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Wallis JA, Shepperd S, Makela P, Han JX, Tripp EM, Gearon E, Disher G, Buchbinder R, O'Connor D. Factors influencing the implementation of early discharge hospital at home and admission avoidance hospital at home: a qualitative evidence synthesis. Cochrane Database Syst Rev 2024; 3:CD014765. [PMID: 38438114 PMCID: PMC10911892 DOI: 10.1002/14651858.cd014765.pub2] [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] [Indexed: 03/06/2024]
Abstract
BACKGROUND Worldwide there is an increasing demand for Hospital at Home as an alternative to hospital admission. Although there is a growing evidence base on the effectiveness and cost-effectiveness of Hospital at Home, health service managers, health professionals and policy makers require evidence on how to implement and sustain these services on a wider scale. OBJECTIVES (1) To identify, appraise and synthesise qualitative research evidence on the factors that influence the implementation of Admission Avoidance Hospital at Home and Early Discharge Hospital at Home, from the perspective of multiple stakeholders, including policy makers, health service managers, health professionals, patients and patients' caregivers. (2) To explore how our synthesis findings relate to, and help to explain, the findings of the Cochrane intervention reviews of Admission Avoidance Hospital at Home and Early Discharge Hospital at Home services. SEARCH METHODS We searched MEDLINE, CINAHL, Global Index Medicus and Scopus until 17 November 2022. We also applied reference checking and citation searching to identify additional studies. We searched for studies in any language. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with qualitative data collection and analysis methods examining the implementation of new or existing Hospital at Home services from the perspective of different stakeholders. DATA COLLECTION AND ANALYSIS Two authors independently selected the studies, extracted study characteristics and intervention components, assessed the methodological limitations using the Critical Appraisal Skills Checklist (CASP) and assessed the confidence in the findings using GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research). We applied thematic synthesis to synthesise the data across studies and identify factors that may influence the implementation of Hospital at Home. MAIN RESULTS From 7535 records identified from database searches and one identified from citation tracking, we included 52 qualitative studies exploring the implementation of Hospital at Home services (31 Early Discharge, 16 Admission Avoidance, 5 combined services), across 13 countries and from the perspectives of 662 service-level staff (clinicians, managers), eight systems-level staff (commissioners, insurers), 900 patients and 417 caregivers. Overall, we judged 40 studies as having minor methodological concerns and we judged 12 studies as having major concerns. Main concerns included data collection methods (e.g. not reporting a topic guide), data analysis methods (e.g. insufficient data to support findings) and not reporting ethical approval. Following synthesis, we identified 12 findings graded as high (n = 10) and moderate (n = 2) confidence and classified them into four themes: (1) development of stakeholder relationships and systems prior to implementation, (2) processes, resources and skills required for safe and effective implementation, (3) acceptability and caregiver impacts, and (4) sustainability of services. AUTHORS' CONCLUSIONS Implementing Admission Avoidance and Early Discharge Hospital at Home services requires early development of policies, stakeholder engagement, efficient admission processes, effective communication and a skilled workforce to safely and effectively implement person-centred Hospital at Home, achieve acceptance by staff who refer patients to these services and ensure sustainability. Future research should focus on lower-income country and rural settings, and the perspectives of systems-level stakeholders, and explore the potential negative impact on caregivers, especially for Admission Avoidance Hospital at Home, as this service may become increasingly utilised to manage rising visits to emergency departments.
