale Foundation, Cambridge University Hospitals NHS Foundation Trust, UK
| | | | - Pantaleo Giannuzzi
- Cardiology Rehabilitation Division, Scientific Institute of Veruno, Italy
| | - Ian Graham
- Trinity College, University of Dublin, Ireland
| | | | | | - Ulf Landmesser
- Department of Cardiology, Charite Universitätsmedizin Berlin, Germany
| | | | | | - David Walker
- Department of Cardiology, East Sussex Healthcare NHS Trust, UK
| | - Hector Bueno
- Cardiology Department, Universidad Complutense de Madrid, Spain
| | | | - Antonio Pelliccia
- Institute of Sport Medicine and Science, Comitato Olimpico Nazionale Italiano, Italy
| |
Collapse
|
16
|
Piepoli MF, Corrà U, Dendale P, Frederix I, Prescott E, Schmid JP, Cupples M, Deaton C, Doherty P, Giannuzzi P, Graham I, Hansen TB, Jennings C, Landmesser U, Marques-Vidal P, Vrints C, Walker D, Bueno H, Fitzsimons D, Pelliccia A. Challenges in secondary prevention after acute myocardial infarction: A call for action. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 6:299-310. [PMID: 28608759 DOI: 10.1177/2048872616689773] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Worldwide, each year more than 7 million people experience myocardial infarction, in which one-year mortality rates are now in the range of 10%, but vary with patient characteristics. The consequences are even more dramatic: among patients who survive, 20% suffer a second cardiovascular event in the first year and approximately 50% of major coronary events occur in those with a previous hospital discharge diagnosis of ischaemic heart disease. The people behind these numbers spur this call for action. Prevention after myocardial infarction is crucial to reduce risk and suffering. Evidence-based interventions include optimal medical treatment with anti-platelets and statins, achievement of blood pressure, lipid and blood glucose targets, and appropriate lifestyle changes. The European Society of Cardiology and its constituent bodies are determined to embrace this challenge by developing a consensus document in which the existing gaps for secondary prevention strategies are reviewed. Effective interventions in relation to the patients, healthcare providers and healthcare systems are proposed and discussed. Finally, innovative strategies in hospital as well as in outpatient and long-term settings are endorsed.
Collapse
Affiliation(s)
- Massimo F Piepoli
- 1 Cardiac Department, Guglielmo da Saliceto Polichirurgico Hospital AUSL Piacenza, Italy
| | - Ugo Corrà
- 2 Cardiology Rehabilitation Division, Scientific Institute of Veruno, Italy
| | - Paul Dendale
- 3 Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Ines Frederix
- 4 Heart Centre Hasselt, University of Hasselt, Belgium
| | - Eva Prescott
- 5 Department of Cardiology, University of Copenhagen, Denmark
| | | | - Margaret Cupples
- 7 Department of General Practice and Primary Care, Queen's University Belfast, UK
| | - Christi Deaton
- 8 Florence Nightingale Foundation, Cambridge University Hospitals NHS Foundation Trust, UK
| | | | - Pantaleo Giannuzzi
- 2 Cardiology Rehabilitation Division, Scientific Institute of Veruno, Italy
| | - Ian Graham
- 10 Trinity College, University of Dublin, Ireland
| | | | - Catriona Jennings
- 12 Department of Cardiovascular Medicine, Imperial College London, UK
| | - Ulf Landmesser
- 13 Department of Cardiology, Charite Universitätsmedizin Berlin, Germany
| | - Pedro Marques-Vidal
- 14 Department of Internal Medicine, Lausanne University Hospital, Switzerland
| | | | - David Walker
- 16 Department of Cardiology, East Sussex Healthcare NHS Trust, UK
| | - Hector Bueno
- 17 Cardiology Department, Universidad Complutense de Madrid, Spain
| | | | - Antonio Pelliccia
- 19 Institute of Sport Medicine and Science, Comitato Olimpico Nazionale Italiano, Italy
| |
Collapse
|
17
|
Wan H, Zhang L, Witz S, Musselman KJ, Yi F, Mullen CJ, Benneyan JC, Zayas-Castro JL, Rico F, Cure LN, Martinez DA. A literature review of preventable hospital readmissions: Preceding the Readmissions Reduction Act. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/19488300.2016.1226210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
