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You H, Docherty SL, Ashana DC, Oyesanya TO. Transition of Intensive Care Unit Patients and Their Families to Home After Acute Hospital Care. AACN Adv Crit Care 2024; 35:97-108. [PMID: 38848572 DOI: 10.4037/aacnacc2024982] [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: 06/09/2024]
Abstract
Patients in the intensive care unit (ICU) increasingly are expected to eventually return home after acute hospital care. Yet transitional care for ICU patients and their families is often delayed until the patient is about to be transferred to another location or level of care. Transitions theory is a middle-range nursing theory that aims to provide guidance for safe and effective nursing care and research while an individual experiences a transition. Intensive care unit nurses are well positioned to provide ICU transitional care planning early. This article applies the transitions theory as a theoretical model to guide the study of the transition to home after acute hospital care for ICU patients and their families. This theory application can help ICU nurses provide holistic patient- and family-centered transitional care to achieve optimal outcomes by addressing the predischarge and postdischarge needs of patients and families.
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Affiliation(s)
- HyunBin You
- HyunBin You is a PhD candidate, School of Nursing, Duke University, DUMC 3322, 307 Trent Drive, Durham, NC 27710
| | - Sharron L Docherty
- Sharron L. Docherty is Associate Professor, School of Nursing, and Associate Professor, Department of Medicine, Duke University, Durham, North Carolina
| | - Deepshikha C Ashana
- Deepshikha C. Ashana is Assistant Professor, Department of Medicine; Core Faculty Member, Duke-Margolis Center for Health Policy; and Assistant Professor, Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Tolu O Oyesanya
- Tolu O. Oyesanya is Associate Professor, School of Nursing, Duke University, Durham, North Carolina
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Gregersen NV, Refsgaard B, Sørensen D. Preparing safe discharge in a complex practice: A qualitative study of nurses' approach to patients with COPD's hospital discharge from two pulmonary medicinal wards. Scand J Caring Sci 2024. [PMID: 38622922 DOI: 10.1111/scs.13262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/06/2024] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
INTRODUCTION It remains unclear why 17% of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) treated in Danish hospitals are readmitted within 30 days. Hospital discharge is multifaceted. However, the preparation process and nurses' efforts may be essential in ensuring a successful discharge. AIM To explore the process of preparing discharge for patients with COPD in a hospital setting. METHOD Using constructivist grounded theory, we observed 11 nurses' work at two pulmonary medical wards using participant observation. Data collection and analysis were conducted using a constant comparative process encompassing three phases: initial, focused and theoretical. RESULTS We identified important perspectives influencing nurses when patients with COPD are discharged from two pulmonary medical wards. We generated a substantial theory of how nurses integrate various perspectives into their handling of hospital discharge. The theory contains three discharge approaches: co-creating, hesitating and socialising. The co-creating approach focuses on patient and relative involvement and systematic task solution, embedded in a biopsychosocial process, aiming to achieve a safe and sustainable discharge. In contrast, the hesitating approach focuses on discharging patients in line with system requirements and colleagues' expectations. Finally, the socialising approach focuses on creating a pleasant discharge experience for patients and colleagues alike. CONCLUSION This study illuminates three distinct approaches adopted by nurses when discharging a patient with COPD. The co-creating process encompasses patient involvement and systematic task resolution, incorporating a biopsychosocial process. In contrast, the other approaches are more limited in scope: the hesitating approach aims for harmony and collegial consensus, while the socialising approach focuses on ensuring a pleasant discharge experience for everyone. Nurses should therefore be mindful of the approach they adopt and the values associated with it in order to optimise their management of hospital discharge processes.
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Affiliation(s)
| | - Birgit Refsgaard
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dorthe Sørensen
- Research Centre for Health and Welfare Technology, Programme for Rehabilitation, VIA University College, Aarhus, Denmark
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Bryant E, DeBlasis B, Langdon KD, Salisbury H. Transitions of Care. J Cardiovasc Nurs 2024; 39:104-106. [PMID: 38200646 DOI: 10.1097/jcn.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2024]
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Boockvar KS. CORR Insights®: High Risk of Readmission After THA Regardless of Functional Status in Patients Discharged to Skilled Nursing Facility. Clin Orthop Relat Res 2024:00003086-990000000-01474. [PMID: 38259161 DOI: 10.1097/corr.0000000000002989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Kenneth S Boockvar
- Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama, Birmingham, AL, USA
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Robinson-Lane SG, Leggett AN, Johnson FU, Leonard N, Carmichael AG, Oxford G, Miah T, Wright JJ, Blok AC, Iwashyna TJ, Gonzalez R. Caregiving in the COVID-19 pandemic: Family adaptations following an intensive care unit hospitalisation. J Clin Nurs 2024; 33:203-214. [PMID: 36262026 PMCID: PMC9874809 DOI: 10.1111/jocn.16560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/21/2022] [Accepted: 09/29/2022] [Indexed: 01/29/2023]
Abstract
AIM AND OBJECTIVE To identify how family caregivers adapt to the caregiving role following a relative's COVID-19-related intensive care unit (ICU) hospitalisation. BACKGROUND Family caregiving is often associated with poor health amongst caregivers which may limit their capacity to effectively support patients. Though severe COVID-19 infection has necessitated increasing numbers of persons who require caregiver support, little is known about these caregivers, the persons they are caring for, or the strategies used to effectively adjust to the caregiving role. DESIGN A qualitative descriptive study design was adopted, and findings are reported using COREQ. METHODS A secondary analysis of transcripts from semi-structured interviews conducted with recently discharged ICU patients who had COVID-19 (n = 16) and their family caregivers (n = 16) was completed using thematic analysis. MAXQDA 2020 and Miro were used to organise data and complete coding. Analysis involved a structured process of open and closed coding to identify and confirm themes that elucidated adaptation to family caregiving. RESULTS Six themes highlight how family caregivers adapt to the caregiving role following an ICU COVID-19-related hospitalisation including (1) engaging the support of family and friends, (2) increased responsibilities to accommodate caregiving, (3) managing emotions, (4) managing infection control, (5) addressing patient independence and (6) engaging support services. These themes were found to be congruent with the Roy adaptation model. CONCLUSIONS Family caregiving is a stressful transition following a patient's acute hospitalisation. Effective adaptation requires flexibility and sufficient support, beginning with the care team who can adequately prepare the family for the anticipated challenges of recovery. RELEVANCE TO CLINICAL PRACTICE Clinical teams may improve post-hospitalisation care outcomes of patients by preparing families to effectively adjust to the caregiver role-particularly in identifying sufficient support resources. PATIENT OR PUBLIC CONTRIBUTION Participation of patients/caregivers in this study was limited to the data provided through participant interviews.
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Affiliation(s)
- Sheria G. Robinson-Lane
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Amanda N. Leggett
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Florence U. Johnson
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Natalie Leonard
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Alicia G. Carmichael
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Grace Oxford
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Tanbirul Miah
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Johnny J. Wright
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
| | - Amanda C. Blok
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Theodore J. Iwashyna
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Richard Gonzalez
- BioSocial Methods Collaborative, Research Center for Group Dynamics, University of Michigan Institute for Social Research, Ann Arbor, Michigan, USA
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Mardani A, Azizi M, Alazmani Noodeh F, Alizadeh A, Maleki M, Vaismoradi M, Glarcher M. A concept analysis of transitional care for people with cancer. Nurs Open 2024; 11:e2083. [PMID: 38268301 PMCID: PMC10803885 DOI: 10.1002/nop2.2083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024] Open
Abstract
AIM Transitional care as the journey between different caregivers in multiple healthcare centres is crucial for the provision of care to people with cancer, but it is often complex and poorly coordinated. This study aimed to analyse the concept of transitional care for people with cancer. DESIGN Rodgers' evolutionary concept analysis. METHODS A systematic literature search was conducted on the databases of PubMed (including MEDLINE), EMBASE, Scopus and Web of Science to retrieve articles published between 2000 and 2022. RESULTS Twenty-nine eligible articles were selected and their findings were classified in terms of related concepts and alternative terms, antecedents, attributes and consequences. Attributes included three main categories, namely 'nurse-related attributes', 'organisation-related attributes' and 'patient-related attributes'. Antecedents of transitional care for people with cancer were categorized into two main categories: 'patient-related antecedents' and 'caregiver-related antecedents'. Consequences were categorized into 'psychological consequences' and 'objective consequences'.
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Affiliation(s)
- Abbas Mardani
- Department of Medical‐Surgical Nursing, School of Nursing and MidwiferyZanjan University of Medical SciencesZanjanIran
| | - Maryam Azizi
- Department of Health in Disaster and Emergencies, Faculty of NursingAja University of Medical SciencesTehranIran
| | - Farshid Alazmani Noodeh
- Critical Care Nursing Department, Faculty of NursingAja University of Medical SciencesTehranIran
| | - Azizeh Alizadeh
- Department of Education and Research, Army Center of Excellence (NEZAJA)Center of Consultation of Khanevadeh HospitalTehranIran
| | - Maryam Maleki
- Department of Pediatric and Neonatal Intensive Care Nursing Education, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health SciencesNord UniversityBodøNorway
- Faculty of Science and HealthCharles Sturt UniversityOrangeNew South WalesAustralia
| | - Manela Glarcher
- Institute of Nursing Science and PracticeParacelsus Medical UniversitySalzburgAustria
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Zanetoni TC, Cucolo DF, Perroca MG. Interprofessional actions in responsible discharge: contributions to transition and continuity of care. Rev Esc Enferm USP 2023; 57:e20220452. [PMID: 38047743 PMCID: PMC10695169 DOI: 10.1590/1980-220x-reeusp-2022-0452en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 09/28/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE To analyze the interprofessional team's perception of the actions carried out by means of responsible hospital discharge, and their contribution to improving the transition and continuity of patient care. METHODS A qualitative study was carried out in two hospitalization units, in October - November 2020, interviewing health professionals from a teaching hospital in the state of São Paulo. The reports were transcribed and subjected to thematic content analysis. RESULTS Twelve professionals participated (doctor, nurse, physiotherapist, nutritionist, speech therapist and social worker) and three thematic categories emerged from the interviews: 1. informational continuity in responsible discharge; 2. interaction between professionals and services for the transition of care; and 3. workload management for better transition and continuity of care. CONCLUSION The team recognized interprofessional advances and challenges in responsible discharge related to the informational and relational continuity of patient care and highlighted the (over)workload as an unfavorable aspect in the transition process, generating impacts for patients, professionals and health services.
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Affiliation(s)
- Tatiane Cristina Zanetoni
- Faculdade de Medicina de São José do Rio Preto, Programa de Pós-Graduação em Enfermagem, São José do Rio Preto, SP, Brazil
| | - Danielle Fabiana Cucolo
- Pontifícia Universidade Católica de Campinas, Programa de Residência Multiprofissional em Saúde, Campinas, SP, Brazil
| | - Marcia Galan Perroca
- Faculdade de Medicina de São José do Rio Preto, Programa de Pós-Graduação em Enfermagem, São José do Rio Preto, SP, Brazil
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Quillatupa N, Covenas CS. A Culturally Competent Approach to Discharge Planning and Transfer of Care. Cureus 2023; 15:e50235. [PMID: 38192920 PMCID: PMC10773675 DOI: 10.7759/cureus.50235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/10/2024] Open
Abstract
Culturally competent discharge planning and transfer of care play a leading role in communication and the effective provision of high-quality care to patients from diverse sociocultural backgrounds. However, no standardization has been established. Here, we present the case of a Spanish-speaking patient discharged with instructions in English on two separate occasions, which resulted in readmission and deleterious outcomes. We emphasize the need to provide a safe and culturally competent transition of care.
