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D'lima J, Taylor SE, Mitri E, Harding A, Lai J, Manias E. Assessment of inter-rater reliability of screening tools to identify patients at risk of medication-related problems across the emergency department continuum of care. Australas Emerg Care 2024; 27:136-141. [PMID: 37973428 DOI: 10.1016/j.auec.2023.10.005] [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: 06/11/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Following a national multicentre study, two emergency department (ED) screening tools were developed to determine risk of medication-related problems; one for use at ED presentation and another at ED discharge to the community. This study aimed to determine the inter-rater reliability amongst ED health professionals when applying these screening tools to a series of case scenarios. METHODS A prospective, cross-sectional study was undertaken in the ED of a major metropolitan hospital. Twelve case scenarios were developed following ED observation of a range of patients, which were incorporated into a questionnaire and distributed to 50 health professionals. Inter-rater reliabilities of each explanatory variable of the screening tools and overall assessment were calculated using Fleiss' multi-rater kappa. RESULTS The questionnaire was completed by 15 doctors, 19 nurses and 16 pharmacists. Fleiss' kappa showed an overall inter-rater reliability for the ED presentation tool of 0.83 (95% CI 0.83-0.84), indicating near perfect agreement. Fleiss' kappa for the ED discharge tool was 0.83 (95% CI 0.83-0.85), which also showed near perfect agreement. CONCLUSIONS The screening tools produced favourable inter-rater reliability amongst ED health professionals. These results have important implications for ensuring consistency of ED decision-making in screening patients at risk of developing medication-related problems.
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Affiliation(s)
- Jessica D'lima
- The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Simone E Taylor
- Austin Health, Pharmacy Department, Studley Road, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Studley Road, Heidelberg, Victoria, Australia
| | - Elise Mitri
- Austin Health, Pharmacy Department, Studley Road, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Studley Road, Heidelberg, Victoria, Australia
| | - Andrew Harding
- Austin Health, Pharmacy Department, Studley Road, Heidelberg, Victoria, Australia; Austin Health, Emergency Department, Studley Road, Heidelberg, Victoria, Australia
| | - Jerry Lai
- Work Safe, Victoria, Malop Street, Geelong, Victoria, Australia; Deakin University, eSolutions Group, Geelong, Victoria, Australia
| | - Elizabeth Manias
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Burwood, Victoria, Australia; School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia; Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia.
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2
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Beiter ER, Shanbhag A, Junge-Maughan L, Knoph K, Dufour AB, Lipsitz L, Moore A. Interdisciplinary videoconference model for identifying potential adverse transition of care events following hospital discharge to postacute care. BMJ Open Qual 2024; 13:e002508. [PMID: 38789279 PMCID: PMC11129022 DOI: 10.1136/bmjoq-2023-002508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
Discharge from hospitals to postacute care settings is a vulnerable time for many older adults, when they may be at increased risk for errors occurring in their care. We developed the Extension for Community Healthcare Outcomes-Care Transitions (ECHO-CT) programme in an effort to mitigate these risks through a mulitdisciplinary, educational, case-based teleconference between hospital and skilled nursing facility providers. The programme was implemented in both academic and community hospitals. Through weekly sessions, patients discharged from the hospital were discussed, clinical concerns addressed, errors in care identified and plans were made for remediation. A total of 1432 discussions occurred for 1326 patients. The aim of this study was to identify errors occurring in the postdischarge period and factors that predict an increased risk of experiencing an error. In 435 discussions, an issue was identified that required further discussion (known as a transition of care event), and the majority of these were related to medications. In 14.7% of all discussions, a medical error, defined as 'any preventable event that may cause or lead to inappropriate medical care or patient harm', was identified. We found that errors were more likely to occur for patients discharged from surgical services or the emergency department (as compared with medical services) and were less likely to occur for patients who were discharged in the morning. This study shows that a number of errors may be detected in the postdischarge period, and the ECHO-CT programme provides a mechanism for identifying and mitigating these events. Furthermore, it suggests that discharging service and time of day may be associated with risk of error in the discharge period, thereby suggesting potential areas of focus for future interventions.
