1
|
Chodosh J, Connor K, Fowler N, Gao S, Perkins A, Grudzen C, Messina F, Mangold M, Smilowitz J, Boustani M, Borson S. Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients: Protocol for a Multisite Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e36607. [PMID: 36264626 PMCID: PMC9634513 DOI: 10.2196/36607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Older adults with cognitive impairment have more emergency department visits and 30-day readmissions and are more likely to die after visiting the emergency department than people without cognitive impairment. Emergency department providers frequently do not identify cognitive impairment. Use of cognitive screening tools, along with better understanding of root causes for emergency department visits, could equip health care teams with the knowledge needed to develop individually tailored care management strategies for post-emergency department care. By identifying and directly addressing patients' and informal caregivers' (or care partners') psychosocial and health care needs, such strategies could reduce the need for repeat acute care. We have used the terms "caregiver" and "care partner" interchangeably. OBJECTIVE We aimed to describe the protocol for a randomized controlled trial of a new care management intervention, the Program of Intensive Support in Emergency Departments for Care Partners of Cognitively Impaired Patients (POISED) trial, compared with usual care. We described the research design, intervention, outcome measures, data collection techniques, and analysis plans. METHODS Emergency department patients who were aged ≥75 years and screened positive for cognitive impairment via either the Mini-Cog or the proxy-reported Short Informant Questionnaire on Cognitive Decline in the Elderly, with a planned discharge to home, were recruited to participate with their identified informal (family or friend) caregiver in the 2-site POISED randomized controlled trial at New York University Langone Health and Indiana University. The intervention group received 6 months of care management from the POISED Care Team of registered nurses and specialty-trained paraprofessionals, who perform root cause analyses, administer standardized assessments, provide advice, recommend appropriate referrals, and, when applicable, implement dementia-specific comorbid condition protocols. The control group received care as recommended at emergency department discharge (usual care) and were given information about resources for further cognitive assessment. The primary outcome is repeat emergency department use; secondary outcomes include caregiver activation for patient health care management, caregiver depression, anxiety, and experience of social support as important predisposing and time-varying enabling and need characteristics. Data were collected from questionnaires and patients' electronic health records. RESULTS Recruitment was conducted between March 2018 and May 2021. Study findings will be published in peer-reviewed journals and presented to peer audiences, decision makers, stakeholders, and other interested persons. CONCLUSIONS The POISED intervention is a promising approach to tailoring care management based on root causes for emergency department admission of patients with cognitive impairment with the aim of reducing readmissions. This trial will provide insights for caregivers and emergency department and primary care providers on appropriate, personalized, and proactive treatment plans for older adults with cognitive impairment. The findings will be relevant to audiences concerned with quality of life for individuals with cognitive impairment and their caregivers. TRIAL REGISTRATION ClinicalTrials.gov NCT03325608; https://clinicaltrials.gov/ct2/show/NCT03325608. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/36607.
Collapse
Affiliation(s)
- Joshua Chodosh
- Division of Geriatrics and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Karen Connor
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Nicole Fowler
- Center for Aging Research Regenstrief Institute, Inc, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sujuan Gao
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Anthony Perkins
- Indiana University School of Medicine, Indianapolis, IN, United States
| | - Corita Grudzen
- Department of Emergency Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | | | - Michael Mangold
- Irving Medical Center, Columbia University, New York, NY, United States
| | - Jessica Smilowitz
- Division of Geriatrics and Palliative Care, Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States
| | - Malaz Boustani
- Center for Aging Research Regenstrief Institute, Inc, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Soo Borson
- Department of Family Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| |
Collapse
|
2
|
Dessureault M, Dallaire C. Recevoir un soutien aux capacités d’autosoins lors de la transition posthospitalisation en résidence pour aînés en perte d’autonomie : un besoin non comblé. Rech Soins Infirm 2022; 146:19-34. [PMID: 35724020 DOI: 10.3917/rsi.146.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Elderly people who receive appropriate transitional care after hospitalization experience fewer complications. CONTEXT However, in Quebec, transitional care for the elderly is limited to case management and targets elderly people who are in need of resources. This often excludes those who remain in homes for the elderly. OBJECTIVES The objective of this study was to identify the unmet needs of elderly people during the posthospitalization transition to intermediate care facilities in Quebec, as well as the strategies they use on a daily basis to cope with these needs. METHODS A descriptive qualitative study was conducted as part of an intervention research process. Eleven elderly participants and health professionals were recruited (n=11). RESULTS The results presented suggest a need to support patients' capacity for self-care, unmet during the post-hospitalization transition to intermediate care facilities. DISCUSSION Supporting the self-care abilities of elderly people can help ensure their safety when living in homes for the elderly. CONCLUSION Supporting the capacity for self-care is an important component of transitional care after hospitalization, including for elderly people with disabilities.
