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Ajstrup M, Mejdahl CT, Christiansen DH, Nielsen LK. Transition of care in a Danish context: translation, cross-cultural adaptation and content validation of CTM-15 and PACT-M. J Patient Rep Outcomes 2024; 8:58. [PMID: 38856787 PMCID: PMC11164838 DOI: 10.1186/s41687-024-00739-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/28/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Transition of care from hospitalisation to home is a complex process with potential patient safety risks, especially for patients with multimorbidity. Traditionally, the quality of transition of care has been evaluated primarily through readmission rates. However, interpreting the readmission rates presents challenges, and readmission rates fail to capture the patient's perspective on the quality of the care transition. Insight into the patient's experience with their care or a health service can be provided through the use of patient-reported experience measures (PREMs), and the two PREMs Care Transitions Measure 15 (CTM-15) and Partners at Care Transitions Measure part 1 and 2 (PACT-M1 and PACT-M2) assess on the quality of transition of care from the patients' perspective. The aim of this study was to translate, culturally adapt, and assess content validity of CTM-15, PACT-M1, and PACT-M2 for Danish-speaking patients with multimorbidity. METHODS A two-step approach was used for content validation, involving cognitive debriefing and interviews with patients, representing the target group, as well as quantitative data collection from healthcare professionals representing all three sectors of the Danish healthcare system. The patients were systematically interviewed regarding the aspects of content validity; comprehensibility, relevance, and comprehensiveness. The healthcare professionals assessed the relevance and comprehensiveness of each item through questionnaires, allowing the calculation of a content validity index (CVI). An item CVI ≥ 0.78 is considered good. RESULTS The results of the qualitative data indicated that both CTM-15 and the PACT-M questionnaires were considered relevant, and comprehensible, and comprehensive to the target group. The CVI computed at item level determined that PACT-M1 and PACT-M2 demonstrated excellent content validity among the healthcare professionals, whereas the CVI for two items of the CTM-15 fell below the threshold value for "good". CONCLUSION The Danish versions of the PACT-M questionnaires demonstrated good content validity, and the CTM-15 demonstrated acceptable content validity based on qualitative data from patients and quantitative data from healthcare professionals. Further validation of the questionnaires, by assessing their construct validity and reliability is recommended.
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Affiliation(s)
- Merete Ajstrup
- Research Unit for Multimorbidity, Department of Cardiology, Viborg Regional Hospital, Heibergs Allé 2K, Viborg, 8800, Denmark.
- Centre for Research in Health and Nursing, Viborg Regional Hospital, Heibergs Allé 2K, Viborg, 8800, Denmark.
| | | | - David Høyrup Christiansen
- Centre for Research in Health and Nursing, Viborg Regional Hospital, Heibergs Allé 2K, Viborg, 8800, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark
- University Clinic, Elective Surgery Centre, Silkeborg Regional Hospital, Falkevej 1A, Silkeborg, 8600, Denmark
| | - Lene Kongsgaard Nielsen
- Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Blvd. 82, Aarhus, 8200, Denmark
- Quality of Life Research Center, Odense University Hospital, Odense, Denmark
- Department of Internal Medicine, Gødstrup Hospital, Herning, Denmark
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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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Marsall M, Hornung T, Bäuerle A, Weigl M. Quality of care transition, patient safety incidents, and patients' health status: a structural equation model on the complexity of the discharge process. BMC Health Serv Res 2024; 24:576. [PMID: 38702719 PMCID: PMC11069201 DOI: 10.1186/s12913-024-11047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The transition of patients between care contexts poses patient safety risks. Discharges to home from inpatient care can be associated with adverse patient outcomes. Quality in discharge processes is essential in ensuring safe transitions for patients. Current evidence relies on bivariate analyses and neglects contextual factors such as treatment and patient characteristics and the interactions of potential outcomes. This study aimed to investigate the associations between the quality and safety of the discharge process, patient safety incidents, and health-related outcomes after discharge, considering the treatments' and patients' contextual factors in one comprehensive model. METHODS Patients at least 18 years old and discharged home after at least three days of inpatient treatment received a self-report questionnaire. A total of N = 825 patients participated. The assessment contained items to assess the quality and safety of the discharge process from the patient's perspective with the care transitions measure (CTM), a self-report on the incidence of unplanned readmissions and medication complications, health status, and sociodemographic and treatment-related characteristics. Statistical analyses included structural equation modeling (SEM) and additional analyses using logistic regressions. RESULTS Higher quality of care transition was related to a lower incidence of medication complications (B = -0.35, p < 0.01) and better health status (B = 0.74, p < 0.001), but not with lower incidence of readmissions (B = -0.01, p = 0.39). These effects were controlled for the influences of various sociodemographic and treatment-related characteristics in SEM. Additional analyses showed that these associations were only constant when all subscales of the CTM were included. CONCLUSIONS Quality and safety in the discharge process are critical to safe patient transitions to home care. This study contributes to a better understanding of the complex discharge process by applying a model in which various contextual factors and interactions were considered. The findings revealed that high quality discharge processes are associated with a lower likelihood of patient safety incidents and better health status at home even, when sociodemographic and treatment-related characteristics are taken into account. This study supports the call for developing individualized, patient-centered discharge processes to strengthen patient safety in care transitions.
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Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany.
| | | | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany
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Ferry J, Lewis O, Lloyd J, El-Boghdadly K, Kearns R, Albrecht E, Altermatt F, Ashokka B, Ayad AE, Aziz ES, Aziz L, Jagannathan B, Bouarroudj N, Chin KJ, Delbos A, de Gracia A, Ip VHY, Kwofie K, Layera S, Lobo CA, Mohammed M, Moka E, Moreno M, Morgan B, Polela A, Rahimzadeh P, Tangwiwat S, Uppal V, Vaz Perez M, Volk T, Wong PBY, Bowness JS, Macfarlane AJR. Research priorities in regional anaesthesia: an international Delphi study. Br J Anaesth 2024; 132:1041-1048. [PMID: 38448274 PMCID: PMC11103078 DOI: 10.1016/j.bja.2024.01.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 01/05/2024] [Accepted: 01/24/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Regional anaesthesia use is growing worldwide, and there is an increasing emphasis on research in regional anaesthesia to improve patient outcomes. However, priorities for future study remain unclear. We therefore conducted an international research prioritisation exercise, setting the agenda for future investigators and funding bodies. METHODS We invited members of specialist regional anaesthesia societies from six continents to propose research questions that they felt were unanswered. These were consolidated into representative indicative questions, and a literature review was undertaken to determine if any indicative questions were already answered by published work. Unanswered indicative questions entered a three-round modified Delphi process, whereby 29 experts in regional anaesthesia (representing all participating specialist societies) rated each indicative question for inclusion on a final high priority shortlist. If ≥75% of participants rated an indicative question as 'definitely' include in any round, it was accepted. Indicative questions rated as 'definitely' or 'probably' by <50% of participants in any round were excluded. Retained indicative questions were further ranked based on the rating score in the final Delphi round. The final research priorities were ratified by the Delphi expert group. RESULTS There were 1318 responses from 516 people in the initial survey, from which 71 indicative questions were formed, of which 68 entered the modified Delphi process. Eleven 'highest priority' research questions were short listed, covering themes of pain management; training and assessment; clinical practice and efficacy; technology and equipment. CONCLUSIONS We prioritised unanswered research questions in regional anaesthesia. These will inform a coordinated global research strategy for regional anaesthesia and direct investigators to address high-priority areas.
