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Hajebrahimi S, Talebpour A, Kabiri N, Ahmadian N, Soleimanzadeh F, Behbahani Z, Salehi-Pourmehr H. Promoting post discharge telephone follow-up of patients with transurethral resection for bladder cancer: a best practice implementation project. JBI Evid Implement 2023; 21:251-258. [PMID: 37159920 DOI: 10.1097/xeb.0000000000000374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
INTRODUCTION AND OBJECTIVES Telephone follow-up (TFU) is a method that can be recommended for patients with chronic disease, including patients with nonmuscle-invasive bladder cancer (NMIBC) after transurethral resection of the bladder (TURB). This project aimed to improve postdischarge TFU of patients with TURB in a tertiary care system and referral system in Tabriz, Iran. METHODS This evidence implementation project used the JBI evidence implementation framework. Two audit criteria were used. A baseline audit was conducted, followed by the implementation of multiple strategies. The project was finalized with a follow-up audit to evaluate changes in practice. RESULTS The aggregated data collated from the urology ward demonstrated that all criteria had achieved 0% compliance in the baseline audit round. Strategies such as patient education about TFU, educational pamphlets developed according to the latest validated guidelines, and a mobile app for education material about bladder cancer, diagnosis, management, and follow-up were implemented. The Phase 3 follow-up showed an 88% increase in compliance with staff education about the postdischarge TFU as a component of comprehensive discharge planning and a 22% achievement of timely patient follow-up by telephone. CONCLUSIONS A clinical audit is an effective approach to promoting postdischarge TFU in bladder cancer cases following TURB. TFU for bladder cancer patients who underwent TURB is an optimal goal that is easily achieved through patient, nursing staff, and residents' education using the latest guidelines.
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Affiliation(s)
- Sakineh Hajebrahimi
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A JBI Center of Excellence
- Urology Department, Imam Reza General Hospital, Tabriz University of Medical Sciences
- Clinical Research Development Unit, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amin Talebpour
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A JBI Center of Excellence
| | - Neda Kabiri
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A JBI Center of Excellence
| | - Niloufar Ahmadian
- Urology Department, Imam Reza General Hospital, Tabriz University of Medical Sciences
- Clinical Research Development Unit, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzin Soleimanzadeh
- Urology Department, Imam Reza General Hospital, Tabriz University of Medical Sciences
- Clinical Research Development Unit, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahereh Behbahani
- Urology Department, Imam Reza General Hospital, Tabriz University of Medical Sciences
- Clinical Research Development Unit, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hanieh Salehi-Pourmehr
- Research Center for Evidence-Based Medicine, Iranian EBM Center: A JBI Center of Excellence
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Coombes J, Holland AJA, Ryder C, Finlay SM, Hunter K, Bennett-Brook K, Orcher P, Scarcella M, Briscoe K, Forbes D, Jacques M, Maze D, Porykali B, Bourke E, Kairuz Santos CA. Discharge interventions for First Nations people with a chronic condition or injury: a systematic review. BMC Health Serv Res 2023; 23:604. [PMID: 37296401 DOI: 10.1186/s12913-023-09567-5] [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: 12/07/2022] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander peoples have a unique place in Australia as the original inhabitants of the land. Similar to other First Nations people globally, they experience a disproportionate burden of injury and chronic health conditions. Discharge planning ensures ongoing care to avoid complications and achieve better health outcomes. Analysing discharge interventions that have been implemented and evaluated globally for First Nations people with an injury or chronic conditions can inform the implementation of strategies to ensure optimal ongoing care for Aboriginal and Torres Strait Islander people. METHODS A systematic review was conducted to analyse discharge interventions conducted globally among First Nations people who sustained an injury or suffered from a chronic condition. We included documents published in English between January 2010 and July 2022. We followed the reporting guidelines and criteria set in Preferred Reporting Items for Systematic Review (PRISMA). Two independent reviewers screened the articles and extracted data from eligible papers. A quality appraisal of the studies was conducted using the Mixed Methods Appraisal Tool and the CONSIDER statement. RESULTS Four quantitative and one qualitative study out of 4504 records met inclusion criteria. Three studies used interventions involving trained health professionals coordinating follow-up appointments, linkage with community care services and patient training. One study used 48-hour post discharge telephone follow-up and the other text messages with prompts to attend check-ups. The studies that included health professional coordination of follow-up, linkage with community care and patient education resulted in decreased readmissions, emergency presentations, hospital length of stay and unattended appointments. CONCLUSION Further research on the field is needed to inform the design and delivery of effective programs to ensure quality health aftercare for First Nations people. We observed that discharge interventions in line with the principal domains of First Nations models of care including First Nations health workforce, accessible health services, holistic care, and self-determination were associated with better health outcomes. REGISTRATION This study was prospectively registered in PROSPERO (ID CRD42021254718).