Collapse
Affiliation(s)
- Maude Dessureault
- Infirmière, Ph.D, professeure adjointe, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Clémence Dallaire
- Infirmière, Ph.D, professeure titulaire, Université Laval, Québec, Canada
| |
Collapse
|
3
|
Hansen TK, Pedersen LH, Shahla S, Damsgaard EM, Bruun JM, Gregersen M. Effects of a new early municipality-based versus a geriatric team-based transitional care intervention on readmission and mortality among frail older patients - a randomised controlled trial. Arch Gerontol Geriatr 2021; 97:104511. [PMID: 34479071 DOI: 10.1016/j.archger.2021.104511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 01/22/2023]
Abstract
Purpose Previous studies reported reduced risk of readmission, mortality and shorter length of hospital stay (LOS) among geriatric patients receiving an early (<24h), hospital-based geriatric team intervention after discharge. The objective of this study was to compare a novel, early municipality-based, nurse-led and general practitioner (GP)-supported transitional care intervention (TCI) to an established hospital-based TCI among frail, older, geriatric patients. Material and methods A randomised controlled trial was conducted within a single geriatric department and the adjacent municipality. Inclusion criteria: acutely admitted, frail patients 75+ years old. Eligible patients were randomly allocated (1:1) to the two TCIs. Primary outcome was 30-day unplanned readmission. Secondary outcomes were 90-day all-cause mortality and LOS. Stratified analysis according to type of dwelling was made. Odds ratios (OR) with 95% confidence intervals (CI), and number needed to treat (NNT) were reported. Results 3,103 patients (median age (IQR): 85 (80-90); 57% female) were included. Readmission rates were 22% in the municipality-based intervention (n=332/1,545), and 18% in the hospital-based intervention (n=276/1,558); OR was 1.27, 95% CI (1.06-1.52), p=0.008 and NNT=27. OR for cohabiting patients was 1.47, 95% CI (1.02-2.08); p=0.035. No significant difference was observed in mortality (22% vs. 21%; OR=1.05, 95% CI (0.89-1.25), p=0.577) or LOS (median (IQR): 6 (2-8) vs. 6 (2-8) days, p=0.1787). Conclusions The new municipality-based, nurse-led and GP-supported intervention was inferior to the hospital-based geriatric team intervention in preventing 30-day readmission among frail, geriatric patients. There was no significant difference between the two interventions in regard to 90-day mortality or LOS.
Collapse
Affiliation(s)
| | | | - Seham Shahla
- Medical Department, Randers Regional Hospital, Randers, Denmark
| | - Else Marie Damsgaard
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Meldgaard Bruun
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
4
|
Xing L, Wei J. The effect of self-management on the knowledge, beliefs, behavior and subjective well-being in stroke patients during the rehabilitation phase. Am J Transl Res 2021; 13:8337-8343. [PMID: 34377325 PMCID: PMC8340169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 03/26/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the effects of self-management on the knowledge, beliefs, behavior, and subjective well-being in stroke patients during the rehabilitation phase. METHODS the data from 60 first-episode stroke patients in the rehabilitation phase who were discharged from the Department of Neurology were analyzed in this retrospective study. The patients were assigned to an observational group or a control group, with 30 patients in each group. The routine intervention mode was used in the control group, and the self-management intervention mode was used in the observation group. Subsequently, the muscle strength of the upper and lower extremities, the self-care ability scores, the ADL, NIHSS, and FMA scores, the subjective well-being levels, and the patients' complication rates were compared between two groups. RESULTS After the intervention, the muscle strength of the upper and lower extremities, the self-care ability scores, and the ADL, NIHSS, and FMA scores of the patients in the observational group were all better than they were in the control group, with statistically significant differences (all P<0.05). The subjective well-being levels of the patients in the observation group were also significantly better than they were in the control group (P<0.05). The incidence of complications in the observation group was lower than it was in the control group (P<0.05). CONCLUSION Self-management intervention measures effectively improve the self-care abilities, enhance patient confidence in self-management, and help to improve the quality of life in stroke patients during the rehabilitation phase.
Collapse
Affiliation(s)
- Lin Xing
- Medical School, Baoji Vocational Technology CollegeBaoji, Shaanxi Province, China
| | - Jianhui Wei
- Department of Neurology, Baoji Central HospitalBaoji, Shaanxi Province, China
| |
Collapse
|
5
|
Nazareno J, Zhang W, Silver B, Dosa D, Gozalo P, Thomas K. Home Health Utilization in Assisted Living Settings. Med Care Res Rev 2020; 77:620-629. [PMID: 30885049 PMCID: PMC6752987 DOI: 10.1177/1077558719835049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Home health agencies (HHAs) are one of the most commonly used third-party providers in the assisted living (AL) setting. One way ALs may be potentially able to meet the needs of their residents despite increased impairment is through supplementing the services offered with those delivered by HHAs. We explore the growth in the delivery of HHA services to Medicare beneficiaries in AL compared with other home settings between 2012 and 2014. We also examine demographic, cognitive, and functional characteristics of beneficiaries; HHA provider characteristics; and the variation in the percentage of home health use in ALs across the country. Our findings suggest that there was a slight growth in the share of HHA services being delivered in AL. HHA recipients in AL were more likely to have cognitive and activities of daily living impairments than those receiving HHA services in other settings. This is among the first studies to examine HHA utilization in AL.
