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Griffin JM, Kaufman BG, Bangerter L, Holland DE, Vanderboom CE, Ingram C, Wild E, Dose AM, Stiles C, Thompson V. Improving Transitions in Care for Patients and Family Caregivers Living in Rural and Underserved Areas: The Caregiver Advise, Record, Enable (CARE) Act. J Aging Soc Policy 2024; 36:581-588. [PMID: 35156557 PMCID: PMC9374844 DOI: 10.1080/08959420.2022.2029272] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
Abstract
In this Perspective, we contend bold action is needed to improve transitions from hospitals to home for aging patients and their family caregivers living in rural and underserved areas. The Caregiver Advise, Record, Enable (CARE) Act, passed in over 40 US states, is intended to provide family caregivers of hospitalized patients with the knowledge and skills needed for safe and efficient transitions. It has broken important ground for family caregivers who assist with transitions in patient care. It may fall short, however, in addressing the unique needs of family caregivers living in rural and underserved areas. We contend that to realize the intended safety, cost, and care quality benefits of the CARE Act, especially for those living in rural and underserved areas, states need to expand the Act's scope. We provide three recommendations: 1) modify hospital information systems to support the care provided by family caregivers; 2) require assessments of family caregivers that reflect the challenges of family caregiving in rural and underserved areas; and 3) identify local resources to improve discharge planning. We describe the rationale for each recommendation and the potential ways that an expanded CARE Act could reduce the risks associated with transitions in care for aging patients.
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Affiliation(s)
- Joan M. Griffin
- Division of Health Care Delivery Research (HCDR) and Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 1 Street SW, Rochester, MN 55905
| | | | | | - Diane E. Holland
- Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | - Catherine E. Vanderboom
- Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | | | | | - Ann Marie Dose
- Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
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Kent EE, Deaton S, Keesee E. North Carolina Caregiver Listening Study: Caregiver Experiences and Perspectives on Services and Supports in an Aging U.S. State. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2024:1-24. [PMID: 38743400 DOI: 10.1080/01634372.2024.2351072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/30/2024] [Indexed: 05/16/2024]
Abstract
Family caregivers experience health, financial, and social burdens related to caregiving responsibilities. North Carolina has an estimated 1.3 million caregivers, equating to a value of $13.1 billion per year. Caregiving demands warrant additional understanding of the caregiver lived experiences. Our objective was to document these North Carolina caregiver experiences during the era of COVID-19 through focus groups. Participants were recruited through diverse community organizations. All 44 caregivers who completed interest solicitation surveys were invited to participate; 29 caregivers participated across 11 groups. Thematic analysis was used to code and synthesize transcripts from each participant using Dedoose software and guided by the Consolidated Criteria for Reporting Qualitative Research (COREQ). Caregiver routines (caregiving as an all-encompassing role; dimensions of support); most challenging parts (exhaustion and defeat; lacking support; evolving relationships); most rewarding parts (care recipient resilience; quality time; sense of purpose); social service and healthcare system interactions (positive interactions; negative interactions; inaccessible services); COVID-19 impacts on caregiving (opportunities; challenges); and caregiver suggestions for system improvements (increasing financial support; improved coordination; ideological shifts). Caregivers shared unmet needs, challenges, and opportunities for improvement. Examining these needs and experience-informed recommendations can help advance additional caregiving research, policy-making, and program development.
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Affiliation(s)
- Erin E Kent
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
- Cecil G. Sheps Health Services Research Center, UNC Chapel Hill, North Carolina, United States
| | - Sue Deaton
- Patient Centered Innovation, Inc, Greenville, North Carolina, United States
| | - Emmaline Keesee
- Cecil G. Sheps Health Services Research Center, UNC Chapel Hill, North Carolina, United States
- Health Policy Department, Vanderbilt University Medical Center, Nashville Tennessee, United States
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Raj M. Organizational and Policy Challenges and Priorities for Integrating Family Care Partners Into the Healthcare Team. Adv Health Care Manag 2024; 22:231-237. [PMID: 38262018 DOI: 10.1108/s1474-823120240000022011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Family care partners are significantly involved in healthcare tasks in order to support adult relatives. Yet, unlike pediatric models of care where caregivers of children are formally integrated into healthcare teams, care partners of adults are rarely engaged in a formal, structured, or consistent manner. Their inclusion in the healthcare team is critical to their capacity to continue supporting their relative. A meaningful dialogue between policy and healthcare management is required to identify feasible and effective ways of engaging family care partners in healthcare teams.
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Fox MT, Butler JI. Rural caregivers' preparedness for detecting and responding to the signs of worsening health conditions in recently hospitalised patients at risk for readmission: a qualitative descriptive study. BMJ Open 2023; 13:e076149. [PMID: 38154900 PMCID: PMC10759104 DOI: 10.1136/bmjopen-2023-076149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 11/17/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES This study aimed to explore informal rural caregivers' perceived preparedness to detect and respond to the signs of worsening health conditions in patients recently discharged from hospital and at risk for readmission. DESIGN A qualitative descriptive design and semistructured interviews were used. Data were thematically analysed. SETTING Data collection occurred in 2018 and 2019 in rural communities in Southwestern and Northeastern Ontario, Canada. PARTICIPANTS The study included sixteen informal caregivers who were all family members of a relative discharged from hospital at high risk for readmission following hospitalisation mostly for a medical illness (63%). Participants were mostly women (87.5%), living with their relative (62.5%) who was most often a parent (56.3%). RESULTS Three themes were identified: (1) warning signs and rural communities, (2) perceived preparedness, and (3) improving preparedness. The first theme elucidates informal caregivers' view that they needed to be prepared because they were taking over care previously provided by hospital healthcare professionals yet lacked accessible medical help in rural communities. The second theme captures informal caregivers' perceptions that they lacked knowledge of how to detect warning signs and how to respond to them appropriately. The last theme illuminates informal caregivers' suggestions for improving preparation related to warning signs. CONCLUSIONS Informal caregivers in rural communities were largely unprepared for detecting and responding to the signs of worsening health conditions for patients at high risk for hospital readmission. Healthcare professionals can anticipate that informal caregivers, particularly those whose relatives live far from medical help, need information on how to detect and respond to warning signs, and may prioritise their time to this aspect of postdischarge care for these caregivers.
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Affiliation(s)
- Mary T Fox
- School of Nursing, Centre for Aging Research and Education, York University, Toronto, Ontario, Canada
| | - Jeffrey I Butler
- School of Nursing, Centre for Aging Research and Education, York Univ, Toronto, Ontario, Canada
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Longacre ML, Chwistek M, Keleher C, Siemon M, Egleston BL, Collins M, Fang CY. Patient-Caregiver Portal System in Palliative Oncology: Assessment of Usability and Perceived Benefit. JMIR Hum Factors 2023; 10:e47624. [PMID: 37917129 PMCID: PMC10654898 DOI: 10.2196/47624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/06/2023] [Accepted: 08/27/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND The engagement of family caregivers in oncology is not universal or systematic. OBJECTIVE We implemented a process intervention (ie, patient-caregiver portal system) with an existing patient portal system to (1) allow a patient to specify their caregiver and communication preferences with that caregiver, (2) connect the caregiver to a unique caregiver-specific portal page to indicate their needs, and (3) provide an electronic notification of the dyad's responses to the care team to inform clinicians and connect the caregiver to resources as needed. METHODS We assessed usability and satisfaction with this patient-caregiver portal system among patients with cancer receiving palliative care, their caregivers, and clinicians. RESULTS Of 31 consented patient-caregiver dyads, 20 patients and 19 caregivers logged in. Further, 60% (n=12) of patients indicated a preference to communicate equally or together with their caregiver. Caregivers reported high emotional (n=9, 47.3%), financial (n=6, 31.6%), and physical (n=6, 31.6%) caregiving-related strain. The care team received all patient-caregiver responses electronically. Most patients (86.6%, 13/15 who completed the user experience interview) and caregivers (94%, 16/17 who completed the user experience interview) were satisfied with the system, while, of the 6 participating clinicians, 66.7% agreed "quite a bit" (n=1, 16.7%) or "very much" (n=3, 50%) that the system allowed them to provide better care. CONCLUSIONS Our findings demonstrate system usability, including a systematic way to identify caregiver needs and share with the care team in a way that is acceptable to patients and caregivers and perceived by clinicians to benefit clinical care. Integration of a patient-caregiver portal system may be an effective approach for systematically engaging caregivers. These findings highlight the need for additional research among caregivers of patients with less advanced cancer or with different illnesses.
