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Ariza-Vega P, Prieto-Moreno R, Mora-Traverso M, Molina-García P, Ashe MC, Martín-Matillas M. Co-creation of mHealth intervention for older adults with hip fracture and family caregivers: a qualitative study. Disabil Rehabil Assist Technol 2024; 19:1009-1018. [PMID: 36308295 DOI: 10.1080/17483107.2022.2138999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/30/2022] [Accepted: 10/18/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE Hip fracture results in an older person's loss of independence. Limited healthcare resources make mobile Health (mHealth) an alternative. Engaging key stakeholders in health technology development is essential to overcome existing barriers. The aim of this study was to establish perspectives of older adults with hip fracture, family caregivers and health professionals (stakeholders) on the development of a mHealth system. MATERIALS AND METHODS Qualitative study guided by user-centered design principles with focus groups to engage stakeholders during the development. Seven focus groups were conducted [older adults with hip fracture (n = 2), caregivers (n = 3), and health providers (n = 2)] with 45 participants (14 older adults, 21 caregivers and 10 health providers). Inclusion criteria were older adults ≥ 65 years who sustained a hip fracture in the previous 3 months; family caregiver of a person with hip fracture; and health providers with 2+ years of clinical experience working older adults with hip fracture. We followed standard methods for focus groups, including recording sessions, transcription and conducting an inductive content analysis. The same moderator, with clinical and research experience, conducted all focus groups. RESULTS Three themes were generated to consider for a future mHealth intervention: (1) user-friendly design; (2) content to include recovery and prevention information; and (3) implementation factors. Our mHealth system was developed based on feedback from participants. CONCLUSIONS Co-creating mHealth technology with stakeholders is essential for uptake and adherence. We provide an overview of the development of ActiveHip+, an mHealth system for the clinical care of older adults with hip fracture.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Rafael Prieto-Moreno
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Marta Mora-Traverso
- PA-HELP "Physical Activity for HEaLth Promotion" Research group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Pablo Molina-García
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
| | - Maureen C Ashe
- Department of Family Practice, The University of British Columbia, Vancouver, Canada
| | - Miguel Martín-Matillas
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain
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Smith TO, Khoury R, Hanson S, Welsh A, Grant K, Clark AB, Ashford PA, Hopewell S, Pfeiffer K, Logan P, Crotty M, Costa ML, Lamb S. Hospital-based caregiver intervention for people following hip fracture surgery (HIP HELPER): multicentre randomised controlled feasibility trial with embedded qualitative study in England. BMJ Open 2023; 13:e073611. [PMID: 38070926 PMCID: PMC10729129 DOI: 10.1136/bmjopen-2023-073611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES To assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. DESIGN Two-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study. SETTING National Health Service (NHS) providers in five English hospitals. PARTICIPANTS Community-dwelling adults, aged 60 years and over, who undergo hip fracture surgery and their informal caregivers. INTERVENTION Usual care: usual NHS care. EXPERIMENTAL usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme comprised three, 1 hour, one-to-one training sessions for a patient and caregiver, delivered by a nurse, physiotherapist or occupational therapist in the hospital setting predischarge. After discharge, patients and caregivers were supported through three telephone coaching sessions. RANDOMISATION AND BLINDING Central randomisation was computer generated (1:1), stratified by hospital and level of patient cognitive impairment. There was no blinding. MAIN OUTCOME MEASURES Data collected at baseline and 4 months post randomisation included: screening logs, intervention logs, fidelity checklists, acceptability data and clinical outcomes. Interviews were conducted with a subset of participants and health professionals. RESULTS 102 participants were enrolled (51 patients; 51 caregivers). Thirty-nine per cent (515/1311) of patients screened were eligible. Eleven per cent (56/515) of eligible patients consented to be randomised. Forty-eight per cent (12/25) of the intervention group reached compliance to their allocated intervention. There was no evidence of treatment contamination. Qualitative data demonstrated the trial and HIP HELPER programme was acceptable. CONCLUSIONS The HIP HELPER programme was acceptable to patient-caregiver dyads and health professionals. The COVID-19 pandemic impacting on site's ability to deliver the research. Modifications are necessary to the design for a viable definitive RCT. TRIAL REGISTRATION NUMBER ISRCTN13270387.
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Affiliation(s)
- Toby O Smith
- Warwick Medical School, University of Warwick, Coventry, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Reema Khoury
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Sarah Hanson
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Allie Welsh
- School of Education, University of East Anglia, Norwich, UK
| | - Kelly Grant
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Allan B Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - K Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Phillipa Logan
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Matthew L Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
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Chen JJ, Cheng YC, Lin LH, Chiang CC, Lin KH, Liu TC, Chou YJ, Lee IH, Huang N. Perception of transitional care quality associated with functional outcomes among patients with fractures and stroke in Taiwan. Geriatr Nurs 2023; 53:247-254. [PMID: 37598428 DOI: 10.1016/j.gerinurse.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
This study aimed to examine the relationship between self-perceived quality of transitional care and functional outcome among patients with stroke and fractures. The Care Transition Measure (CTM-15) was used to survey patient's self-perceived transitional care quality before discharge. General estimating equations were used to investigate the influences of transitional care quality on patient's functional outcomes at before, 1 week after, and 1 or 3 months after discharge. Among stroke patients, higher CTM-15 scores were positively associated with greater outcome in Instrumental Activities of Daily Living (IADL) following discharge. Higher scores for "reader-friendly written care plan," "consideration of patient's preferences," and "understanding of health management" had significantly positive effects on functional recovery in IADL among both patient groups following discharge. These findings suggest that heterogeneity in transitional care needs between medical and surgical patients shall not be overlooked. A one-size-fits-all strategy may be insufficient for ensuring patient care continuity following discharge.