Collapse
Affiliation(s)
| | | | - Benjamin Silver
- Brown University, Providence, RI, USA
- U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA
- RTI International—Health Care Financing and Payment, Research Triangle Park, NC, USA
| | - David Dosa
- Brown University, Providence, RI, USA
- U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA
| | | | - Kali Thomas
- Brown University, Providence, RI, USA
- U.S. Department of Veterans Affairs Medical Center, Providence, RI, USA
| |
Collapse
|
6
|
Connolly T, Mahoney E. Stroke survivors’ experiences transitioning from hospital to home. J Clin Nurs 2018; 27:3979-3987. [DOI: 10.1111/jocn.14563] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/02/2018] [Accepted: 06/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | - Ellen Mahoney
- Connell School of Nursing; Boston College; Chestnut Hill Massachusetts
| |
Collapse
|
7
|
Naef R, Ernst J, Bürgi C, Petry H. Quality of acute care for persons with cognitive impairment and their families: A scoping review. Int J Nurs Stud 2018; 85:80-89. [PMID: 29859348 DOI: 10.1016/j.ijnurstu.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND An increasing number of older persons with cognitive impairment use inpatient services for co-occurring acute illness. Research has demonstrated that persons with cognitive impairment face more adverse health outcomes during hospitalization than their age counterparts without cognitive impairment. As hospitals tend to be ill equipped to meet the complex care needs of this population, various initiatives underscore the need to better utilize existing evidence to improve quality of care. OBJECTIVES To map the extent of knowledge about quality of acute care in inpatient settings, and to synthesize knowledge on strategies to improve quality care for persons with cognitive impairment and their families. DESIGN A scoping review using Arksey and O'Malley's methodological framework. DATA SOURCES CINAHL and Medline were searched and reference lists of pertinent articles screened to identify publications regarding acute care for persons with cognitive impairment. REVIEW METHODS Two reviewers independently screened and identified publications based on eligibility criteria. Publications were included if they targeted acute care issues relating to persons with cognitive impairment 65 years or older, their family members, or health professionals caring for them, and were published after 2000 in English or German. Publications were read and data were extracted using a predefined template. Thematic analysis was conducted by two reviewers. RESULTS Of the 1445 identified publications, 66 were included. Quality of acute inpatient services pertained to structural (such as staff capacity and knowledge) and process dimensions (such as forming a caring relationship, assessing and intervening). Strategies identified to improve care quality included interventions at the point of care, such as specific tools and specialist roles to improve patient outcomes, as well as educational and training interventions to enable staff to care for this patient group. CONCLUSIONS There is a discrepancy between clearly defined best practice for persons with cognitive impairment utilising inpatient services, and the quality of care actually experienced by patients, family members, and staff. Research reveals a sobering picture of inadequate care and manifold challenges encountered by this patient group, family members and staff alike. Promising strategies to improve care quality target health professionals' knowledge and capacity to work with this group and include specific tools and models of care, such as specialist roles and units. Organisation-wide efforts to ensure quality care for this patient group are needed, as is further research to determine which implementation and intervention strategies achieve the most beneficial outcomes for all involved.
Collapse
Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
| | - Jutta Ernst
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Bürgi
- Division of Abdomen-Metabolism, University Hospital Zurich, Zurich, Switzerland
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
8
|
Pickens S, Boss L, Ahn H, Jefferson F. Identifying Cognitive Impairment in Hospitalized Older Adults to Prevent Readmission: Two Case Studies. Clin Gerontol 2018; 41:101-107. [PMID: 28686529 DOI: 10.1080/07317115.2017.1333971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To describe two patient outcomes post-discharge from an acute hospital admission. Both patients underwent cognitive testing during hospitalization. METHODS A battery of cognitive tests was administered to two hospitalized older adult patients. Both patients were evaluated in their homes within 72 hours of discharge and again at 14- and 30-days by a nurse practitioner. RESULTS One of the patients was readmitted within 30 days of hospital discharge due to complications from an amputation. This patient did not perform well on cognitive measures which may have been related to his pain levels and/or his medication regimen. CONCLUSIONS Not all readmissions are avoidable; however, if readmissions are related to cognitive impairment, implementing strategies tailored to this population may reduce readmission rates. CLINICAL IMPLICATIONS Risk factors for readmission should be identified so the discharge team can develop a tailored plan of care. Including both the patient and an informal caregiver may reduce the chance of a hospital readmission in older adults with cognitive impairment regardless of the etiology.
Collapse
Affiliation(s)
- Sabrina Pickens
- a The University of Texas Health Science Center at Houston School of Nursing , Houston , Texas , USA
| | - Lisa Boss
- a The University of Texas Health Science Center at Houston School of Nursing , Houston , Texas , USA.,b Memorial Herman Northeast Hospital , Humble , Texas , USA
| | - Hyochol Ahn
- a The University of Texas Health Science Center at Houston School of Nursing , Houston , Texas , USA
| | | |
Collapse
|
9
|
Mora K, Dorrejo XM, Carreon KM, Butt S. Nurse practitioner-led transitional care interventions: An integrative review. J Am Assoc Nurse Pract 2017; 29:773-790. [DOI: 10.1002/2327-6924.12509] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 12/22/2022]
|