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Landi S, Panella MM, Leardini C. Disentangling organizational levers and economic benefits in transitional care programs: a systematic review and configurational analysis. BMC Health Serv Res 2024; 24:46. [PMID: 38195545 PMCID: PMC10777542 DOI: 10.1186/s12913-023-10461-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/08/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Promoting safe and efficient transitions of care is critical to reducing readmission rates and associated costs and improving the quality of patient care. A growing body of literature suggests that transitional care (TC) programs are effective in improving quality of life and reducing unplanned readmissions for several patient groups. TC programs are highly complex and multidimensional, requiring evidence on how specific practices and system characteristics influence their effectiveness in patient care, readmission reduction and costs. METHODS Using a systematic review and a configurational approach, the study examines the role played by system characteristics (size, ownership, professional skills, technology used), the organizational components implemented, analyzing their combinations, and the potential economic impact of TC programs. RESULTS The more organizational components are implemented, the greater the likelihood that a TC program will be successful in reducing readmission rates. Not all components have the same effect. The results show that certain components, 'post-discharge symptom monitoring and management' and 'discharge planning', are necessary but not sufficient to achieve the outcome. The results indicate the existence of two different combinations of components that can be considered sufficient for the reduction of readmissions. Furthermore, while system characteristics are underexplored, the study shows different ways of incorporating the skill mix of professionals and their mode of coordination in TC programs. Four organizational models emerge: the health-based monocentric, the social-based monocentric, the multidisciplinary team and the mono-specialist team. The economic impact of the programs is generally positive. Despite an increase in patient management costs, there is an overall reduction in all post-intervention costs, particularly those related to readmissions. CONCLUSIONS The results underline the importance of examining in depth the role of system characteristics and organizational factors in facilitating the creation of a successful TC program. The work gives preliminary insights into how to systematize organizational practices and different coordination modes for facilitating decision-makers' choices in TC implementation. While there is evidence that TC programs also have economic benefits, the quality of economic evaluations is relatively low and needs further study.
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Affiliation(s)
- Stefano Landi
- Department of Management, Università di Verona, Via Cantarane, 24, 37129, Verona, Italy.
| | - Maria Martina Panella
- IRCCS- Azienda ospedaliera universitaria Bologna, Policlinico di S.Orsola-Malpighi, Via Pietro Albertoni, 15, Bologna, Italy
| | - Chiara Leardini
- Department of Management, Università di Verona, Via Cantarane, 24, 37129, Verona, Italy
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Saragosa M, Kuluski K, Okrainec K, Jeffs L. “Seeing the day-to-day situation”: A grounded theory of how persons living with dementia and their family caregivers experience the hospital to home transition and beyond. J Aging Stud 2023. [DOI: 10.1016/j.jaging.2023.101132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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Agerholm J, Jensen NK, Liljas A. Healthcare professionals' perception of barriers and facilitators for care coordination of older adults with complex care needs being discharged from hospital: A qualitative comparative study of two Nordic capitals. BMC Geriatr 2023; 23:32. [PMID: 36658516 PMCID: PMC9854150 DOI: 10.1186/s12877-023-03754-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The handover of older adults with complex health and social care from hospital admissions to homebased healthcare requires coordination between multiple care providers. Providing insight to the care coordination from healthcare professionals' views is crucial to show what efforts are needed to manage patient handovers from hospitals to home care, and to identify strengths and weaknesses of the care systems in which they operate. OBJECTIVE This is a comparative study aiming to examine healthcare professionals' perceptions on barriers and facilitators for care coordination for older patients with complex health and social care needs being discharged from hospital in two capital cities Copenhagen (DK) and Stockholm (SE). METHOD Semi-structured interviews were conducted with 25 nurses and 2 assistant nurses involved in the coordination of the discharge process at hospitals or in the home healthcare services (Copenhagen n = 11, Stockholm n = 16). The interview guide included questions on the participants' contributions, responsibilities, and influence on decisions during the discharge process. They were also asked about collaboration and interaction with other professionals involved in the process. The data was analysed using thematic analysis. RESULTS Main themes were communication ways, organisational structures, and supplementary work by staff. We found that there were differences in the organisational structure of the two care systems in relation to integration between different actors and differences in accessibility to patient information, which influenced the coordination. Municipal discharge coordinators visiting patients at the hospital before discharge and the follow-home nurse were seen as facilitators in Copenhagen. In Stockholm the shared information system with access to patient records were lifted as a facilitator for coordination. Difficulties accessing collaborators were experienced in both settings. We also found that participants in both settings to a high degree engage in work tasks outside of their responsibilities to ensure patient safety. CONCLUSIONS There are lessons to be learned from both care systems. The written e-communication between hospitals and home health care runs more smoothly in Stockholm, whereas it is perceived as a one-way communication in Copenhagen. In Copenhagen there are more sector-overlapping work which might secure a safer transition from hospital to home. Participants in both settings initiated own actions to weigh out imperfections of the system.
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Affiliation(s)
- Janne Agerholm
- grid.4714.60000 0004 1937 0626Aging Research Center, Karolinska Institutet, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Natasja Koitzsch Jensen
- grid.5254.60000 0001 0674 042XSector of Social Medicin, Copenhagen University, Copenhagen, Denmark
| | - Ann Liljas
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Shannon B, Shannon H, Bowles KA, Williams C, Andrew N, Morphet J. Health professionals' experience of implementing and delivering a 'Community Care' programme in metropolitan Melbourne: a qualitative reflexive thematic analysis. BMJ Open 2022; 12:e062437. [PMID: 35803639 PMCID: PMC9272113 DOI: 10.1136/bmjopen-2022-062437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore the experiences of health professionals involved in delivering a multidisciplinary Community Care programme that provides a transitional care coordination service for patients visiting a tertiary hospital service in Melbourne, Australia. DESIGN Reflexive thematic analysis was used to identify themes from descriptions of delivering the programme, including its perceived strengths and challenges. PARTICIPANTS 12 healthcare professionals from four disciplines working in the Community Care programme were interviewed. RESULTS Four themes were identified: (1) 'increasingly complex', depicts the experience of delivering care to patients with increasingly complex health needs; (2) 'plugging unexpected gaps', describes meeting patient's healthcare needs; (3) 'disconnected', explains system-based issues which made participants feel disconnected from the wider health service; (4) 'a misunderstood programme', illustrates that a poor understanding of the programme within the health service is a barrier to patient enrolment which may have been exacerbated by a service name change. CONCLUSIONS The healthcare professionals involved in this study described the experience of providing care to patients as challenging, but felt they made a positive difference. By unravelling the patients' health problems in context of their surroundings, they were able to recognise the increasingly complex patients' health needs. The disconnection they faced to integrate within the wider healthcare system made their role at times difficult. This disconnection was partly contributed to by the fact that they felt the programme was misunderstood.