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Affiliation(s)
| | - Marcin Chwistek
- Supportive Oncology and Palliative Care Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Cynthia Keleher
- Web Technologies Department, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Mark Siemon
- Web Technologies Department, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Brian L Egleston
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Molly Collins
- Supportive Oncology and Palliative Care Program, Fox Chase Cancer Center, Philadelphia, PA, United States
| | - Carolyn Y Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, United States
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Eskes AM, Tobiano G, Carlini J, Kuijpers C, Musters SCW, Chaboyer W. Fundamentally shifting discharge planning and post-hospital care. Int J Nurs Stud 2023; 145:104533. [PMID: 37285731 DOI: 10.1016/j.ijnurstu.2023.104533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Affiliation(s)
- Anne M Eskes
- Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands; Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, G01 2.03, QLD 4222, Australia.
| | - Georgia Tobiano
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, G01 2.03, QLD 4222, Australia
| | - Joan Carlini
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, G01 2.03, QLD 4222, Australia; Gold Coast Hospital and Health Service Consumer Advisory Group, QLD, Australia
| | - Carolina Kuijpers
- Family Caregiver - Consumer Perspective, Swifterbant, the Netherlands
| | - Selma C W Musters
- Amsterdam UMC location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
| | - Wendy Chaboyer
- Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, G01 2.03, QLD 4222, Australia
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Kent EE. Centering patients with advanced cancer includes supporting their caregivers. J Natl Cancer Inst 2023; 115:881-882. [PMID: 37400993 PMCID: PMC10407712 DOI: 10.1093/jnci/djad110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 07/05/2023] Open
Affiliation(s)
- Erin E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Raj M, Stephenson AL, DePuccio MJ, Sullivan EE, Tarver W, Fleuren B, Thomas SC, Scheck McAlearney A. Conceptual Framework for Integrating Family Caregivers Into the Health Care Team: A Scoping Review. Med Care Res Rev 2023; 80:131-144. [PMID: 36000495 DOI: 10.1177/10775587221118435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
More than 80% of family care partners of older adults are responsible for coordinating care between and among providers; yet, their inclusion in the health care delivery process lacks recognition, coordination, and standardization. Despite efforts to include care partners (e.g., through informal or formal proxy access to their care recipient's patient portal), policies and procedures around care partner inclusion are complex and inconsistently implemented. We conducted a scoping review of peer-reviewed articles published from 2015 to 2021 and reviewed a final sample of 45 U.S.-based studies. Few articles specifically examine the inclusion of care partners in health care teams; those that do, do not define or measure care partner inclusion in a standardized way. Efforts to consider care partners as "partners" rather than "visitors" require further consideration of how to build health care teams inclusive of care partners. Incentives for health care organizations and providers to practice inclusive team-building may be required.
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Affiliation(s)
| | | | | | | | | | | | - Samuel C Thomas
- Stanford School of Medicine and Intermountain Healthcare, USA
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Griffin JM, Vanderboom CE, Gustavson A, Kaufman BG, Ingram C, Wild E, Dose AM, Mandrekar J, Holland DE. A Methodological Approach for Documenting Multi-Component Interventions Targeting Family Caregivers. J Appl Gerontol 2023; 42:487-492. [PMID: 36341961 PMCID: PMC9957899 DOI: 10.1177/07334648221137882] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Managing the complex care needs of seriously ill patients transitioning from hospital to home can have detrimental effects on family caregivers (FCG). Multi-component interventions tailored to FCG needs are most effective at reducing caregiver burden, distress, and depression. However, gaps exist in determining best methods to assess, document, and analyze intervention components for FCGs. Common methods used to capture patient data during transitions in care may not be appropriate or allowed for FCG needs. As such, we present a methodological approach for electronically capturing, reporting, and analyzing multiple intervention components. This approach uses a standardized terminology and pathway for tailoring intervention components in real time while evaluating intervention effects across time. We use examples from a randomized controlled trial to illustrate the benefits of the current approach for analyzing the effectiveness of multi-component interventions in the context of caregiving research.
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Affiliation(s)
- Joan M. Griffin
- Professor of Health Services Research, Division of Health Care Delivery Research (HCDR) and Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota,Corresponding and reprint request author: Joan M. Griffin, PhD, 200 1 Street SW, Rochester, MN 55905, , Phone: 507-538-1490, Fax: 507-284-1731
| | - Catherine E. Vanderboom
- Principal Health Services Analyst, Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | - Allison Gustavson
- Core Investigator, Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System and Assistant Professor, Department of Medicine, University of Minnesota
| | - Brystana G Kaufman
- Assistant Professor of Population Health Sciences, Duke University, Durham, North Carolina
| | - Cory Ingram
- Assistant Professor of Family Medicine and Palliative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ellen Wild
- Research Interventionist, Mayo Clinic, Rochester, Minnesota
| | - Ann Marie Dose
- Principal Health Services Analyst, Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | - Jay Mandrekar
- Professor, Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Diane E. Holland
- Principal Health Services Analyst, Health Services Research, Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
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Longacre ML, Miller MF, Fang CY. The psychometric properties of a caregiving-related strain scale in oncology. Qual Life Res 2023; 32:285-294. [PMID: 36053408 DOI: 10.1007/s11136-022-03235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Caregivers are rarely assessed for caregiving-related strain. This study explored the psychometric properties of the caregiving-related physical, emotional, and financial strain questions in the National Alliance for Caregiving's (NAC) survey and a new total score (NAC-3). METHODS Comparisons were made to existing caregiver quality of life, distress, and burden instruments through an online, cross-sectional survey of U.S. adult cancer caregivers. RESULTS Findings from 299 caregivers showed that the NAC-3 was moderately to strongly associated with each of the comparison instruments. Similar concepts were also shown to be more strongly correlated (except physical health construct) and dissimilar concepts items had weaker correlations. CONCLUSION Findings suggest that the total score and individual items are psychometrically sound for use as compared to established caregiving-related instruments. The total score and items provide a concise option, potentially beneficial for clinical use, and can be compared to nationally representative samples of caregivers through NAC's surveys.
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Affiliation(s)
- Margaret L Longacre
- Department of Public Health, College of Health Sciences, Arcadia University, 450 S. Easton Rd, Glenside, PA, USA.
| | - Melissa F Miller
- Department of Public Health, College of Health Sciences, Arcadia University, 450 S. Easton Rd, Glenside, PA, USA
| | - Carolyn Y Fang
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA, USA
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Family caregivers' perspectives on the acceptability of four interventions proposed for rural transitional care: A multi-method study. PLoS One 2022; 17:e0279187. [PMID: 36534678 PMCID: PMC9762580 DOI: 10.1371/journal.pone.0279187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is a critical need for hospital-to-home transitional care interventions to prepare family caregivers for patients' post-discharge care in rural communities. Four evidence-based interventions (named discharge planning, treatments, warning signs, and physical activity) have the potential to meet this need but family caregivers' perspectives on the acceptability of the interventions have not been examined. This gap is significant because unacceptable interventions are unlikely to be used or used as designed, thereby undermining outcome achievement. Accordingly, this study examined the perceived acceptability of the four interventions to rural family caregivers. MATERIALS AND METHODS A multi-method descriptive design was used. The quantitative method entailed the administration of an established scale to assess the interventions' perceived acceptability to family caregivers. The qualitative method involved semi-structured interviews to explore family caregivers' perceived acceptability of the interventions in greater depth, including acceptable and unacceptable aspects, in the context of their own transitional care experience. Participants were the family caregivers of a relative who had been discharged home in a rural community from an acute care hospital in Ontario, Canada. RESULTS The purposive sample included 16 participants who were mostly middle-aged women (n = 14; 87.5%) caring for a parent (n = 9; 56.3%) at high risk for hospital readmission. The mean scores on the acceptability measure were 3 or higher for all interventions, indicating that, on average, the four interventions were perceived as acceptable. In terms of acceptable aspects, four themes were identified: the interventions: 1) involve family caregivers and proactively prepare them for discharge, 2) provide clear, written, and detailed guidance, 3) place the onus on healthcare providers to initiate communication, and 4) ensure post-discharge follow-up. In terms of unacceptable aspects, one theme was identified: the physical activity intervention would be challenging to implement. DISCUSSION The findings support implementing the four interventions in practice throughout the hospital-to-home transition. Healthcare providers should assess family caregivers' comfort in participating in the physical activity intervention and tailor their role accordingly.
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Zheng Y, Anton B, Rodakowski J, Altieri Dunn SC, Fields B, Hodges JC, Donovan H, Feiler C, Martsolf G, Bilderback A, Martin SC, Li D, James AE. Associations Between Implementation of the Caregiver Advise Record Enable (CARE) Act and Health Service Utilization for Older Adults with Diabetes: Retrospective Observational Study. JMIR Aging 2022; 5:e32790. [PMID: 35727611 PMCID: PMC9257609 DOI: 10.2196/32790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/13/2022] [Accepted: 04/24/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The Caregiver Advise Record Enable (CARE) Act is a state level law that requires hospitals to identify and educate caregivers ("family members or friends") upon discharge. OBJECTIVE This study examined the association between the implementation of the CARE Act in a Pennsylvania health system and health service utilization (ie, reducing hospital readmission, emergency department [ED] visits, and mortality) for older adults with diabetes. METHODS The key elements of the CARE Act were implemented and applied to the patients discharged to home. The data between May and October 2017 were pulled from inpatient electronic health records. Likelihood-ratio chi-square tests and multivariate logistic regression models were used for statistical analysis. RESULTS The sample consisted of 2591 older inpatients with diabetes with a mean age of 74.6 (SD 7.1) years. Of the 2591 patients, 46.1% (n=1194) were female, 86.9% (n=2251) were White, 97.4% (n=2523) had type 2 diabetes, and 69.5% (n=1801) identified a caregiver. Of the 1801 caregivers identified, 399 (22.2%) received discharge education and training. We compared the differences in health service utilization between pre- and postimplementation of the CARE Act; however, no significance was found. No significant differences were detected from the bivariate analyses in any outcomes between individuals who identified a caregiver and those who declined to identify a caregiver. After adjusting for risk factors (multivariate analysis), those who identified a caregiver (12.2%, 219/1801) was associated with higher rates of 30-day hospital readmission than those who declined to identify a caregiver (9.9%, 78/790; odds ratio [OR] 1.38, 95% CI 1.04-1.87; P=.02). Significantly lower rates were detected in 7-day readmission (P=.02), as well as 7-day (P=.03) and 30-day (P=.01) ED visits, among patients with diabetes whose identified caregiver received education and training than those whose identified caregiver did not receive education and training in the bivariate analyses. However, after adjusting for risk factors, no significance was found in 7-day readmission (OR 0.53, 95% CI 0.27-1.05; P=.07), 7-day ED visit (OR 0.63, 95% CI 0.38-1.03; P=.07), and 30-day ED visit (OR 0.73, 95% CI 0.52-1.02; P=.07). No significant associations were found for other outcomes (ie, 30-day readmission and 7-day and 30-day mortality) in both the bivariate and multivariate analyses. CONCLUSIONS Our study found that the implementation of the CARE Act was associated with certain health service utilization. The identification of caregivers was associated with higher rates of 30-day hospital readmission in the multivariate analysis, whereas having identified caregivers who received discharge education was associated with lower rates of readmission and ED visit in the bivariate analysis.
