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Ferreira R, Pedrosa AR, Reis N, Sousa L, Nicolau C, Ferreira B, Rocha B, Baixinho CL. Transitional care for older persons with need of geriatric rehabilitation nursing interventions. BMC Nurs 2024; 23:376. [PMID: 38834990 DOI: 10.1186/s12912-024-02050-4] [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: 03/19/2024] [Accepted: 05/29/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND The literature review notes that people in need of care from Rehabilitation Programs do not always see their continuity ensured. OBJECTIVE This study aim to analyze the perspective of Specialists Nurse in Rehabilitation Nursing in relation to the organization and specialized intervention of transitional care for older people in need of rehabilitation programs. METHODS This is a qualitative study within the interpretivist paradigm. A focus group with 8 nurses and 13 interviews with Portuguese nurses were carried out between April 2022 and February 2023. Content analysis was carried out. RESULTS The triangulation of the data made it possible to identify 3 categories: Coordination of a transitional care program; Empowering the person to self-manage the transitional care process and Empowering the Informal Caregiver. CONCLUSIONS It is imperative to promote the coordination of transitional care, increase the functional capacity of the person and empower the informal caregiver.
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Affiliation(s)
- Rogério Ferreira
- Polytechnic Institute of Beja, Higher School of Health, Rua Pedro Soares, 7800-295, Beja, Portugal
- Comprehensive Health Research Centre (CHRC), 7000-811, Évora, Portugal
| | - Ana Rita Pedrosa
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160, Lisbon, Portugal
| | - Neuza Reis
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160, Lisbon, Portugal
| | - Luís Sousa
- Comprehensive Health Research Centre (CHRC), 7000-811, Évora, Portugal
- Higher School of Atlantic Health, 2730-036, Barcarena, Oeiras, Portugal
| | - Célia Nicolau
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160, Lisbon, Portugal
- Alentejo Coastal Hospital (HLA), Alentejo Coastal Local Health Unit (ULSLA), 7540-230, Santiago do Cacém, Portugal
| | - Bruno Ferreira
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160, Lisbon, Portugal
- Polytechnic Institute of Setúbal, Higher School of Health, 2910-761, Setúbal, Portugal
| | - Belmiro Rocha
- Associação Portuguesa de Enfermeiros de Reabilitação (APER), 4500-627, Silvalde, Portugal
| | - Cristina Lavareda Baixinho
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160, Lisbon, Portugal.
- Center for Innovative Care and Health Technology (ciTechcare), 2410-541, Leiria, Portugal.
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Evaluating a transitional care program for the oldest adults: results from the quantitative phase of a mixed-methods study. QUALITY IN AGEING AND OLDER ADULTS 2023. [DOI: 10.1108/qaoa-03-2022-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Purpose
This quantitative phase of a mixed-methods study aims to describe the effect of the Transitional Care Bridge (TCB) programme on functional decline, mortality, health-care utilisation and health outcomes compared to usual care in a regional hospital in the Netherlands.
Design/methodology/approach
In a pre- and post-cohort study, patients aged ≥70 years, admitted to the hospital for ≥48 h and discharged home with an Identification of Seniors at Risk score of ≥2, were included. The TCB programme, started before discharge, encompassed six visits by the community nurse (CN). Data were obtained from the hospital registry and by three questionnaires over a three months period, addressing activities of daily living (ADL), self-rated health, self-rated quality of life and health-care utilisation.
Findings
In total, 100 patients were enrolled in this study, 50 patients in the TCB group and 50 patients in the usual care group. After three months, 36.7% was dependent on ADL in the TCB group compared to 47.1% in the usual care group. Mean number of visits by the CN in the TCB group was 3.8. Although the TCB group had a lower mortality, this study did not find any statistically significant differences in health outcomes and health-care utilisation.
Research limitations/implications
Challenges in the delivery of the programme may have influenced patient outcomes. More research is needed on implementation of evidence-based programmes in smaller research settings. A qualitative phase of the study needs to address these outcomes and explore the perspectives of health professionals and patients on the delivery of the programme.
