1
|
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.
Collapse
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
| |
Collapse
|
2
|
Crowley R, Atiq O, Hilden D. Long-Term Services and Supports for Older Adults: A Position Paper From the American College of Physicians. Ann Intern Med 2022; 175:1172-1174. [PMID: 35816710 DOI: 10.7326/m22-0864] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The number of Americans aged 65 years or older is expected to increase in the coming decades. Because the risk for disability increases with age, more persons will need long-term services and supports (LTSS) to help with bathing, eating, dressing, and other everyday tasks. Long-term services and supports are delivered in nursing homes, assisted living facilities, the person's home, and other settings. However, the LTSS sector faces several challenges, including keeping patients and staff safe during the COVID-19 pandemic, workforce shortages, quality problems, and fragmented coverage options. In this position paper, the American College of Physicians offers policy recommendations on LTSS coverage, financing, workforce, safety and quality, and emergency preparedness and calls on policymakers and other stakeholders to reform and improve the LTSS sector so that care is high quality, accessible, equitable, and affordable.
Collapse
Affiliation(s)
- Ryan Crowley
- American College of Physicians, Washington, DC (R.C.)
| | - Omar Atiq
- University of Arkansas for Medical Sciences, Little Rock, Arkansas (O.A.)
| | - David Hilden
- Hennepin Healthcare, Minneapolis, Minnesota (D.H.)
| | | |
Collapse
|
3
|
Toles M, Colón-Emeric C, Hanson LC, Naylor M, Weinberger M, Covington J, Preisser JS. Transitional care from skilled nursing facilities to home: study protocol for a stepped wedge cluster randomized trial. Trials 2021; 22:120. [PMID: 33546737 PMCID: PMC7863858 DOI: 10.1186/s13063-021-05068-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Skilled nursing facility (SNF) patients are medically complex with multiple, advanced chronic conditions. They are dependent on caregivers and have experienced recent acute illnesses. Among SNF patients, the rate of mortality or acute care use is over 50% within 90 days of discharge, yet these patients and their caregivers often do not receive the quality of transitional care that prepares them to manage serious illnesses at home. Methods The study will test the efficacy of Connect-Home, a successfully piloted transitional care intervention targeting seriously ill SNF patients discharged to home and their caregivers. The study setting will be SNFs in North Carolina, USA, and, following discharge, in patients’ home. Using a stepped wedge cluster randomized trial design, six SNFs will transition at randomly assigned intervals from standard discharge planning to the Connect-Home intervention. The SNFs will contribute data for patients (N = 360) and their caregivers (N = 360), during both the standard discharge planning and Connect-Home time periods. Connect-Home is a two-step intervention: (a) SNF staff create an individualized Transition Plan of Care to manage the patient’s illness at home; and (b) a Connect-Home Activation RN visits the patient’s home to implement the written Transition Plan of Care. A key feature of the trial includes training of the SNF and Home Care Agency staff to complete the transition plan rather than using study interventionists. The primary outcomes will be patient preparedness for discharge and caregiver preparedness for caregiving role. With the proposed sample and using a two-sided test at the 5% significance level, we have 80% power to detect a 18% increase in the patient’s preparedness for discharge score. We will employ linear mixed models to compare observations between intervention and usual care periods to assess primary outcomes. Secondary outcomes include (a) patients’ quality of life, functional status, and days of acute care use and (b) caregivers’ burden and distress. Discussion Study results will determine the efficacy of an intervention using existing clinical staff to (a) improve transitional care for seriously ill SNF patients and their caregivers, (b) prevent avoidable days of acute care use in a population with persistent risks from chronic conditions, and (c) advance the science of transitional care within end-of-life and palliative care trajectories of SNF patients and their caregivers. While this study protocol was being implemented, the COVID-19 pandemic occurred and this protocol was revised to mitigate COVID-related risks of patients, their caregivers, SNF staff, and the study team. Thus, this paper includes additional material describing these modifications. Trial registration ClinicalTrials.gov NCT03810534. Registered on January 18, 2019.
Collapse
Affiliation(s)
- M Toles
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, USA.
| | - C Colón-Emeric
- School of Medicine and the Durham VA GRECC, Duke University, Durham, USA
| | - L C Hanson
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - M Naylor
- School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - M Weinberger
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - J Covington
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - J S Preisser
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| |
Collapse
|
4
|
Takahashi PY, Leppin AL, Hanson GJ. Hospital to Community Transitions for Older Adults: An Update for the Practicing Clinician. Mayo Clin Proc 2020; 95:2253-2262. [PMID: 32736941 DOI: 10.1016/j.mayocp.2020.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 01/16/2020] [Accepted: 02/04/2020] [Indexed: 01/17/2023]
Abstract
Spurred by changes in both population demographics and health care reimbursement, health care providers are responding by using new models to more fully support the posthospital transition. This paper reviews common models for posthospital transition and also describes the Mayo Clinic model for care transition. Models are designed with the intent of managing the cost of health care by reducing 30-day hospital readmissions and improving management of chronic disease. Meta-analyses have proved helpful in identifying the most effective program elements designed to reduce 30-day hospital readmissions. These elements include a bundled and multidisciplinary approach to best meet the needs of patients. Successful care teams also emphasize self-empowerment for both patients and caregivers. There are 2 general types of practice. In 1 model, introduced by Mary Naylor, an advanced-practice provider cares for the patient for a set period of time, which includes home visits. In the second model, introduced by Eric Coleman, a transitions coach, who can be an RN, a social worker, or a trained volunteer, serves as the health care coach, while improving self-efficacy. Both models have been successful. At Mayo Clinic, the Mayo Clinic Care Transitions program has encompassed a 7-year experience, using the services of an advanced practice provider. In previous studies, this model demonstrated a 20.1% (95% confidence interval [CI], 15.8 to 24.1%) decrease in 30-day readmission in controls compared with 12.4% (95% CI, 8.9 to 15.7%) in the control group. Although this model was successful in reducing 30-day readmissions, there was no difference between groups at 180 days. In patients experiencing the highest deciles of cost (8th decile), enrollment in a care transitions program reduced their overall cost by $2700. This cost savings was statistically significant. Both patients and caregivers participating in the program appreciated the home visits and felt more comfortable communicating at home.