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Affiliation(s)
- Norka Quillatupa
- Geriatrics, University of California, Los Angeles (UCLA) - Kern Medical, Bakersfield, USA
| | - Cecilia S Covenas
- Family Medicine, Rio Bravo Family Medicine Program, Bakersfield, USA
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Welsh A, Hanson S, Pfeiffer K, Khoury R, Clark A, Ashford PA, Hopewell S, Logan P, Crotty M, Costa M, Lamb S, Smith T, Hip Helper Study C. Perspectives of informal caregivers who support people following hip fracture surgery: a qualitative study embedded within the HIP HELPER feasibility trial. BMJ Open 2023; 13:e074095. [PMID: 37977867 PMCID: PMC10660837 DOI: 10.1136/bmjopen-2023-074095] [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: 03/27/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVES This study aims to illuminate the perspectives of informal caregivers who support people following hip fracture surgery. DESIGN A qualitative study embedded within a now completed multicentre, feasibility randomised controlled trial (HIP HELPER). SETTING Five English National Health Service hospitals. PARTICIPANTS We interviewed 20 participants (10 informal caregivers and 10 people with hip fracture), following hip fracture surgery. This included one male and nine females who experienced a hip fracture; and seven male and three female informal caregivers. The median age was 72.5 years (range: 65-96 years), 71.0 years (range: 43-81 years) for people with hip fracture and informal caregivers, respectively. METHODS Semistructured, virtual interviews were undertaken between November 2021 and March 2022, with caregiver dyads (person with hip fracture and their informal caregiver). Data were analysed thematically. FINDINGS We identified two main themes: expectations of the informal caregiver role and reality of being an informal caregiver; and subthemes: expectations of care and services; responsibility and advocacy; profile of people with hip fracture; decision to be a caregiver; transition from hospital to home. CONCLUSION Findings suggest informal caregivers do not feel empowered to advocate for a person's recovery or navigate the care system, leading to increased and unnecessary stress, anxiety and frustration when supporting the person with hip fracture. We suggest that a tailored information giving on the recovery pathway, which is responsive to the caregiving population (ie, considering the needs of male, younger and more active informal caregivers and people with hip fracture) would smooth the transition from hospital to home. TRIAL REGISTRATION NUMBER ISRCTN13270387.Cite Now.
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Affiliation(s)
- Allie Welsh
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Sarah Hanson
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Klaus Pfeiffer
- Department of Clinical Gerontology and Geriatric Rehabilitation, Robert Bosch Hospital, Stuttgart, Germany
| | - Reema Khoury
- Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK
| | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Pip Logan
- Community Health Sciences, University of Nottingham, Nottingham, UK
| | - Maria Crotty
- Rehabilitation, Aged and Extended Care, Flinders University, Adelaide, South Australia, Australia
| | - Matthew Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sallie Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Toby Smith
- School of Health Sciences, University of East Anglia, Norwich, UK
- University of Warwick, Coventry, UK
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Flores-Sandoval C, Orange JB, Ryan BL, Adams TL, Suskin N, McKelvie R, Elliott J, Sibbald SL. Transitional Care from Hospital to Cardiac Rehabilitation During COVID-19: The Perspectives of Older Adults and Their Healthcare Providers. J Patient Exp 2023; 10:23743735231213757. [PMID: 38026069 PMCID: PMC10644752 DOI: 10.1177/23743735231213757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Transitional care to cardiac rehabilitation during the pandemic was a complex process for older adults, with additional challenges for decision-making and participation. This study aimed to explore the perspectives of older adults and health providers on transitional care from the hospital to cardiac rehabilitation, focusing on patient participation in decision-making. A qualitative exploratory design was used. Semi-structured interviews were conducted with 15 older adults and 6 healthcare providers. Document analysis and reflexive journaling were used to support triangulation of findings. Six themes emerged from the data, related to insufficient follow-up from providers, the importance of patients' emotional and psychological health and the support provided by family members, the need for information tailored to patients' needs and spaces for participation in decision-making, as well as challenges during COVID-19, including delayed medical procedures, rushed discharge and isolating hospital stays. The findings of this study indicated a number of potential gaps in the provision of transitional care services as reported by older adults who had a cardiovascular event, often during the first few weeks post hospital discharge.
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Affiliation(s)
| | - Joseph B. Orange
- Faculty of Health Sciences, Western University, London, Canada
- Faculty of Health Sciences, School of Communication Sciences and Disorders and Canadian Centre for Activity and Aging, Western University, London, Canada
| | - Bridget L. Ryan
- Departments of Family Medicine and Epidemiology and Biostatistics, Centre for Studies in Family Medicine, London, Canada
| | | | - Neville Suskin
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
- St. Joseph's Hospital Cardiac Rehabilitation & Secondary Prevention Program, London, Canada
- St. Joseph's Health Care, London, Canada
| | - Robert McKelvie
- St. Joseph's Hospital Cardiac Rehabilitation & Secondary Prevention Program, London, Canada
- St. Joseph's Health Care, London, Canada
| | | | - Shannon L. Sibbald
- Faculty of Health Sciences, Western University, London, Canada
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
- School of Health Studies, Western University, London, Canada
- Interfaculty Program in Public Health, Western University, London, Canada
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Elsener M, Santana Felipes RC, Sege J, Harmon P, Jafri FN. Telehealth-based transitional care management programme to improve access to care. BMJ Open Qual 2023; 12:e002495. [PMID: 37940335 PMCID: PMC10632879 DOI: 10.1136/bmjoq-2023-002495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND The transition from hospital to home is a vulnerable time for patients and families that can be improved through care coordination and structured discharge planning. LOCAL PROBLEM Our organisation aimed to develop and expand a programme that could improve 30-day readmission rates on overall and disease-specific populations by assessing the impact of a telehealth outreach by a registered nurse (RN) after discharge from an acute care setting on 30-day hospital readmission. METHODS This is a prospective observational design conducted from May 2021 to December 2022 with an urban, non-academic, acute care hospital in Westchester County, New York. Outcomes for patients discharged home following inpatient hospitalisation were analysed within this study. We analysed overall and disease-specific populations (congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and pneumonia (PNA)) as compared with a 40-month prestudy cohort. INTERVENTIONS Patients were identified in a non-random fashion meeting criterion of being discharged home after an inpatient admission. Participants received a telephonic outreach by an RN within 72 hours of discharge. Contacted patients were asked questions addressing discharge instructions, medication access, follow-up appointments and social needs. Patients were offered services and resources based on their individual needs in response to the survey. RESULTS 68.2% of the 24 808 patients were contacted to assess and offer services. Median readmission rates for these patients were 1.2% less than the prestudy cohort (11.0% to 9.8%). Decreases were also noted for disease-specific conditions (CHF (14.3% to 9.1%), COPD (20.0% to 13.4%) and PNA (14.9% to 14.0%)). Among those in the study period, those that were contacted between 24 and 48 hours after discharge were 1.2 times less likely to be readmitted than if unable to be contacted (254/3742 (6.8%) vs 647/7866 (8.2%); p=0.005). CONCLUSIONS Using a multifaceted telehealth approach to improve patient engagement and access reduced 30-day hospital readmission for patients discharged from the acute care setting.
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Affiliation(s)
- Michelle Elsener
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | | | - Jonathan Sege
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | - Priscilla Harmon
- Transitional Care, White Plains Hospital, White Plains, New York, USA
| | - Farrukh N Jafri
- Emergency Department, White Plains Hospital, White Plains, New York, USA
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Poulin LIL, Skinner MW, Fox MT. Bed flow priorities and the spatial and temporal dimensions of rural older adult care. Soc Sci Med 2023; 336:116266. [PMID: 37812966 DOI: 10.1016/j.socscimed.2023.116266] [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: 04/29/2022] [Revised: 04/13/2023] [Accepted: 09/22/2023] [Indexed: 10/11/2023]
Abstract
Despite prior research that examines the spatial and temporal dimensions of older adult care, there is disparate research on the influence of patient flow priorities on older adult care over time and place. Drawing on a qualitative case study of rural older adult transitions in care in the Canadian context we examine how patient flow prioritization undervalues older patients' needs and the local contexts in which care is provided. Certainly, accounting for the spatial and temporal dimensions of older adult care has broader implications that will enhance future research, policy and practice. Policy makers, researchers and clinicians may then use these recommendations as a stepping stone to align the health care system with the older populations that they serve.
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Affiliation(s)
- Laura I L Poulin
- Trent University, 1600 West Bank Dr., Peterborough, Ontario, K9L 0G2, Canada.
| | - Mark W Skinner
- Trent School of the Envronment, Trent University, 1600 West Bank Dr., Peterborough, Ontario, K9L 0G2, Canada.
| | - Mary T Fox
- School of Nursing, York University Centre for Aging Research & Education, York University, Health Nursing & Environmental Studies, Suite 340, Keele Campus, Canada.
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Lawton R, Murray J, Baxter R, Richardson G, Cockayne S, Baird K, Mandefield L, Brealey S, O'Hara J, Foy R, Sheard L, Cracknell A, Breckin E, Hewitt C. Evaluating an intervention to improve the safety and experience of transitions from hospital to home for older people (Your Care Needs You): a protocol for a cluster randomised controlled trial and process evaluation. Trials 2023; 24:671. [PMID: 37838678 PMCID: PMC10576890 DOI: 10.1186/s13063-023-07716-z] [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: 07/25/2023] [Accepted: 10/07/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Older patients often experience safety issues when transitioning from hospital to home. The 'Your Care Needs You' (YCNY) intervention aims to support older people to 'know more' and 'do more' whilst in hospital so that they are better prepared for managing at home. METHODS A multi-centre cluster randomised controlled trial (cRCT) will evaluate the effectiveness and cost-effectiveness of the YCNY intervention. Forty acute hospital wards (clusters) in England from varying medical specialities will be randomised to deliver YCNY or care-as-usual on a 1:1 basis. The primary outcome will be unplanned hospital readmission rates within 30 days of discharge. This will be extracted from routinely collected data of at least 5440 patients (aged 75 years and older) discharged to their own homes during the 4- to 5-month YCNY intervention period. A nested cohort of up to 1000 patients will be recruited to the study to collect secondary outcomes via follow-up questionnaires at 5-, 30- and 90-day post-discharge. These will include measures of patient experience of transitions, patient-reported safety events, quality of life and healthcare resource use. Unplanned hospital readmission rates at 60 and 90 days of discharge will be collected from routine data. A process evaluation (primarily interviews and observations with patients, carers and staff) will be conducted to understand the implementation of the intervention and the contextual factors that shape this, as well as the intervention's underlying mechanisms of action. Fidelity of intervention delivery will also be assessed across all intervention wards. DISCUSSION This study will establish the effectiveness and cost-effectiveness of the YCNY intervention which aims to improve patient safety and experience for older people during transitions of care. The process evaluation will generate insights about how the YCNY intervention was implemented, what elements of the intervention work and for whom, and how to optimise its implementation so that it can be delivered with high fidelity in routine service contexts. TRIAL REGISTRATION UK Clinical Research Network Portfolio: 44559; ISTCRN: ISRCTN17062524. Registered on 11/02/2020.
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Affiliation(s)
- Rebecca Lawton
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK.
- School of Psychology, University of Leeds, Leeds, UK.
| | - Jenni Murray
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
| | - Ruth Baxter
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
| | | | | | | | | | | | - Jane O'Hara
- School of Healthcare, University of Leeds, Leeds, UK
| | - Robbie Foy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Alison Cracknell
- Leeds Centre for Older People's Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edmund Breckin
- Yorkshire Quality and Safety Research group, Bradford Institute for Health Research, Bradford, UK
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Collins J, Lizarondo L, Taylor S, Porritt K. Adult patient and carer experiences of planning for hospital discharge after a major trauma event: a qualitative systematic review. Disabil Rehabil 2023; 45:3435-3455. [PMID: 36299236 DOI: 10.1080/09638288.2022.2133180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 09/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE To identify, evaluate and synthesize qualitative literature on adult patients and carer experiences of planning for discharge from an acute setting after a major trauma event. METHODS The JBI approach to meta-aggregation was followed. Qualitative studies exploring patient and carer discharge planning experiences of major trauma were included in the systematic review. A comprehensive search was conducted in five databases, supplemented by grey literature. Eligible studies were appraised for methodological quality by two reviewers and data extracted using standardized JBI tools. RESULTS Four synthesized findings emerged using 69 findings from sixteen papers. (i) Patients and carers feel generally unprepared to manage at home after discharge, (ii) early identification of patients' post discharge needs allows for appropriate referrals and supports to be organised prior to discharge, (iii) patients and carers value participation in the discharge planning process to facilitate a considered, organized and timely discharge from hospital (iv) the timely presentation, delivery, language used, format and relevancy of information impacts how patients and carers manage their discharge. CONCLUSION This meta-synthesis demonstrates that patients and carers predominantly have poor experiences of discharge planning after major trauma. Adoption of patient centered principles may improve patient and carer experiences of the discharge planning process. IMPLICATIONS FOR REHABILITATIONPatients and their carers benefit from a client-centred approach where their needs are recognised and their collaboration encouraged in important decisions, and if they are adequately prepared to reintegrate into their community.Patients can benefit from having a trauma pathway healthcare professional to provide support and advocacy services throughout their hospital admission and after discharge.Discharge planning that is organised, prepared and collaborative leads to a more positive patient experience.Discharge information should be individualised and presented in an easily accessible format for patients and carers.