Originality/value
This study provides valuable information on the transitional care programme in a smaller setting.
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The Effect of Nursing Discharge Planning Program to Prevent Recurrent Falls, Readmission, and Length of Hospital Stay in the Aged Patients. TOPICS IN GERIATRIC REHABILITATION 2022. [DOI: 10.1097/tgr.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Jehloh L, Songwathana P, Sae-Sia W. Transitional care interventions to reduce emergency department visits in older adults: A systematic review. BELITUNG NURSING JOURNAL 2022; 8:187-196. [PMID: 37547112 PMCID: PMC10401376 DOI: 10.33546/bnj.2100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/24/2022] [Accepted: 05/30/2022] [Indexed: 08/08/2023] Open
Abstract
Background Preventable illnesses cause many emergency department visits in older adults, which can be minimized by implementing appropriate transitional care interventions. However, the most effective transitional care strategies for older adults are unknown. Objective To discover and consolidate transitional care interventions that can help older people avoid going to the emergency department. Methods From January 2011 to August 2021, PubMed, The Cochrane Library, CINAHL, Web of Science, ProQuest, and The JAMA Network were used to search. Two authors independently screened and selected papers, assessed the risk of bias, and extracted data into a standardized form in accordance with Cochrane guidelines. For the risk of bias in studies, the RevMan 5.4.1 program was utilized. Results Six randomized controlled trials, four non-randomized controlled trials, and three retrospective investigations were among the 13 studies examined. All studies evaluated emergency department visits but in different periods (ranging from 1-12 months after discharge) and with varying groups of baselines (pre-post intervention and between groups). The multi-component strategies, either pre or postdischarge phase using high-intensity care delivered within six months of discharge, were implemented in transitional care that had been shown to reduce emergency department visits in older adults. Conclusion To prevent emergency department visits by older patients, nurses should arrange for a high-intensity transitional care intervention that involves both pre-and postdischarge interventions. The effectiveness of the intervention in reducing emergency department visits in older adults is difficult to determine due to inter-study heterogeneity and poor methodological quality. There is a need for more evidence-based research with consistent and trustworthy effect assessments. PROSPERO registration number CRD42021261326.
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Affiliation(s)
- Latifah Jehloh
- Faculty of Nursing, Prince of Songkla University, Thailand
| | | | - Wipa Sae-Sia
- Faculty of Nursing, Prince of Songkla University, Thailand
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Singh H, Tang T, Steele Gray C, Kokorelias K, Thombs R, Plett D, Heffernan M, Jarach CM, Armas A, Law S, Cunningham HV, Nie JX, Ellen ME, Thavorn K, Nelson MLA. Recommendations for the Design and Delivery of Transitions-Focused Digital Health Interventions: Rapid Review. JMIR Aging 2022; 5:e35929. [PMID: 35587874 PMCID: PMC9164100 DOI: 10.2196/35929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Older adults experience a high risk of adverse events during hospital-to-home transitions. Implementation barriers have prevented widespread clinical uptake of the various digital health technologies that aim to support hospital-to-home transitions. Objective To guide the development of a digital health intervention to support transitions from hospital to home (the Digital Bridge intervention), the specific objectives of this review were to describe the various roles and functions of health care providers supporting hospital-to-home transitions for older adults, allowing future technologies to be more targeted to support their work; describe the types of digital health interventions used to facilitate the transition from hospital to home for older adults and elucidate how these interventions support the roles and functions of providers; describe the lessons learned from the design and implementation of these interventions; and identify opportunities to improve the fit between technology and provider functions within the Digital Bridge intervention and other transition-focused digital health interventions. Methods This 2-phase rapid review involved a selective review of providers’ roles and their functions during