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Gusdal AK, Söderman M, Pettersson T, Kaup J, Gustafsson LK. Healthcare and social care professionals' experiences of respite care: a critical incident study. Int J Qual Stud Health Well-being 2024; 19:2352888. [PMID: 38735060 PMCID: PMC11089915 DOI: 10.1080/17482631.2024.2352888] [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: 12/14/2023] [Accepted: 05/05/2024] [Indexed: 05/14/2024] Open
Abstract
INTRODUCTION Aging in place is favoured among older persons and supported by research in Sweden, although it poses challenges for overburdened informal caregivers. While respite care can offer support, its accessibility is hindered by organizational challenges and informal caregivers' delays in using it. The experiences of informal caregivers are well-studied, but the professionals' experiences of respite care quality and critical incident management are underexplored. AIM To explore professionals' experiences of critical incidents in respite care, consequences for the persons being cared for, and strategies to manage critical incidents. MATERIALS AND METHODS A qualitative, critical incident technique was used, and three group interviews with a total of 16 professionals were conducted. RESULTS Barriers to quality respite care included communication gaps during care transitions, environmental shortcomings in respite care facilities, lack of support for informal caregivers, and inadequacies in respite care decisions. Strategies to manage critical incidents included individualized care, continuity and communication in care transitions, a conducive environment, support for informal caregivers, and care professionals' positive approach. CONCLUSIONS The study emphasizes the need for focused efforts on communication, continuity, and a supportive environment. Addressing identified challenges and applying suggested strategies will be key to maximizing the potential of respite care as a vital support for care recipients and their informal caregivers.
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Affiliation(s)
- Annelie K. Gusdal
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
| | - Mirkka Söderman
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
| | - Tina Pettersson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
| | - Jaana Kaup
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
| | - Lena-Karin Gustafsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna/Västerås, Sweden
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Beck SH, Eilertsen G, Andersen-Ranberg K, Janssens A, Nielsen DS. In the footstep of the old patient from hospital to home: A qualitative field observation study. Scand J Caring Sci 2024; 38:745-755. [PMID: 38610099 DOI: 10.1111/scs.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/25/2024] [Accepted: 03/09/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Older people often have multiple health conditions and therefore extended care needs. The transition from the hospital back to their home requires careful planning. The fragmented healthcare system and rapid discharge from the hospital can result in limited involvement of the older patient in the discharge planning process. We aimed to explore how older hospitalised patients experienced the transition from hospital to home and how possibilities and constraints in interactions with relevant parties in the transition affected their everyday lives. METHOD An ethnographic participant observation study including interviews was conducted with 10 older hospitalised patients. The theoretical perspective in the study is critical psychology and data were analysed using the condition-, meaning- and reasoning analysis. RESULTS Three themes were identified: (1) Lost in transition - the person's ability to act is limited, (2) In transition - the relatives become important, (3) At home - the home transforms into a workplace. CONCLUSION Lack of involvement becomes a condition for older patients as some struggle to create meaning in their transition, affecting their everyday lives. The patients experienced their relatives as important as they ensured that the HCPs got to know their values and wishes. This knowledge is important for HCPs working closely with older people both at the hospital and at home ensuring active involvement of the older person with respect and acknowledgement of the older person's wishes, needs, resources and vulnerability.
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Affiliation(s)
- Sanne Have Beck
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, Faculty of Health and Social Sciences, Universitetet I Sørøst-Norge, Drammen, Norway
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Astrid Janssens
- Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Public Health, User Perspective and Community-Based Interventions, University of Southern Denmark, Odense, Denmark
- Centre for Research with Patients and Relatives, Odense University Hospital, Odense, Denmark
- University of Exeter Medical School, Exeter, UK
| | - Dorthe Susanne Nielsen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
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Khalil M, Woldesenbet S, Munir MM, Khan MMM, Rashid Z, Altaf A, Katayama E, Dillhoff M, Tsai S, Pawlik TM. Impact of early primary care physician follow-up on hospital readmission following gastrointestinal cancer surgery. J Surg Oncol 2024; 130:241-248. [PMID: 38798272 DOI: 10.1002/jso.27696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND We sought to examine the association between primary care physician (PCP) follow-up on readmission following gastrointestinal (GI) cancer surgery. METHODS Patients who underwent surgery for GI cancer were identified using the Surveillance, Epidemiology and End Results (SEER) database. Multivariable regression was performed to examine the association between early PCP follow-up and hospital readmission. RESULTS Among 60 957 patients who underwent GI cancer surgery, 19 661 (32.7%) visited a PCP within 30-days after discharge. Of note, patients who visited PCP were less likely to be readmitted within 90 days (PCP visit: 17.4% vs. no PCP visit: 28.2%; p < 0.001). Median postsurgical expenditures were lower among patients who visited a PCP (PCP visit: $4116 [IQR: $670-$13 860] vs. no PCP visit: $6700 [IQR: $870-$21 301]; p < 0.001). On multivariable analysis, PCP follow-up was associated with lower odds of 90-day readmission (OR: 0.52, 95% CI: 0.50-0.55) (both p < 0.001). Moreover, patients who followed up with a PCP had lower risk of death at 90-days (HR: 0.50, 95% CI: 0.40-0.51; p < 0.001). CONCLUSION PCP follow-up was associated with a reduced risk of readmission and mortality following GI cancer surgery. Care coordination across in-hospital and community-based health platforms is critical to achieve optimal outcomes for patients.
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Affiliation(s)
- Mujtaba Khalil
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Muhammad Muntazir Mehdi Khan
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Zayed Rashid
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Abdullah Altaf
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Erryk Katayama
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Mary Dillhoff
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Susan Tsai
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
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Oche O, Murry LT, Keller MS, Pevnick JM, Schnipper JL, Nguyen AT, Ko EM, Kennelty KA. Pharmacist, nurse, and physician perspectives on the implementation of the pharmacist discharge care (pharm-dc) intervention: A qualitative study. Res Social Adm Pharm 2024; 20:740-746. [PMID: 38744561 PMCID: PMC11235093 DOI: 10.1016/j.sapharm.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/25/2024] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND The PHARMacist Discharge Care (PHARM-DC) intervention is a pharmacist-led Transitions of Care (TOC) program intended to reduce 30-day hospital readmissions and emergency department visits which has been implemented at two hospitals in the United States. The objectives of this study were to: 1) explore perspectives surrounding the PHARM-DC program from healthcare providers, leaders, and administrators at both institutions, and 2) identify factors which may contribute to intervention success and sustainability. METHODS Focus groups and interviews were conducted with pharmacists, physicians, nurses, hospital leaders, and pharmacy administrators at two institutions in the Northeastern and Western United States. Interviews were audio recorded and transcribed, with transcriptions imported into NVivo for qualitative analysis. Thematic analysis was performed using an iterative process, with two study authors independently coding transcripts to identify themes. RESULTS Overall, 37 individuals participated in ten focus groups and seven interviews. The themes identified included: 1) Organizational, Pharmacist, and Patient Factors Contributing to Transitions of Care, 2) Medication Challenges in Transitions of Care at Admission and Discharge, 3) Transitions of Care Communication and Discharge Follow-up, and 4) Opportunities for Improvement and Sustainability. The four themes were mapped to the constructs of the CFIR and RE-AIM frameworks. Some factors facilitating intervention success and sustainability were accurate medication histories collected on admission, addressing medication barriers before discharge, coordinating discharge using electronic health record discharge features, and having a structured process for intervention training and delivery. Barriers to intervention implementation and sustainability included gaps in communication with other care team members, and variable pharmacist skills for delivering the intervention. This study identified that using educational resources to standardize the TOC process addressed the issue of variations in pharmacists' skills for delivering TOC interventions. CONCLUSIONS Nurses, physicians, pharmacists, pharmacist leaders, and hospital administrators were in agreement regarding the usefulness of the PHARM-DC intervention, while acknowledging challenges in its implementation and opportunities for improvement. Future research should focus on developing training materials to standardize and scale the intervention, eliminating barriers to medication access pre-discharge, coordinating discharge across care team members, and communicating medication changes to primary care providers post-discharge.
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Affiliation(s)
- Onyeche Oche
- The University of Iowa College of Pharmacy, Department of Pharmacy Practice and Science, 180 Grand Ave Iowa City, IA 52246, United States.
| | - Logan T Murry
- The University of Iowa College of Pharmacy, Department of Pharmacy Practice and Science, 180 Grand Ave Iowa City, IA 52246, United States.
| | - Michelle S Keller
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, United States.
| | - Joshua M Pevnick
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States; Division of Informatics, Department of Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
| | - Jeffrey L Schnipper
- Medicine Unit, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
| | - An T Nguyen
- Division of General Internal Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
| | - EunJi Michelle Ko
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, MA, United States.
| | - Korey A Kennelty
- The University of Iowa College of Pharmacy, Department of Pharmacy Practice and Science, 180 Grand Ave Iowa City, IA 52246, United States; The University of Iowa College of Medicine, Department of Family Medicine, United States.
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Han Y, Chen J, Xu Y, Huang P, Hou L. Nurse-led medication management as a critical component of transitional care for preventing drug-related problems. Aging Clin Exp Res 2024; 36:151. [PMID: 39060872 PMCID: PMC11282160 DOI: 10.1007/s40520-024-02799-3] [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: 04/23/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
Drug-related problems (DRPs) are critical medical issues during transition from hospital to home with high prevalence. The application of a variety of interventional strategies as part of the transitional care has been studied for preventing DRPs. However, it remains challenging for minimizing DRPs in patients, especially in older adults and those with high risk of medication discrepancies after hospital discharge. In this narrative review, we demonstrated that age, specific medications and polypharmacy, as well as some patient-related and system-related factors all contribute to a higher prevalence of transitional DPRs, most of which could be largely prevented by enhancing nurse-led multidisciplinary medication reconciliation. Nurses' contributions during transitional period for preventing DRPs include information collection and evaluation, communication and education, enhancement of medication adherence, as well as coordination among healthcare professionals. We concluded that nurse-led strategies for medication management can be implemented to prevent or solve DRPs during the high-risk transitional period, and subsequently improve patients' satisfaction and health-related outcomes, prevent the unnecessary loss and waste of medical expenditure and resources, and increase the efficiency of the multidisciplinary teamwork during transitional care.
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Affiliation(s)
- Yingting Han
- Department of Nursing, Renhe Hospital, Baoshan District, No. 1999, West Changjiang Rd, Baoshan District, Shanghai, 200431, China.
| | - Jia Chen
- Department of Nursing, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No. 639, Zhizaoju Rd, Huangpu District, Shanghai, 200011, China
| | - Yulei Xu
- Department of Nursing, Renhe Hospital, Baoshan District, No. 1999, West Changjiang Rd, Baoshan District, Shanghai, 200431, China
| | - Peihua Huang
- Department of Nursing, Renhe Hospital, Baoshan District, No. 1999, West Changjiang Rd, Baoshan District, Shanghai, 200431, China
| | - Lili Hou
- Department of Nursing, Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, No. 639, Zhizaoju Rd, Huangpu District, Shanghai, 200011, China.
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Ling T, Basic D, Tcharkhedian E, Campisi J, Pringle B, Khoo A. Care in the Community: A COVID-19 initiative to reduce hospital re-presentations among community-dwelling people. Australas J Ageing 2024. [PMID: 39007519 DOI: 10.1111/ajag.13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 05/12/2024] [Accepted: 06/11/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE The COVID-19 pandemic has had a substantial impact on the utilisation of hospital and emergency department (ED) services. We examined the effect of a rapid response service on hospital re-presentations among people discharged from the ED and short-stay wards at a tertiary referral hospital. METHODS This retrospective cohort study compared 112 patients who completed the Care in the Community program with 112 randomly selected controls. Both cases and controls were discharged from hospital between September 2020 and June 2021. Intervention patients were evaluated by a multidisciplinary team, who implemented a goal-directed program of up to 4-weeks duration. Logistic regression, negative binomial regression and Cox proportional hazards regression were used to evaluate outcomes at 28 days and at 6 months. RESULTS The median time between referral and the first home visit was 3.9 days. In adjusted analyses, the intervention reduced hospital re-presentations at 28 days (odds ratio: .40, 95% confidence interval (CI): .17-.94) and lengthened the time to the first hospital re-presentation (hazard ratio: .59, 95% CI: .38-.92). Although the intervention did not reduce the total number of hospital re-presentations at 6 months (adjusted incidence rate ratio: .73, 95% CI: .49-1.08), it reduced total time spent in hospital by 303 days (582 vs. 885). CONCLUSIONS This study is among the first to investigate the effect of a community-based intervention on hospital re-presentations during the COVID-19 pandemic. It provides evidence that a sustainable 4-week intervention is associated with reduced hospital re-presentations and time spent in hospital.
