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Haire E, Worley E, Jones SG, Ling A, Stoneham B, Wiggins N. Could it have been predicted? A retrospective analysis of the last year of life for people who died whilst in an intermediate care centre. Future Healthc J 2024; 11:100136. [PMID: 38831941 PMCID: PMC11144746 DOI: 10.1016/j.fhj.2024.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Objectives Intermediate care centres (ICCs) exist in the UK to bridge between acute hospital and home for those with rehabilitation needs. A national study shows 25% of ICC in-patients died within a year of admission. High quality end-of-life care includes early conversations with a person and their loved ones about what matters to them; timely identification of those who are likely to be nearing the end of their life is key. Methods This retrospective quantitative review of 98 patient notes reviewed deaths in one NHS trust, comparing 50 deaths in the acute hospital and 48 in the ICC. Data included frailty score, previous hospital admissions, specialist palliative input and conversations between professionals, patients and their loved ones. Supportive and Palliative Care Indicators Tool (SPICT) scores were used to identify those likely to have a poor prognosis. Results Results showed statistically significant differences between the groups. The ICC cohort were older with higher clinical frailty scores. They were less likely to have previous hospital admissions but more likely to have poor prognostic features on final admission. Despite this, the possibility of deterioration was discussed them less frequently than the acute hospital cohort, and fewer saw the Palliative care team. Conclusion This data suggests support is needed in ICCs to recognise those likely to be nearing end-of-life. One challenge is patients are more likely to be seen as 'well' in a rehabilitation focused environment. This paper suggests a 'proactive approach' trial using SPICT for ongoing assessment of ICC in-patients supporting identification of a deteriorating person and avoid missed opportunities for key conversations.
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Affiliation(s)
- Ellen Haire
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
| | - Emma Worley
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
| | - Stuart Glynne Jones
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
| | - Andrea Ling
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
| | - Bethany Stoneham
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
| | - Natasha Wiggins
- Great Western Hospital NHS Foundation Trust, Marlborough road, Swindon SN3 6BB, United Kingdom
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Quigley N, Binnie A, Baig N, Opgenorth D, Senaratne J, Sligl WI, Zuege DJ, Rewa O, Bagshaw SM, Tsang J, Lau VI. Modelling the potential increase in eligible participants in clinical trials with inclusion of community intensive care unit patients in Alberta, Canada: a decision tree analysis. Can J Anaesth 2024; 71:390-399. [PMID: 38129358 DOI: 10.1007/s12630-023-02669-y] [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: 03/28/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Critical care research in Canada is conducted primarily in academically affiliated intensive care units (ICUs) with established research infrastructure. Efforts are made to engage community hospital ICUs in research, although the impacts of their inclusion in clinical research have never been explicitly quantified. We therefore sought to determine the number of additional eligible patients that could be recruited into critical care trials and the change in time to study completion if community ICUs were included in clinical research. METHODS We conducted a decision tree analysis using 2018 Alberta Health Services data. Patient demographics and clinical characteristics for all ICU patients were compared against eligibility criteria from ten landmark, randomized, multicentre critical care trials. Individual patients from academic and community ICUs were assessed for eligibility in each of the ten studies, and decision tree analysis models were built based on prior inclusion and exclusion criteria from those trials. RESULTS The number of potentially eligible patients for the ten trials ranged from 2,082 to 10,157. Potentially eligible participants from community ICUs accounted for 40.0% of total potentially eligible participants. The recruitment of community ICU patients in trials would have increased potential enrolment by an average of 64.0%. The inclusion of community ICU patients was predicted to decrease time to trial completion by a mean of 14 months (43% reduction). CONCLUSION Inclusion of community ICU patients in critical care research trials has the potential to substantially increase enrolment and decrease time to trial completion.
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Affiliation(s)
- Nicholas Quigley
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada.
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440 112 St, Edmonton, AB, T6G 2B7, Canada.
| | - Alexandra Binnie
- Department of Critical Care, William Osler Health System, Brampton, ON, Canada
| | - Nadia Baig
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
| | - Dawn Opgenorth
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
| | - Janek Senaratne
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
| | - Wendy I Sligl
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Danny J Zuege
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Oleksa Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Jennifer Tsang
- Division of Critical Care Medicine, Niagara Health, St. Catharines, ON, Canada
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Vincent I Lau
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
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Miller R, Rimmer E, Blattner K, Withington S, Ram S, Topping M, Kaka H, Bergin A, Pirini J, Smith M, Nixon G. A retrospective observational study examining interhospital transfers from six New Zealand rural hospitals in 2019. Aust J Rural Health 2023; 31:921-931. [PMID: 37491762 DOI: 10.1111/ajr.13024] [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: 02/28/2023] [Revised: 07/04/2023] [Accepted: 07/09/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE The aim of this study was to identify the percentage of patients that were transferred from rural hospitals and who received an investigation or intervention at an urban hospital that was not readily available at the rural hospital. METHODS A retrospective observational study. DESIGN Patients were randomly selected and clinical records were reviewed. Patient demographic and clinical information was collected, including any interventions or investigations occurring at the urban referral hospital. These were compared against the resources available at the rural hospitals. SETTING Six New Zealand (NZ) rural hospitals were included. PARTICIPANTS Patients that were transferred from a rural hospital to an urban hospital between 1 Jan 2019 and 31 December 2019 were included. MAIN OUTCOME MEASURES The primary outcome measure was the percentage of patients who received an investigation or intervention that was not available at the rural hospital. RESULTS There were 584 patients included. Overall 73% of patients received an intervention or investigation that was not available at the rural hospital. Of the six rural hospitals, there was one outlier, where only 37% of patients transferred from that hospital received an investigation or intervention that was not available rurally. Patients were most commonly referred to general medicine (23%) and general surgery (18%). Of the investigations or interventions performed, 43% received a CT scan and 25% underwent surgery. CONCLUSIONS Most patients that are transferred to urban hospitals receive an intervention or investigation that was not available at the rural hospital.