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Affiliation(s)
- Jenny Ferry
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK
| | - Owen Lewis
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK
| | - James Lloyd
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK
| | - Kariem El-Boghdadly
- Department of Anaesthesia & Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK; Centre for Human and Applied Physiological Sciences, King's College London, London, UK
| | - Rachel Kearns
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Eric Albrecht
- University Hospital of Lausanne, Lausanne, Switzerland; Department of Anaesthesia, University of Lausanne, Lausanne, Switzerland
| | - Fernando Altermatt
- Department of Anesthesiology, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Amany E Ayad
- Department of Anesthesia, ICU and Pain, Cairo University, Cairo, Egypt
| | - Ezzat S Aziz
- Department of Anesthesia, ICU and Pain, Cairo University, Cairo, Egypt
| | - Lutful Aziz
- Department of Anaesthesia and Pain Medicine, Evercare Hospital, Dhaka, Bangladesh
| | | | | | - Ki Jinn Chin
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada; Department of Anesthesiology and Pain Medicine, Toronto Western Hospital, Toronto, ON, Canada
| | - Alain Delbos
- Department of Anesthesia, Medipole Garonne, Toulouse, France
| | - Alex de Gracia
- Hospital Rafael Estevez, Caja de Seguro Social, Aguadulce, Panama
| | - Vivian H Y Ip
- Department of Anesthesia and Pain Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Kwesi Kwofie
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sebastian Layera
- Department of Anesthesiology and Perioperative Medicine, University of Chile, Santiago, Chile
| | | | | | - Eleni Moka
- Creta InterClinic Hospital, Hellenic Healthcare Group (HHG), Heraklion, Crete, Greece
| | - Milena Moreno
- Department of Anaesthesiology, Pontifical Xavierian University, Bogotá, Colombia; Hospital Universitario San Ignacio, Bogotá, Columbia
| | - Bethan Morgan
- Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Arthur Polela
- Department of Anaesthesia and Critical Care, Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
| | - Poupak Rahimzadeh
- Pain Research Center, Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Suwimon Tangwiwat
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Vishal Uppal
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada
| | - Marcelo Vaz Perez
- Departament of Anesthesiology and Pain Therapy of Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, Brazil
| | - Thomas Volk
- Department of Anaesthesiology, Intensive Care and Pain Therapy, Saarland University Medical Centre, Homburg, Germany; Faculty of Medicine, Saarland University, Homburg, Germany
| | - Patrick B Y Wong
- Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, ON, Canada
| | - James S Bowness
- Department of Anaesthesia, Aneurin Bevan University Health Board, Newport, South Wales, UK; Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.
| | - Alan J R Macfarlane
- Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK; School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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Jeffery S, Monkhouse J, Bertini L, Walker S, Sharp R. Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement. BMJ Open Qual 2023; 12:e002515. [PMID: 38114247 DOI: 10.1136/bmjoq-2023-002515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Discharge to Assess (D2A) emerged as a critical process during the COVID-19 pandemic facilitating patient flow within hospitals, however research on the post-discharge community services of this pathway remains limited. We conducted an evaluation to examine the impacts, capacity, processes and barriers associated with D2A and to identify best practice across three sites in the southeast of England. METHODS We interviewed 29 commissioners, providers and staff members involved in the delivery of D2A pathways within three Health and Care Partnerships. Framework analysis of the collected data revealed three prominent themes: the commissioning of services encompassing funding, structure, culture, and expected outcomes; multidisciplinary collaboration including staff skills, team connections, and coordination; and information and knowledge exchange such as assessment methods, record management, and availability of operational insights. RESULTS 62 specific enablers and blockers to effective D2A practice emerged. DISCUSSION These findings supported the development of a comprehensive service improvement toolkit. CONCLUSION Five recommendations are proposed: 1. Examination of pathways against the 62 enablers and blockers to identify and resolve pathway obstacles; 2. Establish a local operational policy accessible to all providers; 3. Enhance coordination and communication among service providers, patients and carers; 4. Strengthen oversight of service user flow; 5. Develop a consistent Patient Reported Outcomes Measure to facilitate feedback and service enhancements for individuals discharged from urgent care pathways.
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Affiliation(s)
- Stuart Jeffery
- Centre for Health Services Studies, University of Kent, Canterbury, UK
- NIHR Applied Research Collaboration Kent Surrey Sussex, Hove, UK
| | - Jenny Monkhouse
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Lavinia Bertini
- NIHR Applied Research Collaboration Kent Surrey Sussex, Hove, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Susie Walker
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Rebecca Sharp
- Kent Surrey Sussex Academic Health Science Network, Crawley, UK
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Wieczorek E, Kocot E, Evers S, Sowada C, Pavlova M. Development of a tool for assessing the performance of long-term care systems in relation to care transition: Transitional Care Assessment Tool in Long-Term Care (TCAT-LTC). BMC Geriatr 2023; 23:760. [PMID: 37986151 PMCID: PMC10662551 DOI: 10.1186/s12877-023-04467-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Improving the quality and safety of care transitions is a priority in many countries. Carrying out performance measurements play a significant role in improving quality of decisions undertaken by different actors involved in reforms. Therefore, the main objective of this paper is to present the development of an evaluation tool for assessing the performance of long-term care systems in relation to care transition, namely the Transitional Care Assessment Tool in Long-Term Care (TCAT-LTC). This study is performed as part of a larger European TRANS-SENIOR project. METHODS The development of the TCAT-LTC involved three steps. First, we developed a conceptual model based on Donabedian's quality framework and literature review. Second, we carried out a thorough process of item pool generation using deductive (systematic literature review) and deductive-inductive methods (in-depth interviews) with experts in the field of long-term care. Third, we conducted preliminary validation of the tool by asking experts in research and practice to provide an opinion on a tool and to assess content validity. Future fourth step will involve a tool's pilot with country experts from Germany, the Netherlands and Poland. RESULTS By applying methodological triangulation, we developed the TCAT-LTC, which consists of 2 themes, 12 categories and 63 items. Themes include organizational and financial aspects. Organizational aspects include categories such as communication, transfer of information, availability and coordination of resources, training and education of staff, education/support of the patient/informal caregiver, involvement of the patient/informal caregiver, telemedicine and e-Health, and social care. Financial aspects include categories such as primary care, hospital, and long-term care. We also present the instructions on the application of the TCAT-LTC. CONCLUSIONS In this paper, we presented the development of the TCAT-LTC evaluation tool for assessing the performance of long-term care systems in relation to care transition. The TCAT-LTC is the first tool to assess the performance of long-term care systems in relation to care transition. Assessments can be carried out at the national and international level and enable to monitor, evaluate, and compare performance of the long-term care systems in relation to care transition within and across countries.
