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McCauley K. Insights Into Improving Outcomes for Post-Myocardial Infarction Veterans After Hospitalization at Veteran's Health Administration Versus Non-Veteran's Health Administration Hospitals. Med Care 2024; 62:69-71. [PMID: 38133571 DOI: 10.1097/mlr.0000000000001964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Affiliation(s)
- Kathleen McCauley
- Biobehavioral Health Sciences Department, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Ardmore, PA
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LoGrippo M, Griffith P, McCauley K. Incorporating the Transitional Care Model within NP program curricula to achieve care coordination competency. J Prof Nurs 2023; 49:1-9. [PMID: 38042541 DOI: 10.1016/j.profnurs.2023.08.004] [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: 10/21/2022] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 12/04/2023]
Abstract
PURPOSE Education for nurse practitioners (NPs) requires knowledge and skill acquisition for managing transitions in care, especially among older adults with complex care needs. A team of nurse researchers and educators provided a competency-based approach for educating future NPs on the care delivery of older adults using the Transitional Care Model's (TCM) evidence-based interventions. METHODS NP faculty integrated an online course offering didactic teaching that would enhance clinical learning. The online content included a case study of an NP navigating an older adult through transitions in care. Students completed evidence-based interventions with patients while in their clinical rotations. RESULTS Using the structured and purposeful interventions within the clinical practicum provided exposure to and experience with the application of the model's nine components. NP students applied knowledge and demonstrated skills through direct care experiences in the clinical setting. This learning supports the achievement of advanced nursing practice competencies depicted in the American Association of Colleges of Nursing (AACN)'s The Essentials: Core Competencies for Professional Nursing Education (2021). CONCLUSIONS This is one example of how a NP program integrates evidence-based interventions to ensure that NP graduates are well-positioned and ready for managing transitions of complex care for older adults.
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Affiliation(s)
- Maria LoGrippo
- School of Nursing, University of Pennsylvania, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA.
| | - Patricia Griffith
- School of Nursing, University of Pennsylvania, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA.
| | - Kathleen McCauley
- School of Nursing, University of Pennsylvania, Claire M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA.
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Hirschman KB, McHugh M, Morgan B. An integrative review of measures of transitions and care coordination for persons living with dementia and their caregivers. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2023; 9:e12391. [PMID: 37555017 PMCID: PMC10404587 DOI: 10.1002/trc2.12391] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/21/2023] [Accepted: 04/21/2023] [Indexed: 08/10/2023]
Abstract
Introduction High rates of hospital visits and readmissions are common among persons living with dementia, resulting in frequent transitions in care and care coordination. This paper identifies and evaluates existing measures of transitions and care coordination for persons living with dementia and their caregivers. Methods This integrative review builds off a prior review using a systematic search of online databases (PubMed, EBSCO, CINAHL, PsycInfo, and Scopus) to identify records and locate reports (or articles) that use measures of care transitions and care coordination. Identified measures were compared to the Alzheimer's Association's Dementia Care Practice Recommendations to evaluate strengths and weaknesses of the measure in this population, such as if measures were person- and family-centered. Results Seventy-one reports using measures of transitions in care and care coordination for persons living with dementia and their caregivers were identified. There were multiple measures identified in some reports. Three main areas of measures were classified into: identification of the population (3 measures, 8 reports), transitional care and care coordination delivery (14 measures, 17 reports), and transitional care and care coordination outcomes (e.g., health-care use, cost, and mortality; 17 measures, 60 reports). A strength of the three main areas of measures was that a portion of the measures were person- and family-centered. Variability in the operational definitions of some measures and time intensiveness of collecting the measure (e.g., number of items, the time it takes to complete the items) were common weaknesses. Discussion Transitions and care coordination measures are varied across studies targeted at persons living with dementia and their caregivers. Existing measures focus heavily on outcomes, specifically health-care resource use, and cost, rather than the elements of transitional care or care coordination. Future measure development focused on care transitions and service coordination is needed.
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Affiliation(s)
| | - Molly McHugh
- University of PennsylvaniaSchool of NursingPhiladelphiaPennsylvaniaUSA
| | - Brianna Morgan
- University of PennsylvaniaSchool of NursingPhiladelphiaPennsylvaniaUSA
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Kovaleva MA, Kleinpell R, Dietrich MS, Jones AC, Boon JT, Duggan MC, Dennis BM, Lauderdale J, Maxwell CA. Caregivers’ experience with Tele-Savvy Caregiver Program post-hospitalization. Geriatr Nurs 2023; 51:156-166. [PMID: 36990041 DOI: 10.1016/j.gerinurse.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 03/30/2023]
Abstract
Despite the frequent hospitalizations and readmissions of persons living with dementia (PLWD), no telehealth transitional care interventions focus on PLWDs' unpaid caregivers. Tele-Savvy Caregiver Program is a 43-day evidence-based online psychoeducational intervention for PLWDs' caregivers. The aim of this formative evaluation was to explore caregivers' acceptability of and experience with their participation in Tele-Savvy after their PLWDs' hospital discharge. Additionally, we gathered caregivers' feedback on the recommended features of a transitional care intervention, suitable for caregivers' schedule and needs post-discharge. Fifteen caregivers completed the interviews. Data were analyzed via conventional content analysis. Four categories were identified: (1) Tele-Savvy improved participants' understanding of dementia and caregiving; (2) hospitalization started a "new level of normal"; (3) PLWDs' health concerns; and (4) transitional care intervention development. Participation in Tele-Savvy was acceptable for most caregivers. Participants' feedback provides content and structural guidance for the development of a new transitional care intervention for PLWDs' caregivers.