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Affiliation(s)
- Yaguang Zheng
- Meyers College of Nursing, New York University, New York, NY, United States
| | - Bonnie Anton
- Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Juleen Rodakowski
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Beth Fields
- Department of Kinesiology, School of Education, University of Wisconsin-Madison, Madison, WI, United States
| | - Jacob C Hodges
- Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Heidi Donovan
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | | | - Grant Martsolf
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrew Bilderback
- Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Susan C Martin
- Wolff Center at University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Dan Li
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alton Everette James
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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Semere W, Cemballi AG, Schillinger D, Casillas A, Lemberg M, Lyles CR. "We need to bring them out from the shadows:" A qualitative study of safety net physician leaders' perspectives on caregivers. PATIENT EDUCATION AND COUNSELING 2022; 105:1663-1670. [PMID: 34756473 PMCID: PMC9033884 DOI: 10.1016/j.pec.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore physician leaders' perspectives on processes and priorities for engaging with caregivers in their clinical practices as well as within their safety net health systems. METHODS We conducted in-depth semi-structured interviews with primary care physicians in care management leadership at three California safety net health systems. Interviews explored physicians' experiences managing medically and socially complex patients with caregivers. Using thematic analysis, two qualitative researchers independently analyzed interview transcripts and established consensus with the broader research team through iterative input to derive major themes. RESULTS Fifteen physicians completed interviews. Nine participants were women, 8 were White and 10 reported Spanish language proficiency. Participant interviews generated six major themes: challenges uncovering caregiver identities, recognizing variation in caregivers' roles, adapting visit communication strategies to include caregivers, engaging caregivers in patient care, and caring for the caregiver. CONCLUSIONS Engaging caregivers is challenging given the limited recognition of caregiver involvement in patient care by health systems. Adapting visit communication to include caregivers requires bridging language and literacy barriers. PRACTICE IMPLICATIONS Developing mechanisms to enable the consistent identification of patients' caregivers, facilitate ongoing communication with caregivers, and extend support for them could improve outcomes for vulnerable patients and their families.
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Affiliation(s)
- Wagahta Semere
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA.
| | - Anupama G Cemballi
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Dean Schillinger
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Miya Lemberg
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
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Burgdorf JG, Wolff JL, Chase JA, Arbaje AI. Barriers and Facilitators to Family Caregiver Training during Home Health Care: A Multi-Site Qualitative Analysis. J Am Geriatr Soc 2022; 70:1325-1335. [PMID: 35323993 PMCID: PMC9106880 DOI: 10.1111/jgs.17762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/28/2022] [Accepted: 03/11/2022] [Indexed: 11/17/2022]
Abstract
Background During Medicare home health care (HHC), family caregiver assistance is often integral to implementing the care plan and avoiding readmission. Family caregiver training delivered by HHC clinicians (nurses and physical therapists [PTs]) helps ensure caregivers' ability to safely assist when HHC staff are not present. Yet, family caregiver training needs often go unmet during HHC, increasing the risk of adverse patient outcomes. There is a critical knowledge gap regarding challenges HHC clinicians face in providing necessary family caregiver training. Methods Multisite qualitative study using semi‐structured, in‐depth key informant interviews with Registered Nurses (n = 11) and PTs (n = 8) employed by four HHC agencies. Participating agencies were diverse in rurality, scale, ownership, and geographic region. Key informant interviews were audio‐recorded, transcribed, and analyzed using directed content analysis to identify existing facilitators and barriers to family caregiver training during HHC. Results Clinicians had an average of 9.3 years (range = 1.5–23 years) experience in HHC, an average age of 45.1 years (range = 28–63 years), and 95% were female. Clinicians identified facilitators and barriers to providing family caregiver training at the individual, interpersonal, and structural levels. The most salient factors included clinician–caregiver communication and rapport, accuracy of hospital discharge information, and access to resources such as additional visits and social work consultation. Clinicians noted the COVID‐19 pandemic introduced additional challenges to providing family caregiver training, including caregivers' reduced access to hospital staff prior to discharge. Conclusions HHC clinicians identified a range of barriers and facilitators to delivering family caregiver training during HHC; particularly highlighting the role of clinician–caregiver communication. To support caregiver training in this setting, there is a need for updated reimbursement structures supporting greater visit flexibility, improved discharge communication between hospital and HHC, and structured communication aids to facilitate caregiver engagement and assessment.
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Affiliation(s)
- Julia G Burgdorf
- Center for Home Care Policy & Research, Visiting Nurse Service of New York.,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
| | - Jo-Ana Chase
- Sinclair School of Nursing, University of Missouri
| | - Alicia I Arbaje
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine
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15
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Griffin JM, Riffin C, Bangerter LR, Schaepe K, Havyer RD. Provider Perspectives on Integrating Family Caregivers into Patient Care Encounters. Health Serv Res 2021; 57:892-904. [PMID: 34957543 PMCID: PMC9264458 DOI: 10.1111/1475-6773.13932] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/05/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine and compare healthcare provider perceptions for integrating family caregivers into patient encounters and other processes of care by medical specialty. DATA SOURCES/SETTING Data were from nineteen interviews conducted in 2018, ten with primary care or palliative care providers and nine with proceduralists or interventionists in practices located in Minnesota, Florida, and Arizona. STUDY DESIGN This was a qualitative study using data collected from one-on-one, semi-structured interviews with physicians. DATA COLLECTION Using purposeful 'maximum variation' sampling to capture differences between primary and palliative care providers and proceduralists/interventionists, data were collected, reviewed, coded, and then analyzed using inductive content analysis with a constant comparison approach. PRIMARY FINDINGS Primary care providers described a lack of organizational and institutional resources to support caregivers. Accordingly, they were compelled to curb caregiver engagement in order to meet patients' clinical care needs within the time and workflow demands in encounters. Proceduralists and interventionists described the need to assess caregivers for suitability to provide care during intense periods of treatment. They reported having access to more formal organizational resources for supporting caregivers. Overall, providers described a paradox, where caregivers are seen as contributing value to patient encounters until they need training, education, or support to provide care, at which point they become burdensome and require more time and resources than are typically available. CONCLUSIONS Results highlight how organizational constraints inhibit caregiver engagement in patient encounters and influence provider attitudes about engaging caregivers and assessing their unmet needs. Findings also provide insights into challenges across practice types for implementing state and federal laws that promote caregiver engagement. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Joan M Griffin
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
| | - Catherine Riffin
- Weill Cornell Medicine, 420 East 70th Street, 3rd Floor (LH-317), New York, New York, United States
| | | | - Karen Schaepe
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
| | - Rachel D Havyer
- Mayo Clinic, 200 First Avenue SW, Rochester, Minnesota, United States
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16
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Sokas CM, Hu FY, Dalton MK, Jarman MP, Bernacki RE, Bader A, Rosenthal RA, Cooper Z. Understanding the role of informal caregivers in postoperative care transitions for older patients. J Am Geriatr Soc 2021; 70:208-217. [PMID: 34668189 DOI: 10.1111/jgs.17507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/18/2021] [Accepted: 09/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Older adults may have new care needs and functional limitations after surgery. Many rely on informal caregivers (unpaid family or friends) after discharge but the extent of informal support is unknown. We sought to examine the role of informal postoperative caregiving on transitions of care for older adults undergoing routine surgical procedures. MATERIALS AND METHODS We performed a retrospective cohort study using ACS NSQIP Geriatric Pilot Project data, 2014-2018. Patients were ≥65 years and underwent an inpatient surgical procedure. Patients who lived at home alone were compared with those who lived with support from informal caregivers (family and/or friends). Primary outcomes were discharge destination (home vs. post-acute care) and readmission within 30 days. Multivariable logistic regression was used to determine the association between support at home, discharge destination, and readmission. RESULTS Of 18,494 patients, 25% lived alone before surgery. There was no difference in loss of independence (decline in functional status or new use of mobility aid) after surgery between patients who lived alone or with others (18.7% vs. 19.5%, p = 0.24). Nevertheless, twice as many patients who lived alone were discharged to a non-home location (10.2% vs. 5.1%; OR: 2.24, CI: 1.93-2.56). Patients who lived alone and were discharged home with new informal caregivers had increased odds of readmission (OR: 1.43, CI: 1.09-1.86). CONCLUSION Living alone independently predicts discharge to post-acute care, and patients who received new informal caregiver support at home have higher odds of readmission. These findings highlight opportunities to improve discharge planning and care.