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Affiliation(s)
- Estera Wieczorek
- Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Skawińska 8, 31-066, Krakow, Poland.
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands.
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands.
| | - Ewa Kocot
- Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Skawińska 8, 31-066, Krakow, Poland
| | - Silvia Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands
| | - Christoph Sowada
- Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Collegium Medicum, Skawińska 8, 31-066, Krakow, Poland
| | - Milena Pavlova
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, Maastricht, MD, 6200, The Netherlands
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Foo CD, Yan JY, Chan ASL, Yap JCH. Identifying Key Themes of Care Coordination for Patients with Chronic Conditions in Singapore: A Scoping Review. Healthcare (Basel) 2023; 11:healthcare11111546. [PMID: 37297686 DOI: 10.3390/healthcare11111546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
A projected rise in patients with complex health needs and a rapidly ageing population will place an increased burden on the healthcare system. Care coordination can bridge potential gaps during care transitions and across the care continuum to facilitate care integration and the delivery of personalised care. Despite having a national strategic vision of improving care integration across different levels of care and community partners, there is no consolidation of evidence specifically on the salient dimensions of care coordination in the Singapore healthcare context. Hence, this scoping review aims to uncover the key themes that facilitate care coordination for patients with chronic conditions in Singapore to be managed in the community while illuminating under-researched areas in care coordination requiring further exploration. The databases searched were PubMed, CINAHL, Scopus, Embase, and Cochrane Library. Results from Google Scholar were also included. Two independent reviewers screened articles in a two-stage screening process based on the Cochrane scoping review guidelines. Recommendation for inclusion was indicated on a three-point scale and rating conflicts were resolved through discussion. Of the 5792 articles identified, 28 were included in the final review. Key cross-cutting themes such as having standards and guidelines for care programmes, forging stronger partnerships across providers, an interoperable information system across care interfaces, strong programme leadership, financial and technical resource availabilities and patient and provider-specific factors emerged. This review also recommends leveraging these themes to align with Singapore's national healthcare vision to contain rising healthcare costs.
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Affiliation(s)
- Chuan De Foo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Jia Yin Yan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Audrey Swee Ling Chan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Jason C H Yap
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
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Liu LM, Sun MJ, Liu MT, Wang JN, Zhang YZ, Dela Rosa RD. Assessing the agreement between the partners at care transitions measure and the care transitions measure for elderly patients with chronic diseases. BMC Health Serv Res 2023; 23:460. [PMID: 37161474 PMCID: PMC10170717 DOI: 10.1186/s12913-023-09228-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/28/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Elderly patients with chronic diseases are very vulnerable during the transition from hospital to home and have a high need for transitional care. The quality of transitional care is closely related to patient health outcomes. Using appropriate scales to evaluate the quality of transitional care is important for efforts aimed at improving it. The study aimed to analyze the consistency between the Chinese version of the Partners at Care Transitions Measure (PACT-M) and the Care Transition Measure (CTM) in assessing the quality of transition care in elderly patients with chronic diseases. METHODS This is a cross-sectional study, we used a convenience sampling method to investigate patients with chronic diseases aged ≧ 65 years who were about to be discharged from the three affiliated hospitals of Zhengzhou University in Henan Province, from August 2021 to May 2022. The sample consisted of 196 elderly patients with chronic diseases. Data were collected using a demographic survey, PACT-M, and CTM. We used EpiData 3.1 software for systematic logical error checking, SPSS 21.0 to analyze the data, and the Bland-Altman analysis to analyze the consistency of the two scales. RESULTS The mean total scores for PACT-M and CTM were 65.52 ± 6.23 and 52.07 ± 7.26, respectively. The 95% confidence interval (CI) for the mean difference and ratios were (-31.52, 4.61) and (0.85, 1.72), with 3.57% and 5.10% of the points outside the 95% CI limits, separately. CONCLUSIONS The difference analysis of Bland-Altman showed a good consistency of the two scales, while the rate analysis did not meet the a priori definition of good consistency, but it is very close to 5%. Therefore, the consistency of the two scales in assessing the quality of transitional care for elderly patients with chronic diseases needs to be further validated.
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Affiliation(s)
- La-Mei Liu
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-Tech District, Zhengzhou City, 450000, Henan Province, China
| | - Meng-Jie Sun
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-Tech District, Zhengzhou City, 450000, Henan Province, China
| | - Meng-Ting Liu
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-Tech District, Zhengzhou City, 450000, Henan Province, China
| | - Jia-Nan Wang
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-Tech District, Zhengzhou City, 450000, Henan Province, China
| | - Yi-Zhen Zhang
- Shanxi Bethune Hospital, 99 Longcheng Street, Xiaodian District, Taiyuan City, 030032, Shanxi Province, China
| | - Ronnell D Dela Rosa
- School of Nursing, Philippine Women's University, Taft Avenue, Malate, 1004, Manila, Philippines.
- College of Nursing and Midwifery, Bataan Peninsula State University, City of Balanga 2100, Bataan, Philippines.