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Affiliation(s)
- Evan R Beiter
- Stanford University School of Medicine, Stanford, California, USA
| | | | | | - Kristen Knoph
- Pharmacy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alyssa B Dufour
- Harvard Medical School, Boston, Massachusetts, USA
- Hinda and Arthur Marcus Institute for Aging Research, Boston, Massachusetts, USA
| | - Lewis Lipsitz
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Amber Moore
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
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Thiengtham S, Chiang-Hanisko L, D'Avolio D, Sritanyarat W. Experience of Transitional Care Among Thai-Isan Older Stroke Survivors and Their Family Caregivers. QUALITATIVE HEALTH RESEARCH 2024:10497323241232937. [PMID: 38482851 DOI: 10.1177/10497323241232937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The transitional care model for people who have suffered brain injuries is a relatively recent addition to the Thai healthcare system. The aim of this study was to explore experience of Thai Isan older stroke survivors and their family caregivers across different points of transition from hospital to home. Fifteen dyads of older stroke survivors and their family caregivers were recruited following the inclusion and exclusion criteria. Data were collected through participant observations and semi-structured interviews. Forty-seven participation observation field notes and twenty-four interview transcriptions were analyzed using the Four Phases of the Data Analysis Enabler and the Leininger-Templin-Thompson Ethnoscript Coding Enabler. Three themes emerged: I feel lost with managing care at home; it has been challenging for our family to maintain continuity of care; and it is a matter of who fits in and is convenient for family care responsibilities. The findings of this study have highlighted the dispersion of care among Thai-Isan people during the patient's transition to home. Therefore, a transitional care plan should be developed that specifies who is responsible for monitoring and supporting patients and families throughout this period.
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Affiliation(s)
- Supavadee Thiengtham
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Lenny Chiang-Hanisko
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Deborah D'Avolio
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
| | - Wanapa Sritanyarat
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
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4
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Byrnes M, Thompson NR, Hantus ST, Fesler JR, Ying Z, Ayub N, Rubinos C, Zafar S, Sivaraju A, Punia V. Characteristics and Attendance of Patients Eligible for the PASS Clinic: A Transition of Care Model After Acute Symptomatic Seizures. Neurol Clin Pract 2024; 14:e200232. [PMID: 38213398 PMCID: PMC10781564 DOI: 10.1212/cpj.0000000000200232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/04/2023] [Indexed: 01/13/2024]
Abstract
Background and Objectives Most acute symptomatic seizure (ASyS) patients stay on antiseizure medications (ASM) long-term, despite low epilepsy development risk. The Post-Acute Symptomatic Seizure (PASS) clinic is a transition of care model for ASyS patients who individualize ASM management with the goal of a safe deprescription. We evaluated patients discharged on ASMs after a witnessed or suspected ASyS to analyze their PASS clinic visit attendance and its predictors. Methods A single-center, retrospective cohort study of adults without epilepsy who were discharged from January 1, 2019, to September 30, 2019, on first-time ASMs due to witnessed or suspected ASyS (PASS clinic-eligible). We fit a cause-specific Cox proportional hazards model to analyze factors associated with PASS clinic attendance, which depends on survival in this patient population that has a high early postdischarge mortality (a competing risk). We checked for multicollinearity and the assumption of proportional hazards. Results Among 307 PASS clinic-eligible patients, 95 (30.9%) attended the clinic and 136 (44.3%) died during a median follow-up of 14 months (interquartile range = 2-34). ASyS occurred in 60.2% (convulsive 47%; electrographic 26.7%) of patients. ASMs were continued in the absence of ASyS or epileptiform abnormalities (EAs) in 27% of patients. Multivariable analysis revealed that the presence of EAs (HR = 1.69, 95% CI 1.10-2.59), PASS clinic appointments provided before discharge (HR = 3.39, 95% CI 2.15-5.33), and less frequently noted ASyS etiologies such as autoimmune encephalitis (HR = 2.03, 95% CI 1.07-3.86) were associated with an increased clinic attendance rate. Medicare/Medicaid insurance (HR = 0.43, 95% CI 0.24-0.78, p = 0.005) and the presence of progressive brain injury (i.e., tumors; HR = 0.55, 95% CI 0.32-0.95, p = 0.032) were associated with reduced rate of PASS clinic attendance. Discussion Our real-world data highlight the need for appropriate postdischarge follow-up of ASyS patients, which can be fulfilled by the PASS clinic model. Modest PASS clinic attendance can be significantly improved by adhering to a structured discharge planning process whereby appointments are provided before discharge. Future research comparing patient outcomes, specifically safe ASM discontinuation in a PASS clinic model to routine clinical care, is needed.