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Affiliation(s)
- Claire M Sokas
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Frances Y Hu
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Michael K Dalton
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Molly P Jarman
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA
| | - Rachelle E Bernacki
- Department of Medicine, Division of Palliative Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Angela Bader
- Department of Anesthesia, Brigham & Women's Hospital, Boston, Massachusetts, USA
| | | | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Woman's Hospital, Boston, Massachusetts, USA.,Department of Surgery, Brigham and Woman's Hospital, Boston, Massachusetts, USA
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17
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Longacre ML, Weber-Raley L, Kent EE. Toward Engaging Caregivers: Inclusion in Care and Receipt of Information and Training among Caregivers for Cancer Patients Who Have Been Hospitalized. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:611-620. [PMID: 31898180 DOI: 10.1007/s13187-019-01673-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Practice recommendations and policies (e.g., CARE Act) emphasize identifying and training a family caregiver during a patient's hospitalization, but engagement of caregivers is not standard in the USA. To inform caregiver engagement, we highlight (1) the frequency of cancer patient hospitalizations as well as (2) the caregiving characteristics and perceptions of inclusion in care and receipt of training among caregivers for patients who had been hospitalized. To further highlight this group of cancer caregivers, we compare to (1) cancer caregivers for patients who had not been hospitalized; (2) caregivers for patients with a primary condition other than cancer who had been hospitalized; and (3) caregivers for patients with a primary condition other than cancer who had not been hospitalized This secondary analysis is drawn from the National Alliance for Caregiving's (NAC)/AARP Caregiving in the US dataset of unpaid adult (i.e., age 18 and older) caregivers. A higher percentage of the cancer caregivers compared to non-cancer caregivers reported multiple hospitalizations for their care recipient over the previous year. Many cancer caregivers for patients who had been hospitalized reported high objective burden (68%) and that caregiving was highly stressful (49%). A majority of these caregivers (60%) indicated that a healthcare provider had asked them what they needed to assist the patient, while fewer (34%) were asked about their needs to take care of themselves, which, though low, was significantly higher compared to caregivers of patients with a primary condition other than cancer that had been hospitalized. The most frequently endorsed training method for the cancer caregivers of patients who had been hospitalized was "being shown how to do a skill by a qualified person" (67%) followed by "performing a skill while a qualified person watches" (57%). Findings suggest that the oncology context might be more advanced in terms of engaging and supporting caregivers, but that improvement is still needed. Furthermore, these findings identify preferred training methods among those who have been in the hospital context as a caregiver.
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Affiliation(s)
- M L Longacre
- Department of Public Health, College of Health Sciences, Arcadia University, Brubaker Hall 214, 450 S. Easton Rd, Glenside, PA, 19038, USA.
| | | | - E E Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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18
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Burgdorf JG, Fabius CD, Riffin C, Wolff JL. Receipt of Posthospitalization Care Training Among Medicare Beneficiaries' Family Caregivers. JAMA Netw Open 2021; 4:e211806. [PMID: 33724393 PMCID: PMC7967076 DOI: 10.1001/jamanetworkopen.2021.1806] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/23/2021] [Indexed: 01/25/2023] Open
Abstract
Importance Medicare conditions of participation require hospitals to provide training to family and unpaid caregivers when their support is necessary to enact the postdischarge care plan. However, caregivers often report feeling unprepared for this role. Objective To describe the characteristics of caregivers who assist with posthospitalization care transitions and assess the prevalence of and factors associated with receipt of adequate transitional care training. Design, Setting, and Participants This cross-sectional study analyzed data from the 2017 National Health and Aging Trends Study and its linked National Study of Caregiving, surveys of Medicare beneficiaries and their family and unpaid caregivers. The present study included family caregivers for community-living Medicare beneficiaries 65 years or older with disabilities. Data analysis was performed from June to September 2020. Main Outcomes and Measures Characteristics of family caregivers by whether they assisted during a posthospitalization care transition in the year preceding the survey interview. Unweighted frequencies and weighted percentages, as well as the results of weighted Pearson and Wald tests for differences between groups, are reported. Receipt of the training needed to manage the older adult's posthospitalization care transition (hereafter referred to as adequate transitional care training) as a function of individual caregiver characteristics was modeled using multivariable, weighted logistic regression. Results Of 1905 family caregivers, 618 (58.9%) were 60 years or older, 1288 (63.8%) were female, and 796 (41.7%) assisted with a posthospitalization care transition. Those who assisted with a posthospitalization care transition were more likely to report experiencing financial (154 [18.3%] vs 123 [10.1%]; P < .001), emotional (344 [41.3%] vs 342 [31.1%]; P < .001), and physical (200 [22.2%] vs 170 [14.6%]; P = .001) difficulty associated with caregiving. Among caregivers who assisted during a posthospitalization care transition, 490 (59.1%) reported receiving adequate transitional care training. Caregivers were less likely to report receiving adequate training if they assisted an older adult who was female (316 [62.3%] vs 227 [73.2%]; P = .02), Black (163 [14.0%] vs 121 [19.8%]; P = .02), or enrolled in Medicaid (127 [21.2%] vs 90 [31.9%]; P = .01). After adjusting for older adult characteristics, caregivers were half as likely to report receiving adequate training if they were Black (adjusted odds ratio [aOR], 0.52; 95% CI, 0.31-0.89) or experienced financial difficulty (aOR, 0.50; 95% CI, 0.31-0.81). Caregivers were more than twice as likely to report receiving adequate training if they were female (aOR, 2.44; 95% CI, 1.65-3.61) or spoke with the older adult's clinician about his or her care in the past year sometimes or often vs never (aOR, 1.93; 95% CI, 1.19-3.12). Conclusions and Relevance In this cross-sectional study, caregivers were less likely to receive adequate transitional care training if they were Black; experienced financial difficulty; or cared for a Black, female, or Medicaid-enrolled older adult. These findings suggest that changes to the discharge process, such as using standardized caregiver assessments, may be necessary to ensure equitable support of family caregivers.
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Affiliation(s)
- Julia G. Burgdorf
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Chanee D. Fabius
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Catherine Riffin
- Department of Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Jennifer L. Wolff
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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19
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Longacre ML, Keleher C, Chwistek M, Odelberg M, Siemon M, Collins M, Fang CY. Developing an Integrated Caregiver Patient-Portal System. Healthcare (Basel) 2021; 9:193. [PMID: 33578838 PMCID: PMC7916542 DOI: 10.3390/healthcare9020193] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/19/2021] [Accepted: 02/05/2021] [Indexed: 01/05/2023] Open
Abstract
We have developed an integrated caregiver patient-portal system (i.e., patient-caregiver portal) that (1) allows a patient to identify their primary caregiver and their communication preferences with that caregiver in the healthcare setting; (2) connects the caregiver to a unique portal page to indicate their needs; and (3) informs the healthcare team of patient and caregiver responses to aid in integrating the caregiver. The purpose of this manuscript is to report on the formative phases (Phases I and II) of system development. Phase I involved a pre-assessment to anticipate complexity or barriers in the system design and future implementation. We used the non-adaption, abandonment, scale-up, spread, and sustainability (NASSS) framework and rubric to conduct this pre-assessment. Phase II involved exploring reactions (i.e., concerns or benefits) to the system among a small sample of stakeholders (i.e., 5 palliative oncology patients and their caregivers, N = 10). The purpose of these two phases was to identify system changes prior to conducting usability testing among patient/caregiver dyads in palliative oncology (phase III). Completion of the NASSS rubric highlighted potential implementation barriers, such as the non-uniformity of caregiving, disparities in portal use, and a lack of cost-benefit (value) findings in the literature. The dyads' feedback reinforced several NASSS ratings, including the benefits of connecting caregivers and allowing for caregiver voice as well as the concerns of limited use of patient-portals by the patients (but not the caregivers) and the need for user assistance during stressful health events. One change that resulted from this analysis was ensuring that we provided research participants (users) with detailed guidance and support on how to log in and use a patient-caregiver portal. In future iterations, we will also consider allowing more than one caregiver to be included and incorporating additional strategies to enable caregivers to interact in the system as part of the care team (e.g., via email).
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Affiliation(s)
- Margaret L. Longacre
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038, USA;
| | - Cynthia Keleher
- Fox Chase Cancer Center, Web Technologies Department, Philadelphia, PA 19111, USA; (C.K.); (M.S.)
| | - Marcin Chwistek
- Fox Chase Cancer Center, Supportive Oncology and Palliative Care Program, Philadelphia, PA 19111, USA; (M.C.); (M.C.)
| | - Michelle Odelberg
- Department of Public Health, College of Health Sciences, Arcadia University, Glenside, PA 19038, USA;
| | - Mark Siemon
- Fox Chase Cancer Center, Web Technologies Department, Philadelphia, PA 19111, USA; (C.K.); (M.S.)
| | - Molly Collins
- Fox Chase Cancer Center, Supportive Oncology and Palliative Care Program, Philadelphia, PA 19111, USA; (M.C.); (M.C.)
| | - Carolyn Y. Fang
- Fox Chase Cancer Center, Cancer Prevention and Control Program, Philadelphia, PA 19111, USA;
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20
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Longacre ML, Miller MF, Fang CY. Racial and ethnic variations in caregiving-related physical, emotional, and financial strain during COVID-19 among those caring for adult cancer patients. Support Care Cancer 2021; 29:4137-4146. [PMID: 33404809 PMCID: PMC7785926 DOI: 10.1007/s00520-020-05933-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/03/2020] [Indexed: 11/16/2022]
Abstract
Purpose Cancer caregiving is shown to be a burdensome experience in typical times. The purpose of this study was to describe cancer caregivers’ emotional, physical, and financial strain during the COVID-19 pandemic and compared to preCOVID-19, and explore racial and ethnic variations in caregiver strain. Methods We conducted a cross-sectional online survey using Lucid, LLC, incorporating quotas for race, ethnicity, gender and age. Caregivers had to be adults living in the USA and currently providing unpaid care to an adult cancer patient (i.e., during COVID-19) and prior to the pandemic. We assessed the caregivers’ emotional, physical, and financial strain and asked them to compare to preCOVID-19 caregiving. Analyses included descriptive and linear regression adjusting for sociodemographic and caregiving-related variables. Results A total of 285 caregivers met eligibility, and most were nonHispanic white (72.3%) and female (59.6%). Based on a scale of “1: Much lower” to “5: Much higher”, the financial, physical and emotional strain/stress experienced by caregivers compared to preCOVID-19 was, on average, 3.52 (SD: 0.82; range: 1–5) for financial strain, 3.61 (SD: 0.86; range: 1–5) for physical strain, and 3.88 (SD: 0.89; range: 1–5) for emotional stress. NonHispanic black caregivers were significantly more likely than nonHispanic white caregivers to indicate that caregiving-related financial strain was higher than preCOVID-19. Moreover, Hispanic caregivers compared to nonHispanic white caregivers reported caregiving-related emotional stress was higher than preCOVID-19. Conclusion These findings suggest a need to be attentive to racial and ethnic variations in emotional and financial strain and provide targeted support in clinical care and via public policy during a public health crisis.