18
|
Piepoli MF, Corrà U, Dendale P, Frederix I, Prescott E, Schmid JP, Cupples M, Deaton C, Doherty P, Giannuzzi P, Graham I, Hansen TB, Jennings C, Landmesser U, Marques-Vidal P, Vrints C, Walker D, Bueno H, Fitzsimons D, Pelliccia A. Challenges in secondary prevention after acute myocardial infarction: A call for action. Eur J Prev Cardiol 2016; 23:1994-2006. [DOI: 10.1177/2047487316663873] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Massimo F Piepoli
- Cardiac Department, Guglielmo da Saliceto Polichirurgico Hospital AUSL Piacenza, Italy
| | - Ugo Corrà
- Cardiology Rehabilitation Division, Scientific Institute of Veruno, Italy
| | - Paul Dendale
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Ines Frederix
- Heart Centre Hasselt, University of Hasselt, Belgium
| | - Eva Prescott
- Department of Cardiology, University of Copenhagen, Denmark
| | | | - Margaret Cupples
- Department of General Practice and Primary Care, Queen’s University Belfast, UK
| | - Christi Deaton
- Florence Nightingale Foundation, Cambridge University Hospitals NHS Foundation Trust, UK
| | | | - Pantaleo Giannuzzi
- Cardiology Rehabilitation Division, Scientific Institute of Veruno, Italy
| | - Ian Graham
- Trinity College, University of Dublin, Ireland
| | | | | | - Ulf Landmesser
- Department of Cardiology, Charite Universitätsmedizin Berlin, Germany
| | | | | | - David Walker
- Department of Cardiology, East Sussex Healthcare NHS Trust, UK
| | - Héctor Bueno
- Cardiology Department, Universidad Complutense de Madrid, Spain
| | | | - Antonio Pelliccia
- Institute of Sport Medicine and Science, Comitato Olimpico Nazionale Italiano, Italy
| |
Collapse
|
19
|
Figueroa JF, Schnipper JL, McNally K, Stade D, Lipsitz SR, Dalal AK. How often are hospitalized patients and providers on the same page with regard to the patient's primary recovery goal for hospitalization? J Hosp Med 2016; 11:615-9. [PMID: 26929079 DOI: 10.1002/jhm.2569] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND To deliver high-quality, patient-centered care during hospitalization, healthcare providers must correctly identify the patient's primary recovery goal. OBJECTIVE To determine the degree of concordance between patients and key hospital providers. DESIGN A validated questionnaire administered to a random sample of hospitalized patients alongside their nurse and physician provider. Goals included: "be cured," "live longer," "improve/maintain health," "be comfortable," "accomplish a particular life goal," or "other." SETTING Major academic hospital in Boston, Massachusetts. PARTICIPANTS Adult patients admitted for more than 48 hours from November 2013 to May 2014 were eligible. When a patient was incapacitated, a legal proxy was interviewed. The nurse and physician provider were then interviewed within 24 hours. MEASUREMENTS Frequencies of responses for each recovery goal and the rate of concordance among the patient, nurse, and physician provider were measured. The frequency of responses across groups were compared using adjusted χ(2) analyses. Inter-rater agreement was measured using 2-way Kappa tests. RESULTS All 3 participants were interviewed in 109 of the 181 (60.2%) patients approached (or with proxy available). Significant differences in selected goals were observed across respondent groups (P < 0.001). Patients frequently chose "be cured" (46.8%). Nurses and physician providers frequently selected "improve or maintain health" (38.5% and 46.8%, respectively). All 3 participants selected the same goal in 22 cases (20.2%). Inter-rater agreement was poor to slight for all pairs (kappa 0.09 [-0.03-0.19], 0.19 [0.08-0.30], and 0.20 [0.08-0.32] for patient-physician, patient-nurse, and nurse-physician, respectively). CONCLUSIONS We observed poor to slight concordance among hospitalized patients and key medical team members with regard to the patient's primary recovery goal. Journal of Hospital Medicine 2016;11:615-619. © 2016 Society of Hospital Medicine.
