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Daus M, Lee M, Ujano-De Motta LL, Holstein A, Morgan B, Albright K, Ayele R, McCarthy M, Sjoberg H, Jones CD. Perspectives on supporting Veterans' social needs during hospital to home health transitions: findings from the Transitions Nurse Program. BMC Health Serv Res 2024; 24:520. [PMID: 38658937 PMCID: PMC11043030 DOI: 10.1186/s12913-024-10900-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Veterans who need post-acute home health care (HHC) are at risk for adverse outcomes and unmet social needs. Veterans' social needs could be identified and met by community-based HHC clinicians due to their unique perspective from the home environment, acuity of Veterans they serve, and access to Veterans receiving community care. To understand these needs, we explored clinician, Veteran, and care partner perspectives to understand Veterans' social needs during the transition from hospital to home with skilled HHC. METHODS Qualitative data were collected through individual interviews with Veterans Health Administration (VHA) inpatient & community HHC clinicians, Veterans, and care partners who have significant roles facilitating Veterans' hospital to home with HHC transition. To inform implementation of a care coordination quality improvement intervention, participants were asked about VHA and HHC care coordination and Veterans' social needs during these transitions. Interviews were recorded, transcribed, and analyzed inductively using thematic analysis and results were organized deductively according to relevant transitional care domains (Discharge Planning, Transition to Home, and HHC Delivery). RESULTS We conducted 35 interviews at 4 VHA Medical Centers located in Western, Midwestern, and Southern U.S. regions during March 2021 through July 2022. We organized results by the three care transition domains and related themes by VHA, HHC, or Veteran/care partner perspective. Our themes included (1) how social needs affected access to HHC, (2) the need for social needs screening during hospitalization, (3) delays in HHC for Veterans discharged from community hospitals, and (4) a need for closed-loop communication between VHA and HHC to report social needs. CONCLUSIONS HHC is an underexplored space for Veterans social needs detection. While this research is preliminary, we recommend two steps forward from this work: (1) develop closed-loop communication and education pathways with HHC and (2) develop a partnership to integrate a social risk screener into HHC pathways.
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Affiliation(s)
- Marguerite Daus
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA.
| | - Marcie Lee
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Lexus L Ujano-De Motta
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | | | - Brianne Morgan
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Karen Albright
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- OCHIN, Inc., Portland, OR, USA
| | - Roman Ayele
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michaela McCarthy
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Heidi Sjoberg
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Christine D Jones
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Yu A, Chopra V, Mueller SK, Wray CM, Jones CD. Engineering safe care journeys: Reenvisioning interhospital transfers. J Hosp Med 2024. [PMID: 38193639 DOI: 10.1002/jhm.13266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024]
Affiliation(s)
- Amy Yu
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Vineet Chopra
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stephanie K Mueller
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Charlie M Wray
- Department of Medicine, University of California, San Francisco, California, USA
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Christine D Jones
- Department of Medicine, Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Medicine, Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado, USA
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Jones CD, Moss A, Sevick C, Roczen M, Sterling MR, Portz J, Lum HD, Yu A, Urban JA, Khazanie P. Factors Associated With Mortality and Hospice Use Among Medicare Beneficiaries With Heart Failure Who Received Home Health Services. J Card Fail 2023:S1071-9164(23)00921-1. [PMID: 38142043 DOI: 10.1016/j.cardfail.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 11/14/2023] [Accepted: 11/14/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Although many Medicare beneficiaries with heart failure (HF) are discharged with home health services, little is known about mortality rates and hospice use in this group. OBJECTIVES To identify risk factors for 6-month mortality and hospice use among patients hospitalized due to HF who receive home health care, which could inform efforts to improve palliative and hospice use for these patients. METHODS A retrospective cohort analysis was conducted in a 100% national sample of Medicare fee-for-service beneficiaries with HF who were discharged to home health care between 2017 and 2018. Multivariable Cox regression models examined factors associated with 6-month mortality, and multivariable logistic regression models examined factors associated with hospice use at the time of death. RESULTS A total of 285,359 Medicare beneficiaries were hospitalized with HF and discharged with home health care; 15.5% (44,174) died within 6 months. Variables most strongly associated with mortality included: age > 85 years (hazard ratio [HR] 1.66, 95% CI 1.61-1.71), urgent/emergency hospital admission (HR 1.68, 1.61-1.76), and "serious" condition compared to "stable" condition (HR 1.64, CI 1.52-1.78). Among 44,174 decedents, 48.2% (21,284) received hospice care at the time of death. Those with lower odds of hospice use at death included patients who were: < 65 years (odds ratio [OR] 0.65, CI 0.59-0.72); of Black (OR 0.64, CI 0.59-0.68) or Hispanic race/ethnicity (OR 0.79, CI 0.72-0.88); and Medicaid-eligible (OR 0.80, CI 0.76-0.85). CONCLUSIONS Although many patients hospitalized for HF are at risk of 6-month mortality and may benefit from palliative and/or hospice services, our findings indicate under-use of hospice care and important disparities in hospice use by race/ethnicity and socioeconomic status.
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Affiliation(s)
- Christine D Jones
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO; Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO; Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Division of Geriatrics, Department of Medicine, University of Colorado, Aurora, CO.
| | - Angela Moss
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Carter Sevick
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | | | - Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine at Weill Cornell Medicine, New York, NY
| | - Jennifer Portz
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Hillary D Lum
- Division of Geriatrics, Department of Medicine, University of Colorado, Aurora, CO
| | - Amy Yu
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Jacqueline A Urban
- Division of General Internal Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Prateeti Khazanie
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO; Division of Cardiology, Department of Medicine, University of Colorado, Aurora, CO
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Tietbohl CK, Dafoe A, Jordan SR, Huebschmann AG, Lum HD, Bowles KH, Jones CD. Palliative Care across Settings: Perspectives from Inpatient, Primary Care, and Home Health Care Providers and Staff. Am J Hosp Palliat Care 2023; 40:1371-1378. [PMID: 36908002 PMCID: PMC10495535 DOI: 10.1177/10499091231163156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Early introduction of palliative care can improve patient-centered outcomes for older adults with complex medical conditions. However, identifying the need for and introducing palliative care with patients and caregivers is often difficult. We aim to identify how and why a multi-setting approach to palliative care discussions may improve the identification of palliative care needs and how to facilitate these conversations. METHODS Descriptive qualitative study to inform the development and future pilot testing of a model to improve recognition of, and support for, unmet palliative care needs in home health care (HHC). Thematic analysis of semi-structured interviews with providers across inpatient (n = 11), primary care (n = 17), and HHC settings (n = 10). RESULTS Four key themes emerged: 1) providers across settings can identify palliative care needs using their unique perspectives of the patient's care, 2) identifying palliative care needs is challenging due to infrequent communication and lack of shared information between providers, 3) importance of identifying a clinical lead of patient care who will direct palliative care discussions (primary care provider), and 4) importance of identifying a care coordination lead (HHC) to bridge communication among multi-setting providers. These themes highlight a multi-setting approach that would improve the frequency and quality of palliative care discussions. CONCLUSIONS A lack of structured communication across settings is a major barrier to introducing and providing palliative care. A novel model that improves communication and coordination of palliative care across HHC, inpatient and primary care providers may facilitate identifying and addressing palliative care needs in medically complex older adults.
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Affiliation(s)
- Caroline K. Tietbohl
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - Ashley Dafoe
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
| | - Sarah R. Jordan
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Amy G. Huebschmann
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Children’s Hospital Colorado, Aurora, CO, USA
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Ludeman Family Center for Women’s Health Research, University of Colorado School of Medicine, Department of Medicine, Aurora, CO, USA
| | - Hillary D. Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kathryn H. Bowles
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Christine D. Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA
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Fainstad T, Syed A, Shah Thibodeau P, Vinaithirthan V, Jones CD, Thurmon K, Mann A. Better Together: A Novel Online Physician Group Coaching Program to Reduce Burnout in Trainees: A Longitudinal Analysis. Acad Med 2023; 98:S201-S202. [PMID: 37983447 DOI: 10.1097/acm.0000000000005412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Affiliation(s)
- Tyra Fainstad
- Author affiliations: T. Fainstad, A. Syed, V. Vinaithirthan, C.D. Jones, K. Thurmon, A. Mann, University of Colorado School of Medicine; P. Shah Thibodeau, University of Denver, School of Work
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Mann A, Shah AN, Thibodeau PS, Dyrbye L, Syed A, Woodward MA, Thurmon K, Jones CD, Dunbar KS, Fainstad T. Online Well-Being Group Coaching Program for Women Physician Trainees: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2335541. [PMID: 37792378 PMCID: PMC10551770 DOI: 10.1001/jamanetworkopen.2023.35541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/21/2023] [Indexed: 10/05/2023] Open
Abstract
Importance Physician burnout disproportionately affects women physicians and begins in training. Professional coaching may improve well-being, but generalizable evidence is lacking. Objective To assess the generalizability of a coaching program (Better Together Physician Coaching) in a national sample of women physician trainees. Design, Setting, and Participants A randomized clinical trial involving trainees in 26 graduate medical education institutions in 19 states was conducted between September 1, 2022, and December 31, 2022. Eligible participants included physician trainees at included sites who self-identified as a woman (ie, self-reported their gender identity as woman, including those who reported woman if multiple genders were reported). Intervention A 4-month, web-based, group coaching program. Main Outcomes and Measures The primary outcomes were change in burnout (measured using subscales for emotional exhaustion, depersonalization, and personal achievement from the Maslach Burnout Inventory). Secondary outcomes included changes in impostor syndrome, moral injury, self-compassion, and flourishing, which were assessed using standardized measures. A linear mixed model analysis was performed on an intent-to-treat basis. A sensitivity analysis was performed to account for the missing outcomes. Results Among the 1017 women trainees in the study (mean [SD] age, 30.8 [4.0] years; 540 White participants [53.1%]; 186 surgical trainees [18.6%]), 502 were randomized to the intervention group and 515 were randomized to the control group. Emotional exhaustion decreased by an estimated mean (SE) -3.81 (0.73) points in the intervention group compared with a mean (SE) increase of 0.32 (0.57) points in the control group (absolute difference [SE], -4.13 [0.92] points; 95% CI, -5.94 to -2.32 points; P < .001). Depersonalization decreased by a mean (SE) of -1.66 (0.42) points in the intervention group compared with a mean (SE) increase of 0.20 (0.32) points in the control group (absolute difference [SE], -1.87 [0.53] points; 95%CI, -2.91 to -0.82 points; P < .001). Impostor syndrome decreased by a mean (SE) of -1.43 (0.14) points in the intervention group compared with -0.15 (0.11) points in the control group (absolute difference [SE], -1.28 (0.18) points; 95% CI -1.63 to -0.93 points; P < .001). Moral injury decreased by a mean (SE) of -5.60 (0.92) points in the intervention group compared with -0.92 (0.71) points in the control group (absolute difference [SE], -4.68 [1.16] points; 95% CI, -6.95 to -2.41 points; P < .001). Self-compassion increased by a mean (SE) of 5.27 (0.47) points in the intervention group and by 1.36 (0.36) points in the control group (absolute difference [SE], 3.91 [0.60] points; 95% CI, 2.73 to 5.08 points; P < .001). Flourishing improved by a mean (SE) of 0.48 (0.09) points in the intervention group vs 0.09 (0.07) points in the control group (absolute difference [SE], 0.38 [0.11] points; 95% CI, 0.17 to 0.60 points; P < .001). The sensitivity analysis found similar findings. Conclusions and Relevance The findings of this randomized clinical trial suggest that web-based professional group-coaching can improve outcomes of well-being and mitigate symptoms of burnout for women physician trainees. Trial Registration ClinicalTrials.gov Identifier: NCT05222685.