hospital-to-home transitions (phase 1) and a structured literature review on digital health interventions used to support older adults’ hospital-to-home transitions (phase 2). During the analysis, the technology functions identified in phase 2 were linked to the provider roles and functions identified in phase 1. Results In phase 1, various provider roles were identified that facilitated hospital-to-home transitions, including navigation-specific roles and the roles of nurses and physicians. The key transition functions performed by providers were related to the 3 categories of continuity of care (ie, informational, management, and relational continuity). Phase 2, included articles (n=142) that reported digital health interventions targeting various medical conditions or groups. Most digital health interventions supported management continuity (eg, follow-up, assessment, and monitoring of patients’ status after hospital discharge), whereas informational and relational continuity were the least supported. The lessons learned from the interventions were categorized into technology- and research-related challenges and opportunities and informed several recommendations to guide the design of transition-focused digital health interventions. Conclusions This review highlights the need for Digital Bridge and other digital health interventions to align the design and delivery of digital health interventions with provider functions, design and test interventions with older adults, and examine multilevel outcomes. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2020-045596
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Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,March of Dimes Canada, Toronto, ON, Canada.,Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kristina Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Rachel Thombs
- Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Donna Plett
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Matthew Heffernan
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carlotta M Jarach
- Department of Environmental Health Sciences, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alana Armas
- March of Dimes Canada, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Susan Law
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Moriah E Ellen
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Michelle LA Nelson
- March of Dimes Canada, Toronto, ON, Canada.,Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Pedrosa R, Ferreira Ó, Baixinho CL. Rehabilitation Nurse’s Perspective on Transitional Care: An Online Focus Group. J Pers Med 2022; 12:jpm12040582. [PMID: 35455698 PMCID: PMC9025548 DOI: 10.3390/jpm12040582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/23/2022] [Accepted: 04/03/2022] [Indexed: 02/01/2023] Open
Abstract
The increasing incidence of chronic and dependence leads to the need for hospitalization and adaptation in the process of returning home, as well as transition between care levels to ensure continuity of care. The World Health Organization has been warning about this problem since 2016, and consider reorganizing the care model as one of the solutions. The present study aimed to analyse the nurses’ perspective on transitional care for dependent people with rehabilitation care needs after hospital discharge. Methods: A focus group was developed with the participation of Rehabilitation Nurses from the hospital and community context, and content analysis was defined a posteriori. Results: From the content analysis emerged four related categories: promotion of continuity of care, nurse of advanced practice as a care manager, capacitation of the person and caregiver, and promotion of the care coordination. Conclusions: The present study allowed the strategies identification that minimize fragmentation risk of care and promote the person participation in transitional care. Ensuring transitional care is imperative to increase the quality of care, the satisfaction of professionals, clients, and the development of a system of sustainable health.
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Affiliation(s)
- Rita Pedrosa
- Nursing School of Lisbon, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-090 Lisbon, Portugal; (Ó.F.); (C.L.B.)
- Correspondence:
| | - Óscar Ferreira
- Nursing School of Lisbon, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-090 Lisbon, Portugal; (Ó.F.); (C.L.B.)
| | - Cristina Lavareda Baixinho
- Nursing School of Lisbon, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1600-090 Lisbon, Portugal; (Ó.F.); (C.L.B.)