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Affiliation(s)
- MarieElena Byrnes
- Epilepsy Center (MB, STH, JRF, ZY, VP), Neurological Institute; Department of Quantitative Health Sciences (NRT), Lerner Research Institute; Center for Outcomes Research and Evaluation (NRT), Neurological Institute, Cleveland Clinic, OH; Rhode Island Hospital (NA), Brown University; University of North Carolina (CR), Chapel Hill; Massachusetts General Hospital (SZ), Harvard University; Yale New Haven Hospital (AS), Yale University
| | - Nicolas R Thompson
- Epilepsy Center (MB, STH, JRF, ZY, VP), Neurological Institute; Department of Quantitative Health Sciences (NRT), Lerner Research Institute; Center for Outcomes Research and Evaluation (NRT), Neurological Institute, Cleveland Clinic, OH; Rhode Island Hospital (NA), Brown University; University of North Carolina (CR), Chapel Hill; Massachusetts General Hospital (SZ), Harvard University; Yale New Haven Hospital (AS), Yale University
| | - Stephen T Hantus
- Epilepsy Center (MB, STH, JRF, ZY, VP), Neurological Institute; Department of Quantitative Health Sciences (NRT), Lerner Research Institute; Center for Outcomes Research and Evaluation (NRT), Neurological Institute, Cleveland Clinic, OH; Rhode Island Hospital (NA), Brown University; University of North Carolina (CR), Chapel Hill; Massachusetts General Hospital (SZ), Harvard University; Yale New Haven Hospital (AS), Yale University
| | - Jessica R Fesler
- Epilepsy Center (MB, STH, JRF, ZY, VP), Neurological Institute; Department of Quantitative Health Sciences (NRT), Lerner Research Institute; Center for Outcomes Research and Evaluation (NRT), Neurological Institute, Cleveland Clinic, OH; Rhode Island Hospital (NA), Brown University; University of North Carolina (CR), Chapel Hill; Massachusetts General Hospital (SZ), Harvard University; Yale New Haven Hospital (AS), Yale University
| | - Zhong Ying
- Epilepsy Center (MB, STH, JRF, ZY, VP), Neurological Institute; Department of Quantitative Health Sciences (NRT), Lerner Research Institute; Center for Outcomes Research and Evaluation (NRT), Neurological Institute, Cleveland Clinic, OH; Rhode Island Hospital (NA), Brown University; University of North Carolina (CR), Chapel Hill; Massachusetts General Hospital (SZ), Harvard University; Yale New Haven Hospital (AS), Yale University
| | - Neishay Ayub
- Epilepsy Center (MB, STH, JRF, ZY, VP), Neurological Institute; Department of Quantitative Health Sciences (NRT), Lerner Research Institute; Center for Outcomes Research and Evaluation (NRT), Neurological Institute, Cleveland Clinic, OH; Rhode Island Hospital (NA), Brown University; University of North Carolina (CR), Chapel Hill; Massachusetts General Hospital (SZ), Harvard University; Yale New Haven Hospital (AS), Yale University
| | - Clio Rubinos
- Epilepsy Center (MB, STH, JRF, ZY, VP), Neurological Institute; Department of Quantitative Health Sciences (NRT), Lerner Research Institute; Center for Outcomes Research and Evaluation (NRT), Neurological Institute, Cleveland Clinic, OH; Rhode Island Hospital (NA), Brown University; University of North Carolina (CR), Chapel Hill; Massachusetts General Hospital (SZ), Harvard University; Yale New Haven Hospital (AS), Yale University
| | - Sahar Zafar
- Epilepsy Center (MB, STH, JRF, ZY, VP), Neurological Institute; Department of Quantitative Health Sciences (NRT), Lerner Research Institute; Center for Outcomes Research and Evaluation (NRT), Neurological Institute, Cleveland Clinic, OH; Rhode Island Hospital (NA), Brown University; University of North Carolina (CR), Chapel Hill; Massachusetts General Hospital (SZ), Harvard University; Yale New Haven Hospital (AS), Yale University
| | - Adithya Sivaraju
- Epilepsy Center (MB, STH, JRF, ZY, VP), Neurological Institute; Department of Quantitative Health Sciences (NRT), Lerner Research Institute; Center for Outcomes Research and Evaluation (NRT), Neurological Institute, Cleveland Clinic, OH; Rhode Island Hospital (NA), Brown University; University of North Carolina (CR), Chapel Hill; Massachusetts General Hospital (SZ), Harvard University; Yale New Haven Hospital (AS), Yale University
| | - Vineet Punia
- Epilepsy Center (MB, STH, JRF, ZY, VP), Neurological Institute; Department of Quantitative Health Sciences (NRT), Lerner Research Institute; Center for Outcomes Research and Evaluation (NRT), Neurological Institute, Cleveland Clinic, OH; Rhode Island Hospital (NA), Brown University; University of North Carolina (CR), Chapel Hill; Massachusetts General Hospital (SZ), Harvard University; Yale New Haven Hospital (AS), Yale University