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Affiliation(s)
- Rory Miller
- Thames Hospital, University of Otago, Dunedin, New Zealand
| | | | | | - Steve Withington
- University of Otago - Rural Health Academic Centre - Ashburton, Ashburton Hospital, Ashburton, New Zealand
| | | | | | - Hemi Kaka
- University of Otago, Dunedin, New Zealand
| | | | | | - Michelle Smith
- Dunstan Hospital, University of Otago, Dunedin, New Zealand
| | - Garry Nixon
- Dunstan Hospital, University of Otago, Dunedin, New Zealand
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Hedman M, Doolan-Noble F, Stokes T, Brännström M. Doctors' experiences of providing care in rural hospitals in Southern New Zealand: a qualitative study. BMJ Open 2022; 12:e062968. [PMID: 36600351 PMCID: PMC9730364 DOI: 10.1136/bmjopen-2022-062968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore rural hospital doctors' experiences of providing care in New Zealand rural hospitals. DESIGN The study had a qualitative design, using qualitative content analysis. SETTING The study was conducted in South Island, New Zealand, and included nine different rural hospitals. RESPONDENTS Semistructured interviews were conducted with 16 rural hospital doctors. RESULTS Three themes were identified: 'Applying a holistic perspective in the care', 'striving to maintain patient safety in sparsely populated areas' and 'cooperating in different teams around the patient'. Rural hospital care more than general hospital care was seen as offering a holistic perspective on patient care based on closeness to their home and family, the generalist perspective of care and personal continuity. The presentation of acute life-threatening low-frequency conditions at rural hospitals were associated with feelings of concern due to limited access to ambulance transportation and lack of experience.Overall, however, patient safety in rural hospitals was considered equal or better than in general hospitals. Doctors emphasised the central role of rural hospitals in the healthcare pathways of rural patients, and the advantages and disadvantages with small non-hierarchical multidisciplinary teams caring for patients. Collaboration with hospital specialists was generally perceived as good, although there was a sense that urban colleagues do not understand the additional medical and practical assessments needed in rural compared with the urban context. CONCLUSIONS This study provides an understanding of how rural hospital doctors value the holistic generalist perspective of rural hospital care, and of how they perceive the quality and safety of that care. The long distances to general hospital care for acute cases were considered concerning.
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Affiliation(s)
- Mante Hedman
- Public Health and Clinical Medicine, Umea University, Umeå, Sweden
| | - Fiona Doolan-Noble
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
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Davidson D, Williams I, Glasby J, Paine AE. 'Localism and intimacy, and… other rather imponderable reasons of that sort': A qualitative study of patient experience of community hospitals in England. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6404-e6413. [PMID: 36326043 PMCID: PMC10092860 DOI: 10.1111/hsc.14083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/03/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Debates over the value and contribution of community hospitals are hampered by a lack of empirical assessment of the experience of patients using these services. This paper presents findings from a study which included a focus on patient and family-carer experiences of community hospitals in England. We adopted a qualitative design involving nine case study hospitals. Data collection included interviews with patients (n = 60), carers (n = 28) and staff (n = 89). Through patients and carers highlighting the value of community hospitals feeling 'close to home', providing holistic and personalised care and supporting them through difficult transitions, the study confirms the importance of functional and interpersonal aspects of care, while also highlighting the importance of social and psychological aspects. These included having family, friends and the community close, maintaining social connections during periods of hospital treatment, and feeling less anonymous and anxious when attending the hospital due to the high levels of familiarity and connectedness. Although the experiences uncovered in this study were not uniformly positive, patients and carers placed a high overall value on the care provided by community hospitals, often arguing that these were distinctive when compared to their experiences of using other health and care services. The study suggests the need to weigh the full range of these dimensions of patient experience-functional, interpersonal, social and psychological-when assessing the role and contribution of community hospitals.
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Affiliation(s)
- Deborah Davidson
- Health Services Management CentreSchool of Social PolicyUniversity of BirminghamBirminghamUnited Kingdom
| | - Iestyn Williams
- Health Services Management CentreSchool of Social PolicyUniversity of BirminghamBirminghamUnited Kingdom
| | - Jon Glasby
- School of Social PolicyUniversity of BirminghamBirminghamUnited Kingdom
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Saari H, Ryynänen OP, Lönnroos E, Kekolahti P, Mäntyselkä P, Kokko S. Factors Associated With Discharge Destination in Older Patients: Finnish Community Hospital Cohort Study. J Am Med Dir Assoc 2022; 23:1868.e1-1868.e8. [PMID: 35961413 DOI: 10.1016/j.jamda.2022.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 06/07/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Primary care physician-led community hospitals provide basic hospital care for older people in Finland. Yet little is known of the outcomes of the care. We investigated factors associated with discharge destination after hospitalization in a community hospital and the role of active rehabilitation during the stay. DESIGN Prospective observational study. SETTING AND PARTICIPANTS Short-term community hospital stays of older adults (≥65 years) living in the Kuopio University Hospital district in central and eastern Finland. METHODS Data on short-term (1-31 days) hospital stays from 51 community hospitals were collected with an electronic survey between January and June 2016. Physicians, secretaries, and rehabilitation staff from each community hospital completed the data collection form. Discharge destination was defined as home, residential care or death, and active rehabilitation as frequency of rehabilitation at least once a day. Analyses were conducted using the Bayesian approach and the BayesiaLab 9.1 tool. RESULTS Data of 11,628 community hospital stays were analyzed. The patients' mean age was 81.6 years (SD 7.9), and 57.5% were women. A younger age (65-74 years), a high number of rehabilitation staff (>2 per 10 patients), and receiving rehabilitation at least once a day were associated with discharging patients to their own homes. Daily rehabilitation was associated with returning to home in all patient groups. CONCLUSIONS AND IMPLICATIONS Older patients admitted to a community hospital for any reason may benefit from active rehabilitation. The role of community hospitals in the acute care and rehabilitation of older patients is important in aging societies.