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Affiliation(s)
- Brendan Shannon
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
- Ambulance Victoria, Doncaster, Victoria, Australia
| | - Hollie Shannon
- Department of Social Work and Human Services, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | - Kelly-Ann Bowles
- Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Cylie Williams
- Academic Research Unit, Peninsula Health, Frankston, Victoria, Australia
- School of Primary and Allied Health Care, Monash University, Peninsula, Victoria, Australia
| | - Nadine Andrew
- Peninsula Clinical School, Monash University, Frankston, Victoria, Australia
| | - Julia Morphet
- Nursing & Midwifery, Monash University, Clayton, Victoria, Australia
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Improving In-Hospital Care For Older Adults: A Mixed Methods Study Protocol to Evaluate a System-Wide Sub-Acute Care Intervention in Canada. Int J Integr Care 2022; 22:25. [PMID: 35431701 PMCID: PMC8973798 DOI: 10.5334/ijic.5953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 03/16/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction: Acute care hospitals often inadequately prepare older adults to transition back to the community. Interventions that seek to improve this transition process are usually evaluated using healthcare use outcomes (e.g., hospital re-visit rates) only, and do not gather provider and patient perspectives about strategies to better integrate care. This protocol describes how we will use complementary research approaches to evaluate an in-hospital sub-acute care (SAC) intervention, designed to better prepare and transition older adults home. Methods: In three sequential research phases, we will assess (1) SAC transition pathways and effectiveness using administrative data, (2) provider fidelity to SAC core practices using chart audits, and (3) SAC implementation outcomes (e.g., facilitators and barriers to success, strategies to better integrate care) using provider and patient interviews. Results: Findings from each phase will be combined to determine SAC effectiveness and efficiency; to assess intervention components and implementation processes that ‘work’ or require modification; and to identify provider and patient suggestions for improving care integration, both while patients are hospitalized and to some extent after they transition back home. Discussion: This protocol helps to establish a blueprint for comprehensively evaluating interventions conducted in complex care settings using complementary research approaches and data sources.
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Development of an evidence-based reference framework for care coordination with a focus on the micro level of integrated care: A mixed method design study combining scoping review of reviews and nominal group technique. Health Policy 2022; 126:245-261. [DOI: 10.1016/j.healthpol.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
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Morkisch N, Upegui-Arango LD, Cardona MI, van den Heuvel D, Rimmele M, Sieber CC, Freiberger E. Components of the transitional care model (TCM) to reduce readmission in geriatric patients: a systematic review. BMC Geriatr 2020; 20:345. [PMID: 32917145 PMCID: PMC7488657 DOI: 10.1186/s12877-020-01747-w] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 08/31/2020] [Indexed: 01/19/2023] Open
Abstract
Background Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components’ role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes). Methods Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed. Results Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months). Conclusions Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, without increasing cost. Components such as type of staffing, assessing and managing symptoms, educating and promoting self-management, maintaining relationships and fostering coordination seem to have an important role in reducing the readmission rate. Research is needed to perform further investigations addressing geriatric patients well above 65 years old, to further understand the importance of individual components of the TCM in this population.
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Affiliation(s)
| | - Luz D Upegui-Arango
- Bundesverband Geriatrie e.V, Berlin, Germany.,Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Maria I Cardona
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany
| | | | - Martina Rimmele
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany
| | - Cornel Christian Sieber
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany.,Kantonspital Winterthur/Swiss, Winterthur, Switzerland
| | - Ellen Freiberger
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany.
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Säfström E, Nasstrom L, Liljeroos M, Nordgren L, Årestedt K, Jaarsma T, Stromberg A. Patient Continuity of Care Questionnaire in a cardiac sample: A Confirmatory Factor Analysis. BMJ Open 2020; 10:e037129. [PMID: 32641363 PMCID: PMC7342470 DOI: 10.1136/bmjopen-2020-037129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Even though continuity is essential after discharge, there is a lack of reliable questionnaires to measure and assess patients' perceptions of continuity of care. The Patient Continuity of Care Questionnaire (PCCQ) addresses the period before and after discharge from hospital. However, previous studies show that the factor structure needs to be confirmed and validated in larger samples, and the aim of this study was to evaluate the psychometric properties of the PCCQ with focus on factor structure, internal consistency and stability. DESIGN A psychometric evaluation study. The questionnaire was translated into Swedish using a forward-backward technique and culturally adapted through cognitive interviews (n=12) and reviewed by researchers (n=8). SETTING Data were collected in four healthcare settings in two Swedish counties. PARTICIPANTS A consecutive sampling procedure included 725 patients discharged after hospitalisation due to angina, acute myocardial infarction, heart failure or atrial fibrillation. MEASUREMENT To evaluate the factor structure, confirmatory factor analyses based on polychoric correlations were performed (n=721). Internal consistency was evaluated by ordinal alpha. Test-retest reliability (n=289) was assessed with intraclass correlation coefficient (ICC). RESULTS The original six-factor structure was overall confirmed, but minor refinements were required to reach satisfactory model fit. The standardised factor loadings ranged between 0.68 and 0.94, and ordinal alpha ranged between 0.82 and 0.95. All subscales demonstrated satisfactory test-retest reliability (ICC=0.76-0.94). CONCLUSION The revised version of the PCCQ showed sound psychometric properties and is ready to be used to measure perceptions of continuity of care. High ordinal alpha in some subscales indicates that a shorter version of the questionnaire can be developed.
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Affiliation(s)
- Emma Säfström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Lena Nasstrom
- Research and Development Unit, Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden
| | - Maria Liljeroos
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Lena Nordgren
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden
| | - Kristofer Årestedt
- Faculty of health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Anna Stromberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
- Department of Cardiology, Linköping University Hospital, Linkoping, Sweden
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Lockwood C, Mabire C. Hospital discharge planning: evidence, implementation and patient-centered care. JBI Evid Synth 2020; 18:272-274. [DOI: 10.11124/jbies-20-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Roson Rodriguez P, Franco JVA, Garegnani L, Arancibia M, Escobar Liquitay CM, Mohammad HA. Transitional discharge interventions for people with serious mental illness. Hippokratia 2019. [DOI: 10.1002/14651858.cd009788.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Pablo Roson Rodriguez
- Instituto Universitario Hospital Italiano; Research Department; Potosí 4234 Buenos Aires Argentina 1199
| | - Juan VA Franco
- Instituto Universitario Hospital Italiano; Argentine Cochrane Centre; Potosí 4234 Buenos Aires Buenos Aires Argentina C1199ACL
| | - Luis Garegnani
- Instituto Universitario Hospital Italiano; Research Department; Potosí 4234 Buenos Aires Argentina 1199
| | - Marcelo Arancibia
- Universidad de Valparaíso; Interdisciplinary Centre for Health Studies CIESAL; Viña del Mar Chile
| | | | - Husam Aldeen Mohammad
- Al-Mowasat Hospital, Damascus University; Department of Psychiatry; Damascus Syrian Arab Republic
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Richardson A, Blenkinsopp A, Downs M, Lord K. Stakeholder perspectives of care for people living with dementia moving from hospital to care facilities in the community: a systematic review. BMC Geriatr 2019; 19:202. [PMID: 31366373 PMCID: PMC6668086 DOI: 10.1186/s12877-019-1220-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 07/22/2019] [Indexed: 11/23/2022] Open
Abstract
Background People living with dementia in care homes are regularly admitted to hospital. The transition between hospitals and care homes is an area of documented poor care leading to adverse outcomes including costly re-hospitalisation. This review aims to understand the experiences and outcomes of care for people living with dementia who undergo this transition from the perspectives of key stakeholders; people living with dementia, their families and health care professionals. Methods A systematic search was conducted on the CINAHL, ASSIA, EMBASE, MEDLINE, PsychINFO, and Scopus databases without any date restrictions. We hand searched reference lists of included papers. Papers were included if they focused on people living with dementia moving from hospital to a short or long term care setting in the community including sub-acute, rehabilitation, skilled nursing facilities or care homes. Titles, abstracts and full texts were screened. Two authors independently evaluated study quality using a checklist. Themes were identified and discussed to reach consensus. Results In total, nine papers reporting eight studies met the inclusion criteria for the systematic review. A total of 257 stakeholders participated; 37 people living with dementia, 95 family members, and 125 health and social care professionals. Studies took place in Australia, Canada, United Kingdom (UK), and the United States of America (US). Four themes were identified as factors influencing the experience and outcomes of the transition from the perspectives of stakeholders; preparing for transition; quality of communication; the quality of care; family engagement and roles. Conclusion This systematic review presents a compelling case for the need for robust evidence to guide best practice in this important area of multi-disciplinary clinical practice. The evidence suggests this transition is challenging for all stakeholders and that people with dementia have specific needs which need attention during this period. Trial registration PROSPERO Registration Number: CRD42017082041.