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Affiliation(s)
- Mariya A Kovaleva
- College of Nursing - Omaha Division, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE 68198-5330, USA.
| | - Ruth Kleinpell
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Department of Biostatistics, Vanderbilt University School of Medicine, 1161 21st Ave S, #D3300, Nashville, TN 37232, USA
| | - Abigail C Jones
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Yale University School of Nursing, 400 West Campus Drive, Orange, CT 06477, USA
| | - Jeffrey T Boon
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA; Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Maria C Duggan
- Division of Geriatric Medicine, Vanderbilt University School of Medicine, 1161 21st Ave S, #D3300, Nashville, TN 37232, USA; Geriatric Research Education and Clinical Center, Department of Veterans Affairs, Tennessee Valley Healthcare System, 1310 24th Ave South, Nashville, TN 37212-2637, USA
| | - Bradley M Dennis
- Division of Acute Care Surgery, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN 37232, USA
| | - Jana Lauderdale
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
| | - Cathy A Maxwell
- Vanderbilt University School of Nursing, 461 21st Ave S, Nashville, TN 37240, USA
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Naylor MD, Hirschman KB, Morgan B, McHugh M, Hanlon AL, Ahrens M, McCauley K, Shaid EC, Pauly MV. The study protocol to evaluate implementation of the transitional care model in four U.S. healthcare systems during the Covid-19 pandemic. Arch Gerontol Geriatr 2023; 108:104944. [PMID: 36709563 PMCID: PMC9873366 DOI: 10.1016/j.archger.2023.104944] [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: 10/13/2022] [Revised: 01/10/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023]
Abstract
This study protocol describes the conceptual framework, design, and methods being employed to evaluate the implementation of the Transitional Care Model (TCM) as part of a randomized controlled trial. The trial, designed to examine the health and cost outcomes of at-risk hospitalized older adults, is being conducted in the context of the COVID-19 pandemic. This parallel study is guided by the Practical, Robust, Implementation and Sustainability Model (PRISM) and uses a fixed, mixed methods convergent parallel design to identify challenges encountered by participating hospitals and post-acute and community-based providers that impact the implementation of the TCM with fidelity, strategies implemented to address those challenges and the relationships between challenges, strategies, and rates of fidelity to TCM's core components over time. Prior to the study's launch and throughout its implementation, qualitative and quantitative data related to COVID and non-COVID challenges are being collected via surveys and meetings with healthcare system staff. Strategies implemented to address challenges and fidelity to TCM's core components are also being assessed. Analyses of quantitative (established metrics to evaluate TCM's core components) and qualitative data (barriers and facilitators to implementation) are being conducted independently. These datasets are then merged and interpreted together. General linear and mixed effects modeling using all merged data and patients' socio-demographic and social determinants of health characteristics, will be used to examine relationships between key variables and fidelity rates. Implications of study findings in the context of COVID-19 and future research opportunities are suggested. Trial registration: ClinicalTrials.gov Identifier: NCT04212962.
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Affiliation(s)
- Mary D Naylor
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104.
| | - Karen B Hirschman
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104
| | - Brianna Morgan
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104
| | - Molly McHugh
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104
| | - Alexandra L Hanlon
- Center for Biostatistics and Health Data Science, College of Science, Department of Statistics, Virginia Tech, Four Riverside Circle, Roanoke, VA 24016
| | - Monica Ahrens
- Center for Biostatistics and Health Data Science, College of Science, Department of Statistics, Virginia Tech, Four Riverside Circle, Roanoke, VA 24016
| | - Kathleen McCauley
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104
| | - Elizabeth C Shaid
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd., Philadelphia, PA 19104
| | - Mark V Pauly
- Wharton School, University of Pennsylvania, Philadelphia, PA 19104
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Toles M, Leeman J, McKay MH, Covington J, Hanson LC. Adapting the Connect-Home transitional care intervention for the unique needs of people with dementia and their caregivers: A feasibility study. Geriatr Nurs 2022; 48:197-202. [PMID: 36274509 PMCID: PMC9749405 DOI: 10.1016/j.gerinurse.2022.09.016] [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: 08/29/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
AIMS After leaving skilled nursing facilities (SNF), 20% of people with dementia (PWD) are re-hospitalized within 30 days. We assessed fidelity, acceptability, preliminary outcomes, and mechanisms of the Connect-Home ADRD transitional care intervention. DESIGN A feasibility study of Connect-Home ADRD. METHODS The Connect-Home intervention was adapted for dementia-specific needs. PWD and caregiver dyads in 2 SNFs received transitional care. Data sources included interviews with PWD and caregivers and a review of health records. RESULTS 19 of 34 eligible dyads (56%) were enrolled. The intervention was feasible (components delivered for >84% of dyads) and acceptable (dyads rated it very helpful and not difficult to use). Connect-Home ADRD adaptations included in-home support to manage symptoms of dementia and unplanned events, such as transition to hospice. IMPACT Connect-Home ADRD is feasible, acceptable, and merits future research as an intervention to reduce rapid return to acute care following SNF stays.
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Affiliation(s)
- Mark Toles
- The University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, United States.
| | - Jennifer Leeman
- The University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, United States
| | - M Heather McKay
- Partnerships for Health, Manager, 169 Boone Square St #196, Hillsborough, NC 27278, United States
| | - Jacquelyn Covington
- The University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, Campus Box #7460, Chapel Hill, NC 27599-7460, United States
| | - Laura C Hanson
- The University of North Carolina at Chapel Hill, School of Medicine, 321 S Columbia St, Chapel Hill, NC 27599, United States
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Toles M, Leeman J, Gwyther L, Vu M, Vu T, Hanson LC. Unique Care Needs of People with Dementia and Their Caregivers during Transitions from Skilled Nursing Facilities to Home and Assisted Living: A Qualitative Study. J Am Med Dir Assoc 2022; 23:1486-1491. [PMID: 35926571 PMCID: PMC9801685 DOI: 10.1016/j.jamda.2022.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/31/2022] [Accepted: 06/21/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The purpose of the study was to describe unique care needs of people with dementia (PWD) and their caregivers during transitions from skilled nursing facilities (SNF) to home. DESIGN A qualitative study using focus groups, semistructured interviews, and descriptive qualitative analysis. SETTING AND PARTICIPANTS The study was set in one state, in 4 SNFs where staff had experience using a standardized transitional care protocol. The sample included 22 SNF staff, 4 home health nurses, 10 older adults with dementia, and their 10 family caregivers of whom 39 participated in focus groups and/or interviews. METHODS Data collection included 4 focus groups with SNF staff and semistructured interviews with home health nurses, SNF staff, PWD, and their family caregivers. Standardized focus group and interview guides were used to elicit participant perceptions of transitional care. We used the framework analytic approach to qualitative analysis. A steering committee participated in interpretation of findings. RESULTS Participants described 4 unique care needs: (1) PWD and caregivers may not be ready to fully engage in dementia care planning while in the SNF, (2) caregivers are not prepared to manage dementia symptoms at home, (3) SNF staff have difficulty connecting PWD and caregivers to community supports, and (4) caregivers receive little support to address their own needs. CONCLUSIONS AND IMPLICATIONS Based on findings, recommendations are offered for adapting transitional care to address the needs of PWD and their caregivers. Further research is needed (1) to confirm these findings in larger, more diverse samples and (2) to adapt and test interventions to support successful community discharge of PWD and their caregivers.