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Affiliation(s)
- Jeanette Collins
- JBI, University of Adelaide, Adelaide, Australia
- Jeanette Collins, Rehabilitation in the Home (RITH), Perth, Australia
| | | | - Susan Taylor
- School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Australia
- Occupational Therapy Department, Perth Children's Hospital, Child and Adolescent Health Service, Perth, Australia
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Williams A, Kesten KS. Engaging Older Adults and Families Using the IDEAL Discharge Protocol: A Quality Improvement Initiative to Improve Outcomes and Reduce Readmissions. J Gerontol Nurs 2023; 49:13-19. [PMID: 37768584 DOI: 10.3928/00989134-20230915-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Older adults have challenges understanding newly prescribed medications after discharge and must be more adherent with medications and follow up with their primary care provider. A collaborative discharge process is critical to improving patient outcomes and reducing avoidable readmission rates. This quality improvement (QI) initiative engaged 44 patients and families in the IDEAL Discharge Protocol-an evidence-based collaborative care process focused on discussion, education, and post-discharge follow up. Post-discharge follow up resulted in the completion of 52.2% of follow-up calls and 45.5% of follow-up appointments scheduled, and a 4% reduction in readmission rates. Medication adherence was assessed and found to be 93.3%, and 100% of participants received education while engaged in the study. The IDEAL Discharge Protocol aided in improving the discharge process to better equip patients with the tools to transition home successfully after discharge. [Journal of Gerontological Nursing, 49(10), 13-19.].
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Coatsworth-Puspoky R, Dahlke S, Duggleby W, Hunter KF. Safeguarding survival: Older persons with multiple chronic conditions' unplanned readmission experiences: A mixed methods systematic review. J Clin Nurs 2023; 32:5793-5815. [PMID: 37095609 DOI: 10.1111/jocn.16705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to create a holistic understanding of the psychosocial processes of older persons with multiple chronic conditions' experience with unplanned readmission experiences within 30 days of discharge home and identify factors influencing these psychosocial processes. DESIGN Mixed methods systematic review. DATA SOURCES Six electronic databases (Ovid MEDLINE (R) All 1946-present, Scopus, CINAHL, Embase, PsychINFO and Web of Science). REVIEW METHODS Peer-reviewed articles published between 2010 and 2021 and addressed study aims (n = 6116) were screened. Studies were categorised by method: qualitative and quantitative. Qualitative data synthesis used a meta-synthesis approach and applied thematic analysis. Quantitative data synthesis used vote counting. Data (qualitative and quantitative) were integrated through aggregation and configuration. RESULTS Ten articles (n = 5 qualitative; n = 5 quantitative) were included. 'Safeguarding survival' described older persons' unplanned readmission experience. Older persons experienced three psychosocial processes: identifying missing pieces of care, reaching for lifelines and feeling unsafe. Factors influencing these psychosocial processes included chronic conditions and discharge diagnosis, increased assistance with functional needs, lack of discharge planning, lack of support, increased intensity of symptoms and previous hospital readmission experiences. CONCLUSIONS Older persons felt more unsafe as their symptoms increased in intensity and unmanageability. Unplanned readmission was an action older persons required to safeguard their recovery and survival. RELEVANCE TO CLINICAL PRACTICE Nurses play a critical role in assessing and addressing factors that influence older persons' unplanned readmission. Identifying older persons' knowledge about chronic conditions, discharge planning, support (caregivers and community services), changes in functional needs, intensity of symptoms and past readmission experiences may prepare older persons to cope with their return home. Focusing on their health-care needs across the continuum of care (community, home and hospital) will mitigate the risks for unplanned readmission within 30 days of discharge. REPORTING METHOD PRISMA guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution due to design.
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Affiliation(s)
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Fakha A, de Boer B, Hamers JP, Verbeek H, van Achterberg T. Systematic development of a set of implementation strategies for transitional care innovations in long-term care. Implement Sci Commun 2023; 4:103. [PMID: 37641112 PMCID: PMC10463528 DOI: 10.1186/s43058-023-00487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 08/09/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Numerous transitional care innovations (TCIs) are being developed and implemented to optimize care continuity for older persons when transferring between multiple care settings, help meet their care needs, and ultimately improve their quality of life. Although the implementation of TCIs is influenced by contextual factors, the use of effective implementation strategies is largely lacking. Thus, to improve the implementation of TCIs targeting older persons receiving long-term care services, we systematically developed a set of viable strategies selected to address the influencing factors. METHODS As part of the TRANS-SENIOR research network, a stepwise approach following Implementation Mapping (steps 1 to 3) was applied to select implementation strategies. Building on the findings of previous studies, existing TCIs and factors influencing their implementation were identified. A combination of four taxonomies and overviews of change methods as well as relevant evidence on their effectiveness were used to select the implementation strategies targeting each of the relevant factors. Subsequently, individual consultations with scientific experts were performed for further validation of the process of mapping strategies to implementation factors and for capturing alternative ideas on relevant implementation strategies. RESULTS Twenty TCIs were identified and 12 influencing factors (mapped to the Consolidated Framework for Implementation Research) were designated as priority factors to be addressed with implementation strategies. A total of 40 strategies were selected. The majority of these target factors at the organizational level, e.g., by using structural redesign, public commitment, changing staffing models, conducting local consensus discussions, and organizational diagnosis and feedback. Strategies at the level of individuals included active learning, belief selection, and guided practice. Each strategy was operationalized into practical applications. CONCLUSIONS This project developed a set of theory and evidence-based implementation strategies to address the influencing factors, along further tailoring for each context, and enhance the implementation of TCIs in daily practice settings. Such work is critical to advance the use of implementation science methods to implement innovations in long-term care successfully.
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Affiliation(s)
- Amal Fakha
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands.
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands.
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium.
| | - Bram de Boer
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Jan P Hamers
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Hilde Verbeek
- Department of Health Services Research, Maastricht University, CAPHRI Care and Public Health Research Institute, Maastricht, the Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, the Netherlands
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
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Roberts N, Jacmon H, Scanlon B, Battersby C, Buttrum P, James C. How can we meet the needs of patients, their families and their communities? A qualitative study including clinicians, consumer representatives, patients, and community members. BMC Health Serv Res 2023; 23:809. [PMID: 37507758 PMCID: PMC10385916 DOI: 10.1186/s12913-023-09814-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The Diversity Working Group was formed in response to Australian Quality and Safety Health Care Standards that require organisations plan service delivery that incorporates information about the diversity of consumers, and those at higher risk of harm. METHODS A qualitative gap analysis was conducted by a team from varied professional backgrounds including a clinician researcher, a nurse researcher with expertise in culturally and linguistically diverse care and a consumer representative with expertise in advocacy and carer representation. Qualitative questions were co-designed, using a person-centred care lens. Community organisation members, and clinicians and patients from both ambulatory and inpatient areas were approached. Responses were coded independently and synthesised using a Framework Methodology. RESULTS In total 3 community organisation members, 40 clinicians and 30 patients consented to participate in the qualitative study over a period of three weeks. There were three key themes across responses, 'What are diverse needs?'; 'Assigning people to a group does not address a need'; 'Unplanned care makes people feel vulnerable'. Those patients who are isolated, for any number of reasons, were identified as at greater risk of harm. CONCLUSION Taking a person-centred approach can potentially better understand the needs of patients and communities so that this information can be incorporated into health service delivery. Resources are needed to support patients and their families at times of transition care, particularly when care is unplanned.
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Affiliation(s)
- Natasha Roberts
- University of Queensland Centre for Clinical Research, Butterfield St, Herston, QLD, 4029, Australia.
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Herston, Australia.
| | - Helene Jacmon
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Brighid Scanlon
- Royal Brisbane and Women's Hospital, Herston, Australia
- School of Public Health, Queensland University Technology, Kelvin Grove, QLD, Australia
| | | | - Peter Buttrum
- Royal Brisbane and Women's Hospital, Herston, Australia
- The University of Queensland, St Lucia, QLD, Australia
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Lee H, Lee D, Lee S. Need for Information and Communication Technology during COVID-19: An Exploratory Study Using Nurses' Activity Diaries. Healthc Inform Res 2023; 29:256-268. [PMID: 37591681 PMCID: PMC10440201 DOI: 10.4258/hir.2023.29.3.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVES The coronavirus disease 2019 (COVID-19) pandemic has led to high levels of burnout among nurses. Information and communication technology (ICT) may offer a solution to prevent a potential collapse in healthcare. The aim of this study was to identify areas where ICT could provide support, by analyzing the work of nurses during the COVID-19 pandemic. METHODS This retrospective exploratory descriptive study analyzed qualitative data from the activity diaries of seven nurses working in COVID-19 wards or intensive care units. RESULTS The nursing work process during COVID-19 involved "added tasks," "changed tasks," and "reduced tasks" compared to the pre-COVID-19 situation. Nurses reported difficulties in communicating with other healthcare professionals both inside and outside the isolation room, as well as with patients. The use of various ICT solutions, such as real-time video-conferencing systems or mobile robots, could enhance patient monitoring in the isolation room and improve the quality and efficiency of communication. CONCLUSIONS The changes in work tasks not only led to nurse exhaustion but also negatively impacted the quality of care. ICT solutions should be explored to minimize the time spent in the isolation room, thereby reducing the risk of infection spread. This could also enhance communication among patients, family caregivers, and healthcare professionals.
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Affiliation(s)
- Hyeongsuk Lee
- College of Nursing, Gachon University, Incheon,
Korea
| | - Dongmin Lee
- Gachon University Gil Medical Center, Incheon,
Korea
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20
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Kling SMR, Aleshin MA, Saliba-Gustafsson EA, Garvert DW, Brown-Johnson CG, Amano A, Kwong BY, Calugar A, Shaw JG, Ko JM, Winget M. Evolution of a Project to Improve Inpatient-to-Outpatient Dermatology Care Transitions: Mixed Methods Evaluation. JMIR DERMATOLOGY 2023; 6:e43389. [PMID: 37632927 PMCID: PMC10335331 DOI: 10.2196/43389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 03/17/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND In-hospital dermatological care has shifted from dedicated dermatology wards to consultation services, and some consulted patients may require postdischarge follow-up in outpatient dermatology. Safe and timely care transitions from inpatient-to-outpatient specialty care are critical for patient health, but communication around these transitions can be disjointed, and workflows can be complex. OBJECTIVE In this 3-phase quality improvement effort, we developed and evaluated an intervention that leveraged an electronic health record (EHR) feature, known as SmartPhrase, to enable a new workflow to improve transitions from inpatient care to outpatient dermatology. METHODS Phase 1 (February-March 2021) included interviews with patients and process mapping with key stakeholders to identify gaps and inform an intervention: a SmartPhrase table and associated workflow to promote collection of patient information needed for scheduling follow-up and closed-loop communication between dermatology and scheduling teams. In phase 2 (April-May 2021), semistructured interviews-with dermatologists (n=5), dermatology residents (n=5), and schedulers (n=6)-identified pain points and refinements. In phase 3, the intervention was evaluated by triangulating data from these interviews with measured changes in scheduling efficiency, visit completion, and messaging volume preimplementation (January-February 2021) and postimplementation (April-May 2021). RESULTS Preintervention pain points included unclear workflow for care transitions, limited patient input in follow-up planning, multiple messaging channels (eg, EHR based, email, and phone messages), and time-inefficient patient tracking. The intervention addressed most pain points; interviewees reported the intervention was easy to adopt and improved scheduling efficiency, workload, and patient involvement. More visits were completed within the desired timeframe of 14 days after discharge during the postimplementation period (21/47, 45%) than the preimplementation period (28/41, 68%; P=.03). The messaging workload also decreased from 88 scheduling-related messages sent for 25 patients before implementation to 30 messages for 8 patients after implementation. CONCLUSIONS Inpatient-to-outpatient specialty care transitions are complex and involve multiple stakeholders, thus requiring multifaceted solutions. With deliberate evaluation, broad stakeholder input, and iteration, we designed and implemented a successful solution using a standard EHR feature, SmartPhrase, integrated into a standardized workflow to improve the timeliness of posthospital specialty care and reduce workload.