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Affiliation(s)
- Henna Saari
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland.
| | - Olli-Pekka Ryynänen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Eija Lönnroos
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Pekka Kekolahti
- Aalto University, School of Electrical Engineering, Department of Communications and Networking, Espoo, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
| | - Simo Kokko
- Primary Health Care Unit, Kuopio University Hospital, Kuopio, Finland
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Nystrøm V, Lurås H, Moger T, Leonardsen ACL. Finding good alternatives to hospitalisation: a data register study in five municipal acute wards in Norway. BMC Health Serv Res 2022; 22:715. [PMID: 35637492 PMCID: PMC9153207 DOI: 10.1186/s12913-022-08066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In Norway, municipal acute wards (MAWs) have been implemented in primary healthcare since 2012. The MAWs were intended to offer decentralised acute medical care 24/7 for patients who otherwise would be admitted to hospital. The aim of this study was to assess whether the MAW represents the alternative to hospitalisation as intended, through 1) describing the characteristics of patients intended as candidates for MAWs by primary care physicians, 2) exploring the need for extended diagnostics prior to admission in MAWs, and 3) exploring factors associated with patients being transferred from the MAWs to hospital. METHODS The study was based on register data from five MAWs in Norway in the period 2014-2020. RESULTS In total, 16 786 admissions were included. The median age of the patients was 78 years, 60% were women, and the median length of stay was three days. Receiving oral medication (OR 1.23, 95% CI 1.09-1.40), and the MAW being located nearby the hospital (OR 2.29, 95% CI 1.92-2.72) were factors associated with patients admitted to MAW after extended diagnostics. Patients needing advanced treatment, such as oxygen therapy (OR 2.13, 95% CI 1.81-2.51), intravenous medication (OR 1.60, 95% CI 1.45-1.81), intravenous fluid therapy (OR 1.32, 95% CI 1.19-1.47) and MAWs with long travel distance from the MAW to the hospital (OR 1.46, 95% CI 1.22-1.74) had an increased odds for being transferred to hospital. CONCLUSIONS Our findings indicate that MAWs do not represent the alternative to hospitalisation as intended. The results show that patients receiving extended diagnostics before admission to MAW got basic treatment, while patients in need of advanced medical treatment were transferred to hospital from a MAW. This indicates that there is still a potential to develop MAWs in order to fulfil the intended health service level.
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Affiliation(s)
- Vivian Nystrøm
- Department of Health, Welfare and Organisation, Østfold University College, Postal Box Code (PB) 700, 1757 Halden, Norway
- Department of Health Management and Health Economics, University of Oslo, 1089 Blindern, Postal Box Code (PB), 0317 Oslo, Norway
| | - Hilde Lurås
- Health Services Research Unit, Akershus University Hospital, Postal box code (PB) 1000 1478 Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway
| | - Tron Moger
- Department of Health Management and Health Economics, University of Oslo, 1089 Blindern, Postal Box Code (PB), 0317 Oslo, Norway
| | - Ann-Chatrin Linqvist Leonardsen
- Department of Health, Welfare and Organisation, Østfold University College, Postal Box Code (PB) 700, 1757 Halden, Norway
- Østfold Hospital Trust, Grålum, Norway
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Nataliansyah MM, Zhu X, Vaughn T, Mueller K. Beyond patient care: a qualitative study of rural hospitals' role in improving community health. BMJ Open 2022; 12:e057450. [PMID: 35296486 PMCID: PMC8928326 DOI: 10.1136/bmjopen-2021-057450] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Rural population face more health disadvantages than those living in urban and suburban areas. In rural communities, hospitals are frequently the primary organisation with the resources and capabilities to address health issues. This characteristic highlights their potential to be a partner and leader for community health initiatives. This study aims to understand rural hospitals' motivations to engage in community health improvement efforts and examine their strategies to address community health issues. DESIGN Eleven semistructured interviews were conducted with key leaders from four rural hospitals in a US Midwestern state. On-site and telephone interviews were audio-recorded and transcribed. The combination of inductive and deductive qualitative analysis was applied to identify common themes and categories. SETTINGS Participating hospitals are located in US rural counties that have demonstrated progress in creating healthier communities. RESULTS Three types of motivation drive rural hospitals' community health improvement efforts: internal values, economic conditions and social responsibilities. Three categories of strategies to address community health issues were identified: building capacity, building relationships and building programmes. CONCLUSIONS Despite the challenges, rural hospitals can successfully conduct community-oriented programmes. The finds extend the literature on how rural hospitals may strategise to improve rural health by engaging their communities and conduct activities beyond patient care.