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Affiliation(s)
- Mark Toles
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA.
| | - Jennifer Leeman
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA
| | - Lisa Gwyther
- Duke University, School of Medicine, Durham, NC, USA
| | - Maihan Vu
- University of North Carolina at Chapel Hill, Gillings School of Public Health, Chapel Hill, NC, USA
| | - Thi Vu
- Yale University, School of Public Health, New Haven, CT, USA
| | - Laura C Hanson
- University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC, USA
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8
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Ong CEC, Phan P, Wu CX, Chen Z, Quek LS. Value-based analysis of a Singaporean post-ED discharge support program for older adults. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022. [DOI: 10.1177/25160435221113955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective We evaluated the effectiveness of a post emergency department (ED) discharge intervention for frail, older adult patients in reducing hospital admissions. Methods 9-month retrospective real-world evaluation of a quality improvement intervention comparing frail adults 65-years and older who received a post-ED discharge intervention program (SAFE-Lite) with those who were eligible but declined and received usual care instead. The primary outcomes were the differences in rates of first acute hospital admission at 30- and 60-days post-ED discharge. The difference in primary outcome between the two groups was compared using the Cox proportional hazards model. We report adjusted hazards ratios (HRs) with 95% CIs for age, gender, Triage Risk Screening Tool (TRST) scores, as well as baseline ED utilization and acute hospital admission rates in the past year. Results There were 66 patients in the intervention group and 46 patients in the control group. There was no significant difference in risk of acute hospital admission at both 30 days (15 vs. 13%, HR = 0.92, 95% CI: 0.35–2.41) and 60 days (21 vs. 16%, HR = 0.97, 95% CI: 0.42–2.21) for the intervention and control groups. Conclusion Compared to usual post-ED discharge care, SAFE-Lite showed no difference in reducing 30- and 60-day admissions of frail, older patients.
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Affiliation(s)
| | - Phillip Phan
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
- Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Christine Xia Wu
- Quality, Innovation & Improvement, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Zhaoqi Chen
- Quality, Innovation & Improvement, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Lit Sin Quek
- Office of CEO, Ng Teng Fong General Hospital, Singapore, Singapore
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Xu Y, Koh XH, Chua YTS, Tan CGI, Aloweni FAB, Yap BEJ, Tan PC, Chua X, Lim YKS, Oh HC, Teo SHS, Lim SF. The impact of community nursing program on healthcare utilization: A program evaluation. Geriatr Nurs 2022; 46:69-79. [DOI: 10.1016/j.gerinurse.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
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10
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Analysis of the Characteristics of Dominant Diseases in Traditional Chinese Medicine: Based on 95 Diseases. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:6972663. [PMID: 35707474 PMCID: PMC9192295 DOI: 10.1155/2022/6972663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022]
Abstract
Background Traditional Chinese medicine (TCM) has been widely used all over the world and has shown its superiority in some diseases. However, there are no clear evaluation criteria for TCM. In 2019, a list of TCM dominant diseases was published by the Chinese National Administration of Traditional Chinese Medicine. This study aimed to systematically summarize the characteristics of 95 TCM dominant diseases and provide a reference for the establishment of evaluation criteria for TCM dominant diseases. Methods The diagnosis and treatment protocols of all the 95 TCM dominant diseases were screened. The data of disease classification, diseases' code of TCM, length of hospital stay, treatment protocols, and clinical pathways were reviewed and summarized. Results The diseases of the genitourinary and nervous systems accounted for 14.74% and 12.73% of the TCM dominant diseases, respectively. The length of hospital stay for 55 (57.89%) diseases was no more than less than 14 days. Each disease had its specific Chinese herbal decoction pieces and Chinese patent drugs. Chinese medical injections were not widely used. TCM external treatments for these diseases are abundant, with hundreds optional. Conclusion Some potentially promising TCM dominant diseases remain to be identified and deserve further research to establish the evaluation criteria of TCM dominant diseases.
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Nguyen PV, Hjelholt TJ, Heide-Jørgensen U, Pedersen AB. Postoperative complications, mortality, and quality of in-hospital care among hip fracture patients with Parkinson's disease. Injury 2022; 53:2150-2157. [PMID: 35296377 DOI: 10.1016/j.injury.2022.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 02/17/2022] [Accepted: 03/05/2022] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to investigate the association between Parkinson's disease (PD) and postoperative complications, mortality, and quality of in-hospital care in patients with hip fracture. METHODS We included patients aged 65+ years with an incident hip fracture from 2004-2017, registered in the Danish Multidisciplinary Hip Fracture Registry. Patients with PD were identified using diagnosis codes prior to hip fracture. Using log-binomial regression, we calculated both 30-day crude and adjusted risk ratios (aRR) with 95% confidence intervals (CIs) for the following outcomes: any hospital-treated infections, pneumonia, urinary tract infection, sepsis, community-treated infections, cardiovascular events, mortality, and fulfilment of quality indicators of in-hospital care. Analyses were adjusted for age, sex and Charlson comorbidity index score. RESULTS We identified 77,550 hip fracture patients of which 1,915 had PD. Compared to non-PD, patients with PD had higher risk of any hospital-treated - (aRR = 1.27 (CI: 1.10-1.45) and community-treated infection (aRR = 1.22 (CI: 1.13-1.32)), pneumonia (aRR = 1.38 (1.11-1.69)), urinary tract infection (aRR of 1.58 (CI: 1.28-1.92)) and sepsis (aRR = 1.18 (CI: 0.67-1.89)), but a reduced risk of cardiovascular events (aRR = 0.59 (CI: 0.41-0.82)). The aRR for 30-day mortality was 1.11 (CI: 0.97-1.27) for PD vs non-PD patients, and the aHR for 1-year mortality was 1.19 (CI: 1.09-1.30). The aRRs for fulfillment of all relevant quality indicators was about 1 for PD vs non-PD patients. CONCLUSION Hip fracture patients with PD have a higher risk of infections and mortality within 30 days after surgery after adjustment for sex, age, and comorbidity. They do, however, receive comparable quality of in-hospital care after hip fracture compared to non-PD patients.
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Affiliation(s)
- Peter Vn Nguyen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Thomas J Hjelholt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Uffe Heide-Jørgensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark.