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Affiliation(s)
- Adrienne Mann
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Veterans’ Health Administration, Eastern Colorado Health Care System, Aurora
| | - Ami N. Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University Medical Center, Chicago, Illinois
| | - Pari Shah Thibodeau
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Liselotte Dyrbye
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Adnan Syed
- University of Colorado School of Medicine, Aurora
- Veterans’ Health Administration, Eastern CO Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, Colorado
| | | | - Kerri Thurmon
- Division of Urology, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora
| | - Christine D. Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Veterans’ Health Administration, Eastern Colorado Health Care System, Aurora
- Division of Geriatrics, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
| | - Kimiko S. Dunbar
- Children’s Hospital of Colorado, Section of Hospital Medicine, University of Colorado, School of Medicine, Aurora
| | - Tyra Fainstad
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
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Maw AM, Huebschmann AG, Jones CD. Methods progress note: Applying dissemination and implementation science models to enhance hospital-based quality improvement. J Hosp Med 2023; 18:841-844. [PMID: 37225387 DOI: 10.1002/jhm.13139] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/26/2023]
Affiliation(s)
- Anna M Maw
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy G Huebschmann
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christine D Jones
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Rocky Mountain Regional VA Medical Center, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, University of Colorado School of Medicine, Aurora, Colorado, USA
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
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Daus M, Albright K, Jones CD. Disseminating results to participants: An obligation to those who make research possible. J Hosp Med 2023; 18:853-855. [PMID: 36842161 DOI: 10.1002/jhm.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/27/2023] [Accepted: 02/02/2023] [Indexed: 02/27/2023]
Affiliation(s)
- Marguerite Daus
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Karen Albright
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- OCHIN, Inc., Portland, Oregon, USA
| | - Christine D Jones
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Cole CS, Dafoe A, Tietbohl CK, Jordan SR, Huebschmann AG, Lum HD, Jones CD. Care challenges of home health patients living with dementia: a pathway forward with palliative care. BMC Palliat Care 2023; 22:122. [PMID: 37641096 PMCID: PMC10464392 DOI: 10.1186/s12904-023-01247-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Home health care (HHC) is a leading source of care support for older adults with serious illness, particularly patients living with dementia (PLWD). Demand for HHC is expected to continue to grow, driven by an aging population and preference for non-institutional care. HHC agencies are frequently under pressure to find effective approaches for improving care delivery and quality. One strategy that has the potential to improve the quality of life and patient satisfaction in HHC for PLWD is the integration of palliative care. Therefore, we sought to understand the experiences and needs of PLWD and their family caregivers specifically focusing on ways that HHC and palliative care may be integrated as part of the care transition from hospital to home, to better support PLWD and their families. METHODS We conducted a descriptive qualitative study focusing on the perspectives of patients, caregivers, and healthcare team members about palliative care delivery for patients receiving HHC. Interviews were audio-recorded and professionally transcribed. In this analysis, we specifically report on dementia-related content using an iterative, team-based thematic analysis approach. RESULTS We identified three themes: 1) 'Living in the Whirlwind' which describes the many competing demands on caregivers time and the associated feeling of loss of control, 2) 'Thinking Ahead' which describes the importance of thinking beyond the day-to-day tasks to begin planning for the future, and 3) 'Pathways Forward' which describes the integration of palliative care into HHC to provide enhanced support for PLWD and their caregivers. CONCLUSION In this qualitative study, our formative work identified the importance of providing anticipatory guidance (e.g., safety, advance care planning) coupled with emotional and pragmatic care supports (e.g., finding resources, navigating insurance) to sustain caregivers who are struggling with the whirlwind.
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Affiliation(s)
- Connie S Cole
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Ashley Dafoe
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
| | - Caroline K Tietbohl
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah R Jordan
- Division of Healthcare Services, Molina Healthcare of Illinois, Oak Brook, IL, USA
| | - Amy G Huebschmann
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Adult and Child Center for Outcomes Research and Delivery Science, School of Medicine, University of Colorado, Children's Hospital Colorado, Aurora, CO, USA
- Ludeman Family Center for Women's Health Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christine D Jones
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Administration, Eastern Colorado Health Care system, Aurora, CO, USA
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA
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Linker AS, Jones CD, Ruhnke GW. Can we build the plane while flying? Creative approaches to expand the research community in hospital medicine. J Hosp Med 2023. [PMID: 37129425 DOI: 10.1002/jhm.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/15/2023] [Indexed: 05/03/2023]
Affiliation(s)
- Anne S Linker
- Icahn School of Medicine at Mount Sinai, Division of Hospital Medicine, Mount Sinai Hospital, New York, New York, USA
| | - Christine D Jones
- Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
- Division of Geriatrics and Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gregory W Ruhnke
- Department of Medicine, Section of Hospital Medicine, University of Chicago, Chicago, Illinois, USA
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Wray CM, Jones CD. Bridging the Know-Do Gap in Hospital Care Transitions. JAMA Intern Med 2023; 183:424-425. [PMID: 36939664 DOI: 10.1001/jamainternmed.2023.0069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Affiliation(s)
- Charlie M Wray
- Department of Medicine, University of California, San Francisco
- Section of Hospital Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Christine D Jones
- Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Administration, Eastern Colorado Health Care System, Aurora
- Divisions of Hospital Medicine and Geriatrics, Department of Medicine, University of Colorado, Aurora
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Mann A, Leigh Fainstad T, Shah P, Dieujuste N, Jones CD. "It's Nice to Know I'm Not Alone": The Impact of an Online Life Coaching Program on Wellness in Graduate Medical Education: A Qualitative Analysis. Acad Med 2022; 97:S166. [PMID: 37838895 DOI: 10.1097/acm.0000000000004840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Affiliation(s)
- Adrienne Mann
- Author affiliations: A. Mann, Rocky Mountain Regional VA Medical Center, Eastern Colorado Health Care System, University of Colorado School of Medicine; T.L. Fainstad, University of Colorado School of Medicine; P. Shah, Graduate School of Social Work, University of Denver; N. Dieujuste, Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, and Graduate School Clinical Psychology, University of Denver; C.D. Jones, Rocky Mountain Regional VA Medical Center, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, University of Colorado School of Medicine
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Williams PH, Gilmartin HM, Leonard C, McCarthy MS, Kelley L, Grunwald GK, Jones CD, Whittington MD. The Influence of the Rural Transitions Nurse Program for Veterans on Healthcare Utilization Costs. J Gen Intern Med 2022; 37:3529-3534. [PMID: 36042072 PMCID: PMC9585107 DOI: 10.1007/s11606-022-07401-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 01/05/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The Veterans Affairs (VA) Healthcare System Rural Transitions Nurse Program (TNP) addresses barriers veterans face when transitioning from urban tertiary VA hospitals to home. Previous clinical evaluations of TNP have shown that enrolled veterans were more likely to follow up with their primary care provider within 14 days of discharge and experience a significant reduction in mortality within 30 days compared to propensity-score matched controls. OBJECTIVE Examine changes from pre- to post-hospitalization in total, inpatient, and outpatient 30-day healthcare utilization costs for TNP enrollees compared to controls. DESIGN Quantitative analyses modeling the changes in cost via multivariable linear mixed-effects models to determine the association between TNP enrollment and changes in these costs. PARTICIPANTS Veterans meeting TNP eligibility criteria who were discharged home following an inpatient hospitalization at one of the 11 implementation sites from April 2017 to September 2019. INTERVENTION The four-step TNP transitional care intervention. MAIN MEASURES Changes in 30-day total, inpatient, and outpatient healthcare utilization costs were calculated for TNP enrollees and controls. KEY RESULTS Among 3001 TNP enrollees and 6002 controls, no statistically significant difference in the change in total costs (p = 0.65, 95% CI: (- $675, $350)) was identified. However, on average, the increase in inpatient costs from pre- to post-hospitalization was approximately $549 less for TNP enrollees (p = 0.02, 95% CI: (- $856, - $246)). The average increase in outpatient costs from pre- to post-hospitalization was approximately $421 more for TNP enrollees compared to controls (p = 0.003, 95% CI: ($109, $671)). CONCLUSIONS Although we found no difference in change in total costs between veterans enrolled in TNP and controls, TNP was associated with a smaller increase in direct inpatient medical costs and a larger increase in direct outpatient medical costs. This suggests a shifting of costs from the inpatient to outpatient setting.
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Affiliation(s)
- Piper H. Williams
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO USA
| | - Heather M. Gilmartin
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO USA
- Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Chelsea Leonard
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO USA
| | - Michaela S. McCarthy
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO USA
| | - Lynette Kelley
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO USA
| | - Gary K. Grunwald
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO USA
| | - Christine D. Jones
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO USA
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO USA
| | - Melanie D. Whittington
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, CO USA
- University of Kansas Medical Center, Kansas City, KS USA
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Sjoberg H, Kenney RR, Morgan B, Connelly B, Jones CD, Ali HN, Battaglia C, Gilmartin HM. Adaptations to relational facilitation for two national care coordination programs during COVID-19. Front Health Serv 2022; 2:952272. [PMID: 36925807 PMCID: PMC10012763 DOI: 10.3389/frhs.2022.952272] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/29/2022] [Indexed: 11/13/2022]
Abstract
Background Adaptations to implementation strategies are often necessary to support adoption and scale-up of evidence-based practices. Tracking adaptations to implementation strategies is critical for understanding any impacts on outcomes. However, these adaptations are infrequently collected. In this article we present a case study of how we used a new method during COVID-19 to systematically track and report adaptations to relational facilitation, a novel implementation strategy grounded in relational coordination theory. Relational facilitation aims to assess and improve communication and relationships in teams and is being implemented to support adoption of two Quadruple Aim Quality Enhancement Research Initiative (QA QUERI) initiatives: Care Coordination and Integrated Case Management (CC&ICM) and the Transitions Nurse Program for Home Health Care (TNP-HHC) in the Veterans Health Administration (VA). Methods During 2021-2022, relational facilitation training, activities and support were designed as in-person and/or virtual sessions. These included a site group coaching session to create a social network map of care coordination roles and assessment of baseline relationships and communication between roles. Following this we administered the Relational Coordination Survey to assess the relational coordination strength within and between roles. COVID-19 caused challenges implementing relational facilitation, warranting adaptations. We tracked relational facilitation adaptations using a logic model, REDCap tracking tool based on the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) with expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) dimensions, and member checking. Adaptations were analyzed descriptively and for themes using matrix content analysis. Results COVID-19's impact within the VA caused barriers for implementing relational facilitation, warranting eight unique adaptations to the implementation strategy. Most adaptations pertained to changing the format of relational facilitation activities (n = 6; 75%), were based on external factors (n = 8; 100%), were planned (n = 8; 100%) and initiated by the QA QUERI implementation team (n = 8; 100%). Most adaptations impacted adoption (n = 6; 75%) and some impacted implementation (n = 2; 25%) of the CC&ICM and TNP-HHC interventions. Discussion Systematically tracking and discussing adaptations to relational facilitation during the COVID-19 pandemic enhanced engagement and adoption of two VA care coordination interventions. The impact of these rapid, early course adaptations will be followed in subsequent years of CC&ICM and TNP-HHC implementation.