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Affiliation(s)
- Mochamad Muska Nataliansyah
- Department of Surgery, Division of Surgical Oncology, CHDS, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Xi Zhu
- Department of Health Policy and Management, Fileding School of Public Health, UCLA, Los Angeles, California, USA
| | - Thomas Vaughn
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Keith Mueller
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa, USA
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Blattner K, Clay L, Miller R, Nixon G, Crengle S, Richard L, Anton R, Stokes T. New Zealand’s rural hospitals in 2021: findings from an exploratory questionnaire survey. J Prim Health Care 2022; 14:254-258. [DOI: 10.1071/hc22072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/01/2022] [Indexed: 11/23/2022] Open
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Lau VI, Binnie A, Basmaji J, Baig N, Opgenorth D, Cameron S, O'Hearn K, McDonald E, Senaratne J, Sligl W, Zuege DJ, Rewa O, Bagshaw SM, Tsang J. Needs Assessment Survey Identifying Research Processes Which may be Improved by Automation or Artificial Intelligence: ICU Community Modeling and Artificial Intelligence to Improve Efficiency (ICU-Comma). J Intensive Care Med 2021; 37:1296-1304. [PMID: 34898324 PMCID: PMC9468938 DOI: 10.1177/08850666211064844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Critical care research in Canada is conducted primarily in academically-affiliated intensive care units with established research infrastructure, including research coordinators (RCs). Recently, efforts have been made to engage community hospital ICUs in research albeit with barriers. Automation or artificial intelligence (AI) could aid the performance of routine research tasks. It is unclear which research study processes might be improved through AI automation. Methods We conducted a cross-sectional survey of Canadian ICU research personnel. The survey contained items characterizing opinions regarding research processes that may be amenable to AI automation. We distributed the questionnaire via email distribution lists of 3 Canadian research societies. Open-ended questions were analyzed using a thematic content analysis approach. Results A total of 49 survey responses were received (response rate: 8%). Tasks that respondents felt were time-consuming/tedious/tiresome included: screening for potentially eligible patients (74%), inputting data into case report forms (65%), and preparing internal tracking logs (53%). Tasks that respondents felt could be performed by AI automation included: screening for eligible patients (59%), inputting data into case report forms (55%), preparing internal tracking logs (51%), and randomizing patients into studies (45%). Open-ended questions identified enthusiasm for AI automation to improve information accuracy and efficiency while freeing up RCs to perform tasks that require human interaction. This enthusiasm was tempered by the need for proper AI education and oversight. Conclusions There were balanced supportive (increased efficiency and re-allocation of tasks) and challenges (informational accuracy and oversight) with regards to AI automation in ICU research.
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Affiliation(s)
- Vincent I Lau
- 12357University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | | | | | - Nadia Baig
- 12357University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - Dawn Opgenorth
- 12357University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Katie O'Hearn
- 274065Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | - Janek Senaratne
- 12357University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada
| | - Wendy Sligl
- 12357University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada.,3158University of Alberta, Edmonton, Alberta, Canada
| | - Danny J Zuege
- 70401University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Alberta, Canada
| | - Oleksa Rewa
- 12357University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada.,3158University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Alberta, Canada
| | - Sean M Bagshaw
- 12357University of Alberta and Alberta Health Services, Edmonton, Alberta, Canada.,3158University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Alberta, Canada
| | - Jennifer Tsang
- 3710McMaster University, Hamilton, ON, Canada.,37195Niagara Health, St. Catharines, Ontario, Canada
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Hendry A, Tucker H. Guest editorial. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-10-2021-082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tunnard I, Yi D, Ellis-Smith C, Dawkins M, Higginson IJ, Evans CJ. Preferences and priorities to manage clinical uncertainty for older people with frailty and multimorbidity: a discrete choice experiment and stakeholder consultations. BMC Geriatr 2021; 21:553. [PMID: 34649510 PMCID: PMC8515697 DOI: 10.1186/s12877-021-02480-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical uncertainty is inherent for people with frailty and multimorbidity. Depleted physiological reserves increase vulnerability to a decline in health and adverse outcomes from a stressor event. Evidence-based tools can improve care processes and outcomes, but little is known about priorities to deliver care for older people with frailty and multimorbidity. This study aimed to explore the preferences and priorities for patients, family carers and healthcare practitioners to enhance care processes of comprehensive assessment, communication and continuity of care in managing clinical uncertainty using evidence-based tools. METHODS A parallel mixed method observational study in four inpatient intermediate care units (community hospitals) for patients in transition between hospital and home. We used a discrete choice experiment (DCE) to examine patient and family preferences and priorities on the attributes of enhanced services; and stakeholder consultations with practitioners to discuss and generate recommendations on using tools to augment care processes. Data analysis used logit modelling in the DCE, and framework analysis for consultation data. RESULTS Thirty-three patients participated in the DCE (mean age 84 years, SD 7.76). Patients preferred a service where family were contacted on admission and discharge (β 0.36, 95% CI 0.10 to 0.61), care received closer to home (β - 0.04, 95% CI - 0.06 to - 0.02) and the GP is fully informed about care (β 0.29, 95% CI 0.05-0.52). Four stakeholder consultations (n = 48 participants) generated 20 recommendations centred around three main themes: tailoring care processes to manage multiple care needs for an ageing population with frailty and multimorbidity; the importance of ongoing communication with patient and family; and clear and concise evidence-based tools to enhance communication between clinical teams and continuity of care on discharge. CONCLUSION Family engagement is vital to manage clinical uncertainty. Both patients and practitioners prioritise engaging the family to support person-centred care and continuity of care within and across care settings. Patients wished to maximise family involvement by enabling their support with a preference for care close to home. Evidence-based tools used across disciplines and services can provide a shared succinct language to facilitate communication and continuity of care at points of transition in care settings.
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Affiliation(s)
- India Tunnard
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
| | - Deokhee Yi
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
| | - Clare Ellis-Smith
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
| | - Marsha Dawkins
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
| | - Irene J. Higginson
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
| | - Catherine J. Evans
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
- Sussex Community NHS Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW England
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The Contribution of Case Mix, Skill Mix and Care Processes to the Outcomes of Community Hospitals: A Population-Based Observational Study. Int J Integr Care 2021; 21:25. [PMID: 34220389 PMCID: PMC8231454 DOI: 10.5334/ijic.5566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Community hospitals (CHs) could address the emerging complex care needs of patients. We investigated which characteristics of patients’ and CHs affect patient outcomes, in order to identify who could benefit the most from CH care and the best skill mix to deliver this care. Methods: We analysed all elderly patients discharged from the CHs of Emilia-Romagna, Italy. CH skill mix and care processes were collected with an ad hoc survey. The primary outcome was improvement in the Barthel index (BI) on discharge. Hierarchical regression analysis was performed to test the associations under study. Results: 53% of the patients had a BI improvement ≥10. After adjusting for the diverse case mix of the patients, no significant association was found between CH characteristics and BI improvement. Patient characteristics explained only a portion of the variability in CH performance. Discussion: Heterogeneity in case mix reflects the nature of CHs, which play context-specific roles as integrators between primary care services and hospitals. Residual variability in BI improvement rates across CHs might be attributed to aspects of care not detected in our survey. Conclusions: More research is needed to study the impact of CH skill mix and care processes on patient outcomes.