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Affiliation(s)
- Tammy Ling
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - David Basic
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Elise Tcharkhedian
- Department of Physiotherapy, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Josephine Campisi
- Department of Occupational Therapy, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Bernadette Pringle
- Aged Care Services Emergency Team, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Angela Khoo
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
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Arbaje AI, Hsu YJ, Keita M, Greyson S, Wang J, Werner NE, Carl K, Hohl D, Jones K, Bowles KH, Chan KS, Marsteller JA, Gurses AP, Leff B. Development and Validation of the Hospital-to-Home-Health Transition Quality (H3TQ) Index: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality: A Novel Measure to Engage Patients and Home Health Providers in Evaluating Hospital-to-Home Care Transition Quality. Qual Manag Health Care 2024; 33:140-148. [PMID: 37348080 PMCID: PMC10730761 DOI: 10.1097/qmh.0000000000000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Patients requiring skilled home health care (HH) after hospitalization are at high risk of adverse events. Human factors engineering (HFE) approaches can be useful for measure development to optimize hospital-to-home transitions. OBJECTIVE To describe the development, initial psychometric validation, and feasibility of the Hospital-to-Home-Health-Transition Quality (H3TQ) Index to identify patient safety risks. METHODS Development : A multisite, mixed-methods study at 5 HH agencies in rural and urban sites across the United States. Testing : Prospective H3TQ implementation on older adults' hospital-to-HH transitions. Populations Studied : Older adults and caregivers receiving HH services after hospital discharge, and their HH providers (nurses and rehabilitation therapists). RESULTS The H3TQ is a 12-item count of hospital-to-HH transitions best practices for safety that we developed through more than 180 hours of observations and more than 80 hours of interviews. The H3TQ demonstrated feasibility of use, stability, construct validity, and concurrent validity when tested on 75 transitions. The vast majority (70%) of hospital-to-HH transitions had at least one safety issue, and HH providers identified more patient safety threats than did patients/caregivers. The most frequently identified issues were unsafe home environments (32%), medication issues (29%), incomplete information (27%), and patients' lack of general understanding of care plans (27%). CONCLUSIONS The H3TQ is a novel measure to assess the quality of hospital-to-HH transitions and proactively identify transitions issues. Patients, caregivers, and HH providers offered valuable perspectives and should be included in safety reporting. Study findings can guide the design of interventions to optimize quality during the high-risk hospital-to-HH transition.
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Affiliation(s)
- Alicia I. Arbaje
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yea-Jen Hsu
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Maningbe Keita
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Sylvan Greyson
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jiangxia Wang
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Nicole E. Werner
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin—Madison, Madison, Wisconsin
| | | | - Dawn Hohl
- Johns Hopkins Home Care Group, Baltimore, Maryland
| | - Kate Jones
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Kathryn H. Bowles
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, School of Nursing, University of Pennsylvania
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
| | - Kitty S. Chan
- MedStar-Georgetown Surgical Outcomes Research Center, MedStar Health Research Institute and Medstar Georgetown University Hospital, Washington, DC
| | - Jill A. Marsteller
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Ayse P. Gurses
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
- Department of Community and Public Health, Johns Hopkins School of Nursing, Baltimore, Maryland
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Komijani Z, Hosseini M, Nasiri M, Vasli P. The effects of a hospital-to-home care transition program on perceived stress and readiness for hospital discharge in mothers of children with congenital heart disease undergoing corrective surgery. J Pediatr Nurs 2024:S0882-5963(24)00249-5. [PMID: 38944620 DOI: 10.1016/j.pedn.2024.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND The aim of this study was to investigate the effects of a hospital-to-home care transition (H2H-CT) program on perceived stress and readiness for hospital discharge (RHD) in mothers of children with congenital heart disease (CHD) undergoing corrective surgery. METHODS This study used a quasi-experimental design and involved 78 mother-child dyads, 40 dyads in the intervention group and 38 dyads in the control group, who were affected by CHD undergoing corrective surgery. The participants received the H2H-CT program, which consisted of six face-to-face training sessions during hospitalization and six telephone counselling sessions. For perceived stress, data were collected at four intervals, including baseline, immediately, one month and three months after completion of the intervention. For RHD, data were collected at two times: baseline and immediately after the intervention. RESULTS The results demonstrated a statistically significant reduction in the mean perceived stress score in mothers of children with CHD in intervention group before, immediately, four weeks and eight weeks after H2H-CT (P < 0.001). The results also indicated a significant increase in the mean RHD score in the intervention group following H2H-CT (P < 0.001). CONCLUSION The H2H-CT program was found to be an effective intervention in reducing perceived stress and increasing RHD in mothers of children with CHD who undergoing corrective surgery. IMPLICATIONS TO PRACTICE The results can be used by the nursing planners, nursing instructors, and pediatric nurses to use the results to enhance the mental health of mothers and enable them to provide quality care at home.
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Affiliation(s)
- Zohre Komijani
- Student Research Committee, Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Meimanat Hosseini
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- Department of Basic Sciences, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvaneh Vasli
- Department of Community Health Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Zhai S, Zhang Z, Zhang R, Peng Y, Zhang J, Zhang Y, Jin Q, Zhou J, Chen J. Community-dwelling older adults' perspectives on health risks: a qualitative study exploring anxieties, priorities, and expectations in ageing. BMC Public Health 2024; 24:1657. [PMID: 38907192 PMCID: PMC11191137 DOI: 10.1186/s12889-024-18878-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 05/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND With the conflict between the promise of ageing in health and longevity and the limited availability of health resources and social support, older adults in China inevitably experience anxieties surrounding health risks. This study aims to investigate how older adults perceive the health risks that come with getting older, explore the degree to which health risks affect older adults, and advocate for active engagement in practices for managing health risks. METHODS Using purposive sampling, three districts of Beijing (Xicheng District, Fengtai District, and Daxing District, respectively) were selected for the research. Qualitative semi-structured and in-depth interviews were conducted with 70 community-dwelling older adults who participated in the study. Data were extracted and analyzed based on a thematic framework approach. RESULTS Three main themes were identified: (i) the anxieties of older adults concerning health risks in ageing; (ii) the priorities of older adults for health risk management in ageing; (iii) the expectations of older adults for health risk management in ageing. The primary health concerns among older adults included disease incidence and function decline. It was found that basic health management emerged as a critical need for older adults to mitigate health risks. Moreover, it was observed that healthcare support for older adults from familial, institutional, and governmental levels exhibited varying degrees of inadequacy. CONCLUSIONS The primary source of anxieties among older adults regarding health risks predominantly stems from a perceived sense of health deprivation. It is often compounded by persistent barriers to primary care of priorities in managing health risks among older adults. In addition, the expectations of older adults for health risk management emphasize the necessity for integrated care approaches. Therefore, further research should give priority to the prevention and management of health risks, aim to reduce anxieties, provide integrated care to meet the primary needs and expectations of older adults, and ultimately strive toward the overarching goal of promoting health and longevity.
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Affiliation(s)
- Shaoqi Zhai
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Zhiying Zhang
- Outpatient Office, Beijing Luhe Hospital, Capital Medical University, Beijing, 101149, China
| | - Ruyi Zhang
- Ethics Committee Office, Beijing Ditan Hospital, Capital Medical University, No. 8 Jingshun East Street, Chaoyang District, Beijing, 100015, China
| | - Yingchun Peng
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China.
| | - Jiaying Zhang
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Yiyao Zhang
- School of Medical Humanities, Capital Medical University, No.10, Xitoutiao, You An Men Wai, Beijing, 100069, China
| | - Qilin Jin
- Cardiac Surgery Department, People's Hospital of Beijing Daxing District, No.26, Huangcun West Street, Daxing District, Beijing, 102600, China
| | - Jiaojiao Zhou
- Fengtai District Xiluoyuan Community Health Service Centre, Beijing, 100077, China
| | - Jingjing Chen
- Huairou District Liulimiao Community Health Service Centre, Beijing, 101499, China
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Simon SL, Phimphasone-Brady P, McKenney KM, Gulley LD, Bonny AE, Moore JM, Torres-Zegarra C, Cree MG. Comprehensive transition of care for polycystic ovary syndrome from adolescence to adulthood. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:443-455. [PMID: 38552655 DOI: 10.1016/s2352-4642(24)00019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 05/18/2024]
Abstract
Polycystic ovary syndrome (PCOS) is a lifelong chronic condition that affects one in ten females and can be diagnosed in adolescence. As adolescents with PCOS transition to adulthood, counselling for lifestyle management and mental health concerns often transition from involving the family unit to increasingly individual-focused approaches. PCOS is associated with a large range of comorbidities affecting reproductive, metabolic, dermatological, and psychological health. The diagnosis and comorbidities of PCOS are influenced by pubertal hormones and need to be reassessed continuously to ensure that treatment remains appropriate for age and development. As young patients grow up, personal concerns often change, especially in relation to reproductive management. In this Review, we present prevalence rates, screening tools, and treatment recommendations for PCOS-related conditions, and we consider the diagnostic and clinical elements of optimal transition of care models that ensure continuity of comprehensive care for adolescents moving from the paediatric health-care system to the adult health-care system.
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Affiliation(s)
- Stacey L Simon
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Children's Hospital Colorado Aurora, CO, USA.
| | | | - Kathryn M McKenney
- Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lauren D Gulley
- Children's Hospital Colorado Aurora, CO, USA; Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Andrea E Bonny
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jaime M Moore
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Children's Hospital Colorado Aurora, CO, USA
| | - Carla Torres-Zegarra
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Children's Hospital Colorado Aurora, CO, USA
| | - Melanie G Cree
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Ludeman Center for Women's Health Research, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Children's Hospital Colorado Aurora, CO, USA
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11
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Nelson MLA, MacEachern E, Prvu Bettger J, Camicia M, García JJ, Kapral MK, Mathiesen C, Cameron JI. Exploring the Inclusion of Person-Centered Care Domains in Stroke Transitions of Care Interventions: A Scientific Statement From the American Heart Association. Stroke 2024; 55:e169-e181. [PMID: 38557155 DOI: 10.1161/str.0000000000000462] [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] [Indexed: 04/04/2024]
Abstract
BACKGROUND Health care teams along the stroke recovery continuum have a responsibility to support care transitions and return to the community. Ideally, individualized care will consider patient and family preferences, best available evidence, and health care professional input. Person-centered care can improve patient-practitioner interactions through shared decision-making in which health professionals and institutions are sensitive to those for whom they provide care. However, it is unclear how the concepts of person-centered care have been described in reports of stroke transitional care interventions. METHODS A secondary analysis of a systematic review and meta-analysis was undertaken. We retrieved all included articles (n=17) and evaluated the extent to which each intervention explicitly addressed 7 domains of person-centered care: alignment of care with patients' values, preferences, and needs; coordination of care; information and education; physical comfort; emotional support; family and friend involvement; and smooth transition and continuity of care. RESULTS Most of the articles included some aspects of person-centeredness; we found that certain domains were not addressed in the descriptions of transitional care interventions, and no articles mentioned all 7 domains of person-centered care. We identified 3 implications for practice and research: (1) delineating person-centered care components when reporting interventions, (2) elucidating social and cultural factors relevant to the study sample and intervention, and (3) clearly describing the role of family and nonmedical support in the intervention. CONCLUSIONS There is still room for greater consistency in the reporting of person-centeredness in stroke transitions of care interventions, despite a long-standing definition and conceptualization of person-centered care in academic and clinically focused literature.