Collapse
Affiliation(s)
- Paul Y Takahashi
- Division of Community Internal Medicine and Division of Geriatrics and Gerontology, Mayo Clinic, Rochester, MN; Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN.
| | - Aaron L Leppin
- Division of Health Care Policy and Research, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN
| | - Gregory J Hanson
- Division of Community Internal Medicine and Division of Geriatrics and Gerontology, Mayo Clinic, Rochester, MN; Robert and Arlene Kogod Center on Aging, Mayo Clinic, Rochester, MN
| |
Collapse
|
5
|
O'Neill M, Ryan A, Tracey A, Laird L. "You're at their mercy": Older peoples' experiences of moving from home to a care home: A grounded theory study. Int J Older People Nurs 2020; 15:e12305. [PMID: 31997550 DOI: 10.1111/opn.12305] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 11/27/2019] [Accepted: 01/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Internationally, it is recognised that the transition to a care home environment can be an emotional and stressful occasion for older people and their families. There is a paucity of research that takes into consideration the initial phase of the relocation process, incorporating individuals' experiences of the move. AIM To explore individuals' experiences of moving into a care home. This paper has a specific focus on the preplacement (7 days) and immediate postplacement (within 3 days) period of the move to the care home. DESIGN A grounded theory method was used to conduct semi-structured interviews with 23 participants. RESULTS Data analysis revealed five distinct categories that captured the experience of the preplacement and immediate postplacement period. These were as follows: (a) inevitability of the move: "I had to come here," (b) making the move: "Abrupt Departures," (c) decision-making and exercising choice: "What can I do, I have no choice," (d) maintaining identity: "Holding on to self" and (e) maintaining connections: "I like my family to be near." Together, these five categories formed the basis of the concept "You're at their Mercy" which encapsulates the perceived transition experience of the older people within the study. Participants felt that the move was out of their control and that they were "at the mercy" of others who made decisions about their long-term care. CONCLUSIONS Moving to a care home represents a uniquely significant relocation experience for the individual. Key factors influencing the move were the individuals' perceived lack of autonomy in the pre- and postrelocating period of moving to a care home. Nurses have a key role to play in working with older people to influence policy and practice around decision-making, planning and moving to a care home with greater emphasis on autonomy and choice so that older people do not feel "at the mercy" of others as they navigate such a major transition. IMPLICATIONS FOR PRACTICE There is a need to standardise approaches and develop person-centred interventions to support older people considering relocation to a care home and nurses have a key role to play in making this happen.
Collapse
Affiliation(s)
- Marie O'Neill
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Londonderry, UK
| | - Assumpta Ryan
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Londonderry, UK
| | | | - Liz Laird
- School of Nursing and Institute of Nursing and Health Research, Ulster University, Londonderry, UK
| |
Collapse
|
6
|
Dys S, Smith L, Tunalilar O, Carder P. Revisiting the Role of Physicians in Assisted Living and Residential Care Settings. Gerontol Geriatr Med 2020; 6:2333721420979840. [PMID: 33354590 PMCID: PMC7734500 DOI: 10.1177/2333721420979840] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/22/2020] [Accepted: 11/09/2020] [Indexed: 11/16/2022] Open
Abstract
As the United States population ages, a higher share of adults is likely to use long-term services and supports. This change increases physicians' need for information about assisted living and residential care (AL/RC) settings, which provide supportive care and housing to older adults. Unlike skilled nursing facilities, states regulate AL/RC settings through varying licensure requirements enforced by state agencies, resulting in differences in the availability of medical and nursing services. Where some settings provide limited skilled nursing care, in others, residents rely on resident care coordinators, or their own physicians to oversee chronic conditions, medications, and treatments. The following narrative review describes key processes of care where physicians may interact with AL/RC operators, staff, and residents, including care planning, managing Alzheimer's disease and related conditions, medication management, and end-of-life planning. Communication and collaboration between physicians and AL/RC operators are a crucial component of care management.