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Laws L, Ritter L, Loescher L, McEwen M. Stroke-Specific Refinements to Naylor's Transitional Care Model to Address the Storm of Uncertainty and Unmet Survivor and Caregiver Needs. J Neurosci Nurs 2022; 54:23-29. [PMID: 35007260 DOI: 10.1097/jnn.0000000000000629] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: By 2030, there will be approximately 7.6 million stroke survivors (SSs) in the United States, yet comprehensive transitional care (TC) for stroke is not widely available. Stroke strikes without warning and leaves in its wake a "storm" of uncertainty for SSs and caregivers (CGs) as they encounter a myriad of unmet physical, mental, emotional, and financial needs that are not wholly addressed by passive healthcare delivery systems. Needed is a stroke-specific TC model that bridges this storm to active delivery of SS and CG postacute care. Naylor's Transitional Care Model (NTCM) has not been examined for how it can frame comprehensive stroke care. The purpose of this study was to solicit SS and CG descriptions of TC experiences to inform the NTCM with refined operational definitions and exemplars specific to stroke. METHODS: Focus groups conducted for this qualitative descriptive study were guided by interview questions based on the 8 NTCM operational definitions. Data were analyzed using inductive and deductive qualitative content analysis methods. RESULTS: Post-acute-stroke care does not comprehensively meet the needs of SSs and CGs. Participants described TC deficits across all 8 NTCM components. Two new subcomponents that could be applied for a stroke-specific NTCM emerged: psychological and transportation challenges. CONCLUSION: Unmet needs identified by SSs and CGs were used to extend NTCM specific to the stroke population and to develop the Recommendations and Exemplars for Stroke Specific Comprehensive Transitional Care Delivery (see Supplementary Digital Content, available at http://links.lww.com/JNN/A385). Researchers and practitioners can use the findings to develop and deliver more comprehensive TC to SSs and CGs.
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Ryvicker M, Barrón Y, Shah S, Moore SM, Noble JM, Bowles KH, Merrill J. Clinical and Demographic Profiles of Home Care Patients With Alzheimer's Disease and Related Dementias: Implications for Information Transfer Across Care Settings. J Appl Gerontol 2022; 41:534-544. [PMID: 33749369 PMCID: PMC8450301 DOI: 10.1177/0733464821999225] [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: 11/15/2022] Open
Abstract
Home health care (HHC) clinicians serving individuals with Alzheimer's disease and related dementias (ADRD) do not always have information about the person's ADRD diagnosis, which may be used to improve the HHC plan of care. This retrospective cohort study examined characteristics of 56,652 HHC patients with varied documentation of ADRD diagnoses. Data included clinical assessments and Medicare claims for a 6-month look-back period and 4-year follow-up. Nearly half the sample had an ADRD diagnosis observed in the claims either prior to or following the HHC admission. Among those with a prior diagnosis, 63% did not have it documented on the HHC assessment; the diagnosis may not have been known to the HHC team or incorporated into the care plan. Patients with ADRD had heightened risk for adverse outcomes (e.g., urinary tract infection and aspiration pneumonia). Interoperable data across health care settings should include ADRD-specific elements about diagnoses, symptoms, and risk factors.
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Affiliation(s)
- Miriam Ryvicker
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
- Vital Statistics Consulting
| | - Yolanda Barrón
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
| | - Shivani Shah
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
| | - Stanley M. Moore
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
| | | | - Kathryn H. Bowles
- Center for Home Care Policy & Research, Visiting Nurse Service of New York
- University of Pennsylvania School of Nursing
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Fox MT, Sidani S, Butler JI, Skinner MW, Macdonald M, Durocher E, Hunter KF, Wagg A, Weeks LE, MacLeod A, Dahlke S. Optimizing hospital-to-home transitions for older persons in rural communities: a participatory, multimethod study protocol. Implement Sci Commun 2021; 2:81. [PMID: 34294145 PMCID: PMC8295643 DOI: 10.1186/s43058-021-00179-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/27/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Transitional care involves time-limited interventions focusing on the continuity of care from hospital to home, to optimize patient functioning and management. Providing interventions, as part of transitional care, that optimize the functioning of older people with dementia is critical due to the small window of opportunity in which they can return to their baseline levels of functioning. Yet prior research on transitional care has not included interventions focused on functioning and did not target older people with dementia in rural communities, limiting the applicability of transitional care to this population. Accordingly, the goal of this study is to align hospital-to-home transitional care with the function-related needs of older people with dementia and their family-caregivers in rural communities. METHODS In this multimethod study, two phases of activities are planned in rural Ontario and Nova Scotia. In phase I, a purposive sample of 15-20 people with dementia and 15-20 family-caregivers in each province will rate the acceptability of six evidence-based interventions and participate in semi-structured interviews to explore the interventions' acceptability and, where relevant, how to improve their acceptability. Acceptable interventions will be further examined in phase II, in which a purposive sample of healthcare providers, stratified by employment location (hospital vs. homecare) and role (clinician vs. decision-maker), will (1) rate the acceptability of the interventions and (2) participate in semi-structured focus group discussions on the facilitators and barriers to delivering the interventions, and suggestions to enable their incorporation into rural transitional care. Two to three focus groups per stratum (8-10 healthcare providers per focus group) will be held for a total of 8-12 focus groups per province. Data analysis will involve qualitative content analysis of interview and focus group discussions and descriptive statistics of intervention acceptability ratings. DISCUSSION Findings will (1) include a set of acceptable interventions for rural transitional care that promote older patients' functioning and family-caregivers' ability to support patients' functioning, (2) identify resources needed to incorporate the interventions into rural transitional care, and (3) provide high-quality evidence to inform new transitional care practices and policies and guide future research.