Collapse
Affiliation(s)
- Jose F Figueroa
- Department of Medicine, Harvard Medical School, Boston, Massachusetts.
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Jeffrey L Schnipper
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kelly McNally
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Diana Stade
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stuart R Lipsitz
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anuj K Dalal
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
20
|
Chandler E, Slade D, Pun J, Lock G, Matthiessen CMIM, Espindola E, Ng C. Communication in Hong Kong Accident and Emergency Departments: The Clinicians' Perspectives. Glob Qual Nurs Res 2015; 2:2333393615576714. [PMID: 28462303 PMCID: PMC5342630 DOI: 10.1177/2333393615576714] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 01/07/2015] [Accepted: 01/29/2015] [Indexed: 12/30/2022] Open
Abstract
In this article, we report findings from the first qualitatively driven study of patient–clinician communication in Hong Kong Accident and Emergency Departments (AEDs). In light of the Hong Kong Hospital Authority’s policy emphasis on patient-centered care and communication in the public hospitals it oversees, we analyze clinicians’ perceptions of the role and relevance of patient-centered communication strategies in emergency care. Although aware of the importance of effective communication in emergency care, participants discussed how this was frequently jeopardized by chronic understaffing, patient loads, and time pressures. This was raised in relation to the absence of spoken interdisciplinary handovers, the tendency to downgrade interpersonal communication with patients, and the decline in staff attendance at communication training courses. Participants’ frequent descriptions of patient-centered communication as dispensable from, and time-burdensome in, AEDs highlight a discrepancy between the stated Hong Kong Hospital Authority policy of patient-centered care and the reality of contemporary Hong Kong emergency practice.
Collapse
Affiliation(s)
- Eloise Chandler
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Diana Slade
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Jack Pun
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Graham Lock
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Christian M I M Matthiessen
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Elaine Espindola
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Carman Ng
- The International Research Centre for Communication in Healthcare, The Hong Kong Polytechnic University, Hong Kong SAR, China
| |
Collapse
|
21
|
Goldstone LW, Saldaña SN, Werremeyer A. Pharmacist provision of patient medication education groups. Am J Health Syst Pharm 2015; 72:487-92. [DOI: 10.2146/ajhp140182] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Lisa W. Goldstone
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Arizona, Tucson
| | - Shannon N. Saldaña
- Psychiatry, Intermountain Primary Children’s Hospital, Salt Lake City, UT, and Adjunct Assistant Professor of Psychiatry, School of Medicine, University of Utah, Salt Lake City
| | - Amy Werremeyer
- Department of Pharmacy Practice, College of Pharmacy, Nursing and Allied Sciences, North Dakota State University, Fargo
| |
Collapse
|
22
|
Jackson C, Shahsahebi M, Wedlake T, DuBard CA. Timeliness of outpatient follow-up: an evidence-based approach for planning after hospital discharge. Ann Fam Med 2015; 13:115-22. [PMID: 25755032 PMCID: PMC4369604 DOI: 10.1370/afm.1753] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Timely outpatient follow-up has been promoted as a key strategy to reduce hospital readmissions, though one-half of patients readmitted within 30 days of hospital discharge do not have follow-up before the readmission. Guidance is needed to identify the optimal timing of hospital follow-up for patients with conditions of varying complexity. METHODS Using North Carolina Medicaid claims data for hospital-discharged patients from April 2012 through March 2013, we constructed variables indicating whether patients received follow-up visits within successive intervals and whether these patients were readmitted within 30 days. We constructed 7 clinical risk strata based on 3M Clinical Risk Groups (CRGs) and determined expected readmission rates within each CRG. We applied survival modeling to identify groups that appear to benefit from outpatient follow-up within 3, 7, 14, 21, and 30 days after discharge. RESULTS The final study sample included 44,473 Medicaid recipients with 65,085 qualifying discharges. The benefit of early follow-up varied according to baseline readmission risk. For example, follow-up within 14 days after discharge was associated with 1.5%-point reduction in readmissions in the lowest risk strata (P <.001) and a 19.1%-point reduction in the highest risk strata (P <.001). Follow-up within 7 days was associated with meaningful reductions in readmission risk for patients with multiple chronic conditions and a greater than 20% baseline risk of readmission, a group that represented 24% of discharged patients. CONCLUSIONS Most patients do not meaningfully benefit from early outpatient follow-up. Transitional care resources would be best allocated toward ensuring that highest risk patients receive follow-up within 7 days.