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Murray J, Baxter R, Lawton R, Hardicre N, Shannon R, Langley J, Partridge R, Moore S, O'Hara JK. Unpacking the Cinderella black box of complex intervention development through the Partners at Care Transitions (PACT) programme of research. Health Expect 2023. [PMID: 37186409 DOI: 10.1111/hex.13682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 09/19/2022] [Accepted: 11/15/2022] [Indexed: 05/17/2023] Open
Abstract
INTRODUCTION Complex intervention development has been described as the 'Cinderella' black box in health services research. Greater transparency in the intervention development process is urgently needed to help reduce research waste. METHODS We applied a new consensus-based framework for complex intervention development to our programme of research, in which we developed an intervention to improve the safety and experience of care transitions for older people. Through this process, we aimed to reflect on the framework's utility for intervention development and identify any important gaps within it to support its continued development. FINDINGS The framework was a useful tool for transparent reporting of the process of complex intervention development. We identified potential 'action' gaps in the framework including 'consolidation of evidence' and 'development of principles' that could bracket and steer decision-making in the process. CONCLUSIONS We consider that the level of transparency demonstrated in this report, aided through use of the framework, is essential in the quest for reducing research waste. PATIENT OR PUBLIC CONTRIBUTION We have involved our dedicated patient and public involvement group in all work packages of this programme of research. Specifically, they attended and contributed to co-design workshops and contributed to finalizing the intervention for the pilot evaluation. Staff also participated by attending co-design workshops, helping us to prioritize content ideas for the intervention and supporting the development of intervention components outside of the workshops.
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Affiliation(s)
- Jenni Murray
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, West Yorkshire, UK
| | - Ruth Baxter
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, West Yorkshire, UK
| | | | - Natasha Hardicre
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, West Yorkshire, UK
| | - Rosie Shannon
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, West Yorkshire, UK
- School of Psychology, University of Leeds, Leeds, UK
| | | | | | - Sally Moore
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, West Yorkshire, UK
| | - Jane K O'Hara
- School of Healthcare, University of Leeds, Leeds, UK
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10
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Larsson K, Wallroth V, Schröder A. Efforts of a Mobile Geriatric Team from a Next-of-Kin Perspective: A Phenomenographic Study. Healthcare (Basel) 2023; 11:healthcare11071038. [PMID: 37046965 PMCID: PMC10094527 DOI: 10.3390/healthcare11071038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/15/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
Many older adults with complex illnesses are today cared for by their next of kin in their own homes and are often sent between different caregivers in public healthcare. Mobile Geriatric Teams (MGTs) are a healthcare initiative for older adults with extensive care needs living at home, coordinated between hospital, primary, and municipal care. The study aims to describe how next of kin experience care efforts from an MGT for their older adult family members. The study has a descriptive qualitative design and uses a phenomenographic approach. Fourteen next of kin to older adult family members who receive efforts from an MGT were interviewed. Two descriptive categories reflecting their experiences emerged: Professional care and No longer having the main responsibility. The study shows that the participants valued that the staff was very competent, that the physician made home visits and could make quick decisions, and that treatments were given at home. They feel that they receive support and experience security and that a burden is lifted from them. Our study shows that through the MGT, next of kin become involved in the care and are relieved of the burden of responsibility of caring for their older family member.
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Affiliation(s)
- Kjerstin Larsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden
| | - Veronika Wallroth
- Division of Social Work (SOCARB), Department of Culture and Society (IKOS), Linköping University, 581 83 Linköping, Sweden
| | - Agneta Schröder
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, 702 81 Örebro, Sweden
- Department of Nursing, Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU), 2815 Gjövik, Norway
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11
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Baxter R, Murray J, Cockayne S, Baird K, Mandefield L, Mills T, Lawton R, Hewitt C, Richardson G, Sheard L, O'Hara JK. Improving the safety and experience of transitions from hospital to home: a cluster randomised controlled feasibility trial of the 'Your Care Needs You' intervention versus usual care. Pilot Feasibility Stud 2022; 8:222. [PMID: 36183129 PMCID: PMC9525931 DOI: 10.1186/s40814-022-01180-3] [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: 06/20/2022] [Accepted: 09/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background The ‘Your Care Needs You’ (YCNY) intervention aims to increase the safety and experience of transitions for older people through greater patient involvement during the hospital stay. Methods A cluster randomised controlled feasibility trial was conducted on NHS inpatient wards (clusters) where ≥ 40% of patients were routinely ≥ 75 years. Wards were randomised to YCNY or usual care using an unequal allocation ratio (3:2). We aimed to recruit up to 20 patients per ward. Follow-up included routine data collection and questionnaires at 5-, 30-, and 90-days post-discharge. Eligible patients were ≥ 75 years, discharged home, stayed overnight on participating wards, and could read and understand English. The trial assessed the feasibility of delivering YCNY and the trial methodology through recruitment rates, outcome completion rates, and a qualitative evaluation. The accuracy of using routinely coded data for the primary outcome in the definitive trial was assessed by extracting discharge information for up to ten nonindividual consenting patients per ward. Results Ten wards were randomised (6 intervention, 4 control). One ward withdrew, and two wards were unable to deliver the intervention. Seven-hundred twenty-one patients were successfully screened, and 161 were recruited (95 intervention, 66 control). The patient post-discharge attrition rate was 17.4% (n = 28). Primary outcome data were gathered for 91.9% of participants with 75.2% and 59.0% providing secondary outcome data at 5 and 30 days post-discharge respectively. Item completion within questionnaires was generally high. Post-discharge follow-up was terminated early due to the COVID-19 pandemic affecting 90-day response rates (16.8%). Data from 88 nonindividual consenting patients identified an error rate of 15% when using routinely coded data for the primary outcome. No unexpected serious adverse events were identified. Most patients viewed YCNY favourably. Staff agreed with it in principle, but ward pressures and organisational contexts hampered implementation. There was a need to sustain engagement, provide clarity on roles and responsibilities, and account for fluctuations in patients’ health, capacity, and preferences. Conclusions If implementation challenges can be overcome, YCNY represents a step towards involving older people as partners in their care to improve the safety and experience of their transitions from hospital to home. Trial registration ISRCTN: 51154948. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01180-3.