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Nystrøm V, Lurås H, Midlöv P, Leonardsen ACL. What if something happens tonight? A qualitative study of primary care physicians' perspectives on an alternative to hospital admittance. BMC Health Serv Res 2021; 21:447. [PMID: 33975573 PMCID: PMC8112060 DOI: 10.1186/s12913-021-06444-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/26/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians' (PCPs') perspectives on admission to a MAW as an alternative to hospitalisation. METHODS The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. RESULTS The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients' condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients' and relatives' participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients' wishes conflicted with what PCPs considered professionally sound. CONCLUSIONS The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services.
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Affiliation(s)
- Vivian Nystrøm
- Department of Health and Welfare, Østfold University College, (PB) 700, 1757 Halden, Norway
| | - Hilde Lurås
- Health Services Research Unit, Akershus University Hospital, (PB) 1000, 1478 Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, (PB) 50332, 202 13 Malmö, Sweden
| | - Ann-Chatrin Linqvist Leonardsen
- Department of Health and Welfare, Østfold University College, (PB) 700, 1757 Halden, Norway
- Østfold Hospital Trust, Halden, Norway
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Gasperini B, Pelusi G, Frascati A, Sarti D, Dolcini F, Espinosa E, Prospero E. Predictors of adverse outcomes using a multidimensional nursing assessment in an Italian community hospital. PLoS One 2021; 16:e0249630. [PMID: 33857183 PMCID: PMC8049226 DOI: 10.1371/journal.pone.0249630] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is growing evidence about the role of nurses in patient outcomes in several healthcare settings. However, there is still a lack of evidence about the transitional care setting. We aimed to assess the association between patient characteristics identified in a multidimensional nursing assessment and outcomes of mortality and acute hospitalization during community hospital stay. METHODS A retrospective observational study was performed on patients consecutively admitted to a community hospital (CH) in Loreto (Ancona, Italy) between January 1st, 2018 and May 31st, 2019. The nursing assessment included sociodemographic characteristics, functional status, risk of falls (Conley Score) and pressure damage (Norton scale), nursing diagnoses, presence of pressure sores, feeding tubes, urinary catheters or vascular access devices and comorbidities. Two logistic regression models were developed to assess the association between patient characteristics identified in a multidimensional nursing assessment and outcomes of mortality and acute hospitalization during CH stay. RESULTS We analyzed data from 298 patients. The mean age was 83 ± 9.9 years; 60.4% (n = 180) were female. The overall mean length of stay was 42.8 ± 36 days (32 ± 32 days for patients who died and 33.9 ± 35 days for patients who had an acute hospitalization, respectively). An acute hospitalization was reported for 13.4% (n = 40) of patients and 21.8% (n = 65) died. An increased risk of death was related to female sex (OR 2.25, 95% CI 1.10-4.62), higher Conley Score (OR 1.19; 95% CI 1.03-1.37) and having a vascular access device (OR 3.64, 95% CI 1.82-7.27). A higher Norton score was associated with a decreased risk of death (OR 0.71, 95% CI 0.62-0.81). The risk for acute hospitalization was correlated with younger age (OR 0.94, 95% CI 0.91-0.97), having a vascular access device (OR 2.33, 95% CI 1.02-5.36), impaired walking (OR 2.50, 95% CI 1.03-6.06) and it is inversely correlated with a higher Conley score (OR 0.84, 95% CI 0.77-0.98). CONCLUSION Using a multidimensional nursing assessment enables identification of risk of nearness of end of life and acute hospitalization to target care and treatment. The present study adds further knowledge on this topic and confirms the importance of nursing assessment to evaluate the risk of patients' adverse outcome development.
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Affiliation(s)
- Beatrice Gasperini
- Section of Hygiene and Public Health, Università Politecnica delle Marche, Ancona, Italy
- Geriatrics, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano (PU), Italy
| | - Gilda Pelusi
- School of Nursing, Università Politecnica delle Marche, Ancona, Italy
| | | | - Donatella Sarti
- Section of Hygiene and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | | | - Emma Espinosa
- Geriatrics, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano (PU), Italy
| | - Emilia Prospero
- Section of Hygiene and Public Health, Università Politecnica delle Marche, Ancona, Italy
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Hedman M, Boman K, Brännström M, Wennberg P. Clinical profile of rural community hospital inpatients in Sweden - a register study. Scand J Prim Health Care 2021; 39:92-100. [PMID: 33569976 PMCID: PMC7971215 DOI: 10.1080/02813432.2021.1882086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE Patients in Sweden's rural community hospitals have not been clinically characterised. We compared characteristics of patients in general practitioner-led community hospitals in northern Sweden with those admitted to general hospitals. DESIGN Retrospective register study. SETTING Community and general hospitals in Västerbotten and Norrbotten counties, Sweden. PATIENTS Patients enrolled at community hospitals and hospitalised in community and general hospitals between 1 January 2010 and 31 December 2014. OUTCOME MEASURES Age, sex, number of admissions, main, secondary and total number of diagnoses. RESULTS We recorded 16,133 admissions to community hospitals and 60,704 admissions to general hospitals. Mean age was 76.8 and 61.2 years for community and general hospital patients (p < .001). Women were more likely than men to be admitted to a community hospital after age adjustment (odds ratio (OR): 1.11; 95% confidence interval (CI): 1.09-1.17). The most common diagnoses in community hospital were heart failure (6%) and pneumonia (5%). Patients with these diagnoses were more likely to be admitted to a community than a general hospital (OR: 2.36; 95% CI: 2.15-2.59; vs. OR: 3.32: 95% CI: 2.77-3.98, respectively, adjusted for age and sex). In both community and general hospitals, doctors assigned more diagnoses to men than to women (both p<.001). CONCLUSIONS Patients at community hospitals were predominantly older and women, while men were assigned more diagnoses. The most common diagnoses were heart failure and pneumonia. Our observed differences should be further explored to define the optimal care for patients in community and general hospitals.Key pointsThe patient characteristics at Swedish general practitioner-led rural community hospitals have not yet been reported. This study characterises inpatients in community hospitals compared to those referred to general hospitals.• Patients at community hospitals were predominantly older, with various medical conditions that would have led to a referral to general hospitals elsewhere in Sweden. • Compared to men, women were more likely to be admitted to community hospitals than to general hospitals, even after adjustment for age. To the best of our knowledge, this pattern has not been reported in other countries with community hospitals. • In both community hospitals and general hospitals, doctors assigned more diagnoses to men than to women.