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Kalu ME, Maximos M, Sengiad S, Dal Bello-Haas V. The Role of Rehabilitation Professionals in Care Transitions for Older Adults: A Scoping Review. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2019. [DOI: 10.1080/02703181.2019.1621418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Michael E. Kalu
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Melody Maximos
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Sirirat Sengiad
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Vanina Dal Bello-Haas
- Physical Therapy Program, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Beiler J, Opper K, Weiss M. Integrating Research and Quality Improvement Using TeamSTEPPS. CLIN NURSE SPEC 2019; 33:22-32. [DOI: 10.1097/nur.0000000000000417] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bahr SJ, Weiss ME. Clarifying model for continuity of care: A concept analysis. Int J Nurs Pract 2018; 25:e12704. [DOI: 10.1111/ijn.12704] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 09/17/2018] [Accepted: 09/20/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Sarah J. Bahr
- College of NursingMarquette University Milwaukee Wisconsin USA
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Hall KK, Petsky HL, Chang AB, O'Grady KF. Caseworker-assigned discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness. Cochrane Database Syst Rev 2018; 11:CD012315. [PMID: 30387126 PMCID: PMC6517201 DOI: 10.1002/14651858.cd012315.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Chronic respiratory conditions are major causes of mortality and morbidity. Children with chronic health conditions have increased morbidity associated with their physical, emotional, and general well-being. Acute respiratory exacerbations (AREs) are common in children with chronic respiratory disease, often requiring admission to hospital. Reducing the frequency of AREs and recurrent hospitalisations is therefore an important goal in the individual and public health management of chronic respiratory illnesses in children. Discharge planning is used to decide what a person needs for transition from one level of care to another and is usually considered in the context of discharge from hospital to the home. Discharge planning from hospital for ongoing management of an illness has historically been referral to a general practitioner or allied health professional or self management by the individual and their family with limited communication between the hospital and patient once discharged. Effective discharge planning can decrease the risk of recurrent AREs requiring medical care. An individual caseworker-assigned discharge plan may further decrease exacerbations. OBJECTIVES To evaluate the efficacy of individual caseworker-assigned discharge plans, as compared to non-caseworker-assigned plans, in preventing hospitalisation for AREs in children with chronic lung diseases such as asthma and bronchiectasis. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of Trials, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, trials registries, and reference lists of articles. The latest searches were undertaken in November 2017. SELECTION CRITERIA All randomised controlled trials comparing individual caseworker-assigned discharge planning compared to traditional discharge-planning approaches (including self management), and their effectiveness in reducing the subsequent need for emergency care for AREs (hospital admissions, emergency department visits, and/or unscheduled general practitioner visits) in children hospitalised with an acute exacerbation of chronic respiratory disease. We excluded studies that included children with cystic fibrosis. DATA COLLECTION AND ANALYSIS We used standard Cochrane Review methodological approaches. Relevant studies were independently selected in duplicate. Two review authors independently assessed trial quality and extracted data. We contacted the authors of one study for further information. MAIN RESULTS We included four studies involving a total of 773 randomised participants aged between 14 months and 16 years. All four studies involved children with asthma, with the case-planning undertaken by a trained nurse educator. However, the discharge planning/education differed among the studies. We could include data from only two studies (361 children) in the meta-analysis. Two further studies enrolled children in both inpatient and outpatient settings, and one of these studies also included children with acute wheezing illness (no previous asthma diagnosis); the data specific to this review could not be obtained. For the primary outcome of exacerbations requiring hospitalisation, those in the intervention group were significantly less likely to be rehospitalised (odds ratio (OR) 0.29, 95% confidence interval (CI) 0.16 to 0.50) compared to controls. This equates to 189 (95% CI 124 to 236) fewer admissions per 1000 children. No adverse events were reported in any study. In the context of substantial statistical heterogeneity between the two studies, there were no statistically significant effects on emergency department (OR 0.37, 95% CI 0.04 to 3.05) or general practitioner (OR 0.87, 95% CI 0.22 to 3.44) presentations. There were no data on cost-effectiveness, length of stay of subsequent hospitalisations, or adherence to medications. One study reported quality of life, with no significant differences observed between the intervention and control groups.We considered three of the studies to have an unclear risk of bias, primarily due to inadequate description of the blinding of participants and investigators. The fourth study was assessed as at high risk of bias as a single unblinded investigator was used. Using the GRADE system, we assessed the quality of the evidence as moderate for the outcome of hospitalisation and low for the outcomes of emergency department visits and general practitioner consultations. AUTHORS' CONCLUSIONS Current evidence suggests that individual caseworker-assigned discharge plans, as compared to non-caseworker-assigned plans, may be beneficial in preventing hospital readmissions for acute exacerbations in children with asthma. There was no clear indication that the intervention reduces emergency department and general practitioner attendances for asthma, and there is an absence of data for children with other chronic respiratory conditions. Given the potential benefit and cost savings to the healthcare sector and families if hospitalisations and outpatient attendances can be reduced, there is a need for further randomised controlled trials encompassing different chronic respiratory illnesses, ethnicity, socio-economic settings, and cost-effectiveness, as well as defining the essential components of a complex intervention.
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Affiliation(s)
- Kerry K Hall
- Griffith UniversityMenzies Health Institute QueenslandRecreation RoadNathanBrisbaneQueenslandAustralia4101
| | - Helen L Petsky
- Griffith UniversitySchool of Nursing and Midwifery, Griffith University and Menzies Health Institute QueenslandBrisbaneQueenslandAustralia
| | - Anne B Chang
- Menzies School of Health Research, Charles Darwin UniversityChild Health DivisionPO Box 41096DarwinNorthern TerritoriesAustralia0811
- Queensland University of TechnologyInstitute of Health and Biomedical InnovationBrisbaneAustralia
- Lady Cilento Children's HospitalDepartment of Respiratory and Sleep MedicineBrisbaneAustralia
- Centre for Children's Health ResearchCough, Asthma, Airways Research GroupSouth BrisbaneAustralia
| | - KerryAnn F O'Grady
- Queensland University of TechnologyInstitute of Health and Biomedical InnovationBrisbaneAustralia
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Allen J, Hutchinson AM, Brown R, Livingston PM. User experience and care for older people transitioning from hospital to home: Patients' and carers' perspectives. Health Expect 2017; 21:518-527. [PMID: 29120529 PMCID: PMC5867324 DOI: 10.1111/hex.12646] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2017] [Indexed: 11/29/2022] Open
Abstract
Background Transitioning from hospital to home is challenging for many older people living with chronic health conditions. Transitional care facilitates safe and timely transfer of patients between levels of care and across care settings and includes communication between practitioners, assessment and planning, preparation, medication reconciliation, follow‐up care and self‐management education. To date, there is limited understanding of how to actively involve care recipient service users in transitional care. Objective This study was part of a larger research project. The objective of this article was to report the first study phase, in which we aimed to describe user experience pertaining to patients and carers. Design, setting and participants The study design was qualitative descriptive using interviews. Patients (n = 19) and carers (n = 7) participated in semi‐structured interviews about their experience of transition from hospital to home in an urban Australian health‐care setting. Interview data were analysed using thematic analysis. Findings All participants reported that they needed to become independent in transition. Participants perceived a range of social processes supported their independence at home: supportive relationships with carers, caring relationships with health‐care practitioners, seeking information, discussing and negotiating the transitional care plan and learning to self‐care. Discussion Findings contribute to our understanding that quality transitional care should focus on patients’ need to regain independence. Social processes supporting the capacities of patients and carers should be emphasized in future initiatives. Conclusion Future transitional care interventions should emphasize strategies to enable negotiation for suitable supports and assist care recipients to overcome barriers identified in this study.