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Affiliation(s)
- Julieann Coombes
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Andrew J A Holland
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Courtney Ryder
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
- Indigenous Health College of Medicine and Public Health, Flinders University, Adelaide, SA, 5042, Australia
| | - Summer May Finlay
- School of Health and Society, Wollongong University, Wollongong, NSW, 2522, Australia
| | - Kate Hunter
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Keziah Bennett-Brook
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Phillip Orcher
- Agency for Clinical Innovations, 1 Reserve Rd, St Leonards, NSW, 2065, Australia
| | - Michele Scarcella
- The Sydney Children's Hospital Network (SCHN), Sydney, NSW, 2145, Australia
| | - Karl Briscoe
- National Association of Aboriginal and Torres Strait Islander Health Workers and Practitioners (NAATSIHWP), 31-37 Townshend Street, Phillip ACT, 2606, Australia
| | - Dale Forbes
- Department Community and Justice NSW, Sydney, NSW, 2012, Australia
| | - Madeleine Jacques
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Deborah Maze
- Department of Paediatric Surgery, The Children's Hospital at Westmead, Corner Hawkesbury Road and, Hainsworth St, Westmead, NSW, 2145, Australia
| | - Bobby Porykali
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Elizabeth Bourke
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia
| | - Camila A Kairuz Santos
- The George Institute for Global Health, Level 5/1 King Street, Newtown, NSW, 2042, Australia.
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Vergara FH, Budhathoki C, Sheridan DJ, Davis JE, Sullivan NJ. Predictors for Telephone Outreach Post-hospital Discharge. Prof Case Manag 2021; 26:286-297. [PMID: 34609341 DOI: 10.1097/ncm.0000000000000530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF STUDY The specific aims of this study were to examine whether sociodemographic variables and medical-surgical diagnoses were associated with telephone follow-up (TFU) reach rates, emergency department visits, and hospital readmissions. PRIMARY PRACTICE OF SETTING Acute care inpatient units in an academic medical center. METHODOLOGY AND SAMPLE A correlational design was utilized, and a prospective medical record review of patients was conducted while implementing face-to-face prehospital discharge meeting interventions. The study sample (N = 176) included adult patients in two neurosurgical wards who were admitted between June 2016 and September 2016. Parametric and nonparametric tests were used to explore the balance between the intervention group receiving a face-to-face prehospital discharge meeting and comparison group receiving standard prehospital discharge care. Bivariate statistics were employed to determine associations between variables. RESULTS A total of 15 sociodemographic and medical-surgical variables were used to correlate TFU reach rates, emergency department (ED) visits, and readmission rates. Educational attainment (p = .002), employment status (p = .014), parental status (p = .010), and hospital service (p = .039) had significant differences between the intervention and comparison groups. Results demonstrated an improved reach rate for the intervention group but despite the differences in the groups, phi and Cramer's V coefficients did not correlate any associations with TFU reach rate, ED visits, and readmission rates with sociodemographic and surgical variables. This outcome affirmed that despite the similarities and differences in the sample, a face-to-face meeting prehospital discharge is an effective intervention to improve telephone outreach. IMPLICATIONS TO CASE MANAGEMENT PRACTICE There is a need to determine the most cost-effective way to increase TFU reach rates to prevent subsequent ED visits and hospital readmissions. There is also a need to develop a tool that can predict the hardest-to-reach patients posthospital discharge, so that case managers can meet those patients before leaving the hospital. In addition, it is important to identify alternative methods of "face-to-face" interactions during the COVID-19 pandemic crises. Case managers must explore ways with caution to leverage secured digital technology to bridge the gap of communicating with patients and family members when hospital visitations are limited.