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Affiliation(s)
- Heidi Sjoberg
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Rachael R. Kenney
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Brianne Morgan
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Brigid Connelly
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
| | - Christine D. Jones
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Hebatallah Naim Ali
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA, United States
| | - Catherine Battaglia
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
- Colorado School of Public Health, Department of Health Systems, Management and Policy, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
| | - Heather M. Gilmartin
- Rocky Mountain Regional VA Medical Center, VA Eastern Colorado Healthcare System, Aurora, CO, United States
- Colorado School of Public Health, Department of Health Systems, Management and Policy, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States
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15
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Albright K, Jones CD. Methodological progress note: The case for mixed methods in quality improvement and research projects. J Hosp Med 2022; 17:468-471. [PMID: 35535915 DOI: 10.1002/jhm.12806] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/02/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Karen Albright
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Affairs Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Division of General Internal Medicine, Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Christine D Jones
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Veterans Health Affairs Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Division of Hospital Medicine, Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
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Fainstad T, Mann A, Suresh K, Shah P, Dieujuste N, Thurmon K, Jones CD. Effect of a Novel Online Group-Coaching Program to Reduce Burnout in Female Resident Physicians: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2210752. [PMID: 35522281 PMCID: PMC9077483 DOI: 10.1001/jamanetworkopen.2022.10752] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
IMPORTANCE Female resident physicians are disproportionately affected by burnout, which can have serious consequences for their well-being and career trajectory. Growing evidence supports the use of professional coaching to reduce burnout in resident physicians, yet individual coaching is resource intensive and infeasible for many training programs. OBJECTIVE To assess whether a structured professional group-coaching program for female resident physicians would lead to decreased burnout. DESIGN, SETTING, AND PARTICIPANTS This pilot randomized clinical trial was conducted from January 1 to June 30, 2021, among 101 female resident physicians in graduate medical education at the University of Colorado who voluntarily enrolled in the trial after a recruitment period. Surveys were administered to participants before and after the intervention. INTERVENTION With the use of a computer-generated 1:1 algorithm, 50 participants were randomly assigned to the intervention group and 51 participants were randomly assigned to the control group. The intervention group was offered a 6-month, web-based group-coaching program, Better Together Physician Coaching, developed and facilitated by trained life coaches and physicians. The control group received residency training as usual, with no coaching during the study. The control group was offered the 6-month coaching program after study completion. MAIN OUTCOMES AND MEASURES The primary outcome of burnout was measured using the Maslach Burnout Inventory, defined by 3 Likert-type 7-point subscales: emotional exhaustion, depersonalization, and professional accomplishment. Higher scores on the emotional exhaustion and depersonalization subscales and lower scores on the professional accomplishment subscale indicate higher burnout. Secondary outcomes of impostor syndrome, self-compassion, and moral injury were assessed using the Young Impostor Syndrome Scale, Neff's Self-Compassion Scale-Short Form, and the Moral Injury Symptom Scale-Healthcare Professionals, respectively. An intention-to-treat analysis was performed. RESULTS Among the 101 female residents in the study, the mean (SD) age was 29.4 (2.3) years, 96 (95.0%) identified as heterosexual, and 81 (80.2%) identified as White. There were 19 residents (18.8%) from surgical subspecialties, with a range of training levels represented. After 6 months of professional coaching, emotional exhaustion decreased in the intervention group by a mean (SE) of 3.26 (1.25) points compared with a mean (SE) increase of 1.07 (1.12) points in the control group by the end of the study (P = .01). The intervention group experienced a significant reduction in presence of impostor syndrome compared with controls (mean [SE], -1.16 [0.31] vs 0.11 [0.27] points; P = .003). Self-compassion scores increased in the intervention group by a mean (SE) of 5.55 (0.89) points compared with a mean (SE) reduction of 1.32 (0.80) points in the control group (P < .001). No statistically significant differences in depersonalization, professional accomplishment, or moral injury scores were observed. Owing to the differential follow-up response rates in the treatment groups (88.2% in the control group [45 of 51]; 68.0% in the intervention group [34 of 50]), a sensitivity analysis was performed to account for the missing outcomes, with similar findings. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, professional coaching reduced emotional exhaustion and impostor syndrome scores and increased self-compassion scores among female resident physicians. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05280964.
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Affiliation(s)
- Tyra Fainstad
- Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Lowry Internal Medicine, Denver, Colorado
| | - Adrienne Mann
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Krithika Suresh
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora
| | - Pari Shah
- Graduate School of Social Work, University of Denver, Denver, Colorado
| | - Nathalie Dieujuste
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora
| | - Kerri Thurmon
- Division of Urology, Department of Surgery, Denver Health, Denver, Colorado
| | - Christine D. Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora
- Veterans’ Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora
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17
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Golden BP, Lum HD, Jones CD. Improving goal-concordant care in the hospital for patients with dementia in the COVID-19 era. J Hosp Med 2022; 17:412-413. [PMID: 35403344 PMCID: PMC9088338 DOI: 10.1002/jhm.12817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Blair P. Golden
- Department of MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Hillary D. Lum
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Christine D. Jones
- Department of MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of MedicineRocky Mountain Regional VA Medical CenterAuroraColoradoUSA
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18
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Yu A, Jordan SR, Gilmartin H, Mueller SK, Holliman BD, Jones CD. "Our Hands Are Tied Until Your Doctor Gets Here": Nursing Perspectives on Inter-hospital Transfers. J Gen Intern Med 2022; 37:1729-1736. [PMID: 34993869 PMCID: PMC8735724 DOI: 10.1007/s11606-021-07276-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 11/10/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND The transfer of patients between hospitals (inter-hospital transfer, or IHT) is a common occurrence for patients, but guidelines to ensure safe and effective IHTs are lacking. Poor IHTs result in higher rates of mortality, longer lengths of stay, and higher hospitalization costs compared to admissions from the emergency department. Nurses are often the first point of contact for IHT patients and can provide valuable insights on key challenges to IHT processes. OBJECTIVE To characterize the experiences of inpatient floor-level bedside nurses caring for IHT patients and identify care coordination challenges and solutions. DESIGN/PARTICIPANTS/APPROACH Qualitative study using semi-structured focus groups and interviews conducted from October 2019 to July 2020 with 21 inpatient floor-level nurses caring for adult medicine patients at an academic hospital. Nurses were recruited using a purposive convenience sampling approach. A combined inductive and deductive coding approach guided by thematic analysis was used for data analysis. KEY RESULTS Results from this study are mapped to the Agency for Healthcare Research and Quality Care Coordination Measurement Framework domains of communication, assessing needs and goals, and negotiating accountability. The following key themes characterize nurses' experiences with IHT related to these domains: (1) challenges with information exchange and team communication during IHT, (2) environmental and information preparation needed to anticipate transfers, and (3) determining responsibility and care plans after the IHT patient has arrived at the accepting facility. CONCLUSIONS Nurses described the absence of standardized processes to coordinate care before or at the time of patient arrival. Challenges to communication and coordination during IHTs negatively impacted patient care and nursing professional satisfaction. To streamline care for IHT patients and reduce nursing stress, future IHT interventions should include standardized handoff reports, timely identification and easy access to admitting clinicians, and timely clinician evaluation and orders.
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Affiliation(s)
- Amy Yu
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12401 E. 17th Avenue Mailstop F-782, Aurora, CO, 80045, USA.
| | - Sarah R Jordan
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Heather Gilmartin
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stephanie K Mueller
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Brooke Dorsey Holliman
- Department of Family Medicine, University of Colorado Denver School of Medicine, Aurora, CO, USA
| | - Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12401 E. 17th Avenue Mailstop F-782, Aurora, CO, 80045, USA
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA
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19
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Fosnot L, Jones CD, Keniston A, Burden M, Indovina KA, Patel H. Hospitalists' perspectives on challenging patient encounters and physician well-being: A qualitative study. Patient Educ Couns 2022; 105:1209-1215. [PMID: 34511284 DOI: 10.1016/j.pec.2021.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 07/29/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Challenging patient encounters contribute to physician burnout, though little is known about how these impact hospitalists specifically. This study explores how hospitalists characterize challenging patient encounters and their impact on hospitalist well-being to inform organizational efforts. METHODS We conducted a qualitative, descriptive study with 15 physician hospitalist faculty at two locations, a tertiary academic and safety-net hospital, utilizing a conceptual framework based on the Stanford Wellness Framework for physician resilience around challenging patient encounters. RESULTS Two themes emerged: feelings of helplessness and time-consuming encounters. Helplessness was associated with systems issues, misaligned patient/provider goals, and violence. Time-consuming encounters were due to systems issues, misaligned goals requiring prolonged conversations, and patient factors. These factors were found to negatively impact hospitalist well-being. Resilience strategies included developing and teaching empathy and seeking expert/colleague opinion through debriefing, peer-to-peer interactions, and external resources. CONCLUSIONS Organizational strategies to support hospitalists in the context of challenging patient encounters require a multifaceted approach: improved system processes, fostering a local culture of empathy-building, and supporting peer-to-peer relationships and debriefing mechanisms. PRACTICE IMPLICATIONS Enhanced communication around system process improvements and culture of wellness, in addition to communication skills and mindfulness, could improve hospitalist well-being.
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Affiliation(s)
- Lisa Fosnot
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Christine D Jones
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Angela Keniston
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
| | - Kimberly A Indovina
- Division of Hospital Medicine, University of Colorado, Denver Health, Denver, CO, USA.
| | - Hemali Patel
- Division of Hospital Medicine, University of Colorado, 12401 E 17th Avenue, Aurora, CO 80045, USA.