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Affiliation(s)
- Jing-Jer Chen
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chun Cheng
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Li-Hwa Lin
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chao-Ching Chiang
- Department of Orthopaedics, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kung-Hou Lin
- Division of Orthopaedic Trauma, Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Ching Liu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-Hui Lee
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Nicole Huang
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Hedqvist AT, Praetorius G, Ekstedt M. Exploring interdependencies, vulnerabilities, gaps and bridges in care transitions of patients with complex care needs using the Functional Resonance Analysis Method. BMC Health Serv Res 2023; 23:851. [PMID: 37568114 PMCID: PMC10422836 DOI: 10.1186/s12913-023-09832-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 07/18/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Hospital discharge is a complex process encompassing multiple interactions and requiring coordination. To identify potential improvement measures in care transitions for people with complex care needs, intra- and inter-organisational everyday work needs to be properly understood, including its interdependencies, vulnerabilities and gaps. The aims of this study were to 1) map coordination and team collaboration across healthcare and social care organisations, 2) describe interdependencies and system variability in the discharge process for older people with complex care needs, and 3) evaluate the alignment between discharge planning and the needs in the home. METHODS Data were collected through participant observations, interviews, and document review in a region of southern Sweden. The Functional Resonance Analysis Method (FRAM) was used to model the discharge process and visualise and analyse coordination of care across healthcare and social care organisations. RESULTS Hospital discharge is a time-sensitive process with numerous couplings and interdependencies where healthcare professionals' performance is constrained by system design and organisational boundaries. The greatest vulnerability can be found when the patient arrives at home, as maladaptation earlier in the care chain can lead to an accumulation of issues for the municipal personnel in health and social care working closest to the patient. The possibilities for the personnel to adapt are limited, especially at certain times of day, pushing them to make trade-offs to ensure patient safety. Flexibility and appropriate resources enable for handling variability and responding to uncertainties in care after discharge. CONCLUSIONS Mapping hospital discharge using the FRAM reveals couplings and interdependencies between various individuals, teams, and organisations and the most vulnerable point, when the patient arrives at home. Resilient performance in responding to unexpected events and variations during the first days after the return home requires a system allowing flexibility and facilitating successful adaptation of discharge planning.
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Affiliation(s)
- Ann-Therese Hedqvist
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
- Ambulance Service, Region Kalmar County, Västervik, Sweden.
| | - Gesa Praetorius
- Swedish National Road and Transport Research Institute, Linköping, Sweden
- Department of Maritime Operations, University of South-Eastern Norway, Borre, Norway
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden
- Department of Learning, Informatics, Management and Ethics, LIME, Karolinska Institutet, Stockholm, Sweden
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Sun M, Qian Y, Liu L, Wang J, Zhuansun M, Xu T, Rosa RD. Transition of care from hospital to home for older people with chronic diseases: a qualitative study of older patients' and health care providers' perspectives. Front Public Health 2023; 11:1128885. [PMID: 37181713 PMCID: PMC10174044 DOI: 10.3389/fpubh.2023.1128885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/29/2023] [Indexed: 05/16/2023] Open
Abstract
Background Transitional care is a critical area of care delivery for older adults with chronic illnesses and complex health conditions. Older adults have high, ongoing care needs during the transition from hospital to home due to certain physical, psychological, social, and caregiving burdens, and in practice, patients' needs are not being met or are receiving transitional care services that are unequal and inconsistent with their actual needs, hindering their safe, healthy transition. The purpose of this study was to explore the perceptions of older adults and health care providers, including older adults, about the transition of care from hospital to home for older patients in one region of China. Objective To explore barriers and facilitators in the transition of care from hospital to home for older adults in China from the perspectives of older patients with chronic diseases and healthcare professionals. Methods This was a qualitative study based on a semi-structured approach. Participants were recruited from November 2021 to October 2022 from a tertiary and community hospital. Data were analyzed using thematic analysis. Results A total of 20 interviews were conducted with 10 patients and 9 medical caregivers, including two interviews with one patient. The older adult/adults patients included 4 men and 6 women with an age range of 63 to 89 years and a mean age of 74.3 ± 10.1 years. The medical caregivers included two general practitioners and seven nurses age range was 26 to 40 years with a mean age of 32.8 ± 4.6 years. Five themes were identified: (1) attitude and attributes; (2) better interpersonal relationships and communication between HCPs and patients; (3) improved Coordination of Healthcare Services Is Needed; (4) availability of resources and accessibility of services; and (5) policy and environment fit. These themes often serve as both barriers and facilitators to older adults' access to transitional care. Conclusions Given the fragmentation of the health care system and the complexity of care needs, patient and family-centered care should be implemented. Establish interconnected electronic information support systems; develop navigator roles; and develop competent organizational leaders and appropriate reforms to better support patient transitions.
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Affiliation(s)
- Mengjie Sun
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Yumeng Qian
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Lamei Liu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Jianan Wang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Mengyao Zhuansun
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Tongyao Xu
- School of Nursing and Health, Zhengzhou University, Zhengzhou, Henan, China
| | - Ronnell Dela Rosa
- School of Nursing, Philippine Women's University, Manila, Philippines
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Ariza-Vega P, Prieto-Moreno R, Castillo-Pérez H, Martínez-Ruiz V, Romero-Ayuso D, Ashe MC. Family Caregivers' Experiences with Tele-Rehabilitation for Older Adults with Hip Fracture. J Clin Med 2021; 10:jcm10245850. [PMID: 34945145 PMCID: PMC8708159 DOI: 10.3390/jcm10245850] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 01/17/2023] Open
Abstract
Background: There is a knowledge gap for implementing tele-rehabilitation (telerehab) after hip fracture. We recently conducted a clinical trial (ClinicalTrials.gov Identifier: NCT02968589) to test a novel online family caregiver-supported rehabilitation program for older adults with hip fracture, called @ctivehip. In this qualitative substudy, our objective was to use semi-structured interviews to explore family caregivers experience with the telerehab program. Methods: Twenty-one family caregivers were interviewed between three and six months after the older adults completed @ctivehip. One occupational therapist with research and clinical experience, but not involved in the main trial, conducted and transcribed the interviews. We conducted a multi-step content analysis, and two authors completed one coding cycle and two recoding cycles. Results: Family caregivers who enrolled in @ctivehip were satisfied with the program, stated it was manageable to use, and perceived benefits for older adults’ functional recovery after hip fracture. They also suggested improvements for the program content, such as more variety with exercises, and increased monitoring by health professionals. Conclusions: This work extends existing literature and generates research hypotheses for future studies to test telerehab content and program implementation.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain; (P.A.-V.); (D.R.-A.)