Collapse
Affiliation(s)
- Carlos Jackson
- Community Care of North Carolina, Raleigh, North Carolina
| | - Mohammad Shahsahebi
- Duke Family Medicine, Duke University Medical Center, Durham, North Carolina
| | | | | |
Collapse
|
23
|
The International Society for Heart and Lung Transplantation Guidelines for the management of pediatric heart failure: Executive summary. J Heart Lung Transplant 2014; 33:888-909. [DOI: 10.1016/j.healun.2014.06.002] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/04/2014] [Indexed: 01/11/2023] Open
|
24
|
Readmissions in Neurosurgery: A Qualitative Inquiry. World Neurosurg 2014; 82:376-9. [DOI: 10.1016/j.wneu.2014.02.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/03/2014] [Accepted: 02/17/2014] [Indexed: 11/19/2022]
|
25
|
Schweitzer M, Aucoin J, Docherty SL, Rice HE, Thompson J, Sullivan DT. Evaluation of a discharge education protocol for pediatric patients with gastrostomy tubes. J Pediatr Health Care 2014; 28:420-8. [PMID: 24582896 DOI: 10.1016/j.pedhc.2014.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/18/2014] [Accepted: 01/20/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION To evaluate the impact of a preprocedure education protocol for children who receive a gastrostomy tube (GT). METHODS A preintervention-postintervention design, using surveys and comparison between preprotocol and postprotocol cohorts, was used to evaluate the effect of implementation of a standardized GT education protocol with 26 subjects on caregiver, patient, and provider outcomes. RESULTS The use of a preprocedure education protocol resulted in improved patient outcomes and increased caregiver knowledge and confidence and was considered a positive change by the providers. DISCUSSION Often education is a forgotten part of a medical procedure, and the importance of education is typically only recognized after an adverse event occurs. Establishing a standardized evidence-based education protocol for GT care improves overall care and satisfaction. Use of a systematic and family-centered interdisciplinary approach markedly improves patient care.
Collapse
|
26
|
McCoy KA, Bear-Pfaffendof K, Foreman JK, Daniels T, Zabel EW, Grangaard LJ, Trevis JE, Cummings KA. Reducing avoidable hospital readmissions effectively: a statewide campaign. Jt Comm J Qual Patient Saf 2014; 40:198-204. [PMID: 24919250 DOI: 10.1016/s1553-7250(14)40026-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Reducing Avoidable Readmissions Effectively (RARE) Campaign was designed to engage hospitals and care providers in Minnesota across the continuum of care to prevent avoidable hospital readmissions within 30 days of hospital discharge. METHODS Support for hospitals was provided on a one-on-one basis by a RARE resource consultant, as well as through the campaign website and a monthly newsletter. Hospitals had the opportunity to participate in any of three learning collaboratives-Care Transitions Intervention, Project RED (ReEngineered Discharge), or SAFE Transitions of Care. The operating and supporting partners of the RARE Campaign offered monthly webinars for sharing of best practices, and hosted Action Learning Days and celebratory events. Potentially preventable readmissions (PPRs) were tracked over time, and a ratio of actual-to-expected PPRs (A/E PPRs) was calculated for each hospital and reported quarterly. RESULTS As of December 31, 2013, 82 hospitals were participating, with 58 (71%) taking part in at least one learning collaborative. More than 7,000 readmissions have been prevented, and patients have spent more than 28,000 nights of sleep in their own beds rather than in a hospital. By the end of September 2013, the A/E PPR ratio was reduced by 12%-from .98 to .86. CONCLUSIONS The peer-to-peer networking and collaboration between hospitals facing similar issues, coupled with statewide resources, collaborating Operating Partners, and support for system improvements, have led to improved discharge planning, better management of care transitions and medications, engaged patients and families, and lower readmission rates.