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Affiliation(s)
- Mante Hedman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- CONTACT Mante Hedman Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kurt Boman
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | | | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Evans CJ, Potts L, Dalrymple U, Pring A, Verne J, Higginson IJ, Gao W. Characteristics and mortality rates among patients requiring intermediate care: a national cohort study using linked databases. BMC Med 2021; 19:48. [PMID: 33579284 PMCID: PMC7880511 DOI: 10.1186/s12916-021-01912-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Adults increasingly live and die with chronic progressive conditions into advanced age. Many live with multimorbidity and an uncertain illness trajectory with points of marked decline, loss of function and increased risk of end of life. Intermediate care units support mainly older adults in transition between hospital and home to regain function and anticipate and plan for end of life. This study examined the patient characteristics and the factors associated with mortality over 1 year post-admission to an intermediate care unit to inform priorities for care. METHODS A national cohort study of adults admitted to intermediate care units in England using linked individual-level Hospital Episode Statistics and death registration data. The main outcome was mortality within 1 year from admission. The cohort was examined as two groups with significant differences in mortality between main diagnosis of a non-cancer condition and cancer. Data analysis used Kaplan-Meier curves to explore mortality differences between the groups and a time-dependant Cox proportional hazards model to determine mortality risk factors. RESULTS The cohort comprised 76,704 adults with median age 81 years (IQR 70-88) admitted to 220 intermediate care units over 1 year in 2016. Overall, 28.0% died within 1 year post-admission. Mortality varied by the main diagnosis of cancer (total n = 3680, 70.8% died) and non-cancer condition (total n = 73,024, 25.8% died). Illness-related factors had the highest adjusted hazard ratios [aHRs]. At 0-28 days post-admission, risks were highest for non-cancer respiratory conditions (pneumonia (aHR 6.17 [95%CI 4.90-7.76]), chronic obstructive pulmonary disease (aHR 5.01 [95% CI 3.78-6.62]), dementia (aHR 5.07 [95% CI 3.80-6.77]) and liver disease (aHR 9.75 [95% CI 6.50-14.6]) compared with musculoskeletal disorders. In cancer, lung cancer showed largest risk (aHR 1.20 [95%CI 1.04-1.39]) compared with cancer 'other'. Risks increased with high multimorbidity for non-cancer (aHR 2.57 [95% CI 2.36-2.79]) and cancer (aHR 2.59 [95% CI 2.13-3.15]) (reference: lowest). CONCLUSIONS One in four patients died within 1 year. Indicators for palliative care assessment are respiratory conditions, dementia, liver disease, cancer and rising multimorbidity. The traditional emphasis on rehabilitation and recovery in intermediate care units has changed with an ageing population and the need for greater integration of palliative care.
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Affiliation(s)
- Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England. .,Sussex Community NHS Foundation Trust HQ, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Laura Potts
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Ursula Dalrymple
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Andrew Pring
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Julia Verne
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England
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Gehrke P, Binnie A, Chan SPT, Cook DJ, Burns KEA, Rewa OG, Herridge M, Tsang JLY. Fostering community hospital research. CMAJ 2020; 191:E962-E966. [PMID: 31481424 DOI: 10.1503/cmaj.190055] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Paige Gehrke
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Alexandra Binnie
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Stephanie P T Chan
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Deborah J Cook
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Karen E A Burns
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Oleksa G Rewa
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Margaret Herridge
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont
| | - Jennifer L Y Tsang
- Niagara Health (Gehrke, Tsang), St. Catharines, Ont.; Niagara Regional Campus (Chan, Tsang), Michael G. DeGroote School of Medicine, McMaster University, St. Catharines, Ont.; William Osler Health System (Binnie), Brampton, Ont.; Sturgeon Community Hospital (Rewa), St. Albert, Alta.; University of Alberta Hospital (Rewa), Edmonton, Alta.; Department of Critical Care Medicine (Rewa), University of Alberta, Edmonton, Alta.; University Health Network (Herridge); Department of Medicine (Herridge, Burns), University of Toronto, Toronto, Ont.; St. Joseph's Health Care (Cook), Hamilton, Ont.; Departments of Medicine (Cook, Tsang), and Clinical Epidemiology & Biostatistics (Cook), McMaster University, Hamilton, Ont.; St. Michael's Hospital (Burns), Toronto, Ont.