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Affiliation(s)
- Jacqueline Allen
- School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia.,Centre for Quality and Patient Safety, Monash Health Partnership, Monash Health, Burwood, Vic., Australia
| | - Rhonda Brown
- School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia
| | - Patricia M Livingston
- Faculty of Health & School of Nursing and Midwifery, Deakin University, Geelong, Burwood, Vic., Australia
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Graham JE, Prvu Bettger J, Middleton A, Spratt H, Sharma G, Ottenbacher KJ. Effects of Acute-Postacute Continuity on Community Discharge and 30-Day Rehospitalization Following Inpatient Rehabilitation. Health Serv Res 2017; 52:1631-1646. [PMID: 28580725 PMCID: PMC5583304 DOI: 10.1111/1475-6773.12678] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine the effects of facility-level acute-postacute continuity on probability of community discharge and 30-day rehospitalization following inpatient rehabilitation. DATA SOURCES We used national Medicare enrollment, claims, and assessment data to study 541,097 patients discharged from 1,156 inpatient rehabilitation facilities (IRFs) in 2010-2011. STUDY DESIGN We calculated facility-level continuity as the percentages of an IRF's patients admitted from each contributing acute care hospital. Patients were categorized into three groups: low continuity (<26 percent from same hospital that discharged the patient), medium continuity (26-75 percent from same hospital), or high continuity (>75 percent from same hospital). The multivariable models included an interaction term to examine the potential moderating effects of facility type (freestanding facility vs. hospital-based rehabilitation unit) on the relationships between facility-level continuity and our two outcomes: community discharge and 30-day rehospitalization. PRINCIPAL FINDINGS Medicare beneficiaries in hospital-based rehabilitation units were more likely to be referred from a high-contributing hospital compared to those in freestanding facilities. However, the association between higher acute-postacute continuity and desirable outcomes is significantly better in freestanding rehabilitation facilities than in hospital-based units. CONCLUSIONS Improving continuity is a key premise of health care reform. We found that both observed referral patterns and continuity-related benefits differed markedly by facility type. These findings provide a starting point for health systems establishing or strengthening acute-postacute relationships to improve patient outcomes in this new era of shared accountability and public quality reporting programs.
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Affiliation(s)
- James E. Graham
- Division of Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonTX
| | | | - Addie Middleton
- Division of Rehabilitation SciencesUniversity of Texas Medical BranchGalvestonTX
| | - Heidi Spratt
- Office of BiostatisticsDepartment of Preventive Medicine & Community HealthUniversity of Texas Medical BranchGalvestonTX
| | - Gulshan Sharma
- Division of Pulmonary Critical Care and Sleep MedicineUniversity of Texas Medical BranchGalvestonTX
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Georgiadis A, Corrigan O. The Experience of Transitional Care for Non-Medically Complex Older Adults and Their Family Caregivers. Glob Qual Nurs Res 2017; 4:2333393617696687. [PMID: 28462358 PMCID: PMC5367270 DOI: 10.1177/2333393617696687] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 01/13/2017] [Accepted: 01/20/2017] [Indexed: 11/17/2022] Open
Abstract
Transitional care research has mainly focused on the experiences of older adults with complex medical conditions. To date, few publications examine the experience of transitional care for non-medically complex older adults. In this article, we draw on and thematically analyze interview and audio-diary data collected at three hospitals in Eastern England, and we explore the experience of transitional care of 18 older adults and family caregivers. Participants reported mixed experiences when describing their care transitions, which indicated variations in care quality. To achieve independence and overcome the difficulties with care transitions, participants used a range of interrogative techniques, such as questioning and information seeking. We contend that the existing transitional care interventions are inappropriate to address the care needs of non-medically complex older adults and family caregivers. Implications for frontline health care staff and health services researchers are discussed.
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Alyousef B, Carayon P, Hoonakker P, Hundt AS, Salek D, Tomcavage J. Obstacles Experienced by Care Managers in Managing Information for the Care of Chronically Ill Patients. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER INTERACTION 2017; 33:313-321. [PMID: 31186604 PMCID: PMC6557451 DOI: 10.1080/10447318.2016.1270017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Care managers play a key role in coordinating care, especially for patients with chronic conditions. They use multiple health information technology application in order to access, process and communicate patient-related information. Using the work system model and its extension, the SEIPS model (Carayon et al., 2006a; Smith and Carayon-Sainfort, 1989), we describe obstacles experienced by care manager in managing patient-related information. A web-based questionnaire was used to collect data from 80 care managers (61% response rate) located in clinics, hospitals and a call center. Care managers were more likely to consider 'inefficiencies in access to patient-related information' and 'having to use multiple information systems' as major obstacles than 'lack of computer training and support' and 'inefficient use of case management software.' Care managers who reported inefficient use of software as an obstacle were more likely to report high workload. Future research should explore strategies used by care managers' to address obstacles, and efforts should be targeted at improving the health information technologies used by care managers.
