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Choi JY, Kim H, Chun S, Jung YI, Yoo S, Oh IH, Kim GS, Ko JY, Lim JY, Lee M, Lee J, Kim KI. Information technology-supported integrated health service for older adults in long-term care settings. BMC Med 2024; 22:212. [PMID: 38807210 PMCID: PMC11134747 DOI: 10.1186/s12916-024-03427-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND To examine the effectiveness and safety of a data sharing and comprehensive management platform for institutionalized older patients. METHODS We applied information technology-supported integrated health service platform to patients who live at long-term care hospitals (LTCHs) and nursing homes (NHs) with cluster randomized controlled study. We enrolled 555 patients aged 65 or older (461 from 7 LTCHs, 94 from 5 NHs). For the intervention group, a tablet-based platform comprising comprehensive geriatric assessment, disease management, potentially inappropriate medication (PIM) management, rehabilitation program, and screening for adverse events and warning alarms were provided for physicians or nurses. The control group was managed with usual care. Co-primary outcomes were (1) control rate of hypertension and diabetes, (2) medication adjustment (PIM prescription rate, proportion of polypharmacy), and (3) combination of potential quality-of-care problems (composite quality indicator) from the interRAI assessment system which assessed after 3-month of intervention. RESULTS We screened 1119 patients and included 555 patients (control; 289, intervention; 266) for analysis. Patients allocated to the intervention group had better cognitive function and took less medications and PIMs at baseline. The diabetes control rate (OR = 2.61, 95% CI 1.37-4.99, p = 0.0035), discontinuation of PIM (OR = 4.65, 95% CI 2.41-8.97, p < 0.0001), reduction of medication in patients with polypharmacy (OR = 1.98, 95% CI 1.24-3.16, p = 0.0042), and number of PIMs use (ꞵ = - 0.27, p < 0.0001) improved significantly in the intervention group. There was no significant difference in hypertension control rate (OR = 0.54, 95% CI 0.20-1.43, p = 0.2129), proportion of polypharmacy (OR = 1.40, 95% CI 0.75-2.60, p = 0.2863), and improvement of composite quality indicators (ꞵ = 0.03, p = 0.2094). For secondary outcomes, cognitive and motor function, quality of life, and unplanned hospitalization were not different significantly between groups. CONCLUSIONS The information technology-supported integrated health service effectively reduced PIM use and controlled diabetes among older patients in LTCH or NH without functional decline or increase of healthcare utilization. TRIAL REGISTRATION Clinical Research Information Service, KCT0004360. Registered on 21 October 2019.
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Affiliation(s)
- Jung-Yeon Choi
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hongsoo Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
- Institute of Aging, Seoul National University, Seoul, Republic of Korea
| | - Seungyeon Chun
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Young-Il Jung
- Department of Environmental Health, Korea National Open University, Seoul, Republic of Korea
| | - Sooyoung Yoo
- Healthcare ICT Research Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In-Hwan Oh
- Department of Preventive Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Gi-Soo Kim
- Department of Industrial Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Jin Young Ko
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Minho Lee
- Healthcare Convergence R&D Center, ezCaretech Co. Ltd, Seoul, Republic of Korea
| | - Jongseon Lee
- Healthcare Convergence R&D Center, Healthconnect Co. Ltd, Seoul, Republic of Korea
| | - Kwang-Il Kim
- Departments of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
- Departments of Internal Medicine, Seoul National University College of Medicine, 82 Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Kyeongi-do, 13620, Republic of Korea.
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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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Kuye IO, Dalal S, Eid S, Gundareddy V. Hospitalists Improving Transitions of Care Through Virtual Collaborative Rounding with Skilled Nursing Facilities-the HiToC SNF Study. J Gen Intern Med 2023; 38:3628-3632. [PMID: 37783978 PMCID: PMC10713912 DOI: 10.1007/s11606-023-08345-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 07/20/2023] [Indexed: 10/04/2023]
Abstract
BACKGROUND Over one in five Medicare patients discharged to skilled nursing facilities (SNFs) are re-hospitalized within 30 days of discharge. Poor communication between the hospital and SNF upon hospital discharge is frequently cited as the most common cause of readmission. AIM The goal of this program was to assess the ability of a weekly post-discharge hospitalist led virtual rounding program to augment the written discharge summary sent to SNFs. SETTING Two academic hospitals and six SNFs in Baltimore, MD. PARTICIPANTS Hospitalists and medical directors or directors of nursing from the partner SNF. PROGRAM DESCRIPTION During weekly encounters, the hospitalist and SNF providers discussed the clinical status, discharge medications, treatment plan, and follow-up care of all discharged patients. The intervention took place from July 2021 to December 2021. PROGRAM EVALUATION During the study, 544 patients were discussed in a post-discharge virtual encounter. After the discussions, hospitalists identified clinically significant errors in 124 discharge summaries. A survey of participating hospitalists and SNF medical and nursing leadership indicated the intervention was thought to improve care transitions. DISCUSSION Our innovation was successful in identifying errors in discharge summaries and was thought to improve the transition of care by participating SNF and hospitalist providers.