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Affiliation(s)
- Samantha M R Kling
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Maria A Aleshin
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Erika A Saliba-Gustafsson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Donn W Garvert
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Cati G Brown-Johnson
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Alexis Amano
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Bernice Y Kwong
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Ana Calugar
- Ambulatory Quality Department, Stanford Health Care, Stanford, CA, United States
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Justin M Ko
- Department of Dermatology, Stanford University School of Medicine, Stanford, CA, United States
| | - Marcy Winget
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Bankole AO, Girdwood T, Leeman J, Womack J, Toles M. Identifying unmet needs of older adults transitioning from home health care to independence at home: A qualitative study. Geriatr Nurs 2023; 51:293-302. [PMID: 37031581 PMCID: PMC10247499 DOI: 10.1016/j.gerinurse.2023.03.015] [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: 12/05/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 04/11/2023]
Abstract
Health care practices to prepare older adults and their family caregivers for transitions from home health care (HHC) to independence at home are rarely studied. The objective of this multiple case study was to describe HHC patient and clinician perceptions of unmet needs after HHC discharge and recommendations to address them in future research. In this qualitative study, data were collected using chart-reviews and semi-structured interviews with paired patients (or caregivers as proxy) and HHC clinicians (N=17 pairs). We identified three themes: (1) low patient and caregiver engagement in care planning increased risk for preventable health events after HHC discharge, (2) limited continuity of care restricted patient and caregiver access to community-based services, and (3) gaps in patient and caregiver education influenced independent care of chronic illnesses after discharge. Findings suggest opportunities to improve care practices to prepare older adults and their caregivers for transitions from HHC to independence at home.
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Affiliation(s)
- Ayomide Okanlawon Bankole
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, USA.
| | | | - Jennifer Leeman
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, USA
| | - Jennifer Womack
- Appalachian State University, Beaver College of Health Sciences, Boone, NC, USA
| | - Mark Toles
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, USA
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22
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Olson LM, Zonsius MC, Rodriguez-Morales G, Emery-Tiburcio EE. Promoting Safe Mobility Strategies for partnering with caregivers to maximize older adults' functional ability. Home Healthc Now 2023; 41:105-111. [PMID: 36867484 DOI: 10.1097/nhh.0000000000001149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
This article is the fifth in a series, Supporting Family Caregivers in the 4Ms of an Age-Friendly Health System, published in collaboration with the AARP Public Policy Institute as part of the ongoing Supporting Family Caregivers: No Longer Home Alone series. The 4Ms of an Age-Friendly Health System (What Matters, Medication, Mentation, and Mobility) is an evidence-based framework for assessing and acting on critical issues in the care of older adults across settings and transitions of care. Engaging the health care team, including older adults and their family caregivers, with the 4Ms framework can help to ensure that every older adult gets the best care possible, is not harmed by health care, and is satisfied with the care they receive. The articles in this series present considerations for implementing the 4Ms framework in the inpatient hospital setting and incorporating family caregivers in doing so. Resources for both nurses and family caregivers, including a series of accompanying videos developed by AARP and the Rush Center for Excellence in Aging and funded by The John A. Hartford Foundation, are also provided. Nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet-Information for Family Caregivers-and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Olson,L.M., et al. Promote Safe Mobility. Am J Nurs 2022; 122(7): 46-52.
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Affiliation(s)
- Linda M Olson
- Linda M. Olson is a chairperson and program director in the Department of Occupational Therapy in the College of Health Sciences at Rush University Medical Center in Chicago, where Mary C. Zonsius is an associate professor in the College of Nursing, Grisel Rodriguez-Morales is a manager and assistant professor in the Department of Social Work and Community Health, and Erin E. Emery-Tiburcio is an associate professor in the Department of Psychiatry and Behavioral Sciences. Contact author: Linda M. Olson, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Mitchell S, Kallen MA, Troost JP, Bragg A, Martin-Howard J, Moldovan I, Miner JA, Jack BW, Carlozzi NE. Development and calibration data for the Illness Burden item bank: a new computer adaptive test for persons with type 2 diabetes mellitus. Qual Life Res 2023; 32:797-811. [PMID: 36282447 PMCID: PMC10472317 DOI: 10.1007/s11136-022-03282-0] [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] [Accepted: 10/11/2022] [Indexed: 10/31/2022]
Abstract
PURPOSE The purpose of this study was to develop a new measure, the Re-Engineered Discharge for Diabetes Computer Adaptive Test (REDD-CAT) Illness Burden item bank, to evaluate the impact that a chronic condition has on independent living, the ability to work (including working at home), social activities, and relationships. METHODS Semi-structured interviews were used to inform the development of an item pool (47 items) that captured patients' beliefs about how a diagnosis of type 2 diabetes interferes with different aspects of their lives. The Illness Burden item bank was developed and tested in 225 people with type 2 diabetes mellitus. RESULTS No items had sparse response option cells or problems with monotonicity; two items were deleted due to low item-rest correlations. Factor analyses supported the retention of 29 items. With those 29 remaining items, a constrained (common slope) graded response model fit assessment indicated that two items had misfit; they were excluded. No items displayed differential item functioning by age, sex, education, or socio-economic status. The final item bank is comprised of 27 items. Preliminary data supported the reliability (internal consistency and test-retest reliability) and validity (convergent, discriminant, and known-groups) of the new bank. CONCLUSION The Illness Burden item bank can be administered as a computer adaptive test or a 6-item short form. This new measure captures patients' perceptions of the impact that having type 2 diabetes has on their daily lives; it can be used in conjunction with the REDD-CAT measurement system to evaluate important social determinants of health in persons with type 2 diabetes mellitus.
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Affiliation(s)
- Suzanne Mitchell
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Alexa Bragg
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Ioana Moldovan
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, Center for Clinical Outcomes Development and Application (CODA), University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA
| | - Brian W Jack
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, Center for Clinical Outcomes Development and Application (CODA), University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA.
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Carlozzi NE, Kallen MA, Troost JP, Bragg A, Martin-Howard J, De La Cruz B, Miner JA, Moldovan I, Jack BW, Mitchell S. Development and calibration data for the Healthcare Access Item Bank: a new computer adaptive test for persons with type 2 diabetes mellitus. Qual Life Res 2023; 32:781-796. [PMID: 36315318 PMCID: PMC10472318 DOI: 10.1007/s11136-022-03278-w] [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] [Accepted: 10/08/2022] [Indexed: 03/08/2023]
Abstract
PURPOSE The purpose of this study was to develop a new measure to evaluate the ability to receive medical services when needed among persons with type 2 diabetes mellitus. METHODS The Healthcare Access measure was developed using data from 225 persons with type 2 diabetes mellitus who completed an item pool comprised of 54 questions pertaining to their experience accessing healthcare services. RESULTS Exploratory and confirmatory factor analyses supported the retention of 45 items. In addition, a constrained graded response model (GRM), as well as analyses that examined item misfit and differential item functioning (investigated for age, sex, education, race, and socioeconomic status), supported the retention of 44 items in the final item bank. Expert review and GRM item calibration products were used to inform the selection of a 6-item static short form and to program the Healthcare Access computer adaptive test (CAT). Preliminary data supported the reliability (i.e., internal consistency and test-retest reliability) and validity (i.e., convergent, discriminant, and known-groups) of the new measure. CONCLUSIONS The new Healthcare Access item bank can be used to examine the experiences that persons with type 2 diabetes mellitus have with healthcare access, to better target treatment improvements and mitigate disparities; it will be available as a part of the Neuro-Qol measurement system through healthmeasures.net and the PROMIS Application Programmable Interface (API) in early 2023.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
- Department of Physical Medicine & Rehabilitation, Center for Clinical Outcomes Development and Application (CODA), University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA.
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Alexa Bragg
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Jessica Martin-Howard
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
| | | | - Jennifer A Miner
- Department of Physical Medicine & Rehabilitation, Center for Clinical Outcomes Development and Application (CODA), University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA
| | - Ioana Moldovan
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Brian W Jack
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
| | - Suzanne Mitchell
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Family Medicine, Boston Medical Center, Boston, MA, USA
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Petersen JJ, Østergaard B, Svavarsdóttir EK, Palonen M, Brødsgaard A. Hospital and homecare nurses' experiences of involvement of patients and families in transition between hospital and municipalities: A qualitative study. Scand J Caring Sci 2023; 37:196-206. [PMID: 36349680 DOI: 10.1111/scs.13130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/08/2022] [Accepted: 10/15/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Involving patients and families in nursing care is essential to improve patients' health outcomes. Furthermore, families play an essential role in supporting patients by helping nurses understand the patient's everyday life. However, families also need support. Involvement of patients and families is especially important when patients are transferred between hospital and home as transitions heighten the risk of compromising quality and safety in care. However, no consensus exists on how to involve them. Consequently, this may challenge a systematic approach toward patient and family involvement. AIM To describe hospital and homecare nurses' experiences with involving patients and their family members in nursing care in the transition between hospital and municipalities. METHOD Focus group interviews were conducted in the Gastro unit at a large university hospital in Denmark. Participants included 10 hospital nurses from three wards at the Gastro unit and six homecare nurses from one of three municipalities in the hospital catchment area (total n = 16). Data were analysed using qualitative content analysis. The study is reported according to the Consolidated Criteria for Reporting Qualitative Research. FINDINGS Our analysis revealed one overall theme - "The complexity of involvement" - based on four categories: gap between healthcare sectors increases the need for patient and family involvement, lack of time is a barrier to patient and family involvement, involvement is more than information, and involvement as a balancing act. CONCLUSION The nurses experienced patients' and families' involvement as essential, but a discrepancy was found between nurses' intentions and their actions. Aspects related to a gap between healthcare sectors and various understandings of involvement challenged the systematic involvement of patients and families in the transition between healthcare sectors. However, the nurses were highly motivated to achieve a close cross-sectoral collaboration and to show commitment towards patients and families.
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Affiliation(s)
- Julie Jacoby Petersen
- Department of Surgical Gastroenterology, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark.,Section for Nursing, Department of Public Health, University of Aarhus, Aarhus, Denmark
| | - Birte Østergaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Mira Palonen
- Faculty of Social Sciences, health sciences, Tampere University, Tampere, Finland
| | - Anne Brødsgaard
- Section for Nursing, Department of Public Health, University of Aarhus, Aarhus, Denmark.,Department of Paediatrics and Adolescent Medicin, Copenhagen University Hospital Amager Hvidovre, Hvidovre, Denmark
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Kraun L, De Vliegher K, Ellen M, van Achterberg T. Interventions for the empowerment of older people and informal caregivers in transitional care decision-making: short report of a systematic review. BMC Geriatr 2023; 23:113. [PMID: 36855081 PMCID: PMC9976408 DOI: 10.1186/s12877-023-03813-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 02/08/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Care transitions across different settings necessitate careful decision-making for all parties involved, yet research indicates that older people and informal caregivers do not have a strong voice in such decisions. OBJECTIVE To provide a systematic overview of the literature about interventions designed to empower older people and informal caregivers in transitional care decision-making. DESIGN A systematic review (Prospero Protocol CRD42020167961; funded by the EU's Horizon 2020 program). DATA SOURCES Five databases were searched: PubMed, EMBASE, Web of Science, PsycINFO, and CINAHL. REVIEW METHODS The review included evaluations of empowerment in decision-making interventions for older people and informal caregivers facing care transitions, that were published from the inception of the databases up until April 2022. Data extractions were performed by two independent researchers and the quality of studies was assessed with the relevant JBI-critical appraisal tools. A narrative descriptive analysis of the results was performed. FINDINGS Ten studies, reporting on nine interventions, and including a total of 4642 participants, were included. Interventions included transition preparation tools, support from transition coaches, shared decision-making interventions, and advance care planning. Designs and outcomes assessed were highly diverse and showed a mix of positive and lacking effects. CONCLUSIONS There is a lack of research on how to empower older people and their informal caregivers in transitional care decision-making. Empowerment in decision-making is usually not central in transitional care interventions, and effects on actual empowerment are mostly not assessed. Conclusions on how to empower older people and informal caregivers in transitional care decision-making cannot be drawn.