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2410-541 Leiria, Portugal
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Abstract
BACKGROUND Discharge planning is a routine feature of health systems in many countries that aims to reduce delayed discharge from hospital, and improve the co-ordination of services following discharge from hospital and reduce the risk of hospital readmission. This is the fifth update of the original review. OBJECTIVES To assess the effectiveness of planning the discharge of individual patients moving from hospital. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two trials registers on 20 April 2021. We searched two other databases up to 31 March 2020. We also conducted reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA Randomised trials that compared an individualised discharge plan with routine discharge that was not tailored to individual participants. Participants were hospital inpatients. DATA COLLECTION AND ANALYSIS Two review authors independently undertook data analysis and quality assessment using a pre-designed data extraction sheet. We grouped studies by older people with a medical condition, people recovering from surgery, and studies that recruited participants with a mix of conditions. We calculated risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous data using fixed-effect meta-analysis. When combining outcome data it was not possible because of differences in the reporting of outcomes, we summarised the reported results for each trial in the text. MAIN RESULTS We included 33 trials (12,242 participants), four new trials included in this update. The majority of trials (N = 30) recruited participants with a medical diagnosis, average age range 60 to 84 years; four of these trials also recruited participants who were in hospital for a surgical procedure. Participants allocated to discharge planning and who were in hospital for a medical condition had a small reduction in the initial hospital length of stay (MD - 0.73, 95% confidence interval (CI) - 1.33 to - 0.12; 11 trials, 2113 participants; moderate-certainty evidence), and a relative reduction in readmission to hospital over an average of three months follow-up (RR 0.89, 95% CI 0.81 to 0.97; 17 trials, 5126 participants; moderate-certainty evidence). There was little or no difference in participant's health status (mortality at three- to nine-month follow-up: RR 1.05, 95% CI 0.85 to 1.29; 8 trials, 2721 participants; moderate certainty) functional status and psychological health measured by a range of measures, 12 studies, 2927 participants; low certainty evidence). There was some evidence that satisfaction might be increased for patients (7 trials), caregivers (1 trial) or healthcare professionals (2 trials) (very low certainty evidence). The cost of a structured discharge plan compared with routine discharge is uncertain (7 trials recruiting 7873 participants with a medical condition; very low certainty evidence). AUTHORS' CONCLUSIONS A structured discharge plan that is tailored to the individual patient probably brings about a small reduction in the initial hospital length of stay and readmissions to hospital for older people with a medical condition, may slightly increase patient satisfaction with healthcare received. The impact on patient health status and healthcare resource use or cost to the health service is uncertain.
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Affiliation(s)
- Daniela C Gonçalves-Bradley
- Center for Health Technology and Services Research (CINTESIS), Porto, Portugal
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Natasha A Lannin
- Brain Recovery and Rehabilitation Group, Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Lindy Clemson
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, St Leonards, Australia
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Pedrosa ARC, Ferreira ÓR, Baixinho CRSL. Transitional rehabilitation care and patient care continuity as an advanced nursing practice. Rev Bras Enferm 2022; 75:e20210399. [DOI: 10.1590/0034-7167-2021-0399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/08/2021] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To analyze the needs and facilitating and hindering elements related to transitional rehabilitation care. Methods: Integrative literature review oriented toward answering the question “What nursing interventions guarantee transitional rehabilitation care to dependent adult or elderly people when they return home after hospitalization?”. Results: The patients did not participate much in the planning of hospital discharge and decision-making when they had to return home. Informal caretakers reported that professionals showed detachment during hospitalization and delayed guiding instructions. Health professionals mentioned lack of time to offer this care modality as a difficulty. Final considerations: Ensuring training, follow-up, and coordination between care levels is essential. Care integration can reduce hospital stay and the impact of post-discharge complications. Transitional care contributes to a sustainable health system, higher care quality, and client satisfaction.
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Affiliation(s)
- Ana Rita Cardoso Pedrosa
- Hospital de Vila Franca de Xira, Portugal; Inovação e Desenvolvimento em Enfermagem de Lisboa, Portugal
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Batista J, Pinheiro CM, Madeira C, Gomes P, Ferreira ÓR, Baixinho CL. Transitional Care Management from Emergency Services to Communities: An Action Research Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212052. [PMID: 34831807 PMCID: PMC8624079 DOI: 10.3390/ijerph182212052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
In recent years, nurses have developed projects in the area of hospital to community transition. The objective of the present study was to analyze the transitional care offered to elderly people after they used emergency services and were discharged to return to the community. The action research method was chosen. The participants were nurses, elderly people 70 years old or older, and their caregivers. The study was carried out from October 2018 to August 2019. The data were collected by means of semi-structured interviews with the nurses, analysis of medical records, participatory observation, phone calls to the elderly people and caregivers, and team meetings. The qualitative data were submitted to Bardin’s content analysis. Statistical treatment was carried out by applying SPSS version 23.0. The institution’s research ethics committee approved the research. Only 31.4% of the sample experienced care continuity after discharge, and the rate of readmission to emergency services during the first 30 days after discharge was 33.4%. The referral letters lacked data on information provided to patients or caregivers, and nurses mentioned difficulties in communication between care levels, as well as obstacles to teamwork; they also mentioned that the lack of health policies and clinical rules to formalize transitional care between the hospital and the community perpetuated non-coordination of care between the two contexts. The low level of literacy of patients and their relatives are mentioned as a cause for not understanding the information regarding seeking primary health care services and handing the discharge letter. It was concluded that there is an urgent need to mobilize health teams toward action in the patients’ process of returning home, and this factor must be taken into account in care planning.