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Affiliation(s)
- Ifedayo O Kuye
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Sonia Dalal
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shaker Eid
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Venkat Gundareddy
- Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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MQIHA-ECHO: An Innovative Private-public Partnership to Improve Quality Outcomes in Post-acute Facilities. J Am Med Dir Assoc 2022; 23:1886-1887. [DOI: 10.1016/j.jamda.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 06/21/2022] [Indexed: 11/20/2022]
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Bellantoni J, Clark E, Wilson J, Pendergast J, Pavon JM, White HK, Malone D, Knechtle W, Jolly Graham A. Implementation of a telehealth videoconference to improve hospital-to-skilled nursing care transitions: Preliminary data. J Am Geriatr Soc 2022; 70:1828-1837. [PMID: 35332931 DOI: 10.1111/jgs.17751] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 12/29/2021] [Accepted: 01/01/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transition-related patient safety errors are high among patients discharged from hospitals to skilled nursing facilities (SNFs), and interventions are needed to improve communication between hospitals and SNF providers. Our objective was to describe the implementation of a pilot telehealth videoconference program modeled after Extension for Community Health Outcomes-Care Transitions and examine patient safety errors and readmissions. METHODS A multidisciplinary telehealth videoconference program was implemented at two academic hospitals for patients discharged to participating SNFs. Process measures, patient safety errors, and hospital readmissions were evaluated retrospectively for patients discussed at weekly conferences between July 2019-January 2020. Results were mapped to the constructs of the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) model. Descriptive statistics were reported for the conference process measures, patient and index hospitalization characteristics, and patient safety errors. The primary clinical outcome was all-cause 30-day readmissions. An intention-to-treat (ITT) analysis was conducted using logistic regression models fit to compare the probability of 30-day hospital readmission in patients discharged to participating SNFs across 7 months prior to after telehealth project implementation. RESULTS There were 263 patients (67% of eligible patients) discussed during 26 telehealth videoconferences. Mean discussion time per patient was 7.7 min and median prep time per patient was 24.2 min for the hospital pharmacist and 10.3 min for the hospital clinician. A total of 327 patient safety errors were uncovered, mostly related to communication (54%) and medications (43%). Differences in slopes (program period vs. pre-implementation) of the probability of readmission across the two time periods were not statistically significant (OR 0.95, [95% CI 0.75, 1.19]). CONCLUSIONS A pilot care innovations telehealth videoconference between hospital-based and SNF provider teams was successfully implemented within a large health system and enhanced care transitions by optimizing error-prone transitions. Future work is needed to understand process flow within nursing homes and its impact on clinical outcomes.
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Affiliation(s)
- Julia Bellantoni
- University of Colorado School of Medicine, Department of Medicine, Aurora, Colorado, USA
| | - Elspeth Clark
- Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Jonathan Wilson
- Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Jane Pendergast
- Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina, USA.,Division of Geriatrics, Department of Medicine, Duke University Claude D. Pepper Older Americans Independence Center, Durham, North Carolina, USA
| | - Juliessa M Pavon
- Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina, USA.,Division of Geriatrics, Department of Medicine, Duke University Claude D. Pepper Older Americans Independence Center, Durham, North Carolina, USA.,Geriatric Research Education Clinical Center, Durham Veteran Affairs Health Care System, Durham, North Carolina, USA
| | - Heidi K White
- Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Deanna Malone
- Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - William Knechtle
- Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Aubrey Jolly Graham
- Duke University, Division of General Internal Medicine, Department of Medicine, Durham, North Carolina, USA
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Taupin D, Anderson TS, Merchant EA, Kapoor A, Sokol-Hessner L, Yang JJ, Auerbach AD, Stevens JP, Herzig SJ. Preventability of 30-Day Hospital Revisits Following Admission with COVID-19 at an Academic Medical Center. Jt Comm J Qual Patient Saf 2021; 47:696-703. [PMID: 34548237 PMCID: PMC8383478 DOI: 10.1016/j.jcjq.2021.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic may have affected the preventability of 30-day hospital revisits, including readmissions and emergency department (ED) visits without admission. This study was conducted to examine the preventability of 30-day revisits for patients admitted with COVID-19 in order to inform the design of interventions that may decrease preventable revisits in the future. METHODS The study team retrospectively reviewed a cohort of adults admitted to an academic medical center with COVID-19 between March 21 and June 29, 2020, and discharged alive. Patients with a 30-day revisit following hospital discharge were identified. Two-physician review was used to determine revisit preventability, identify factors contributing to preventable revisits, assess potential preventive interventions, and establish the influence of pandemic-related conditions on the revisit. RESULTS Seventy-six of 576 COVID-19 hospitalizations resulted in a 30-day revisit (13.2%), including 21 ED visits without admission (3.6%) and 55 readmissions (9.5%). Of these 76 revisits, 20 (26.3%) were potentially preventable. The most frequently identified factors contributing to preventable revisits were related to the choice of postdischarge location and to patient/caregiver understanding of the discharge medication regimen, each occurring in 25.0% of cases. The most frequently cited potentially preventive intervention was "improved self-management plan at discharge," occurring in 65.0% of cases. Five of the 20 preventable revisits (25.0%) had contributing factors that were thought to be directly related to the COVID-19 pandemic. CONCLUSION Although only approximately one quarter of 30-day hospital revisits following admission with COVID-19 were potentially preventable, these results highlight opportunities for improvement to reduce revisits going forward.
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