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Affiliation(s)
- Margaret L Longacre
- Department of Public Health, College of Health Sciences, Arcadia University, 214 Brubaker Hall, 450S. Easton Rd., Glenside, PA, 19038, USA.
| | - Melissa F Miller
- Department of Public Health, College of Health Sciences, Arcadia University, 214 Brubaker Hall, 450S. Easton Rd., Glenside, PA, 19038, USA
| | - Carolyn Y Fang
- Fox Chase Cancer Center, Cancer Prevention and Control Program, Philadelphia, PA, USA
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21
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Shang J, Wang J, Adams V, Ma C. Risk factors for infection in home health care: Analysis of national Outcome and Assessment Information Set data. Res Nurs Health 2020; 43:373-386. [PMID: 32652615 DOI: 10.1002/nur.22053] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/21/2020] [Accepted: 06/23/2020] [Indexed: 11/06/2022]
Abstract
Patients in home health care (HHC), a rapidly growing healthcare sector, are at high risk for infections. This study aimed to identify risk factors for infections among HHC patients using the Outcome and Assessment Information Set (OASIS) data. We used a 5% random sample of the 2013 national OASIS data. Infections were identified if records indicated that patients were hospitalized or received emergency care for one of three types of infections (respiratory, wound site, and urinary tract infection). Multivariate logistic regression models were used to identify risk factors for each individual infection type. The final analysis included 128,163 patients from 8,255 HHC agencies nationwide. Approximately 3.2% of the patients developed infections during their HHC stay that led to hospitalization or emergency care treatment. We found that associations between demographics and infection risk are specific to the type of infection. In general, a history of multiple hospitalizations in past 6 months, comorbidity, having a severe condition at HHC admission, and impaired physical functioning increased HHC patients' risk of infections. We also identified that HHC patients with caregivers who needed training in providing medical procedure or treatment are at higher risk for wound-site infections. Our findings suggest that patients with underlying medical conditions and limited physical function status are more likely to develop infection. The caregiver's lack of training in providing needed care at home also places HHC patients at high risk for infection. Education for patients and caregivers should be tailored based on their health literacy level to ensure complete understanding.
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Affiliation(s)
- Jingjing Shang
- School of Nursing, Columbia University, New York City, New York
| | - Jinjiao Wang
- School of Nursing, University of Rochester, Rochester, New York
| | - Victoria Adams
- Infection Prevention and Control, Visiting Nurse Service of New York, New York City, New York
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, New York City, New York
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22
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Burgdorf JG, Arbaje AI, Wolff JL. Training Needs Among Family Caregivers Assisting During Home Health, as Identified by Home Health Clinicians. J Am Med Dir Assoc 2020; 21:1914-1919. [PMID: 32641271 DOI: 10.1016/j.jamda.2020.05.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To estimate the proportion of family caregivers assisting older adults during Medicare home health who have an identified need for activity-specific training and identify characteristics associated with caregiver training needs. DESIGN Nationally representative retrospective cohort study. SETTING AND PARTICIPANTS 1758 (weighted n = 8,477,990) Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) and received Medicare-funded home health care between 2011 and 2016. MEASURES Older adult and caregiving network characteristics before home health (sociodemographic factors, caregiver assistance, older adult health and function) were drawn from NHATS; characteristics during home health (family caregiver training needs, older adult health and function) were drawn from home health patient assessments. Weighted proportions of family caregivers with an identified need for activity-specific training were estimated. Weighted, multivariable logistic regressions modeled associations between older adult/caregiving network characteristics and family caregivers' identified activity-specific training needs during home health. RESULTS More than 1 in 3 (35.7%) family caregivers assisting older adults during Medicare home health had an identified training need with at least 1 caregiving activity. Rates of need for training varied widely, from 8.6% among caregivers helping with advocacy to 48.2% among caregivers helping with medical procedures. In weighted analyses that adjusted for older adults' health and function, family caregivers were less likely to have identified training needs when assisting older adults with ongoing disability or who received caregiver assistance before home health admission. CONCLUSIONS AND IMPLICATIONS Findings highlight the pervasiveness of family caregivers' training needs, particularly with medically oriented activities, and indicate that escalations in older adults' care needs are linked to caregiver training needs. Therefore, transitions of care may present critical opportunities to connect family caregivers with training resources.
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Affiliation(s)
- Julia G Burgdorf
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Alicia I Arbaje
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA; Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Armstrong Institute Center for Health Care Human Factors, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
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23
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Leighton C, Fields B, Rodakowski JL, Feiler C, Hawk M, Bellon JE, James AE. A Multisite Case Study of Caregiver Advise, Record, Enable Act Implementation. THE GERONTOLOGIST 2020; 60:776-786. [PMID: 30726908 DOI: 10.1093/geront/gnz011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The Commonwealth of Pennsylvania passed the Caregiver Advise, Record, Enable (CARE) Act on April 20, 2016. We designed a study to explore early implementation at a large, integrated delivery financing system. Our goal was to assess the effects of system-level decisions on unit implementation and the incorporation of the CARE Act's three components into routine care delivery. RESEARCH DESIGN AND METHODS We conducted a multisite, ethnographic case study at three different hospitals' medical-surgical units. We conducted observations and semi-structured interview to understand the implementation process and the approach to caregiver identification, notification, and education. We used thematic analysis to code interviews and observations and linked findings to the Promoting Action on Research Implementation in Health Services framework. RESULTS Organizational context and electronic health record capability were instrumental to the CARE Act implementation and integration into workflow. The implementation team used a decentralized strategy and a variety of communication modes, relying on local hospital units to train staff and make the changes. We found that the system facilitated the CARE Act implementation by placing emphasis on the documentation and charting to demonstrate compliance with the legal requirements. DISCUSSION AND IMPLICATIONS General acute hospitals will be making or have made similar decisions on how to operationalize the regulatory components and demonstrate compliance with the CARE Act. This study can help to inform others as they design and improve their compliance and implementation strategies.
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Affiliation(s)
- Cassandra Leighton
- Department of Health Policy and Management, University of Pittsburgh, Pennsylvania
- Health Policy Institute, University of Pittsburgh, Pennsylvania
| | - Beth Fields
- Health Policy Institute, University of Pittsburgh, Pennsylvania
- Center for Health Equity and Research Promotion, Pittsburgh, Pennsylvania
| | - Juleen L Rodakowski
- Department of Occupational Therapy, University of Pittsburgh, Pennsylvania
- Clinical and Translational Science Institute, University of Pittsburgh, Pennsylvania
| | | | - Mary Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pennsylvania
| | | | - A Everette James
- Department of Health Policy and Management, University of Pittsburgh, Pennsylvania
- Health Policy Institute, University of Pittsburgh, Pennsylvania
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24
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Jain B, Syed S, Hafford-Letchfield T, O'Farrell-Pearce S. Dog-assisted interventions and outcomes for older adults in residential long-term care facilities: A systematic review and meta-analysis. Int J Older People Nurs 2020; 15:e12320. [PMID: 32394594 DOI: 10.1111/opn.12320] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To comprehensively review studies on dog-assisted interventions (DAIs) among older people in residential long-term care facilities (RLTCFs) and to provide an overview of their interventions, outcomes and methodological quality. METHOD We searched 18 electronic databases to identify English articles (published January 2000-December 2019) reporting on well-defined DAIs targeting older adults (≥65 years) in RLTCF. Data were extracted by two independent reviewers. Descriptive statistics were produced for quantitative studies, with key themes identified among qualitative studies. Where possible, estimates were pooled from randomised controlled trials using random effects meta-analyses. RESULTS Forty-three relevant studies (39 quantitative; 4 qualitative) were identified. The majority of quantitative studies were assessed as low-quality according to the MMAT criteria (n = 26, 67%). Almost half of the quantitative studies (n = 18, 46%) found no significant changes over time or between groups across outcomes measured. The most salient intervention effects included improved social functioning (n = 10), reduced depressive symptoms (n = 6) and loneliness (n = 5). A random-effects meta-analysis revealed a medium effect in favour of DAT on reducing depressive or loneliness symptoms (pooled SMD: 0.66, 95%CI 0.21-1.11; I2 = 50.5; five trials), relative to treatment as usual. However, compared to treatment as usual, no overall effect of DAI on activities of daily living was detected (p = .737). Key themes from qualitative studies included (a) animals as effective transitional objects, (b) the therapeutic value of pets and (c) the significance of the care environment and stakeholders in facilitating DAI. IMPLICATIONS FOR PRACTICE The findings of this review indicate that while DAI has value for older people in RLTCF, challenges remain in accurately measuring its impact to provide a stronger evidence-base. Standardisation of DAI service design, delivery and evaluation is required for future research and practice in providing holistic care for older adults.