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Affiliation(s)
- José Batista
- Vila Franca de Xira Hospital, 2600-009 Vila Franca de Xira, Portugal;
- Correspondence: ; Tel.: +351-917102953
| | | | - Carla Madeira
- Vila Franca de Xira Hospital, 2600-009 Vila Franca de Xira, Portugal;
| | - Pedro Gomes
- Portuguese Institute of Oncology, Nursing Research, Innovation and Development Centre of Lisbon, 1900-160 Lisbon, Portugal;
| | - Óscar Ramos Ferreira
- Nursing School of Lisbon, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal; (Ó.R.F.); (C.L.B.)
| | - Cristina Lavareda Baixinho
- Nursing School of Lisbon, Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal; (Ó.R.F.); (C.L.B.)
- Center for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, 2411-901 Leiria, Portugal
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Gilbert T, Occelli P, Rabilloud M, Poupon-Bourdy S, Riche B, Touzet S, Bonnefoy M. A Nurse-Led Bridging Program to Reduce 30-Day Readmissions of Older Patients Discharged From Acute Care Units. J Am Med Dir Assoc 2020; 22:1292-1299.e5. [PMID: 33229305 DOI: 10.1016/j.jamda.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Older hospitalized patients are at high risk of early readmissions, requiring the implementation of enhanced coordinated transition programs on discharge. The objective of this study was to evaluate the impact of a nurse-led transition bridging program on the rate of unscheduled readmissions of older patients within 30 days from discharge from geriatric acute care units. DESIGN A stepped-wedge cluster randomized trial. SETTING AND PARTICIPANTS Seven hundred five patients aged ≥75 years hospitalized in one of 10 acute geriatric units, with at least 2 readmission risk-screening criteria (derived from the Triage Risk Screening Tool), were included from July 2015 to August 2016. METHODS The intervention condition consisted in a nurse-led hospital-to-home bridging program with 4 weeks postdischarge follow-up (2 home visits and 2 telephone calls). Unscheduled hospital readmission or emergency department (ED) visits were compared in intervention and control condition within 30 days from discharge. RESULTS The rate of 30-day readmission or ED visit was 15.5% in the intervention condition vs 17.6% in the control condition [hazard ratio stratified on clusters: 0.61 (upper limit unilateral 95% confidence interval = 1.11), P = .09]. Rate of presence of professional caregivers was increased in the intervention condition (P < .001). CONCLUSIONS AND IMPLICATIONS Although the intervention resulted in an increase in the rate of implementation of a package of care at the 4-week of follow-up, we could not demonstrate a reduction in the rate of 30-day readmissions or ED visits of older patients at risk of readmission. These findings support the evaluation of this type of program on the longer term.
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Affiliation(s)
- Thomas Gilbert
- Service de médecine gériatrique, Hospices Civils de Lyon, Groupement Hospitalier Sud, CHU de Lyon, Bénite-Pierre Cedex, France; HESPER, EA 7425 Université Claude Bernard lyon 1, Lyon 8 Cedex, France.