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Jehloh L, Songwathana P, Kitrungrote L, Bourbonnais A. Perspectives of family caregivers and nurses on hospital discharge transitional care for Muslim older adults living with COPD: a qualitative study. BMC Nurs 2024; 23:273. [PMID: 38659051 PMCID: PMC11044287 DOI: 10.1186/s12912-024-01943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The increased number of emergency department visits among older adults living with chronic obstructive pulmonary disease reflects the challenges of hospital discharge transition, especially in those from a cultural minority. The barriers and facilitators of this discharge from the perspective of formal and informal care providers, such as nurses and family caregivers, are important to identify to provide effective symptom management and quality of care. The purpose of this study was to describe the barriers and facilitators in caring for Muslim older adults with chronic obstructive pulmonary disease (COPD) during hospital discharge transitional care. METHODS A descriptive qualitative study was conducted in a hospital of Thailand where Muslim people are a cultural minority. Thirteen family caregivers of Muslim older adults living with COPD and seven nurses were purposively recruited and participated in semi-structured interviews and focus group discussions. Content analysis was used to analyze the data. RESULTS Five barriers and three facilitating factors of transitional care for Muslim older adults living with COPD were outlined. Barriers included: (1) lack of knowledge about the causes and management of dyspnea, (2) inadequate discharge preparation, (3) language barrier, (4) discontinuity of care, and (5) COVID-19 epidemic. Facilitators included: (1) the ability to understand Malayu language, (2) the presence of healthcare professionals of the same gender, and (3) the presence of Muslim healthcare providers. CONCLUSION Family caregivers require more supportive care to meet the care needs of Muslim older adults living with COPD. Alternative nurse-based transitional care programs for these older adult caregivers should be developed.
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Affiliation(s)
- Latifah Jehloh
- Faculty of Nursing, Prince of Narathiwas University, Muang, Narathiwat, Thailand
| | - Praneed Songwathana
- Faculty of Nursing, Prince of Songkla University, Hatyai, Songkhla, Thailand.
| | - Luppana Kitrungrote
- Faculty of Nursing, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, Montréal, Québec, Canada
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13
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Jensen LWH, Rahbek O, Lauritsen REK, Kold S, Dinesen B. Patient Perspectives on Communication Pathways After Orthopedic Surgery and Discharge and Evaluation of Team-Based Digital Communication: Qualitative Exploratory Study. JMIR Hum Factors 2024; 11:e49696. [PMID: 38551641 PMCID: PMC11015373 DOI: 10.2196/49696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/29/2024] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND The transition from hospital to home after orthopedic surgery requires smooth communication and coordination between patients and their team of care to avoid fragmented care pathways. Digital communication is increasingly being used to facilitate easy and accessible asynchronous communication between patients and health care professionals across settings. A team-based approach to digital communication may provide optimized quality of care in the postoperative period following orthopedic surgery and hospital discharge. OBJECTIVE This study was divided into two phases that aimed to (1) explore the perspectives of patients undergoing orthopedic surgery on current communication pathways at a tertiary hospital in Denmark and (2) test and explore patients' experiences and use of team-based digital communication following hospital discharge (eDialogue). METHODS A triangulation of qualitative data collection techniques was applied: document analysis, participant observations (n=16 hours), semistructured interviews with patients before (n=31) and after (n=24) their access to eDialogue, and exploration of use data. RESULTS Findings show that patients experience difficult communication pathways after hospital discharge and a lack of information due to inadequate coordination of care. eDialogue was used by 84% (26/31) of the patients, and they suggested that it provided a sense of security, coherence, and proximity in the aftercare rearranging communication pathways for the better. Specific drivers and barriers to use were identified, and these call for further exploration of eDialogue. CONCLUSIONS In conclusion, patients evaluated eDialogue positively and suggested that it could support them after returning home following orthopedic surgery.
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Affiliation(s)
- Lili Worre Høpfner Jensen
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Kold
- Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Birthe Dinesen
- Laboratory for Welfare Technologies - Digital Health & Rehabilitation, Sport Sciences - Performance & Technology, Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
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14
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Jensen LWH, Rahbek O, Lauritsen REK, Kold S, Dinesen B. Health Care Professionals' Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study. JMIR Hum Factors 2024; 11:e53391. [PMID: 38457798 PMCID: PMC10960209 DOI: 10.2196/53391] [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: 10/09/2023] [Revised: 11/21/2023] [Accepted: 01/31/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs' needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. OBJECTIVE This study aimed to (1) investigate HCPs' perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). METHODS We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. RESULTS HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. CONCLUSIONS eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources.
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Affiliation(s)
- Lili Worre Høpfner Jensen
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Rahbek
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | | | - Søren Kold
- Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Aalborg, Denmark
| | - Birthe Dinesen
- Laboratory for Welfare Technologies-Digital Health and Rehabilitation, ExerciseTech, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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15
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Condon B, Griffin A, Fitzgerald C, Shanahan E, Glynn L, O'Connor M, Hayes C, Manning M, Galvin R, Leahy A, Robinson K. Older adults experience of transition to the community from the emergency department: a qualitative evidence synthesis. BMC Geriatr 2024; 24:233. [PMID: 38448831 PMCID: PMC10916040 DOI: 10.1186/s12877-024-04751-6] [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: 08/15/2023] [Accepted: 01/27/2024] [Indexed: 03/08/2024] Open
Abstract
AIM Older adults comprise a growing proportion of Emergency Department (ED) attendees and are vulnerable to adverse outcomes following an ED visit including ED reattendance within 30 days. Interventions to reduce older adults' risk of adverse outcomes following an ED attendance are proliferating and often focus on improving the transition from the ED to the community. To optimise the effectiveness of interventions it is important to determine how older adults experience the transition from the ED to the community. This study aims to systematically review and synthesise qualitative studies reporting older adults' experiences of transition to the community from the ED. METHODS Six databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES, PsycINFO, and Social Science Full Text) were searched in March 2022 and 2023. A seven-step approach to meta-ethnography, as described by Noblit and Hare, was used to synthesise findings across included studies. The methodological quality of the included studies was appraised using the 10-item Critical Appraisal Skills Programme (CASP) checklist for qualitative research. A study protocol was registered on PROSPERO (Registration: CRD42022287990). FINDINGS Ten studies were included, and synthesis led to the development of five themes. Unresolved symptoms reported by older adults on discharge impact their ability to manage at home (theme 1). Limited community services and unresolved symptoms drive early ED reattendance for some older adults (theme 2). Although older adults value practical support and assistance transporting home from the ED this is infrequently provided (theme 3). Accessible health information and interactions are important for understanding and self-managing health conditions on discharge from the ED (theme 4). Fragmented Care between ED and community is common, stressful and impacts on older adult's ability to manage health conditions (theme 5). A line of argument synthesis integrated these themes into one overarching concept; after an ED visit older adults often struggle to manage changed, complex, health and care needs at home, in the absence of comprehensive support and guidance. DISCUSSION/ CONCLUSION Key areas for consideration in future service and intervention development are identified in this study; ED healthcare providers should adapt their communication to the needs of older adults, provide accessible information and explicitly address expectations about symptom resolution during discharge planning. Concurrently, community health services need to be responsive to older adults' changed health and care needs after an ED visit to achieve care integration. Those developing transitional care interventions should consider older adults needs for integration of care, symptom management, clear communication and information from providers and desire to return to daily life.
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Affiliation(s)
- Brian Condon
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Christine Fitzgerald
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Elaine Shanahan
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- HRB, Primary Care Clinical Trials Network, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
- School of Medicine, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Christina Hayes
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Aoife Leahy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Maximos M, Dal Bello-Haas V, Tang A, Stratford P, Kalu M, Virag O, Kaasalainen S, Gafni A. Barriers and Facilitators of a Community-Based, Slow-Stream Rehabilitation, Hospital-to-Home Transition Program for Older Adults: Perspectives of a Multidisciplinary Care Team. Can J Aging 2024; 43:124-140. [PMID: 37665030 DOI: 10.1017/s0714980823000442] [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] [Indexed: 09/05/2023] Open
Abstract
The purpose of this study was to examine the perspectives of support staff, health care professionals, and care coordinators working in or referring to a community-based, slow-stream rehabilitation, hospital-to-home transition program regarding gaps in services, and barriers and facilitators related to implementation and functioning of the program. This was a qualitative descriptive study. Recruitment was conducted through purposive sampling, and 23 individuals participated in a focus groups or individual semi-structured interview. Transcripts were analyzed by six researchers using inductive thematic analysis. Themes that emerged were organized based on a socio-ecological framework. Themes were categorized as: (1) macro level, meaning gaps while waiting for program, limited program capacity, and gaps in service post-program completion; (2) meso level, meaning lack of knowledge and awareness of the program, lack of specific referral process and procedures, lack of specific eligibility criteria, and need for enhanced communication among care settings; or (3) micro level, meaning services provided, program participant benefits, person-centred communication, program structure constraints, need for use of outcome measures, and follow-up or lack of follow-up. Implementation of seamless patient information sharing, documentation, use of specific referral criteria, and use of standardized outcome measures may reduce the number of unsuitable referrals and provide useful information for referral and program staff.
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Affiliation(s)
- Melody Maximos
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Paul Stratford
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Michael Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Olivia Virag
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Sharon Kaasalainen
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Amiram Gafni
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
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Michaelis C, Hundt E, Lombardi W, Howie Esquivel J. Transitions in care: Piloting a neurocritical care clinic with nurse practitioners and physician associates. J Am Assoc Nurse Pract 2024; 36:153-159. [PMID: 37751220 DOI: 10.1097/jxx.0000000000000950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/25/2023] [Indexed: 09/27/2023]
Abstract
ABSTRACT The transition period from hospital to home is a vulnerable time for rehospitalization and adverse events for patients. Follow-up clinic visits within 7-14 days of discharge is an effective strategy for reducing hospital readmissions. Neurocritical care patients have a unique set of needs to safely transition to home. We evaluated the feasibility of a Neuroscience Rapid Follow-Up Clinic with nurse practitioners (NPs) and physician associates (PAs) to meet transitional care gaps in neurocritical care patients and prevent rehospitalization. Clinic procedures and documentation templates were customized for the pilot clinic. Five NPs and one PA underwent a brief training course for the ambulatory care setting. Eligible patients were tracked throughout the hospitalization and the team made follow-up appointments. The pilot clinic took place from October 2022 to January 2023. Nine patients were seen in the clinic approximately 8 days after discharge. The clinic attendance rate was 90%. Among the clinic attendees, 66% received referrals to a primary care provider or other services, one third received medication changes or refills and all received patient-specific education. There were no rehospitalizations among the clinic patients. Implementation of this pilot clinic was possible with the current departmental resources. This innovative model of care has the potential to reduce hospital readmissions.
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Affiliation(s)
| | - Elizabeth Hundt
- University of Virginia School of Nursing, Charlottesville, Virginia
| | - William Lombardi
- UVA Center for Advanced PracticeUVA Center for Advanced Practice, University of Virginia Medical Center, Charlottesville, Virginia
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18
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Berthelsen C, Møller N, Bunkenborg G. Transitional care model for older adults with multiple chronic conditions: An evaluation of benefits utilising an umbrella review. J Clin Nurs 2024; 33:481-496. [PMID: 38108223 DOI: 10.1111/jocn.16913] [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: 01/27/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 12/19/2023]
Abstract
AIMS To synthesise and describe the combined evidence from systematic reviews of interventions using elements from the Transitional Care Model, on the content and timeframe of the interventions and the related improvement of outcomes for older patients with multiple chronic conditions. BACKGROUND The population of older patients with multiple chronic conditions is increasing worldwide and trajectories are often complicated by risk factors. The Transitional Care Model may contain elements to support transitions between hospital and home. DESIGN An umbrella review. REVIEW METHODS A comprehensive search in five electronic databases was performed in April 2021 based on the search terms: 'Patients ≥60 years,' 'multi-morbidity,' 'Transitional care model,' 'Transitional care,' and 'Systematic review.' PRISMA guidelines was used. RESULTS Five systematic reviews published from 2011 to 2020 comprising 62 intervention studies (59 randomised controlled trials and three quasi-experimental trials) were included in the review. The synthesis predominantly revealed significant improvements in decreasing re-admissions and financial costs and increasing patients' quality of life and satisfaction during discharge. CONCLUSION The results of the review indicate that multiple elements from the Transitional Care Model have achieved significant improvements in older patients' transitions from hospital to home. Especially a combination of coordination, communication, collaboration and continuity of care in transitions, organised information and education for patients and pre-arranged structured post-discharge follow-ups. IMPACT The transition from hospital to home is a complex process for older patients with multiple chronic conditions. A specific focus on coordination, continuity, and patient education should be implemented in the discharge process. Nurses with specialised knowledge in transitional care are needed to ensure safe transitions. PATIENT AND PUBLIC CONTRIBUTION The umbrella review is part of a larger research program which involved a patient expert advisory board, which participated in discussing the relevance of the elements within the umbrella review.