Collapse
Affiliation(s)
- Sarah Dys
- Oregon Health & Science University-Portland State University, Portland, OR, USA
- Portland State University, Portland, OR, USA
| | - Lindsey Smith
- Oregon Health & Science University-Portland State University, Portland, OR, USA
- Portland State University, Portland, OR, USA
| | | | - Paula Carder
- Oregon Health & Science University-Portland State University, Portland, OR, USA
- Portland State University, Portland, OR, USA
| |
Collapse
|
7
|
Unroe KT, O'Kelly Phillips E, Effler S, Ersek MT, Hickman SE. Comfort Measures Orders and Hospital Transfers: Insights From the OPTIMISTIC Demonstration Project. J Pain Symptom Manage 2019; 58:559-566. [PMID: 31233842 DOI: 10.1016/j.jpainsymman.2019.06.012] [Citation(s) in RCA: 5] [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] [Received: 05/02/2019] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
Abstract
CONTEXT Nursing facility residents and their families may identify "comfort measures" as their overall goal of care, yet some hospital transfers still occur. OBJECTIVES Describe nursing facility residents with comfort measures and their hospital transfers. METHODS Mixed methods, including root cause analyses of transfers by registered nurses and interviews with a subset of health care providers and family members involved in transfers. Participants were residents in 19 central Indiana facilities with comfort measures orders who experienced unplanned transfers to the hospital between January 1, 2015 and June 30, 2016. Project demographic and clinical characteristics of the residents were obtained from the Minimum Data Set 3.0. Interviews were conducted with stakeholders involved in transfer decisions. Participants were prompted to reflect on reasons for the transfer and outcomes. Interviews were transcribed and coded using qualitative descriptive methods. RESULTS Residents with comfort measures orders (n = 177) experienced 204 transfers. Most events were assessed as unavoidable (77%). Communication among staff, or between staff and the resident/family, primary care provider, or hospital was the most frequently noted area needing improvement (59.5%). In interviews, participants (n = 11) highlighted multiple issues, including judgments about whether decisions were "good" or "bad," and factors that were important to decision-making, including communication, nursing facility capabilities, clinical situation, and goals of care. CONCLUSION Most transfers of residents with comfort measures orders were considered unavoidable. Nonetheless, we identified several opportunities for improving care processes, including communication and addressing acute changes in status.
Collapse
Affiliation(s)
- Kathleen T Unroe
- Indiana University School of Medicine, Indianapolis, Indiana, USA; Regenstrief Institute, Indianapolis, Indiana, USA.
| | | | | | - Mary T Ersek
- Department of Veterans Affairs, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Susan E Hickman
- Indiana University School of Medicine, Indianapolis, Indiana, USA; Regenstrief Institute, Indianapolis, Indiana, USA; Indiana University School of Nursing, Indianapolis, Indiana, USA
| |
Collapse
|
8
|
Schnitker L, Fielding E, MacAndrew M, Beattie E, Lie D, FitzGerald G. A national survey of aged care facility managers' views of preparedness for natural disasters relevant to residents with dementia. Australas J Ageing 2019; 38:182-189. [PMID: 30791179 DOI: 10.1111/ajag.12619] [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: 10/23/2017] [Revised: 06/10/2018] [Accepted: 12/16/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim was to explore the natural disaster preparedness strategies of Australian residential aged care facilities (RACFs), focussing on aspects relevant to people with dementia. METHODS An online survey was sent to 2617 RACF managers, with 416 responding. Questions included the following: (a) demographics; (b) presence and detail level of disaster/evacuation plans; and (c) references to people with dementia. RESULTS One in four facilities had experienced a natural disaster in the previous five years. The majority had plans for natural disaster and evacuation. Two-thirds recognised the unique needs of people with dementia. Managers anticipated that residents with dementia would require more staff time and resources and might become disoriented. CONCLUSIONS Gaps identified in existing RACF evacuation plans highlighted challenges in ensuring the ongoing safety and care of residents, especially those with dementia. Facilities need to have adequate plans and processes that minimise the potential risks of natural disasters.
Collapse
Affiliation(s)
- Linda Schnitker
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elaine Fielding
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Margaret MacAndrew
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Elizabeth Beattie
- Dementia Centre for Research Collaboration, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Lie
- Queensland Department of Health, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Gerard FitzGerald
- Centre for Emergency and Disaster Management, School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
9
|
Takahashi PY, Finnie DM, Quigg SM, Borkenhagen LS, Kumbamu A, Kimeu AK, Griffin JM. Understanding experiences of patients and family caregivers in the Mayo Clinic Care Transitions program: a qualitative study. Clin Interv Aging 2018; 14:17-25. [PMID: 30587950 PMCID: PMC6304078 DOI: 10.2147/cia.s183893] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Care transitions programs are increasingly used to improve care and reduce re-admission of patients after hospitalization. To learn from the experience of patients who have participated in the Mayo Clinic Care Transitions (MCCT) program and to understand the patient experience, we sought perspectives of patients, caregivers, and providers who worked with participants of the MCCT program. Methods Investigators interviewed 17 patients and nine of their caregivers about their experience with the MCCT program. Eight health care providers described provider experiences with the MCCT program. Data from semistructured interviews were audio recorded, transcribed, and evaluated through content analysis. Inductive coding methods were used to elicit themes about patient experience with the MCCT program. Results Patients, caregivers, and providers emphasized that the MCCT program prevented hospitalizations and contributed to the health and quality of life of participants. All three stakeholder groups emphasized the value of the home visit and provision of the visit on a patient’s “home turf” as central to the program. Patients appreciated speaking to a provider without the stress and exertion of a trip to the clinic. Caregivers appreciated improved communication provided in the home visit and felt that home visits gave them peace of mind. Patients, caregivers, and providers also identified the need for improved phone triage and communication. Conclusion Patients, caregivers, and providers acknowledged the care transitions problem and emphasized the benefits of seeing patients on their home turf rather than in an office visit. This qualitative study of patient, caregiver, and provider experiences further validates the importance of the MCCT program.