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Davidson D, Ellis Paine A, Glasby J, Williams I, Tucker H, Crilly T, Crilly J, Mesurier NL, Mohan J, Kamerade D, Seamark D, Marriott J. Analysis of the profile, characteristics, patient experience and community value of community hospitals: a multimethod study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BackgroundCommunity hospitals have been part of England’s health-care landscape since the mid-nineteenth century. Evidence on them has not kept pace with their development.AimTo provide a comprehensive analysis of the profile, characteristics, patient experience and community value of community hospitals.DesignA multimethod study with three phases. Phase 1 involved national mapping and the construction of a new database of community hospitals through data set reconciliation and verification. Phase 2 involved nine case studies, including interviews and focus groups with patients (n = 60), carers (n = 28), staff (n = 132), volunteers (n = 68), community stakeholders (n = 74) and managers and commissioners (n = 9). Phase 3 involved analysis of Charity Commission data on voluntary support.SettingCommunity hospitals in England.ResultsThe study identified 296 community hospitals with beds in England. Typically, the hospitals were small (< 30 beds), in rural communities, led by doctors/general practitioners (GPs) and nurses, without 24/7 on-site medical cover and provided step-down and step-up inpatient care, with an average length of stay of < 30 days and a variable range of intermediate care services. Key to patients’ and carers’ experiences of community hospitals was their closeness to ‘home’ through their physical location, environment and atmosphere and the relationships that they support; their provision of personalised, holistic care; and their role in supporting patients through difficult psychological transitions. Communities engage with and support their hospitals through giving time (average 24 volunteers), raising money (median voluntary income £15,632), providing services (voluntary and community groups) and giving voice (e.g. taking part in communication and consultation). This can contribute to hospital utilisation and sustainability, patient experience, staff morale and volunteer well-being. Engagement varies between and within communities and over time. Community hospitals are important community assets, representing direct and indirect value: instrumental (e.g. health care), economic (e.g. employment), human (e.g. skills development), social (e.g. networks), cultural (e.g. identity and belonging) and symbolic (e.g. vitality and security). Value varies depending on place and time.LimitationsThere were limitations to the secondary data available for mapping community hospitals and tracking charitable funds and to the sample of case study respondents, which concentrated on people with a connection to the hospitals.ConclusionsCommunity hospitals are diverse but are united by a set of common characteristics. Patients and carers experience community hospitals as qualitatively different from other settings. Their accounts highlight the importance of considering the functional, interpersonal, social and psychological dimensions of experience. Community hospitals are highly valued by their local communities, as demonstrated through their active involvement as volunteers and donors. Community hospitals enable the provision of local intermediate care services, delivered through an embedded, relational model of care, which generates deep feelings of reassurance. However, current developments may undermine this, including the withdrawal of GPs, shifts towards step-down care for non-local patients and changing configurations of services, providers and ownership.Future workComparative studies of patient experience in different settings; longitudinal studies of community support and value; studies into the implications of changes in community hospital function, GP involvement, provider-mix and ownership; and international comparative studies could all be undertaken.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Deborah Davidson
- School of Social Policy, University of Birmingham, Birmingham, UK
| | | | - Jon Glasby
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Iestyn Williams
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Helen Tucker
- Helen Tucker Associates Ltd, Newport, Shropshire, UK
| | | | | | - Nick Le Mesurier
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - John Mohan
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Daiga Kamerade
- School of Health and Society, University of Salford, Salford, UK
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O'Grady N. Community hospital closures and the impact on older people. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2018; 27:1280-1281. [PMID: 30457386 DOI: 10.12968/bjon.2018.27.21.1280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Nina O'Grady
- Advanced Clinical Practitioner, Babington Community Hospital, Derbyshire Community Health Services NHS Trust
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Turner A, Mulla A, Booth A, Aldridge S, Stevens S, Begum M, Malik A. The international knowledge base for new care models relevant to primary care-led integrated models: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [PMID: 29972636 DOI: 10.3310/hsdr06250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BackgroundThe Multispecialty Community Provider (MCP) model was introduced to the NHS as a primary care-led, community-based integrated care model to provide better quality, experience and value for local populations.ObjectivesThe three main objectives were to (1) articulate the underlying programme theories for the MCP model of care; (2) identify sources of theoretical, empirical and practice evidence to test the programme theories; and (3) explain how mechanisms used in different contexts contribute to outcomes and process variables.DesignThere were three main phases: (1) identification of programme theories from logic models of MCP vanguards, prioritising key theories for investigation; (2) appraisal, extraction and analysis of evidence against a best-fit framework; and (3) realist reviews of prioritised theory components and maps of remaining theory components.Main outcome measuresThe quadruple aim outcomes addressed population health, cost-effectiveness, patient experience and staff experience.Data sourcesSearches of electronic databases with forward- and backward-citation tracking, identifying research-based evidence and practice-derived evidence.Review methodsA realist synthesis was used to identify, test and refine the following programme theory components: (1) community-based, co-ordinated care is more accessible; (2) place-based contracting and payment systems incentivise shared accountability; and (3) fostering relational behaviours builds resilience within communities.ResultsDelivery of a MCP model requires professional and service user engagement, which is dependent on building trust and empowerment. These are generated if values and incentives for new ways of working are aligned and there are opportunities for training and development. Together, these can facilitate accountability at the individual, community and system levels. The evidence base relating to these theory components was, for the most part, limited by initiatives that are relatively new or not formally evaluated. Support for the programme theory components varies, with moderate support for enhanced primary care and community involvement in care, and relatively weak support for new contracting models.Strengths and limitationsThe project benefited from a close relationship with national and local MCP leads, reflecting the value of the proximity of the research team to decision-makers. Our use of logic models to identify theories of change could present a relatively static position for what is a dynamic programme of change.ConclusionsMultispecialty Community Providers can be described as complex adaptive systems (CASs) and, as such, connectivity, feedback loops, system learning and adaptation of CASs play a critical role in their design. Implementation can be further reinforced by paying attention to contextual factors that influence behaviour change, in order to support more integrated working.Future workA set of evidence-derived ‘key ingredients’ has been compiled to inform the design and delivery of future iterations of population health-based models of care. Suggested priorities for future research include the impact of enhanced primary care on the workforce, the effects of longer-term contracts on sustainability and capacity, the conditions needed for successful continuous improvement and learning, the role of carers in patient empowerment and how community participation might contribute to community resilience.Study registrationThis study is registered as PROSPERO CRD42016039552.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Alison Turner