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20
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Khan S, Jones CD, Kelly MM. Trust during care transitions: Building the relationship between hospitalists and outpatient clinicians. J Hosp Med 2022; 17:322-323. [PMID: 35403336 DOI: 10.1002/jhm.12821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Sarah Khan
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Michelle M Kelly
- Division of Hospital Medicine, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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21
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Jordan SR, Daddato AE, Patel HP, Jones CD. Forgotten frontline workers: Environmental health service employees' perspectives on working during the COVID-19 pandemic. J Hosp Med 2022; 17:158-168. [PMID: 35504593 PMCID: PMC9088319 DOI: 10.1002/jhm.12781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/06/2022] [Accepted: 01/07/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Environmental Health Service employees (EVS) sanitize healthcare facilities and are critical to preventing infection, but are under-resourced during the COVID-19 pandemic and at risk of burnout. OBJECTIVE Understand demands on EVS' work and strain on resources during COVID-19. DESIGN Qualitative descriptive study conducted in winter 2020-2021. SETTING One quaternary care academic medical center in Colorado. PARTICIPANTS A convenience sample of 16 EVS out of 305 eligible at the medical center. Fifty percent identified as Black, 31% as Hispanic, 6% as Asian, and 6% as White (another 6% identified as mixed race). Sixty-nine percent were female, and half were born in a country outside the United States. MEASURES Semistructured telephone interviews. Interviews were audio-recorded and transcribed, and thematic analysis was used to identify key themes. RESULTS Four themes illustrate EVS experiences with job strain and support during COVID-19: (1) Needs for ongoing training/education, (2) Emotional challenges of patient care, (3) Resource/staffing barriers, and (4) Lack of recognition as frontline responders. Despite feeling unrecognized during the pandemic, EVS identified structural supports with potential to mitigate job strain, including opportunities for increased communication with interdisciplinary colleagues, intentional acknowledgment, and education for those who speak languages other than English. Strategies that can increase physical and emotional resources and reduce job demands have potential to combat EVS burnout. CONCLUSIONS As the surge of COVID-19 cases continues to overwhelm healthcare facilities, healthcare systems and interdisciplinary colleagues can adopt policies and practices that ensure lower-wage healthcare workers have access to resources, education, and emotional support.
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Affiliation(s)
- Sarah R. Jordan
- Department of Medicine, Division of Geriatric MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Andrea E. Daddato
- Kaiser Permanente Colorado Institute for Health ResearchAuroraColoradoUSA
| | - Hemali P. Patel
- Department of Medicine, Division of Hospital MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Christine D. Jones
- Department of Medicine, Division of Hospital MedicineUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Denver/Seattle Center of Innovation for Veteran‐Centered and Value Driven CareVHA Eastern Colorado Healthcare SystemAuroraColoradoUSA
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22
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Gilmartin HM, Warsavage T, Hines A, Leonard C, Kelley L, Wills A, Gaskin D, Ujano-De Motta L, Connelly B, Plomondon ME, Yang F, Kaboli P, Burke RE, Jones CD. Effectiveness of the rural transitions nurse program for Veterans: A multicenter implementation study. J Hosp Med 2022; 17:149-157. [PMID: 35504490 DOI: 10.1002/jhm.12802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Veterans are often transferred from rural areas to urban VA Medical Centers for care. The transition from hospital to home is vulnerable to postdischarge adverse events. OBJECTIVE To evaluate the effectiveness of the rural Transitions Nurse Program (TNP). DESIGN, SETTING, AND PARTICIPANTS National hybrid-effectiveness-implementation study, within site propensity-matched cohort in 11 urban VA hospitals. 3001 Veterans were enrolled in TNP from April 2017 to September 2019, and 6002 matched controls. INTERVENTION AND OUTCOMES The intervention was led by a transitions nurse who assessed discharge readiness, provided postdischarge communication with primary care providers (PCPs), and called the Veteran within 72 h of discharge home to assess needs, and encourage follow-up appointment attendance. Controls received usual care. The primary outcomes were PCP visits within 14 days of discharge and all-cause 30-day readmissions. Secondary outcomes were 30-day emergency department (ED) visits and 30-day mortality. Patients were matched by length of stay, prior hospitalizations and PCP visits, urban/rural status, and 32 Elixhauser comorbidities. RESULTS The 3001 Veterans enrolled in TNP were more likely to see their PCP within 14 days of discharge than 6002 matched controls (odds ratio = 2.24, 95% confidence interval [CI] = 2.05-2.45). TNP enrollment was not associated with reduced 30-day ED visits or readmissions but was associated with reduced 30-day mortality (hazard ratio = 0.33, 95% CI = 0.21-0.53). PCP and ED visits did not have a significant mediating effect on outcomes. The observational design, potential selection bias, and unmeasurable confounders limit causal inference. CONCLUSIONS TNP was associated with increased postdischarge follow-up and a mortality reduction. Further investigation to understand the reduction in mortality is needed.
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Affiliation(s)
- Heather M Gilmartin
- Research Department, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Department of Health Systems, Management and Policy, School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Theodore Warsavage
- Research Department, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Anne Hines
- Research Department, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Chelsea Leonard
- Research Department, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Lynette Kelley
- Research Department, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Ashlea Wills
- Research Department, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - David Gaskin
- Research Department, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Lexus Ujano-De Motta
- Research Department, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Brigid Connelly
- Research Department, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
| | - Mary E Plomondon
- Clinical Assessment Reporting and Tracking Program, Office of Quality and Patient Safety, Veterans' Health Administration, Washington, District of Columbia, USA
| | - Fan Yang
- Department of Biostatistics and Informatics, School of Public Health, University of Colorado, Aurora, Colorado, USA
| | - Peter Kaboli
- Research Department, Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, and Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Robert E Burke
- Research Department, Center for Health Equity Research and Promotion, Corporal Crescenz Veterans Health Administration Medical Center, Philadelphia, Pennsylvania, USA
- Hospital Medicine Section - Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Christine D Jones
- Research Department, Denver/Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, VHA Eastern Colorado Healthcare System, Aurora, Colorado, USA
- Division of Hospital Medicine, Department of Medicine, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
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Nunnery MA, Gilmartin H, McCarthy M, Motta LUD, Wills A, Kelley L, Jones CD, Leonard C. Sustainment stories: a qualitative analysis of barriers to sustainment of the National Rural Transitions of Care Nurse Program. BMC Health Serv Res 2022; 22:119. [PMID: 35090448 PMCID: PMC8796421 DOI: 10.1186/s12913-021-07420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 12/13/2021] [Indexed: 12/03/2022] Open
Abstract
Background Understanding how to successfully sustain evidence-based care coordination interventions across diverse settings is critical to ensure that patients continue to receive high quality care even after grant funding ends. The Transitions Nurse Program (TNP) is a national intervention in the Veterans Administration (VA) that coordinates care for high risk veterans transitioning from acute care VA medical centers (VAMCs) to home. As part of TNP, a VA facility receives funding for a full-time nurse to implement TNP, however, this funding ends after implementation. In this qualitative study we describe which elements of TNP sites planned to sustain as funding concluded, as well as perceived barriers to sustainment. Methods TNP was implemented between 2016 and 2020 at eleven VA medical centers. Three years of funding was provided to each site to support hiring of staff, implementation and evaluation of the program. At the conclusion of funding, each site determined if they would sustain components or the entirety of the program. Prior to the end of funding at each site, we conducted midline and exit interviews with Transitions nurses and site champions to assess plans for sustainment and perceived barriers to sustainment. Interviews were analyzed using iterative, team-based inductive deductive content analysis to identify themes related to planned sustainment and perceived barriers to sustainment. Results None of the 11 sites planned to sustain TNP in its original format, though many of the medical centers anticipated offering components of the program, such as follow up calls after discharge to rural areas, documented warm hand off to PACT team, and designating a team member as responsible for patient rural discharge follow up. We identified three themes related to perceived sustainability. These included: 1) Program outcomes that address leadership priorities are necessary for sustainment.; 2) Local perceptions of the need for TNP or redundancy of TNP impacted perceived sustainability; and 3) Lack of leadership buy-in, changing leadership priorities, and leadership turnover are perceived barriers to sustainment. Conclusions Understanding perceived sustainability is critical to continuing high quality care coordination interventions after funding ends. Our findings suggest that sustainment of care coordination interventions requires an in-depth understanding of the facility needs and local leadership priorities, and that building adaptable programs that continually engage key stakeholders is essential. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07420-1.
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Jones CD, Thomas J, Ytell K, Roczen ML, Levy CR, Jordan SR, Lum HD, Gritz M. Is Health Information Exchange Participation Associated With Hospital Readmissions From Home Health Care? J Am Med Dir Assoc 2022; 23:170-173.e2. [PMID: 34480865 PMCID: PMC10955507 DOI: 10.1016/j.jamda.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/27/2021] [Accepted: 08/11/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, Aurora, CO, USA.
| | - Jacob Thomas
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kate Ytell
- Data Science to Patient Value Program, ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Marisa L Roczen
- Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cari R Levy
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, Aurora, CO, USA; Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah R Jordan
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; VA Eastern Colorado Geriatrics Research Education and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO, USA
| | - Mark Gritz
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Data Science to Patient Value Program, ACCORDS, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Division of Health Care Policy and Research, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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Plys E, Morrow CD, Portz JD, Jones CD, Piper C, Boxer RS. Psychological interventions with older adults during inpatient postacute rehabilitation: A systematic review. Rehabil Psychol 2021; 66:233-247. [PMID: 34472922 PMCID: PMC8622202 DOI: 10.1037/rep0000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Older adults in inpatient postacute care settings report high rates of depression and anxiety. Psychological interventions address these symptoms through educational, cognitive, behavioral, relaxation, and/or psychosocial approaches. The purpose of this study was to systematically evaluate the quality of existing literature on psychological interventions for depression and/or anxiety among older adults during an inpatient postacute care stay. Method: Medline, Embase, Cochrane Library, CINAHL, PsycINFO, and Google Scholar were searched for key concepts. Studies were included that (a) sampled skilled nursing facility or inpatient rehabilitation facility patients, (b) evaluated a psychological intervention, (c) measured depression and/or anxiety symptoms before and after interventions, and (d) had a mean or median age of 65+. Two raters assessed articles for inclusion and risk of bias. Results: Search strategies identified 7,506 articles for screening; nine met inclusion criteria. Included studies varied by study design, intervention type, and methodological quality. Only one study had low overall risk of bias. Four studies demonstrated preliminary treatment benefits for depression symptoms; none reported benefits for anxiety symptoms. Conclusions: Most of the included studies were limited by small sample size and high risk of bias. Thus, currently, there is insufficient evidence to support the effectiveness of psychological interventions for depression or anxiety among older adults during an inpatient postacute care stay. The authors offer a detailed discussion of methodological limitations, empirical gaps, and future directions to develop this body of literature. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Evan Plys
- Department of Psychiatry, University of Colorado School of Medicine
| | - Cynthia D Morrow
- Health Systems Management and Policy, Colorado School of Public Health
| | - Jennifer D Portz
- Division of General Internal Medicine, University of Colorado School of Medicine
| | - Christine D Jones
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System
| | - Christi Piper
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus
| | - Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente of Colorado
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McCarthy MS, Ujano-De Motta LL, Nunnery MA, Gilmartin H, Kelley L, Wills A, Leonard C, Jones CD, Rabin BA. Understanding adaptations in the Veteran Health Administration's Transitions Nurse Program: refining methodology and pragmatic implications for scale-up. Implement Sci 2021; 16:71. [PMID: 34256763 PMCID: PMC8276503 DOI: 10.1186/s13012-021-01126-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When complex health services interventions are implemented in real-world settings, adaptations are inevitable. Adaptations are changes made to an intervention, implementation strategy, or context prior to, during, and after implementation to improve uptake and fit. There is a growing interest in systematically documenting and understanding adaptations including what is changed, why, when, by whom, and with what impact. The rural Transitions Nurse Program (TNP) is a program in the Veterans Health Administration (VHA), designed to safely transition a rural veteran from a tertiary hospital back home. TNP has been implemented in multiple cohorts across 11 sites nationwide over 4 years. In this paper, we describe adaptations in five TNP sites from the first cohort of sites and implications for the scale-up of TNP and discuss lessons learned for the systematic documentation and analysis of adaptations. METHODS We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) expanded version of the original Stirman framework to guide the rapid qualitative matrix analysis of adaptations. Adaptations were documented using multiple approaches: real-time database, semi-structured midpoint and exit interviews with implementors, and member checking with the implementation team. Interviews were recorded and transcribed. To combine multiple sources of adaptations, we used key domains from our framework and organized adaptations by time when the adaptation occurred (pre-, early, mid-, late implementation; sustainment) and categorized them as proactive or reactive. RESULTS Forty-one unique adaptations were reported during the study period. The most common type of adaptation was changes in target populations (patient enrollment criteria) followed by personnel changes (staff turnover). Most adaptations occurred during the mid-implementation time period and varied in number and type of adaptation. The reasons for this are discussed, and suggestions for future adaptation protocols are included. CONCLUSIONS This study demonstrates the feasibility of systematically documenting adaptations using multiple methods across time points. Implementors were able to track adaptations in real time across the course of an intervention, which provided timely and actionable feedback to the implementation team overseeing the national roll-out of the program. Longitudinal semi-structured interviews can complement the real-time database and elicit reflective adaptations.
