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Mary A, Mzayek F, Lefler LL, Jiang YJ, Meadows Taylor M. Case Management in Prevention of 30-Day Readmission in Post-Coronary Artery Bypass Graft Surgery. Prof Case Manag 2024:01269241-990000000-00015. [PMID: 38421737 DOI: 10.1097/ncm.0000000000000718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF STUDY Thirty-day readmission is associated with increased morbidity and mortality among postoperative coronary artery bypass graft (CABG) surgery patients. Interventions such as case management and follow-up care may reduce 30-day readmission. The purpose of this article is to report a study on modifiable factors that may have significant implications for case management in the prevention of readmission after CABG surgery. PRIMARY PRACTICE SETTINGS The study population included all the adult patients who underwent first-time CABG surgery from January 1, 2013, to January 1, 2016, from a Mid-South hospital. METHODOLOGY AND SAMPLE A retrospective case-control study was employed to examine 1,712 patients who underwent CABG surgery. RESULTS The results revealed that patients readmitted within 30 days had a significantly shorter length of stay (LOS) (6 days vs. 10 days; p < .0001), more days in intensive care unit (6 days vs. 4 days; p = .0391), and significantly higher diabetes/renal (4% vs. 1%), infection (17% vs. 2%), and respiratory-related diagnoses (10% vs. 1%; p < .0001). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Among these factors, hospital LOS is a major factor that can be addressed through case management in addition to other modifiable risk factors. Understanding modifiable factors associated with higher readmission risk is crucial for effective intervention and case management planning.
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Affiliation(s)
- Annapoorna Mary
- Annapoorna Mary, PhD, MSc(N), RN, CNE, practices in Critical Care & Emergency Room & MRT. Her research interests are critical care, medical surgical nursing, cardiac nursing, and nursing education (critical thinking and clinical reasoning & EBP)
- Fawaz Mzayek, PhD, MD, MPH, is an Associate Professor of Epidemiology. He has extensive experience in the epidemiology of cardiovascular disease. He has been working with large datasets from longitudinal studies such as the Bogalusa Heart Study, a longitudinal, community-based study of the natural evolution of cardiovascular disease
- Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, FAAN, is an Associate Dean for Research/William A. and Ruth F. Loewenberg Chair of Excellence in Nursing. Dr. Lefler has developed innovative models of care and education and conducted a program of research that informs treatment of older adults with cardiovascular disease
- Yu (Joyce) Jiang, PhD, is an Assistant Professor in the Division of Epidemiology, Biostatistics, and Environmental Health. Her general research interests include Bayesian data analysis, clinical trial studies, cancer epidemiology, and genomics. As a biostatistician, she has broad interests in biological science, medicine, public health, and all other related fields
- Meghan-Meadows Taylor, PhD, MPH, is an accomplished researcher with a diverse background in academia and health care. Her research primarily focuses on multidisciplinary management of chronic diseases in community-based health care systems, with the ultimate goal of optimizing diagnosis and treatment approaches
| | - Fawaz Mzayek
- Annapoorna Mary, PhD, MSc(N), RN, CNE, practices in Critical Care & Emergency Room & MRT. Her research interests are critical care, medical surgical nursing, cardiac nursing, and nursing education (critical thinking and clinical reasoning & EBP)
- Fawaz Mzayek, PhD, MD, MPH, is an Associate Professor of Epidemiology. He has extensive experience in the epidemiology of cardiovascular disease. He has been working with large datasets from longitudinal studies such as the Bogalusa Heart Study, a longitudinal, community-based study of the natural evolution of cardiovascular disease
- Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, FAAN, is an Associate Dean for Research/William A. and Ruth F. Loewenberg Chair of Excellence in Nursing. Dr. Lefler has developed innovative models of care and education and conducted a program of research that informs treatment of older adults with cardiovascular disease
- Yu (Joyce) Jiang, PhD, is an Assistant Professor in the Division of Epidemiology, Biostatistics, and Environmental Health. Her general research interests include Bayesian data analysis, clinical trial studies, cancer epidemiology, and genomics. As a biostatistician, she has broad interests in biological science, medicine, public health, and all other related fields
- Meghan-Meadows Taylor, PhD, MPH, is an accomplished researcher with a diverse background in academia and health care. Her research primarily focuses on multidisciplinary management of chronic diseases in community-based health care systems, with the ultimate goal of optimizing diagnosis and treatment approaches