| | - Pauline Occelli
- HESPER, EA 7425 Université Claude Bernard lyon 1, Lyon 8 Cedex, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche clinique et Epidémiologique, Lyon, France
| | - Muriel Rabilloud
- Université de Lyon, F-69000, Lyon, France; Université Lyon 1, Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Stéphanie Poupon-Bourdy
- HESPER, EA 7425 Université Claude Bernard lyon 1, Lyon 8 Cedex, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche clinique et Epidémiologique, Lyon, France
| | - Benjamin Riche
- Université de Lyon, F-69000, Lyon, France; Université Lyon 1, Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Sandrine Touzet
- HESPER, EA 7425 Université Claude Bernard lyon 1, Lyon 8 Cedex, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche clinique et Epidémiologique, Lyon, France
| | - Marc Bonnefoy
- Service de médecine gériatrique, Hospices Civils de Lyon, Groupement Hospitalier Sud, CHU de Lyon, Bénite-Pierre Cedex, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, Villeurbanne, France; CarMeN, U1060 INSERM, Oullins Cedex, France
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Ferreira BADS, Gomes TJB, Baixinho CRSL, Ferreira ÓMR. Transitional care to caregivers of dependent older people: an integrative literature review. Rev Bras Enferm 2020; 73:e20200394. [PMID: 33175000 DOI: 10.1590/0034-7167-2020-0394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To identify the needs of caregivers of dependent older people related to self-care in the transition from hospital to home. METHODS Integrative literature review that followed a predefined protocol, carried out from March to May 2019 in the platforms EBSCO, B-On, Scopus, Web of Science, and Joanna Briggs Institute. Descriptors and eligibility criteria were defined for the bibliographic sample, which was ten articles. The search was limited to articles published between 2015 and 2019 to guarantee evidence topicality. RESULTS The needs of caregivers related to transitional care can be grouped into five categories: needs in the transition into the role of caregiver; needs related to self-care of caregivers themselves; health needs; economic needs; and social and collective needs. FINAL CONSIDERATIONS The work developed by nurses regarding transitional care of caregivers must have two focuses: managing care provided to dependent older people and managing the needs of caregivers and the care offered to them.
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Menezes TMDO, Oliveira ALBD, Santos LB, Freitas RAD, Pedreira LC, Veras SMCB. Hospital transition care for the elderly: an integrative review. Rev Bras Enferm 2020; 72:294-301. [PMID: 31826223 DOI: 10.1590/0034-7167-2018-0286] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/31/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to identify evidence of scientific production on hospital transition care provided to the elderly. METHOD an integrative review, with publications search in the MEDLINE, PubMed, LILACS, BDENF, Index Psychology and SciELO databases, with keywords and Mesh terms: elderly, hospitalization, patient discharge, health of the elderly, and transitional care, between 2013 and 2017 in English, Portuguese and Spanish. The 14 selected articles analysis was carried out through exploratory and critical reading of titles, abstracts and results of the researches. RESULTS transitional care can prevent re-hospitalizations as they enable rehabilitation, promotion and cure of illnesses in the elderly. FINAL CONSIDERATIONS transitional care implies the improvement of the quality of life of the elderly person, requiring skilled health professionals who involve the family through accessible communication.
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Bierhals CCBK, Day CB, Mocellin D, Santos NOD, Predebon ML, Pizzol FLFD, Fuhrmann AC, Medeiros GGD, Aires M, Paskulin LMG. Use of health services by elderly people post-stroke: a randomized controlled trial. Rev Gaucha Enferm 2020; 41:e20190138. [DOI: 10.1590/1983-1447.2020.20190138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/30/2019] [Indexed: 11/22/2022] Open
Abstract
Abstract Aim: To verify the relation of a nursing home care educational intervention in the use of health services by elderly people post-stroke. Methods: A randomized controlled trial conducted with 44 family caregivers of elderly people post-stroke. Data was collected between May/2016 and July/2018 in a hospital in the South of Brazil and at the participants’ homes. The intervention group (IG=21) received home visits by nurses after hospital discharge. The control group (CG=23) had a conventional follow-up in a conventional health services. The Pearson’s Chi-Square Test or the Fisher’s Exact Test was performed for assessment of the outcome at 60 days and 1 year after discharge. Clinical Trial registration NCT02807012. Results: There was a significant difference regarding the use of hospital outpatient service (IG=100%, CG=78.3%, p<0.050) 60 days after discharge. Conclusion: The great use of outpatient service by the IG demonstrates the effectiveness of nursing educational intervention focused on health care network after discharge.