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Affiliation(s)
- Michaela S McCarthy
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), VA Eastern Colorado Health Care System, 1700 N. Wheeling Street, P1-151 Research, Denver, CO, 80045, USA.
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Lexus L Ujano-De Motta
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), VA Eastern Colorado Health Care System, 1700 N. Wheeling Street, P1-151 Research, Denver, CO, 80045, USA
| | - Mary A Nunnery
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), VA Eastern Colorado Health Care System, 1700 N. Wheeling Street, P1-151 Research, Denver, CO, 80045, USA
| | - Heather Gilmartin
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), VA Eastern Colorado Health Care System, 1700 N. Wheeling Street, P1-151 Research, Denver, CO, 80045, USA
- Health Systems, Management, and Policy, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO, USA
| | - Lynette Kelley
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), VA Eastern Colorado Health Care System, 1700 N. Wheeling Street, P1-151 Research, Denver, CO, 80045, USA
| | - Ashlea Wills
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), VA Eastern Colorado Health Care System, 1700 N. Wheeling Street, P1-151 Research, Denver, CO, 80045, USA
| | - Chelsea Leonard
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), VA Eastern Colorado Health Care System, 1700 N. Wheeling Street, P1-151 Research, Denver, CO, 80045, USA
| | - Christine D Jones
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), VA Eastern Colorado Health Care System, 1700 N. Wheeling Street, P1-151 Research, Denver, CO, 80045, USA
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Borsika A Rabin
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care (COIN), VA Eastern Colorado Health Care System, 1700 N. Wheeling Street, P1-151 Research, Denver, CO, 80045, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- UC San Diego Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
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Naderi R, Oberndorfer TA, Jordan SR, Dollar B, Cumbler EU, Jones CD. Resident perspectives on the value of interdisciplinary conference calls for geriatric patients. BMC Med Educ 2021; 21:314. [PMID: 34082723 PMCID: PMC8173720 DOI: 10.1186/s12909-021-02750-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 05/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND There are limited competency-based educational curricula for transitions of care education (TOC) for internal medicine (IM) residency programs. The University of Colorado implemented a virtual interdisciplinary conference call, TEAM (Transitions Expectation and Management), between providers on the inpatient Acute Care of the Elder (ACE) unit and the outpatient Seniors Clinic at the University of Colorado Hospital. Residents rotating on the ACE unit participated in weekly conferences discussing Seniors Clinic patients recently discharged, or currently hospitalized, to address clinical concerns pertaining to TOC. Our goals were to understand resident perceptions of the educational value of these conferences, and to determine if these experiences changed attitudes or practice related to care transitions. METHODS We performed an Institutional Review Board-approved qualitative study of IM housestaff who rotated on the ACE unit during 2018-2019. Semi-structured interviews were conducted to understand perceptions of the value of TEAM calls for residents' own practice and the impact on patient care. Data was analyzed inductively, guided by thematic analysis. RESULTS Of the 32 IM residents and interns who rotated on ACE and were invited to participate, 11 agreed to an interview. Three key themes emerged from interviews that highlighted residents' experiences identifying and navigating some of their educational 'blind spots:' 1) Awareness of patient social complexities, 2) Bridging gaps in communication across healthcare settings, 3) Recognizing the value of other disciplines during transitions. CONCLUSIONS This study highlights learner perspectives of the benefit of interdisciplinary conference calls between inpatient and outpatient providers to enhance transitions of care, which provide meaningful feedback and serve as a vehicle for residents to recognize the impact of their care decisions in the broader spectrum of patients' experience during hospital discharge. Educators can maximize the value of these experiences by promoting reflective debriefs with residents and bringing to light previously unrecognized knowledge gaps around hospital discharge.
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Affiliation(s)
- Roxana Naderi
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, Mailstop F782, Aurora, CO 80045 USA
| | - Tyson A. Oberndorfer
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Avenue, Mailstop 8111, Aurora, CO 80045 USA
| | - Sarah R. Jordan
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Avenue, Mailstop 8111, Aurora, CO 80045 USA
| | - Blythe Dollar
- Department of Medicine, University of Colorado Anschutz Medical Campus, 12631 E 17th Avenue, Aurora, CO 80045 USA
| | - Ethan U. Cumbler
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, Mailstop F782, Aurora, CO 80045 USA
| | - Christine D. Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 12401 E 17th Avenue, Mailstop F782, Aurora, CO 80045 USA
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, 1700 North Wheeling Street, Aurora, CO 80045-7211 USA
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Ang KK, Jones CD. 507 Total Lower Lip Reconstruction: A Systematic Review and Treatment Algorithm. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
To critically appraise the outcomes of different techniques described for total lower lip reconstruction in a retrospective study, where these factors were specifically documented.
Method
A comprehensive literature review was conducted over a 20-year period using Pudmed and EMBASE using the search terms “local”, “regional”, “functional”, “total lip reconstruction”. Data collected included: patient demographics, aetiology for lip reconstruction, reconstruction methods and outcomes (functional, aesthetic, complications).
Results
204 patients from 28 studies were included. Squamous cell carcinoma of the lower lip (93.1%) was the most common cause for reconstruction. Of all the flaps, 67% were local flaps, 8.5% were regional flaps and 24.6% were free flaps. Most studies used a wide variety of objective and subjective outcome measures whereas only 4 used validated scoring systems to determine functional and aesthetic outcomes.
Conclusions
Despite a myriad of different techniques described, we are currently unable to determine a superior technique. Given the ultimate goal of reconstruction is to restore form and function, we recommend the use of a standardised recording of functional and aesthetic outcome measure to allow comparison and identification of best technique for lower lip reconstruction to optimise patients' outcomes.
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Affiliation(s)
- K K Ang
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
| | - C D Jones
- Aberdeen Royal Infirmary, Aberdeen, United Kingdom
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del Pino‐Jones A, Cervantes L, Flores S, Jones CD, Keach J, Ngov L, Schwartz DA, Wierman M, Anstett T, Bowden K, Keniston A, Burden M. Advancing Diversity, Equity, and Inclusion in Hospital Medicine. J Hosp Med 2021; 16:198-203. [PMID: 33617435 PMCID: PMC9514373 DOI: 10.12788/jhm.3574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/17/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND In nearly all areas of academic medicine, disparities still exist for women and underrepresented minorities (URMs). OBJECTIVES Develop a strategic plan for advancing diversity, equity, and inclusion (DEI); implement and evaluate the plan, specifically focusing on compensation, recruitment, and policies. DESIGN, SETTING, PARTICIPANTS Programmatic evaluation conducted in the division of hospital medicine (DHM) at a major academic medical center involving DHM faculty and staff. MEASUREMENTS (1) Development and implementation of strategic plan, including policies, processes, and practices related to key components of DEI program; (2) assessment of specific DEI outcomes, including plan implementation, pre-post salary data disparities based on academic rank, and pre-post disparities for protected time for similar roles. RESULTS Using information gathered from a focus group with DHM faculty, an iterative strategic plan for DEI was developed and deployed, with key components of focus being institutional structures, our people, our environments, and our core mission areas. A director of DEI was established to help oversee these efforts. Using a two-phase approach, salary disparities by rank were eliminated. Internally funded protected time was standardized for leadership roles. A data dashboard has been developed to track high-level successes and areas for future focus. CONCLUSION Using a systematic evidence-based approach with key stakeholder involvement, a division-wide DEI strategy was developed and implemented. While this work is ongoing, short-term wins are possible, in particular around salary equity and development of policies and structures to promote DEI.
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Affiliation(s)
- Amira del Pino‐Jones
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Lilia Cervantes
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
- Denver Health and Hospital AuthorityDenverColorado
- Department of Medicine and Office of ResearchDenver HealthDenverColorado
| | - Sonia Flores
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Christine D Jones
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Joseph Keach
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
- Denver Health and Hospital AuthorityDenverColorado
| | - Li‐Kheng Ngov
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - David A Schwartz
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Margaret Wierman
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Tyler Anstett
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Kasey Bowden
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Angela Keniston
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Marisha Burden
- Department of MedicineUniversity of Colorado School of MedicineAuroraColorado
- Division of Hospital MedicineUniversity of Colorado School of MedicineAuroraColorado
- University of Colorado School of MedicineAuroraColorado
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Affiliation(s)
- Farah Acher Kaiksow
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- Corresponding Author: Farah Acher Kaiksow, MD, MPP; Telephone: 608-262-2434 ; Twitter: @kaiksow
| | - Christine D Jones
- Department of Medicine, Rocky Mountain Regional VA Medical Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Sara G Murray
- Department of Medicine, University of California, San Francisco, California
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Jones CD, Bowles KH. Emerging Challenges and Opportunities for Home Health Care in the Time of COVID-19. J Am Med Dir Assoc 2020; 21:1517-1518. [PMID: 33138933 PMCID: PMC7498200 DOI: 10.1016/j.jamda.2020.09.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Aurora, CO, USA; Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO, USA.
| | - Kathryn H Bowles
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA; Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
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Sterling MR, Kern LM, Safford MM, Jones CD, Feldman PH, Fonarow GC, Sheng S, Matsouaka RA, DeVore AD, Lytle B, Xu H, Allen LA, Deswal A, Yancy CW, Albert NM. Home Health Care Use and Post-Discharge Outcomes After Heart Failure Hospitalizations. JACC Heart Fail 2020; 8:1038-1049. [PMID: 32800510 DOI: 10.1016/j.jchf.2020.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVES This study compared the characteristics of Medicare beneficiaries who were hospitalized for heart failure (HF) and then discharged home who received home health care (HHC) to the characteristics of those who did not, and examined associations among HHC and readmission and mortality rates. BACKGROUND After hospitalization for HF, some patients receive HHC. However, the use of HHC over time, the factors associated with its use, and the post-discharge outcomes after receiving it are not well studied. METHODS This study used Get With The Guidelines-HF data, merged with Medicare fee-for-service claims. Propensity score matching and Cox proportional hazards models were used to evaluate the associations between HHC and post-discharge outcomes. RESULTS From 2005 to 2015, 95,531 patients were admitted for HF, and 32,697 (34.2%) received HHC after discharge. The rate of HHC increased over time from 31.4% to 36.1% (p < 0.001). HHC recipients were older, more likely to be female, and had more comorbidities. HHC was associated with a higher risk of all-cause 30-day readmission (hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 1.20 to 1.30), HF-specific 30-day readmission (HR: 1.20; 95% CI: 1.13 to 1.28), all-cause 90-day readmission (HR: 1.23; 95% CI: 1.19 to 1.26), HF-specific 90-day readmission (HR: 1.16; 95% CI: 1.11 to 1.22), and all-cause 30-and 90-day mortality, respectively (HR: 1.70; 95% CI: 1.56 to 1.86) and HR: 1.49; 95% CI: 1.41 to 1.57) compared to those who did not receive HHC. CONCLUSIONS Use of HHC after HF hospitalization increased among Medicare beneficiaries. HHC recipients were older and sicker than non-HHC recipients. Although HHC was associated with a higher risk of readmissions and mortality, this finding should be interpreted cautiously, given the presence of unmeasured variables that could affect receipt of HHC. Research is needed to determine whether the results reflect appropriate health care use.