Collapse
|
27
|
Gordon JE, Leiman JM, Deland EL, Pardes H. Delivering value: provider efforts to improve the quality and reduce the cost of health care. Annu Rev Med 2013; 65:447-58. [PMID: 24111890 DOI: 10.1146/annurev-med-100312-135931] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Growing concern regarding costs of care and health outcomes in the United States has led to widespread calls to address the issue of health care spending. Today, providers across the country are working both to improve the quality and to reduce the cost of health care. These activities span multiple care delivery settings and include care standardization and redesign, shared decision making, palliative care, care coordination, readmission reduction, patient engagement, predictive modeling, and direct cost reduction. These efforts differ from those undertaken in the past because of the availability of information technology tools to collect and analyze data, and because of the emphasis on cost reduction in conjunction with quality improvement. Although the available literature reflects only a small fraction of the provider activities currently in progress, there is cause for hope for achieving a sustainable, innovative, and value-driven health care system.
Collapse
|
28
|
Incremental analysis of the reengineering of an outpatient billing process: an empirical study in a public hospital. BMC Health Serv Res 2013; 13:215. [PMID: 23763904 PMCID: PMC3722093 DOI: 10.1186/1472-6963-13-215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 06/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A smartcard is an integrated circuit card that provides identification, authentication, data storage, and application processing. Among other functions, smartcards can serve as credit and ATM cards and can be used to pay various invoices using a 'reader'. This study looks at the unit cost and activity time of both a traditional cash billing service and a newly introduced smartcard billing service in an outpatient department in a hospital in Taipei, Taiwan. METHODS The activity time required in using the cash billing service was determined via a time and motion study. A cost analysis was used to compare the unit costs of the two services. A sensitivity analysis was also performed to determine the effect of smartcard use and number of cashier windows on incremental cost and waiting time. RESULTS Overall, the smartcard system had a higher unit cost because of the additional service fees and business tax, but it reduced patient waiting time by at least 8 minutes. Thus, it is a convenient service for patients. In addition, if half of all outpatients used smartcards to pay their invoices, along with four cashier windows for cash payments, then the waiting time of cash service users could be reduced by approximately 3 minutes and the incremental cost would be close to breaking even (even though it has a higher overall unit cost that the traditional service). CONCLUSIONS Traditional cash billing services are time consuming and require patients to carry large sums of money. Smartcard services enable patients to pay their bill immediately in the outpatient clinic and offer greater security and convenience. The idle time of nurses could also be reduced as they help to process smartcard payments. A reduction in idle time reduces hospital costs. However, the cost of the smartcard service is higher than the cash service and, as such, hospital administrators must weigh the costs and benefits of introducing a smartcard service. In addition to the obvious benefits of the smartcard service, there is also scope to extend its use in a hospital setting to include the notification of patient arrival and use in other departments.
Collapse
|
29
|
Romagnoli KM, Handler SM, Ligons FM, Hochheiser H. Home-care nurses' perceptions of unmet information needs and communication difficulties of older patients in the immediate post-hospital discharge period. BMJ Qual Saf 2013. [PMID: 23362507 DOI: 10.1136/bmjqs-2012–001207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To understand home-care nurses' perceptions of the post-hospitalisation information needs and communication problems of older patients, and how these factors might contribute to undesirable outcomes including poor patient reintegration into prior living environments and unplanned hospital readmissions. DESIGN A ranked list of information needs experienced by patients was developed by two Nominal Group Technique (NGT) sessions from the perspective of home-care nurses. The list was combined with results from previously published work to develop a web-based survey administered to home-care nurses to elicit perceptions of patients' post-hospitalisation information needs. RESULTS Seventeen nurses participated in the NGT sessions, producing a list of 28 challenges grouped into five themes: medications, disease/condition, non-medication care/treatment/safety, functional limitations and communication problems. The survey was sent to 220 home-care nurses, with a 54.1% (119/220) response rate. Respondents identified several frequent, high-impact information and communication needs that have received little attention in readmission literature, including information about medication regimens; the severity of their condition; the hospital discharge management process; non-medication care regimens such as wound care, use of durable medical equipment and home safety; the extent of care needed; and which providers are best suited to provide that care. Responses also identified several communication difficulties that may play a role in readmissions. CONCLUSIONS Information needs and communication problems identified by home-care nurses expanded upon and reinforced results from prior studies. These results might be used to develop interventions that may improve information sharing among clinicians, patients and caregivers during care transitions to ensure patient reintegration into prior living environments, potentially preventing unplanned hospital readmissions.