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Affiliation(s)
- Lotan Kraun
- Nursing Departement, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium. .,KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, University of Leuven, Leuven, Belgium. .,Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
| | - Kristel De Vliegher
- Nursing Departement, Wit-Gele Kruis van Vlaanderen, Brussels, Belgium.,KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, University of Leuven, Leuven, Belgium
| | - Moriah Ellen
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management and Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.,Institute of Health Policy Management and Evaluation, Dalla Lana School Of Public Health, University of Toronto, Toronto, Canada
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, University of Leuven, Leuven, Belgium
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Yoshimura M, Kawamura M, Hasegawa S, Ito YM, Takahashi K, Sumi N. Development and validation of the Care Transitions Scale for Patients with Heart Failure: A tool for nurses to assess patients' readiness for hospital discharge. Jpn J Nurs Sci 2023; 20:e12522. [PMID: 36755473 DOI: 10.1111/jjns.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/06/2022] [Accepted: 12/22/2022] [Indexed: 02/10/2023]
Abstract
AIM This study aimed to develop and assess the validity and reliability of the Care Transitions Scale for Patients with Heart Failure (CTS-HF) as a nurse-reported measure for evaluating patients' readiness for hospital discharge. METHODS We conducted a cross-sectional study of cardiovascular ward nurses from 163 hospitals across Japan. Structural validity was assessed using exploratory factor analysis with development participants and confirmatory factor analysis with validation participants. Convergent validity was assessed by correlation with the Discharge Planning of Ward Nurses scale (DPWN). Hypotheses testing for construct validity was performed as comparisons between subgroups of transitional care practice. RESULTS Valid responses were obtained from 704 nurses (development participants, n = 352; validation participants, n = 352). The final scale comprised 21 items divided into six factors: "Clear preparation for how to manage health at home," "Adjusting to home care/support system," "Transitions of medication management from hospital to home," "Dealing with patients' concerns and questions," "Transitions of disease management from hospital to home," and "Family support." Indices of fit supported these results (comparative fit index = 0.944, root mean square error of approximation = 0.057). The CTS-HF was significantly correlated with the DPWN. The nurses' subgroup with higher transitional care practice had higher CTS-HF scores. Cronbach's alpha was .93 for the CTS-HF. CONCLUSIONS The CTS-HF showed sufficient reliability and validity for use in evaluating discharge care. Further studies are needed regarding the usefulness of this scale in nursing practice.
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Affiliation(s)
- Mai Yoshimura
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Masumi Kawamura
- Department of Nursing, Sapporo-Kosei General Hospital, Sapporo, Japan
| | - Satoko Hasegawa
- Department of Nursing, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M Ito
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Keita Takahashi
- Data Science Center, Promotion Unit, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Naomi Sumi
- Department of Fundamental Nursing, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
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Wellman CD, Franks AM, Stickler M, Rollyson W, Korkmaz A, Christiansen MQ, Petrany SM. Targeted care coordination towards patients with a history of multiple readmissions effectively reduces readmissions. Fam Pract 2023:cmad009. [PMID: 36730038 DOI: 10.1093/fampra/cmad009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND To decrease hospital readmission rates, clinical practices create a transition of care (TOC) process to assess patients and coordinate care postdischarge. As current evidence suggests lack of universal benefit, this study's objectives are to determine what patient and process factors associate with hospital readmissions, as well as construct a model to decrease 30-day readmissions. METHODS Three months of retrospective discharged patient data (n = 123) were analysed for readmission influences including: patient-specific comorbidities, admission-specific diagnoses, and TOC components. A structured intervention of weekly contact, the Care Coordination Cocoon (CCC), was created for multiply readmitted patients (MRPs), defined as ≥2 readmissions. Three months of postintervention data (n = 141) were analysed. Overall readmission rates and patient- and process-specific characteristics were analysed for associations with hospital readmission. RESULTS Standard TOC lacked significance. Patient-specific comorbidities of cancer (odds ratio [OR] 6.27; 95% confidence interval [CI] 1.73-22.75) and coronary artery disease (OR 6.71; 95% CI 1.84-24.46), and admission-specific diagnoses within pulmonary system admissions (OR 7.20; 95% CI 1.96-26.41) were associated with readmissions. Post-CCC data demonstrated a 48-h call (OR 0.21; 95% CI 0.09-0.50), answered calls (OR 0.16; CI 0.07-0.38), 14-day scheduled visit (OR 0.20; 95% CI 0.07-0.54), and visit arrival (OR 0.39; 95% CI 0.17-0.91) independently associated with decreased readmission rate. Patient-specific (hypertension-OR 3.65; CI 1.03-12.87) and admission-specific (nephrologic system-OR 3.22; CI 1.02-10.14) factors associated with readmissions which differed from the initial analysis. CONCLUSIONS Targeting a practice's MRPs with CCC resources improves the association of TOC components with readmissions and rates decreased. This is a more efficient use of TOC resources.
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Affiliation(s)
- Courtney D Wellman
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Adam M Franks
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Morgan Stickler
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - William Rollyson
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Alperen Korkmaz
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Matthew Q Christiansen
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
| | - Stephen M Petrany
- Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV, United States
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Reeves MJ, Boden-Albala B, Cadilhac DA. Care Transition Interventions to Improve Stroke Outcomes: Evidence Gaps in Underserved and Minority Populations. Stroke 2023; 54:386-395. [PMID: 36689590 DOI: 10.1161/strokeaha.122.039565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 12/09/2022] [Indexed: 01/24/2023]
Abstract
In many countries hospital length of stay after an acute stroke admission is typically just a few days, therefore, most of a person's recovery from stroke occurs in the community. Care transitions, which occur when there is a change in, or handoff between 2 different care settings or providers, represent an especially vulnerable period for patients and caregivers. For some patients with stroke the return home is associated with substantial practical, psychosocial, and health-related challenges leading to substantial burden for the individual and caregiver. Underserved and minority populations, because of their exposure to poor environmental, social, and economic conditions, as well as structural racism and discrimination, are especially vulnerable to the problems of complicated care transitions which in turn, can negatively impact stroke recovery. Overall, there remain significant unanswered questions about how to promote optimal recovery in the post-acute care period, particularly for those from underserved communities. Evidence is limited on how best to support patients after they have returned home where they are required to navigate the chronic stages of stroke with little direct support from health professionals.
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Affiliation(s)
- Mathew J Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Bernadette Boden-Albala
- Department of Health Society and Behavior, Department of Epidemiology and Biostatistics, Program in Public Health, Department of Neurology, School of Medicine, University of California (B.B.-A.)
| | - Dominique A Cadilhac
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia (D.A.C.)
- Stroke theme, the Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia (D.A.C.)
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30
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Transição do cuidado de pessoas idosas do hospital para casa. ACTA PAUL ENFERM 2023. [DOI: 10.37689/acta-ape/2023ao00291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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31
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Agerholm J, Jensen NK, Liljas A. Healthcare professionals' perception of barriers and facilitators for care coordination of older adults with complex care needs being discharged from hospital: A qualitative comparative study of two Nordic capitals. BMC Geriatr 2023; 23:32. [PMID: 36658516 PMCID: PMC9854150 DOI: 10.1186/s12877-023-03754-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 01/13/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The handover of older adults with complex health and social care from hospital admissions to homebased healthcare requires coordination between multiple care providers. Providing insight to the care coordination from healthcare professionals' views is crucial to show what efforts are needed to manage patient handovers from hospitals to home care, and to identify strengths and weaknesses of the care systems in which they operate. OBJECTIVE This is a comparative study aiming to examine healthcare professionals' perceptions on barriers and facilitators for care coordination for older patients with complex health and social care needs being discharged from hospital in two capital cities Copenhagen (DK) and Stockholm (SE). METHOD Semi-structured interviews were conducted with 25 nurses and 2 assistant nurses involved in the coordination of the discharge process at hospitals or in the home healthcare services (Copenhagen n = 11, Stockholm n = 16). The interview guide included questions on the participants' contributions, responsibilities, and influence on decisions during the discharge process. They were also asked about collaboration and interaction with other professionals involved in the process. The data was analysed using thematic analysis. RESULTS Main themes were communication ways, organisational structures, and supplementary work by staff. We found that there were differences in the organisational structure of the two care systems in relation to integration between different actors and differences in accessibility to patient information, which influenced the coordination. Municipal discharge coordinators visiting patients at the hospital before discharge and the follow-home nurse were seen as facilitators in Copenhagen. In Stockholm the shared information system with access to patient records were lifted as a facilitator for coordination. Difficulties accessing collaborators were experienced in both settings. We also found that participants in both settings to a high degree engage in work tasks outside of their responsibilities to ensure patient safety. CONCLUSIONS There are lessons to be learned from both care systems. The written e-communication between hospitals and home health care runs more smoothly in Stockholm, whereas it is perceived as a one-way communication in Copenhagen. In Copenhagen there are more sector-overlapping work which might secure a safer transition from hospital to home. Participants in both settings initiated own actions to weigh out imperfections of the system.
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Affiliation(s)
- Janne Agerholm
- grid.4714.60000 0004 1937 0626Aging Research Center, Karolinska Institutet, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Natasja Koitzsch Jensen
- grid.5254.60000 0001 0674 042XSector of Social Medicin, Copenhagen University, Copenhagen, Denmark
| | - Ann Liljas
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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32
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Pope EI, Joseph M. Barriers, goals, and enablers of transition of care in pediatric dermatology. Pediatr Dermatol 2022; 40:231-237. [PMID: 36384244 DOI: 10.1111/pde.15191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/27/2022] [Indexed: 11/18/2022]
Abstract
Adolescent patients with complex skin disorders may require ongoing care for their conditions as they "age out" of the pediatric setting into adult care. Yet despite consensus from the Canadian Paediatric Society and American Academy of Pediatrics on the importance of dedicated transition programs for these patients, there is a scarcity of such programs worldwide, and no formal programs in Canada. This paper explores several barriers, goals, and potential enablers of transition programs in this discipline and proposes principles of transition versus transfer in the context of pediatric dermatology.
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Affiliation(s)
- Eliza I Pope
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Marissa Joseph
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Dermatology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Flaks-Manov N, Shadmi E, Yahalom R, Perry-Mezre H, Balicer RD, Srulovici E. Identification of elderly patients at risk for 30-day readmission: Clinical insight beyond big data prediction. J Nurs Manag 2022; 30:3743-3753. [PMID: 34661943 DOI: 10.1111/jonm.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/13/2021] [Accepted: 10/13/2021] [Indexed: 12/30/2022]
Abstract
AIM This study explores the potential benefit of combining clinicians' risk assessments and the automated 30-day readmission prediction model. BACKGROUND Automated readmission prediction models based on electronic health records are increasingly applied as part of prevention efforts, but their accuracy is moderate. METHODS This prospective multisource study was based on self-reported surveys of clinicians and data from electronic health records. The survey was performed at 15 internal medicine wards of three general Clalit hospitals between May 2016 and June 2017. We examined the degree of concordance between the Preadmission Readmission Detection Model, clinicians' readmission risk classification and the likelihood of actual readmission. Decision trees were developed to classify patients by readmission risk. RESULTS A total of 694 surveys were collected for 371 patients. The disagreement between clinicians' risk assessment and the model was 34.5% for nurses and 33.5% for physicians. The decision tree algorithms identified 22% and 9% (based on nurses and physicians, respectively) of the model's low-medium-risk patients as high risk (accuracy 0.8 and 0.76, respectively). CONCLUSIONS Combining the Readmission Model with clinical insight improves the ability to identify high-risk elderly patients. IMPLICATIONS FOR NURSING MANAGEMENT This study provides algorithms for the decision-making process for selecting high-risk readmission patients based on nurses' evaluations.