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Jung D, Pollack HA, Konetzka RT. Predicting Hospitalization among Medicaid Home- and Community-Based Services Users Using Machine Learning Methods. J Appl Gerontol 2023; 42:241-251. [PMID: 36164857 PMCID: PMC10069559 DOI: 10.1177/07334648221129548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
We compare multiple machine learning algorithms and develop models to predict future hospitalization among Home- and Community-Based Services (HCBS) Users. Furthermore, we calculate feature importance, the score of input variables based on their importance to predict the outcome, to identify the most relevant variables to predict hospitalization. We use the 2012 national Medicaid Analytic eXtract data and Medicare Provider Analysis and Review data. Predicting any hospitalization, Random Forest appears to be the most robust approach, though XGBoost achieved similar predictive performance. While the importance of features varies by algorithm, chronic conditions, previous hospitalizations, as well as use of services for ambulance, personal care, and durable medical equipment were generally found to be important predictors of hospitalization. Utilizing prediction models to identify those who are prone to hospitalization could be useful in developing early interventions to improve outcomes among HCBS users.
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Affiliation(s)
- Daniel Jung
- Department of Health Policy and Management, 1355University of Georgia, Athens, USA
| | - Harold A Pollack
- School of Social Service Administration, 278762University of Chicago, IL, USA
| | - R Tamara Konetzka
- Division of Biological Sciences, Department of Public Health Sciences, University of Chicago, IL, USA
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Fischer SH, Shih RA, McMullen TL, Edelen MO, Ahluwalia SC, Chen EK, Dalton SE, Paddock S, Rodriguez A, Saliba D, Mandl S, Mota T. Standardized assessment of medication reconciliation in post-acute care. J Am Geriatr Soc 2022; 70:1047-1056. [PMID: 35235200 DOI: 10.1111/jgs.17655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/16/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Medication reconciliation (MR) facilitates safety during transitions of care, which occur frequently across post-acute care (PAC) settings. Under the intent of the IMPACT Act of 2014, the Centers for Medicare & Medicaid Services contracted with the RAND Corporation to develop and test standardized assessment data elements (SADEs) that assess the MR process. METHODS We employed an iterative process that incorporated stakeholder input and three rounds of testing to identify, refine, and evaluate MR SADEs. Testing took place in 186 PAC sites (57 home health agencies, 28 inpatient rehabilitation facilities, 28 long-term care hospitals, and 73 skilled nursing facilities). There were 2951 patients in the final test. Novel MR SADEs, based on the Joint Commission's framework, were refined. The final SADEs assessed whether: patient was taking high-risk medications; an indication was noted for each medication class; discrepancies were identified; patient or family/caregiver was involved in addressing discrepancies; discrepancies were communicated to physician (or designee) within 24 h; recommended physician actions regarding discrepancies were implemented within 24 h after physician response; and the reconciled list was communicated to patient, prescriber, and/or pharmacy. Two assessors per facility collected data for each patient. Analyses described completion time, data missingness, and interrater reliability, as well as feedback on assessor burden. RESULTS Time to complete the MR SADEs was 3.2 min. Missing data were <5%. Interrater reliability was moderate to high (κ: 0.42 [whether a reconciled list was communicated to prescribers] to 0.89 [identifying patients taking hypoglycemics]). For identifying high-risk medication classes, interrater reliability was high (κ: 0.72-0.89). There were minimal differences by setting. CONCLUSIONS This is the first set of MR SADEs that have been assessed across the PAC settings. Results demonstrate feasibility, based on missing data and completion time, and moderate to strong reliability, based on interrater comparisons, of assessing MR.