Collapse
Affiliation(s)
- Paul Y Takahashi
- Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA,
| | - Dawn M Finnie
- Robert D and Patricia E Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Stephanie M Quigg
- Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA,
| | - Lynn S Borkenhagen
- Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA,
| | - Ashok Kumbamu
- Robert D and Patricia E Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Ashley K Kimeu
- Department of Internal Medicine, Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA,
| | - Joan M Griffin
- Robert D and Patricia E Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.,Department of Health Science Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
10
|
Popejoy LL, Vogelsmeier AA, Wakefield BJ, Galambos CM, Lewis AM, Huneke D, Mehr DR. Adapting Project RED to Skilled Nursing Facilities. Clin Nurs Res 2018; 29:149-156. [PMID: 30556413 DOI: 10.1177/1054773818819261] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes our recommendation for adapting hospital-based RED (Reengineered Discharge) processes to skilled nursing facilities (SNFs). Using focus groups, the SNFs' discharge processes were assessed twice additionally, research staff then recorded field notes documenting discussions about facility discharge processes as they related to RED processes. Data were systematically analyzed using thematic analysis to identify recommendations for adapting RED to the SNF setting including (a) rapidly identifying, involving, and preparing family/caregivers to implement a patient focused SNF discharge plan; (b) reconnecting patients quickly to primary care providers; and (c) educating patients at discharge about their target health condition, medications, and impact of changes on other chronic health needs. Limited SNF staff capacity and corporate-level policies limited adoption of some key RED components. Transitional care processes such as RED, developed to avoid discharge problems, can be adapted for SNFs to improve their discharges.
Collapse
|
11
|
Chronic obstructive pulmonary disease in the long-term care setting: current practices, challenges, and unmet needs. Curr Opin Pulm Med 2018; 23 Suppl 1:S1-S28. [PMID: 28990958 DOI: 10.1097/mcp.0000000000000416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
: Chronic obstructive pulmonary disease (COPD) is a prevalent and disabling disorder in the United States, especially affecting older individuals, women, and those with a history of smoking. Studies show that COPD may be underrepresented, underdiagnosed, and undertreated in elderly patients residing in long-term care (LTC) facilities. The quality of care for LTC residents with COPD is heterogeneous in regard to both the facility and the patient. For LTC facilities, care should be driven by staff education, interstaff communication, and interfacility communication. From the perspective of the LTC patient, choice of medication and device should be based on appropriate diagnosis, comorbidities, ability to perform treatment, and patient preferences. Nebulization is currently underutilized in LTC settings, although it would benefit older patients with low peak inspiratory flow, cognitive impairment, and/or physical impairment, which may preclude them from using other inhalation devices. Authors developed a COPD treatment algorithm that focuses on three primary patient aspects to consider when deciding on respiratory device in patients in LTC facilities: inspiratory flow, hand dexterity and coordination, and cognitive capacity.
Collapse
|
12
|
Sykes S, Baillie L, Thomas B, Scotter J, Martin F. Enhancing Care Transitions for Older People through Interprofessional Simulation: A Mixed Method Evaluation. Int J Integr Care 2017; 17:3. [PMID: 29588636 PMCID: PMC5853909 DOI: 10.5334/ijic.3055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 10/11/2017] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION The educational needs of the health and social care workforce for delivering effective integrated care are important. This paper reports on the development, pilot and evaluation of an interprofessional simulation course, which aimed to support integrated care models for care transitions for older people from hospital to home. THEORY AND METHODS The course development was informed by a literature review and a scoping exercise with the health and social care workforce. The course ran six times and was attended by health and social care professionals from hospital and community (n = 49). The evaluation aimed to elicit staff perceptions of their learning about care transfers of older people and to explore application of learning into practice and perceived outcomes. The study used a sequential mixed method design with questionnaires completed pre (n = 44) and post (n = 47) course and interviews (n = 9) 2-5 months later. RESULTS Participants evaluated interprofessional simulation as a successful strategy. Post-course, participants identified learning points and at the interviews, similar themes with examples of application in practice were: Understanding individual needs and empathy; Communicating with patients and families; Interprofessional working; Working across settings to achieve effective care transitions. CONCLUSIONS AND DISCUSSION An interprofessional simulation course successfully brought together health and social care professionals across settings to develop integrated care skills and improve care transitions for older people with complex needs from hospital to home.