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Affiliation(s)
- Mary T. Fox
- School of Nursing, Faculty of Health, York University Centre for Aging Research and Education, York University, HNES suite 343, 4700 Keele St, Toronto, Ontario M3J 1P3 Canada
| | - Souraya Sidani
- School of Nursing, Faculty of Community Services, Ryerson University, 350 Victoria Street, Toronto, Ontario M5B 2K3 Canada
| | - Jeffrey I. Butler
- School of Nursing, York University Centre for Aging Research and Education, Faculty of Health, York University, HNES suite 343, 4700 Keele Street, Toronto, Ontario M3J 1P3 Canada
| | - Mark W. Skinner
- Trent School of the Environment, Trent University, 1600 West Bank Drive, Peterborough, Ontario K9L 0G2 Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Room 130, Forrest Bldg., PO Box 15000, 5869 University Avenue, Halifax, Nova Scotia B3H 4R2 Canada
| | - Evelyne Durocher
- School of Rehabilitation Science, Institute of Applied Health Sciences, Faculty of Health Sciences, McMaster University, Room 428, 1400 Main St. W, Hamilton, Ontario L8S 1C7 Canada
| | - Kathleen F. Hunter
- Faculty of Nursing, University of Alberta, 5-293 Edmonton Clinic Health Academy 11405-87 Ave NW, Edmonton, Alberta T6G 1C9 Canada
| | - Adrian Wagg
- Department of Geriatric Medicine, University of Alberta, 1-198 Clinical Sciences Building, Edmonton, Canada
| | - Lori E. Weeks
- School of Nursing, Dalhousie University, Room G30, Forrest Bldg. PO Box 15000, Halifax, Nova Scotia B3H 4R2 Canada
| | - Ann MacLeod
- Trent/Fleming School of Nursing, Trent University, 1600 West Bank Drive, Peterborough, Ontario K9L 0G2 Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy 11405-87 Ave NW, Edmonton, Alberta T6G 1C9 Canada
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15
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Johanna Josepha Op't Hoog SA, Eskes AM, Johanna van Mersbergen-de Bruin MP, Pelgrim T, van der Hoeven H, Vermeulen H, Maria Vloet LC. The effects of intensive care unit-initiated transitional care interventions on elements of post-intensive care syndrome: A systematic review and meta-analysis. Aust Crit Care 2021; 35:309-320. [PMID: 34120805 DOI: 10.1016/j.aucc.2021.04.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/25/2021] [Accepted: 04/27/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The aim of the study was to assess the effectiveness of intensive care unit (ICU)-initiated transitional care interventions for patients and families on elements of post-intensive care syndrome (PICS) and/or PICS-family (PICS--F). REVIEW METHOD USED This is a systematic review and meta-analysis SOURCES: The authors searched in biomedical bibliographic databases including PubMed, Embase (OVID), CINAHL Plus (EBSCO), Web of Science, and the Cochrane Library and included studies written in English conducted up to October 8, 2020. REVIEW METHODS We included (non)randomised controlled trials focussing on ICU-initiated transitional care interventions for patients and families. Two authors conducted selection, quality assessment, and data extraction and synthesis independently. Outcomes were described using the three elements of PICS, which were categorised into (i) physical impairments (pulmonary, neuromuscular, and physical function), (ii) cognitive impairments (executive function, memory, attention, visuo-spatial and mental processing speed), and (iii) psychological health (anxiety, depression, acute stress disorder, post-traumatic stress disorder, and depression). RESULTS From the initially identified 5052 articles, five studies were included (i.e., two randomised controlled trials and three nonrandomised controlled trials) with varied transitional care interventions. Quality among the studies differs from moderate to high risk of bias. Evidence from the studies shows no significant differences in favour of transitional care interventions on physical or psychological aspects of PICS-(F). One study with a nurse-led structured follow-up program showed a significant difference in physical function at 3 months. CONCLUSIONS Our review revealed that there is a paucity of research about the effectiveness of transitional care interventions for ICU patients with PICS. All, except one of the identified studies, failed to show a significant effect on the elements of PICS. However, these results should be interpreted with caution owing to variety and scarcity of data. PROSPERO REGISTRATION CRD42020136589 (available via https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020136589).
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Affiliation(s)
- Sabine Adriana Johanna Josepha Op't Hoog
- Department of Intensive Care, Elisabeth Tweesteden Hospital, Tilburg, the Netherlands; Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands.
| | - Anne Maria Eskes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | | | - Thomas Pelgrim
- Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands
| | | | - Hester Vermeulen
- Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, the Netherlands; Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands
| | - Lilian Christina Maria Vloet
- Research Department of Emergency and Critical Care, HAN University of Applied Science, Nijmegen, the Netherlands; Radboud University Medical Centre, Radboud Institute for Health Sciences IQ Healthcare, the Netherlands; Foundation Family and Patient Centered Intensive Care, Alkmaar, the Netherlands
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16
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Suksatan W, Tankumpuan T. The Effectiveness of Transition Care Interventions from Hospital to Home on Rehospitalization in Older Patients with Heart Failure: An Integrative Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2021. [DOI: 10.1177/10848223211023887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart failure (HF) is one of the common causes of rehospitalization in older people leading to an increase in the number of mortalities, disabilities, and readmission rates. However, there has been a lack of literature reviews on current evidence regarding the effects of transition care interventions (TCI) on rehospitalization before discharge from hospital to home. The current review aims to examine the effectiveness of transition care interventions on rehospitalization within 30-days for older patients with HF. The current review of international knowledge employs the PRISMA guidelines and includes primary studies published between 2011 and 2021 taken from PubMed, CINAHL, PsycINFO, Cochrane, and Scopus. Our review identified 15 relevant studies that together examined 10,701 patients with HF. We found that the effectiveness of TCIs could reduce rehospitalization rates and costs of care. The findings asserted that nurses, pharmacists, and multidisciplinary teams were predominantly provided transition care interventions. In principle, transition care intervention could inform policymakers to develop the current discharge planning practices in older HF patients. Therefore, interdisciplinary healthcare teams and caregivers should develop the transition care interventions with long-term periods before discharge from hospital to their home, particularly for older patients with HF in order to improve their capacity for self-care, quality of care, and promote continuing care.
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Affiliation(s)
- Wanich Suksatan
- HRH Princess Chulabhorn College of Medical Science, Faculty of Nursing, Chulabhorn Royal Academy, Bangkok, Thailand
- Saint Louis University, Trudy Busch-Valentine School of Nursing, St. Louis, MO, USA
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17
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Karrer M, Schnelli A, Zeller A, Mayer H. A systematic review of interventions to improve acute hospital care for people with dementia. Geriatr Nurs 2021; 42:657-673. [PMID: 33823424 DOI: 10.1016/j.gerinurse.2021.03.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 01/08/2023]
Abstract
The aim of this study was to provide an overview of interventions targeting hospital care of patients with dementia. We conducted a systematic review, including interventional study designs. We searched five electronic databases, conducted a hand search and performed citation tracking. To assess risk of bias, we used Cochrane Collaboration's tool, ROBANS and AMSTAR. We narratively summarized the outcomes. The findings of twenty studies indicated a broad range of interventions and outcomes. We categorised the interventions into eight intervention types. Educational programmes were the most reported intervention type and resulted in improved staff outcomes. Family-/person-centred care programmes, use of specially trained nurses and delirium management programmes were effective in improving some patient-related outcomes. However, current evidence is insufficient to declare which interventions are effective in improving dementia care in acute hospitals. Future research should focus on relevant patient and family caregiver outcomes and must consider the complexity of the interventions when evaluating them.