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Affiliation(s)
| | | | - Tara L McMullen
- Pain Management, Opioid Safety, and PDMP Program Office, Veterans Health Administration, Washington, District of Columbia, USA
| | - Maria O Edelen
- RAND Corporation, Boston, Massachusetts, USA.,Patient Reported Outcomes Value and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sangeeta C Ahluwalia
- RAND Corporation, Santa Monica, California, USA.,UCLA Fielding School of Public Health, Los Angeles, California, USA
| | | | | | - Susan Paddock
- NORC at the University of Chicago, Chicago, Illinois, USA
| | | | - Debra Saliba
- RAND Corporation, Santa Monica, California, USA.,University of California Los Angeles/JH Borun Center for Gerontological Research, Los Angeles, California, USA.,VA GLAHS, GRECC and HSR&D Center of Innovation, Los Angeles, California, USA
| | - Stella Mandl
- Division of Health Care Financing, Office of Health Policy in the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services, Washington, District of Columbia, USA
| | - Teresa Mota
- Abt Associates, Cambridge, Massachusetts, USA
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7
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Donsel PO, Missel M. What's going on after hospital? - Exploring the transition from hospital to home and patient experiences of nurse-led follow-up phone calls. J Clin Nurs 2021; 30:1694-1705. [PMID: 33616272 DOI: 10.1111/jocn.15724] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the transition from hospital to home and patient experiences of nurse-led post-operative follow-up phone calls after thoracic surgery. BACKGROUND Enhanced Recovery After Surgery protocol places new demands on patients after hospital. Need for a proactive approach to improve the post-operative follow-up process in the home is required. DESIGN Qualitative intervention study. METHODS Interviews were conducted with patients who had received a post-operative phone call after hospital discharge (n = 15). The analysis was inspired by Gadamer and Meleis. COREQ guidelines were followed. RESULTS Two overall themes emerged: (1) The follow-up phone call, which concerns experiences involving the actual call and (2) Transitioning from hospital to home, which through four subthemes illuminates; how patients describe their initial time at home, that patients experience a changed body after surgery, that patients feel alone after returning home and that a call from a nurse can help patients not to feel left out and finally why it is absolutely essential that nurses initiate the phone call. CONCLUSION Patients are at different stages in their transition process after hospital, making timing of follow-up tricky. Being part of an Enhanced Recovery After Surgery programme has implications for the initial period after discharge; dominated by fatigue, pain and experiences of a changed body. Patients experience being left alone with their illness, and the phone call helps to relieve this isolation. It is essential that the nurse call the patient since the patients want to avoid disturbing the staff. RELEVANCE TO CLINICAL PRACTICE Healthcare workers can use the findings to understand how patients experience the transition from hospital to home when enrolled in an Enhanced Recovery After Surgery programme. Need for support from a nurse following discharge is suggested.