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Affiliation(s)
- Connie Berthelsen
- Medical department, Zealand University Hospital, Køge, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Nicoline Møller
- Research Unit, Zealand University Hospital, Roskilde, Denmark
| | - Gitte Bunkenborg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Roskilde, Denmark
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19
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Mosher HJ, Hadlandsmyth K, Alexander B, Lund BC. Continuation of Buprenorphine During Hospitalization and Subsequent Retention in Therapy: an Observational Study in Veterans Administration Hospitals. J Gen Intern Med 2024; 39:207-213. [PMID: 37752303 PMCID: PMC10853128 DOI: 10.1007/s11606-023-08420-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Inpatient hospitalization has the potential to disrupt buprenorphine therapy. OBJECTIVE Among patients receiving outpatient buprenorphine prior to admission, we determined the rate of discontinuation during medical and surgical admissions to VA hospitals and its association with subsequent post-discharge continuation of buprenorphine therapy. DESIGN AND MAIN MEASURES We conducted an observational study using Veterans Administration data from 10/1/2018 to 3/31/2020 for all medical and surgical admissions where Veterans had active buprenorphine prescriptions at the time of admission. Pre-admission buprenorphine prescriptions were categorized as either sublingual (presumed indication for opioid use disorder (OUD)) or buccal/topical (presumed indication for pain). The primary measure of post-discharge buprenorphine receipt was any outpatient buprenorphine prescription dispensed between 1 day prior to discharge and 60 days following discharge. KEY RESULTS A total of 830 unique inpatient hospitalizations to medical or surgical services occurred among Veterans receiving sublingual (48.3%) or buccal/topical (51.7%) buprenorphine prior to admission. Fewer than half (43.9%) of these patients received buprenorphine at some point during the medical or surgical portion of their hospital stay. Among the 766 patients discharged from a medical or surgical unit, 74.3% received an outpatient buprenorphine prescription within the 60 days following discharge (80.2% sublingual and 69.1% buccal/topical). Among patients who had received buprenorphine during the final 36 h prior to discharge, subsequent outpatient buprenorphine receipt was observed in 94.0%, compared to only 63.7% among those not receiving buprenorphine during the final 36 h (χ2 = 83.5, p < 0.001). CONCLUSION Inpatient buprenorphine administrations near the time of discharge were highly predictive of continued outpatient therapy and a significant subset of patients did not continue or reinitiate buprenorphine therapy following discharge. As recommendations for perioperative and inpatient management of buprenorphine coalescence around continuation, efforts are needed to optimize hospital-based buprenorphine practices.
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Affiliation(s)
- Hilary J Mosher
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Katherine Hadlandsmyth
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA.
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Bruce Alexander
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA
| | - Brian C Lund
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA
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20
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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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Mardani A, Azizi M, Alazmani Noodeh F, Alizadeh A, Maleki M, Vaismoradi M, Glarcher M. A concept analysis of transitional care for people with cancer. Nurs Open 2024; 11:e2083. [PMID: 38268301 PMCID: PMC10803885 DOI: 10.1002/nop2.2083] [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: 02/17/2023] [Revised: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
AIM Transitional care as the journey between different caregivers in multiple healthcare centres is crucial for the provision of care to people with cancer, but it is often complex and poorly coordinated. This study aimed to analyse the concept of transitional care for people with cancer. DESIGN Rodgers' evolutionary concept analysis. METHODS A systematic literature search was conducted on the databases of PubMed (including MEDLINE), EMBASE, Scopus and Web of Science to retrieve articles published between 2000 and 2022. RESULTS Twenty-nine eligible articles were selected and their findings were classified in terms of related concepts and alternative terms, antecedents, attributes and consequences. Attributes included three main categories, namely 'nurse-related attributes', 'organisation-related attributes' and 'patient-related attributes'. Antecedents of transitional care for people with cancer were categorized into two main categories: 'patient-related antecedents' and 'caregiver-related antecedents'. Consequences were categorized into 'psychological consequences' and 'objective consequences'.
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Affiliation(s)
- Abbas Mardani
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyZanjan University of Medical SciencesZanjanIran
| | - Maryam Azizi
- Department of Health in Disaster and Emergencies, Faculty of NursingAja University of Medical SciencesTehranIran
| | - Farshid Alazmani Noodeh
- Critical Care Nursing Department, Faculty of NursingAja University of Medical SciencesTehranIran
| | - Azizeh Alizadeh
- Department of Education and Research, Army Center of Excellence (NEZAJA)Center of Consultation of Khanevadeh HospitalTehranIran
| | - Maryam Maleki
- Department of Pediatric and Neonatal Intensive Care Nursing Education, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health SciencesNord UniversityBodøNorway
- Faculty of Science and HealthCharles Sturt UniversityOrangeNew South WalesAustralia
| | - Manela Glarcher
- Institute of Nursing Science and PracticeParacelsus Medical UniversitySalzburgAustria
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Mohamedsharif A, Elfeaki M, Bushra R, Gemperli A. Effectiveness of hospital-to-home transitional care interventions and consultation for implementation in Sudan: a scoping review of systematic reviews. FRONTIERS IN HEALTH SERVICES 2023; 3:1288575. [PMID: 38162192 PMCID: PMC10755884 DOI: 10.3389/frhs.2023.1288575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024]
Abstract
Background Hospital discharge is often associated with a lack of continuity resulting in fragmented care, particularly in low-income countries. As there is limited information about interventions in these countries and no study evaluating the effectiveness of hospital discharge interventions, we conducted a scoping review to identify effective hospital-to-home transitional care interventions and explore their applicability in a low-income country (Sudan). Methods Our scoping review of systematic reviews and meta-analyses classed interventions as effective, ineffective, undesirable, or uncertain, based on the quality of their evidence and their estimated effects on the following outcomes: readmission rates, mortality, costs, quality of life, and adverse outcomes) and certainty of evidence. Our authors from Sudan used the SUPPORT summary tool to determine if three effective interventions could be implemented in Sudan. Results Out of 3,276 articles that were identified, and 72 articles were reviewed, 10 articles has been included in the review. Seven interventions were classified as effective, one as ineffective, and none with undesirable effects. Eight interventions were classified as having an uncertain effect. The effective interventions were composed of home visits, information and communication technology (ICT), case manager models, multidisciplinary teams, and self-management support. Conclusions The finding of this study suggested that a combining two to four interventions can improve enhance hospital-to-home transitional care. Effective interventions are composed of home visits, ICT, case manager models, multidisciplinary teams, and self-management support. The implementation of these interventions in Sudan was found to be undermined by contextual factors such as inadequate human resources, telecommunication instability, and inequality in accessibility. These interventions could be tailored based on an in-depth understanding of the contextual factors in low-income countries that influence implementation. Systematic Review Registration https://osf.io/9eqvr/, doi: 10.17605/OSF.IO/9EQVR.
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Affiliation(s)
- Asma Mohamedsharif
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Mohammed Elfeaki
- Directorate of Quality, Development and Accreditation, Federal Ministry of Health, Khartoum, Sudan
| | - Rayan Bushra
- Department of General Medicine, Ibrahim Malik Teaching Hospital, Khartoum, Sudan
| | - Armin Gemperli
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center of Primary and Community Care, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
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23
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Golan L. "Secrets From the Children's Room": New Understandings of Inappropriate and Abusive Sexual Behavior Among Siblings after the COVID-19 Crisis in Israel. TRAUMA, VIOLENCE & ABUSE 2023; 24:3037-3048. [PMID: 36154745 DOI: 10.1177/15248380221124255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This article discusses the COVID-19 crisis's impact on inappropriate and abusive sexual behavior among siblings (IASBAS) and how perceptions of this phenomenon affect construction of the post-crisis reality in Israel. Sibling sexual abuse, the most frequent type of sexual assault against children, does not occur in a vacuum; it is affected by the environment in which children live and develop. The pandemic created situational risk factors and a "germination substrate" for risk of abuse in "normative" families and escalation in families in which it had previously occurred. The first part of the article, based on research data and reports, reviews the objective reality that emerged in Israel and worldwide due to the pandemic. Part two describes situational risk factors converging to a new dangerous situation for children's abuse and victimization that resulted from this crisis: domestic violence (direct, indirect, and sexual), at-risk children returning and staying at home, increased exposure to online sexual content, parental dysfunction, and lack of formal and informal support sources. These risk factors are mutually reinforcing, thus exacerbating the risk of sexual assault among siblings. Part three describes the etiology characterizing the complex phenomenon of IASBAS. Part four discusses the significance of the risk factors at various stages and conditions for its development, identification, prevention or preventing escalation, and providing professional support, all of which affect the post-crisis reality. Part five offers recommendations for prevention, detection, and intervention that help deal with the reality "the day after."
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Affiliation(s)
- Limor Golan
- Kinneret College on the Sea of Galilee, Tiberias, Israel
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24
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Bolster-Foucault C, Holyoke P. Resource Utilization Groups in transitional home care: validating the RUG-III/HC case-mix system in hospital-to-home care programs. BMC Health Serv Res 2023; 23:1324. [PMID: 38037101 PMCID: PMC10687885 DOI: 10.1186/s12913-023-10150-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/16/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Transitional hospital-to-home care programs support safe and timely transition from acute care settings back into the community. Case-mix systems that classify transitional care clients into groups based on their resource utilization can assist with care planning, calculating reimbursement rates in bundled care funding models, and predicting health human resource needs. This study evaluated the fit and relevance of the Resource Utilization Groups version III for Home Care (RUG-III/HC) case-mix classification system in transitional care programs in Ontario, Canada. METHODS We conducted a retrospective analysis of clinical assessment data and administrative billing records from a cohort of clients (n = 1,680 care episodes) in transitional home care programs in Ontario. We classified care episodes into established RUG-III/HC groups based on clients' clinical and functional characteristics and calculated four case-mix indices to describe care relative resource utilization in the study sample. Using these indices in linear regression models, we evaluated the degree to which the RUG-III/HC system can be used to predict care resource utilization. RESULTS A majority of transitional home care clients are classified as being Clinically complex (41.6%) and having Reduced physical functions (37.8%). The RUG-III/HC groups that account for the largest share of clients are those with the lowest hierarchical ranking, indicating low Activities of Daily Living limitations but a range of Instrumental Activities of Daily Living limitations. There is notable heterogeneity in the distribution of clients in RUG-III/HC groups across transitional care programs. The case-mix indices reflect decreasing hierarchical resource use within but not across RUG-III/HC categories. The RUG-III/HC predicts 23.34% of the variance in resource utilization of combined paid and unpaid care time. CONCLUSIONS The distribution of clients across RUG-III/HC groups in transitional home care programs is remarkably different from clients in long-stay home care settings. Transitional care programs have a higher proportion of Clinically complex clients and a lower proportion of clients with Reduced physical function. This study contributes to the development of a case-mix system for clients in transitional home care programs which can be used by care managers to inform planning, costing, and resource allocation in these programs.
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Affiliation(s)
- Clara Bolster-Foucault
- Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, 2001 McGill College, Montreal, QC, Canada.
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, Canada.
| | - Paul Holyoke
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, Canada
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Listorti E, Pastore E, Alfieri A. How to direct patients to high-volume hospitals: exploring the influencing drivers. BMC Health Serv Res 2023; 23:1269. [PMID: 37974191 PMCID: PMC10655263 DOI: 10.1186/s12913-023-10229-9] [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: 11/30/2022] [Accepted: 10/26/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND During the last decade, planning concentration policies have been applied in healthcare systems. Among them, attention has been given to guiding patients towards high-volume hospitals that perform better, acccording to the volume-outcome association. This paper analyses which factors drive patients to choose big or small hospitals (with respect to the international standards of volumes of activity). METHODS We examined colon cancer surgeries performed in Piedmont (Italy) between 2004 and 2018. We categorised the patient choice of the hospital as big/small, and we used this outcome as main dependent variable of descriptive statistics, tests and logistic regression models. As independent variables, we included (i) patient characteristics, (ii) characteristics of the closest big hospital (which should be perceived as the most immediate to be chosen), and (iii) territorial characteristics (i.e., characteristics of the set of hospitals among which the patient can choose). We also considered interactions among variables to examine which factors influence all or a subset of patients. RESULTS Our results confirm that patient personal characteristics (such as age) and hospital characteristics (such as distance) play a primary role in the patient decision process. The findings seem to support the importance of closing small hospitals when they are close to big hospitals, although differences emerge between rural and urban areas. Other interesting insights are provided by examining the interactions between factors, e.g., patients affected by comorbidities are more responsive to hospital quality even though they are distant. CONCLUSIONS Reorganising healthcare services to concentrate them in high-volume hospitals emerged as a crucial issue more than forty years ago. Evidence suggests that concentration strategies guarantee better clinical performance. However, in healthcare systems in which patients are free to choose where to be treated, understanding patients' behaviour and what drives them towards the most effective choice is of paramount importance. Our study builds on previous research that has already analysed factors influencing patients' choices, and takes a step further to enlighten which factors drive patients to choose between a small or a big hospital (in terms of volume). The results could be used by decision makers to design the best concentration strategy.