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Affiliation(s)
| | - Lisa M Kern
- Weill Cornell Medicine, New York, New York, USA
| | | | | | | | - Gregg C Fonarow
- University of California Los Angeles, Los Angeles, California, USA
| | - Shubin Sheng
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | | | | | - Haolin Xu
- Duke University, Durham, North Carolina, USA
| | - Larry A Allen
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Anita Deswal
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Maw A, Ortiz-Lopez C, Morris M, Jones CD, Gee E, Tchernodrinski S, Kramer HR, Galen B, Dempsey A, Soni NJ. Hospitalist Perspectives of Available Tests to Monitor Volume Status in Patients With Heart Failure: A Qualitative Study. Cureus 2020; 12:e8844. [PMID: 32617243 PMCID: PMC7325405 DOI: 10.7759/cureus.8844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Acute decompensated heart failure is the leading admitting diagnosis in patients 65 years and older with more than 1 million hospitalizations per year in the US alone. Traditional tools to evaluate for and monitor volume status in patients with heart failure, including symptoms and physical exam findings, are known to have limited accuracy. In contrast, point of care lung ultrasound is a practical and evidenced-based tool for monitoring of volume status in patients with heart failure. However, few inpatient clinicians currently use this tool to monitor diuresis. We performed semi-structured interviews of 23 hospitalists practicing in five geographically diverse academic institutions in the US to better understand how hospitalists currently assess and monitor volume status in patients hospitalized with heart failure. We also explored their perceptions and attitudes toward adoption of lung ultrasound. Hospitalist participants reported poor reliability and confidence in the accuracy of traditional tools to monitor diuresis and expressed interest in learning or were already using lung ultrasound for this purpose. The time required for training and access to equipment that does not impede workflow were considered important barriers to its adoption by interviewees.
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Affiliation(s)
- Anna Maw
- Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | | | - Megan Morris
- Family Medicine, University of Colorado, Denver, USA
| | | | - Elaine Gee
- Medicine, Weill Cornell Medical College, New York, USA
| | | | | | | | | | - Nilam J Soni
- Medicine, University of Texas Health San Antonio, San Antonio, USA.,Medicine, South Texas Veterans Health Care System, San Antonio, USA
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Jones CD, Nearing KA, Burke RE, Lum HD, Boxer RS, Stevens-Lapsley JE, Ozkaynak M, Levy CR. "What Would It Take to Transform Post-Acute Care?" 2019 Conference Proceedings on Re-envisioning Post-Acute Care. J Am Med Dir Assoc 2020; 21:1012-1014. [PMID: 32192872 DOI: 10.1016/j.jamda.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 01/23/2020] [Accepted: 02/03/2020] [Indexed: 01/06/2023]
Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO.
| | - Kathryn A Nearing
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Eastern Colorado VA Geriatric Research Education and Clinical Center, Aurora, CO
| | - Robert E Burke
- Center for Health Equity Research and Promotion, Corporal Michael Crescenz VA Medical Center, Philadelphia, PA; Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Eastern Colorado VA Geriatric Research Education and Clinical Center, Aurora, CO
| | - Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Jennifer E Stevens-Lapsley
- Eastern Colorado VA Geriatric Research Education and Clinical Center, Aurora, CO; Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Mustafa Ozkaynak
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Cari R Levy
- Veterans Health Administration, Eastern Colorado Health Care System, Denver-Seattle Center of Innovation for Veteran-Centered and Value Driven Care, Aurora, CO; Division of Health Care Policy and Research, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Jones CD, Boxer RS. Home care after elective vascular surgery: still more questions than answers. BMJ Qual Saf 2019; 29:968-970. [PMID: 31796575 DOI: 10.1136/bmjqs-2019-009754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, United States
| | - Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA
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Del Pino-Jones A, Bowden K, Misky G, Jones CD. Improving Care for Patients with Sickle Cell Disease: a Qualitative Study of Hospitalized Sickle Cell Patients. J Gen Intern Med 2019; 34:2693-2694. [PMID: 31452034 PMCID: PMC6854201 DOI: 10.1007/s11606-019-05304-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amira Del Pino-Jones
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
- Department of Medicine, Division of Hospital Medicine, Aurora, CO, USA.
| | - Kasey Bowden
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Gregory Misky
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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Sterling MR, Silva AF, Leung PBK, Shaw AL, Tsui EK, Jones CD, Robbins L, Escamilla Y, Lee A, Wiggins F, Sadler F, Shapiro MF, Charlson ME, Kern LM, Safford MM. "It's Like They Forget That the Word 'Health' Is in 'Home Health Aide'": Understanding the Perspectives of Home Care Workers Who Care for Adults With Heart Failure. J Am Heart Assoc 2019; 7:e010134. [PMID: 30571599 PMCID: PMC6405555 DOI: 10.1161/jaha.118.010134] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Home care workers (HCWs) increasingly provide long‐term and posthospitalization care for community‐dwelling adults with heart failure (HF). They observe, assist, and advise these patients, yet few studies have examined their role in HF. As the foundation for future interventions, we sought to understand the perspectives of HCWs caring for adults with HF. Methods and Results We conducted 8 focus groups in partnership with the Home Care Industry Education Fund, a benefit fund of the 1199 Service Employees International Union United Healthcare Workers East, the largest healthcare union in the United States. English‐ and Spanish‐speaking HCWs with HF clients were eligible to participate. Data were analyzed thematically. Forty‐six HCWs employed by 21 unique home care agencies participated. General and HF‐specific themes emerged. Generally, HCWs (1) feel overworked and undervalued; (2) find communication and care to be fragmented; (3) are dedicated to clients and families but are caught in the middle; and, despite this, (4) love their job. With respect to HF, HCWs (1) find it frightening and unpredictable; (2) are involved in HF self‐care without any HF training; and (3) find the care plan problematic. Conclusions Although frequently involved in HF self‐care, most HCWs have not received HF training. In addition, many felt poorly supported by other healthcare providers and the care plan, especially when their clients’ symptoms worsened. Interventions that provide HF‐specific training and aim to improve communication between members of the home health care team may enhance HCWs’ ability to care for adults with HF and potentially lead to better patient outcomes.
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Affiliation(s)
- Madeline R Sterling
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Ariel F Silva
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Peggy B K Leung
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Amy L Shaw
- 2 Division of Geriatrics and Palliative Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Emma K Tsui
- 3 Department of Community Health and Social Sciences Graduate School of Public Health and Health Policy City University of New York NY
| | | | | | | | - Ann Lee
- 6 1199SEIU - Home Care Industry Education Fund New York NY
| | - Faith Wiggins
- 6 1199SEIU - Home Care Industry Education Fund New York NY
| | - Frances Sadler
- 6 1199SEIU - Home Care Industry Education Fund New York NY
| | - Martin F Shapiro
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Mary E Charlson
- 7 Division of Clinical Epidemiology and Evaluative Science Research Department of Medicine Weill Cornell Medicine New York NY
| | - Lisa M Kern
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
| | - Monika M Safford
- 1 Division of General Internal Medicine Department of Medicine Weill Cornell Medicine New York NY
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Wallace MA, Hammes A, Rothman MS, Trizno AA, Jones CD, Cumbler E, McDevitt K, Carlson NE, Stoneback JW. Fixing a Fragmented System: Impact of a Comprehensive Geriatric Hip Fracture Program on Long-Term Mortality. Perm J 2019; 23:18.286. [PMID: 31702983 DOI: 10.7812/tpp/18.286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Geriatric hip fractures are increasingly common and confer substantial morbidity and mortality. Fragmentation in geriatric hip fracture care remains a barrier to improved outcomes. OBJECTIVE To evaluate the impact of a comprehensive geriatric hip fracture program on long-term mortality. DESIGN We conducted a retrospective cohort study of patients aged 65 years and older admitted to our academic medical center between January 1, 2012, and March 31, 2016 with an acute fragility hip fracture. Mortality data were obtained for in-state residents from the state public health department. MAIN OUTCOME MEASURES Mortality within 1 year of index admission and overall survival based on available follow-up data. RESULTS We identified 243 index admissions during the study period, including 135 before and 108 after program implementation in October 2014. The postintervention cohort trended toward a lower unadjusted 1-year mortality rate compared with the preintervention cohort (15.7% vs 24.4%, p = 0.111), as well as lower adjusted mortality at 1 year (relative risk = 0.73, 95% confidence interval = 0.46-1.16, p = 0.18), although the differences were not statistically significant. The postintervention cohort had significantly higher overall survival than did the preintervention cohort (hazard ratio for death = 0.43, 95% confidence interval = 0.25-0.74, p = 0.002). CONCLUSION Fixing fragmentation in geriatric hip fracture care such as through an orthogeriatric model is essential to improving overall survival for this patient population.
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Affiliation(s)
- Mary Anderson Wallace
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Andrew Hammes
- Department of Biostatistics and Informatics, University of Colorado, Aurora
| | - Micol S Rothman
- Division of Endocrinology, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Anastasiya A Trizno
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora
| | - Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Ethan Cumbler
- Division of Hospital Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Kelly McDevitt
- University of Colorado Health, Longs Peak Hospital, Longmont
| | - Nichole E Carlson
- Department of Biostatistics and Informatics, University of Colorado, Aurora
| | - Jason W Stoneback
- Department of Orthopedic Surgery, University of Colorado School of Medicine, Aurora
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Callister C, Jones J, Schroeder S, Breathett K, Dollar B, Sanghvi UJ, Harnke B, Lum HD, Jones CD. Caregiver Experiences of Care Coordination for Recently Discharged Patients: A Qualitative Metasynthesis. West J Nurs Res 2019; 42:649-659. [PMID: 31585516 DOI: 10.1177/0193945919880183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Caregivers of patients often provide key support for patients after hospitalization. This qualitative metasynthesis describes caregiver perspectives about care coordination for patients discharged from the hospital. A literature search of Ovid Medline and CINAHL completed on May 23, 2018, identified 1,546 studies. Twelve articles were included in the final metasynthesis. Caregiver perspectives about care coordination were compiled into overall themes. A subanalysis of studies in which patients were discharged with home health services was completed. Five main themes emerged related to caregiver perspectives on care coordination after hospitalization: (a) Suboptimal access to clinicians after discharge, (b) Feeling disregarded by clinicians, (c) Need for information and training at discharge, (d) Overwhelming responsibilities to manage appointments and medications, and (e) Need for emotional support.Findings from this metasynthesis suggest the need for clinicians to engage with caregivers to provide support, training, and communication after hospital discharge.