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Affiliation(s)
| | - Pascale Carayon
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison
| | - Peter Hoonakker
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
| | - Ann Schoofs Hundt
- Center for Quality and Productivity Improvement, University of Wisconsin-Madison
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Hall KK, Chang AB, O'Grady KF. Discharge plans to prevent hospital readmission for acute exacerbations in children with chronic respiratory illness. Hippokratia 2016. [DOI: 10.1002/14651858.cd012315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kerry K Hall
- Queensland University of Technology; Institute of Health and Biomedical Innovation; 62 Graham Street South Brisbane Brisbane Queensland Australia 4101
| | - Anne B Chang
- Queensland University of Technology; Institute of Health and Biomedical Innovation; 62 Graham Street South Brisbane Brisbane Queensland Australia 4101
- Menzies School of Health Research, Charles Darwin University; Child Health Division; PO Box 41096 Darwin Northern Territories Australia 0811
| | - KerryAnn F O'Grady
- Queensland University of Technology; Institute of Health and Biomedical Innovation; 62 Graham Street South Brisbane Brisbane Queensland Australia 4101
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Scott J, Heavey E, Waring J, Jones D, Dawson P. Healthcare professional and patient codesign and validation of a mechanism for service users to feedback patient safety experiences following a care transfer: a qualitative study. BMJ Open 2016; 6:e011222. [PMID: 27406641 PMCID: PMC4947796 DOI: 10.1136/bmjopen-2016-011222] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To develop and validate a mechanism for patients to provide feedback on safety experiences following a care transfer between organisations. DESIGN Qualitative study using participatory methods (codesign workshops) and cognitive interviews. Workshop data were analysed concurrently with participants, and cognitive interviews were thematically analysed using a deductive approach based on the developed feedback mechanism. PARTICIPANTS Expert patients (n=5) and healthcare professionals (n=11) were recruited purposively to develop the feedback mechanism in 2 workshops. Workshop 1 explored principles underpinning safety feedback mechanisms, and workshop 2 included the practical development of the feedback mechanism. Final design and content of the feedback mechanism (a safety survey) were verified by workshop participants, and cognitive interviews (n=28) were conducted with patients. RESULTS Workshop participants identified that safety feedback mechanisms should be patient-centred, short and concise with clear signposting on how to complete, with an option to be anonymous and balanced between positive (safe) and negative (unsafe) experiences. The agreed feedback mechanism consisted of a survey split across 3 stages of the care transfer: departure, journey and arrival. Care across organisational boundaries was recognised as being complex, with healthcare professionals acknowledging the difficulty implementing changes that impact other organisations. Cognitive interview participants agreed the content of the survey was relevant but identified barriers to completion relating to the survey formatting and understanding of a care transfer. CONCLUSIONS Participatory, codesign principles helped overcome differences in understandings of safety in the complex setting of care transfers when developing a safety survey. Practical barriers to the survey's usability and acceptability to patients were identified, resulting in a modified survey design. Further research is required to determine the usability and acceptability of the survey to patients and healthcare professionals, as well as identifying how governance structures should accommodate patient feedback when relating to multiple health or social care providers.
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Affiliation(s)
- Jason Scott
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Emily Heavey
- Social Policy Research Unit, York University, York, UK
| | - Justin Waring
- Centre for Health Innovation, Leadership and Learning, Nottingham University, Nottingham, UK
| | - Diana Jones
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Pamela Dawson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
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Rezk K, Miller CA. Delays in Discharge in Neuro-Oncology: Using a Lean Six Sigma-Inspired Approach to Identify Internal Causes. Can Oncol Nurs J 2016; 26:215-220. [PMID: 31148659 DOI: 10.5737/23688076263215220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Discharge planning processes have implications for patients and families, healthcare providers, and organizations at large. As such, delays in discharge may result in suboptimal patient outcomes, increased resource utilization, and overall disruptions to patient flow. A quality improvement project was conducted using a Lean Six Sigma approach to identify internal causes of delays in discharge in newly diagnosed patients with a high grade glioma on a neurosurgical unit. Internal causes of delays in discharge were related to communication. The main subthemes were multidisciplinary rounds, incongruent messages being delivered to patients and families, and discrepancies between team members resulting in unclear plans. Findings from this project may be used to promote more effective communication that will facilitate safe and timely discharge for neuro-oncology patients.
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Affiliation(s)
| | - Catherine-Anne Miller
- Clinical Nurse Specialist, MUHC Brain Tumour Program, Montreal Neurological Institute and Hospital.,
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24
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Rezk K, Miller CA. Délais dans l’octroi des congés en neuro-oncologie : utilisation d’une approche inspirée des méthodes Lean Six Sigma pour en déterminer les causes internes. Can Oncol Nurs J 2016; 26:221-227. [PMID: 31148712 DOI: 10.5737/23688076263221227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Catherine-Anne Miller
- Infirmière clinicienne spécialisée, Centre de santé de l'Université McGill - Programme de recherche sur les tumeurs cérébrales, Institut et hôpital neurologiques de Montréal.,
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25
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Chen HM, Tu YH, Chen CM. Effect of Continuity of Care on Quality of Life in Older Adults With Chronic Diseases: A Meta-Analysis. Clin Nurs Res 2016; 26:266-284. [PMID: 26790451 DOI: 10.1177/1054773815625467] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
As the population ages, continuity of care (CoC) has increasingly become a particular important issue. Articles published from 1994 to 2014 were identified from electronic databases. Studies with randomized controlled design and elderly adults with chronic illness were included if Short Form-36 (SF-36) was used as an outcome indicator to evaluate the effect of CoC. Seven studies were included for analysis with the sum of 1,394 participants. The results showed that CoC intervention can significantly improve physical function, physical role function, general health, social function, and vitality of QoL for elderly people with chronic disease.
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Affiliation(s)
- Hsiao-Mei Chen
- 1 Institute of Allied Health Sciences College of Medicine, National Cheng Kung University, Tainan City, Taiwan.,2 Cheng Ching Hospital, Taichung City, Taiwan
| | - Yi-Hsuan Tu
- 3 Department of Statistics, National Cheng Kung University, Tainan City, Taiwan
| | - Ching-Min Chen
- 4 Department of Nursing, National Cheng Kung University, Tainan City, Taiwan
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26
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Comparative Effectiveness of Risk-Stratified Care Management in Reducing Readmissions in Medicaid Adults With Chronic Disease. J Healthc Qual 2016. [DOI: 10.1097/01.jhq.0000462683.70630.d7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Allen J, Hutchinson AM, Brown R, Livingston PM. Quality care outcomes following transitional care interventions for older people from hospital to home: a systematic review. BMC Health Serv Res 2014; 14:346. [PMID: 25128468 PMCID: PMC4147161 DOI: 10.1186/1472-6963-14-346] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/01/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Provision of high quality transitional care is a challenge for health care providers in many western countries. This systematic review was conducted to (1) identify and synthesise research, using randomised control trial designs, on the quality of transitional care interventions compared with standard hospital discharge for older people with chronic illnesses, and (2) make recommendations for research and practice. METHODS Eight databases were searched; CINAHL, Psychinfo, Medline, Proquest, Academic Search Complete, Masterfile Premier, SocIndex, Humanities and Social Sciences Collection, in addition to the Cochrane Collaboration, Joanna Briggs Institute and Google Scholar. Results were screened to identify peer reviewed journal articles reporting analysis of quality indicator outcomes in relation to a transitional care intervention involving discharge care in hospital and follow-up support in the home. Studies were limited to those published between January 1990 and May 2013. Study participants included people 60 years of age or older living in their own homes who were undergoing care transitions from hospital to home. Data relating to study characteristics and research findings were extracted from the included articles. Two reviewers independently assessed studies for risk of bias. RESULTS Twelve articles met the inclusion criteria. Transitional care interventions reported in most studies reduced re-hospitalizations, with the exception of general practitioner and primary care nurse models. All 12 studies included outcome measures of re-hospitalization and length of stay indicating a quality focus on effectiveness, efficiency, and safety/risk. Patient satisfaction was assessed in six of the 12 studies and was mostly found to be high. Other outcomes reflecting person and family centred care were limited including those pertaining to the patient and carer experience, carer burden and support, and emotional support for older people and their carers. Limited outcome measures were reported reflecting timeliness, equity, efficiencies for community providers, and symptom management. CONCLUSIONS Gaps in the evidence base were apparent in the quality domains of timeliness, equity, efficiencies for community providers, effectiveness/symptom management, and domains of person and family centred care. Further research that involves the person and their family/caregiver in transitional care interventions is needed.