| | - Leanne L Lefler
- Annapoorna Mary, PhD, MSc(N), RN, CNE, practices in Critical Care & Emergency Room & MRT. Her research interests are critical care, medical surgical nursing, cardiac nursing, and nursing education (critical thinking and clinical reasoning & EBP)
- Fawaz Mzayek, PhD, MD, MPH, is an Associate Professor of Epidemiology. He has extensive experience in the epidemiology of cardiovascular disease. He has been working with large datasets from longitudinal studies such as the Bogalusa Heart Study, a longitudinal, community-based study of the natural evolution of cardiovascular disease
- Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, FAAN, is an Associate Dean for Research/William A. and Ruth F. Loewenberg Chair of Excellence in Nursing. Dr. Lefler has developed innovative models of care and education and conducted a program of research that informs treatment of older adults with cardiovascular disease
- Yu (Joyce) Jiang, PhD, is an Assistant Professor in the Division of Epidemiology, Biostatistics, and Environmental Health. Her general research interests include Bayesian data analysis, clinical trial studies, cancer epidemiology, and genomics. As a biostatistician, she has broad interests in biological science, medicine, public health, and all other related fields
- Meghan-Meadows Taylor, PhD, MPH, is an accomplished researcher with a diverse background in academia and health care. Her research primarily focuses on multidisciplinary management of chronic diseases in community-based health care systems, with the ultimate goal of optimizing diagnosis and treatment approaches
| | - Yu Joyce Jiang
- Annapoorna Mary, PhD, MSc(N), RN, CNE, practices in Critical Care & Emergency Room & MRT. Her research interests are critical care, medical surgical nursing, cardiac nursing, and nursing education (critical thinking and clinical reasoning & EBP)
- Fawaz Mzayek, PhD, MD, MPH, is an Associate Professor of Epidemiology. He has extensive experience in the epidemiology of cardiovascular disease. He has been working with large datasets from longitudinal studies such as the Bogalusa Heart Study, a longitudinal, community-based study of the natural evolution of cardiovascular disease
- Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, FAAN, is an Associate Dean for Research/William A. and Ruth F. Loewenberg Chair of Excellence in Nursing. Dr. Lefler has developed innovative models of care and education and conducted a program of research that informs treatment of older adults with cardiovascular disease
- Yu (Joyce) Jiang, PhD, is an Assistant Professor in the Division of Epidemiology, Biostatistics, and Environmental Health. Her general research interests include Bayesian data analysis, clinical trial studies, cancer epidemiology, and genomics. As a biostatistician, she has broad interests in biological science, medicine, public health, and all other related fields
- Meghan-Meadows Taylor, PhD, MPH, is an accomplished researcher with a diverse background in academia and health care. Her research primarily focuses on multidisciplinary management of chronic diseases in community-based health care systems, with the ultimate goal of optimizing diagnosis and treatment approaches
| | - Meghan Meadows Taylor
- Annapoorna Mary, PhD, MSc(N), RN, CNE, practices in Critical Care & Emergency Room & MRT. Her research interests are critical care, medical surgical nursing, cardiac nursing, and nursing education (critical thinking and clinical reasoning & EBP)
- Fawaz Mzayek, PhD, MD, MPH, is an Associate Professor of Epidemiology. He has extensive experience in the epidemiology of cardiovascular disease. He has been working with large datasets from longitudinal studies such as the Bogalusa Heart Study, a longitudinal, community-based study of the natural evolution of cardiovascular disease
- Leanne L. Lefler, PhD, ACNS-BC, APRN, FAHA, FAAN, is an Associate Dean for Research/William A. and Ruth F. Loewenberg Chair of Excellence in Nursing. Dr. Lefler has developed innovative models of care and education and conducted a program of research that informs treatment of older adults with cardiovascular disease
- Yu (Joyce) Jiang, PhD, is an Assistant Professor in the Division of Epidemiology, Biostatistics, and Environmental Health. Her general research interests include Bayesian data analysis, clinical trial studies, cancer epidemiology, and genomics. As a biostatistician, she has broad interests in biological science, medicine, public health, and all other related fields
- Meghan-Meadows Taylor, PhD, MPH, is an accomplished researcher with a diverse background in academia and health care. Her research primarily focuses on multidisciplinary management of chronic diseases in community-based health care systems, with the ultimate goal of optimizing diagnosis and treatment approaches