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Affiliation(s)
- Franz H Vergara
- Franz H. Vergara, DNP/PhD, RN, ONC, CCM, was a Patient Access Line (PAL) case manager who conducted the inaugural nurse-led telephone follow-up call at The Johns Hopkins Hospital, Baltimore, Maryland. The PAL department was a successful program, preventing readmissions of 777 patients and reducing $11.8 million within 40 months. Currently, Dr. Vergara is a director at Inova Mount Vernon Hospital, Alexandria, Virginia
- Chakra Budhathoki, PhD, is an associate professor and biostatistician, The Johns Hopkins University School of Nursing, Baltimore, Maryland
- Daniel J. Sheridan, PhD, RN, FAAN , is a faculty member, The Johns Hopkins University School of Nursing, Baltimore, Maryland. Dr. Sheridan served as Dr. Vergara's dissertation cochairman at the Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri
- Jean E. Davis, PhD, RN, FAAN , is a PhD program director and professor, University of South Carolina, College of Nursing. Dr. Davis served as Dr. Vergara's dissertation cochairwoman at the Goldfarb School of Nursing, Barnes-Jewish College
- Nancy J. Sullivan, DNP, RN , is an assistant professor and simulation director, The Johns Hopkins University School of Nursing, Baltimore, Maryland. Dr. Sullivan was a clinical nurse specialist for the readmission reduction task force at The Johns Hopkins Hospital. Dr. Sullivan served in the PhD committee and also served as the DNP culminating project coordinator of Dr. Vergara
| | - Chakra Budhathoki
- Franz H. Vergara, DNP/PhD, RN, ONC, CCM, was a Patient Access Line (PAL) case manager who conducted the inaugural nurse-led telephone follow-up call at The Johns Hopkins Hospital, Baltimore, Maryland. The PAL department was a successful program, preventing readmissions of 777 patients and reducing $11.8 million within 40 months. Currently, Dr. Vergara is a director at Inova Mount Vernon Hospital, Alexandria, Virginia
- Chakra Budhathoki, PhD, is an associate professor and biostatistician, The Johns Hopkins University School of Nursing, Baltimore, Maryland
- Daniel J. Sheridan, PhD, RN, FAAN , is a faculty member, The Johns Hopkins University School of Nursing, Baltimore, Maryland. Dr. Sheridan served as Dr. Vergara's dissertation cochairman at the Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri
- Jean E. Davis, PhD, RN, FAAN , is a PhD program director and professor, University of South Carolina, College of Nursing. Dr. Davis served as Dr. Vergara's dissertation cochairwoman at the Goldfarb School of Nursing, Barnes-Jewish College
- Nancy J. Sullivan, DNP, RN , is an assistant professor and simulation director, The Johns Hopkins University School of Nursing, Baltimore, Maryland. Dr. Sullivan was a clinical nurse specialist for the readmission reduction task force at The Johns Hopkins Hospital. Dr. Sullivan served in the PhD committee and also served as the DNP culminating project coordinator of Dr. Vergara
| | - Daniel J Sheridan
- Franz H. Vergara, DNP/PhD, RN, ONC, CCM, was a Patient Access Line (PAL) case manager who conducted the inaugural nurse-led telephone follow-up call at The Johns Hopkins Hospital, Baltimore, Maryland. The PAL department was a successful program, preventing readmissions of 777 patients and reducing $11.8 million within 40 months. Currently, Dr. Vergara is a director at Inova Mount Vernon Hospital, Alexandria, Virginia
- Chakra Budhathoki, PhD, is an associate professor and biostatistician, The Johns Hopkins University School of Nursing, Baltimore, Maryland
- Daniel J. Sheridan, PhD, RN, FAAN , is a faculty member, The Johns Hopkins University School of Nursing, Baltimore, Maryland. Dr. Sheridan served as Dr. Vergara's dissertation cochairman at the Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri
- Jean E. Davis, PhD, RN, FAAN , is a PhD program director and professor, University of South Carolina, College of Nursing. Dr. Davis served as Dr. Vergara's dissertation cochairwoman at the Goldfarb School of Nursing, Barnes-Jewish College
- Nancy J. Sullivan, DNP, RN , is an assistant professor and simulation director, The Johns Hopkins University School of Nursing, Baltimore, Maryland. Dr. Sullivan was a clinical nurse specialist for the readmission reduction task force at The Johns Hopkins Hospital. Dr. Sullivan served in the PhD committee and also served as the DNP culminating project coordinator of Dr. Vergara
| | - Jean E Davis
- Franz H. Vergara, DNP/PhD, RN, ONC, CCM, was a Patient Access Line (PAL) case manager who conducted the inaugural nurse-led telephone follow-up call at The Johns Hopkins Hospital, Baltimore, Maryland. The PAL department was a successful program, preventing readmissions of 777 patients and reducing $11.8 million within 40 months. Currently, Dr. Vergara is a director at Inova Mount Vernon Hospital, Alexandria, Virginia
- Chakra Budhathoki, PhD, is an associate professor and biostatistician, The Johns Hopkins University School of Nursing, Baltimore, Maryland