Collapse
Affiliation(s)
- Susie Sykes
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, GB
| | - Lesley Baillie
- School of Health, Wellbeing and Social Care, Open University, Walton Hall, Milton Keynes, MK7 6AA, GB
| | - Beth Thomas
- Simulation and Interactive Learning (SaIL) Centre, Guy’s and St Thomas’ NHS Foundation Trust, GB
| | - Judy Scotter
- School of Health and Social Care, London South Bank University, 103 Borough Road, London, SE1 0AA, GB
| | - Fiona Martin
- Clever Together, 2 Primrose Street, London, EC2A 2EX, GB
| |
Collapse
|
13
|
Toles M, Colón-Emeric C, Naylor MD, Asafu-Adjei J, Hanson LC. Connect-Home: Transitional Care of Skilled Nursing Facility Patients and their Caregivers. J Am Geriatr Soc 2017; 65:2322-2328. [PMID: 28815552 DOI: 10.1111/jgs.15015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Older adults that transfer from skilled nursing facilities (SNF) to home have significant risk for poor outcomes. Transitional care of SNF patients (i.e., time-limited services to ensure coordination and continuity of care) is poorly understood. OBJECTIVE To determine the feasibility and relevance of the Connect-Home transitional care intervention, and to compare preparedness for discharge between comparison and intervention dyads. DESIGN A non-randomized, historically controlled design-enrolling dyads of SNF patients and their family caregivers. SETTING Three SNFs in the Southeastern United States. PARTICIPANTS Intervention dyads received Connect-Home; comparison dyads received usual discharge planning. Of 173 recruited dyads, 145 transferred to home, and 133 completed surveys within 3 days of discharge. INTERVENTION The Connect-Home intervention consisted of tools and training for existing SNF staff to deliver transitional care of patient and caregiver dyads. MEASUREMENTS Feasibility was assessed with a chart review. Relevance was assessed with a survey of staff experiences using the intervention. Preparedness for discharge, the primary outcome, was assessed with Care-Transitions Measure-15 (CTM-15). RESULTS The intervention was feasible and relevant to SNF staff (i.e., 96.9% of staff recommended intervention use in the future). Intervention dyads, compared to comparison dyads, were more prepared for discharge (CTM-15 score 74.7 vs 65.3, mean ratio 1.16, 95% CI: 1.08, 1.24). CONCLUSION Connect-Home is a promising transitional care intervention for older patients discharged from SNF care. The next step will be to test the intervention using a cluster randomized trial, with patient outcomes including re-hospitalization.
Collapse
Affiliation(s)
- Mark Toles
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Mary D Naylor
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Laura C Hanson
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
14
|
Meehan R. Transitions From Acute Care to Long-Term Care: Evaluation of the Continued Access Model. J Appl Gerontol 2017; 38:510-529. [PMID: 28786316 DOI: 10.1177/0733464817723565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Improving communication during transitions from acute care hospitals into long-term post-acute care (LTPAC) settings is imperative for clinical staff to have the information they need to admit and care for the patient with accurate medical information provided in an efficient way. The research goals of this study are to examine the user experience of a new data sharing method, "Continued Access," a supplement to the standard summary of care, and to evaluate staff attitudes of the model on LTPAC residents' care. Clinical staff ( n = 20) from a U.S. Midwestern LTPAC setting were interviewed to give their evaluation of the new model of data access, their concerns, and ways to improve the effectiveness of the model. Respondents reported better opportunities for quality care based on improved insight and clarity around patients' medical history, medications, and tests. Strategies for integrating Continued Access into the workflow and improving quality outcomes are discussed.
Collapse
|
15
|
Jeffs L, Saragosa M, Law M, Kuluski K, Espin S, Merkley J, Bell CM. Elucidating the information exchange during interfacility care transitions: Insights from a Qualitative Study. BMJ Open 2017; 7:e015400. [PMID: 28706095 PMCID: PMC5734419 DOI: 10.1136/bmjopen-2016-015400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the perceptions of patients, their caregivers and healthcare professionals associated with the exchange of information during transitioning from two acute care hospitals to one rehabilitation hospital. DESIGN An exploratory qualitative study using semi-structured interviews and observation. PARTICIPANTS AND SETTING Patients over the age of 65 years admitted to an orthopaedic unit for a non-elective admission, their caregivers and healthcare professionals involved in their care. Participating sites included orthopaedic inpatient units from two acute care teaching hospitals and one orthopaedic unit at a rehabilitation hospital in an urban setting. FINDINGS Three distinct themes emerged from participants' narrative of their transitional care experience: (1) having no clue what the care plan is, (2) being told and notified about the plan and (3) experiencing challenges absorbing information. Participating patients and their caregivers reported not being engaged in an active discussion with healthcare professionals about their care transition plan. Several healthcare professionals described withholding information within the plan until they themselves were clear about the transition outcomes. CONCLUSION This study highlights the need to increase efforts to ensure that effective information exchanges occur during transition from acute care hospital to rehabilitation settings.
Collapse
Affiliation(s)
- Lianne Jeffs
- St Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's, Toronto, Canada
| | - Marianne Saragosa
- St Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael's, Toronto, Canada
| | - Madelyn Law
- Department of Health Science, Brock University, St Michael's, Toronto, Canada
| | - Kerry Kuluski
- Community Health Sciences, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Jane Merkley
- Executive Offices, Sinai Health System, Toronto, Canada
| | - Chaim M Bell
- Department of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
16
|
Moore JR, Sullivan MM. Enhancing the ADMIT Me Tool for Care Transitions for Individuals With Alzheimer's Disease. J Gerontol Nurs 2017; 43:32-38. [PMID: 28095582 DOI: 10.3928/00989134-20170112-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 11/15/2016] [Indexed: 11/20/2022]
Abstract
One of the goals of the National Plan to Address Alzheimer's Disease is to ensure safe care transitions. To facilitate safe and effective transitions from home to hospital, the ADMIT (Alzheimer's, Dementia, Memory Impaired Transitions) Me tool was developed and three focus groups were conducted with caregivers (n = 6), emergency department nurses (n = 6), and first responders (n = 14) to determine its usefulness and applicability to practice. Feedback was used to enhance the tool to reflect their needs. Each group expressed that the tool would help promote safety in care transitions. Using ADMIT Me, nurses can practice with clear communication and collaboration in care transitions, and provide patient-centered care based on the behaviors and unique needs of the individual with dementia. [Journal of Gerontological Nursing, 43(5), 32-38.].