Collapse
Affiliation(s)
- Katrina M Romagnoli
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, 5607 Baum Boulevard, BAUM 417D, Pittsburgh, PA 15206-3701, USA.
| | | | | | | |
Collapse
|
30
|
Romagnoli KM, Handler SM, Ligons FM, Hochheiser H. Home-care nurses' perceptions of unmet information needs and communication difficulties of older patients in the immediate post-hospital discharge period. BMJ Qual Saf 2013; 22:324-32. [PMID: 23362507 DOI: 10.1136/bmjqs-2012-001207] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To understand home-care nurses' perceptions of the post-hospitalisation information needs and communication problems of older patients, and how these factors might contribute to undesirable outcomes including poor patient reintegration into prior living environments and unplanned hospital readmissions. DESIGN A ranked list of information needs experienced by patients was developed by two Nominal Group Technique (NGT) sessions from the perspective of home-care nurses. The list was combined with results from previously published work to develop a web-based survey administered to home-care nurses to elicit perceptions of patients' post-hospitalisation information needs. RESULTS Seventeen nurses participated in the NGT sessions, producing a list of 28 challenges grouped into five themes: medications, disease/condition, non-medication care/treatment/safety, functional limitations and communication problems. The survey was sent to 220 home-care nurses, with a 54.1% (119/220) response rate. Respondents identified several frequent, high-impact information and communication needs that have received little attention in readmission literature, including information about medication regimens; the severity of their condition; the hospital discharge management process; non-medication care regimens such as wound care, use of durable medical equipment and home safety; the extent of care needed; and which providers are best suited to provide that care. Responses also identified several communication difficulties that may play a role in readmissions. CONCLUSIONS Information needs and communication problems identified by home-care nurses expanded upon and reinforced results from prior studies. These results might be used to develop interventions that may improve information sharing among clinicians, patients and caregivers during care transitions to ensure patient reintegration into prior living environments, potentially preventing unplanned hospital readmissions.
Collapse
Affiliation(s)
- Katrina M Romagnoli
- Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, 5607 Baum Boulevard, BAUM 417D, Pittsburgh, PA 15206-3701, USA.
| | | | | | | |
Collapse
|
31
|
Fuji KT, Abbott AA, Norris JF. Exploring care transitions from patient, caregiver, and health-care provider perspectives. Clin Nurs Res 2012; 22:258-74. [PMID: 23113935 DOI: 10.1177/1054773812465084] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Care transitions involve coordination of patient care across multiple care settings. Many problems occur during care transitions resulting in negative patient outcomes and unnecessary readmissions. The purpose of this study was to describe the experience of care transitions from patient, caregiver, and health-care provider perspectives in a single metropolitan Midwest city. A qualitative descriptive design was used to solicit patients', caregivers', and health-care providers' perceptions of care transitions, their role within the process, barriers to effective care transitions, and strategies to overcome these barriers. Five themes emerged: preplanned admissions are ideal; lack of needed patient information upon admission; multiple services are needed in preparing patients for discharge; rushed or delayed discharges lead to patient misunderstanding; and difficulties in following aftercare instructions. Findings illustrated provider difficulty in meeting multiple care needs, and the need for patient-centered care to achieve positive outcomes associated with quality measures, reduced readmissions, and care transitions.
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW : This review summarizes the systematic approaches that can be used to optimize secondary stroke prevention. Systematic secondary stroke prevention involves not only prescribing stroke patients the appropriate medications to manage risk factors, but also optimizing the effectiveness of those drugs by focusing on medication adherence. Medication adherence is defined as the extent to which patients take their medications as prescribed by their providers. RECENT FINDINGS : Many potential barriers to adherence exist, including relationships among patient, provider, and the health system. Medication reconciliation at discharge and early follow-up are steps that may increase medication adherence, decrease medication errors, and improve the transition to home. In addition, inclusion of the primary provider or stroke specialist in decisions regarding the management of antithrombotic therapy for procedures is important, as discontinuing these medications is often associated with recurrent ischemic events. SUMMARY : Prevention of recurrent stroke should be a priority for patients, caregivers, providers, and health systems. Medication-taking behavior should be considered from all of these perspectives in order to optimize adherence.