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Affiliation(s)
| | | | - Duane Mocellin
- Universidade Federal do Rio Grande do Sul (UFRGS), Brazil
| | | | | | | | | | | | - Marines Aires
- Universidade Integrada do Alto Uruguai e Missões (URI), Brazil
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Phan K, Cheung ZB, Vig KS, Hussain AK, Lima MC, Kim JS, Di Capua J, Cho SK. Age Stratification of 30-Day Postoperative Outcomes Following Excisional Laminectomy for Extradural Cervical and Thoracic Tumors. Global Spine J 2018; 8:490-497. [PMID: 30258755 PMCID: PMC6149039 DOI: 10.1177/2192568217745824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To evaluate age as an independent predictive factor for perioperative morbidity and mortality in patients undergoing surgical decompression for metastatic cervical and thoracic spinal tumors using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2011 to 2014. METHODS We identified 1673 adult patients undergoing excisional laminectomy of cervical and thoracic extradural tumors. Patients were stratified into quartiles based on age, with Q1 including patients aged 18 to 49 years, Q2 including patients aged 50 to 60 years, Q3 including patients aged 61 to 69 years, and Q4 including patients ≥70 years. Univariate and multivariate regression analyses were performed to examine the association between age and 30-day perioperative morbidity and mortality. RESULTS Age was an independent risk factor for 30-day venous thromboembolism (VTE) and reoperation. Patients in Q3 for age had nearly a 4 times increased risk of VTE than patients in Q1 (odds ratio [OR] 3.97; 95% CI 1.91-8.25; P < .001). However, there was no significant difference in VTE between patients in Q4 and Q1 (P = .069). Patients in Q2 (OR 1.99; 95% CI 1.06-3.74; P = .032) and Q4 (OR 2.18; 95% CI 1.06-4.52; P = .036) for age had a 2 times increased risk of reoperation compared with patients in Q1. CONCLUSIONS Age was an independent predictive factor for perioperative VTE and reoperation, but there was no clear age-dependent relationship between increasing age and the risk of these perioperative complications.
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Affiliation(s)
- Kevin Phan
- Prince of Wales Private Hospital, Sydney, New South Wales, Australia
- University of New South Wales (UNSW), Sydney, New South Wales,
Australia
| | - Zoe B. Cheung
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Khushdeep S. Vig
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Mauricio C. Lima
- Spine Group of the Department of Orthopedics of University of Campinas
(UNICAMP), Campinas, São Paulo, Brazil
- Scoliosis Group of AACD (Associação de Assistência à Criança Deficiente),
São Paulo, Brazil
| | - Jun S. Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - John Di Capua
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Alonso C, Ferrer M, Santana M, Hernández L, de la Cruz García M, del Castillo J, Armengol J, Gregorio P, Manuel E, Martín-Sánchez F. Multidimensional intervention to improve the short-term prognosis of frail elderly patients discharged from a short-stay unit: A quasiexperimental study. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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16
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Intervención multidimensional que mejora el pronóstico a corto plazo entre los ancianos frágiles dados de alta desde una unidad de corta estancia: estudio cuasiexperimental. Rev Clin Esp 2018; 218:163-169. [DOI: 10.1016/j.rce.2018.01.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/21/2022]
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17
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Fu JB, Raj VS, Guo Y. A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence-Based Outcomes. PM R 2017; 9:S324-S334. [PMID: 28942907 PMCID: PMC5736373 DOI: 10.1016/j.pmrj.2017.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 11/18/2022]
Abstract
Cancer inpatients commonly suffer from impairments that can prohibit safe discharge home from the acute care inpatient medical service and thus require transfer to a postacute inpatient rehabilitation facility. It has been demonstrated in multiple studies that cancer rehabilitation inpatients are able to make statistically significant functional improvements and at a similar pace as their noncancer counterparts. Medical fragility and reimbursement regulations are concerns that affect acceptance and triage of cancer rehabilitation inpatients. Strategies to rehabilitate these challenging patients include considering risk factors for medical complications, consult-based inpatient rehabilitation, and improved communication and coordination with oncology teams.