Collapse
|
17
|
Berish DE, Applebaum R, Straker JK. The Residential Long-Term Care Role in Health Care Transitions. J Appl Gerontol 2016; 37:1472-1489. [PMID: 27837055 DOI: 10.1177/0733464816677188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The objective of the current study is to describe the activities long-term care facilities are undertaking to reduce hospital admissions and readmissions by working to improve health care transitions. The data were collected via an online survey from 888 nursing facilities (NFs) and 527 residential care facilities (RCFs) that completed the care integration module of the Ohio Biennial Survey of Long-Term Care. Questions focused on partnerships, current work, type of care model, and perceived barriers to reducing hospital readmissions. More than nine in 10 (93.1%) of NFs and 63.6% of RCFs reported being engaged in a program to reduce hospital admissions/readmissions. Evidence-based care models were utilized by two thirds of NFs and one third of RCFs. Financial barriers were the most frequently cited challenges faced by facilities. Long-term care settings are increasingly becoming transitional care stops for short-term stay residents. Ensuring that facilities are well versed in current transition research and practice is critical to improve system outcomes.
Collapse
|
18
|
Newcomer R, Harrington C, Hulett D, Kang T, Ko M, Bindman A. Health Care Use Before and After Entering Long-Term Services and Supports. J Appl Gerontol 2016; 37:26-40. [DOI: 10.1177/0733464816641393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: We examined the health care utilization patterns of Medicare and Medicaid enrollees (MMEs) before and after initiating long-term care in the community or after admission to a nursing facility (NF). Method: We used administrative data to compare hospitalizations, emergency department (ED) visits, and post-acute care use of MMEs receiving long-term care in California in 2006-2007. Results: MMEs admitted to a NF for long-term care had much greater use of hospitalizations, ED visits, and post-acute care before initiating long-term care than those entering long-term care in the community. Post-entry, community service users had less than half the average monthly hospital and ED use compared with the NF cohort. Conclusion: Hospital and ED use prior to and following NF and personal care program entry suggest a need for reassessing the monitoring of these high-risk populations and the communication between health and community care providers.
Collapse
Affiliation(s)
| | | | - Denis Hulett
- University of California, San Francisco, CA, USA
| | - Taewoon Kang
- University of California, San Francisco, CA, USA
| | - Michelle Ko
- University of California, San Francisco, CA, USA
| | | |
Collapse
|
19
|
Kataoka-Yahiro MR, McFarlane S, Koijane J, Li D. Culturally Competent Palliative and Hospice Care Training for Ethnically Diverse Staff in Long-Term Care Facilities. Am J Hosp Palliat Care 2016; 34:335-346. [DOI: 10.1177/1049909116638347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Between 2013 and 2030, older adults 65 years and older of racial/ethnic populations in the U.S. is projected to increase by 123% in comparison to the Whites (Non-Hispanics). To meet this demand, training of ethnically diverse health staff in long-term care facilities in palliative and hospice care is imperative. The purpose of this study was to evaluate a palliative and hospice care training of staff in two nursing homes in Hawaii - (a) to evaluate knowledge and confidence over three time periods, and (b) to compare staff and family caregiver satisfaction at end of program. The educational frameworks were based on cultural and communication theories. Fifty-two ethnically diverse staff, a majority being Asian (89%), participated in a 10-week module training and one 4 hour communication skills workshop. Staff evaluation included knowledge and confidence surveys, pre- and post-test knowledge tests, and FAMCARE-2 satisfaction instrument. There were nine Asian (89%) and Pacific Islander (11%) family caregivers who completed the FAMCARE-2 satisfaction instrument. The overall staff knowledge and confidence results were promising. The staff rated overall satisfaction of palliative care services lower than the family caregivers. Implications for future research, practice, and education with palliative and hospice care training of ethnically diverse nursing home staff is to include patient and family caregiver satisfaction of palliative and hospice care services, evaluation of effectiveness of cross-cultural communication theories in palliative and hospice care staff training, and support from administration for mentorship and development of these services in long term care facilities.
Collapse
Affiliation(s)
- Merle R. Kataoka-Yahiro
- Department of Nursing, School of Nursing and Dental Hygiene, University of Hawai’i at Manoa, Honolulu, HI, USA
| | - Sandra McFarlane
- Corporate Human Resources, Hawaii Health Systems Corporation, Honolulu, HI, USA
| | - Jeannette Koijane
- Kokua Mau–Hawaii Hospice and Palliative Care Organization, Honolulu, HI, USA
| | - Dongmei Li
- University of Rochester, School of Medicine and Dentistry, Clinical and Translational Science Institute, Rochester, NY, USA
| |
Collapse
|
20
|
Abstract
BACKGROUND A fragmented health care system leads to an increased demand for continuity of care across health care levels. Research indicates age-related differences during care transition, with the oldest patients having experiences and needs that differ from those of other patients. To meet the older patients' needs and preferences during care transition, professionals must understand their experiences. OBJECTIVE The purpose of the study was to explore how patients ≥80 years of age experienced the care transition from hospital to municipal health care services. METHODS The study has a descriptive, explorative design, using semistructured interviews. Fourteen patients aged ≥80 participated in the study. Qualitative content analysis was used to describe the individuals' experiences during care transition. RESULTS Two complementary themes emerged during the analysis: "Participation depends on being invited to plan the care transition" and "Managing continuity of care represents a complex and challenging process". DISCUSSION Lack of participation, insufficient information, and vague responsibilities among staff during care transition seemed to limit the continuity of care. The patients are the vulnerable part of the care transition process, although they possess important resources, which illustrate the importance of making their voice heard. Older patients are therefore likely to benefit from more intensive support. A tailored, patient-centered follow-up of each patient is suggested to ensure that patient preferences and continuity of care to adhere to the new situation.