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Affiliation(s)
- Jacqueline Allen
- />Deakin University, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Alison M Hutchinson
- />Deakin University, School of Nursing and Midwifery; Centre for Nursing Research – Deakin University and Monash Health Partnership, Monash Health, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Rhonda Brown
- />Deakin University, School of Nursing and Midwifery, 221 Burwood Hwy, Burwood, 3125 Vic Australia
| | - Patricia M Livingston
- />Faculty of Health & School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood, 3125 Vic Australia
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Noseworthy AM, Sevigny E, Laizner AM, Houle C, La Riccia P. Mental health care professionals' experiences with the discharge planning process and transitioning patients attending outpatient clinics into community care. Arch Psychiatr Nurs 2014; 28:263-71. [PMID: 25017560 DOI: 10.1016/j.apnu.2014.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/11/2014] [Accepted: 05/11/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care reform promotes delivery of mental health care in the community. Outpatient mental healthcare professionals (HCPs) are pressured to discharge patients. This study's purpose: to understand the experience and perceptions of mental HCPs with discharge planning and transitioning patients into community care. METHODS Twelve HCPs participated in semi-structured qualitative interviews. FINDINGS Three main categories: engaging in the discharge planning process, making the transition smooth, and guiding values emerged. A conceptual framework was created to explain the phenomenon. CONCLUSION HCPs valued strengthening partnerships and building relationships to ensure smooth transition. Sufficient resources and trust imperative for safe patient discharge.
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Affiliation(s)
| | - Elizabeth Sevigny
- McGill University Ingram School of Nursing, Montréal, Québec, Canada.
| | - Andrea M Laizner
- McGill University Health Centre, Royal Victoria Hospital-S11, Montréal, Québec, Canada.
| | - Claudine Houle
- McGill University Health Centre, Royal Victoria Hospital-S11, Montréal, Québec, Canada.
| | - Pina La Riccia
- McGill University Health Centre, Royal Victoria Hospital-S11, Montréal, Québec, Canada.
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29
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D'Angelo D, Mastroianni C, Hammer JM, Piredda M, Vellone E, Alvaro R, De Marinis MG. Continuity of Care During End of Life: An Evolutionary Concept Analysis. Int J Nurs Knowl 2014; 26:80-9. [DOI: 10.1111/2047-3095.12041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Hewner S, Seo JY, Gothard SE, Johnson BJ. Aligning population-based care management with chronic disease complexity. Nurs Outlook 2014; 62:250-8. [PMID: 24882573 DOI: 10.1016/j.outlook.2014.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/11/2014] [Accepted: 03/25/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND Risk-stratified care management requires knowledge of the complexity of chronic disease and comorbidity, information that is often not readily available in the primary care setting. The purpose of this article was to describe a population-based approach to risk-stratified care management that could be applied in primary care. METHODS Three populations (Medicaid, Medicare, and privately insured) at a regional health plan were divided into risk-stratified cohorts based on chronic disease and complexity, and utilization was compared before and after the implementation of population-specific care management teams of nurses. RESULTS Risk-stratified care management was associated with reductions in hospitalization rates in all three populations, but the opportunities to avoid admissions were different. CONCLUSIONS Knowledge of population complexity is critical to the development of risk-stratified care management in primary care, and a complexity matrix can help nurses identify gaps in care and align interventions to cohort and population needs.
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Affiliation(s)
- Sharon Hewner
- University at Buffalo, State University of New York, School of Nursing, Buffalo, NY.
| | - Jin Young Seo
- University at Buffalo, State University of New York, School of Nursing, Buffalo, NY
| | - Sandra E Gothard
- University at Buffalo, State University of New York, School of Nursing, Buffalo, NY
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31
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Seddon D, Krayer A, Robinson C, Woods B, Tommis Y. Care coordination: translating policy into practice for older people. QUALITY IN AGEING AND OLDER ADULTS 2013. [DOI: 10.1108/14717791311327033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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32
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Vandyk AD, Graham ID, VanDenKerkhof EG, Ross-White A, Harrison MB. Towards a conceptual consensus of continuity in mental healthcare: focused literature search and theory analysis. INT J EVID-BASED HEA 2013; 11:94-109. [DOI: 10.1111/1744-1609.12024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Navarro AE, Enguídanos S, Wilber KH. Identifying risk of hospital readmission among Medicare aged patients: an approach using routinely collected data. Home Health Care Serv Q 2012; 31:181-95. [PMID: 22656916 DOI: 10.1080/01621424.2012.681561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Readmission provisions in the Patient Protection and Affordable Care Act of March 2010 have created urgent fiscal accountability requirements for hospitals, dependent upon a better understanding of their specific populations, along with development of mechanisms to easily identify these at-risk patients. Readmissions are disruptive and costly to both patients and the health care system. Effectively addressing hospital readmissions among Medicare aged patients offers promising targets for resources aimed at improved quality of care for older patients. Routinely collected data, accessible via electronic medical records, were examined using logistic models of sociodemographic, clinical, and utilization factors to identify predictors among patients who required rehospitalization within 30 days. Specific comorbidities and discharge care orders in this urban, nonprofit hospital had significantly greater odds of predicting a Medicare aged patient's risk of readmission within 30 days.
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Affiliation(s)
- Adria E Navarro
- Azusa Pacific University, Department of Graduate Social Work, School of Behavioral and Applied Sciences, Azusa, California 91702-7000, USA.
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Bisantz AM, Carayon P, Miller A, Khunlertkit A, Arbaje A, Xiao Y. Using Human Factors And Systems Engineering To Improve Care Coordination. ACTA ACUST UNITED AC 2012. [DOI: 10.1177/1071181312561179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Institute of Medicine (IOM) describes care coordination as one of the six dimensions of health care to overcome barriers and accomplish improvements in the quality of care (IOM, 2001). Care coordination has received more research attention because of its potential to improve the quality and safety of care. Despite numerous efforts to improve care coordination, there is limited evidence regarding their effectiveness and the benefits described vary widely among studies. Moreover, we know little about the specific characteristics of care coordination. In this panel, the speakers will share their experiences regarding (1) barriers to and strategies for effective care coordination, (2) different care coordination mechanisms that affect quality and safety of care, and (3) the use of a human factors engineering approach to understand and improve care coordination. The panel members will use their research experiences and the existing literature to provide a better understanding of different aspects of care coordination and to identify future research directions.