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Affiliation(s)
- Catherine Callister
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Shara Schroeder
- College of Liberal Arts and Sciences, Department of Sociology, University of Colorado, Denver, CO, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, University of Arizona, Sarver Heart Center, Tucson, AZ, USA
| | - Blythe Dollar
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Urvi Jhaveri Sanghvi
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ben Harnke
- Health Sciences Library University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
| | - Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Veterans Affairs Medical Center, Aurora, Colorado, USA
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Jones CD, Falvey J, Hess E, Levy CR, Nuccio E, Barón AE, Masoudi FA, Stevens-Lapsley J. Predicting Hospital Readmissions from Home Healthcare in Medicare Beneficiaries. J Am Geriatr Soc 2019; 67:2505-2510. [PMID: 31463941 DOI: 10.1111/jgs.16153] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/02/2019] [Accepted: 07/22/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To use patient-level clinical variables to develop and validate a parsimonious model to predict hospital readmissions from home healthcare (HHC) in Medicare fee-for-service beneficiaries. DESIGN Retrospective analysis using multivariable logistic regression and gradient boosting machine (GBM) learning to develop and validate a predictive model. SETTING/PARTICIPANTS/MEAUREMENTS A 5% national sample of patients, aged 65 years or older, with Medicare fee-for-service who received skilled HHC services within 5 days of hospital discharge in 2012 (n = 43 407). Multiple data sets were merged, including Medicare Outcome and Assessment Information Set, Home Health Claims, Medicare Provider Analysis and Review, and Master Beneficiary Summary Files, to extract patient-level variables from the first HHC visit after discharge and measure 30-day readmission outcomes. RESULTS Among 43 407 patients with inpatient hospitalizations followed by HHC, 14.7% were readmitted within 30 days. Of the 53 candidate variables, seven remained in the final model as individually predictive of outcome: Elixhauser comorbidity index, index hospital length of stay, urinary catheter presence, patient status (ie, fragile health with high risk of complications or serious progressive condition), two or more hospitalizations in prior year, pressure injury risk or presence, and surgical wound presence. Of interest, surgical wounds, either from a total hip or total knee arthroplasty procedure or another surgical procedure, were associated with fewer readmissions. The optimism-corrected c-statistics for the full model and parsimonious model were 0.67 and 0.66, respectively, indicating fair discrimination. The Brier score for both models was 0.120, indicating good calibration. The GBM model identified similar predictive variables. CONCLUSION Variables available to HHC clinicians at the first postdischarge HHC visit can predict readmission risk and inform care plans in HHC. Future analyses incorporating measures of social determinants of health, such as housing instability or social support, have the potential to enhance prediction of this outcome. J Am Geriatr Soc 67:2505-2510, 2019.
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Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Jason Falvey
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado.,Section of General Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Edward Hess
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Cari R Levy
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.,Division of Health Care Policy and Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Eugene Nuccio
- Division of Health Care Policy and Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Anna E Barón
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.,Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer Stevens-Lapsley
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado.,Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.,VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora
| | - Cari R Levy
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Aurora.,Division of Health Care Policy and Research, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora
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Gustavson AM, Drake C, Lakin A, Daddato AE, Falvey JR, Capell W, Lum HD, Jones CD, Unroe KT, Towsley GL, Stevens-Lapsley JE, Levy CR, Boxer RS. Conducting Clinical Research in Post-acute and Long-term Nursing Home Care Settings: Regulatory Challenges. J Am Med Dir Assoc 2019; 20:798-803. [PMID: 31248598 PMCID: PMC6703170 DOI: 10.1016/j.jamda.2019.04.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 04/11/2019] [Accepted: 04/20/2019] [Indexed: 11/20/2022]
Abstract
Despite multiple initiatives in post-acute and long-term nursing home care settings (NHs) to improve the quality of care while reducing health care costs, research in NHs can prove challenging. Extensive regulation for both research and NHs is designed to protect a highly vulnerable population but can be a deterrent to conducting research. This article outlines regulatory challenges faced by NHs and researchers, such as protecting resident privacy as well as health information and obtaining informed consent. The article provides lessons learned to help form mutually beneficial partnerships between researchers and NHs to conduct studies that grow and advance NH research initiatives and clinical care.
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Affiliation(s)
- Allison M Gustavson
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Cynthia Drake
- Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Alison Lakin
- Colorado Multi-Institutional Review Board (COMIRB), University of Colorado School of Medicine, Aurora, CO
| | - Andrea E Daddato
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, CO
| | - Jason R Falvey
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
| | - Warren Capell
- Department of Medicine, University of Colorado, Aurora, CO
| | - Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, CO; Veterans Affairs Geriatric Research, Education and Clinical Center, Aurora, CO
| | | | | | - Gail L Towsley
- University of Utah, College of Nursing, Salt Lake City, UT
| | - Jennifer E Stevens-Lapsley
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO; Veterans Affairs Geriatric Research, Education and Clinical Center, Aurora, CO
| | - Cari R Levy
- Rocky Mountain Regional Medical Center, Aurora, CO
| | - Rebecca S Boxer
- Division of Geriatric Medicine, Department of Medicine, University of Colorado, Aurora, CO; Veterans Affairs Geriatric Research, Education and Clinical Center, Aurora, CO.
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Chopra V, Burden M, Jones CD, Mueller S, Gupta V, Ahuja N, Sigmund A, Eid SM. State of Research in Adult Hospital Medicine: Results of a National Survey. J Hosp Med 2019; 14:207-211. [PMID: 30933670 DOI: 10.12788/jhm.3136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Little is known about the state of research in academic hospital medicine (HM) despite the substantial growth of this specialty. METHODS We used the Society of Hospital Medicine (SHM) membership database to identify research programs and their leadership. In addition, the members of the SHM Research Committee identified individuals who lead research programs in HM. A convenience sample of programs and individuals was thus created. A survey instrument containing questions regarding institutional information, research activities, training opportunities, and funding sources was pilot tested and refined for electronic dissemination. Data were summarized using descriptive statistics. RESULTS A total of 100 eligible programs and corresponding individuals were identified. Among these programs, 28 completed the survey in its entirety (response rate 28%). Among the 1,586 faculty members represented in the 28 programs, 192 (12%) were identified as engaging in or having obtained extramural funding for research, and 656 (41%) were identified as engaging in quality improvement efforts. Most programs (61%) indicated that they received $500,000 or less in research funding, whereas 29% indicated that they received >$1 million in funding. Major sources of grant support included the Agency for Healthcare Research and Quality, National Institutes of Health, and the Veterans Health Administration. Only five programs indicated that they currently have a research fellowship program in HM. These programs cited lack of funding as a major barrier to establishing fellowships. Almost half of respondents (48%) indicated that their faculty published between 11-50 peer-reviewed manuscripts each year. CONCLUSION This survey provides the first national summary of research activities in HM. Future waves of the survey can help determine whether the research footprint of the field is growing.
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Affiliation(s)
- Vineet Chopra
- The Division of Hospital Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado
| | - Christine D Jones
- Division of Hospital Medicine, University of Colorado, Aurora, Colorado
| | - Stephanie Mueller
- Hospital Medicine Unit, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Vineet Gupta
- Division of Hospital Medicine, University of California San Diego, San Diego, California
| | - Neera Ahuja
- Section of Hospital Medicine, Stanford University School of Medicine, Palo Alto, California
| | | | - Shaker M Eid
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
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- Society of Hospital Medicine, Philadelphia, Pennsylvania
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Jones CD, Jones J, Bowles KH, Flynn L, Masoudi FA, Coleman EA, Levy C, Boxer RS. Quality of Hospital Communication and Patient Preparation for Home Health Care: Results From a Statewide Survey of Home Health Care Nurses and Staff. J Am Med Dir Assoc 2019; 20:487-491. [PMID: 30799224 DOI: 10.1016/j.jamda.2019.01.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 09/21/2018] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To evaluate the quality of communication between hospitals and home health care (HHC) clinicians and patient preparedness to receive HHC in a statewide sample of HHC nurses and staff. DESIGN A web-based 48-question cross-sectional survey of HHC nurses and staff in Colorado to describe the quality of communication after hospital discharge and patient preparedness to receive HHC from the perspective of HHC nurses and staff. Questions were on a Likert scale, with optional free-text questions. SETTING AND PARTICIPANTS Between January and June 2017, we sent a web-based survey to individuals from the 56 HHC agencies in the Home Care Association of Colorado that indicated willingness to participate. RESULTS We received responses from 50 of 122 individuals (41% individual response rate) representing 14 of 56 HHC agencies (25% agency response rate). Half of the respondents were HHC nurses, the remainder were managers, administrators, or quality assurance clinicians. Among respondents, 60% (n = 30) reported receiving insufficient information to guide patient management in HHC and 44% (n = 22) reported encountering problems related to inadequate patient information. Additional tests recommended by hospital clinicians was the communication domain most frequently identified as insufficient (58%). More than half of respondents (52%) indicated that patient preparation to receive HHC was inadequate, with patient expectations frequently including extended-hours caregiving, housekeeping, and transportation, which are beyond the scope of HHC. Respondents with electronic health record (EHR) access for referring providers were less likely to encounter problems related to a lack of information (27% vs 57% without EHR access, P = .04). Respondents with EHR access were also more likely to have sufficient information about medications and contact isolation. CONCLUSIONS/IMPLICATIONS Communication between hospitals and HHC is suboptimal, and patients are often not prepared to receive HHC. Providing EHR access for HHC clinicians is a promising solution to improve the quality of communication.