- Daniel J. Sheridan, PhD, RN, FAAN , is a faculty member, The Johns Hopkins University School of Nursing, Baltimore, Maryland. Dr. Sheridan served as Dr. Vergara's dissertation cochairman at the Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri
- Jean E. Davis, PhD, RN, FAAN , is a PhD program director and professor, University of South Carolina, College of Nursing. Dr. Davis served as Dr. Vergara's dissertation cochairwoman at the Goldfarb School of Nursing, Barnes-Jewish College
- Nancy J. Sullivan, DNP, RN , is an assistant professor and simulation director, The Johns Hopkins University School of Nursing, Baltimore, Maryland. Dr. Sullivan was a clinical nurse specialist for the readmission reduction task force at The Johns Hopkins Hospital. Dr. Sullivan served in the PhD committee and also served as the DNP culminating project coordinator of Dr. Vergara
| | - Nancy J Sullivan
- Franz H. Vergara, DNP/PhD, RN, ONC, CCM, was a Patient Access Line (PAL) case manager who conducted the inaugural nurse-led telephone follow-up call at The Johns Hopkins Hospital, Baltimore, Maryland. The PAL department was a successful program, preventing readmissions of 777 patients and reducing $11.8 million within 40 months. Currently, Dr. Vergara is a director at Inova Mount Vernon Hospital, Alexandria, Virginia
- Chakra Budhathoki, PhD, is an associate professor and biostatistician, The Johns Hopkins University School of Nursing, Baltimore, Maryland
- Daniel J. Sheridan, PhD, RN, FAAN , is a faculty member, The Johns Hopkins University School of Nursing, Baltimore, Maryland. Dr. Sheridan served as Dr. Vergara's dissertation cochairman at the Goldfarb School of Nursing, Barnes-Jewish College, St. Louis, Missouri
- Jean E. Davis, PhD, RN, FAAN , is a PhD program director and professor, University of South Carolina, College of Nursing. Dr. Davis served as Dr. Vergara's dissertation cochairwoman at the Goldfarb School of Nursing, Barnes-Jewish College
- Nancy J. Sullivan, DNP, RN , is an assistant professor and simulation director, The Johns Hopkins University School of Nursing, Baltimore, Maryland. Dr. Sullivan was a clinical nurse specialist for the readmission reduction task force at The Johns Hopkins Hospital. Dr. Sullivan served in the PhD committee and also served as the DNP culminating project coordinator of Dr. Vergara
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Blignault I, Norsa L, Blackburn R, Bloomfield G, Beetson K, Jalaludin B, Jones N. "You Can't Work with My People If You Don't Know How to": Enhancing Transfer of Care from Hospital to Primary Care for Aboriginal Australians with Chronic Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7233. [PMID: 34299688 PMCID: PMC8306914 DOI: 10.3390/ijerph18147233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022]
Abstract
Indigenous Australians experience significantly poorer health compared to other Australians, with chronic disease contributing to two-thirds of the health gap. We report on an evaluation of an innovative model that leverages mainstream and Aboriginal health resources to enable safe, supported transfer of care for Aboriginal adults with chronic conditions leaving hospital. The multisite evaluation was Aboriginal-led and underpinned by the principles of self-determination and equity and Indigenous research protocols. The qualitative study documented processes and captured service user and provider experiences. We found benefits for patients and their families, the hospital and the health system. The new model enhanced the patient journey and trust in the health service and was a source of staff satisfaction. Challenges included staff availability, patient identification and complexity and the broader issue of cultural safety. Critical success factors included strong governance with joint cultural and clinical leadership and enduring relationships and partnerships at the service delivery, organisation and system levels. A holistic model of care, bringing together cultural and clinical expertise and partnering with Indigenous community organisations, can enhance care coordination and safety across the hospital-community interface. It is important to consider context as well as specific program elements in design, implementation and evaluation.
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Affiliation(s)
- Ilse Blignault
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia;
| | - Liz Norsa
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751, Australia;
| | - Raylene Blackburn
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - George Bloomfield
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - Karen Beetson
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
| | - Bin Jalaludin
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
- Ingham Institute for Applied Medical Research, UNSW Sydney, Liverpool, NSW 2170, Australia
| | - Nathan Jones
- South Western Sydney Local Health District, Liverpool, NSW 1871, Australia; (R.B.); (G.B.); (K.B.); (B.J.); (N.J.)