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Affiliation(s)
- Melanie Karrer
- Departement of Nursing Science, University of Vienna, Alser Straße 23/12, 1080 Vienna, Austria; Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, OST Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland.
| | - Angela Schnelli
- Departement of Nursing Science, University of Vienna, Alser Straße 23/12, 1080 Vienna, Austria; Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, OST Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Adelheid Zeller
- Competence Center Dementia Care, Institute of Applied Nursing Sciences, Department of Health, OST Eastern Switzerland University of Applied Sciences, Rosenbergstrasse 59, 9000 St.Gallen, Switzerland
| | - Hanna Mayer
- Departement of Nursing Science, University of Vienna, Alser Straße 23/12, 1080 Vienna, Austria
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18
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Coskun S, Duygulu S. The effects of Nurse Led Transitional Care Model on elderly patients undergoing open heart surgery: a randomized controlled trial. Eur J Cardiovasc Nurs 2021; 21:46-55. [PMID: 33821999 DOI: 10.1093/eurjcn/zvab005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/04/2020] [Accepted: 01/14/2021] [Indexed: 11/13/2022]
Abstract
AIMS Rate and number of successful cases in open heart surgery has been increasing due to the advances in medical technology and surgery. To improve patient convalescence results and reduce rate of post-discharge readmission to hospital and unplanned post-discharge rehospitalization, home-care and follow-up process of patients should be managed successfully. To evaluate the effectiveness of Nurse Led Transitional Care Model on the functional autonomy, quality of life, readmission, and rehospitalization rates of elderly patients undergoing open heart surgery. A randomized controlled trial was conducted from November 2017 to December 2018 and performed according to the CONSORT Guidelines. METHODS AND RESULTS Sixty-six elderly patients were randomly allocated to the intervention (n: 33) and control (n: 33) groups. Patients in intervention group were given care based on the Transitional Care Model until the post-discharge 9th week starting from date of hospitalization. Patients in control group were given standard care services. Functional autonomy, quality of life levels, and repeated admission/re-hospitalization rates to the clinic were evaluated. The Functional Autonomy Measurement System and SF-36 Quality of Life Scale scores of the intervention group were higher than that of the control group at the 9th week (P < 0.05). In addition, rate of readmission and rehospitalization during the follow-up period (6 months) of patients in the intervention group was found to be lower than the patients in the control group (P < 0.05). CONCLUSION Care services offered under the Transitional Care Model improved functional autonomy and quality of life and decreased post-discharge hospital readmission and rehospitalization rates of patients. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov (ID: NCT04384289).
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Affiliation(s)
- Simge Coskun
- Bolu Abant Izzet Baysal University, Faculty of Health Sciences, Nursing Department, 14100 Gölköy Campus/ Bolu/ Turkey
| | - Sergul Duygulu
- Hacettepe University, Faculty of Nursing, 06100 S?hhiye/ Ankara / Turkey
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19
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Emmerton D, Abdelhafiz AH. Care for Older People with Dementia During COVID-19 Pandemic. ACTA ACUST UNITED AC 2021; 3:437-443. [PMID: 33527095 PMCID: PMC7837877 DOI: 10.1007/s42399-020-00715-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 02/07/2023]
Abstract
Older people living with dementia, who are likely frail with multiple comorbidities, appear particularly vulnerable to COVID-19. Care for older people with comorbid dementia and COVID-19 is a challenge to health care professionals due to their complex needs. COVID-19 is a respiratory disease which typically presents with respiratory symptoms; however, in older people with dementia, it may present atypically with delirium. Delirium may precede respiratory symptoms, and in some cases, it may be the only symptom, leading to a delay in the diagnosis. Therefore, screening for delirium should be part of the routine clinical practice for older people with dementia and suspected COVID-19 infection. Due to the complexity of care required for older people with dementia affected by COVID-19, a holistic and individualised approach that includes acute, transitional and long-term care is required. Advanced decision-making, for example, ceiling of care and resuscitation decisions, should be made early on admission to hospital. Screening for frailty with clinical frailty scale may help to aid decision-making. Palliative care and relief of suffering should be considered from the outset. Early and regular involvement of patients and their families in care plans and periodic updates regarding any changes in the clinical condition are good clinical practice. The introduction of telehealth programmes that are suitable for older people with poor cognitive function and also cover diverse cultural backgrounds are urgently required for the future support of this vulnerable group of patients.
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Affiliation(s)
- Demelza Emmerton
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, S60 2UD UK
| | - Ahmed H. Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, S60 2UD UK
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20
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Topaz M, Adams V, Wilson P, Woo K, Ryvicker M. Free-Text Documentation of Dementia Symptoms in Home Healthcare: A Natural Language Processing Study. Gerontol Geriatr Med 2020; 6:2333721420959861. [PMID: 33029550 PMCID: PMC7520927 DOI: 10.1177/2333721420959861] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/18/2020] [Accepted: 08/21/2020] [Indexed: 01/11/2023] Open
Abstract
Background Little is known about symptom documentation related to Alzheimer's disease and related dementias (ADRD) by home healthcare (HHC) clinicians. Objective This study: (1) developed a natural language processing (NLP) algorithm that identifies common neuropsychiatric symptoms of ADRD in HHC free-text clinical notes; (2) described symptom clusters and hospitalization or emergency department (ED) visit rates for patients with and without these symptoms. Method We examined a corpus of -2.6 million free-text notes for 112,237 HHC episodes among 89,459 patients admitted to a non-profit HHC agency for post-acute care with any diagnosis. We used NLP software (NimbleMiner) to construct indicators of six neuropsychiatric symptoms. Structured HHC assessment data were used to identify known ADRD diagnoses and construct measures of hospitalization/ED use during HHC. Results Neuropsychiatric symptoms were documented for 40% of episodes. Common clusters included impaired memory, anxiety and/or depressed mood. One in three episodes without an ADRD diagnosis had documented symptoms. Hospitalization/ED rates increased with one or more symptoms present. Conclusion HHC providers should examine episodes with neuropsychiatric symptoms but no ADRD diagnoses to determine whether ADRD diagnosis was missed or to recommend ADRD evaluation. NLP-generated symptom indicators can help to identify high-risk patients for targeted interventions.