- Physical Medicine and Rehabilitation Service, Biohealth Research Institute, Virgen de las Nieves University Hospital, 18012 Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, 18071 Granada, Spain
| | - Rafael Prieto-Moreno
- Physical Medicine and Rehabilitation Service, Biohealth Research Institute, Virgen de las Nieves University Hospital, 18012 Granada, Spain
- PA-HELP “Physical Activity for HEaLth Promotion” Research Group, Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, 18071 Granada, Spain
- Correspondence:
| | | | - Virginia Martínez-Ruiz
- Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, 18016 Granada, Spain;
- Center for Biomedical Research in Network of Epidemiology and Public Health (CIBERESP), 28029, Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), 18014 Granada, Spain
| | - Dulce Romero-Ayuso
- Department of Physiotherapy, University of Granada, 18016 Granada, Spain; (P.A.-V.); (D.R.-A.)
| | - Maureen C. Ashe
- Centre for Hip Health and Mobility, Department of Family Practice, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
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Zalmay P, Collis J, Wilson H. Patients Lacking the Capacity to Consent to Hip Fracture Surgery May Be Undergoing Major Operations Without Their Next of Kin Being Involved in Best-Interests Decisions: A Quality Improvement Report. Cureus 2021; 13:e20322. [PMID: 35028219 PMCID: PMC8742997 DOI: 10.7759/cureus.20322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Cognitively impaired patients with a hip fracture may be undergoing major operations without attempts being made to involve their next of kin (NoK) in best-interest decisions. Methods We used the Plan-Do-Study-Act (PDSA) methodology to guide our quality improvement (QI) project. Cognitively impaired hip fracture patients were identified retrospectively by searching the hip fracture database of a medium-sized district general hospital (DGH). Their medical notes were reviewed for documented attempts at contacting their NoK prior to surgery as well as on completion of the NoK section of the Consent Form Four. Intervention A simple feedback intervention was delivered in the form of a mixed verbal and visual presentation to the orthopaedic registrars responsible for obtaining consent from these patients. Results Post-intervention, there were documented attempts at contacting the NoK before surgery for all patients, a significant improvement from only 80%. There was also a significant increase in completion of the NoK section of the consent form, from 30% to 64.3%. Conclusions Simple audit and feedback interventions can produce significant positive changes in communication between clinicians and the NoK of cognitively impaired patients with hip fractures. Further interventions have been implemented to sustain these improvements.
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Affiliation(s)
- Pardis Zalmay
- Trauma and Orthopaedics, Royal Surrey County Hospital NHS Foundation Trust, London, GBR
| | - Justin Collis
- Trauma and Orthopaedics, Medway Maritime NHS Foundation Trust, Gillingham, GBR
| | - Helen Wilson
- Geriatrics, Royal Surrey County Hospital NHS Foundation Trust, London, GBR
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De Vincentis A, Behr AU, Bellelli G, Bravi M, Castaldo A, Galluzzo L, Iolascon G, Maggi S, Martini E, Momoli A, Onder G, Paoletta M, Pietrogrande L, Roselli M, Ruggeri M, Ruggiero C, Santacaterina F, Tritapepe L, Zurlo A, Antonelli Incalzi R. Orthogeriatric co-management for the care of older subjects with hip fracture: recommendations from an Italian intersociety consensus. Aging Clin Exp Res 2021; 33:2405-2443. [PMID: 34287785 DOI: 10.1007/s40520-021-01898-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/28/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Health outcomes of older subjects with hip fracture (HF) may be negatively influenced by multiple comorbidities and frailty. An integrated multidisciplinary approach (i.e. the orthogeriatric model) is, therefore, highly recommended, but its implementation in clinical practice suffers from the lack of shared management protocols and poor awareness of the problem. The present consensus document has been implemented to address these issues. AIM To develop evidence-based recommendations for the orthogeriatric co-management of older subjects with HF. METHODS A 20-member Expert Task Force of geriatricians, orthopaedics, anaesthesiologists, physiatrists, physiotherapists and general practitioners was established to develop evidence-based recommendations for the pre-, peri-, intra- and postoperative care of older in-patients (≥ 65 years) with HF. A modified Delphi approach was used to achieve consensus, and the U.S. Preventive Services Task Force system was used to rate the strength of recommendations and the quality of evidence. RESULTS A total of 120 recommendations were proposed, covering 32 clinical topics and concerning preoperative evaluation (11 topics), perioperative (8 topics) and intraoperative (3 topics) management, and postoperative care (10 topics). CONCLUSION These recommendations should ease and promote the multidisciplinary management of older subjects with HF by integrating the expertise of different specialists. By providing a convenient list of topics of interest, they might assist in identifying unmet needs and research priorities.
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The value of caregiver inclusive practices in geriatric transitions of care: A systematic review. Health Policy 2021; 125:888-898. [PMID: 34034905 DOI: 10.1016/j.healthpol.2021.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 04/26/2021] [Accepted: 05/03/2021] [Indexed: 11/22/2022]
Abstract
Globally, hospital length of stay is decreasing, yet the number of aged patients requiring complex care is increasing. This causes more patients, and their informal caregivers, to self-manage in the community following acute care discharge. This study aims to assess whether transitional care programs that integrate caregivers provide better value care than routine care. In this systematic review, Medline Ovid, EMBASE Ovid, CINAHL EbscoHOST, Scopus, and Proquest were searched for any study design that investigated a caregiver inclusive transitional care intervention in a population of people with geriatric syndrome, enroled a comparator group, and assessed population health, experience, and/or cost related outcomes. Risk of bias was assessed by two reviewers using ROBINS I and RoB 2. The review included 23 studies and results were mixed. Consistently positive results occurred for patient and caregiver satisfaction. Cost tended to increase with caregiver inclusive practices. Most studies found no difference in population health outcomes. There was insufficient evidence on healthcare professional experience. Currently, there is insufficient evidence to determine whether caregiver inclusive transitions of care provide better value care than routine care. Studies that rigorously implement and evaluate caregiver inclusive care models are urgently required to inform future policy.
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Transitional Care Experiences of Patients with Hip Fracture Across Different Health Care Settings. Int J Integr Care 2021; 21:2. [PMID: 33867897 PMCID: PMC8034406 DOI: 10.5334/ijic.4720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Transitions of care often result in fragmented care, leading to unmet patient needs and poor satisfaction with care, especially in patients with multiple chronic conditions. This project aimed to understand how experiences of patients with hip fracture, caregivers, and healthcare providers differ across different points of transition. Methods A secondary analysis of 103 qualitative, semi-structured interviews was conducted using emergent coding techniques, to gain an understanding of how transitional care experiences may differ across varying settings of care. Following the secondary analysis, a focus group interview was conducted to review findings. Results Seven key themes, each relating to distinct transition points, emerged from the secondary analysis: (1) Multiple providers contributed to patient and caregiver confusion; (2) Family caregivers were not considered important in the patient's care; (3) System-related issues impacted experiences; (4) Patients and caregivers felt uninformed; (5) Transitions increased stress in patients and caregivers; (6) Care was not tailored to patient needs; (7) Providers faced barriers in getting adequate information. The focus group results built upon these themes, adding some additional context to understand the current transitional care landscape. Discussion In transitions to formal care settings, similarities were related to feeling confused, while in transitions to home, similarities existed in regards to feeling unprepared. These findings support the view that models of integrated care should consider the context to which they are applied.