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Affiliation(s)
- Ruth Baxter
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK. .,School of Psychology, University of Leeds, Leeds, UK.
| | - Jenni Murray
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | | | | | | | - Thomas Mills
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.,School of Psychology, University of Leeds, Leeds, UK
| | | | | | | | - Jane K O'Hara
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.,School of Healthcare, University of Leeds, Leeds, UK
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12
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Yoshimura M, Sumi N. Measurement tools that assess the quality of transitional care from patients' perspective: A literature review. Jpn J Nurs Sci 2022; 19:e12472. [PMID: 35132783 DOI: 10.1111/jjns.12472] [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: 10/22/2021] [Revised: 12/06/2021] [Accepted: 12/28/2021] [Indexed: 11/30/2022]
Abstract
AIM Transitional care is important for improving the quality of life of patients discharged from hospitals. Patient-reported experience measures help improve transitional care quality. Thus, this literature review aimed to identify and appraise measurement tools that assess transitional care quality from the patient's perspective and identify its components. METHODS Development and validation studies were systematically searched in the PubMed and CINAHL databases. The review team appraised the methodological quality and statistical results of measurement properties using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. RESULTS A total of 30 studies and seven instruments were identified. The target population was patients discharged from hospital to a home or nursing home (mean age = 52-84 years). The measurement time was before or after the discharge. The number of items in the original versions of the measures ranged from eight to 41, with short versions ranging from three to 12. The overall methodological quality of structural validity, internal consistency, and hypotheses testing was mostly "very good or adequate," according to COSMIN criteria. However, content validity and development were mostly "inadequate or doubtful" or not reported. The main components of included measures comprised "self-care after discharge," "providing information to the patient," "patient engagement in the care plan," and "dealing with patient's concerns." CONCLUSION The quality appraisal results and identified components are useful for choosing measurement tools in clinical practice and research. The Care Transitions Measure is the most widely validated measurement tool.
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Affiliation(s)
- Mai Yoshimura
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Naomi Sumi
- Department of Fundamental Nursing, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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13
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Cechinel-Peiter C, Lanzoni GMDM, de Mello ALSF, Acosta AM, Pina JC, de Andrade SR, Oelke ND, dos Santos JLG. Quality of transitional care of children with chronic diseases: a cross-sectional study. Rev Esc Enferm USP 2022; 56:e20210535. [PMID: 35404992 PMCID: PMC10081595 DOI: 10.1590/1980-220x-reeusp-2021-0535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/17/2022] [Indexed: 04/16/2023] Open
Abstract
Abstract Objective: To analyze which factors may be associated with the quality-of-care transition of children with chronic diseases from the hospital to their home. Method: A cross-sectional, quantitative study, carried out in two hospitals in Southern Brazil, from February to September 2019. Participants included 167 family members of children with chronic disease. Data collection took place through a demographic questionnaire, and the use of the Brazilian version of the Care Transitions Measure (CTM-15). Results: The average score for the quality of care transition was 90.1 (sd = 19.5) (0–100). Factor 1, “Health management preparation”, was the one with the highest self-perceived average, 92.3 (sd = 11.6), while Factor 4, “Care plan”, had the lowest average, 86.3 (sd = 21.3). The quality of care transition was higher for patients living in municipalities belonging to health regions other than the hospital’s. Conclusion: The quality of care transition for children with chronic diseases, perceived by the children’s family members, in the discharge process from the hospital to home, was considered high. Living in a health region other than the hospital’s region was associated with better perception of the quality of care transition.
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14
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Liu LM, Liu MT, Sun MJ, Wang JN, Lin BL, Wang P, Li QF. Validity and reliability of the Chinese version of the partners at care transitions measure. BMC Health Serv Res 2021; 21:1284. [PMID: 34844597 PMCID: PMC8630870 DOI: 10.1186/s12913-021-07298-z] [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: 08/18/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Partners at Care Transitions Measure (PACT-M) is a measure that assesses the quality and safety of care during the transition from hospital to home from the patient's perspective. The aim of this study was to examine the psychometric properties of the Chinese version of the PACT-M in Mainland China. METHODS This was a cross-sectional study. A convenience sample of patients was recruited from three tertiary hospitals affiliated with Zhengzhou University, China. A total of 402 participants were interviewed before discharge, and 306 participants were interviewed one month after discharge from hospital to home using the Chinese version of the PACT-M. The statistical methods used in this study include the critical ratio value, item total correlation, test-retest, Cronbach's alpha, confirmatory factor analysis and exploratory factor analysis. RESULTS The Chinese version of the PACT-M consists of PACT-M1 and PACT-M2, both of which have two dimensions, the number of items in both parts are consistent with the original English language version. The Cronbach's alpha values of the PACT-M1 and PACT-M2 were 0.802 and 0.741, and the test-retest reliability values were 0.885 and 0.837. The item content validity index and scale content validity index values of the PACT-M1 and PACT-M2 were all 1.0. CONCLUSION The Chinese version of the PACT-M shows acceptable validity and reliability and can be used to assess the quality and safety of transitional care from hospital to home from the patient's perspective in mainland China.
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Affiliation(s)
- La-Mei Liu
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China. .,School of Nursing, Philippine Women's University, Manila, Philippines.
| | - Ment-Ting Liu
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China
| | - Meng-Jie Sun
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China
| | - Jia-Nan Wang
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China
| | - Bei-Lei Lin
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China
| | - Peng Wang
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China
| | - Qiu-Fang Li
- School of Nursing and Health, Zhengzhou University, 100 Science Avenue, High-tech district, Zhengzhou City, 450000, Henan province, China
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15
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Bawazeer G, Sales I, Alsunaidi A, Aljahili S, Aljawadi MH, Almalag HM, Alkofide H, Adam Mahmoud M, Alayoubi F, Aljohani M. Student-Led discharge counseling program for High-Risk medications in a teaching hospital in Saudi Arabia: A pilot study. Saudi Pharm J 2021; 29:1129-1136. [PMID: 34703366 PMCID: PMC8523331 DOI: 10.1016/j.jsps.2021.08.004] [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: 04/07/2021] [Revised: 07/04/2021] [Accepted: 08/01/2021] [Indexed: 12/13/2022] Open
Abstract
Discharge counseling by pharmacists reduces adverse medication events, emergency department visits, and readmissions. Studies indicate that pharmacy students in advanced pharmacy practice experiences (APPE) can deliver effective medication-related activities. An open label randomized controlled trial was conducted in adults discharged on warfarin, insulin, or both. Pharmacy students performed medication reconciliation, structured medication counseling, and follow-up calls 72-hours post-discharge. The usual care arm received traditional education. The primary outcome was the 30-day readmission rate post-discharge. Ninety-eight patients on high-risk medications were randomized to intervention (n = 51) or usual care (n = 47). The 30-day hospital readmission rate was lower in the intervention group (8/51, 15% vs. 11/47, 23%); (p = 0.48). There was no statistical difference in the time to first unplanned health care use (hazard ratio = 0.49 (95 %CI, 0.19–1.24), or the time-to-first clinic visit post-discharge (p = 0.94) between the two arms. Students identified 26 drug-related problems during reconciliation. Patients in the intervention arm reported high satisfaction with the service (mean 3.94; SD 0.11). Involving APPE students in the transition of care activities presents an excellent opportunity to minimize pharmacists' workload while maintaining patient care services.