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Affiliation(s)
- Briony Jain
- Department of Mental Health and Social Work, Middlesex University, London, UK
| | - Shabeer Syed
- Department of Mental Health and Social Work, Middlesex University, London, UK
| | - Trish Hafford-Letchfield
- Department of Mental Health and Social Work, Middlesex University, London, UK.,School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
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Fuller TE, Pong DD, Piniella N, Pardo M, Bessa N, Yoon C, Boxer RB, Schnipper JL, Dalal AK. Interactive Digital Health Tools to Engage Patients and Caregivers in Discharge Preparation: Implementation Study. J Med Internet Res 2020; 22:e15573. [PMID: 32343248 PMCID: PMC7218608 DOI: 10.2196/15573] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/16/2019] [Accepted: 02/04/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Poor discharge preparation during hospitalization may lead to adverse events after discharge. Checklists and videos that systematically engage patients in preparing for discharge have the potential to improve safety, especially when integrated into clinician workflow via the electronic health record (EHR). OBJECTIVE This study aims to evaluate the implementation of a suite of digital health tools integrated with the EHR to engage hospitalized patients, caregivers, and their care team in preparing for discharge. METHODS We used the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify pertinent research questions related to implementation. We iteratively refined patient and clinician-facing intervention components using a participatory process involving end users and institutional stakeholders. The intervention was implemented at a large academic medical center from December 2017 to July 2018. Patients who agreed to participate were coached to watch a discharge video, complete a checklist assessing discharge readiness, and request postdischarge text messaging with a physician 24 to 48 hours before their expected discharge date, which was displayed via a patient portal and bedside display. Clinicians could view concerns reported by patients based on their checklist responses in real time via a safety dashboard integrated with the EHR and choose to open a secure messaging thread with the patient for up to 7 days after discharge. We used mixed methods to evaluate our implementation experience. RESULTS Of 752 patient admissions, 510 (67.8%) patients or caregivers participated: 416 (55.3%) watched the video and completed the checklist, and 94 (12.5%) completed the checklist alone. On average, 4.24 concerns were reported per each of the 510 checklist submissions, most commonly about medications (664/2164, 30.7%) and follow-up (656/2164, 30.3%). Of the 510 completed checklists, a member of the care team accessed the safety dashboard to view 210 (41.2%) patient-reported concerns. For 422 patient admissions where postdischarge messaging was available, 141 (33.4%) patients requested this service; of these, a physician initiated secure messaging for 3 (2.1%) discharges. Most patient survey participants perceived that the intervention promoted self-management and communication with their care team. Patient interview participants endorsed gaps in communication with their care team and thought that the video and checklist would be useful closer toward discharge. Clinicians participating in focus groups perceived the value for patients but suggested that low awareness and variable workflow regarding the intervention, lack of technical optimization, and inconsistent clinician leadership limited the use of clinician-facing components. CONCLUSIONS A suite of EHR-integrated digital health tools to engage patients, caregivers, and clinicians in discharge preparation during hospitalization was feasible, acceptable, and valuable; however, important challenges were identified during implementation. We offer strategies to address implementation barriers and promote adoption of these tools. TRIAL REGISTRATION ClinicalTrials.gov NCT03116074; https://clinicaltrials.gov/ct2/show/NCT03116074.
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Affiliation(s)
| | - Denise D Pong
- Brigham and Women's Hospital, Boston, MA, United States
| | | | - Michael Pardo
- Brigham and Women's Hospital, Boston, MA, United States
| | - Nathaniel Bessa
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | - Robert B Boxer
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Jeffrey Lawrence Schnipper
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Anuj K Dalal
- Brigham and Women's Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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Decreasing Heart Failure Readmissions Among Older Patients With Cognitive Impairment by Engaging Caregivers. J Cardiovasc Nurs 2020; 35:253-261. [DOI: 10.1097/jcn.0000000000000670] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Green YS, Hajduk AM, Song X, Krumholz HM, Sinha SK, Chaudhry SI. Usefulness of Social Support in Older Adults After Hospitalization for Acute Myocardial Infarction (from the SILVER-AMI Study). Am J Cardiol 2020; 125:313-319. [PMID: 31787249 DOI: 10.1016/j.amjcard.2019.10.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 01/14/2023]
Abstract
The availability of social support is associated with health outcomes after acute myocardial infarction (AMI), yet previous studies have largely considered social support as a single entity, rather than examining its discrete domains. Furthermore, few studies have investigated the impact of social support in older AMI patients, in whom it may be especially important. We aimed to determine the associations between 5 discrete domains of social support - emotional support, informational support, tangible support, positive social interaction, and affectionate support - with 6-month readmission and mortality in older patients hospitalized for AMI, adjusting for known predictors of post-AMI outcomes. Three thousand six participants 75 years and older were recruited from a network of 94 hospitals across the United States. A 5-item version of the Medical Outcomes Study Social Support Survey was used to measure perceived social support, and readmission and mortality were ascertained 6 months after initial hospitalization. Independent associations were determined using multivariable regression. Among 3,006 participants, mean age was 82 years, 44% were female, and 11% non-white. Participants who were female, non-white, less educated, and lived alone tended to report lower social support. In multivariable analyses, low informational support was associated with readmission (odds ratio 1.22; 95% confidence interval 1.01 to 1.47), and low emotional support with mortality (odds ratio 1.43; 95% confidence interval 1.04 to 1.97). In conclusion, individual domains of social support had distinct, independent associations with post-AMI outcomes, lending a more nuanced and precise understanding of this important social determinant of health. Understanding these distinct associations can inform the development of interventions and policies to improve post-AMI outcomes.
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Affiliation(s)
- Yaakov S Green
- Yale University School of Medicine, New Haven, Connecticut
| | - Alexandra M Hajduk
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
| | - Xuemei Song
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Samir K Sinha
- Departments of Medicine, Family and Community Medicine, Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarwat I Chaudhry
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut
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28
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Where are the family caregivers? Finding family caregiver-related content in foundational nursing documents. J Prof Nurs 2020; 36:76-84. [DOI: 10.1016/j.profnurs.2019.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 05/13/2019] [Accepted: 06/03/2019] [Indexed: 11/21/2022]
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Burgdorf J, Arbaje A, Wolff JL. Older Adult Factors Associated With Identified Need for Family Caregiver Assistance During Home Health Care. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2019. [DOI: 10.1177/1084822319876608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Family caregivers make important contributions to home health care for older adults, but knowledge of the specific roles they assume is lacking. We analyzed data from 1,758 community-dwelling Medicare beneficiaries aged 65+ receiving Medicare-funded home health care between 2011 and 2016, using linked National Health and Aging Trends Study and Outcomes and Assessment Information Set data. Most (86.7%) beneficiaries receiving home health care had an identified need for family caregiver assistance, and nearly 6 in 10 (57.9%) had identified need for caregiver assistance with five or more tasks. After examining significant associations between older adult characteristics and identified needs for caregiver assistance with specific tasks, we identified three profiles of older adults who demonstrate similar patterns of identified need for family caregiver assistance during home health. These profiles include: (1) older adults with greater functional impairment who more often had identified need for assistance with Instrumental Activities of Daily Living, advocacy, or Activities of Daily Living; (2) older adults with cognitive impairment who more often had identified need for assistance with medication administration or supervision; and (3) older adults with greater clinical severity who more often had identified need for assistance with medical procedures and equipment. Findings support calls to develop training interventions and strengthen the partnership between home health providers and family caregivers. These three profiles present a potential framework for the development of family caregiver training programs.
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Affiliation(s)
- Julia Burgdorf
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alicia Arbaje
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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30
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Nadig NR, Sterba KR, Johnson EE, Goodwin AJ, Ford DW. Inter-ICU transfer of patients with ventilator dependent respiratory failure: Qualitative analysis of family and physician perspectives. PATIENT EDUCATION AND COUNSELING 2019; 102:1703-1710. [PMID: 30979579 DOI: 10.1016/j.pec.2019.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 04/01/2019] [Accepted: 04/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Ventilator dependent respiratory failure (VDRF) patients are seriously ill and often transferred between ICUs. Our objective was to obtain multi-stakeholder insights into the experiences of families during inter-ICU transfer. METHODS We conducted a qualitative study using semi-structured interviews with family members of VDRF patients as well as clinicians that have received or transferred VDRF patients to our hospital. Interviews were transcribed and template analysis was used to identify themes within/across stakeholder groups. RESULTS Patient, family, clinician and systems-level factors were identified as key themes during inter-ICU transfer. The main findings highlight that family members were rarely engaged in the decision to transfer as well as a lack of standardized communication between clinicians during care transitions. Family members were reassured with the care after transfer in spite of practical and financial challenges. Clinicians acknowledged the lack of a systematic approach for meeting the needs of families and suggested various resources. CONCLUSIONS This is one of the first qualitative studies to gather a multi-stakeholder perspective and identify problems faced by families during inter-ICU transfer of VDRF patients. PRACTICE IMPLICATIONS Our results provide a starting point for the development of family-centered support interventions which will need to be tested in future studies.
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Affiliation(s)
- Nandita R Nadig
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 96 Jonathan Lucas Dr., Suite 816 CSB, Charleston, SC, 29425, USA.
| | - Katherine R Sterba
- Department of Public Health Sciences, Medical University of South Carolina, 135 Cannon Street, Suite 303 MSC 835, Charleston, SC, 29425, USA.
| | - Emily E Johnson
- College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA.
| | - Andrew J Goodwin
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 96 Jonathan Lucas Dr., Suite 816 CSB, Charleston, SC, 29425, USA.
| | - Dee W Ford
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 96 Jonathan Lucas Dr., Suite 816 CSB, Charleston, SC, 29425, USA.