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Abeda Mulla
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Shiona Aldridge
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Sharon Stevens
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Mahmoda Begum
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
| | - Anam Malik
- The Strategy Unit, NHS Midlands and Lancashire Commissioning Support Unit, West Bromwich, UK
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Farmer J, Davis H, Blackberry I, de Cotta T. Assessing the value of rural community health services. Aust J Prim Health 2018; 24:221-226. [PMID: 29784081 DOI: 10.1071/py17125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 02/11/2018] [Indexed: 11/23/2022]
Abstract
Rural health services are challenging to manage, a situation perhaps exacerbated by necessity to comply with one-size-fits-all performance frameworks designed for larger services. This raises the questions: do we know what rural health services are doing that is valuable and how should that be evaluated? Twenty-eight qualitative interviews with CEOs and staff of seven Victorian rural health services were conducted, exploring what they value about their 'best practice'. Themes emergent from analysis were compared with 19 government-produced health planning and performance documents. It was found that most dimensions of rural services value aligned with current performance frameworks, but a significant theme about 'community' was missing. Highlighting the relevance of this theme, achieving community-oriented goals accounted for one-third of best practice case studies identified by health services personnel. It is concluded that generating community outcomes is a significant area of value aimed for by rural health services that is missing from current performance measurement frameworks applied to Victorian health services. In this study, a new Evaluative Framework is outlined and further steps needed are suggested.
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Affiliation(s)
- Jane Farmer
- Centre for Social Impact, Swinburne University, John Street, Hawthorn, Vic. 3122, Australia
| | - Hilary Davis
- Centre for Social Impact, Swinburne University, John Street, Hawthorn, Vic. 3122, Australia
| | - Irene Blackberry
- John Richards Initiative, La Trobe University, University Drive, Wodonga, Vic. 3690, Australia
| | - Tracy de Cotta
- Centre for Social Impact, Swinburne University, John Street, Hawthorn, Vic. 3122, Australia
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Pitchforth E, Nolte E, Corbett J, Miani C, Winpenny E, van Teijlingen E, Elmore N, King S, Ball S, Miler J, Ling T. Community hospitals and their services in the NHS: identifying transferable learning from international developments – scoping review, systematic review, country reports and case studies. HEALTH SERVICES AND DELIVERY RESEARCH 2017. [DOI: 10.3310/hsdr05190] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BackgroundThe notion of a community hospital in England is evolving from the traditional model of a local hospital staffed by general practitioners and nurses and serving mainly rural populations. Along with the diversification of models, there is a renewed policy interest in community hospitals and their potential to deliver integrated care. However, there is a need to better understand the role of different models of community hospitals within the wider health economy and an opportunity to learn from experiences of other countries to inform this potential.ObjectivesThis study sought to (1) define the nature and scope of service provision models that fit under the umbrella term ‘community hospital’ in the UK and other high-income countries, (2) analyse evidence of their effectiveness and efficiency, (3) explore the wider role and impact of community engagement in community hospitals, (4) understand how models in other countries operate and asses their role within the wider health-care system, and (5) identify the potential for community hospitals to perform an integrative role in the delivery of health and social care.MethodsA multimethod study including a scoping review of community hospital models, a linked systematic review of their effectiveness and efficiency, an analysis of experiences in Australia, Finland, Italy, Norway and Scotland, and case studies of four community hospitals in Finland, Italy and Scotland.ResultsThe evidence reviews found that community hospitals provide a diverse range of services, spanning primary, secondary and long-term care in geographical and health system contexts. They can offer an effective and efficient alternative to acute hospitals. Patient experience was frequently reported to be better at community hospitals, and the cost-effectiveness of some models was found to be similar to that of general hospitals, although evidence was limited. Evidence from other countries showed that community hospitals provide a wide spectrum of health services that lie on a continuum between serving a ‘geographic purpose’ and having a specific population focus, mainly older people. Structures continue to evolve as countries embark on major reforms to integrate health and social care. Case studies highlighted that it is important to consider local and national contexts when looking at how to transfer models across settings, how to overcome barriers to integration beyond location and how the community should be best represented.LimitationsThe use of a restricted definition may have excluded some relevant community hospital models, and the small number of countries and case studies included for comparison may limit the transferability of findings for England. Although this research provides detailed insights into community hospitals in five countries, it was not in its scope to include the perspective of patients in any depth.ConclusionsAt a time when emphasis is being placed on integrated and community-based care, community hospitals have the potential to assume a more strategic role in health-care delivery locally, providing care closer to people’s homes. There is a need for more research into the effectiveness and cost-effectiveness of community hospitals, the role of the community and optimal staff profile(s).FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Emma Pitchforth
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Ellen Nolte
- European Observatory on Health Systems and Policies, London School of Economics and Political Science and London School of Hygiene & Tropical Medicine, London, UK
| | - Jennie Corbett
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Céline Miani
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Eleanor Winpenny
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Edwin van Teijlingen
- Department of Human Sciences and Public Health, University of Bournemouth, Bournemouth, UK
| | - Natasha Elmore
- Cambridge Centre for Health Services Research (CCHSR), Institute of Public Health, University of Cambridge, Cambridge, UK
| | | | - Sarah Ball
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
| | - Joanna Miler
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Tom Ling
- Cambridge Centre for Health Services Research (CCHSR), RAND Europe, Cambridge, UK
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