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Bhagavathy MG, Anniyappa S, Thankappan R, Bharathi B. Lived experiences of stroke survivors in India: A phenomenological study. BELITUNG NURSING JOURNAL 2022; 8:405-413. [PMID: 37554493 PMCID: PMC10405661 DOI: 10.33546/bnj.2161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/29/2022] [Accepted: 09/19/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Stroke is a major cause of long-term disability and has a potentially enormous emotional and socio-economic impact on patients, their families, and health services. Perceptions of patients with stroke have already been studied worldwide, which are unique in terms of their cultural background. However, in India, there is a lack of studies about the experience of the disease by stroke survivors and their perspectives of understanding the situation. OBJECTIVE This study aimed to explore lived experience of stroke survivors in India. METHODS A phenomenological study design was used. In-depth interviews were conducted with a purposive sample of ten stroke survivors who had experienced post-stroke deficits three months to one year after stroke. Data were analyzed using Diekelmann's hermeneutical approach to identify underlying themes. RESULTS Two main themes emerged: (1) emergence of stroke (actual occurrence, mental perception, and recognition of illness) and (2) therapeutic concerns (enhanced and weakened recovery). CONCLUSION Recognizing how patients experience the illness is crucial in planning care for stroke survivors. Strengthening factors enhancing recovery and limiting the hindering factors through effective therapeutic management is a necessity. The findings might also contribute to refining existing interventions and designing holistic multi-component rehabilitation programs that facilitate easy recovery. The study also highlights the need for providing information to general public on recognizing warning signs of stroke.
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Affiliation(s)
- Manjula G Bhagavathy
- Department of Medical-Surgical Nursing, College of Nursing, King Khalid University, Khamis Mushait, Saudi Arabia
| | - Saravana Anniyappa
- Department of Obstetrics and Gynecology, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Bindu Bharathi
- Department of Public Health Nursing, College of Nursing, Northern Border University, Arar, Saudi Arabia
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Posri N, Srisatidnarakul B, Hickman RL. Development of a Readiness for Hospital Discharge assessment tool in Thai patients with stroke. BELITUNG NURSING JOURNAL 2022; 8:75-83. [PMID: 37521078 PMCID: PMC10386804 DOI: 10.33546/bnj.1968] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/12/2021] [Accepted: 01/08/2022] [Indexed: 08/01/2023] Open
Abstract
Background The transition from hospital to home among patients with stroke is quite challenging. If the patients are not ready for hospital discharge, their condition may worsen, which also causes a high rate of readmission. Although instruments to measure readiness for hospital discharge exist, none of them fit with the Thailand context. Objective This study aimed to develop a Readiness for Hospital Discharge assessment tool in Thai patients with stroke. Methods The study was conducted from February to September 2020, which consisted of several steps: 1) conducting an extensive literature review, 2) content validity with five experts, 3) pilot testing with 30 samples, and 4) field testing with 348 participants. Content validity index (CVI) was used to measure the content validity, Cronbach's alpha and inter-item correlation to evaluate reliability, and multiple logistic regression analysis to measure the construct validity. Results The findings showed good validity and reliability, with I-CVI of 0.85, Cronbach's alpha of 0.94, and corrected item-total correlation ranging from 0.43 to 0.86. The construct validity was demonstrated through the results of regression analysis showing that the nine variables include level of consciousness (OR = 0.544; CI 95% = 0.311 - 0.951), verbal response (OR = 0.445; 95% CI 0.272- 0.729), motor power right leg (OR = 0.165; 95% CI 0.56- 0.485), visual field (OR = 0.188; 95% CI 0.60-0.587), dysphagia (OR = 0.618; 95% CI 0.410-0.932), mobility (OR = 0.376; 95% CI 0.190 - 0.741), self-feeding (OR = 0.098; 95% CI 0.036 -0.265), bathing (OR = 0.099; 95% CI 0.026-0.378), and bladder control (OR = 0.589; 95% CI 0.355-0.977) that significantly influenced the hospital readmission within 30 days in patients with stroke. Conclusion The Readiness for Hospital Discharge assessment tool is valid and reliable. Healthcare providers, especially nurses, can use this tool to assess discharge conditions for patients with stroke with greater accuracy in predicting hospital readmission.
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Affiliation(s)
| | | | - Ronald L. Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
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