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Affiliation(s)
- Ann M. Bisantz
- University at Buffalo, Department of Industrial and Systems Engineering
| | - Pascale Carayon
- University of Wisconsin-Madison, Department of Industrial and Systems Engineering
| | - Anne Miller
- Vanderbilt University Medical Center, School of Nursing
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35
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Holland DE, Knafl GJ, Bowles KH. Targeting hospitalised patients for early discharge planning intervention. J Clin Nurs 2012; 22:2696-703. [PMID: 22906077 DOI: 10.1111/j.1365-2702.2012.04221.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES The purpose of the study was to describe the ability of an evidence-based discharge planning (DP) decision support tool to identify and prioritise patients appropriate for early DP intervention. Specifically, we aimed to determine whether patients with a high Early Screen for Discharge Planning (ESDP) score report more problems and continuing care needs in the first few weeks after discharge than patients with low ESDP scores. BACKGROUND Improved methods are needed to efficiently and accurately identify hospitalised patients at risk of complex discharge plans. DESIGN A descriptive cross-sectional study was designed using a quality health outcomes framework. METHODS The ESDP was administered to 260 adults hospitalised in an academic health centre who returned home after discharge. Problems and continuing care needs were self-reported on the Problems After Discharge Questionnaire - English Version, mailed 6-10 days after discharge. RESULTS Patients with high ESDP scores reported significantly more problems [mean, 16·3 (standard deviation ±8·7)] than those with low scores [12·2 (±8·4)]. Within the Problems After Discharge Questionnaire subscales, patients with high ESDP scores reported significantly more problems with personal care, household activities, mobility and physical difficulties than patients with low screen scores. Significantly more of the patients with a high ESDP score received consults to a Discharge Planner and referrals for postacute services than patients with low screen scores. CONCLUSION The ESDP is effective as a decision support tool in identifying patients to prioritise for early DP intervention. RELEVANCE TO CLINICAL PRACTICE Use of an evidence-based DP decision support tool minimises biases inherent in decision-making, promotes efficient use of hospital DP resources, and improves the opportunity for patients to access community resources they need to promote successful recovery after hospitalisation.
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Affiliation(s)
- Diane E Holland
- Authors: Diane E Holland, PhD, RN, Clinical Nurse Researcher, Mayo Clinic, Eisenberg, Rochester, MN; George J Knafl, PhD, Professor, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC; Kathryn H Bowles, PhD, RN, FAAN, Associate Professor, Biobehavioral Health Sciences Division, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Aubin M, Giguère A, Martin M, Verreault R, Fitch MI, Kazanjian A, Carmichael PH. Interventions to improve continuity of care in the follow-up of patients with cancer. Cochrane Database Syst Rev 2012:CD007672. [PMID: 22786508 DOI: 10.1002/14651858.cd007672.pub2] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Care from the family physician is generally interrupted when patients with cancer come under the care of second-line and third-line healthcare professionals who may also manage the patient's comorbid conditions. This situation may lead to fragmented and uncoordinated care, and results in an increased likelihood of not receiving recommended preventive services or recommended care. OBJECTIVES To classify, describe and evaluate the effectiveness of interventions aiming to improve continuity of cancer care on patient, healthcare provider and process outcomes. SEARCH METHODS We searched the Cochrane Effective Practice and Organization of Care Group (EPOC) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, and PsycINFO, using a strategy incorporating an EPOC Methodological filter. Reference lists of the included study reports and relevant reviews were also scanned, and ISI Web of Science and Google Scholar were used to identify relevant reports having cited the studies included in this review. SELECTION CRITERIA Randomised controlled trials (including cluster trials), controlled clinical trials, controlled before and after studies and interrupted time series evaluating interventions to improve continuity of cancer care were considered for inclusion. We included studies that involved a majority (> 50%) of adults with cancer or healthcare providers of adults with cancer. Primary outcomes considered for inclusion were the processes of healthcare services, objectively measured healthcare professional, informal carer and patient outcomes, and self-reported measures performed with scales deemed valid and reliable. Healthcare professional satisfaction was included as a secondary outcome. DATA COLLECTION AND ANALYSIS Two reviewers described the interventions, extracted data and assessed risk of bias. The authors contacted several investigators to obtain missing information. Interventions were regrouped by type of continuity targeted, model of care or interventional strategy and were compared to usual care. Given the expected clinical and methodological diversity, median changes in outcomes (and bootstrap confidence intervals) among groups of studies that shared specific features of interest were chosen to analyse the effectiveness of included interventions. MAIN RESULTS Fifty-one studies were included. They used three different models, namely case management, shared care, and interdisciplinary teams. Six additional interventional strategies were used besides these models: (1) patient-held record, (2) telephone follow-up, (3) communication and case discussion between distant healthcare professionals, (4) change in medical record system, (5) care protocols, directives and guidelines, and (6) coordination of assessments and treatment.Based on the median effect size estimates, no significant difference in patient health-related outcomes was found between patients assigned to interventions and those assigned to usual care. A limited number of studies reported psychological health, satisfaction of providers, or process of care measures. However, they could not be regrouped to calculate median effect size estimates because of a high heterogeneity among studies. AUTHORS' CONCLUSIONS Results from this Cochrane review do not allow us to conclude on the effectiveness of included interventions to improve continuity of care on patient, healthcare provider or process of care outcomes. Future research should evaluate interventions that target an improvement in continuity as their primary objective and describe these interventions with the categories proposed in this review. Also of importance, continuity measures should be validated with persons with cancer who have been followed in various settings.
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Affiliation(s)
- Michèle Aubin
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec city, Canada.
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Uijen AA, Schers HJ, Schellevis FG, van den Bosch WJHM. How unique is continuity of care? A review of continuity and related concepts. Fam Pract 2012; 29:264-71. [PMID: 22045931 DOI: 10.1093/fampra/cmr104] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The concept of 'continuity of care' has changed over time and seems to be entangled with other care concepts, for example coordination and integration of care. These concepts may overlap, and differences between them often remain unclear. OBJECTIVE In order to clarify the confusion of tongues and to identify core values of these patient-centred concepts, we provide a historical overview of continuity of care and four related concepts: coordination of care, integration of care, patient-centred care and case management. METHODS We identified and reviewed articles including a definition of one of these concepts by performing an extensive literature search in PubMed. In addition, we checked the definition of these concepts in the Oxford English Dictionary. RESULTS Definitions of continuity, coordination, integration, patient-centred care and case management vary over time. These concepts show both great entanglement and also demonstrate differences. Three major common themes could be identified within these concepts: personal relationship between patient and care provider, communication between providers and cooperation between providers. Most definitions of the concepts are formulated from the patient's perspective. CONCLUSIONS The identified themes appear to be core elements of care to patients. Thus, it may be valuable to develop an instrument to measure these three common themes universally. In the patient-centred medical home, such an instrument might turn out to be an important quality measure, which will enable researchers and policy makers to compare care settings and practices and to evaluate new care interventions from the patient perspective.
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Affiliation(s)
- Annemarie A Uijen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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Negarandeh R, Nayeri ND, Shirani F, Janani L. The impact of discharge plan upon re-admission, satisfaction with nursing care and the ability to self-care for coronary artery bypass graft surgery patients. Eur J Cardiovasc Nurs 2012; 11:460-5. [PMID: 21640653 DOI: 10.1016/j.ejcnurse.2011.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Grafting coronary arteries and post operative recovery has many challenges, which can be ameliorated through continues care and an appropriate discharge plan. Therefore, the current study was undertaken aiming to evaluate the impact of discharge plan on satisfaction with nursing care, ability to self-care, and incidence of re-admission. METHOD This is a quasi experimental study involving patients who were due to undergo coronary artery bypass graft in Chamran Hospital in 2010. In the intervention group, the discharge plan was initiated at the time of admission and continued for 2 weeks after discharge by home visit and telephone follow ups. Satisfaction with nursing care was assessed 2 days after discharge, whilst patients' ability for self-care was measured 6 weeks and 3 months post discharge and the incidence of re-admission was determined at the 3 months point. FINDINGS Satisfaction levels with nursing care and the ability to take self-care were higher in intervention group comparing with control group (p < 0.001). There was a significant difference for self-care ability between pre test and post test in both groups but the improvement was more pronounced for the intervention group (p = 0.04). There was no significant difference between the two groups in terms of re-admission incidence after 3 months (p = 0.15). DISCUSSION AND CONCLUSION The results indicate that the discharge plan, as a method of continual care plan, can lead to higher satisfaction levels and enhanced self-care abilities of patients. Such discharge plan can therefore be utilised as an effective method of continuous care for patients who are going to undergo coronary artery bypass graft.