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Bridging the Gap: A Mixed Methods Study Investigating Caregiver Integration for People with Geriatric Syndrome. Int J Integr Care 2021; 21:14. [PMID: 33776603 PMCID: PMC7977015 DOI: 10.5334/ijic.5577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction Transitions of care between acute hospital and community settings are points of vulnerability for people with geriatric syndrome. Routinely including informal caregivers into the transition processes may mitigate risk. Guidance for operational aspects of caregiver inclusion is currently lacking in healthcare policy and fails to address the barriers faced by caregivers and healthcare professionals. Methods A questionnaire and a semi-structured interview were piloted with acute care physiotherapists who facilitate patient discharge into community settings. The questionnaire was analysed using summary statistics and interviews were thematically analysed by researchers, using NVivo 12 software. Results Questionnaire responses indicated mixed satisfaction with current caregiver integration by the multidisciplinary team. Four themes were shaped in the interviews: inconsistent caregiver engagement, individuals working in a system, an outdated model of care, and invisible care gaps. Discussion Feedback loops constructed from participant questionnaires and interview responses informed the identification of barriers and solutions. These are system wide and address automated integration, cultural shift, reimbursement models, and flexible structures to enhance informal caregiver participation. Future research is urgently required to translate, implement, and evaluate enhanced caregiver integration to ensure sustainable, person-centred healthcare delivery.
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Ariza-Vega P, Castillo-Pérez H, Ortiz-Piña M, Ziden L, Palomino-Vidal J, Ashe MC. The Journey of Recovery: Caregivers' Perspectives From a Hip Fracture Telerehabilitation Clinical Trial. Phys Ther 2021; 101:6044311. [PMID: 33351931 DOI: 10.1093/ptj/pzaa220] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 09/12/2020] [Accepted: 11/23/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The objective was to explore family caregivers' perspectives of the recovery process of older adults with hip fracture and describe experiences from caregivers who: (1) used the online intervention, or (2) received home-based care provided by the Andalusian Public Health Care System. METHODS This was an exploratory secondary study with informal family caregivers who had an older adult family member with hip fracture enrolled in a novel telerehabilitation (telerehab) clinical trial. Forty-four caregivers of older adults with hip fracture were interviewed at 6 to 9 months after their family member's hip fracture. RESULTS Caregivers shared concerns of family members' survival and recovery; they recounted increased stress and anxiety due to the uncertainty of new tasks associated with providing care and the impact on their lifestyle. Although most caregivers were satisfied with the health care received, they made suggestions for better organization of hospital discharge and requests for home support. The main reasons why caregivers and their family member chose the telerehab program were to enhance recovery after fracture, gain knowledge for managing at home, and because of the convenience of completing the exercises at home. There were more family caregivers in the control group who expressed a high level of stress and anxiety, and they also requested more social and health services compared with caregivers whose family member received telerehab. CONCLUSION Family caregivers are an essential component of recovery after hip fracture by providing emotional and physical support. However, future clinical interventions should evaluate person-centered interventions to mitigate possible stress and anxiety experienced by family caregivers. IMPACT Family caregivers' perspectives are necessary in the co-design of management strategies for older adults after hip fracture.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital, Biohealth Research Institute, Granada, Spain.,Department of Physiotherapy, PA-HELP "Physical Activity for HEaLth Promotion" research group, University of Granada, Granada, Spain
| | | | - Mariana Ortiz-Piña
- Department of Physiotherapy, PA-HELP "Physical Activity for HEaLth Promotion" research group, University of Granada, Granada, Spain
| | - Lena Ziden
- Department of Health and Rehabilitation, The Sahlgrenska University Hospital, Gothenberg, Sweden; and Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | | | - Maureen C Ashe
- Department of Family Practice, University of British Columbia, Vancouver, Canada.,Centre for Hip Health and Mobility, Vancouver, Canada
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Kalu ME, Okoh AC, Nwankwo H, Anieto E, Adandom I, Jumbo S, Ekezie U, Diameta E, Akinrolie O, Obi P, Omeje C, Mohammad S, Ajulo M, Opara M, Abaraogu UO. Physiotherapists’ role during hospital-to-home transition for older adults with hip fracture and mobility limitation: A research protocol. INTERNATIONAL JOURNAL OF CARE COORDINATION 2020. [DOI: 10.1177/2053434520937408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Functional deficits such as gait speed, muscle strength or reduced activities in daily living after discharge are predictors for hospital readmission for older adults with hip fractures. However, physiotherapists (PTs) who are inherently mobility experts, do not actively participate during the hospital-to-home transition of older adults with hip fractures in the developing countries, including Nigeria. This qualitative study aims to describe and explore how PTs working within inpatient rehabilitation units prepare older adults (≥60 years) with a hip fracture for transfer to their home in the community. Methods We will adopt Sally Thorne’s Interpretive Description approach to purposively select 25 PTs with 5-years experience of participating in discharging older adults with hip fractures from inpatient rehabilitation-to-home. Data collection will include (a) semi-structured, one-on-one interviews with PTs, (b) discharge summaries of two older adults, and (c) final focus group discussion with PTs. We will ask the physiotherapists to provide discharge summaries of two older adults - one that they described as a “difficult” case and one that they described as an “easy” case during inpatient rehabilitation-to-home transition. Data will be analyzed employing Sally Thorne’s “borrowing techniques”- content and thematic analysis for the patients’ discharge summaries and PT interviews, respectively.