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Affiliation(s)
- Elisabetta Listorti
- Centre for Research on Health and Social Care Management (CERGAS), SDA Bocconi School of Management - Bocconi University, Milan, Italy.
| | - Erica Pastore
- Department of Management and Production Engineering, Politecnico di Torino, Turin, Italy
| | - Arianna Alfieri
- Department of Management and Production Engineering, Politecnico di Torino, Turin, Italy
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Radcliff T, Ayele R, McCreight M, Lui W, Battaglia C. Implementation of VA care coordination program to improve transitional care for veterans post-non-VA hospital discharge: an incremental cost analysis. Implement Sci Commun 2023; 4:135. [PMID: 37957780 PMCID: PMC10642017 DOI: 10.1186/s43058-023-00513-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The Veterans Affairs (VA) Healthcare System Community Hospital Transitions Program (CHTP) was implemented as a nurse-led intervention to reduce barriers that patients experience when transitioning from community hospitals to VA primary care settings. A previous analysis indicated that veterans who enrolled in CHTP received timely follow-up care and communications that improved care coordination, but did not examine cost implications for the VA. METHODS A budget impact analysis used the VA (payer) perspective. CHTP implementation team members and study records identified key resources required to initially implement and run the CHTP. Statistical analysis of program participants and matched controls at two study sites was used to estimate incremental VA primary care costs per veteran. Using combined program implementation, operations, and healthcare cost estimates to guide key model assumptions, overall CHTP costs were estimated for a 5-year time horizon, including a discount rate of 3%, annual inflation of 2.5%, and a sensitivity analysis that considered two options for staffing the program at VA Medical Center (VAMC) sites. RESULTS Implementation at two VAMCs required 3 months, including central program support and site-level onboarding, with costs of $34,094 (range: $25,355-$51,602), which included direct and indirect resource costs of personnel time, materials, space, and equipment. Subsequent annual costs to run the program at each site depended heavily on the staffing mix and caseload of veterans, with a baseline estimate of $193,802 to $264,868. Patients enrolled in CHTP had post-hospitalization VA primary care costs that were higher than matched controls. Over 5 years, CHTP sites staffed to serve 25-30 veterans per full-time equivalent transition team member per month had an estimated budget impact of $625 per veteran served if the transitional team included a medical social worker to support veterans with more social behavioral needs and less complex medical cases or $815 per veteran if nurses served all cases. CONCLUSIONS Evidence-based care coordination programs that support patients' return to VA primary care after a community hospital stay are feasible to implement and run. Further, flexibility in staffing this type of program is increasingly relevant as the VA and other healthcare systems consider methods to reduce provider burnout, optimize staffing, reduce costs, and address other staffing challenges while improving patient care.
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Affiliation(s)
- Tiffany Radcliff
- Denver-Seattle Center of Innovation, Department of Veterans Affairs, VA Eastern Colorado Healthcare System, MS 151, Aurora, CO, USA.
- School of Public Health, Texas A&M University, 157B SPH Administration Building, MS 1266, College Station, TX, 77843-1266, USA.
| | - Roman Ayele
- Denver-Seattle Center of Innovation, Department of Veterans Affairs, VA Eastern Colorado Healthcare System, MS 151, Aurora, CO, USA
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marina McCreight
- Denver-Seattle Center of Innovation, Department of Veterans Affairs, VA Eastern Colorado Healthcare System, MS 151, Aurora, CO, USA
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Wenhui Lui
- Denver-Seattle Center of Innovation, Department of Veterans Affairs, VA Eastern Colorado Healthcare System, MS 151, Aurora, CO, USA
| | - Catherine Battaglia
- Denver-Seattle Center of Innovation, Department of Veterans Affairs, VA Eastern Colorado Healthcare System, MS 151, Aurora, CO, USA
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Varela T, Zamorano P, Muñoz P, Espinoza M, Tellez A, Irazoqui E, Suarez F. Evaluation of a Transitional Care Strategy Implemented in Adults With High-Risk and Multimorbidity in Chile. Value Health Reg Issues 2023; 38:85-92. [PMID: 37634320 DOI: 10.1016/j.vhri.2023.07.003] [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: 11/03/2022] [Revised: 07/10/2023] [Accepted: 07/26/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES Fragmentation of continuity of care impacts the health system's efficiency and increases inequity. It severely affects high-risk patients with multimorbidity, requiring coordinated care to avoid preventable complications. The Centro de Innovación en Salud ANCORA UC, together with the Servicio de Salud Metropolitano Sur Oriente, and the National Health Fund, implemented a transitional care strategy for high-risk adults with multimorbidity at 3 hospitals in the southeast of Santiago. The study aimed to evaluate the impact on length of hospital stay, consultations with primary care physicians and contacts after discharge, and also to describe the implementation process of the transition nurse activities. METHODS A cohort study was performed between 2017 and 2019, with 137 hospitalizations from exposed patients and 167 hospitalizations from unexposed patients. The results of the study showed a significant decrease in the length of hospital stays and an increase in consultations with physicians. RESULTS The results of the implementation process showed that the transition nurse followed-up in a mean of 24 hospitalizations monthly, and 91% of the discharged patients were contacted via the telephone within 7 days. The implementation process showed that the transition nurse's tasks merged with the daily clinical activities in which training on case management, transition care, and continuous support were key aspects of success. CONCLUSION We conclude that transitional care intervention has a strong potential in addressing fragmentation of care and is feasible to install and sustain over time in the Chilean context. Finally, this study provides a detailed description of the intervention strategy contributing to its spread and scale-up.
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Affiliation(s)
- Teresita Varela
- Centro de Innovación en Salud ANCORA UC, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paula Zamorano
- Centro de Innovación en Salud ANCORA UC, Pontificia Universidad Católica de Chile, Santiago, Chile; Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Paulina Muñoz
- Centro de Innovación en Salud ANCORA UC, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel Espinoza
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile Santiago, Santiago, Chile.
| | - Alvaro Tellez
- Centro de Innovación en Salud ANCORA UC, Pontificia Universidad Católica de Chile, Santiago, Chile; Departamento de Medicina Familiar UC, Centro de Innovación en Salud ANCORA UC, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Esteban Irazoqui
- Centro de Innovación en Salud ANCORA UC, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Suarez
- Unidad de Análisis y Gestión de la Información en Salud, Servicio de Salud Metropolitano Sur Oriente, Santiago, Chile
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Fakha A, de Boer B, Hamers JP, Verbeek H, van Achterberg T. Systematic development of a set of implementation strategies for transitional care innovations in long-term care. Implement Sci Commun 2023; 4:103. [PMID: 37641112 PMCID: PMC10463528 DOI: 10.1186/s43058-023-00487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Numerous transitional care innovations (TCIs) are being developed and implemented to optimize care continuity for older persons when transferring between multiple care settings, help meet their care needs, and ultimately improve their quality of life. Although the implementation of TCIs is influenced by contextual factors, the use of effective implementation strategies is largely lacking. Thus, to improve the implementation of TCIs targeting older persons receiving long-term care services, we systematically developed a set of viable strategies selected to address the influencing factors. METHODS As part of the TRANS-SENIOR research network, a stepwise approach following Implementation Mapping (steps 1 to 3) was applied to select implementation strategies. Building on the findings of previous studies, existing TCIs and factors influencing their implementation were identified. A combination of four taxonomies and overviews of change methods as well as relevant evidence on their effectiveness were used to select the implementation strategies targeting each of the relevant factors. Subsequently, individual consultations with scientific experts were performed for further validation of the process of mapping strategies to implementation factors and for capturing alternative ideas on relevant implementation strategies. RESULTS Twenty TCIs were identified and 12 influencing factors (mapped to the Consolidated Framework for Implementation Research) were designated as priority factors to be addressed with implementation strategies. A total of 40 strategies were selected. The majority of these target factors at the organizational level, e.g., by using structural redesign, public commitment, changing staffing models, conducting local consensus discussions, and organizational diagnosis and feedback. Strategies at the level of individuals included active learning, belief selection, and guided practice. Each strategy was operationalized into practical applications. CONCLUSIONS This project developed a set of theory and evidence-based implementation strategies to address the influencing factors, along further tailoring for each context, and enhance the implementation of TCIs in daily practice settings. Such work is critical to advance the use of implementation science methods to implement innovations in long-term care successfully.
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Affiliation(s)
- Amal Fakha
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium.
| | - Bram de Boer
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Jan P Hamers
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
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Kim SK, Hwang YS, Ock M, Jo HS. Development of Items for Transitional Care Service and Outcome Indicators of Discharged Patients for Improvement in Quality of Care. J Korean Med Sci 2023; 38:e246. [PMID: 37582496 PMCID: PMC10427215 DOI: 10.3346/jkms.2023.38.e246] [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: 11/15/2022] [Accepted: 04/11/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND In this study, with the aim of improving the quality of transitional care service for discharged patients, the Health Care Quality and Outcomes Indicators of the Organization for Economic Co-operation and Development and National Health Service Outcomes Framework of the UK were applied to derive service items for provision and develop evaluation indicators under categories of effectiveness, safety, and patient-centeredness. METHOD A scoping review was conducted to derive core concepts and evidence materials/data for transitional care service. For the derived items of transitional care service and evaluation indicators, a three-round Delphi study was conducted with experts in the fields of healthcare/medicine/nursing/social welfare. RESULTS First, as a result of the scoping review, components of transitional care service (assessment of need by period of transitional care service, multi-professional team, connection to community resources, etc.) and themes for outcome indicators (effectiveness, patient safety, patient-centeredness) were derived. Second, by classifying the items for assessment according to the hospitalization and transition period and conducting a Delphi study to derive service items for transitional care service, during the hospitalization period, presence/absence of a caregiver and need for a caregiver, activities of daily living, and necessity for home-based care services were identified as items of high priority. Regarding patient safety, risk of falls and fractures during hospitalization, and necessity for medication reconciliation were identified as the items of high importance. For the transition period, provision of education regarding adequate responses and handling of emergencies, provision of information and guidance on application of services for basic livelihood security program beneficiaries, and education for patient skills in self-management of health were derived as items of high priority. Third, for the derivation of outcome indicators for transitional care service, in the "effectiveness" category, the experts rated a reduction in the 30-day readmission rate as an item of high importance along with a decrease in emergency department visits, reduction in preventable admissions as indicators of high relevance. In terms of "patient safety," a decrease in drug adverse reactions, and reduction in the incidence of falls and pressure ulcers were identified as indicators of high priority. Finally, for the category of "patient-centeredness," patient experience assessment, level of service satisfaction reported by patients and their caregivers, and reducing burden on caregivers were identified as indicators of high priority. CONCLUSION This study suggest practical implications for the service with high relevance and necessity for transitional period. It also presented outcome indicators of transitional care service to contribute toward an improvement in the quality of care.
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Affiliation(s)
- Su Kyoung Kim
- Department of Health Policy and Management, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Yu Seong Hwang
- Department of Health Policy and Management, School of Medicine, Kangwon National University, Chuncheon, Korea
| | - Minsu Ock
- Department of Preventive Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Heui Sug Jo
- Department of Health Policy and Management, School of Medicine, Kangwon National University, Chuncheon, Korea.