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Affiliation(s)
- Jason A Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Cabrini Health, Malvern, Australia
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Petra Makela
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Jia Xi Han
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Evie M Tripp
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emma Gearon
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gary Disher
- New South Wales Ministry of Health, St Leonards, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Denise O'Connor
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Welch V, Mathew CM, Babelmorad P, Li Y, Ghogomu ET, Borg J, Conde M, Kristjansson E, Lyddiatt A, Marcus S, Nickerson JW, Pottie K, Rogers M, Sadana R, Saran A, Shea B, Sheehy L, Sveistrup H, Tanuseputro P, Thompson‐Coon J, Walker P, Zhang W, Howe TE. Health, social care and technological interventions to improve functional ability of older adults living at home: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1175. [PMID: 37051456 PMCID: PMC8988637 DOI: 10.1002/cl2.1175] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Background By 2030, the global population of people older than 60 years is expected to be higher than the number of children under 10 years, resulting in major health and social care system implications worldwide. Without a supportive environment, whether social or built, diminished functional ability may arise in older people. Functional ability comprises an individual's intrinsic capacity and people's interaction with their environment enabling them to be and do what they value. Objectives This evidence and gap map aims to identify primary studies and systematic reviews of health and social support services as well as assistive devices designed to support functional ability among older adults living at home or in other places of residence. Search Methods We systematically searched from inception to August 2018 in: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CENTRAL, CINAHL, PsycINFO, AgeLine, Campbell Library, ASSIA, Social Science Citation Index and Social Policy & Practice. We conducted a focused search for grey literature and protocols of studies (e.g., ProQuest Theses and Dissertation Global, conference abstract databases, Help Age, PROSPERO, Cochrane and Campbell libraries and ClinicalTrials.gov). Selection Criteria Screening and data extraction were performed independently in duplicate according to our intervention and outcome framework. We included completed and on-going systematic reviews and randomized controlled trials of effectiveness on health and social support services provided at home, assistive products and technology for personal indoor and outdoor mobility and transportation as well as design, construction and building products and technology of buildings for private use such as wheelchairs, and ramps. Data Collection and Analysis We coded interventions and outcomes, and the number of studies that assessed health inequities across equity factors. We mapped outcomes based on the International Classification of Function, Disability and Health (ICF) adapted categories: intrinsic capacities (body function and structures) and functional abilities (activities). We assessed methodological quality of systematic reviews using the AMSTAR II checklist. Main Results After de-duplication, 10,783 records were screened. The map includes 548 studies (120 systematic reviews and 428 randomized controlled trials). Interventions and outcomes were classified using domains from the International Classification of Function, Disability and Health (ICF) framework. Most systematic reviews (n = 71, 59%) were rated low or critically low for methodological quality.The most common interventions were home-based rehabilitation for older adults (n = 276) and home-based health services for disease prevention (n = 233), mostly delivered by visiting healthcare professionals (n = 474). There was a relative paucity of studies on personal mobility, building adaptations, family support, personal support and befriending or friendly visits. The most measured intrinsic capacity domains were mental function (n = 269) and neuromusculoskeletal function (n = 164). The most measured outcomes for functional ability were basic needs (n = 277) and mobility (n = 160). There were few studies which evaluated outcome domains of social participation, financial security, ability to maintain relationships and communication.There was a lack of studies in low- and middle-income countries (LMICs) and a gap in the assessment of health equity issues. Authors' Conclusions There is substantial evidence for interventions to promote functional ability in older adults at home including mostly home-based rehabilitation for older adults and home-based health services for disease prevention. Remotely delivered home-based services are of greater importance to policy-makers and practitioners in the context of the COVID-19 pandemic. This map of studies published prior to the pandemic provides an initial resource to identify relevant home-based services which may be of interest for policy-makers and practitioners, such as home-based rehabilitation and social support, although these interventions would likely require further adaptation for online delivery during the COVID-19 pandemic. There is a need to strengthen assessment of social support and mobility interventions and outcomes related to making decisions, building relationships, financial security, and communication in future studies. More studies are needed to assess LMIC contexts and health equity issues.
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Affiliation(s)
- Vivian Welch
- Methods CentreBruyère Research InstituteOttawaCanada
| | | | | | - Yanfei Li
- Evidence‐Based Social Science Research Center, School of Public HealthLanzhou UniversityLanzhouChina
| | | | | | - Monserrat Conde
- Cochrane Campbell Global Ageing Partnership FieldFaroPortugal
| | | | | | - Sue Marcus
- Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | | | | | - Morwenna Rogers
- NIHR ARC, South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | | | | | - Beverly Shea
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Lisa Sheehy
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
| | - Heidi Sveistrup
- Bruyère Research InstituteUniversity of OttawaOttawaCanada
- Faculty of Health SciencesUniversity of OttawaOttawaCanada
| | | | - Joanna Thompson‐Coon
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical SchoolExeterUK
| | - Peter Walker
- Faculty of MedicineUniversity of OttawaOttawaCanada
| | - Wei Zhang
- Access to Medicines, Vaccines and Health ProductsWorld Health OrganizationGenevaSwitzerland
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St John PD, Swift AU, Tate RB. Patterns of Functional Impairment over Time Amongst Older Men-the Manitoba Follow-up Study. Can Geriatr J 2021; 24:144-150. [PMID: 34079608 PMCID: PMC8137456 DOI: 10.5770/cgj.24.453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background To determine the incidence and prevalence patterns of activity of daily living (ADL) impairments in ageing men. Methods 3,983 men were enrolled in the Manitoba Follow-up Study (MFUS) cohort study in 1948. From 1996 onwards, functional status was measured. We classified basic (BADL) and instrumental (IADL) into mutually exclusive categories as a time dependant factor after the second survey wave as: First survey response; no limitation; incident (first episode of disability); persistent (limitation which was seen on all questionnaires after the incident episode); resilient (noted in previous surveys but not present); and recurrent (noted in present survey, and limitations noted as present and absent in previous surveys). Results There were 1,745 participants in 1996 at a mean age of 76 years. Incident BADL limitations increased substantially with age: from 1% at age 75 to 15% at age 95. Similarly, persistent limitations increased with age: from 0.4% at age 75 to 18% at age 95. However, BADL function was fluid, with many individuals grouped within the resilient and recurrent patterns. Similar age effects and variability were noted in IADLs. Conclusion New and persistent disabilities are highly associated with age. However, there is considerable change in functional status over time.