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Affiliation(s)
- Ghada Bawazeer
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | - Ibrahim Sales
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | - Afnan Alsunaidi
- Dr. Sulaiman Alhabib Medical Group, P.O. Box 91877, Riyadh 11643, Saudi Arabia
| | - Sarah Aljahili
- Saudi Food and Drug Authority, 4904 Northern Ring Branch Rd., Hittin District, Unit number: 1, Riyadh 13513 - 7148, Saudi Arabia
| | - Mohammad H Aljawadi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | - Haya M Almalag
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | - Hadeel Alkofide
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia
| | - Mansour Adam Mahmoud
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Mohamed bin Naif Road, Al-Madinah Al-Munawarah 42353, Saudi Arabia
| | - Fakhr Alayoubi
- Corporate of Pharmacy Services, King Saud University Medical City, Riyadh 12746, Saudi Arabia
| | - Majda Aljohani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, P.O. Box 2454, Riyadh 11451, Saudi Arabia.,King Saud Medical City, Al Imam Abdulaziz Bin Mohammad Bin Saud Street 7610, Riyadh 12746, Saudi Arabia
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16
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Bowness JS, Pawa A, Turbitt L, Bellew B, Bedforth N, Burckett-St Laurent D, Delbos A, Elkassabany N, Ferry J, Fox B, French JLH, Grant C, Gupta A, Harrop-Griffiths W, Haslam N, Higham H, Hogg R, Johnston DF, Kearns RJ, Kopp S, Lobo C, McKinlay S, Memtsoudis S, Merjavy P, Moka E, Narayanan M, Narouze S, Noble JA, Phillips D, Rosenblatt M, Sadler A, Sebastian MP, Taylor A, Thottungal A, Valdés-Vilches LF, Volk T, West S, Wolmarans M, Womack J, Macfarlane AJR. International consensus on anatomical structures to identify on ultrasound for the performance of basic blocks in ultrasound-guided regional anesthesia. Reg Anesth Pain Med 2021; 47:106-112. [PMID: 34552005 DOI: 10.1136/rapm-2021-103004] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022]
Abstract
There is no universally agreed set of anatomical structures that must be identified on ultrasound for the performance of ultrasound-guided regional anesthesia (UGRA) techniques. This study aimed to produce standardized recommendations for core (minimum) structures to identify during seven basic blocks. An international consensus was sought through a modified Delphi process. A long-list of anatomical structures was refined through serial review by key opinion leaders in UGRA. All rounds were conducted remotely and anonymously to facilitate equal contribution of each participant. Blocks were considered twice in each round: for "orientation scanning" (the dynamic process of acquiring the final view) and for the "block view" (which visualizes the block site and is maintained for needle insertion/injection). Strong recommendations for inclusion were made if ≥75% of participants rated a structure as "definitely include" in any round. Weak recommendations were made if >50% of participants rated a structure as "definitely include" or "probably include" for all rounds (but the criterion for "strong recommendation" was never met). Thirty-six participants (94.7%) completed all rounds. 128 structures were reviewed; a "strong recommendation" is made for 35 structures on orientation scanning and 28 for the block view. A "weak recommendation" is made for 36 and 20 structures, respectively. This study provides recommendations on the core (minimum) set of anatomical structures to identify during ultrasound scanning for seven basic blocks in UGRA. They are intended to support consistent practice, empower non-experts using basic UGRA techniques, and standardize teaching and research.
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Affiliation(s)
- James Simeon Bowness
- OxSTaR, Oxford University, Oxford, UK .,Department of Anaesthesia, Aneurin Bevan Health Board, Newport, UK
| | - Amit Pawa
- Department of Anaesthesia, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Lloyd Turbitt
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Boyne Bellew
- Department of Surgery & Cancer, Imperial College London, London, UK.,Department of Anaesthesia, Imperial College Healthcare NHS Trust, London, UK
| | - Nigel Bedforth
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Alain Delbos
- Department of Anesthesia, Clinique Médipole Garonne, Toulouse, France
| | - Nabil Elkassabany
- Department of Anesthesiology & Intensive Care, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Jenny Ferry
- Department of Anaesthesia, Aneurin Bevan Health Board, Newport, UK
| | - Ben Fox
- Department of Anaesthesia, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, Norfolk, UK
| | - James L H French
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Calum Grant
- Department of Anaesthesia, NHS Tayside, Dundee, UK
| | - Ashwani Gupta
- Department of Anaesthesia, Queen Elizabeth Hospital, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | | | - Nat Haslam
- Department of Anaesthesia, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Helen Higham
- OxSTaR, Oxford University, Oxford, UK.,Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Rosemary Hogg
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - David F Johnston
- Department of Anaesthesia, Belfast Health and Social Care Trust, Belfast, UK
| | - Rachel Joyce Kearns
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.,Department of Anaesthesia, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sandra Kopp
- Department of Anesthesiology & Perioperative Medicine, Mayo Clinic Graduate School for Biomedical Sciences, Rochester, Minnesota, USA
| | - Clara Lobo
- Anestesiologista, Hospital das Forças Armadas Polo do Porto, Porto, Portugal
| | - Sonya McKinlay
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.,Department of Anaesthesia, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Stavros Memtsoudis
- Department of Anesthesiology, Critical Care & Pain Management, Hospital for Specialist Surgery, New York, New York, USA.,Weill Cornell Medical College, New York, New York, USA
| | - Peter Merjavy
- Department of Anaesthesia, Craigavon Area Hospital, Portadown, UK
| | - Eleni Moka
- Department of Anaesthesiology, Hellenic Healthcare Group (HHG), Heraklion Crete, Greece
| | - Madan Narayanan
- Department of Anaesthesia, Frimley Park Hospital, Frimley, UK
| | - Samer Narouze
- Center for Pain Medicine, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA
| | | | - David Phillips
- Department of Anaesthesia, Aneurin Bevan Health Board, Newport, UK
| | | | - Amy Sadler
- Department of Anaesthesia, NHS Tayside, Dundee, UK
| | - Maria Paz Sebastian
- Department of Anaesthetics, Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | | | - Athmaja Thottungal
- Department of Anaesthesia & Pain Management, East Kent Hospitals University NHS Foundation Trust, Canterbury, UK
| | | | - Thomas Volk
- Department of Anaesthesiology, Critical Care & Pain Therapy, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Simeon West
- Department of Anaesthetics, University College London, London, UK
| | - Morné Wolmarans
- Anaesthesiology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Jonathan Womack
- Department of Anaesthesia, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Alan James Robert Macfarlane
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK.,Department of Anaesthesia, Glasgow Royal Infirmary, Glasgow, UK