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Affiliation(s)
- Pernille Orloff Donsel
- Department of Cardiothoracic Surgery, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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8
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Bondi S, Yang D, Croll L, Torres J. Patient Characteristics Associated With Readmission to 3 Neurology Services at an Urban Academic Center. Neurohospitalist 2020; 11:25-32. [PMID: 33868553 DOI: 10.1177/1941874420953320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose Hospital 30-day readmissions in patients with primary neurological problems are not well characterized. We sought to determine patient characteristics associated with readmission across 3 different inpatient neurology services at New York University Langone Hospital. Methods We retrospectively reviewed all 30-day readmissions from the General Neurology, Epilepsy, and Stroke services at NYULH Brooklyn and Manhattan campuses from 2016-2017 and compared them to a random sample of non-readmitted neurology patients. We used univariate analyses to compare demographics, clinical characteristics, disease specific metrics, and discharge factors of non-readmitted and readmitted groups and binomial logistic regression to examine specific variables with adjustment for confounders. Results We included 284 patients with 30-day readmissions and 306 control patients without readmissions matched by discharge location and service. After adjusting for confounders, we found that the following factors were associated with increased readmission risk: a recent hospital encounter increased risk for all services, increased number of medications at discharge, intensive care unit stay, higher length of stay, and prior history of seizure for the General Neurology Service, increased number of medications at discharge for the Epilepsy Service, and active malignancy and higher discharge modified Rankin Scale score for the Stroke Service. Conclusion This study identifies potential risk factors for readmission in patients across multiple neurology services. Further research is needed to establish whether these risk factors hold across multiple institutions.
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Affiliation(s)
- Steven Bondi
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Dixon Yang
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Leah Croll
- Department of Neurology, New York University Langone Health, New York, NY, USA
| | - Jose Torres
- Department of Neurology, New York University Langone Health, New York, NY, USA
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Improving Care Transitions to Drive Patient Outcomes: The Triple Aim Meets the Four Pillars. Prof Case Manag 2020; 24:297-305. [PMID: 31580296 DOI: 10.1097/ncm.0000000000000387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this article is to examine how case managers can support positive outcomes during care transitions by focusing on the goals of the Triple Aim () and Coleman's Four Pillars (). Case managers can play a pivotal role to ensure high-quality transitions by assessing patients and identifying those who are at high risk; coordinating care and services among providers and settings; reconciling medications; and facilitating education of patients and their support systems to improve self-management. These activities are congruent with an underlying value of case management as defined by the Code of Professional Conduct for Case Managers: "improving client [i.e., patient] health, wellness and autonomy through advocacy, communication, education, identification of service resources, and service facilitation" (). CASE MANAGEMENT PRIMARY PRACTICE SETTINGS Case managers across health or human services must assess for, identify, and understand the vulnerability of patients during care transitions and must adopt best practices to support successful care transitions. This includes case managers in acute care, primary care, rehabilitation, home health, community-based, and other settings. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Two frameworks that support care transitions are the Triple Aim of improving the individual's experience of care, advancing the health of populations, and reducing the costs of care (), and Coleman's "Four Pillars" of care transition activities of medication management, patient-centered health records, follow-up visits with providers and specialists, and patient knowledge about red flags that indicate worsening conditions or drug reactions (). From a case management perspective, these approaches and their goals are interrelated. As an advocate for the individual and at the hub of the care team, the professional case manager engages in important activities such as facilitating communication across multiple providers and care settings, arranging "warm handoffs," undertaking medication reconciliation, and engaging in follow-up, particularly with high-risk patients. To support successful transitions of care, case managers must adopt best practices and advocate within their organizations for systematic approaches to care transitions to improve outcomes.