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Affiliation(s)
- Michael E Kalu
- McMaster University, Canada
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
| | - Augustine C Okoh
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
- University of Portharcourt Teaching Hospital, Nigeria
| | - Henrietha Nwankwo
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
- Mackenzie Physiotherapy Clinic, Nigeria
| | - Ebuka Anieto
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
- Obafemi Awolowo Teaching Hospital Complex, Nigeria
| | - Israel Adandom
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
- Cedacrest Hopitals, Nigeria
| | - Samuel Jumbo
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
- Lily Hospitals Limited, Nigeria
- Western University, Canada
| | - Uduonu Ekezie
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
- University of Nigeria, Nigeria
| | - Emofe Diameta
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
- Humanity Hospital Limited, Nigeria
| | - Olayinka Akinrolie
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
- University of Manitoba, Canada
| | - Perpetua Obi
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
- Peak Wellness Center, Abuja
| | - Chidinma Omeje
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
| | | | - Michael Ajulo
- Emerging Researchers & Professionals in Ageing-African Network, Nigeria
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Asif M, Cadel L, Kuluski K, Everall AC, Guilcher SJT. Patient and caregiver experiences on care transitions for adults with a hip fracture: a scoping review. Disabil Rehabil 2019; 42:3549-3558. [PMID: 31081400 DOI: 10.1080/09638288.2019.1595181] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The purpose of this scoping review was to explore the literature on experiences and perspectives of patients with hip fractures and their caregivers during transitions in care.Methods: Seven databases were searched for studies published between 1 January 2000 and 3 July 2018. Grey literature was also searched.Results: Eleven articles met the inclusion criteria. The scoping review found that patients and caregivers encounter several challenges during care transitions including the following: lack of information sharing, role confusion and disorganized discharge planning. Common suggestions reported in the literature for improving care transitions were: increasing written communication, offering a patient representative role, using technology for knowledge dissemination and increasing geriatrician involvement.Conclusions: The results of this scoping review provide a useful foundation from which to build strategies to address challenges such as lack of information sharing, role confusion and disorganized discharge planning experienced by patients and caregivers during care transitions. Further research needs to explore the development of strategies to promote patient-centered care especially during discharge from an acute care facility.Implications for rehabilitationEncourage health care providers to collaborate with patients with hip fracture and caregivers on decision-making about rehabilitation and recovery goals, discharge planning and safe patient transfer.Assess the needs of patients with hip fracture and caregivers before, during and after a care transition to deliver patient and family-centered care across multiple care settings.Provide patients with hip fracture and caregivers standardized information-exchange tools to increase timely, accurate exchange of information during care transitions.Encourage formal discussions about roles and responsibilities in the transitions in care process among patients with hip fracture, caregivers and health care providers.
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Affiliation(s)
- Maliha Asif
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Kerry Kuluski
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Amanda C Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Ariza-Vega P, Ortiz-Piña M, Mora-Traverso M, Martín-Martín L, Salazar-Graván S, Ashe MC. Development and Evaluation of a Post-Hip Fracture Instructional Workshop for Caregivers. J Geriatr Phys Ther 2019; 43:128-136. [PMID: 30913137 DOI: 10.1519/jpt.0000000000000230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE A hip fracture is an unexpected traumatic event. Caregivers of patients with an acute hip fracture have only short time to learn the new skills of postoperative care and handling of the patient. This sudden responsibility changes the life of the caregivers who perceive a higher level of preoccupation about the care of their family member/friend. The objective of this study was to develop and test feasibility for a post-hip fracture inpatient instructional workshop for caregivers of older adults with hip fracture and to establish their knowledge of hip fracture recovery and perceptions of the utility and satisfaction with the workshop. METHODS This 2-part study was conducted at the University Hospital of Granada, Spain, from September 2016 to April 2017. We invited caregivers of patients (60 years of age or older) hospitalized for a surgically treated fall-related hip fracture to attend an informational and skill development hospital-based workshop (60-90 minutes in duration) on postdischarge management strategies. Following the workshop, we invited caregivers to complete a questionnaire to obtain their knowledge about care after hip fracture and their perceived concerns. Furthermore, we requested that they provide feedback on workshop utility and satisfaction (0-10 points) and suggestions for improving the workshop. RESULTS AND DISCUSSION We delivered 42 workshops over an 8 month period. One hundred three caregivers attended the sessions and enrolled in the study, mean (SD) age: 52.1 (12.8) years. Sixty-nine percent of the caregivers were women. Caregivers' main concern was apprehension for delivering physical care to their family member/friend (75%), followed by lack of time (42%). Caregivers who were employed were 3.16 times as likely to be concerned about time availability to provide care for their family member/friend. The median (Q1, Q3) of both workshop utility and satisfaction was 10 (10, 10), minimum-maximum: 7 to 10. CONCLUSIONS Caregivers in this study stated that the workshop was useful and satisfactory. Because caregivers play such a vital role in recovery after hip fracture, providing knowledge and skill development as part of health care delivery may support more person-centered care.
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Affiliation(s)
- Patrocinio Ariza-Vega
- Physical Medicine and Rehabilitation Service, Virgen de las Nieves University Hospital of Granada, Granada, Spain; Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain; and PA-HELP "Physical Activity for HEaLth Promotion" Research Group, University of Granada, Granada, Spain
| | - Mariana Ortiz-Piña
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - Marta Mora-Traverso
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Department of Physiotherapy, Faculty of Health Science, University of Granada, Granada, Spain
| | - Susana Salazar-Graván
- Orthopaedic Surgery and Traumatology Service, Health Campus Hospital, Granada, Spain
| | - Maureen C Ashe
- Department of Family Practice, University of British Columbia, Vancouver, Canada; and Centre for Hip Health and Mobility, Vancouver, Canada
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A Framework for Supporting Post-acute Care Transitions of Older Patients With Hip Fracture. J Am Med Dir Assoc 2019; 20:414-419.e1. [PMID: 30852166 DOI: 10.1016/j.jamda.2019.01.147] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/16/2019] [Accepted: 01/22/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Improving care transitions is of critical importance for older patients, especially those with complex care needs. Our study examined the "Transitions of Care" (ToC) of complex, post-acute older adults at multiple time points. The objective of this article is to identify domains relevant to health care transitions of post-acute older patients with hip fracture so as to inform future ToC interventions. DESIGN Here we conducted a framework-based synthesis of the 12 peer-reviewed manuscripts that were published from our multisite, ethnographic study. SETTING AND PARTICIPANTS All 12 manuscripts were based on 1 study, described here. Data were collected in multiple regions, in acute and sub-acute care wards, rehabilitation programs, home care agencies, long-term care and assisted living facilities, and patients' private homes. We completed 51 interviews with 23 postoperative hip fracture patients aged ≥65 years, 24 interviews with 19 family caregivers, and 96 interviews with 92 health care providers. Interviews with patients, family caregivers, and health care providers were conducted at each transition point for a total of 171 individual interviews. RESULTS Taken together, our framework analysis of the 12 manuscripts identified 8 themes related to ToC. Two themes, patient complexity and system constraints, are contextual factors that tend to impede ToC and may be less amenable to change. The remaining 6 themes, patient involvement and choice, family caregiver roles, strong relationships, coordination of roles, documentation, and information sharing, have the potential to support and improve ToC. CONCLUSIONS AND IMPLICATIONS With comprehensive data from a range of stakeholders, collected at multiple transition points along the health care continuum, in our final 6 themes we identify potential points of intervention for clinicians and teams seeking to improve ToC for older complex patients.