Collapse
Affiliation(s)
- Else Cathrine Rustad
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
- Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway
- Research Network on Integrated Health Care in Western Norway, Helse Fonna Local Health Authority, Haugesund, Norway
- Department of Clinical Medicine, Helse Fonna Local Health Authority, Haugesund, Norway
- Correspondence: Else Cathrine Rustad, Stord/Haugesund University College, Klingenbergvegen 8, N-5414 Stord, Norway, Email
| | - Bodil Furnes
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Berit Seiger Cronfalk
- Faculty of Health and Caring Sciences, Stord Haugesund University College, Stord, Norway
- Palliative Research Center, Ersta Sköndal University College, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Elin Dysvik
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
21
|
Callinan SM, Brandt NJ. Tackling Communication Barriers Between Long-Term Care Facility and Emergency Department Transfers to Improve Medication Safety in Older Adults. J Gerontol Nurs 2015; 41:8-13. [DOI: 10.3928/00989134-20150616-04] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
22
|
Jacobson J, Gomersall JS, Campbell J, Hughes M. Carersʼ experiences when the person for whom they have been caring enters a residential aged care facility permanently: a systematic review. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513070-00018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
23
|
Naylor MD, Hirschman KB, O'Connor M, Barg R, Pauly MV. Engaging older adults in their transitional care: what more needs to be done? J Comp Eff Res 2014; 2:457-68. [PMID: 24236743 DOI: 10.2217/cer.13.58] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Multiple studies reveal that the healthcare needs of chronically ill older adults are poorly managed and often have devastating consequences. This paper examines available evidence related to improving care management and outcomes in this vulnerable patient group. Findings reinforce the need for enhanced patient engagement and suggest comparative effectiveness research as an important and immediate path to optimize patient-clinician partnerships. An ongoing study in care management is described as an example of such comparative effectiveness research. An overview of the barriers to implementation of evidence-based strategies related to health literacy, shared decision-making and accountability for self-management is provided, followed by a set of recommendations designed to facilitate comparative effectiveness research that advances engagement of high-risk older adults and their family caregivers.
Collapse
Affiliation(s)
- Mary D Naylor
- University of Pennsylvania, School of Nursing, Fagin Hall Room 341, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA
| | | | | | | | | |
Collapse
|
24
|
Lee JH, Kim SJ, Lam J, Kim S, Nakagawa S, Yoo JW. The effects of shared situational awareness on functional and hospital outcomes of hospitalized older adults with heart failure. J Multidiscip Healthc 2014; 7:259-65. [PMID: 25061316 PMCID: PMC4085298 DOI: 10.2147/jmdh.s62269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Functional decline of hospitalized older adults is common and triggers health care expenditures. Physical therapy can retard the functional decline that occurs during hospitalization. This study aims to examine whether shared situational awareness (SSA) intervention may enhance the benefits of physical therapy for hospitalized older persons with a common diagnosis, heart failure. METHOD An SSA intervention that involved daily multidisciplinary meetings was applied to the care of functionally declining older adults admitted to the medicine floor for heart failure. Covariates were matched between the intervention group (n=473) and control group (n=475). Both intervention and control groups received physical therapy for ≥0.5 hours per day. The following three outcomes were compared between groups: 1) disability, 2) transition to skilled nursing facility (SNF, post-acute care setting), and 3) 30-day readmission rate. RESULTS Disability was lower in the intervention group (28%) than in the control group (37%) (relative risk [RR] =0.74; 95% confidence interval [CI], 0.35-0.97; P=0.026), and transition to SNF was lower in the intervention group (22%) than in the control group (30%) (RR =0.77; 95% CI, 0.39-0.98; P=0.032). The 30-day readmission rate did not significantly differ between the two groups. CONCLUSION SSA intervention enhanced the benefits of physical therapy for functionally declining older adults. When applied to older adults with heart failure in the form of daily multidisciplinary meetings, SSA intervention improved functional outcomes and reduced transfer to SNFs after hospitalization.