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Affiliation(s)
- Reza Negarandeh
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Tehran University of Medical Science, Tehran, Iran.
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Byrne K, Orange JB, Ward-Griffin C. Care transition experiences of spousal caregivers: from a geriatric rehabilitation unit to home. QUALITATIVE HEALTH RESEARCH 2011; 21:1371-1387. [PMID: 21525238 DOI: 10.1177/1049732311407078] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The purpose of this study was to develop a theoretical framework about caregivers' experiences and the processes in which they engaged during their spouses' transition from a geriatric rehabilitation unit to home. We used a constructivist grounded theory methodology approach. Forty-five interviews were conducted across three points in time with 18 older adult spousal caregivers. A theoretical framework was developed within which reconciling in response to fluctuating needs emerged as the basic social process. Reconciling included three subprocesses (i.e., navigating, safekeeping, and repositioning), and highlighted how caregivers responded to the fluctuating needs of their spouse, to their own needs, and to those of the marital dyad. Reconciling was situated within a context shaped by a trajectory of prior care transitions and intertwined life events experienced by caregivers. Findings serve as a resource for scientists, rehabilitation clinicians, educators, and decision makers toward improving transitional care for spousal caregivers.
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Affiliation(s)
- Kerry Byrne
- University of British Columbia, Department of Sociology, Vancouver, British Columbia, Canada.
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La dimissione del paziente anziano fragile con complessità assistenziale: un problema o una sfida? ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Gill L, White L, Cameron ID. Qualitative triadic study of the relational factors influencing the formation of quality in a community-based aged health care service network. Health Mark Q 2011; 28:155-73. [PMID: 21590562 DOI: 10.1080/07359683.2011.572004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A service is produced through the interactions of the various service participants. This study aims to identify the factors that influence the interactions of the service providers, recipients, and enablers of a community-based aged health care service, within a single service network. Interviews were conducted with the manager, three care workers, and five clients using the convergent interview technique. Data were analyzed inductively using thematic content analysis. Client focus, client contribution, client empowerment, and provider empowerment were identified as key themes. Whilst these themes are independently supported by the literature, they have previously been studied largely in isolation to each other.
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Affiliation(s)
- Liz Gill
- Department of Pharmacy, The University of Sydney, Australia.
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Rydeman I, Törnkvist L. Getting prepared for life at home in the discharge process--from the perspective of the older persons and their relatives. Int J Older People Nurs 2011; 5:254-64. [PMID: 21083804 DOI: 10.1111/j.1748-3743.2009.00190.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To examine how older persons in need of home-nursing care and their relatives experience the discharge process and develop a model that explains the experience. BACKGROUND The discharge process has well-known deficiencies and is therefore a challenging issue requiring improvement in many countries. Research focusing on patient-centred factors has attracted very little critical attention. DESIGN Grounded theory was used to analyze semi-structured interviews with 26 older persons and their relatives. FINDINGS The analysis resulted in a theoretical model that depicts factors determining whether the older persons and their relatives feel prepared or unprepared for life at home at the time of discharge. CONCLUSIONS The older persons and/or their relatives felt prepared at the time of discharge if their needs were satisfied in the three significant areas of preparation. Not only were the professionals' skills of the utmost importance in preparing the older persons/relatives, but also the latter's own approach if the professionals were unskilled. RELEVANCE FOR CLINICAL PRACTICE A knowledge of the preparation areas and skills can be of use for improving the quality of the discharge process from the older persons' and their relatives' perspective, i.e. through policies, checklists and teaching programmes.
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Affiliation(s)
- IngBritt Rydeman
- Department of Neurobiology, Care Science and Society, Center for family and community medicine, Karolinska Institutet, Stockholm, Sweden.
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Gill L, White L, Cameron I. Transitional aged care and the patient's view of quality. QUALITY IN AGEING AND OLDER ADULTS 2010. [DOI: 10.5042/qiaoa.2010.0285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ellitt GR, Brien JAE, Asiani P, Chen TF. Quality Patient Care and Pharmacists' Role in Its Continuity—A Systematic Review. Ann Pharmacother 2009; 43:677-91. [PMID: 19336645 DOI: 10.1345/aph.1l505] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background:Continuity of care is important for the delivery of quality health care. Despite the abundance of research on this concept in the medical and nursing literature, there is a lack of consensus on its definition. As pharmacists have moved beyond their historical product-centered practice, a source of patient-centered research on continuity of care for practice application is required.Objective:To determine the scope of research in which pharmacists were directly involved in patients' continuity of care and to examine how the phrase continuity of care was defined and applied in practice.Methods:A working definition of continuity of care and a tool for relevance quality assessment of search articles were developed. MEDLINE, International Pharmaceutical Abstracts, EMBASE, and the Cochrane Collaboration evidence-based medicine reviews and bibliographies were searched (1996–March 2008). Reporting clarity was assessed by the Consolidated Standards of Reporting Trials checklist and outcomes were grouped by economic, clinical, and/or humanistic classification.Results:The search yielded 21 clinical and randomized controlled trials, including 11 pharmacist-only and 10 multidisciplinary studies. A broad range of research topics was identified and detailed analysis provided ready reference for considerations of research replication or practice application. Studies revealed a range of research aims, settings, subject characteristics, attrition rates and group sizes, interventions, measurement tools, outcomes, and definitions of continuity of care. Research focused on patients with depression (n = 4), cardiovascular disease {n = 4), diabetes (n = 2), and dyslipidemia (n = 1); specific drugs included non–tricyclic antidepressants, cardiovascular drugs, and benzodiazepines. From the proposed endpoints of economic cost (n = 6) and clinical (n = 14) and humanistic (n = 16) outcomes, 15 studies reported statistically significant results.Conclusions:Medication management at primary, secondary, and tertiary levels of care indicated an expanded role and collaboration of pharmacists in continuity of care. However, the exclusion of disadvantaged patients in 19 studies is at odds with continuity of care for these patients, who may have been the most in need for the same reason that they were excluded.
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Affiliation(s)
- Glena R Ellitt
- MSafetySc, Faculty of Pharmacy, The University of Sydney, Sydney, Australia
| | - Jo-anne E Brien
- Clinical Pharmacy and ProDean, Faculty of Pharmacy, The University of Sydney; Conjoint Professor, Faculty of Medicine, University of New South Wales, Sydney
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Illuminating hospital discharge planning: staff nurse decision making. Appl Nurs Res 2009; 23:198-206. [PMID: 21035029 DOI: 10.1016/j.apnr.2008.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 11/21/2008] [Accepted: 12/02/2008] [Indexed: 11/22/2022]
Abstract
This qualitative study proposed to examine staff RN's decision making related to discharge planning and perceptions of their role. Themes resulting from interviews were "following the script" and "RN as coordinator." The decision to consult a discharge planner occurred when the patient's situation did not follow the RN's expectations. Discharge planning for nonroutine situations was considered disruptive to the RN's workflow. The RN's role was limited to oversight when a discharge planner was involved. Understanding RNs' decision making in this key process provides valuable insights into differentiating routine from nonroutine patient situations and deploying appropriate resources in a timely fashion.
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