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Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kathryn H Bowles
- School of Nursing, University of Pennsylvania, Philadelphia, PA; Visiting Nurse Service of New York, New York, NY
| | | | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Eric A Coleman
- Division of Health Care Policy and Research, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Cari Levy
- Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO
| | - Rebecca S Boxer
- Rocky Mountain Regional Veterans Affairs Medical Center, Denver, CO; Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
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Jones CD, Jones J, Bowles KH, Schroeder S, Masoudi FA, Coleman EA, Falvey J, Levy CR, Boxer RS. Patient, Caregiver, and Clinician Perspectives on Expectations for Home Healthcare after Discharge: A Qualitative Case Study. J Hosp Med 2019; 14:90-95. [PMID: 30785416 PMCID: PMC6574082 DOI: 10.12788/jhm.3140] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Patients discharged from the hospital with skilled home healthcare (HHC) services have multiple comorbidities, high readmission rates, and multiple care needs. In prior work, HHC nurses described that patients often express expectations for services beyond the scope of skilled HHC. OBJECTIVE The objective of this study is to evaluate and compare expectations for HHC from the patient, caregiver, and HHC perspectives after hospital discharge. DESIGN/PARTICIPANTS This was a descriptive qualitative case study including HHC patients, caregivers, and clinicians. Patients were discharged from an academic medical center between July 2017 and February 2018. RESULTS The sample (N = 27) included 11 HHC patients, eight caregivers, and eight HHC clinicians (five nurses and three physical therapists). Patient mean age was 66 years and the majority were female, white, and had Medicare. We observed main themes of clear and unclear expectations for HHC after discharge. Clear expectations occur when the patient and/or caregiver have expectations for HHC aligned with the services received. Unclear expectations occur when the patient and/or caregiver expectations are uncertain or misaligned with the services received. Patients and caregivers with clear expectations for HHC frequently described prior experiences with skilled HHC or work experience within the healthcare field. In most cases with unclear expectations, the patient and caregiver did not have prior experience with HHC. CONCLUSIONS To improve HHC transitions, we recommend actively engaging both patients and caregivers in the hospital and HHC settings to provide education about HHC services, and assess and address additional care needs.
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Affiliation(s)
- Christine D Jones
- Division of Hospital Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Corresponding Author: Christine D. Jones, MD, MS; E-mail: ; Telephone: 720-848-4289; Twitter: @jones_delong
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kathryn H Bowles
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, New York
| | - Shara Schroeder
- College of Liberal Arts and Sciences, Department of Sociology, University of Colorado, Denver, Colorado
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Eric A Coleman
- Division of Health Care Policy and Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jason Falvey
- Physical Therapy Program, Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Veterans Affairs Medical Center, Denver, Colorado
- Yale School of Medicine, New Haven, Connecticut
| | - Cari R Levy
- Division of Health Care Policy and Research, University of Colorado Anschutz Medical Campus, Aurora, Colorado
- Veterans Affairs Medical Center, Denver, Colorado
| | - Rebecca S Boxer
- Veterans Affairs Medical Center, Denver, Colorado
- Division of Geriatric Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Jones CD, Bowles KH, Richard A, Boxer RS, Masoudi FA. High-Value Home Health Care for Patients With Heart Failure: An Opportunity to Optimize Transitions From Hospital to Home. Circ Cardiovasc Qual Outcomes 2018; 10:CIRCOUTCOMES.117.003676. [PMID: 28495675 DOI: 10.1161/circoutcomes.117.003676] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christine D Jones
- From the Hospital Medicine Section, Division of General Internal Medicine (C.D.J.), College of Nursing (A.R.), Division of Geriatric Medicine (R.S.B.), and Division of Cardiology (F.A.M.), University of Colorado Anschutz Medical Campus, Aurora; University of Pennsylvania School of Nursing, Philadelphia (K.H.B.); and Department of Biobehavioral Health Sciences, Visiting Nurse Service of New York, NY (K.H.B.).
| | - Kathryn H Bowles
- From the Hospital Medicine Section, Division of General Internal Medicine (C.D.J.), College of Nursing (A.R.), Division of Geriatric Medicine (R.S.B.), and Division of Cardiology (F.A.M.), University of Colorado Anschutz Medical Campus, Aurora; University of Pennsylvania School of Nursing, Philadelphia (K.H.B.); and Department of Biobehavioral Health Sciences, Visiting Nurse Service of New York, NY (K.H.B.)
| | - Angela Richard
- From the Hospital Medicine Section, Division of General Internal Medicine (C.D.J.), College of Nursing (A.R.), Division of Geriatric Medicine (R.S.B.), and Division of Cardiology (F.A.M.), University of Colorado Anschutz Medical Campus, Aurora; University of Pennsylvania School of Nursing, Philadelphia (K.H.B.); and Department of Biobehavioral Health Sciences, Visiting Nurse Service of New York, NY (K.H.B.)
| | - Rebecca S Boxer
- From the Hospital Medicine Section, Division of General Internal Medicine (C.D.J.), College of Nursing (A.R.), Division of Geriatric Medicine (R.S.B.), and Division of Cardiology (F.A.M.), University of Colorado Anschutz Medical Campus, Aurora; University of Pennsylvania School of Nursing, Philadelphia (K.H.B.); and Department of Biobehavioral Health Sciences, Visiting Nurse Service of New York, NY (K.H.B.)
| | - Frederick A Masoudi
- From the Hospital Medicine Section, Division of General Internal Medicine (C.D.J.), College of Nursing (A.R.), Division of Geriatric Medicine (R.S.B.), and Division of Cardiology (F.A.M.), University of Colorado Anschutz Medical Campus, Aurora; University of Pennsylvania School of Nursing, Philadelphia (K.H.B.); and Department of Biobehavioral Health Sciences, Visiting Nurse Service of New York, NY (K.H.B.)
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Gottenborg E, Maw A, Ngov LK, Burden M, Ponomaryova A, Jones CD. You Can't Have It All: The Experience of Academic Hospitalists During Pregnancy, Parental Leave, and Return to Work. J Hosp Med 2018; 13:836-839. [PMID: 30496328 DOI: 10.12788/jhm.3076] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The United States lags behind most other countries regarding the support for working mothers and parental leave. Data are limited to describe the experience of female hospital medicine physicians during pregnancy, parental leave, and their return to work in academic hospital medicine. METHODS We conducted a qualitative descriptive study including interviews with 10 female academic hospitalists chosen from institutions across the country that are represented in Society of Hospital Medicine (SHM) Committees. Interview guides were based on the following domains: experience in pregnancy, parental leave, and return to work. Interviews were recorded, transcribed verbatim, and analyzed using a general inductive approach to theme analysis using the ATLAS.ti software (Scientific Software Development GmbH, Berlin, Germany). PRIMARY OUTCOME Women in hospital medicine experience the following six common challenges in their experience as new parents, each of which has the potential to impact their career trajectory, wellness, and are associated with areas for institutional improvement: (1) access to paid parental leave, (2) physical challenges, (3) breastfeeding, (4) career opportunities, (5) colleague responses, and (6) empathy in patient care.
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Affiliation(s)
- Emily Gottenborg
- Department of Medicine, Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA.
| | - Anna Maw
- Department of Medicine, Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
| | - Li-Kheng Ngov
- Department of Medicine, Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
| | - Marisha Burden
- Department of Medicine, Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
| | - Anastasiya Ponomaryova
- Department of Medicine, Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
| | - Christine D Jones
- Department of Medicine, Division of Hospital Medicine, University of Colorado, Denver, Colorado, USA
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Abstract
Background Home care workers (HCWs), which include home health aides and personal care aides, are increasingly used by heart failure (HF) patients for post-acute care and long-term assistance. Despite their growing presence, they have largely been left out of HF research and interventions. This systematic review was aimed to 1) describe utilization patterns of HCWs by adults with HF, 2) examine the effect of HCWs on HF outcomes, and 3) review HF interventions that involve HCWs. Methods Five electronic databases (Ovid MEDLINE, Ovid EMBASE, Cochrane Library [Wiley], CINAHL [EBSCO], and AgeLine [EBSCO]) were searched from inception through August 4, 2017. The yield was screened using prespecified inclusion and exclusion criteria. Two authors independently reviewed references and a third reviewer acted as an arbitrator when needed. Data were extracted from articles that met the inclusion criteria. The Downs and Black checklist was used for quality assessment. Due to study heterogeneity, a narrative synthesis was conducted. Results Of the 7,032 studies screened, 13 underwent full-text review, and six met the inclusion criteria. Two descriptive studies found that adults with HF who live alone and have functional and cognitive deficits utilize HCWs. While three retrospective cohort studies examined the association between having an HCW post-HF hospitalization and readmission rates, their findings were conflicting. One quasi-experimental study found that an HCW-delivered educational intervention improved HF patients’ self-care abilities. Overall, despite some significant findings, the studies assessed were of poor-to-fair quality (Downs and Black score range: 10–16 [28 total points]), with most lacking methodological rigor. Conclusion Although HCWs are quite common, the literature on these paraprofessionals in HF is limited. Given the paucity of research in this area and the low quality of studies reviewed here, additional research is warranted on the potential role of HCWs in HF self-care and on outcomes among adults with HF.
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Affiliation(s)
- Madeline R Sterling
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA,
| | - Amy L Shaw
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Peggy Bk Leung
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA,
| | - Monika M Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA,
| | - Christine D Jones
- Division of Hospital Medicine, University of Colorado, Denver, CO, USA
| | - Emma K Tsui
- Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Diana Delgado
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, NY, USA
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Somes E, Dukes J, Brungardt A, Jordan S, DeSanto K, Jones CD, Sanghvi UJ, Breathett K, Jones J, Lum HD. Perceptions of trained laypersons in end-of-life or advance care planning conversations: a qualitative meta-synthesis. BMC Palliat Care 2018; 17:98. [PMID: 30081957 PMCID: PMC6080535 DOI: 10.1186/s12904-018-0354-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/31/2018] [Indexed: 12/03/2022] Open
Abstract
Background Laypersons including volunteers, community health navigators, or peer educators provide important support to individuals with serious illnesses in community or healthcare settings. The experiences of laypersons in communication with seriously ill peers is unknown. Methods We performed an ENTREQ-guided qualitative meta-synthesis. We conducted a systematic search of MEDLINE, PsycINFO, CINAHL, Cochrane Library, and AMED to include qualitative studies with data regarding communication and laypersons in advance care planning, palliative care, or end-of-life settings. Study quality was appraised using a standardized tool. The analysis identified key domains and associated themes relating specifically to laypersons’ perspectives on communication. Results Of 877 articles, nine studies provided layperson quotations related to layperson-to-peer communication associated with advance care planning (n = 4) or end-of-life conversations (n = 5). The studies were conducted in United Kingdom (n = 4) or United States settings (n = 5). The synthesis of layperson perspectives yielded five main domains: 1) layperson-to-peer communication, focusing on the experience of talking with peers, 2) layperson-to-peer interpersonal interactions, focusing on the entire interaction between the layperson and peers, excluding communication-related issues, 3) personal impact on the layperson, 4) layperson contributions, and 5) layperson training. Laypersons described using specific communication skills including the ability to build rapport, discuss sensitive issues, listen and allow silence, and respond to emotions. Conclusions Published studies described experiences of trained laypersons in conversations with peers related to advance care planning or end-of-life situations. Based on these layperson perspectives related to communication, programs should next evaluate the potential impact of laypersons in meaningful conversations.
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Affiliation(s)
- Elizabeth Somes
- Internal Medicine Residency, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Joanna Dukes
- University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Adreanne Brungardt
- Division of Geriatric Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Mail Stop B179, Aurora, CO, 80045, USA
| | - Sarah Jordan
- Division of Geriatric Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Mail Stop B179, Aurora, CO, 80045, USA
| | - Kristen DeSanto
- Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Christine D Jones
- Division of Hospital Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Urvi Jhaveri Sanghvi
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ, USA
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Hillary D Lum
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA. .,Division of Geriatric Medicine, University of Colorado School of Medicine, University of Colorado Anschutz Medical Campus, 12631 E. 17th Ave, Mail Stop B179, Aurora, CO, 80045, USA.
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