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Affiliation(s)
- Natalie Flaks-Manov
- Institute for Computational Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Efrat Shadmi
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel.,Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
| | - Rina Yahalom
- Hospital Division, Clalit Health Services, Tel Aviv, Israel
| | | | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv, Israel
| | - Einav Srulovici
- Cheryl Spencer Department of Nursing, University of Haifa, Haifa, Israel
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34
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Baxter R, Murray J, Cockayne S, Baird K, Mandefield L, Mills T, Lawton R, Hewitt C, Richardson G, Sheard L, O'Hara JK. Improving the safety and experience of transitions from hospital to home: a cluster randomised controlled feasibility trial of the 'Your Care Needs You' intervention versus usual care. Pilot Feasibility Stud 2022; 8:222. [PMID: 36183129 PMCID: PMC9525931 DOI: 10.1186/s40814-022-01180-3] [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: 06/20/2022] [Accepted: 09/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background The ‘Your Care Needs You’ (YCNY) intervention aims to increase the safety and experience of transitions for older people through greater patient involvement during the hospital stay. Methods A cluster randomised controlled feasibility trial was conducted on NHS inpatient wards (clusters) where ≥ 40% of patients were routinely ≥ 75 years. Wards were randomised to YCNY or usual care using an unequal allocation ratio (3:2). We aimed to recruit up to 20 patients per ward. Follow-up included routine data collection and questionnaires at 5-, 30-, and 90-days post-discharge. Eligible patients were ≥ 75 years, discharged home, stayed overnight on participating wards, and could read and understand English. The trial assessed the feasibility of delivering YCNY and the trial methodology through recruitment rates, outcome completion rates, and a qualitative evaluation. The accuracy of using routinely coded data for the primary outcome in the definitive trial was assessed by extracting discharge information for up to ten nonindividual consenting patients per ward. Results Ten wards were randomised (6 intervention, 4 control). One ward withdrew, and two wards were unable to deliver the intervention. Seven-hundred twenty-one patients were successfully screened, and 161 were recruited (95 intervention, 66 control). The patient post-discharge attrition rate was 17.4% (n = 28). Primary outcome data were gathered for 91.9% of participants with 75.2% and 59.0% providing secondary outcome data at 5 and 30 days post-discharge respectively. Item completion within questionnaires was generally high. Post-discharge follow-up was terminated early due to the COVID-19 pandemic affecting 90-day response rates (16.8%). Data from 88 nonindividual consenting patients identified an error rate of 15% when using routinely coded data for the primary outcome. No unexpected serious adverse events were identified. Most patients viewed YCNY favourably. Staff agreed with it in principle, but ward pressures and organisational contexts hampered implementation. There was a need to sustain engagement, provide clarity on roles and responsibilities, and account for fluctuations in patients’ health, capacity, and preferences. Conclusions If implementation challenges can be overcome, YCNY represents a step towards involving older people as partners in their care to improve the safety and experience of their transitions from hospital to home. Trial registration ISRCTN: 51154948. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01180-3.
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Affiliation(s)
- Ruth Baxter
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK. .,School of Psychology, University of Leeds, Leeds, UK.
| | - Jenni Murray
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | | | | | | | - Thomas Mills
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.,School of Psychology, University of Leeds, Leeds, UK
| | | | | | | | - Jane K O'Hara
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK.,School of Healthcare, University of Leeds, Leeds, UK
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Jaromy M, Miller JD. Potential Clinical Applications for Continuous Ketone Monitoring in the Hospitalized Patient with Diabetes. Curr Diab Rep 2022; 22:501-510. [PMID: 35984565 PMCID: PMC9388986 DOI: 10.1007/s11892-022-01489-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW In this review, the authors discuss potential clinical applications for continuous ketone monitoring (CKM) in a broad continuum of clinical settings from pre-hospital care and the emergency department to acute inpatient management and post-discharge follow-up. RECENT FINDINGS Though in its early stages, the concept of a novel continuous ketone sensing technology exerts great potential for use in the detection and hospital management of DKA, namely to overcome diagnostic barriers associated with ketoacidosis in patients with diabetes and obtain real-time BOHB levels, which may be useful in understanding both patients' response to treatment and DKA trajectory. Peri- and intra-operative use of CKM technology can potentially be applied in a number of urgent and elective surgical procedures frequently underwent by patients with diabetes and in the observation of patients during peri-operative fasting. In transitional care management, CKM technology could potentially facilitate patients' safe transition through levels of care, following hospital discharge from a DKA episode. This evaluation of the literature presents the potential advantages of adopting CKM and integrating this technology into the care algorithm of patients at risk for ketoacidosis.
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Affiliation(s)
- Michelle Jaromy
- New York Institute of Technology College of Osteopathic Medicine, 101 Northern Blvd, Glen Head, Oyster Bay, NY 11545 USA
| | - Joshua D. Miller
- Division of Endocrinology and Metabolism, Renaissance School of Medicine at Stony Brook University, 100 Nicolls Rd, Stony Brook, Brookhaven, NY 11794 USA
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Operationalizing Whole-Person Postpartum Care: Health Care Provider-Level Strategies. Clin Obstet Gynecol 2022; 65:611-631. [PMID: 35894737 DOI: 10.1097/grf.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Postpartum mothers report feeling unsupported and unprepared by their health care providers to meet the challenges of the postpartum period. This gap perpetuates a cycle of disappointment with and disengagement from postpartum care services. The need to revamp postpartum care has been recognized at the population level but implementing changes at the health care provider level is challenging without practical guidance. The needs of new mothers are broad in scope and variable between individuals, requiring a whole-person care approach that is comprehensive yet nimble. Presented here are provider-level strategies to promote care that both elicits and is responsive to the unique care goals of this population.
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Cui M, Hua J, Shi X, Yang W, Geng Z, Qian X, Geng G. Factors associated with instrumental support in transitional care among older people with chronic disease: a cross-sectional study. BMC Nurs 2022; 21:230. [PMID: 35996136 PMCID: PMC9394025 DOI: 10.1186/s12912-022-01014-w] [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: 10/31/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Instrumental support, which is defined as practical, tangible, and informational assistance extended to patients, is crucial for older people in transition. However, little is known about instrumental support in transitional care. Thus, the aim of this study was to evaluate the instrumental support of older people in transitional care. Methods This cross-sectional study was conducted using the Questionnaire of Instrumental Support in Transitional Care (QISCT) to collect data from 747 older people in China from September to November 2020. Survey items consisted of a sociodemographic characteristics questionnaire and the QISCT. Multiple regression analyses were conducted to examine the association between independent variables and the QISCT scores. Results The total score of the QISCT was 39.43 (± 9.11), and there was a significant gap between the anticipated support and received support. The satisfaction of instrumental support was low. Multiple regression analyses showed that educational level, the number of intimate relationships, monthly family income, monthly costs of transitional care, diabetes, and chronic obstructive pulmonary disease were associated with instrumental support in transitional care. Conclusions To cope with the burden caused by chronic disease, the government and transitional care teams should establish a demand-oriented transitional care service model and pay more attention to helping older people obtain adequate and satisfactory instrumental support.
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Affiliation(s)
- Min Cui
- School of Medical, Nantong University, No19, Qixiu Road, Chong Chuan District, Nantong, Jiangsu Province, 226001, China
| | - Jianing Hua
- Affiliated Hospital of Jiangnan University, 1800 Lihu Avenue, Wuxi, Jiangsu Province, China
| | - Xiaoliu Shi
- Affiliated Hospital of Nantong University, 20 Xisi Road, Chongchuan District, Nantong, Jiangsu Province, China
| | - Wenwen Yang
- School of Medical, Nantong University, No19, Qixiu Road, Chong Chuan District, Nantong, Jiangsu Province, 226001, China
| | - Zihan Geng
- School of Medical, Nantong University, No19, Qixiu Road, Chong Chuan District, Nantong, Jiangsu Province, 226001, China
| | - Xiangyun Qian
- Affiliated Nantong Hospital 3 of Nantong University, No. 60 Qingnian Zhong road, Chongchuan District, Nantong, 226001, Jiangsu, China.
| | - Guiling Geng
- School of Medical, Nantong University, No19, Qixiu Road, Chong Chuan District, Nantong, Jiangsu Province, 226001, China.
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Yang F, Hua J, Geng G, Cui M, Yang W, Geng Z. Multidimensional measure of instrumental support in transitional care - design and pilot test of a questionnaire assessing instrumental support among older adults with chronic diseases. BMC Geriatr 2022; 22:633. [PMID: 35915411 PMCID: PMC9344671 DOI: 10.1186/s12877-022-03325-8] [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: 11/22/2021] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Previous studies indicated that poor quantity and quality of instrumental support are one of the main barriers in the application of transitional care. Instrumental support, as one common function of social support, is the provision of financial assistance, material goods, or services. The purpose of our study is to develop an Instrumental Support in Transitional Care Questionnaire (ISTCQ) and use this questionnaire to make an assessment among older adults with chronic diseases. Methods The draft questionnaire was examined by 18 experts from different professional fields performing three rounds of content validity testing with the Delphi method. Afterward, we conducted a pilot test recruiting 174 participants as a convenience sample in Nantong, China. The construct validity was confirmed via exploratory factor analysis and reliability was assessed using Cronbach's alpha. Results The authority coefficient of experts was 0.74–0.99 and Kendall harmony coefficient W was 0.381. The exploratory factor analysis indicated that the questionnaire can be interpreted by three factors: namely, anticipated support (items 1, 2, 3, 4), received support (items 5, 6, 7, 8) and support satisfaction (items 9, 10, 11, 12). These three factors (eigenvalues > 1 and factor loading > 0.4) explained 69.128% of the total variance. Furthermore, the calculation of Cronbach's alpha and test–retest reliability have shown good reliability among each dimension of the 12-item questionnaire (Cronbach's alpha 0.711–0.827, test–retest reliability 0.704–0.818). Conclusion Results from the pilot test demonstrated excellent reliability and validity of ISTCQ through each dimension and as an entire.
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Affiliation(s)
- Fengbo Yang
- School of Medical, Nantong University, Nantong, China
| | - Jianing Hua
- Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Guiling Geng
- School of Medical, Nantong University, Nantong, China.
| | - Min Cui
- School of Medical, Nantong University, Nantong, China
| | - Wenwen Yang
- School of Medical, Nantong University, Nantong, China
| | - Zihan Geng
- School of Medical, Nantong University, Nantong, China
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Rizzuto N, Charles G, Knobf MT. Decreasing 30-Day Readmission Rates in Patients With Heart Failure. Crit Care Nurse 2022; 42:13-19. [PMID: 35908767 DOI: 10.4037/ccn2022417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Heart failure affects approximately 6.2 million adults in the United States and has an estimated national cost of $30.7 billion annually. Despite advances in treatment, heart failure is a leading cause of hospital readmissions. Nonadherence to treatment plans, lack of education, and lack of access to care contribute to poorer outcomes. LOCAL PROBLEM For patients with heart failure, the mean readmission rate is 21% nationally and 23% in New York State. Before the pilot heart failure program began, the 30-day readmission rate in the study institution was 28.6%. METHODS A multidisciplinary team created a heart failure self-care pilot program that was implemented on a hospital telemetry unit with 47 patients. Patients received education on their disease process, medications, diet, exercise, and early symptom recognition. Patients received a follow-up telephone call 48 to 72 hours after discharge and were seen by a cardiologist within a week of discharge. RESULTS The 30-day readmission rate for heart failure decreased by 16.6% after implementation of the pilot program, which improved patient adherence to their medication and treatment plan and resulted in a reduction of readmissions. DISCUSSION Patients in the pilot program represented diverse backgrounds. Socioeconomic factors such as the lack of affordable, healthy food choices and easy access to resources were associated with worse outcomes. CONCLUSIONS The evidence-based heart failure program improved knowledge, early symptom recognition, lifestyle modification, and adherence to medication, treatment plan, and follow-up appointments. The multidisciplinary team approach to the heart failure program reduced gaps in care and improved coordination and transition of care.