Collapse
|
33
|
Clancy C, Brach C, Abrams M. Assessing patient experiences of providers' cultural competence and health literacy practices: CAHPS Item Sets. Med Care 2012; 50:S1-2. [PMID: 22895224 DOI: 10.1097/mlr.0b013e3182641e7f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Carolyn Clancy
- Agency for Healthcare Research and Quality, Rockville, MD 20850, USA
| | | | | |
Collapse
|
34
|
Greysen SR, Schiliro D, Horwitz LI, Curry L, Bradley EH. "Out of sight, out of mind": housestaff perceptions of quality-limiting factors in discharge care at teaching hospitals. J Hosp Med 2012; 7:376-81. [PMID: 22378723 PMCID: PMC3423962 DOI: 10.1002/jhm.1928] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2011] [Revised: 12/31/2011] [Accepted: 01/30/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Improving hospital discharge has become a national priority for teaching hospitals, yet little is known about physician perspectives on factors limiting the quality of discharge care. OBJECTIVES To describe the discharge process from the perspective of housestaff physicians, and to generate hypotheses about quality-limiting factors and key strategies for improvement. METHODS Qualitative study with in-depth, in-person interviews with a diverse sample of 29 internal medicine housestaff, in 2010-2011, at 2 separate internal medicine training programs, including 7 different hospitals. We used the constant comparative method of qualitative analysis to explore the experiences and perceptions of factors affecting the quality of discharge care. RESULTS We identified 5 unifying themes describing factors perceived to limit the quality of discharge care: (1) competing priorities in the discharge process; (2) inadequate coordination within multidisciplinary discharge teams; (3) lack of standardization in discharge procedures; (4) poor patient and family communication; and (5) lack of postdischarge feedback and clinical responsibility. CONCLUSIONS Quality-limiting factors described by housestaff identified key processes for intervention. Establishment of clear standards for discharge procedures, including interdisciplinary teamwork, patient communication, and postdischarge continuity of care, may improve the quality of discharge care by housestaff at teaching hospitals.
Collapse
Affiliation(s)
- S Ryan Greysen
- Robert Wood Johnson Clinical Scholars Program-Yale University School of Medicine, New Haven, Connecticut, USA.
| | | | | | | | | |
Collapse
|
35
|
Szecket N, Wong HJ, Wu RC, Berman HD, Morra D. Implementation of a continuous admission model reduces the length of stay of patients on an internal medicine clinical teaching unit. J Hosp Med 2012; 7:55-9. [PMID: 21954169 DOI: 10.1002/jhm.926] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 02/25/2011] [Accepted: 03/17/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Optimizing hospital operations is a critical issue facing healthcare systems. Reducing unnecessary variation in patient flow is likely to improve efficiency and optimize capacity for hospital inpatients. The objective of this study was to determine whether changing admissions, from a "bolus" system to a "drip" system, would result in a smoothed daily discharge rate, and reduce the length of stay of patients on a General Internal Medicine clinical teaching unit over a period of 1 year. METHODS We conducted a retrospective analysis of the General Internal Medicine inpatient service at Toronto General Hospital for the 6-month periods from March to August during 2 consecutive years. Length of stay distributions and daily discharge rate variations were compared between the 2 study periods. RESULTS There were a total of 2734 discharges, 1446 occurring in the pre-change period, and 1288 in the post-change period. There was overall smoothing of the daily discharge rates, and a reduction of 0.3 days in median length of stay in the post-change period (P = 0.0065). CONCLUSIONS Restructuring the admission system to achieve constant daily admissions to each care team resulted in a smoothing of daily discharge rates and improved operational efficiency with shorter lengths of stay.