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McMurray J, McNeil H, Gordon A, Elliott J, Stolee P. Building a Rehabilitative Care Measurement Instrument to Improve the Patient Experience. Arch Phys Med Rehabil 2019; 100:39-44. [DOI: 10.1016/j.apmr.2018.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/14/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
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Elli S, Contro D, Castaldi S, Fornili M, Ardoino I, Caserta AV, Panella L. Caregivers' misperception of the severity of hip fractures. Patient Prefer Adherence 2018; 12:1889-1895. [PMID: 30288029 PMCID: PMC6159810 DOI: 10.2147/ppa.s164380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The aim of our study was to evaluate how the caregiver of a hip fracture patient perceives the patient's health status and autonomy in the period immediately preceding the acute event and whether these judgments are actually in line with the prognosis predicted by the medical team caring for the patient in the rehabilitation structure. PATIENTS AND METHODS We enrolled 147 patients of both sexes, aged ≥65 years, who were referred to our center following surgical treatment of hip fractures of various nature. At the beginning of the rehabilitation program, each patient's caregiver was asked to complete the Blaylock Risk Assessment Screening Score (BRASS) questionnaire. The same questionnaire was compiled contemporaneously by the doctor taking care of the patient. RESULTS Analysis of the data shows that the caregivers tend to assign lower scores than the doctor, with a mean difference in agreement with the Bland-Altman plot of -2.43, 95% CI=-2.93 to -1.93, t-test P<0.001. Furthermore, differences in objectivity emerge in the evaluation of the clinical problems of the patient in a borderline clinical condition. CONCLUSION This study revealed that caregivers systematically misperceive the clinical situation of hip fracture patients prior to the acute event. Altered perception of such an important factor can lead to a general lack of satisfaction with the outcome achieved by the patient at the end of the rehabilitation process. We therefore believe that an adequate, effective communication between the people making up the health care team and the patient's social and family network is the foundation of the rehabilitation process. It is precisely on this foundation that the individual's care and assistance need to be assembled.
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Affiliation(s)
- Sara Elli
- Post Graduate School of Physical and Rehabilitation Medicine, Department of Health Sciences, University of Milan, Milan, Italy,
| | - Diego Contro
- Post Graduate School of Physical and Rehabilitation Medicine, Department of Health Sciences, University of Milan, Milan, Italy,
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Health Management Department, Fondazione IRCCS Ca' Granda OMP, Milan, Italy
| | - Marco Fornili
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ilaria Ardoino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Antonello V Caserta
- Rehabilitation Department, UOC Physical and Rehabilitation Medicine, Traumatology Orthopaedic Specialist Center, Gaetano Pini - CTO, Milan, Italy
| | - Lorenzo Panella
- Rehabilitation Department, UOC Physical and Rehabilitation Medicine, Traumatology Orthopaedic Specialist Center, Gaetano Pini - CTO, Milan, Italy
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Saletti-Cuesta L, Tutton E, Langstaff D, Willett K. Understanding informal carers' experiences of caring for older people with a hip fracture: a systematic review of qualitative studies. Disabil Rehabil 2016; 40:740-750. [PMID: 27976920 DOI: 10.1080/09638288.2016.1262467] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE This systematic review aimed to reconceptualize experiences from a variety of papers to provide direction for research, policy and practice. METHOD Meta-ethnography was used to inform the review, and 21 studies were included. FINDINGS The analysis identified a core theme of "engaging in care: struggling through", as carers, who wanted to be involved in caring, learnt to live with the intense and stressful impact of caring and changes to their life. The core theme is represented through three themes (1) Helping another to live, (2) Adapting ways of living and (3) Negotiating the unknown. CONCLUSIONS The discussion identified a focus on carers of people suffering from a hip fracture, the willingness of informal carers to engage in caring and the intense experience of adapting to changes in relationships and dependency alongside a steep experiential learning curve. Tensions exist in negotiations with complex health care systems as carers do not feel their expertise is valued and struggle to find and understand information. Implications for Rehabilitation Including relatives/carers in the umbrella of care within a family-centred approach. Involving relatives/carers within shared decision-making about care requirements and rehabilitation goals. Utilizing forms of experiential learning to help the development of relatives/carers skills in relation to their role as carer. Providing opportunities for carers to explore ways of sustaining their own health through self-compassion.
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Affiliation(s)
- Lorena Saletti-Cuesta
- a Culture and Society Research and Study Centre, National Scientific and Technical Research Council. (CIECS-CONICET-UNC), Córdoba , Argentina
| | - Elizabeth Tutton
- b Kadoorie Critical Care Research and Education Centre, Oxford University Hospitals, NHS Foundation Trust , Oxford , UK.,c Royal College of Nursing Research Institute, Warwick Medical School, University of Warwick , Warwick , UK
| | - Debbie Langstaff
- d Trauma Unit , John Radcliffe Hospital, Oxford University Hospital, NHS Foundation Trust , Oxford , UK
| | - Keith Willett
- b Kadoorie Critical Care Research and Education Centre, Oxford University Hospitals, NHS Foundation Trust , Oxford , UK.,e Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science , University of Oxford , Oxford , UK
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Ohta B, Mola A, Rosenfeld P, Ford S. Early Discharge Planning and Improved Care Transitions: Pre-Admission Assessment for Readmission Risk in an Elective Orthopedic and Cardiovascular Surgical Population. Int J Integr Care 2016; 16:10. [PMID: 27616965 PMCID: PMC5015549 DOI: 10.5334/ijic.2260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 05/11/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND/METHODS Readmission prevention is a marker of patient care quality and requires comprehensive, early discharge planning for safe hospital transitions. Effectively performed, this process supports patient satisfaction, efficient resource utilization, and care integration. This study developed/tested the utility of a predictive early discharge risk assessment with 366 elective orthopedic/cardiovascular surgery patients. Quality improvement cycles were undertaken for the design and to inform analytic plan. An 8-item questionnaire, which includes patient self-reported health, was integrated into care managers' telephonic pre-admission assessments during a 12-month period. RESULTS Regression models found the questionnaire to be predictive of readmission (p ≤ .005; R(2) = .334) and length-of-stay (p ≤ .001; R(2) = .314). Independent variables of "lives-alone" and "self-rated health" were statistically significant for increased readmission odds, as was "self-rated health" for increased length-of-stay. Quality measures, patient experience and increased rates of discharges-to-home further supported the benefit of embedding these questions into the pro-active planning process. CONCLUSION The pilot discharge risk assessment was predictive of readmission risk and length-of-stay for elective orthopedic/cardiovascular patients. Given the usability of the questionnaire in advance of elective admissions, it can facilitate pro-active discharge planning essential for producing quality outcomes and addressing new reimbursement methodologies for continuum-based episodes of care.