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Affiliation(s)
- Nancy Rizzuto
- Nancy Rizzuto is an adult nurse practitioner and the Director of Nursing, Critical Care, and Cardiology Services, Brookdale University Hospital, Brooklyn, New York
| | - Greg Charles
- Greg Charles is a program director for Cardiology Services and an angioplasty specialist, Brookdale University Hospital
| | - M Tish Knobf
- M. Tish Knobf is a professor of nursing, Yale University School of Nursing, Orange, Connecticut
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Hurtubise K, Gaboury I, Berbari J, Battista MC, Schuster T, Phoenix M, Rosenbaum P, Kraus De Camargo O, Lovo S, Pritchard-Wiart L, Zwicker JG, Beaudoin AJ, Morin M, Poder T, Gagnon MP, Roch G, Levac D, Tousignant M, Colquhoun H, Miller K, Churchill J, Robeson P, Ruegg A, Nault M, Camden C. Training Intervention and Program of Support (TIPS) for fostering adoption of family-centred telehealth in pediatric rehabilitation: Protocol for a multi-method, prospective hybrid type 3 implementation-effectiveness study (Preprint). JMIR Res Protoc 2022; 11:e40218. [PMID: 36306158 PMCID: PMC9652740 DOI: 10.2196/40218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background Children with disability face long wait times for rehabilitation services. Before the COVID-19 pandemic, telehealth adoption was low across pediatric rehabilitation. Owing to the COVID-19 pandemic restrictions, pediatric therapists were asked to rapidly shift to telehealth, often with minimal training. To facilitate the behavior changes necessary for telehealth adoption, provision of appropriate evidence-based training and support is required. However, evidence to support the effective implementation of such training is lacking. The successful real-world implementation of a training intervention and program of support (TIPS) targeting pediatric therapists to enhance the adoption of family-centered telerehabilitation (FCT) requires the evaluation of both implementation and effectiveness. Objective This study aimed to evaluate TIPS implementation in different pediatric rehabilitation settings and assess TIPS effectiveness, as it relates to therapists’ adoption, service wait times, families’ perception of service quality, and costs. Methods This 4-year, pan-Canadian study involves managers, pediatric occupational therapists, physiotherapists, speech-language pathologists, and families from 20 sites in 8 provincial jurisdictions. It will use a multimethod, prospective, hybrid type 3 implementation-effectiveness design. An interrupted time series will assess TIPS implementation. TIPS will comprise a 1-month training intervention with self-paced learning modules and a webinar, followed by an 11-month support program, including monthly site meetings and access to a virtual community of practice. Longitudinal mixed modeling will be used to analyze indicators of therapists’ adoption of and fidelity to FCT collected at 10 time points. To identify barriers and facilitators to adoption and fidelity, qualitative data will be collected during implementation and analyzed using a deductive-inductive thematic approach. To evaluate effectiveness, a quasi-experimental pretest-posttest design will use questionnaires to evaluate TIPS effectiveness at service, therapist, and family levels. Generalized linear mixed effects models will be used in data analysis. Manager, therapist, and family interviews will be conducted after implementation and analyzed using reflective thematic analysis. Finally, cost data will be gathered to calculate public system and societal costs. Results Ethics approval has been obtained from 2 jurisdictions (February 2022 and July 2022); approval is pending in the others. In total, 20 sites have been recruited, and data collection is anticipated to start in September 2022 and is projected to be completed by September 2024. Data analysis will occur concurrently with data collection, with results disseminated throughout the study period. Conclusions This study will generate knowledge about the effectiveness of TIPS targeting pediatric therapists to enhance FCT adoption in pediatric rehabilitation settings, identify facilitators for and barriers to adoption, and document the impact of telehealth adoption on therapists, services, and families. The study knowledge gained will refine the training intervention, enhance intervention uptake, and support the integration of telehealth as a consistent pediatric rehabilitation service option for families of children with disabilities. Trial Registration ClinicalTrials.gov NCT05312827; https://clinicaltrials.gov/ct2/show/NCT05312827 International Registered Report Identifier (IRRID) PRR1-10.2196/40218
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Affiliation(s)
- Karen Hurtubise
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster Univeristy, Hamilton, ON, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, QC, Canada
| | - Jade Berbari
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Claude Battista
- Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill Univeristy, Montreal, QC, Canada
| | - Michelle Phoenix
- School of Rehabilitation Sciences, Faculty of Health Sciences, McMaster Univeristy, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
| | - Peter Rosenbaum
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Olaf Kraus De Camargo
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Stacey Lovo
- School of Rehabilitation Sciences, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Jill G Zwicker
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
- Department of Occupational Sciences and Occupational Therapy, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Audrée Jeanne Beaudoin
- Institut Universitaire de Première Ligne en Santé et Services Sociaux, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- École de Réadaptation, Faculté de Médecine et Sciences de la Santé, Univeristé de Sherbrooke, Sherbrooke, QC, Canada
| | - Mélanie Morin
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- École de Réadaptation, Faculté de Médecine et Sciences de la Santé, Univeristé de Sherbrooke, Sherbrooke, QC, Canada
| | - Thomas Poder
- School of Public Health, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est de l'Île de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Gagnon
- Population Health and Optimal Health Practices Research Unit, Centre Hospitalier de Québec-Univeristé Laval Research Centre, Québec, QC, Canada
- Faculty of Nursing, Univeristé Laval, Québec, QC, Canada
| | - Geneviève Roch
- Population Health and Optimal Health Practices Research Unit, Centre Hospitalier de Québec-Univeristé Laval Research Centre, Québec, QC, Canada
- Faculty of Nursing, Univeristé Laval, Québec, QC, Canada
| | - Danielle Levac
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
- Faculty of Medicine, Univeristé de Montréal, Montréal, QC, Canada
| | - Michel Tousignant
- École de Réadaptation, Faculté de Médecine et Sciences de la Santé, Univeristé de Sherbrooke, Sherbrooke, QC, Canada
| | - Heather Colquhoun
- Occupational Science and Occupational Therapy Department, University of Toronto, Toronto, ON, Canada
| | - Kimberly Miller
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Physical Therapy, Univeristy of British Columbia, Vancouver, BC, Canada
| | | | | | - Andréa Ruegg
- Training Intervention and Program of Support Study Team, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Martine Nault
- Training Intervention and Program of Support Study Team, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Chantal Camden
- CanChild Centre for Childhood Disability Research, School of Rehabilitation Sciences, McMaster University, Hamilton, ON, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- École de Réadaptation, Faculté de Médecine et Sciences de la Santé, Univeristé de Sherbrooke, Sherbrooke, QC, Canada
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Promoting Safe Mobility. Am J Nurs 2022; 122:46-52. [DOI: 10.1097/01.naj.0000842256.48499.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Levoy K, Rivera E, McHugh M, Hanlon A, Hirschman K, Naylor M. Caregiver Engagement Enhances Outcomes Among Randomized Control Trials of Transitional Care Interventions: A Systematic Review and Meta-analysis. Med Care 2022; 60:519-529. [PMID: 35679175 PMCID: PMC9202479 DOI: 10.1097/mlr.0000000000001728] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Fluctuations in health among chronically ill adults result in frequent health care transitions. Some interventions to improve patient outcomes after hospitalization include caregiver engagement as a core component, yet there is unclear evidence of the effects of this component on outcomes. OBJECTIVE The objective of this study was to synthesize evidence regarding the attention given to caregiver engagement in randomized control trials of transitional care interventions (TCIs), estimate the overall intervention effects, and assess caregiver engagement as a moderator of intervention effects. METHODS Three databases were systematically searched for randomized control trials of TCIs targeting adults living with physical or emotional chronic diseases. For the meta-analysis, overall effects were computed using the relative risk (RR) effect size and inverse variance weighting. RESULTS Fifty-four studies met criteria, representing 31,291 participants and 66 rehospitalizations effect sizes. Half (51%) the interventions lacked focus on caregiver engagement. The overall effect of TCIs on all-cause rehospitalizations was nonsignificant at 1 month (P=0.107, k=29), but significant at ≥2 months [RR=0.89; 95% confidence interval (CI): 0.82, 0.97; P=0.007, k=27]. Caregiver engagement moderated intervention effects (P=0.05), where interventions with caregiver engagement reduced rehospitalizations (RR=0.83; 95% CI: 0.75, 0.92; P=0.001), and those without, did not (RR=0.97; 95% CI: 0.87, 1.08; P=0.550). Interventions with and without caregiver engagement did not differ in the average number of components utilized, however, interventions with caregiver engagement more commonly employed baseline needs assessments (P=0.032), discharge planning (P=0.006), and service coordination (P=0.035). DISCUSSION Future TCIs must consistently incorporate the active participation of caregivers in design, delivery, and evaluation.
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Affiliation(s)
- Kristin Levoy
- Department of Community and Health Systems, Indiana University (IU) School of Nursing, 600 Barnhill Dr., Indianapolis, IN 46202
- IU Center for Aging Research, Regenstrief Institute, 1101 W. 10 St., Indianapolis, IN 46202
| | - Eleanor Rivera
- University of Illinois Chicago College of Nursing, 845 S. Damen Ave, Chicago, IL 60612
| | - Molly McHugh
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 3615 Chestnut Street, Ralston-Penn Center, Philadelphia, PA 19104
| | - Alexandra Hanlon
- Center for Biostatistics and Health Data Science, Department of Statistics, College of Science, Virginia Tech, 4 Riverside Circle, Roanoke, VA 24016
| | - Karen Hirschman
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 3615 Chestnut Street, Ralston-Penn Center, Philadelphia, PA 19104
| | - Mary Naylor
- NewCourtland Center for Transitions and Health, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, 3615 Chestnut Street, Ralston-Penn Center, Philadelphia, PA 19104
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Topham EW, Bristol A, Luther B, Elmore CE, Johnson E, Wallace AS. Caregiver Inclusion in IDEAL Discharge Teaching: Implications for Transitions From Hospital to Home. Prof Case Manag 2022; 27:181-193. [PMID: 35617533 PMCID: PMC9177052 DOI: 10.1097/ncm.0000000000000563] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE Despite recognition that unpaid (e.g., family, friends) caregivers (caregivers) play an important role in successful transitions home after hospitalization, limited information is available about whether and how caregiver experiences of discharge align with current strategies for providing high-quality discharge processes, and how these experiences at discharge impact successful transitions home. The purpose of this study was to explore perceptions of caregivers regarding their discharge preparation, focusing particular attention on whether and how they believed discharge preparation impacted postdischarge patient outcomes. METHODS We conducted in-depth, case interviews with four English-speaking caregivers (61-75 years of age). Content analysis was framed by the nature of caregiver involvement proposed by the Agency for Healthcare Research and Quality's (AHRQ's) IDEAL (Include, Discuss, Educate, Assess, Listen) discharge planning strategy. RESULTS Caregivers reported receiving clear discharge instructions, or basic education, and yet felt only passively included in discharge teaching. Once home, the caregivers reported gaps in their knowledge of how to care for the patient, suggesting key gaps related to knowledge of warning signs and problems. Two of the four caregiver participants attributed a hospital readmission to postdischarge knowledge gaps. CONCLUSION The experiences of these caregivers demonstrate how their limited, passive involvement in discharge education may result in suboptimal patient outcomes after hospitalization. Our findings suggest that structured programs aimed at increasing caregiver involvement in discharge, particularly related to assessment of caregiver problem solving, planning, and postdischarge support, are important in efforts seeking to improve care transitions and postdischarge outcomes. IMPLICATIONS FOR CASE MANAGEMENT This study assesses caregivers' experience with discharge planning and problems they encounter post-discharge, providing case managers with important information regarding the effectiveness of discharge processes. This study of caregiver experiences suggests that the IDEAL discharge planning strategy remains a useful and important framework for case managers to follow when providing discharge services.