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Hedqvist AT, Praetorius G, Ekstedt M. Exploring interdependencies, vulnerabilities, gaps and bridges in care transitions of patients with complex care needs using the Functional Resonance Analysis Method. BMC Health Serv Res 2023; 23:851. [PMID: 37568114 PMCID: PMC10422836 DOI: 10.1186/s12913-023-09832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Hospital discharge is a complex process encompassing multiple interactions and requiring coordination. To identify potential improvement measures in care transitions for people with complex care needs, intra- and inter-organisational everyday work needs to be properly understood, including its interdependencies, vulnerabilities and gaps. The aims of this study were to 1) map coordination and team collaboration across healthcare and social care organisations, 2) describe interdependencies and system variability in the discharge process for older people with complex care needs, and 3) evaluate the alignment between discharge planning and the needs in the home. METHODS Data were collected through participant observations, interviews, and document review in a region of southern Sweden. The Functional Resonance Analysis Method (FRAM) was used to model the discharge process and visualise and analyse coordination of care across healthcare and social care organisations. RESULTS Hospital discharge is a time-sensitive process with numerous couplings and interdependencies where healthcare professionals' performance is constrained by system design and organisational boundaries. The greatest vulnerability can be found when the patient arrives at home, as maladaptation earlier in the care chain can lead to an accumulation of issues for the municipal personnel in health and social care working closest to the patient. The possibilities for the personnel to adapt are limited, especially at certain times of day, pushing them to make trade-offs to ensure patient safety. Flexibility and appropriate resources enable for handling variability and responding to uncertainties in care after discharge. CONCLUSIONS Mapping hospital discharge using the FRAM reveals couplings and interdependencies between various individuals, teams, and organisations and the most vulnerable point, when the patient arrives at home. Resilient performance in responding to unexpected events and variations during the first days after the return home requires a system allowing flexibility and facilitating successful adaptation of discharge planning.
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Affiliation(s)
- Ann-Therese Hedqvist
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
- Ambulance Service, Region Kalmar County, Västervik, Sweden.
| | - Gesa Praetorius
- Swedish National Road and Transport Research Institute, Linköping, Sweden
- Department of Maritime Operations, University of South-Eastern Norway, Borre, Norway
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning, Informatics, Management and Ethics, LIME, Karolinska Institutet, Stockholm, Sweden
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Winqvist I, Näppä U, Häggström M. Quality of care during rural care transitions: a qualitative study on structural conditions. BMC Nurs 2023; 22:262. [PMID: 37559083 PMCID: PMC10411022 DOI: 10.1186/s12912-023-01423-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Registered nurses are critical for the delivery of high-quality healthcare during care transitions from hospital to home. Older co-morbid patients are most vulnerable during these transitions. A growing population of older adults with a higher prevalence of diseases implies increased demands on healthcare and its quality, which is affected by the environment where healthcare is provided. One can draw inferences on the quality of care when classified into structure, process, and outcome. This study explored registered nurses' perspectives on structural conditions that promote or hinder good quality care during transitions from hospital to home healthcare in rural areas. METHODS We conducted a reflexive thematic analysis of interviews with 21 registered nurses experienced in care transitions from hospital to home healthcare in a rural area of Sweden. We based the theoretically driven analysis on Donabedian's definition of structures regarding the quality of care. RESULTS The structural conditions were represented by three themes; (I) "Distances and inaccessibility" explains physical matters such as geographical (in)accessibility, bed (un)availability and electronic aids. (II) "Competence of the actors" explains continuity, knowledge and collaboration among the individuals involved. (III) "Levels of organizational governance" explains laws, expectations, values, and agreements regarding care transitions. All themes involved promoting and hindering factors, mutually influencing aspects of the others. CONCLUSIONS Care actors, educators, managers, and decision-makers need to understand how structures in the physical, social and symbolic environment interactively affect the quality of care during care transitions since understanding this is a prerequisite for improvements. These aspects must be considered to optimize conditions for high-quality care transitions from hospital to rural home healthcare and implemented continuously to improve transitions within the respective organization and inter-organizationally. According to this study, these aspects are critical in a rural context due to structural care quality influencers such as geographical challenges, difficulties in finding competent staff members, development of technical devices, and access to the Internet.
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Affiliation(s)
- Idun Winqvist
- Department of Health Sciences, Mid Sweden University, S-831 25 Östersund, Sundsvall, S-851 70, Sweden.
| | - Ulla Näppä
- Department of Health Sciences, Mid Sweden University, S-831 25 Östersund, Sundsvall, S-851 70, Sweden
| | - Marie Häggström
- Department of Health Sciences, Mid Sweden University, S-831 25 Östersund, Sundsvall, S-851 70, Sweden
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Rossi LP, Granger BB, Bruckel JT, Crabbe DL, Graven LJ, Newlin KS, Streur MM, Vadiveloo MK, Walton-Moss BJ, Warden BA, Volgman AS, Lydston M. Person-Centered Models for Cardiovascular Care: A Review of the Evidence: A Scientific Statement From the American Heart Association. Circulation 2023; 148:512-542. [PMID: 37427418 DOI: 10.1161/cir.0000000000001141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Cardiovascular disease remains the leading cause of death and disability in the United States and globally. Disease burden continues to escalate despite technological advances associated with improved life expectancy and quality of life. As a result, longer life is associated with multiple chronic cardiovascular conditions. Clinical guidelines provide recommendations without considering prevalent scenarios of multimorbidity and health system complexities that affect practical adoption. The diversity of personal preferences, cultures, and lifestyles that make up one's social and environmental context is often overlooked in ongoing care planning for symptom management and health behavior support, hindering adoption and compromising patient outcomes, particularly in groups at high risk. The purpose of this scientific statement was to describe the characteristics and reported outcomes in existing person-centered care delivery models for selected cardiovascular conditions. We conducted a scoping review using Ovid MEDLINE, Embase.com, Web of Science, CINAHL Complete, Cochrane Central Register of Controlled Trials through Ovid, and ClinicalTrials.gov from 2010 to 2022. A range of study designs with a defined aim to systematically evaluate care delivery models for selected cardiovascular conditions were included. Models were selected on the basis of their stated use of evidence-based guidelines, clinical decision support tools, systematic evaluation processes, and inclusion of the patient's perspective in defining the plan of care. Findings reflected variation in methodological approach, outcome measures, and care processes used across models. Evidence to support optimal care delivery models remains limited by inconsistencies in approach, variation in reimbursement, and inability of health systems to meet the needs of patients with chronic, complex cardiovascular conditions.
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Han KT, Kim SJ. Is Fragmented Cancer Care Associated With Medical Expenditure? Nationwide Evidence From Patients With Lung Cancer Using National Insurance Claim Data. Int J Public Health 2023; 68:1606000. [PMID: 37485048 PMCID: PMC10356958 DOI: 10.3389/ijph.2023.1606000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
Objectives: We aimed to investigate the association between fragmented cancer care in the early phase after cancer diagnosis and patient outcomes using national insurance claim data. Methods: We identified National Health Insurance beneficiaries diagnosed with lung cancer in South Korea from 2010 to 2014. We included 1,364 lung cancer patients with reduced immortal time bias and heterogeneity. We performed multiple regression analysis using a generalized estimate equation with a gamma distribution for medical expenditures. Results: Among the 1,364 patients with lung cancer, 12.8% had fragmented cancer care. Healthcare costs were higher in fragmented cancer care for both during diagnosis to 365 days and diagnosis to 1,825 days. Linear regression results showed that fragmented cancer care was associated with 1.162 times higher costs during the period from diagnosis to 365 days and 1.163 times the cost for the period from diagnosis to 1,825 days. Conclusion: We found fragmented cancer care is associated with higher medical expenditure. Future health policy should consider the limitation of patients' free will when opting for fragmented cancer care, as there are currently no control mechanisms.
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Affiliation(s)
- Kyu-Tae Han
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Sun Jung Kim
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Asan, Republic of Korea
- Center for Healthcare Management Science, Soonchunhyang University, Asan, Republic of Korea
- Department of Software Convergence, Soonchunhyang University, Asan, Republic of Korea
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Ziebarth DJ, Campbell K, Ahn S, Williams J, Lane M. Using Nursing Interventions Classifications to Document Faith Community Nursing Transitional Care. J Christ Nurs 2023; 40:184-190. [PMID: 36787474 DOI: 10.1097/cnj.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
ABSTRACT One out of five Medicare beneficiaries is readmitted within 30 days after hospital discharge, and as many as three in four readmissions are preventable. This study describes transitional care interventions (TCIs) delivered by one faith community nurse (FCN) to at-risk seniors living in a certain ZIP code. Two years of nursing documentation (2,280 interventions) were translated into Nursing Interventions Classification standardized nursing language. Results indicate the FCN provided priority TCIs including spiritual care. In fully describing TCIs using a nursing language, results support that the FCN transitional care model is a method worth exploring to provide wholistic transitional care.
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35
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Glober N, LaShell A, Montelauro N, Troyer L, Supples M, Unroe K, Tainter C, Faris G, Fuchita M, Boustani M. Impact of interhospital transfer on patients with Alzheimer's disease and other related dementias. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12469. [PMID: 37693225 PMCID: PMC10485388 DOI: 10.1002/dad2.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
Older adults are often transferred from one emergency department (ED) to another hospital for speciality care, but little is known about whether those transfers positively impact patients, particularly those with Alzheimer's disease and other related dementias (ADRD). In this study we aimed to describe the impact of interhospital transfer on older adults with and without ADRD. In a retrospective review of electronic medical records, we collected data on demographics, insurance type, initial code status, intensive care, length of stay, specialist consult, procedure within 48 hours, and discharge disposition for older adults (≥ 65 years). We included older adults with at least one ED visit, who were transferred to a tertiary care hospital. With logistic regression, we estimated odds of death, intensive care stay, or procedure within 48 hours by ADRD diagnosis. Patients with ADRD more often received a geriatrics (p < 0.001) or palliative care consult (p = 0.038). They were less likely to be full code at admission (p < 0.001) or to be discharged home (p < 0.001). Patients living with ADRD less often received intensive care or a procedure within 48 hours of transfer (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.22-2.88). Patients with ADRD were less likely to receive intensive care unit admission or specialist procedures after transfer. Further study is indicated to comprehensively understand patient-centered outcomes.
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Affiliation(s)
- Nancy Glober
- Indiana University School of MedicineIndianapolisIndianaUSA
| | | | | | - Lindsay Troyer
- Indiana University School of MedicineIndianapolisIndianaUSA
| | - Michael Supples
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Kathleen Unroe
- Indiana University School of MedicineIndianapolisIndianaUSA
| | | | - Greg Faris
- Indiana University School of MedicineIndianapolisIndianaUSA
| | | | - Malaz Boustani
- Indiana University School of MedicineIndianapolisIndianaUSA
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36
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Weeda E, Gilbert RE, Kolo SJ, Haney JS, Hazard LT, Taber DJ, Axon RN. Impact of Pharmacist-Driven Transitions of Care Interventions on Post-hospital Outcomes Among Patients With Coronary Artery Disease: A Systematic Review. J Pharm Pract 2023; 36:668-678. [PMID: 34962844 PMCID: PMC9427131 DOI: 10.1177/08971900211064155] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Transitions of care (ToC) aim to provide continuity while preventing loss of information that may result in poor outcomes such as hospital readmission. Readmissions not only burden patients, they also increase costs. Given the high prevalence of coronary artery diseases (CAD) in the United States (US), patients with CAD often make up a significant portion of hospital readmissions. Objective: To conduct a systematic review evaluating the impact of pharmacist-driven ToC interventions on post-hospital outcomes for patients with CAD. Methods: MEDLINE, Scopus, and CINAHL were searched from database inception through 03/2020 using key words for CAD and pharmacists. Studies were included if they: (1) identified adults with CAD at US hospitals, (2) evaluated pharmacist-driven ToC interventions, and (3) assessed post-discharge outcomes. Outcomes were summarized qualitatively. Results: Of the 1612 citations identified, 11 met criteria for inclusion. Pharmacist-driven ToC interventions were multifaceted and frequently included medication reconciliation, medication counseling, post-discharge follow-up and initiatives to improve medication adherence. Hospital readmission and emergency room visits were numerically lower among patients receiving vs not receiving pharmacist-driven interventions, with statistically significant differences observed in 1 study. Secondary prevention measures and adherence tended to be more favorable in the pharmacist-driven intervention groups. Conclusion: Eleven studies of multifaceted, ToC interventions led by pharmacists were identified. Readmissions were numerically lower and secondary prevention measures and adherence were more favorable among patients receiving pharmacist-driven interventions. However, sufficiently powered studies are still required to confirm these benefits.