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Affiliation(s)
- Maxim Topaz
- Columbia University, New York, NY, USA.,Visiting Nurse Service of New York, New York, NY, USA
| | | | - Paula Wilson
- Visiting Nurse Service of New York, New York, NY, USA
| | | | - Miriam Ryvicker
- Visiting Nurse Service of New York, New York, NY, USA.,Vital Statistics Consulting, New York, NY, USA
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21
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Morkisch N, Upegui-Arango LD, Cardona MI, van den Heuvel D, Rimmele M, Sieber CC, Freiberger E. Components of the transitional care model (TCM) to reduce readmission in geriatric patients: a systematic review. BMC Geriatr 2020; 20:345. [PMID: 32917145 PMCID: PMC7488657 DOI: 10.1186/s12877-020-01747-w] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 08/31/2020] [Indexed: 01/19/2023] Open
Abstract
Background Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components’ role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes). Methods Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed. Results Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months). Conclusions Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, without increasing cost. Components such as type of staffing, assessing and managing symptoms, educating and promoting self-management, maintaining relationships and fostering coordination seem to have an important role in reducing the readmission rate. Research is needed to perform further investigations addressing geriatric patients well above 65 years old, to further understand the importance of individual components of the TCM in this population.
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Affiliation(s)
| | - Luz D Upegui-Arango
- Bundesverband Geriatrie e.V, Berlin, Germany.,Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Aachen, Germany
| | - Maria I Cardona
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany
| | | | - Martina Rimmele
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany
| | - Cornel Christian Sieber
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany.,Kantonspital Winterthur/Swiss, Winterthur, Switzerland
| | - Ellen Freiberger
- Institute of Biomedicine of Aging, Nuremberg, Friedrich-Alexander-University Erlangen-Nuremberg, Kobergerstr. 60, 90408, Nuremberg, Germany.
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22
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Delirium in Older People with COVID-19: Clinical Scenario and Literature Review. ACTA ACUST UNITED AC 2020; 2:1790-1797. [PMID: 32904497 PMCID: PMC7455775 DOI: 10.1007/s42399-020-00474-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 01/08/2023]
Abstract
Delirium is a potentially fatal acute brain dysfunction that is characterised by inattention and fluctuating mental changes. It is indicative of an acute serious organ failure or acute infection. Delirium is also associated with undesirable health outcomes that include prolonged hospital stay, long-term cognitive decline and increased mortality. The new SARS-CoV-2 shows, not only pulmonary tropism but also, neurotropism which results in delirium in the acute phase illness particularly in the older age groups. The current assessment for COVID-19 in older people does not routinely include screening for delirium. Implementation of a rapid delirium screening tool is necessary because, without screening, up to 75% of cases can be missed. Delirium can also be exaggerated by health care policies that recommend social isolation and wearing personal protective equipment in addition to less interaction with patients. Non-pharmacological intervention for delirium prevention and management may be helpful if implemented as early and as often as possible in hospitalised older people with COVID-19. A holistic approach that includes psychological support in addition to medical care is needed for older people admitted to hospital with COVID-19.
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23
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Sezgin D, O'Caoimh R, Liew A, O'Donovan MR, Illario M, Salem MA, Kennelly S, Carriazo AM, Lopez-Samaniego L, Carda CA, Rodriguez-Acuña R, Inzitari M, Hammar T, Hendry A. The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review. Eur Geriatr Med 2020; 11:961-974. [PMID: 32754841 PMCID: PMC7402396 DOI: 10.1007/s41999-020-00365-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/11/2020] [Indexed: 11/30/2022]
Abstract
Aim This scoping review examined the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Findings While some studies report positive outcomes on hospital utilisation, the evidence is limited for their effectiveness on emergency department attendances, institutionalisation, function, and cost-effectiveness. Message Intermediate care including transitional care interventions were associated with reduced hospital stay but this finding was not universal. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users. Background and aim Intermediate care describes services, including transitional care, that support the needs of middle-aged and older adults during care transitions and between different settings. This scoping review aimed to examine the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Design A scoping review of the literature was conducted including studies published between 2002 and 2019 with a transitional care and/or intermediate care intervention for adults aged ≥ 50. Searches were performed in CINAHL, Cochrane Library, EMBASE, Open Grey and PubMed databases. Qualitative and quantitative approaches were employed for data synthesis. Results In all, 133 studies were included. Interventions were grouped under four models of care: (a) Hospital-based transitional care (n = 8), (b) Transitional care delivered at discharge and up to 30 days after discharge (n = 70), (c) Intermediate care at home (n = 41), and (d) Intermediate care delivered in a community hospital, care home or post-acute facility (n = 14). While these models were associated with a reduced hospital stay, this was not universal. Intermediate including transitional care services combined with telephone follow-up and coaching support were reported to reduce short and long-term hospital re-admissions. Evidence for improved ADL function was strongest for intermediate care delivered by an interdisciplinary team with rehabilitation at home. Study design and types of interventions were markedly heterogenous, limiting comparability. Conclusions Although many studies report that intermediate care including transitional care models reduce hospital utilisation, results were mixed. There is limited evidence for the effectiveness of these services on function, institutionalisation, emergency department attendances, or on cost-effectiveness. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duygu Sezgin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.