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Affiliation(s)
- Emily Wahlquist Topham
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Alycia Bristol
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Brenda Luther
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Catherine E Elmore
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Erin Johnson
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
| | - Andrea S Wallace
- Emily Wahlquist Topham, HBSN, RN, is an ICU registered nurse at (RN) the Huntsman Cancer Hospital in Salt Lake City, Utah. She received her Honors Bachelor of Science in Nursing (HBSN) from the College of Nursing, University of Utah, in May 2021. After working closely with patients and their family members for several years as a CNA, and during her training as an RN, Emily developed an interest in research and further exploring the role of family/informal caregivers during discharge processes, leading her to conduct these interviews and analyses
- Alycia Bristol, PhD, RN, AGCNS-BC, is an assistant professor at the College of Nursing, University of Utah. Dr. Bristol's research broadly seeks to address the care needs of hospitalized older adults and family caregivers, with a particular focus on patient safety and care quality. Dr. Bristol has conducted research in the areas of caregiving, palliative care, dementia symptom management, and care transitions. She is currently examining the influence of intrahospital transitions on discharge planning and caregivers' readiness for discharge
- Brenda Luther, PhD, RN, is an associate professor at the College of Nursing, University of Utah. Dr. Luther's research started with investigating vital roles and responsibilities for care managers. She also participated in research focused on interdisciplinary team communication to support quality health planning for clients and clinicians
- Catherine E. Elmore, PhD, MSN, RN, CNL, is a nurse scientist and is currently a postdoctoral research fellow in the T32 Interdisciplinary Training in Cancer, Caregiving, and End of Life Care training program at the College of Nursing, University of Utah
- Erin Johnson, PhD, is a research associate at the College of Nursing, University of Utah. Dr. Johnson has a degree in Cognitive Psychology and began her career exploring reading and language development in young children. She now works in the fields of bioethics around genetic testing and health services research
- Andrea Wallace, PhD, RN, FAAN, is an associate professor and associate dean for the research and PhD program at the College of Nursing, University of Utah. Dr. Wallace is a health services researcher who focuses on the effectiveness of health service interventions when delivered during routine care
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Dessureault M, Dallaire C. Recevoir un soutien aux capacités d’autosoins lors de la transition posthospitalisation en résidence pour aînés en perte d’autonomie : un besoin non comblé. Rech Soins Infirm 2022; 146:19-34. [PMID: 35724020 DOI: 10.3917/rsi.146.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Elderly people who receive appropriate transitional care after hospitalization experience fewer complications. CONTEXT However, in Quebec, transitional care for the elderly is limited to case management and targets elderly people who are in need of resources. This often excludes those who remain in homes for the elderly. OBJECTIVES The objective of this study was to identify the unmet needs of elderly people during the posthospitalization transition to intermediate care facilities in Quebec, as well as the strategies they use on a daily basis to cope with these needs. METHODS A descriptive qualitative study was conducted as part of an intervention research process. Eleven elderly participants and health professionals were recruited (n=11). RESULTS The results presented suggest a need to support patients' capacity for self-care, unmet during the post-hospitalization transition to intermediate care facilities. DISCUSSION Supporting the self-care abilities of elderly people can help ensure their safety when living in homes for the elderly. CONCLUSION Supporting the capacity for self-care is an important component of transitional care after hospitalization, including for elderly people with disabilities.
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Affiliation(s)
- Maude Dessureault
- Infirmière, Ph.D, professeure adjointe, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Clémence Dallaire
- Infirmière, Ph.D, professeure titulaire, Université Laval, Québec, Canada
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Information exchange among providers and patient-centeredness in transitional care: A five-year retrospective analysis. Healthcare (Basel) 2022; 10:100626. [DOI: 10.1016/j.hjdsi.2022.100626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 01/18/2022] [Accepted: 03/08/2022] [Indexed: 11/19/2022] Open
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Reig-Garcia G, Bonmatí-Tomàs A, Suñer-Soler R, Malagón-Aguilera MC, Gelabert-Vilella S, Bosch-Farré C, Mantas-Jimenez S, Juvinyà-Canal D. Evaluation and perceptions of a nursing discharge plan among nurses from different healthcare settings in Spain. BMC Health Serv Res 2022; 22:710. [PMID: 35643517 PMCID: PMC9145205 DOI: 10.1186/s12913-022-08109-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
The exchange of information between different healthcare settings through a nursing discharge plan is essential for safe care. However, the factors contributing to achieving the most efficient exchange have not been well studied. This study aimed to evaluate and explore the perceptions of a nursing discharge plan from the perspective of nurses in different healthcare settings.
Methods
A mixed methods approach comprising a specifically designed ad hoc questionnaire (n = 437) and a focus group session (n = 8).
Findings
Overall, 66.1% out of 437 nurses, and especially those working in nursing homes, were satisfied with the nursing discharge plan.
Lack of time to complete the report and poor information about both nursing diagnoses and patients’ social assessment were identified as problem areas. Some proposals emerged from the focus group: providing sufficient time for its completion, giving the nursing discharge plan a more flexible structure permitting more open-ended responses, requiring more information to be provided about the social and psychological situation of the patients, training nurses to use standardized language to avoid possible misinterpretations, and getting nurses from the different health care settings to work together in designing continuity of care plans. Elderly and low-income patients are found to need greater attention when filling out nursing discharge plans.
Conclusions
The study has revealed key aspects that need to be improved and some recommendations in implementing the nursing discharge plan in our health area. These include that there should be more time provided to complete the NDP, and also specific details regarding the format, structure, content of the information that is communicated, and the prioritization of the patient profile.
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Key Care Provision Aspects That Affect Care Transition in the Long-Term Care Systems: Preliminary Review Findings. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116402. [PMID: 35681987 PMCID: PMC9180334 DOI: 10.3390/ijerph19116402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022]
Abstract
The aim of this brief report is to present the protocol and preliminary findings of a systematic review on key aspects of care provision that affect care transition of older adults 60+ within the long-term care systems. This brief report describes and classifies the relevant literature found in the review with the purpose to provide a base for further full systematic reviews, and to outlines a model of organizational and financing aspects that affect care transition. Our search was conducted in MEDLINE, Embase and CINAHL on 2 March 2020, before the COVID-19 pandemic. The protocol was registered at the International Prospective Register of Systematic Reviews (number: CRD42020162566). Ultimately, 229 full-text records were found eligible for further deliberation. We observed an increase in the number of publications on organizational and financial aspects of care transition since 2005. Majority of publications came from the United States, United Kingdom and Australia. In total, 213 (92%) publications discussed organizational aspects and only 16 (8%) publications were related to financial aspects. Records on organizational aspects were grouped into the following themes: communication among involved professional groups, coordination of resources, transfer of information and care responsibility of the patient, training and education of staff, e-health, education and involvement of the patient and family, social care, and opinion of patients. Publications on financial aspects were grouped into provider payment mechanisms, incentives and penalties. Overall, our search pointed out various care provision aspects being studied in the literature, which can be explored in detail in subsequent full systematic reviews focused on given aspects. We also present a model based on our preliminary findings, which enables us to better understand what kind of provision aspects affect care transition. This model can be tested and validated in subsequent research. Understating factors that affect care transition is crucial to improve the quality of transitions and ultimately the outcomes for the patients.
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Effectiveness of care transition strategies for colorectal cancer patients: a systematic review and meta-analysis. Support Care Cancer 2022; 30:6251-6261. [PMID: 35459953 DOI: 10.1007/s00520-022-07033-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Implementing effective strategies to transition care for individuals with colorectal cancer is an important tool to qualify care for affected individuals, as well as contribute to the dispensation of continuous and quality care to patients. OBJECTIVE To evaluate the effectiveness of strategies to transition from hospital care to the community compared to usual care for colorectal cancer patients to reduce hospital stay, readmissions at 30 days, and visit to the emergency department up to 30 days. METHOD Systematic review and meta-analysis followed the recommendations of PRISMA statement, with protocol registered in PROSPERO (CRD 42,020,162,249). Searches were carried out in May 2020 in the following databases: PubMed/MEDLINE, LILACS, EMBASE, and Cochrane Central. Meta-analysis was performed using a random-effects model. The measure of effect used for dichotomous outcomes was relative risk, and for continuous outcomes, the difference of means was used, with their confidence intervals of 95%. Heterogeneity was evaluated using inconsistency statistics. RESULTS Of 631 identified studies, seven studies were included. The meta-analysis of the studies showed a reduction in readmissions at 30 days of 32% and a significant reduction in hospital stay time of approximately one and a half days, both of which were analyzed in favor of the group of care transition interventions. CONCLUSION The findings showed effective care transition strategies for the transition of colorectal cancer patients, such as post-discharge active surveillance program, standardized protocol of improved recovery, and telephone follow-up. TRIAL REGISTRATION CRD42020162249.
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Wang Y, Zhang X, Hu X, Sun X, Wang Y, Huang K, Sun S, Lv X, Xie X. Evaluation of medication risk at the transition of care: a cross-sectional study of patients from the ICU to the non-ICU setting. BMJ Open 2022; 12:e049695. [PMID: 35428614 PMCID: PMC9013992 DOI: 10.1136/bmjopen-2021-049695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To describe the incidence and types of medication errors occurring during the transfer of patients from the intensive care unit (ICU) to the non-ICU setting and explore the key factors affecting medication safety in transfer care. DESIGN Multicentre, retrospective, epidemiological study. PARTICIPANTS Patients transferred from the ICU to a non-ICU setting between 1 July 2019 and 30 June 2020. MAIN OUTCOME MEASURES Incidence and types of medication errors. RESULTS Of the 1546 patients transferred during the study period, 899 (58.15%) had at least one medication error. Most errors (83.00%) were National Coordinating Council (NCC) for Medication Error Reporting and Prevention (MERP) category C. A small number of errors (17.00%) were category D. Among patients with medication errors, there was an average of 1.68 (SD, 0.90; range, 1-5) errors per patient. The most common types of errors were route of administration 570 (37.85%), dosage 271 (17.99%) and frequency 139 (9.23%). Eighty-three per cent of medication errors reached patients but did not cause harm. Daytime ICU transfer (07:00-14:59) and an admission diagnosis of severe kidney disease were found to be factors associated with the occurrence of medication errors as compared with the reference category (OR, 1.40; 95% CI 1.01 to 1.95; OR, 6.78; 95% CI 1.46 to 31.60, respectively).Orders for bronchorespiratory (OR, 5.92; 95% CI 4.2 to 8.32), cardiovascular (OR, 1.91; 95% CI 1.34 to 2.73), hepatic (OR, 1.95; 95% CI 1.30 to 2.91), endocrine (OR, 1.99; 95% CI 1.37 to 2.91), haematologic (OR, 2.58; 95% CI 1.84 to 3.64), anti-inflammatory/pain (OR, 2.80; 95% CI 1.90 to 4.12) and vitamin (OR, 1.73; 95% CI 1.26 to 2.37) medications at transition of care were associated with an increased odds of medication error. CONCLUSIONS More than half of ICU patients experienced medication errors during the transition of care. The vast majority of medication errors reached the patient but did not cause harm.
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Affiliation(s)
- Yao Wang
- School of Pharmacy, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Hefei, Anhui, China
| | - Xueting Zhang
- School of Pharmacy, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Hefei, Anhui, China
| | - Xu Hu
- School of Pharmacy, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Hefei, Anhui, China
| | - Xuqun Sun
- Department of Pharmacy, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yuanyuan Wang
- Department of Pharmacy, Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Kaiyu Huang
- School of Pharmacy, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Hefei, Anhui, China
| | - Sijia Sun
- School of Pharmacy, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Hefei, Anhui, China
| | - Xiongwen Lv
- School of Pharmacy, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Hefei, Anhui, China
| | - Xuefeng Xie
- School of Pharmacy, Anhui Medical University, Hefei, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Anhui Medical University, Hefei, Anhui, China
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Popejoy L, Zaniletti I, Lane K, Anderson L, Miller S, Rantz M. Longitudinal analysis of aging in place at TigerPlace: Resident function and well-being. Geriatr Nurs 2022; 45:47-54. [PMID: 35305514 DOI: 10.1016/j.gerinurse.2022.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/04/2022]
Abstract
This paper reports on a longitudinal eight-year analysis (2011-2019) of trajectory of function and well-being residents of TigerPlace Aging in Place (AIP) model of care. Residents were routinely assessed using standard health assessment instruments. Average scores from each measure were examined for changes or trends in resident function; decline over time was calculated. Scores for depression, mental health subscale Short Form Health Survey-12 (SF-12) remained stable over time. Mini Mental State Exam declined to mild dementia range (21-24). Physical measures SF-12 physical health subscale, ADLs, and IADLs declined slightly, while fall risk increased over time. When yearly trends in AIP were modeled with a referent group there was no significant worsening of functioning. The length of stay for TigerPlace residents continued to remain stable at nearly 30 months. Residents maintained function in the environment of their choice longer at cost less than nursing homes, and just above residential care cost.
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Affiliation(s)
- Lori Popejoy
- Sinclair School of Nursing, University of Missouri, United States.
| | - Isabella Zaniletti
- Statistics, College of Arts and Science, University of Missouri, United States
| | - Kari Lane
- Sinclair School of Nursing, University of Missouri, United States
| | - Linda Anderson
- Sinclair School of Nursing, University of Missouri, United States
| | - Steven Miller
- Sinclair School of Nursing, University of Missouri, United States
| | - Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, United States
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