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Affiliation(s)
- Philip D St John
- Section of Geriatrics, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB.,Centre on Aging, University of Manitoba, Winnipeg, MB
| | - Audrey U Swift
- Dept of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
| | - Robert B Tate
- Centre on Aging, University of Manitoba, Winnipeg, MB.,Dept of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB
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Krasovsky T, Lubetzky AV, Archambault PS, Wright WG. Will virtual rehabilitation replace clinicians: a contemporary debate about technological versus human obsolescence. J Neuroeng Rehabil 2020; 17:163. [PMID: 33298128 PMCID: PMC7724440 DOI: 10.1186/s12984-020-00769-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 10/07/2020] [Indexed: 11/21/2022] Open
Abstract
This article is inspired by a pseudo Oxford-style debate, which was held in Tel Aviv University, Israel at the International Conference on Virtual Rehabilitation (ICVR) 2019, which is the official conference of the International Society for Virtual Rehabilitation. The debate, between two 2-person teams with a moderator, was organized by the ICVR Program committee to address the question "Will virtual rehabilitation replace clinicians?" It brought together five academics with technical, research, and/or clinical backgrounds-Gerry Fluet, Tal Krasovsky, Anat Lubetzky, Philippe Archambault, W. Geoffrey Wright-to debate the pros and cons of using virtual reality (VR) and related technologies to help assess, diagnose, treat, and track recovery, and more specifically investigate the likelihood that advanced technology will ultimately replace human clinicians. Both teams were assigned a side to defend, whether it represented their own viewpoint or not, and to take whatever positions necessary to make a persuasive argument and win the debate. In this paper we present a recapitulation of the arguments presented by both sides, and further include an in-depth consideration of the question. We attempt to judiciously lay out a number of arguments that fall along a spectrum from moderate to extreme; the most extreme and/or indefensible positions are presented for rhetorical and demonstrative purposes. Although there may not be a clear answer today, this paper raises questions which are related to the basic nature of the rehabilitation profession, and to the current and potential role of technology within it.
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Affiliation(s)
- Tal Krasovsky
- Department of Physical Therapy, University of Haifa, Haifa, Israel
- Pediatric Rehabilitation Department, Sheba Medical Center, Ramat Gan, Israel
| | - Anat V Lubetzky
- Department of Physical Therapy, Steinhardt School of Culture Education and Human Development, New York University, New York, NY, USA
| | - Philippe S Archambault
- School of Physical & Occupational Therapy, McGill University, Montreal, Canada
- CRIR - Centre de Recherche Interdisciplinaire en réadaptation, Montreal, Canada
| | - W Geoffrey Wright
- Neuromotor Sciences Program, Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, USA.