Collapse
Affiliation(s)
- Nicolas Szecket
- General Internal Medicine, Center for Innovation in Complex Care, University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | | | | | | | | |
Collapse
|
36
|
An evidence-based case for the value of social workers in efficient hospital discharge. Health Care Manag (Frederick) 2011; 30:242-6. [PMID: 21808176 DOI: 10.1097/hcm.0b013e318225e1dd] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A study was undertaken to make an evidence-based case for the value of social workers in efficient discharge of patients from acute care hospitals and to assist hospital managers in making informed staffing decisions. Hospital administrative databases from March 1 to November 30, 2008, were used for the analysis of inpatient discharges on days when social workers were on vacation compared with days fully staffed with social workers. Two performance measures, daily discharge rate and average length of stay, were evaluated. During the study period, 1825 patients were discharged from the General Internal Medicine inpatient service. Team discharge rates were significantly lower on social work vacation Fridays versus regular Fridays. In contrast, the average length of stay for patients discharged on social work vacation Fridays was significantly shorter than that for patients discharged on regular Fridays. It was concluded that daily discharge rate better quantified the role of social work in patient discharge. More generally, these results provide preliminary support for the need for adequate social work staffing in timely and efficient patient discharge.
Collapse
|
37
|
|
38
|
Villanueva T. Transitioning the patient with acute coronary syndrome from inpatient to primary care. J Hosp Med 2010; 5 Suppl 4:S8-14. [PMID: 20842747 DOI: 10.1002/jhm.829] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patients with acute coronary syndrome (ACS) undergo several transitions in care throughout the hospital stay, from prehospitalization to the postdischarge period when patients return to primary care. Hospitalist core competencies promote safe transitions in care for patients with ACS, including hospital discharge. These competencies also highlight the central role of the hospitalist in facilitating the continuity of care and as a key link between the patient and the primary care provider (PCP). Core competencies address key decision points and processes that occur during hospitalization for ACS including the initial evaluation and risk stratification, medication reconciliation, and discharge planning. Discharge is a crucial transition and one where hospitalists can both facilitate the transition to primary care and improve adherence to quality measures established for ACS. Poor communication during discharge reportedly results in postdischarge adverse events, most often related to medications and lack of follow-up related to pending test results. Standards for a safe discharge such as Project RED (Re-Engineered Discharge), initiatives to improve outcomes after discharge like Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), and adaptive tools including the ACS Transitions Tool support timely and accurate communication of complex information between the hospitalist, the PCP, and the patient. While the role of hospitalists is evolving, it is clear that they have a central role in ensuring safe transitions in care for ACS.
Collapse
Affiliation(s)
- Tomás Villanueva
- Inpatient Medicine Program, Baptist Hospital of Miami, part of Baptist Health South Florida, Miami, Florida 33176, USA.
| |
Collapse
|
39
|
Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: Monitoring and patient education—2009. Am J Health Syst Pharm 2010; 67:542-58. [DOI: 10.2146/ajhp090596] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
| | - Philip J. Schneider
- College of Pharmacy, University of Arizona—Phoenix Biomedical Campus, Phoenix
| | | |
Collapse
|
40
|
Bowles KH, Pham J, O'Connor M, Horowitz DA. Information Deficits in Home Care: A Barrier to Evidence-Based Disease Management. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2009. [DOI: 10.1177/1084822309353145] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A disease management study conducted in home care with 303 patients with diabetes, heart failure, or both revealed information deficits that make disease and quality management difficult. Nurses used a guideline checklist to indicate the amount and type of information available to them on admission and by the end of the episode of care. Nurses reported having data on 7% to 94% of the data elements. Whether a lipid profile had been done, the HbA1C (glycosolated hemoglobin test, also called a hemoglobin A1C) levels, or ejection fractions were known for 7%, 17%, and 18%, respectively. When nurses reported information related to ACE-I use (N = 183), they reported that 76% of patients were on ACE-I (angiotensin-converting enzyme inhibitor) or acceptable alternative for heart failure. But no information was reported on ACE-I use for 12% of the patients (N = 24). Potential solutions to these deficits in information and quality include increased use of guidelines in home care, guideline checklists, information transfer forms, nurse activism to request information, and the adoption of the electronic health record.
Collapse
Affiliation(s)
- Kathryn H. Bowles
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA,
| | - Julie Pham
- Stanford Hospital & Clinics, Stanford, CA, USA
| | - Melissa O'Connor
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | | |
Collapse
|