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Affiliation(s)
- Erin Weeda
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
- College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Rachael E Gilbert
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
| | - Shelby J Kolo
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
| | - Jason S Haney
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
- College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - Linh Tran Hazard
- College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA
| | - David J Taber
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Robert Neal Axon
- Charleston Patient Safety Center of Inquiry, Ralph H Johnson VAMC, Charleston, SC, USA
- Charleston Health Equity and Rural Outreach Innovation Center, Ralph H Johnson VAMC, Charleston, SC, USA
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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37
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Bucy TI, Cross DA. Information sharing to support care transitions for patients with complex mental health and social needs. J Am Geriatr Soc 2023; 71:1963-1973. [PMID: 36762760 PMCID: PMC11103791 DOI: 10.1111/jgs.18278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/21/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Patients with complex behavioral and mental health conditions require significant transitional care coordination. It is unclear how skilled nursing facilities (SNFs) that serve these patients engage in care transfer with hospitals, specifically whether they experience discrepancies in the type of information shared by hospital partners and/or use different approaches to secure needed information. METHODS Cross-sectional analysis of a national 2019-2020 SNF survey that collected information on transitional care practices with referring hospitals; respondents were directors of nursing services. We used chi-squared tests and descriptive statistics to characterize hospital information sharing practices experienced by facilities that accept complex patients (e.g., serious mental illness, substance use disorder, and/or medication assisted treatment), and to compare them to facilities that treat a less complex population. RESULTS A total of 215 SNFs had sufficiently complete responses for inclusion in the analysis. Of these respondents, 57% accepted two or more types of patients with complex conditions of interest; these SNFs were more likely to be urban, for-profit, and serve more dual-eligible patients. SNFs accepting complex patients experience information sharing on par with other facilities, and are more likely to receive information on behavioral, social, mental, and functional status (25.41% vs. 12.90%; p = 0.023). These facilities are also more likely to consistently use electronic methods (e.g., an online portal, shared electronic health record [EHR] access) to retrieve information from partner hospitals. CONCLUSIONS SNFs accepting complex patients demonstrate some evidence of enhanced information retrieval via electronically mediated pathways. Overall, information sharing remains underdeveloped in this care context. Policymakers should continue to prioritize widespread digital infrastructure that supports post-acute care delivery.
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Affiliation(s)
- Taylor I Bucy
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Dori A Cross
- Division of Health Policy & Management, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
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Kovaleva MA, Kleinpell R, Dietrich MS, Jones AC, Boon JT, Duggan MC, Dennis BM, Lauderdale J, Maxwell CA. Caregivers’ experience with Tele-Savvy Caregiver Program post-hospitalization. Geriatr Nurs 2023; 51:156-166. [PMID: 36990041 DOI: 10.1016/j.gerinurse.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/30/2023]
Abstract
Despite the frequent hospitalizations and readmissions of persons living with dementia (PLWD), no telehealth transitional care interventions focus on PLWDs' unpaid caregivers. Tele-Savvy Caregiver Program is a 43-day evidence-based online psychoeducational intervention for PLWDs' caregivers. The aim of this formative evaluation was to explore caregivers' acceptability of and experience with their participation in Tele-Savvy after their PLWDs' hospital discharge. Additionally, we gathered caregivers' feedback on the recommended features of a transitional care intervention, suitable for caregivers' schedule and needs post-discharge. Fifteen caregivers completed the interviews. Data were analyzed via conventional content analysis. Four categories were identified: (1) Tele-Savvy improved participants' understanding of dementia and caregiving; (2) hospitalization started a "new level of normal"; (3) PLWDs' health concerns; and (4) transitional care intervention development. Participation in Tele-Savvy was acceptable for most caregivers. Participants' feedback provides content and structural guidance for the development of a new transitional care intervention for PLWDs' caregivers.
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Affiliation(s)
- Mariya A Kovaleva
- College of Nursing - Omaha Division, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, USA.
| | - Ruth Kleinpell
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Department of Biostatistics, Vanderbilt University School of Medicine, 1161 21st Ave S, #D3300, Nashville, TN 37232, USA
| | - Abigail C Jones
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Yale University School of Nursing, 400 West Campus Drive, Orange, CT 06477, USA
| | - Jeffrey T Boon
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Maria C Duggan
- Division of Geriatric Medicine, Vanderbilt University School of Medicine, 1161 21st Ave S, #D3300, Nashville, TN 37232, USA; Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, 1310 24th Ave South, Nashville, TN 37212-2637, USA
| | - Bradley M Dennis
- Division of Acute Care Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Jana Lauderdale
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
| | - Cathy A Maxwell
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
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Naylor MD, Hirschman KB, Morgan B, McHugh M, Hanlon AL, Ahrens M, McCauley K, Shaid EC, Pauly MV. The study protocol to evaluate implementation of the transitional care model in four U.S. healthcare systems during the Covid-19 pandemic. Arch Gerontol Geriatr 2023; 108:104944. [PMID: 36709563 PMCID: PMC9873366 DOI: 10.1016/j.archger.2023.104944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
This study protocol describes the conceptual framework, design, and methods being employed to evaluate the implementation of the Transitional Care Model (TCM) as part of a randomized controlled trial. The trial, designed to examine the health and cost outcomes of at-risk hospitalized older adults, is being conducted in the context of the COVID-19 pandemic. This parallel study is guided by the Practical, Robust, Implementation and Sustainability Model (PRISM) and uses a fixed, mixed methods convergent parallel design to identify challenges encountered by participating hospitals and post-acute and community-based providers that impact the implementation of the TCM with fidelity, strategies implemented to address those challenges and the relationships between challenges, strategies, and rates of fidelity to TCM's core components over time. Prior to the study's launch and throughout its implementation, qualitative and quantitative data related to COVID and non-COVID challenges are being collected via surveys and meetings with healthcare system staff. Strategies implemented to address challenges and fidelity to TCM's core components are also being assessed. Analyses of quantitative (established metrics to evaluate TCM's core components) and qualitative data (barriers and facilitators to implementation) are being conducted independently. These datasets are then merged and interpreted together. General linear and mixed effects modeling using all merged data and patients' socio-demographic and social determinants of health characteristics, will be used to examine relationships between key variables and fidelity rates. Implications of study findings in the context of COVID-19 and future research opportunities are suggested. Trial registration: ClinicalTrials.gov Identifier: NCT04212962.
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Affiliation(s)
- Mary D Naylor
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104.
| | - Karen B Hirschman
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104
| | - Brianna Morgan
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104
| | - Molly McHugh
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104
| | - Alexandra L Hanlon
- Center for Biostatistics and Health Data Science, College of Science, Department of Statistics, Virginia Tech, Four Riverside Circle, Roanoke, VA 24016
| | - Monica Ahrens
- Center for Biostatistics and Health Data Science, College of Science, Department of Statistics, Virginia Tech, Four Riverside Circle, Roanoke, VA 24016
| | - Kathleen McCauley
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104
| | - Elizabeth C Shaid
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104
| | - Mark V Pauly
- Wharton School, University of Pennsylvania, Philadelphia, PA 19104
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Bankole AO, Girdwood T, Leeman J, Womack J, Toles M. Identifying unmet needs of older adults transitioning from home health care to independence at home: A qualitative study. Geriatr Nurs 2023; 51:293-302. [PMID: 37031581 PMCID: PMC10247499 DOI: 10.1016/j.gerinurse.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/11/2023]
Abstract
Health care practices to prepare older adults and their family caregivers for transitions from home health care (HHC) to independence at home are rarely studied. The objective of this multiple case study was to describe HHC patient and clinician perceptions of unmet needs after HHC discharge and recommendations to address them in future research. In this qualitative study, data were collected using chart-reviews and semi-structured interviews with paired patients (or caregivers as proxy) and HHC clinicians (N=17 pairs). We identified three themes: (1) low patient and caregiver engagement in care planning increased risk for preventable health events after HHC discharge, (2) limited continuity of care restricted patient and caregiver access to community-based services, and (3) gaps in patient and caregiver education influenced independent care of chronic illnesses after discharge. Findings suggest opportunities to improve care practices to prepare older adults and their caregivers for transitions from HHC to independence at home.
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Affiliation(s)
- Ayomide Okanlawon Bankole
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, USA.
| | | | - Jennifer Leeman
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, USA
| | - Jennifer Womack
- Appalachian State University, Beaver College of Health Sciences, Boone, NC, USA
| | - Mark Toles
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, USA
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41
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Chong PH, Hii I, Yeo ZZ. Real-world challenges when facilitating terminal discharge in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2023; 52:213-215. [PMID: 38904534 DOI: 10.47102/annals-acadmedsg.202254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
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42
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Yen HY, Liu D, Chi MJ, Huang HY. Awareness of and subjective needs for post-discharge healthcare services among older adult patients. BMC Nurs 2023; 22:129. [PMID: 37072840 PMCID: PMC10111708 DOI: 10.1186/s12912-023-01247-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 03/13/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Increasing patient awareness of post-discharge care resources is an effective strategy to reduce rehospitalization rates and medical costs. Therefore, the purpose of this study was to explore hospitalized older adult patients' awareness of and subjective demands for post-discharge healthcare services. METHODS A cross-sectional study design was conducted from November 2018 to May 2020. STROBE statement was completed. Participants were inpatients over 65 years of age in the general ward of a medical center in northern Taiwan. A questionnaire was used to collect data by face-to-face interviews. Two hundred and twelve participants were recruited. Home nursing care, home rehabilitation, home respiratory therapy, home services, assistive devices rental, and transportation were the main post-discharge healthcare services in this study. RESULTS Overall, 83.5% of older adult patients were aware of and 55.7% of the older adult patients demanded at least one post-discharge healthcare services. Logistic regression results found that, patients experiencing moderate to severe disability and cognitive impairment, and those hospitalized in the past year had significantly higher demands for services. CONCLUSIONS Developing post-discharge healthcare services for older adult patients provides continuous patient-centered services for assisting patients and their families in adapting to the transition period of the post-acute stage. Satisfying these demands is beneficial for older adult patients and their families, as well as for reducing readmissions and medical costs.
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Affiliation(s)
- Hsin-Yen Yen
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, 250 Wuxing St, Taipei, 11031, Taiwan
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Doresses Liu
- Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mei-Ju Chi
- School of Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, 250 Wuxing St, Taipei, 11031, Taiwan.
- International Ph.D. Program in Gerontology and Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
| | - Hao-Yun Huang
- Registered Nurse, Gold Coast University Hospital, Southport, QLD, Australia
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Toles M, Preisser JS, Colón-Emeric C, Naylor MD, Weinberger M, Zhang Y, Hanson LC. Connect-Home transitional care from skilled nursing facilities to home: A stepped wedge, cluster randomized trial. J Am Geriatr Soc 2023; 71:1068-1080. [PMID: 36625769 PMCID: PMC10089938 DOI: 10.1111/jgs.18218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 11/04/2022] [Accepted: 11/06/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Skilled nursing facility (SNF) patients and their caregivers who transition to home experience complications and frequently return to acute care. We tested the efficacy of the Connect-Home transitional care intervention on patient and caregiver preparedness for care at home, and other patient and caregiver-reported outcomes. METHODS We used a stepped wedge, cluster-randomized trial design to test the intervention against standard discharge planning (control). The setting was six SNFs and six home health offices in one agency. Participants were 327 dyads of patients discharged from SNF to home and their caregivers; 11.1% of dyads in the control condition and 81.2% in the intervention condition were enrolled after onset of COVID-19. Patients were 63.9% female and mean age was 76.5 years. Caregivers were 73.7% female and mean age was 59.5 years. The Connect-Home intervention includes tools, training, and technical assistance to deliver transitional care in SNFs and patients' homes. Primary outcomes measured at 7 days included patient and caregiver measures of preparedness for care at home, the Care Transitions Measure-15 (patient) and the Preparedness for Caregiving Scale (caregiver). Secondary outcomes measured at 30 and 60 days included the McGill Quality of Life Questionnaire, Life Space Assessment, Zarit Caregiver Burden Scale, Distress Thermometer, and self-reported number of patient days in the ED or hospital in 30 and 60 days following SNF discharge. RESULTS The intervention was not associated with improvement in patient or caregiver outcomes in the planned analyses. Post-hoc analyses that distinguished between pre- and post-pandemic effects suggest the intervention may be associated with increased patient preparedness for discharge and decreased number of acute care days. CONCLUSIONS Connect-Home transitional care did not improve outcomes in the planned statistical analysis. Post-hoc findings accounting for COVID-19 impact suggest SNF transitional care has potential to increase patient preparedness and decrease return to acute care.