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Flint LA, David D, Lynn J, Smith AK. Rehabbed to Death: Breaking the Cycle. J Am Geriatr Soc 2019; 67:2398-2401. [DOI: 10.1111/jgs.16128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/13/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Lynn A. Flint
- School of Medicine University of California, San Francisco San Francisco California
- Department of Geriatrics, Palliative and Extended Care, San Francisco VA Medical Center San Francisco California
| | - Daniel David
- New York University, Rory Meyers School of Nursing New York New York
| | - Joanne Lynn
- Center for Appropriate Care Altarum Washington DC
| | - Alexander K. Smith
- School of Medicine University of California, San Francisco San Francisco California
- Department of Geriatrics, Palliative and Extended Care, San Francisco VA Medical Center San Francisco California
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Chase JAD, Russell D, Rice M, Abbott C, Bowles KH, Mehr DR. Caregivers' Experiences Regarding Training and Support in the Post-Acute Home Health-Care Setting. J Patient Exp 2019; 7:561-569. [PMID: 33062879 PMCID: PMC7534114 DOI: 10.1177/2374373519869156] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Post-acute home health-care (HHC) services provide a unique opportunity to train and support family caregivers of older adults returning home after a hospitalization. To enhance family-focused training and support strategies, we must first understand caregivers’ experiences. Objective: To explore caregivers’ experiences regarding training and support for managing older adults’ physical functioning (PF) needs in the post-acute HHC setting. Method: We conducted a qualitative descriptive study using semi-structured telephone interviews of 20 family caregivers. Interviews were recorded, transcribed, and analyzed using conventional content analysis. Results: We identified the following primary categories: facilitators to learning (eg, past experience, learning methods), barriers to learning (eg, learning on their own, communication, timing/logistics, preferred information and timing of information delivery), and interactions with HHC providers (eg, positive/negative interactions, provider training and knowledge). Conclusion: Caregivers were responsive to learning strategies to manage older adults’ PF needs and, importantly, voiced ideas to improve family-focused training and support. HHC providers can use these findings to tailor training and support of family caregivers in the post-acute HHC setting.
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Affiliation(s)
- Jo-Ana D Chase
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - David Russell
- Department of Sociology, Appalachian State University, Boone, NC, USA.,Center for Home Care Policy & Research, Visiting Nurse Service of New York, New York, NY, USA
| | - Meridith Rice
- Sinclair School of Nursing, University of Missouri, Columbia, MO, USA
| | - Carmen Abbott
- Department of Physical Therapy, University of Missouri, Columbia, MO, USA
| | - Kathryn H Bowles
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - David R Mehr
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, USA
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Mazanec SR, Reichlin D, Gittleman H, Daly BJ. Perceived Needs, Preparedness, and Emotional Distress of Male Caregivers of Postsurgical Women With Gynecologic Cancer. Oncol Nurs Forum 2019; 45:197-205. [PMID: 29466348 DOI: 10.1188/18.onf.197-205] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe the perceived needs, preparedness, and emotional distress of male caregivers of postsurgical patients with gynecologic cancer during the transition from hospital to home.
. SAMPLE & SETTING 50 male caregivers of patients with gynecologic cancer on an inpatient unit at University Hospitals Seidman Cancer Center in Cleveland, OH.
. METHODS & VARIABLES Caregiver needs, perceived preparedness, and emotional distress were measured at admission and at one week postdischarge. Instruments included the Comprehensive Needs Assessment Tool for Cancer Caregivers, Preparedness for Caregiving Scale, and National Comprehensive Cancer Network Distress Thermometer. The analysis consisted of descriptive statistics, Spearman's correlations, and univariate linear regressions.
. RESULTS At both time points, male caregivers' greatest needs were interaction with the healthcare staff and information. Perceived preparedness was not associated with emotional distress. Male caregivers who were young, were employed, were unmarried, and had a lower income had greater needs.
. IMPLICATIONS FOR NURSING A relational nursing care approach that maintains effective communication with male caregivers is essential. Nurses should broaden the caregiver assessment beyond the practical care of the patient.
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Affiliation(s)
- Susan R Mazanec
- Frances Payne Bolton School of Nursing, Case Western Reserve University (CWRU)
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34
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Bangerter LR, Fadel M, Riffin C, Splaine M. The Older Americans Act and Family Caregiving: Perspectives from Federal and State Levels. THE PUBLIC POLICY AND AGING REPORT 2019; 29:62-66. [PMID: 31205404 DOI: 10.1093/ppar/prz006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Lauren R Bangerter
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Rochester, MN
| | - Meghan Fadel
- Bureau of Community Integration and Alzheimer's Disease, Division of Long Term Care, New York State Department of Health Office of Health Insurance Programs, Albany
| | - Catherine Riffin
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY
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Wolff JL, Mulcahy J, Huang J, Roth DL, Covinsky K, Kasper JD. Family Caregivers of Older Adults, 1999-2015: Trends in Characteristics, Circumstances, and Role-Related Appraisal. THE GERONTOLOGIST 2019. [PMID: 28637266 DOI: 10.1093/geront/gnx093] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose of Study To assess trends in family caregiving between 1999 and 2015. Design and Methods We construct nationally representative profiles of community-dwelling older adults receiving help with self-care or indoor mobility and their "primary" family or unpaid caregiver using the 1999 and 2004 National Long Term Care Survey, 2011 and 2015 National Health and Aging Trends Study, and linked caregiver surveys. Trends are examined. Results Older adults receiving help were incrementally younger, more racially diverse, and better educated in 2015. Primary caregivers overwhelmingly continued to be spouses and adult children. Arrangements were increasingly 4 years or longer in duration (shifting from 44.8% in 1999 to 60.5% by 2015). On average, primary caregivers provided about or in excess of 30 hr per week at all four time points. Spouses provided fewer hours of care, were twice as likely to work, and half as likely to report substantial emotional, physical, and financial difficulty due to caregiving in 2015 than 1999. Adult children provided comparable hours of care to a more impaired population; a similar proportion reported substantial caregiving-related difficulty at each time. Use of respite care nearly doubled from 8.5% in 1999 to 15.7% in 2015. Dementia caregivers were less likely to report substantial physical and financial difficulty and more likely to use respite care in 2015 than 1999. Implications Family caregivers' circumstances generally improved during the 16-year period. Results diverge from prevailing concerns regarding the state of family caregiving and demonstrate the importance of longitudinally monitoring trends in late-life family caregiving.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John Mulcahy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jin Huang
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David L Roth
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kenneth Covinsky
- Division of Geriatric Medicine, University of California San Francisco
| | - Judith D Kasper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Center on Aging and Health, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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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] [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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Bangerter LR, Griffin J, Harden K, Rutten LJ. Health Information-Seeking Behaviors of Family Caregivers: Analysis of the Health Information National Trends Survey. JMIR Aging 2019; 2:e11237. [PMID: 31518309 PMCID: PMC6714999 DOI: 10.2196/11237] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/16/2018] [Accepted: 08/23/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The growing population of aging adults relies on informal caregivers to help meet their health care needs, get help with decision making, and gather health information. OBJECTIVE The objective of this study was to examine health information-seeking behaviors among caregivers and to identify caregiver characteristics that contribute to difficulty in seeking health information. METHODS Data from the Health Information National Trends Survey 5, Cycle 1 (N=3181) were used to compare health information seeking of caregivers (n=391) with noncaregivers (n=2790). RESULTS Caregivers sought health information for themselves and others using computers, smartphones, or other electronic means more frequently than noncaregivers. Caregivers born outside of the United States reported greater difficulty seeking health information (beta=.42; P=.02). Nonwhite caregivers (beta =-.33; P=.03), those with less education (beta =-.35; P=.02), those with private insurance (beta =-.37; P=.01), and those without a regular health care provider (beta =-.35; P=.01) had less confidence seeking health information. Caregivers with higher income had more confidence (beta =.12; P≤.001) seeking health information. CONCLUSIONS This study highlights the prevalence of electronic means to find health information among caregivers. Notable differences in difficulty and confidence in health information seeking exist between caregivers, indicating the need for more attention to the socioeconomic status and caregivers born outside of the United States. Findings can guide efforts to optimize caregivers' health information-seeking experiences.
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Affiliation(s)
- Lauren R Bangerter
- Robert D and Patricia E Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, United States
| | - Joan Griffin
- Robert D and Patricia E Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, United States
| | - Kristin Harden
- Robert D and Patricia E Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, United States
| | - Lila J Rutten
- Robert D and Patricia E Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, United States
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The CARE Act: Identifying and Supporting Family Caregivers From Hospitals to Home. Dimens Crit Care Nurs 2018; 37:59-61. [PMID: 29381499 DOI: 10.1097/dcc.0000000000000290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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A Framework to Assist Providers in the Management of Patients with Chronic, Nonhealing Wounds. Adv Skin Wound Care 2018; 31:491-501. [DOI: 10.1097/01.asw.0000546117.86938.75] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The Caregiver Advise, Record, Enable (CARE) Act has the potential to make a positive impact in the lives of Latino older adults and their caregivers. As Latino individuals are the fastest growing older adult population, the number of Latino families and caregivers is also expected to grow, particularly among those providing care for someone with Alzheimer's disease or other dementias. Caregiving has been considered a culturally embedded value among Latino individuals. Although few studies have focused on caregiving in this population, those that exist suggest that Latino caregivers struggle to find bilingual and bicultural support and information and show higher levels of distress and health disparities. The purpose of the CARE Act is to help and support family caregivers when older adults are admitted to the hospital and during care transitions. The current article examines the potential implications of this state law, specifically on Latino individuals, including recommendations for policy implementation. [Journal of Gerontological Nursing, 44(3), 9-14.].