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Reeves MJ, Fritz MC, Osunkwo I, Grudzen CR, Hsu LL, Li J, Lawrence RH, Bettger JP. Opening Pandora's Box: From Readmissions to Transitional Care Patient-Centered Outcome Measures. Med Care 2021; 59:S336-S343. [PMID: 34228015 PMCID: PMC8263140 DOI: 10.1097/mlr.0000000000001592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Measuring the effectiveness of transitional care interventions has historically relied on health care utilization as the primary outcome. Although the Care Transitions Measure was the first outcome measure specifically developed for transitional care, its applicability beyond the hospital-to-home transition is limited. There is a need for patient-centered outcome measures (PCOMs) to be developed for transitional care settings (ie, TC-PCOMs) to ensure that outcomes are both meaningful to patients and relevant to the particular care transition. The overall objective of this paper is to describe the opportunities and challenges of integrating TC-PCOMs into research and practice. METHODS AND RESULTS This narrative review was conducted by members of the Patient-Centered Outcomes Research Institute (PCORI) Transitional Care Evidence to Action Network. We define TC-PCOMs as outcomes that matter to patients because they account for their individual experiences, concerns, preferences, needs, and values during the transition period. The cardinal features of TC-PCOMs should be that they are developed following direct input from patients and stakeholders and reflect their lived experience during the transition in question. Although few TC-PCOMs are currently available, existing patient-reported outcome measures could be adapted to become TC-PCOMs if they incorporated input from patients and stakeholders and are validated for the relevant care transition. CONCLUSION Establishing validated TC-PCOMs is crucial for measuring the responsiveness of transitional care interventions and optimizing care that is meaningful to patients.
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Affiliation(s)
| | - Michele C. Fritz
- College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Ifeyinwa Osunkwo
- Sickle Cell Disease Enterprise, Levine Cancer Institute, Department of Medicine & Pediatrics, Atrium Health, Charlotte, NC
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine and Population Health, NYU Grossman School of Medicine, New York, NY
| | - Lewis L. Hsu
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL
| | - Jing Li
- Department of Internal Medicine, Center for Health Services Research (CHSR), University of Kentucky, Lexington, KY
| | - Raymona H. Lawrence
- Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA
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18
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Shin J, Han SH, Choi J, Kim YS, Lee J. The Experience of Providing Older Adult Patients with Transitional Care from an Acute Care Hospital to Home in Cooperation with a Public Health Center. J Korean Med Sci 2020; 35:e348. [PMID: 33045771 PMCID: PMC7550231 DOI: 10.3346/jkms.2020.35.e348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study aimed to describe the experience of providing older adult patients with transitional care from an acute care hospital to home in cooperation with a public health center, in order to present the barriers to that care and suggest better organizational methods. METHODS This was a cross-sectional study to show the results of the Geriatric Screening for Care-10 (GSC-10) and outcomes of transitional care. Among 659 hospitalized patients aged 65 years or above who lived in an administrative district, forty-five subjects were enrolled between June 24, 2019 and January 23, 2020. Within 48 hours of admission, using the 10 areas of GSC-10, they were assessed for cognitive impairment, depression, polypharmacy (5 or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence, and were reassessed before discharge. The transitional care plan (containing the treatment summary, the results of the GSC-10 assessment, and the post-discharge plan) was forwarded to a representative of the public health center, who provided continued disease management and various health care services, such as chronic disease and frailty care, and physical rehabilitation. RESULTS Of all the participants, 64.4% had more than 1 GSC-10 concern. The most prevalent concerns were functional immobility (35.6%) and polypharmacy (22.2%). About 15.6% of the participants were readmitted to a nursing home or hospital. A total of 38 participants received the transitional care intervention. They received an average of 2.7 administered interventions. However, the rate of rejection was high (30.1%) and patients were visited an average of 16.5 days after discharge. CONCLUSION Through our experience of providing transitional care from an acute care hospital to home in cooperation with a public health center, we expect that the transitional care suitable for the Korean medical situation could be established and successful.
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Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
| | - Seol Heui Han
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Neurology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jaekyung Choi
- Department of Family Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
| | - Yoon Sook Kim
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Quality Improvement, Konkuk University Medical Center, Seoul, Korea
| | - Jongmin Lee
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea.
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19
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Improving patient experience and safety at transitions of care through the Your Care Needs You (YCNY) intervention: a study protocol for a cluster randomised controlled feasibility trial. Pilot Feasibility Stud 2020; 6:123. [PMID: 32905158 PMCID: PMC7466784 DOI: 10.1186/s40814-020-00655-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/30/2020] [Indexed: 12/18/2022] Open
Abstract
Background Patients, particularly older people, often experience safety issues when transitioning from hospital to home. Although the evidence is currently equivocal as to how we can improve this transition of care, interventions that support patient involvement may be more effective. The ‘Your Care Needs You’ (YCNY) intervention supports patients to ‘know more’ and ‘do more’ whilst in hospital in order that they better understand their health condition and medications, maintain their daily activities, and can seek help at home if required. The intervention aims to reduce emergency hospital readmissions and improve safety and experience during the transition to home. Methods As part of the Partners At Care Transitions (PACT) programme of research, a multi-centred cluster randomised controlled trial (cRCT) will be conducted to explore the feasibility of the YCNY intervention and trial methodology. Data will be used to refine the intervention and develop a protocol for a definitive cRCT. Ten acute hospital wards (the clusters) from varying medical specialties including older peoples’ medicine, trauma and orthopaedics, cardiology, intermediate care, and stroke will be randomised to deliver YCNY or usual care on a 3:2 basis. Up to 200 patients aged 75 years and over and discharged to their own homes will be recruited to the study. Patients will complete follow-up questionnaires at 5-, 30-, and 90-days post-discharge and readmission data up to 90-days post-discharge will be extracted from their medical records. Study outcomes will include measures of feasibility (e.g. screening, recruitment, and retention data) and processes required to collect routine data at a patient and ward level. In addition, interviews and observations involving up to 24 patients/carers and 28 staff will be conducted to qualitatively assess the acceptability, usefulness, and feasibility of the intervention and implementation package to patients and staff. A separate sub-study will be conducted to explore how accurately primary outcome data (30-day emergency hospital readmissions) can be gathered for the definitive cRCT. Discussion This study will establish the feasibility of the YCNY intervention which aims to improve safety and experience during transitions of care. It will identify key methodological and implementation issues that need to be addressed prior to assessing the effectiveness of the YCNY intervention in a definitive cluster randomised controlled trial. Trial registration UK Clinical Research Network Portfolio: 42191; ISTCRN: ISRCTN51154948. Registered 16/07/2019.