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Affiliation(s)
- Mark Toles
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - John S. Preisser
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cathleen Colón-Emeric
- School of Medicine, Duke University and Geriatric Research Education and Clinical Center at the Durham VA Medical Center, Durham, North Carolina
| | - Mary D. Naylor
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Morris Weinberger
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ying Zhang
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Laura C. Hanson
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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The role of hospitals in strengthening primary health care in the Western Pacific. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 33:100698. [PMID: 36880058 PMCID: PMC9984548 DOI: 10.1016/j.lanwpc.2023.100698] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/19/2022] [Accepted: 01/11/2023] [Indexed: 02/18/2023]
Abstract
Despite the imperative to strengthen primary health care (PHC) to respond to demographic and epistemological transitions, and meet commitments to achieve universal health coverage, health systems remain hospital-centric with health resources largely concentrated in urban centres. This paper examines islands of innovation that demonstrate the role hospitals can play in influencing the provision of PHC. Drawing on the literature and country case studies from the Western Pacific region, we illustrate mechanisms used to unlock hospital resources to improve PHC, with the transition towards "systems-focused hospitals". This paper identifies four "ideal types" of roles hospitals perform to strengthen PHC in different contexts. This provides a framework to inform health systems policy by examining existing and potential roles of hospitals to support the provision of frontline services and reorient health systems towards PHC.
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45
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Petruzzi L, Ewald B, Covington E, Rosenberg W, Golden R, Jones B. Exploring the Efficacy of Social Work Interventions in Hospital Settings: A Scoping Review. SOCIAL WORK IN PUBLIC HEALTH 2023; 38:147-160. [PMID: 35895505 DOI: 10.1080/19371918.2022.2104415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Social workers play an integral role in hospitals, particularly as it relates to improving patient outcomes. This scoping review was conducted to explore the impact of social work interventions in hospital settings on healthcare utilization. Research literature was identified using the following search engines: PsycINFO, CINAHL Plus, SocINDEX & MEDLINE. The initial search was conducted in May 2019, and an updated search was conducted in April 2021. Search results identified 2633 references and 110 articles met criteria for full-text review. Eighteen articles were included in the final review. Social work interventions include transitional care (56%), care coordination (22%), behavioral health (17%) and case management (5%). Significant improvements to readmission, mortality and utilizations rates are reported in over 80% of the studies, however the vast majority are non-randomized quantitative studies. More rigorous studies are needed to expand the literature and further evaluate the effectiveness of social work interventions in hospital settings.
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Affiliation(s)
- Liana Petruzzi
- Department of Social Work, Steve Hicks School of Social Work at the University of Texas at Austin, Austin, TX, USA
| | - Bonnie Ewald
- College of Health Sciences, Department of Social Work, Rush University Medical Center, Chicago, Illinois, USA
| | | | - Walter Rosenberg
- College of Health Sciences, Department of Social Work, Rush University Medical Center, Chicago, Illinois, USA
| | - Robyn Golden
- College of Health Sciences, Department of Social Work, Rush University Medical Center, Chicago, Illinois, USA
| | - Barbara Jones
- Department of Social Work, Steve Hicks School of Social Work at the University of Texas at Austin, Austin, TX, USA
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Reeves MJ, Boden-Albala B, Cadilhac DA. Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations. Stroke 2023; 54:386-395. [PMID: 36689590 DOI: 10.1161/strokeaha.122.039565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 01/24/2023]
Abstract
In many countries hospital length of stay after an acute stroke admission is typically just a few days, therefore, most of a person's recovery from stroke occurs in the community. Care transitions, which occur when there is a change in, or handoff between 2 different care settings or providers, represent an especially vulnerable period for patients and caregivers. For some patients with stroke the return home is associated with substantial practical, psychosocial, and health-related challenges leading to substantial burden for the individual and caregiver. Underserved and minority populations, because of their exposure to poor environmental, social, and economic conditions, as well as structural racism and discrimination, are especially vulnerable to the problems of complicated care transitions which in turn, can negatively impact stroke recovery. Overall, there remain significant unanswered questions about how to promote optimal recovery in the post-acute care period, particularly for those from underserved communities. Evidence is limited on how best to support patients after they have returned home where they are required to navigate the chronic stages of stroke with little direct support from health professionals.
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Affiliation(s)
- Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Bernadette Boden-Albala
- Department of Health Society and Behavior, Department of Epidemiology and Biostatistics, Program in Public Health, Department of Neurology, School of Medicine, University of California (B.B.-A.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (D.A.C.)
- Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (D.A.C.)
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Marston C, Morgan DD, Philip J, Agar M. Supporting Carers as Patients Move between Hospital and Home: A Systematic Review of Interventions to Support These Transitions in Care. J Palliat Med 2023; 26:270-298. [PMID: 36251853 DOI: 10.1089/jpm.2022.0221] [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] [Indexed: 02/03/2023] Open
Abstract
Background: Hospital-to-home transitions become more frequent and complex as people approach end of life. Although carers are critical to enabling these transitions, they report high levels of unmet need. A review of the interventions to assist these care transitions, along with understanding those intervention components and mechanisms that support carers of people with advanced illness, is required to inform an optimal care model for palliative care practice. Aim: To describe the characteristics and reporting quality of intervention studies aimed at improving hospital-to-home transitions for carers of people with advanced illness. Design: This is a systematic review with a narrative synthesis. (international prospective register of systematic reviews [PROSPERO] ID: CRD42020192088). Data Sources: MEDLINE, EMCare, and PsychINFO databases were searched (2000-2021) for prospective studies reporting on interventions that (1) aimed to improve hospital-to-home transitions and (2) targeted carers of people with advanced illness. The Template for Intervention Description and Replication (TIDieR) checklist and constructs of the Care Transition Framework were used to assess the reporting quality of intervention design, delivery, and outcomes. Results: In total, 37 articles were analyzed that included a range of study designs, interventions, and outcomes. Health care utilization (n = 29) and clinical patient-related (n = 21) measures were the most reported outcome. Theoretical discussion was minimal (n = 5) with most studies using efficacy data from past research to justify intervention choice. Conclusion: Carers are critical partners in hospital-to-home transitions at end of life; yet they are largely under-represented in intervention design, delivery, and outcomes. Improving the reporting quality of carer-focused care transition interventions will inform future study design and support translation into practice and policy.
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Affiliation(s)
- Celia Marston
- Department of Occupational Therapy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Department of Occupational Therapy, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Occupational Therapy, Faculty of Medicine Nursing and Health Science, Monash University, Melbourne, Victoria, Australia
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Deidre D Morgan
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, South Australia, Australia
| | - Jennifer Philip
- Palliative Care Service, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Palliative Care Service, St. Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Palliative Care Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Meera Agar
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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Transitional care interventions for supporting frail older adults discharged from hospitals: An umbrella review. Geriatr Nurs 2023; 50:80-89. [PMID: 36669435 DOI: 10.1016/j.gerinurse.2022.12.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/20/2023]
Abstract
Transitional care interventions have been shown to assist frail older adults; however, their true efficacy remains inconclusive. This umbrella review aimed (1) to summarize the components of transitional care interventions in support of frail older adults discharged from hospitals to community-based facilities that may have impacted healthcare outcomes and (2) to synthesize the impacts of these interventions. Systematic reviews published between January 2018 and September 2022 were screened using seven electronic databases. The review protocol followed the Joanna Briggs Institute Reviewers' Manual and was registered in the PROSPERO. Nine relevant systematic reviews were assessed for their methodological quality. Four of the measured primary healthcare outcomes improved as a result of transitional care interventions. In particular, evidence indicates that high-intensity transitional care or transitional care lasting at least one month can improve healthcare outcomes in frail older adults. Additional funding research and practical guidelines are warranted.
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Sun M, Qian Y, Liu L, Wang J, Zhuansun M, Xu T, Rosa RD. Transition of care from hospital to home for older people with chronic diseases: a qualitative study of older patients' and health care providers' perspectives. Front Public Health 2023; 11:1128885. [PMID: 37181713 PMCID: PMC10174044 DOI: 10.3389/fpubh.2023.1128885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
Background Transitional care is a critical area of care delivery for older adults with chronic illnesses and complex health conditions. Older adults have high, ongoing care needs during the transition from hospital to home due to certain physical, psychological, social, and caregiving burdens, and in practice, patients' needs are not being met or are receiving transitional care services that are unequal and inconsistent with their actual needs, hindering their safe, healthy transition. The purpose of this study was to explore the perceptions of older adults and health care providers, including older adults, about the transition of care from hospital to home for older patients in one region of China. Objective To explore barriers and facilitators in the transition of care from hospital to home for older adults in China from the perspectives of older patients with chronic diseases and healthcare professionals. Methods This was a qualitative study based on a semi-structured approach. Participants were recruited from November 2021 to October 2022 from a tertiary and community hospital. Data were analyzed using thematic analysis. Results A total of 20 interviews were conducted with 10 patients and 9 medical caregivers, including two interviews with one patient. The older adult/adults patients included 4 men and 6 women with an age range of 63 to 89 years and a mean age of 74.3 ± 10.1 years. The medical caregivers included two general practitioners and seven nurses age range was 26 to 40 years with a mean age of 32.8 ± 4.6 years. Five themes were identified: (1) attitude and attributes; (2) better interpersonal relationships and communication between HCPs and patients; (3) improved Coordination of Healthcare Services Is Needed; (4) availability of resources and accessibility of services; and (5) policy and environment fit. These themes often serve as both barriers and facilitators to older adults' access to transitional care. Conclusions Given the fragmentation of the health care system and the complexity of care needs, patient and family-centered care should be implemented. Establish interconnected electronic information support systems; develop navigator roles; and develop competent organizational leaders and appropriate reforms to better support patient transitions.
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Affiliation(s)
- Mengjie Sun
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yumeng Qian
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Lamei Liu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jianan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Mengyao Zhuansun
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Tongyao Xu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Ronnell Dela Rosa
- School of Nursing, Philippine Women's University, Manila, Philippines
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50
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Blondal BS, Geirsdottir OG, Halldorsson TI, Beck AM, Jonsson PV, Ramel A. HOMEFOOD Randomised Trial - Six-Month Nutrition Therapy in Discharged Older Adults Reduces Hospital Readmissions and Length of Stay at Hospital Up to 18 Months of Follow-Up. J Nutr Health Aging 2023; 27:632-640. [PMID: 37702336 DOI: 10.1007/s12603-023-1962-5] [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: 03/06/2023] [Accepted: 05/29/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Malnutrition is frequently observed in older adults and is associated with hospital readmissions, length of stay (LOS), and mortality in discharged patients. OBJECTIVE The aim of this study was to investigate effects of six-month nutrition therapy on hospital readmissions, LOS, mortality and need for long-term care residence 1-, 6-, 12- and 18-months post-discharge in older Icelandic adults. DESIGN Secondary analysis of a randomized controlled trial. PARTICIPANTS Participants (>65 years) were randomised into intervention (n=53) and control (n=53) before discharge from a geriatric unit. INTERVENTION The intervention group received nutrition therapy based on the Nutrition Care Process, including home visits, phone calls, freely delivered energy- and protein-rich foods and supplements for six months after hospital discharge. MEASUREMENTS The Icelandic electronic hospital registry was accessed to gain information on emergency room visits (ER), hospital readmissions, LOS, mortality and need for long-term care residence. RESULTS The intervention group had a lower proportion of participants with at least one readmission compared to control (1 month: 1.9% vs 15.8%, P=0.033; 6 months: 25.0% vs 46.2%, P=0.021; 12 months: 38.5% vs 55.8%, P=0.051; and 18 months: 51.9% vs 65.4%, P=0.107). There was also a lower total number of readmissions per participant (1 month: 0.02 vs 0.19, P=0.015; 6 month: 0.33 vs 0.77, P=0.014; 0.62 vs 1.12, P=0.044) and a shorter LOS (1 month: 0.02 vs 0.92, P=0.013; 6 months: 2.44 vs 13.21; P=0.006; 12 months: 5.83 vs 19.40, P=0.034; 18 months: 10.42 vs 26.00, P=0.033) in the intervention group. However, there were no differences between groups in ER visits, mortality and need for long-term care residence. CONCLUSION A six-month nutrition therapy in older Icelandic adults discharged from hospital reduced hospital readmissions and shortens LOS at the hospital up to 18-months post-discharge. However, it did neither affect mortality, ER, nor need of long-term care residence in this group.
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Affiliation(s)
- B S Blondal
- Berglind Soffia Blondal, Faculty of Food Science and Nutrition, University of Iceland, Aragata 14, 101 Reykjavik, Iceland, Telephone: +354 842 0242,
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