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Zhao S, Chen H. Effectiveness of health education by telephone follow-up on self-efficacy among discharged patients with rheumatoid arthritis: A randomised control trial. J Clin Nurs 2019; 28:3840-3847. [PMID: 31325348 DOI: 10.1111/jocn.15002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 06/28/2019] [Accepted: 06/30/2019] [Indexed: 02/05/2023]
Abstract
AIMS AND OBJECTIVES To explore the effectiveness of a health education programme by telephone follow-up on the self-efficacy of patients with rheumatoid arthritis (RA). BACKGROUND Self-efficacy is increasingly perceived to be a cornerstone in improving the capacity of self-management. However, a paucity of research has demonstrated the effectiveness of health education by the use of a telephone follow-up for RA patients in China. DESIGN This study was a randomised control trial. METHODS Recruited patients were randomly divided into control and intervention groups. The intervention group accepted health education by telephone follow-up four times after the patients were discharged. The patients in the control group only accepted telephone follow-up once after they were discharged. Self-efficacy was measured by the use of the Rheumatoid Arthritis Self-Efficacy Questionnaire (RASE), and data were collected at the day before the discharge, the 12th week and the 24th week after patients were discharged. The CONSORT checklist was used to check the procedure. RESULTS A total of 92 discharged patients with rheumatoid arthritis were enrolled. The sociodemographic indexes of the control and intervention groups had no significant differences at baseline (p > .05). The RASE score of the intervention group was higher than that of the control group (p < .05) at the 12th week and the 24th week. CONCLUSION The HET improved the self-efficacy of the discharged patients with RA in the 12th week and the 24th week after discharge. This study demonstrated that our HET can improve the short-term and long-term effects of self-efficacy, which implies that the clinical nursing staff should increase the frequency of HET to improve the patients' knowledge and abilities of self-management. RELEVANCE TO CLINICAL PRACTICE Patients with RA will benefit from a health education programme by telephone follow-up; thus, it is necessary for nursing managers to implement this programme.
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Affiliation(s)
- Shangping Zhao
- The Third Comprehensive Care Unit, West China Hospital, Sichuan University, Chengdu, China
| | - Hong Chen
- West China School of Nursing, Sichuan University, Chengdu, China
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Jayakody A, Oldmeadow C, Carey M, Bryant J, Evans T, Ella S, Attia J, Sanson-Fisher R. Unplanned readmission or death after discharge for Aboriginal and non-Aboriginal people with chronic disease in NSW Australia: a retrospective cohort study. BMC Health Serv Res 2018; 18:893. [PMID: 30477505 PMCID: PMC6258493 DOI: 10.1186/s12913-018-3723-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/16/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Admitted patients with chronic disease are at high risk of an unplanned hospital readmission, however, little research has examined unplanned readmission among Aboriginal people in Australia. This study aimed to examine whether rates of unplanned 28 day hospital readmission, or death, significantly differ between Aboriginal and non-Aboriginal patients in New South Wales, Australia, over a nine-year period. METHODS A retrospective cohort analysis of a sample of de-identified linked hospital administrative data was conducted. Eligible patients were: 1) aged ≥18 years old, 2) admitted to an acute facility in a NSW public hospital between 30th June 2005 and 1st July 2014, and 3) admitted with either cardiovascular disease, chronic respiratory disease, diabetes or renal disease. The primary composite outcome was unplanned readmission or death within 28 days of discharge. Generalized linear models and a test for trend were used to assess rates of unplanned readmission or death over time in Aboriginal and non-Aboriginal patients with chronic disease, accounting for sociodemographic variables. RESULTS The final study cohort included 122,145 separations corresponding to 48,252 patients (Aboriginal = 57.2%, n = 27,601; non-Aboriginal = 42.8%, n = 20,651). 13.9% (n = 16,999) of all separations experienced an unplanned readmission or death within 28 days of discharge. Death within 28 days of discharge alone accounted for only a small number of separations (1.4%; n = 1767). Over the nine-year period, Aboriginal separations had a significantly higher relative risk of an unplanned readmission or death (Relative risk = 1.34 (1.29, 1.40); p-value < 0.0001) compared with non-Aboriginal separations once adjusted for sociodemographic, disease variables and restricted to < 75 years of age. A test for trend, including an interaction between year and Aboriginal status, showed there was no statistically significant change in proportions over the nine-year period for Aboriginal and non-Aboriginal separations (p-value for trend = 0.176). CONCLUSION Aboriginal people with chronic disease had a significantly higher risk of unplanned readmission or death 28 days post discharge from hospital compared with non-Aboriginal people, and there has been no significant change over the nine year period. It is critical that effective interventions to reduce unplanned readmissions for Aboriginal people are identified.
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Affiliation(s)
- Amanda Jayakody
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Christopher Oldmeadow
- CREDITSS—Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, New Lambton Heights, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Tiffany Evans
- CREDITSS—Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, New Lambton Heights, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Stephen Ella
- Nunyara Aboriginal Health Unit, Central Coast Local Health District, Ward Street, Gosford, NSW Australia
| | - John Attia
- CREDITSS—Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, New Lambton Heights, NSW Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW 2308 Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308 Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW Australia
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