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McNeil H, Elliott J, Huson K, Ashbourne J, Heckman G, Walker J, Stolee P. Engaging older adults in healthcare research and planning: a realist synthesis. RESEARCH INVOLVEMENT AND ENGAGEMENT 2016; 2:10. [PMID: 29062511 PMCID: PMC5611557 DOI: 10.1186/s40900-016-0022-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 02/13/2016] [Indexed: 05/15/2023]
Abstract
PLAIN ENGLISH SUMMARY The importance of citizen involvement in healthcare research and planning has been widely recognized. There is however, a lack of understanding of how best to engage older adults, Canada's fastest growing segment of the population and biggest users of the healthcare system. We aimed to address this gap by developing an understanding of the engagement of older adults and their caregivers in healthcare research and planning. We conducted a review of available knowledge on engagement in healthcare research and planning with a focus on older adults and their caregivers. A five stage engagement framework emerged from this study that can be used to guide engagement efforts. We are continuing to collaborate with older adults and decision makers to develop and test strategies based on the presented framework. ABSTRACT Background The importance of engaging the community in healthcare research and planning has been widely recognized. Currently however, there is a limited focus on older adults, Canada's fastest growing segment of the population and biggest users of the healthcare system. Objective This project aimed to develop an understanding of engagement of older adults and their caregivers in healthcare research and planning. Method A realist synthesis was conducted of the available knowledge on engagement in healthcare research and planning. The search methodology was informed by a framework for realist syntheses following five phases, including consultations with older adults. The synthesis included theoretical frameworks, and both peer-reviewed and grey literature. Results The search generated 15,683 articles, with 562 focusing on healthcare research and planning. The review lead to the development of a framework to engage older adults and their caregivers in healthcare research and planning. The 5 stages environment, plan, establish, build, and transition are accompanied with example context, mechanism, and outcomes to guide the use of this framework. Conclusion We have identified a framework that promotes meaningful engagement of older adults and their caregivers. We are continuing to collaborate with our community partners to further develop and evaluate engagement strategies that align with the presented framework.
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Affiliation(s)
- Heather McNeil
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Jacobi Elliott
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Kelsey Huson
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
- Conestoga College, School of Health & Life Sciences and Community Services, Waterloo, ON Canada
| | - Jessica Ashbourne
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - George Heckman
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
- Schlegel-UW Research Institute for Aging, Kitchener, ON Canada
| | - Jennifer Walker
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
- School of Human and Social Development, Nipissing University – Muskoka Campus, Bracebridge, ON Canada
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
- Schlegel-UW Research Institute for Aging, Kitchener, ON Canada
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McMurray J, McNeil H, Lafortune C, Black S, Prorok J, Stolee P. Measuring Patients' Experience of Rehabilitation Services Across the Care Continuum. Part II: Key Dimensions. Arch Phys Med Rehabil 2016; 97:121-30. [DOI: 10.1016/j.apmr.2015.08.408] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/11/2015] [Accepted: 08/03/2015] [Indexed: 12/30/2022]
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Lim SY, Jarvenpaa SL, Lanham HJ. Barriers to Interorganizational Knowledge Transfer in Post-Hospital Care Transitions: Review and Directions for Information Systems Research. J MANAGE INFORM SYST 2015. [DOI: 10.1080/07421222.2015.1095013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Coleman EA, Ground KL, Maul A. The Family Caregiver Activation in Transitions (FCAT) Tool: A New Measure of Family Caregiver Self-Efficacy. Jt Comm J Qual Patient Saf 2015; 41:502-7. [DOI: 10.1016/s1553-7250(15)41066-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Barrière F, Louis N, Boungzate N, Masson C. [Family caregivers and their support at home]. SOINS. GERONTOLOGIE 2015; 20:21-23. [PMID: 26364817 DOI: 10.1016/j.sger.2015.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Home support for carers is a cross-cutting theme running through all the areas of focus of the strategy for the integration of care and assistance services. Thanks to this strategy a health care territory has visibility, legibility and accessibility to the respite care and assistance available to family carers provided by local professionals, notably by those in charge of complex situations, the case managers.
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Affiliation(s)
- François Barrière
- Maia Pays Salonais, 39 rue Saint-François, 13300 Salon-de-Provence, France.