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Oikonomou E, Page B, Lawton R, Murray J, Higham H, Vincent C. Validation of the Partners at Care Transitions Measure (PACT-M): assessing the quality and safety of care transitions for older people in the UK. BMC Health Serv Res 2020; 20:608. [PMID: 32611336 PMCID: PMC7329420 DOI: 10.1186/s12913-020-05369-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 05/26/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The Partners at Care Transitions Measure (PACT-M) is a patient-reported questionnaire for evaluation of the quality and safety of care transitions from hospital to home, as experienced by older adults. PACT-M has two components; PACT-M 1 to capture the immediate post discharge period and PACT-M 2 to assess the experience of managing care at home. In this study, we aim to examine the psychometric properties, factor structure, validity and reliability of the PACT-M. METHODS We administered the PACT-M over the phone and by mail, within one week post discharge with 138 participants and one month after discharge with 110 participants. We performed principal components analysis and factors were assessed for internal consistency, reliability and construct validity. RESULTS Reliability was assessed by calculating Cronbach's alpha for the 9-item PACT-M 1 and 8-item PACT-M 2 and exploratory factor analysis was performed to evaluate dimensionality of the scales. Principal components analysis was chosen using pair-wise deletion. Both PACT-M 1 and PACT-M 2 showed high internal consistency and good internal reliability values and conveyed unidimensional scale characteristics with high reliability scores; above 0.8. CONCLUSIONS The PACT-M has shown evidence to suggest that it is a reliable measure to capture patients' perception of the quality of discharge arrangements and also on patients' ability to manage their care at home one month post discharge. PACT-M 1 is a marker of patient experience of transition and PACT-M 2 of coping at home.
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Affiliation(s)
| | | | - Rebecca Lawton
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute For Health Research, Bradford, UK
| | - Jenni Murray
- Bradford Institute For Health Research, Bradford, UK
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21
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Lorenzini E, Boell JEW, Oelke ND, Rodrigues CD, Trindade LF, Winter VDB, Malkiewiez MM, Flôres GC, Pluta P, Kolankiewicz ACB. Care transition from hospital to home: cancer patients' perspective. BMC Res Notes 2020; 13:267. [PMID: 32487267 PMCID: PMC7268360 DOI: 10.1186/s13104-020-05099-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/19/2020] [Indexed: 11/28/2022] Open
Abstract
Objectives The present database contains information on sociodemographic and clinical data as well as data from the Care Transition Measure (CTM 15-Brazil) of cancer patients undergoing clinical or surgical treatment. Data collection was carried out 7 to 30 days after patients’ hospital discharge from June to August 2019. Understanding these data can contribute to improving quality of care transitions and avoiding hospital readmissions. Data description This data set encompasses 213 cancer patients characterized by the follow variables: gender, age range, place of residence, race, marital status, schooling, paid work activity, type of treatment, cancer staging, metastasis, comorbidities, main complaint, main complaint grouped as, continuing medication, diagnosis, diagnosis grouped as, cancer type, year of diagnosis, oncology treatment, first hospitalization, readmission in the last 30 days, number of hospitalizations in the last 30 days, readmission in the last 6 months, number of hospitalizations in the last 6 months, readmission in the last year, number of hospitalizations in the last year and the questions 1–15 from CTM 15-Brazil.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Pâmella Pluta
- Regional University of the Northwest of the State of Rio Grande do Sul, Ijuí, RS, Brazil
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22
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Boge RM, Haugen AS, Nilsen RM, Bruvik F, Harthug S. Discharge care quality in hospitalised elderly patients: Extended validation of the Discharge Care Experiences Survey. PLoS One 2019; 14:e0223150. [PMID: 31557232 PMCID: PMC6762102 DOI: 10.1371/journal.pone.0223150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/13/2019] [Indexed: 11/29/2022] Open
Abstract
Background The Discharge Care Experiences Survey (DICARES) was previously developed to measure quality of discharge care in elderly patients (≥ 65 years). The objective of this study was to test the factorial validity of responses of the DICARES, and to investigate its association with existing quality indicators. Methods We conducted a cross-sectional study at two hospitals in Bergen, Western Norway. A survey, including DICARES, was sent by postal mail to 1,418 patients 30 days after discharge from hospital. To test the previously identified three-factor structure of the DICARES we applied a first order confirmatory factor analysis with corresponding fit indices and reliability measures. Spearman’s correlation coefficients, and linear regression, was used to investigate the association of DICARES scores with the quality indicators Nordic Patient Experiences Questionnaire and emergency readmission within 30 days. Results A total of 493 (35%) patients completed the survey. The mean age of the respondents was 79 years (SD = 8) and 52% were women. The confirmatory factor analysis showed acceptable fit. Cronbach’s α between items within factors was 0.82 (Coping after discharge), 0.71 (Adherence to treatment), and 0.66 (Participation in discharge planning). DICARES was moderately correlated with the Nordic Patient Experiences Questionnaire (rho = 0.49, P < 0.001). DICARES overall score was higher in patients with no readmissions compared to those who were emergency readmitted within 30 days (P < 0.001), indicating that more positive experiences were associated with fewer readmissions. Conclusions DICARES appears to be a feasible instrument for measuring quality of discharge care in elderly patients (≥ 65 years). This brief questionnaire seems to be sensitive with regard to readmission, and independent of comorbidity. Further studies of patients’ experiences are warranted to identify elements that impact on discharge care in other patient groups.
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Affiliation(s)
- Ranveig Marie Boge
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | - Arvid Steinar Haugen
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Roy Miodini Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Frøydis Bruvik
- Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Bergen, Norway
| | - Stig Harthug
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
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