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Hühne A, Hoch E, Landgraf D. DAILY-A Personalized Circadian Zeitgeber Therapy as an Adjunctive Treatment for Alcohol Use Disorder Patients: Study Protocol for a Randomized Controlled Trial. Front Psychiatry 2020; 11:569864. [PMID: 33519541 PMCID: PMC7840704 DOI: 10.3389/fpsyt.2020.569864] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/09/2020] [Indexed: 01/23/2023] Open
Abstract
Background: Hallmarks of alcohol use disorder (AUD) are disturbances of circadian rhythms and everyday structures. While circadian rhythms dictate the timing of daily recurring activities such as sleep, activity, and meals, conversely, these activities represent time cues, so called Zeitgebers, that the circadian system uses to synchronize with the environment. Here we present a study protocol for our newly developed therapy approach for AUD patients, in which we take advantage of this mutual influence and stabilize and strengthen their circadian system by creating strict daily schedules for daily Zeitgeber activities. Since every person has a circadian system with its own characteristics and is subject to social obligations, the daily plans are personalized for each test person. Our hypothesis is that a regular exposure to Zeitgebers stabilizes behavioral and physiological circadian rhythms and thereby reduces the risk of alcohol relapses and depressive symptoms and facilitates physical recovery in AUD patients during the 1st weeks of their addiction therapy. Methods/design: The study is a 6-weeks single site trial with a controlled, randomized, single-blinded, parallel-group design including patients with a diagnosis of AUD. The study runs parallel to the standard addiction therapy of the clinic. Patients are randomly assigned to either an intervention group (DAILY) or a sham control group (placebo treatment). Questionnaires and physiological assessments of both groups are conducted before and immediately after the intervention or control treatment. According to our hypothesis, the primary outcomes of this study are improvements of regularity, alcohol consumption, and relapse rate in AUD patients compared to AUD patients receiving control treatment. Secondary outcomes are reduced depressive symptoms and increased physical recovery. Discussion: This study is a randomized controlled trial to investigate the efficacy of a personalized circadian Zeitgeber therapy as an adjunctive treatment for alcohol use disorder patients. The overall goal of this and more extended future studies is the development of an adjunctive therapy for AUD patients that is uncomplicated in its use and easy to implement in the clinical and everyday routine. Trial registration: This study is registered at the German Clinical Trial Register with the trial number DRKS00019093 on November 28, 2019.
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Affiliation(s)
- Anisja Hühne
- Circadian Biology Group, Department of Molecular Neurobiology, Clinic of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany.,Munich Medical Research School, Ludwig Maximilian University, Munich, Germany
| | - Eva Hoch
- Cannabinoid Research and Treatment Group, Division of Clinical Psychology and Psychological Treatment, Department of Psychology, Clinic of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
| | - Dominic Landgraf
- Circadian Biology Group, Department of Molecular Neurobiology, Clinic of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilian University, Munich, Germany
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Rush KL, Burton L, Ollivier R, Wilson R, Loewen P, Janke R, Schaab K, Lukey A, Galloway C. Transitions in Atrial Fibrillation Care: A Systematic Review. Heart Lung Circ 2019; 29:1000-1014. [PMID: 32094081 DOI: 10.1016/j.hlc.2019.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) commonly transition between care settings and providers. These transitions are often points in the health care system where errors and clinical deterioration can occur. Anticoagulation interruption or discontinuation and sub-optimal follow-up post-emergency department (ED) discharge are considered major transitional issues. OBJECTIVE The purpose of this study was to synthesise the evidence examining the impact of transitional care interventions on patient, provider, and health care utilisation outcomes. METHODS This systematic mixed studies review examined citations from four databases Medline, CINAHL, EMBASE, and Cochrane Central Controlled Register of Trials (CENTRAL) using relevant search terms. Fourteen (14) moderate to high quality articles were selected. RESULTS The available evidence reporting impacts of transitional interventions on health care utilisation, provider, and patient outcomes in AF patients is mixed and of variable quality. The stronger evidence revealed improvements in patient outcomes including knowledge, quality of life, and medication adherence and increased provider anticoagulant prescriptions resulting from transitional interventions. Hospital admissions and ED visits were not significantly affected by any interventions. CONCLUSIONS Apps and educational toolkits improved patient knowledge. Pathways increased patient quality of life and provider prescription rates. There is a need for more research to determine the AF transition interventions which maximise patient, provider and health care outcomes.