Collapse
Affiliation(s)
- Joo H Lee
- Department of Media and Communication, Hanyang University College of Social Sciences, Seoul, Korea
| | - Sun J Kim
- Department of Public Health, Yonsei University College of Medicine, Seoul, Korea ; Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea
| | - Julia Lam
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sulgi Kim
- Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Shunichi Nakagawa
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ji W Yoo
- Center for Senior Health and Longevity, Aurora Health Care, Milwaukee, WI, USA ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA
| |
Collapse
|
25
|
Baillie L, Gallini A, Corser R, Elworthy G, Scotcher A, Barrand A. Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: a qualitative case study. Int J Integr Care 2014; 14:e009. [PMID: 24868193 PMCID: PMC4027893 DOI: 10.5334/ijic.1175] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 01/29/2014] [Accepted: 02/07/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Frail older people experience frequent care transitions and an integrated healthcare system could reduce barriers to transitions between different settings. The study aimed to investigate care transitions of frail older people from acute hospital wards to community healthcare or community hospital wards, within a system that had vertically integrated acute hospital and community healthcare services. THEORY AND METHODS The research design was a multimethod, qualitative case study of one healthcare system in England; four acute hospital wards and two community hospital wards were studied in depth. The data were collected through: interviews with key staff (n = 17); focus groups (n = 9) with ward staff (n = 36); interviews with frail older people (n = 4). The data were analysed using the framework approach. FINDINGS THREE THEMES ARE PRESENTED: Care transitions within a vertically integrated healthcare system, Interprofessional communication and relationships; Patient and family involvement in care transitions. DISCUSSION AND CONCLUSIONS A vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other's roles and build relationships and trust.
Collapse
Affiliation(s)
- Lesley Baillie
- Faculty of Health and Social Care, Florence Nightingale Foundation Chair of Clinical Nursing Practice, London South Bank University and University College London Hospitals, London, UK
| | - Andrew Gallini
- Nursing for the Hospital of St John & St Elizabeth, London, UK
| | | | - Gina Elworthy
- University of Bedfordshire, Oxford House Campus, Aylesbury, UK
| | - Ann Scotcher
- University of Bedfordshire, Oxford House Campus, Aylesbury, UK
| | | |
Collapse
|
26
|
Perceptions of Nursing Practice Scale Pilot Study: Directors of Nursing in Nursing Homes. JOURNAL OF NURSING REGULATION 2013. [DOI: 10.1016/s2155-8256(15)30123-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
27
|
Kolanowski A, Mulhall P, Yevchak A, Hill N, Fick D. The triple challenge of recruiting older adults with dementia and high medical acuity in skilled nursing facilities. J Nurs Scholarsh 2013; 45:397-404. [PMID: 23859475 DOI: 10.1111/jnu.12042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE To describe strategies, culled from experience, for responding to several recruitment challenges in an ongoing randomized clinical trial of delirium in persons with dementia. ORGANIZING CONSTRUCT Delirium in people with dementia is common across all cultures. Little research supports the use of specific interventions for delirium. Recruitment of an adequate sample is critical to the validity of findings from intervention studies that form the foundation for evidence-based practice. METHODS The trial referenced in this article tests the efficacy of cognitive stimulation for resolving delirium in people with dementia. Participants are recruited at the time of admission to one of eight community-based skilled nursing facilities (SNFs). Eligible participants are 65 years of age or older and community dwelling, and have a diagnosis of dementia and delirium. Recruitment challenges and strategies were identified during weekly team meetings over a 2-year period. FINDINGS Recruitment challenges include factors in the external and internal environment and the participants and their families. Strategies that address these challenges include early site evaluation and strong communication approaches with staff, participants, and families. CONCLUSIONS The recruitment of an adequate sample of acutely ill older adults with dementia in SNFs can pose a challenge to investigators and threaten the validity of findings. Recruitment strategies that help improve the validity of future studies are described. CLINICAL RELEVANCE Worldwide, over 100 million people will have dementia by 2050, placing them at increased risk for delirium. Recruitment strategies that improve the quality of nursing research and, by extension, the care and prevention of delirium in older adults with dementia during rehabilitation in SNFs are greatly needed.
Collapse
Affiliation(s)
- Ann Kolanowski
- Zeta Psi, Elouise Ross Eberly Professor, School of Nursing, The Pennsylvania State University, University Park, PA
| | | | | | | | | |
Collapse
|
28
|
Yoo JW, Seol H, Kim SJ, Yang JM, Ryu WS, Min TD, Choi JB, Kwon M, Kim S. Effects of hospitalist-directed interdisciplinary medicine floor service on hospital outcomes for seniors with acute medical illness. Geriatr Gerontol Int 2013; 14:71-7. [DOI: 10.1111/ggi.12056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Ji Won Yoo
- Department of Internal Medicine and Institute of Gerontology; University of Michigan Medical School; Ann Arbor Michigan USA
- Department of Internal Medicine; Korea University College of Medicine; Seoul Korea
| | - Haesun Seol
- Federally Qualified Health Center; VNA Health Center; Bensenville Illinois USA
| | - Sun Jung Kim
- School of Public Health; Yonsei University; Seoul Korea
| | - Janet Miyoung Yang
- Department of Internal Medicine; Saint Joseph Mercy Hospital; Ann Arbor Michigan USA
| | - Woo Sang Ryu
- Center of Clinical Research; Korea University College of Medicine; Seoul Korea
| | - Too Dae Min
- Center of Clinical Research; Korea University College of Medicine; Seoul Korea
| | - Jong Bum Choi
- Center for Clinical Research; Yonsei University College of Medicine; Seoul Korea
| | - Minkyung Kwon
- Center for Clinical Research; Yonsei University College of Medicine; Seoul Korea
| | - Sulgi Kim
- Department of Epidemiology; School of Public Health; University of Washington; Seattle Washington USA
| |
Collapse
|