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Affiliation(s)
- Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX 77030(∗).
| | - Vishwa S Raj
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation and Levine Cancer Institute, Charlotte, NC(†)
| | - Ying Guo
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX(‡)
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18
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Dupuis M, Kuczewski E, Villeneuve L, Bin-Dorel S, Haine M, Falandry C, Gilbert T, Passot G, Glehen O, Bonnefoy M. Age Nutrition Chirugie (ANC) study: impact of a geriatric intervention on the screening and management of undernutrition in elderly patients operated on for colon cancer, a stepped wedge controlled trial. BMC Geriatr 2017; 17:10. [PMID: 28061830 PMCID: PMC5219771 DOI: 10.1186/s12877-016-0402-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/21/2016] [Indexed: 01/16/2023] Open
Abstract
Background Undernutrition prior to major abdominal surgery is frequent and increases morbidity and mortality, especially in older patients. The management of undernutrition reduces postoperative complications. Nutritional management should be a priority in patient care during the preoperative period. However undernutrition is rarely detected and the guidelines are infrequently followed. Preoperative undernutrition screening should allow a better implementation of the guidelines. Methods/design The ANC (“Age Nutrition Chirurgie”) study is an interventional, comparative, prospective, multicenter, randomized protocol based on the stepped wedge trial design. For the intervention, the surgeon will inform the patient of the establishment of a systematic preoperative geriatric assessment that will allow the preoperative diagnosis of the nutritional status and the implementation of an adjusted nutritional support in accordance with the nutritional guidelines. The primary outcome measure is to determine the impact of the geriatric intervention on the level of perioperative nutritional management, in accordance with the current European guidelines. The implementation of the intervention in the five participating centers will be rolled-out sequentially over six time periods (every six months). Investigators must recommend that all patients aged 70 years or over and who are consulting for a surgery for a colorectal cancer should consider participating in this study. Discussion The ANC study is based on an original methodology, the stepped wedge trial design, which is appropriate for evaluating the implementation of a geriatric and nutritional assessment during the perioperative period. We describe the purpose of this geriatric intervention, which is expected to apply the ESPEN and SFNEP recommendations through the establishment of an undernutrition screening and a management program for patients with cancer. This intervention should allow a decrease in patient morbidity and mortality due to undernutrition. Trial registration This study is registered in ClinicalTrials.gov NCT02084524 on March 11, 2014 (retrospectively registered).
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Affiliation(s)
- Marine Dupuis
- Unité de Recherche Clinique, Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.
| | - Elisabetta Kuczewski
- Service d'Hygiène Épidémiologie Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France
| | - Laurent Villeneuve
- Unité de Recherche Clinique, Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, EAM Parcours Santé Systémique, 4128, Lyon, France.,Université Lyon 1, Lyon, France
| | - Sylvie Bin-Dorel
- Unité de Recherche Clinique, Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France.,Université de Lyon, EAM Parcours Santé Systémique, 4128, Lyon, France.,Université Lyon 1, Lyon, France
| | - Max Haine
- Service de Médecine Gériatrique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Claire Falandry
- Université Lyon 1, EMR 3738, Oullins, France.,Oncologie Médicale, Centre d'Investigation des Thérapeutiques en Oncologie et Hématologie de Lyon (CITOHL), Centre Hospitalier Lyon-Sud, Institut de Cancérologie des Hospices Civils de Lyon (IC-HCL), Lyon, France
| | - Thomas Gilbert
- Service de Médecine Gériatrique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Guillaume Passot
- Université Lyon 1, EMR 3738, Oullins, France.,Service de Chirurgie Viscérale et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Olivier Glehen
- Université Lyon 1, EMR 3738, Oullins, France.,Service de Chirurgie Viscérale et Endocrinienne, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Marc Bonnefoy
- Université Lyon 1, Lyon, France.,Service de Médecine Gériatrique, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France.,INSERM U1060, Laboratoire CarMeN (cardiovasculaire, métabolisme, diabétologie et nutrition), Université Claude Bernard Lyon 1, Pierre-Bénite, France
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