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Affiliation(s)
- Kathy L Rush
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada.
| | - Lindsay Burton
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Rachel Ollivier
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Ryan Wilson
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Peter Loewen
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Robert Janke
- Library, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Kira Schaab
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Alexandra Lukey
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Camille Galloway
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
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Lau BHP, Lou VW, Cheung KSL. Exemplary Care among Chinese Dementia Familial Caregivers. Healthcare (Basel) 2018; 6:healthcare6040141. [PMID: 30563183 PMCID: PMC6315822 DOI: 10.3390/healthcare6040141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study investigates the feasibility of using the Exemplary Care Scale (ECS) among Chinese dementia familial caregivers, and reports its psychometric properties. METHOD Back translation was used to develop the Chinese version of ECS (C-ECS). Three hundred and ninety-seven dyads of caregivers and their relatives with dementia responded to an assessment battery which included questions on care recipients' cognition, behavioral and psychological symptoms, daily activities assistance, social support, and caregiver well-being. RESULTS Results of an exploratory principal component analysis revealed two subscales in the 11-item C-ECS: considerate caregiving and preserving esteem. C-ECS and its subscales demonstrated sufficient reliability, as well as criteria-related validity through its association with care recipient's cognition and health, and caregivers' well-being and social support. DISCUSSION Our findings provide preliminary support to C-ECS as a reliable and valid measure of exemplary caregiving among Hong Kong Chinese familial dementia caregivers. In the light of the increasing importance of familial care in dementia care planning, we recommend the use of this brief scale in regular caregiver assessment in research and service delivery.
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Affiliation(s)
- Bobo Hi Po Lau
- Department of Counselling and Psychology, Hong Kong Shue Yan University, Hong Kong, China
- Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China
- Correspondence: (B.H.P.L.); (K.S.L.C.)
| | - Vivian Weiqun Lou
- Sau Po Centre on Ageing, University of Hong Kong, Hong Kong, China
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China;
| | - Karen Siu Lan Cheung
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China;
- Mindlink Research Centre, Hong Kong, China
- Correspondence: (B.H.P.L.); (K.S.L.C.)
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Le ST, Josephson SA, Puttgen HA, Gibson L, Guterman EL, Leicester HM, Graf CL, Probasco JC. Many Neurology Readmissions Are Nonpreventable. Neurohospitalist 2016; 7:61-69. [PMID: 28400898 DOI: 10.1177/1941874416674409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Reducing unplanned hospital readmissions has become a national focus due to the Centers for Medicare and Medicaid Services' (CMS) penalties for hospitals with high rates. A first step in reducing unplanned readmission is to understand which patients are at high risk for readmission, which readmissions are planned, and how well planned readmissions are currently captured in comparison to patient-level chart review. METHODS We examined all 5455 inpatient neurology admissions over a 2-year period to University of California San Francisco Medical Center and Johns Hopkins Hospital via chart review. We collected information such as patient age, procedure codes, diagnosis codes, all-payer diagnosis-related group, observed length of stay (oLOS), and expected length of stay. We performed multivariate logistic modeling to determine predictors of readmission. Discharge summaries were reviewed for evidence that a subsequent readmission was planned. RESULTS A total of 353 (6.5%) discharges were readmitted within 30 days. Fifty-five (15.6%) of the 353 readmissions were planned, most often for a neurosurgical procedure (41.8%) or immunotherapy (23.6%). Only 8 of these readmissions would have been classified as planned using current CMS methodology. Patient age (odds ratio [OR] = 1.01 for each 10-year increase, P < .001) and estimated length of stay (OR = 1.04, P = .002) were associated with a greater likelihood of readmission, whereas index admission oLOS was not. CONCLUSIONS Many neurologic readmissions are planned; however, these are often classified by current CMS methodology as unplanned and penalized accordingly. Modifications of the CMS lists for potentially planned neurological and neurosurgical procedures and for acute discharge neurologic diagnoses should be considered.
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Affiliation(s)
- Sidney T Le
- University of California San Francisco, San Francisco, CA, USA
| | | | - Hans A Puttgen
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lorrie Gibson
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elan L Guterman
- University of California San Francisco, San Francisco, CA, USA
| | | | - Carla L Graf
- University of California San Francisco, San Francisco, CA, USA
| | - John C Probasco
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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