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Functional Recovery Within a Formal Home Care Program. J Am Med Dir Assoc 2019; 20:1001-1006. [PMID: 30738824 DOI: 10.1016/j.jamda.2018.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 12/11/2018] [Accepted: 12/16/2018] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify home care clients with substantial functional deficits who had capacity to improve and, thus, for whom recovery goals should be articulated. DESIGN Retrospective longitudinal analysis of an international home care database. SETTING AND PARTICIPANTS 523,907 persons receiving home care, having 2 assessments, on average, 8 months apart. MEASURES Recovery algorithm variables included counts of dependencies of activities of daily living (ADL) and instrumental ADL (IADL) tasks, hospitalization in the last 30 days, functional decline in the last 90 days, and self-belief in one's capacity to improve. Primary dependent variable was improvement in the IADL-ADL Functional Hierarchy Scale. RESULTS The Recovery Algorithm has 7 graded levels: the top 3 represent approximately 9% of home care clients, whereas the bottom level (where recovery is least likely to occur) includes 60% of home care clients (many with higher counts of extensive ADL or IADL dependencies). The improvement rates rise from 6.9% to 47.2% across the 7 levels of the algorithm. This relationship between change in IADL-ADL Functional Hierarchy Scale scores and Recovery Algorithm levels remained strong across age categories and cognitive performance levels. Higher rates of improvement occurred for persons who received physical therapy. CONCLUSIONS/IMPLICATIONS The Recovery Algorithm is based on a mix of positive risk indicators and the person's challenged baseline functional status. For persons with higher scores on the algorithm, recovery is expected and should be considered in care plan goals. In addition, use of physical therapy increases the probability of recovery.
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Miles JD, Staples WH, Lee DJ. Attitudes About Cognitive Screening: A Survey of Home Care Physical Therapists. J Geriatr Phys Ther 2018; 42:294-303. [PMID: 29461340 DOI: 10.1519/jpt.0000000000000179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Home care physical therapists (PTs) are inconsistent regarding cognitive screening, possibly because screening tools were traditionally considered the domain of other home care disciplines, or because therapists perceive their dementia training to be inadequate. A cross sectional study was designed to survey home care therapists' attitudes and beliefs about the management of persons with dementia and to find out whether any specific cognitive tools or measures are currently used. METHODS A 5-point Likert-type survey was administered to home care PTs via an online survey. Three state home care associations and individual home care agencies agreed to share the survey link. The survey was also made available to American Physical Therapy Association members through the Home Health and Geriatric Section listservs. RESULTS AND DISCUSSION Two hundred fifty-one PTs opened the survey and 233 completed the survey. Respondents included 180 females and 53 males. Seventy-four had a bachelor's degree (BS), 53 held a master's degree (MS), 104 had achieved a doctor of physical therapy (DPT) or doctor of philosophy (PhD) degree, and 2 did not provide this information. Significant differences were found between those with the highest doctoral degrees and those with master's or bachelor's degrees (P = .01) regarding whether they were qualified to screen (strongly agree, agree) for cognitive deficits. Therapists with the highest degrees also attended continuing education for dementia training more than those with less formal education (P = .042.) Gender differences were found in 2 questions regarding positive outcomes (P = .010 and .42); for both questions, males were more likely to believe that dementia has a negative impact. Eighty-seven percent indicated that PTs are qualified (strongly agree, agree), but only 53% said that they possess the necessary skills (strongly agree, agree) to perform cognitive screens. Specialty certification revealed significant differences in several of the questions. No significance was found for any question regarding years of practice or years in home care. The Mini-Mental State Examination and the Clock Drawing Test were most frequently cited among PTs who conduct cognitive screening. CONCLUSIONS Physical therapists recognize that they are qualified to perform cognitive screening but may need additional training to utilize cognitive findings to enhance interventions and outcomes in home care. More research is needed to determine which screens are most relevant for therapist use and to examine the effect of cognitive screening on therapy outcomes.
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Affiliation(s)
- Jean D Miles
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut.,McLean Home Care & Hospice, Simsbury, Connecticut
| | - William H Staples
- College of Health Sciences, Krannert School of Physical Therapy, University of Indianapolis, Indianapolis, Indiana
| | - Daniel J Lee
- Department of Rehabilitation Sciences, University of Hartford, West Hartford, Connecticut
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C. Ashe M, L. Ekegren C, M. Chudyk A, Fleig L, K. Gill T, Langford D, Martin-Martin L, Ariza-Vega P. Telerehabilitation for community-dwelling middle-aged and older adults after musculoskeletal trauma: A systematic review. AIMS MEDICAL SCIENCE 2018. [DOI: 10.3934/medsci.2018.4.316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Macdonald A. Clinician's Commentary on Armstrong et al. 1. Physiother Can 2016; 68:355-356. [PMID: 27910961 DOI: 10.3138/ptc.2014-66-cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Allan Macdonald
- Director, Student Health and Wellness, Ryerson University; Lecturer and Business and Practice Management Theme Lead, Department of Physical Therapy, Faculty of Medicine, University of Toronto;
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