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Cacchione PZ. Engaging Caregivers During Hospitalizations to Improve Hospital Transitions: The CARE Act. Clin Nurs Res 2018; 27:255-257. [PMID: 29421937 DOI: 10.1177/1054773818759083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dalal AK, Bates DW, Collins S. Opportunities and Challenges for Improving the Patient Experience in the Acute and Postacute Care Setting Using Patient Portals: The Patient's Perspective. J Hosp Med 2017; 12:1012-1016. [PMID: 29073310 DOI: 10.12788/jhm.2860] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Efforts to improve the patient experience are increasingly focusing on engaging patients and their "care partners" by using patient portals. The Acute Care Patient Portal Task Force was supported by the Gordon and Betty Moore Foundation to convene a national meeting of an interdisciplinary group of stakeholders, including patient advocates, to consider how the acute and postacute care patient experience can be improved by using patient-facing technologies. We identified key opportunities and challenges for enhancing cognitive support, promoting respect while maintaining boundaries, and facilitating patient and family empowerment through the lens of the patient. Institutions, clinicians, and vendors would benefit tremendously by considering these 3 patient-centered themes when partnering with patients and family advisors to implement and realize the full potential of patient portals to enhance the acute and postacute care experience.
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Affiliation(s)
- Anuj K Dalal
- Brigham and Women's Hospital, Boston, Massachusetts, USA.
- Harvard Medical School, Boston, Massachusetts, USA
| | - David W Bates
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Collins
- Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Partners Healthcare System, Wellesley, Massachusetts, USA
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Barton AJ. Preparing Students to Prepare Family Members for Caregiving Responsibilities. J Nurs Educ 2017; 56:643-644. [DOI: 10.3928/01484834-20171020-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Dunlay SM, Roger VL, Weston SA, Bangerter LR, Killian JM, Griffin JM. Patient and Spousal Health and Outcomes in Heart Failure. Circ Heart Fail 2017; 10:CIRCHEARTFAILURE.117.004088. [PMID: 29030371 DOI: 10.1161/circheartfailure.117.004088] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 09/12/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND A diagnosis of heart failure (HF) often requires a comprehensive lifestyle change to maintain disease stability. When patients with HF are married, the spouse frequently assumes the caregiving role. Our objectives were to describe the health of spouses of married patients with HF, and examine whether the health of a spouse impacts patient outcomes. METHODS AND RESULTS We identified 905 patients that were married at the time of incident HF diagnosis in Olmsted County, MN, from 2000 to 2012. Using Rochester Epidemiology Project resources, the patient and their spouse's comprehensive longitudinal health histories were linked. Spousal health at patient HF diagnosis was assessed by comorbidity burden, self-reported difficulty with activities of daily living and prior hospitalizations. The associations of spousal health with patient outcomes and patient death with spousal outcomes were examined using Cox and Andersen-Gill models. Spouses of patients with HF were elderly (mean age, 71 years), often had comorbid conditions, and 16% had difficulty with ≥1 activities of daily living. After adjustment for patient age, sex, and comorbidity, there were no independent associations of spousal health and patient risk of death or hospitalization after HF diagnosis. However, the risk of hospitalization (adjusted hazard ratio, 1.34; 95% confidence interval, 1.11-1.60; P=0.002) and death (hazard ratio, 2.10; 95% confidence interval, 1.60-2.75; P<0.001) increased in the surviving spouse after patient death. CONCLUSIONS We found no evidence that the health of a spouse impacts patient outcomes after HF diagnosis. However, after a patient with HF dies, their surviving spouse's risk of hospitalization and death increases.
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Affiliation(s)
- Shannon M Dunlay
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN.
| | - Véronique L Roger
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN
| | - Susan A Weston
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN
| | - Lauren R Bangerter
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN
| | - Jill M Killian
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN
| | - Joan M Griffin
- From the Department of Cardiovascular Diseases (S.M.D., V.L.R.) and Department of Health Sciences Research (S.M.D., V.L.R., S.A.W., L.R.B., J.M.G., J.M.K.), Mayo Clinic, Rochester, MN
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Burke RE, Lawrence E, Ladebue A, Ayele R, Lippmann B, Cumbler E, Allyn R, Jones J. How Hospital Clinicians Select Patients for Skilled Nursing Facilities. J Am Geriatr Soc 2017; 65:2466-2472. [PMID: 28682456 DOI: 10.1111/jgs.14954] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To understand how hospital-based clinicians evaluate older adults in the hospital and decide who will be transferred to a skilled nursing facility (SNF) for postacute care. DESIGN Semistructured interviews paired with a qualitative analytical approach informed by Social Constructivist theory. SETTING Inpatient care units in three hospitals. Purposive sampling was used to maximize variability in hospitals, units within hospitals, and staff on those units. PARTICIPANTS Clinicians (hospitalists, nurses, therapists, social workers, case managers) involved in evaluation and decision-making regarding postacute care (N = 25). MEASUREMENTS Central themes related to clinician evaluation and discharge decision-making. RESULTS Clinicians described pressure to expedite evaluation and discharge decisions, resulting in the use of SNFs as a "safety net" for older adults being discharged from the hospital. The lack of hospital-based clinician knowledge of SNF care practices, quality, or patient outcomes resulted in lack of a standardized evaluation process or a clear primary decision-maker. CONCLUSION Hospital clinician evaluation and decision-making about postacute care in SNFs may be characterized as rushed, without a clear system or framework for making decisions and uninformed by knowledge of SNF or patient outcomes in those discharged to SNFs. This leads to SNFs being used as a "safety net" for many older adults. As hospitals and SNFs are increasingly held jointly accountable for outcomes of individuals transitioning between hospitals and SNFs, novel solutions for improving evaluation and decision-making are urgently needed.
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Affiliation(s)
- Robert E Burke
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado.,Hospital Medicine Section, Department of Medicine, Denver Veterans Affairs Medical Center, Denver, Colorado.,Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | - Emily Lawrence
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Amy Ladebue
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Roman Ayele
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Brandi Lippmann
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Ethan Cumbler
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | - Rebecca Allyn
- Department of Medicine, Denver Health and Hospital Authority, Denver, Colorado
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Sterba KR, Zapka J, Armeson KE, Shirai K, Buchanan A, Day TA, Alberg AJ. Physical and emotional well-being and support in newly diagnosed head and neck cancer patient-caregiver dyads. J Psychosoc Oncol 2017; 35:646-665. [PMID: 28459393 DOI: 10.1080/07347332.2017.1323817] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The purpose of this study was to examine the physical and emotional well-being and social support in newly diagnosed head and neck cancer (HNC) patients and caregivers and identify sociodemographic, clinical, and behavioral risk factors associated with compromised well-being in patients and caregivers. Newly diagnosed HNC patients and their primary caregivers (N = 72 dyads) completed questionnaires before treatment assessing physical and mental well-being, depression, cancer worry, and open-ended support questions. Patients reported worse physical well-being than caregivers (p < 0.05) but similar levels of mental well-being. Caregivers reported providing emotional and instrumental support most frequently with an emphasis on nutrition and assistance with speech, appearance, and addictions. Both patients and their caregivers reported suboptimal mental well-being and depression. Smoking was associated with compromised well-being in patients, caregivers, and dyads. Compromised well-being in patients and their caregivers was more likely when patients were younger, had worse symptoms, and smoked/consumed alcohol (p < 0.05). While patients face more physical strain than caregivers, both equally confront emotional challenges. Results highlight risk factors for compromised well-being in both patients and their caregivers that should be assessed at diagnosis to guide identification of needed dyadic-focused supportive care resources.
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Affiliation(s)
- Katherine R Sterba
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Jane Zapka
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Kent E Armeson
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Keisuke Shirai
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Amy Buchanan
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Terry A Day
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
| | - Anthony J Alberg
- a Hollings Cancer Center , Medical University of South Carolina , Charleston , SC , USA
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Havyer RD, van Ryn M, Wilson PM, Griffin JM. The effect of routine training on the self-efficacy of informal caregivers of colorectal cancer patients. Support Care Cancer 2016; 25:1071-1077. [PMID: 27889827 DOI: 10.1007/s00520-016-3494-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/11/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Little is known about the degree to which caregiver training as part of routine clinical care influences caregiver self-efficacy. The objective of this study was to examine the relationship between training during routine clinical cancer care and self-efficacy among caregivers of colorectal cancer patients. METHODS Caregivers completed a self-administered questionnaire about their experiences with training for specific patient problems and about their task-specific and general caregiving self-efficacy. Associations between training and self-efficacy were examined for each problem using multivariate logistic regression adjusted for caregiver age, race, care burden, education, perception of patient's health, and patient stage of disease. RESULTS Four hundred seventeen caregivers completed the survey (70% response rate), of whom 374 (90%) were female and 284 (68%) were the patient's spouse/partner. Overall, 77 (38%) reported inadequate training for pain, 80 (38%) for bowel, 121 (48%) for fatigue, 65 (26%) for medication administration, and 101 (40%) for other symptoms. The odds of having low self-efficacy were significantly higher among those with perceptions of inadequate training across the following cancer-related problems: pain 10.10 (3.36, 30.39), bowel 5.04 (1.98, 12.82), fatigue 8.45 (3.22, 22.15), managing medications 9.00 (3.30, 24.51), and other 3.87 (1.68, 8.93). CONCLUSIONS Caregivers commonly report inadequate training in routine colorectal cancer care. Significant and consistent associations between training adequacy and self-efficacy were found. This study supports the value of training caregivers in common cancer symptoms. Further work on how and when to provide caregiver training to best impact self-efficacy is needed.
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Affiliation(s)
- Rachel D Havyer
- Division of Primary Care Internal Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Michelle van Ryn
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Patrick M Wilson
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Joan M Griffin
- Division of Health Care Policy and Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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