| | - Natacha Louis
- Maia Pays Salonais, 39 rue Saint-François, 13300 Salon-de-Provence, France
| | - Nhzate Boungzate
- Maia Pays Salonais, c/o CLIC Paris Emeraude Sud, 20 rue de la Glacière, 75013 Paris, France
| | - Christine Masson
- Hôtel du département, Direction de la vie sociale, relais gérontologique, 1 place Monseigneur-de-Galard, 43000 Le-Puy-en-Velay, France
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Lafortune C, Huson K, Santi S, Stolee P. Community-based primary health care for older adults: a qualitative study of the perceptions of clients, caregivers and health care providers. BMC Geriatr 2015; 15:57. [PMID: 25925552 PMCID: PMC4434544 DOI: 10.1186/s12877-015-0052-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 04/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background Older persons are often poorly served by existing models of community-based primary health care (CBPHC). We sought input from clients, informal caregivers, and health care providers on recommendations for system improvements. Methods Focus group interviews were held with clients, informal caregivers, and health care providers in mid-sized urban and rural communities in Ontario. Data were analyzed using a combination of directed and emergent coding. Results were shared with participants during a series of feedback sessions. Results An extensive list of barriers, facilitators, and recommended health system improvements was generated. Barriers included poor system integration and limited access to services. Identified facilitators were person and family-focused care, self-management resources, and successful collaborative practice. Recommended system improvements included expanding and integrating care teams, supports for system navigation, and development of standardized information systems and care pathways. Conclusions Older adults still experience frustrating obstacles when trying to access CBPHC. Identified barriers and facilitators of improved system integration aligned well with current literature and Wagner’s Chronic Care Model. Additional work is needed to implement the recommended improvements and to discern their impact on patient and system outcomes. Electronic supplementary material The online version of this article (doi:10.1186/s12877-015-0052-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claire Lafortune
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Kelsey Huson
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Selena Santi
- Institutional Research, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Paul Stolee
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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Schiller C, Franke T, Belle J, Sims-Gould J, Sale J, Ashe MC. Words of wisdom - patient perspectives to guide recovery for older adults after hip fracture: a qualitative study. Patient Prefer Adherence 2015; 9:57-64. [PMID: 25609927 PMCID: PMC4298293 DOI: 10.2147/ppa.s75657] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Recovery after hip fracture is complex involving many transitions along the care continuum. The recovery process, and these transitions, often present significant challenges for older adults and their families and caregivers. There is an identified need for more targeted information to support older adults and their families throughout the recovery process.Therefore, our goal was to understand the recovery phase after hip fracture from the patient perspective, and identify specific messages that could be integrated into future educational material for clinical practice to support patients during recovery. Using a qualitative description design guided by a strengths-based focus, we invited men and women 60+ years with previous hip fracture and their family members/caregivers to participate in interviews. We used purposive criterion sampling within the community setting to recruit participants. We followed a semi-structured guide to conduct the interviews, either in person or over the telephone, and focused questions on experiences with hip fracture and factors that enabled recovery. Two investigators coded and analyzed interview transcripts to identify key messages. We interviewed a total of 19 participants: eleven older adults who sustained a hip fracture and eight family member/caregivers. Participants described three main messages that enabled recovery: 1) seek support; 2) move more; and 3) preserve perspective. Participants provided vital information about their recovery experience from hip fracture. In future, this knowledge can be incorporated into patient-centered education and shared with older adults, their families, and health care professionals across the continuum of care.
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Affiliation(s)
- Claire Schiller
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Thea Franke
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, Vancouver, BC, Canada
| | - Jessica Belle
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Joanie Sims-Gould
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Joanna Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Maureen C Ashe
- Centre for Hip Health and Mobility, Robert H N Ho Research Centre, Vancouver, BC, Canada
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
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Laugaland K, Aase K, Waring J. Hospital discharge of the elderly--an observational case study of functions, variability and performance-shaping factors. BMC Health Serv Res 2014; 14:365. [PMID: 25175924 PMCID: PMC4159506 DOI: 10.1186/1472-6963-14-365] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 08/27/2014] [Indexed: 11/13/2022] Open
Abstract
Background Understanding and improving hospital discharge has assumed major importance since it represents an error-prone transition in care. One barrier to improvement is the lack of detailed understanding of how hospital discharge is organized, including its interdependencies and influential performance-shaping factors (PSFs). This study examines the discharge of elderly patients using the Functional Resonance Analysis Method, developed to analyze performance variability in complex systems. Our main aim was to identify hospital discharge functions, variability, and PSFs that may explain the variability and different outcomes in discharge practices by incorporating multiple-stakeholder perceptions (health-care providers, patients, next of kin). Methods The data consisted of moderate participant observations of 20 elderly patients (>75) discharged from hospital to primary health care. The data comprised 90 hours’ observations at hospital wards, including 173 conversations with patients, next of kin, and health-care personnel involved in discharge. Results We identified 10 common functions in the discharge of elderly patients to primary health care. We found substantial variability in terms of timing, duration, and precision. Duration is a significant source of variability, primarily determined by the time of day the patient was determined medically fit for discharge. Precision issues related to (1) decision-making criteria concerning the medical fitness decision and appropriate level of care, (2) quality of discharge planning, (3) degree of patient involvement, and (4) quality of information transfer. PSFs were temporal conditions (degree of time pressure), individual and team characteristics, patient factors, organizational factors (unit, specialization, leadership, institutionalized routines), work environment factors (bed availability, availability in municipal services, quality of discharge planning, familiarity with the patient, pressure from next of kin, doctor’s specialization) and regulatory influences (financial incentives). Conclusions The study provides a detailed understanding of the discharge of elderly patients by describing common functions and variability in performance caused by multiple PSFs. Our findings indicate the necessity for studying multiple factors related to discharge, interdependencies, and their effects on a range of discharge outcomes incorporating a multiple-stakeholder perspective. We argue that the existing sequential approaches to the complexity surrounding hospital discharge are inadequate. Given the interdependencies among functions, there is a need for corresponding multi-factorial interventions. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-365) contains supplementary material, which is available to authorized users.
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Blöndal K, Zoëga S, Hafsteinsdottir JE, Olafsdottir OA, Thorvardardottir AB, Hafsteinsdottir SA, Sveinsdóttir H. Attitudes of Registered and Licensed Practical Nurses About the Importance of Families in Surgical Hospital Units: Findings From the Landspitali University Hospital Family Nursing Implementation Project. JOURNAL OF FAMILY NURSING 2014; 20:355-375. [PMID: 25026965 DOI: 10.1177/1074840714542875] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The purpose of this study was to examine attitudes of registered nurses and licensed practical nurses about the importance of the family in surgical hospital units before (T1) and after (T2) implementation of a Family Systems Nursing educational intervention based on the Calgary Family Assessment and Intervention Models. This study was part of the Landspitali University Hospital Family Nursing Implementation Project and used a nonrandomized, quasi-experimental design with nonequivalent group before and after and without a control group. There were 181 participants at T1 and 130 at T2. No difference was found in nurses' attitudes as measured by the Families Importance in Nursing Care-Nurses' Attitudes (FINC-NA) questionnaire, before and after the educational intervention. Attitudes toward families were favorable at both times. Analysis of demographic variables showed that age, work experience, and workplace (inpatient vs. outpatient units) had an effect on the nurses' attitudes toward families. The influence of work experience on attitudes toward family care warrants further exploration.
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Affiliation(s)
- Katrin Blöndal
- University of Iceland, Reykjavik, Iceland Landspitali-The National University Hospital, Reykjavik, Iceland
| | - Sigridur Zoëga
- Landspitali-The National University Hospital, Reykjavik, Iceland
| | | | | | | | | | - Herdis Sveinsdóttir
- University of Iceland, Reykjavik, Iceland Landspitali-The National University Hospital, Reykjavik, Iceland
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