| | - Rónán O'Caoimh
- Department of Geriatric Medicine, Mercy University Hospital Cork, Cork, Ireland.,Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland.,Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | | | - Maddelena Illario
- Campania Region Health Innovation Unit, and Federico II Department of Public Health, Naples, Italy
| | | | - Siobhán Kennelly
- Royal College of Surgeons in Ireland Connolly Hospital, Dublin and Health Service Executive, Dublin, Ireland
| | | | | | - Cristina Arnal Carda
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall D'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Marco Inzitari
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall D'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teija Hammar
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anne Hendry
- NHS Lanarkshire, Bothwell, UK.,School of Health and Life Sciences, University of the West of Scotland, Hamilton, UK
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Vasan A, Morgan JW, Mitra N, Xu C, Long JA, Asch DA, Kangovi S. Effects of a standardized community health worker intervention on hospitalization among disadvantaged patients with multiple chronic conditions: A pooled analysis of three clinical trials. Health Serv Res 2020; 55 Suppl 2:894-901. [PMID: 32643163 PMCID: PMC7518822 DOI: 10.1111/1475-6773.13321] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To analyze the effects of a standardized community health worker (CHW) intervention on hospitalization. DATA SOURCES/STUDY SETTING Pooled data from three randomized clinical trials (n = 1340) conducted between 2011 and 2016. STUDY DESIGN The trials in this pooled analysis were conducted across diseases and settings, with a common study design, intervention, and outcome measures. Participants were patients living in high-poverty regions of Philadelphia and were predominantly Medicaid insured. They were randomly assigned to receive usual care versus IMPaCT, an intervention in which CHWs provide tailored social support, health behavior coaching, connection with resources, and health system navigation. Trial one (n = 446) tested two weeks of IMPaCT among hospitalized general medical patients. Trial two (n = 302) tested six months of IMPaCT among outpatients at two academic primary care clinics. Trial three (n = 592) tested six months of IMPaCT among outpatients at academic, Veterans Affairs (VA), and Federally Qualified Health Center primary care practices. DATA COLLECTION/EXTRACTION METHODS The primary outcome for this study was all-cause hospitalization, as measured by total number of hospital days per patient. Hospitalization data were collected from statewide or VA databases at 30 days postenrollment in Trial 1, twelve months postenrollment in Trial 2, and nine months postenrollment in Trial 3. PRINCIPAL FINDINGS Over 9398 observed patient months, the total number of hospital days per patient in the intervention group was 66 percent of the total in the control group (849 days for 674 intervention patients vs 1258 days for 660 control patients, incidence rate ratio (IRR) 0.66, P < .0001). This reduction was driven by fewer hospitalizations per patient (0.27 vs 0.34, P < .0001) and shorter mean length of stay (4.72 vs 5.57 days, P = .03). The intervention also decreased rates of hospitalization outside patients' primary health system (18.8 percent vs 34.8 percent, P = .0023). CONCLUSIONS Data from three randomized clinical trials across multiple settings show that a standardized CHW intervention reduced total hospital days and hospitalizations outside the primary health system. This is the largest analysis of randomized trials to demonstrate reductions in hospitalization with a health system-based social intervention.
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Affiliation(s)
- Aditi Vasan
- National Clinician Scholars Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,PolicyLab and Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John W Morgan
- National Clinician Scholars Program, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Chang Xu
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Judith A Long
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Corporal Michael J Crescenz VA Medical Center, Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
| | - David A Asch
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Corporal Michael J Crescenz VA Medical Center, Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania
| | - Shreya Kangovi
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.,Corporal Michael J Crescenz VA Medical Center, Center for Health Equity Research and Promotion, Philadelphia, Pennsylvania.,Penn Center for Community Health Workers, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Naylor MD, Hirschman KB, McCauley K. Meeting the Transitional Care Needs of Older Adults with COVID-19. J Aging Soc Policy 2020; 32:387-395. [DOI: 10.1080/08959420.2020.1773189] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mary D. Naylor
- Marian S. Ware Professor in Gerontology, Director of the NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Karen B. Hirschman
- Research Associate Professor, NewCourtland Term Chair in Health Transitions Research, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Kathleen McCauley
- Professor of Cardiovascular Nursing, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Liebzeit D, Bratzke L, Boltz M, Purvis S, King B. Getting Back to Normal: A Grounded Theory Study of Function in Post-hospitalized Older Adults. THE GERONTOLOGIST 2020; 60:704-714. [PMID: 31087040 DOI: 10.1093/geront/gnz057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The literature on transitions after hospitalization is based on a medicalized model focusing primarily on medication management and readmission, but little is known about the process older adults engage in to maintain their normal life posthealth event or how older adults define what the transition is. This grounded theory study aimed to describe how older adults understand and define a transition process, what actions they take based on their understanding, and what consequences they experience as they transition. RESEARCH DESIGN AND METHODS Adults aged 65 and older discharged from a large Midwestern teaching hospital (N = 14) were interviewed using in-depth one-on-one interviews. Data were analyzed using open, axial, and selective coding. RESULTS All participants described the process of transition as moving from a state of normal function to loss, and then working back to a normal state. A conceptual model was developed to illustrate the complexity of movement related to how older adults understand and manage the transition. All participants described starting out being normal until they experienced a major health event (acute or chronic illness). Losing normal involved experiencing a lower level of function both inside and outside the home. Working back to normal was accomplished by two different pathways: those "working to regain" focused on getting back to the level they were at prior to the major health event, whereas those "working to maintain" often involved redefining a new normal. The consequences of the two pathways were quite different, with those working to maintain describing several negative consequences. DISCUSSION AND IMPLICATIONS This study provides a detailed understanding of how older adults transition and the complexity of that transition. Findings provide a foundation for broadening our understanding of function beyond typical activities of daily living and reveal a more complex transition process that can span months to years.
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Affiliation(s)
- Daniel Liebzeit
- University of Wisconsin - Madison School of Nursing, Madison, Wisconsin.,Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Lisa Bratzke
- University of Wisconsin - Madison School of Nursing, Madison, Wisconsin
| | - Marie Boltz
- Pennsylvania State University College of Nursing, Michigan
| | | | - Barbara King
- University of Wisconsin - Madison School of Nursing, Madison, Wisconsin
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Provencher V, Clemson L, Wales K, Cameron ID, Gitlin LN, Grenier A, Lannin NA. Supporting at-risk older adults transitioning from hospital to home: who benefits from an evidence-based patient-centered discharge planning intervention? Post-hoc analysis from a randomized trial. BMC Geriatr 2020; 20:84. [PMID: 32122311 PMCID: PMC7053102 DOI: 10.1186/s12877-020-1494-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Subgroups of older patients experience difficulty performing activities of daily living (ADL) following hospital discharge, as well as unplanned hospital readmissions and emergency department (ED) presentations. We examine whether these subgroups of "at-risk" older patients benefit more than their counterparts from an evidence-based discharge planning intervention, on the following outcomes: (1) independence in ADL, (2) participation in life roles, (3) unplanned re-hospitalizations, and (4) ED presentations. TRIAL DESIGN AND METHODS This study used data from a randomized control trial involving 400 hospitalized older patients with acute and medical conditions, recruited through 5 sites in Australia. Participants receive either HOME, a patient-centered discharge planning intervention led by an occupational therapist; or a structured in-hospital consultation. HOME uses a collaborative approach for goal setting and includes pre and post-discharge home visits as well as telephone follow-up. Characteristics associated with higher risks of adverse outcomes were recorded and at-risk subgroups were created (mild cognitive impairment, walking difficulty, comorbidity, living alone and no support from family). Independence in ADL and participation in life roles were assessed with validated questionnaires. The number of unplanned re-hospitalizations and ED presentations were extracted from medical files. Linear regression models were conducted to detect variation in response to the intervention at 3-months, according to patients' characteristics. RESULTS Analyses revealed significant interaction effects for intervention by cognitive status for unplanned re-hospitalization (p = 0.003) and ED presentations (p = 0.021) at 3 months. Within the at-risk subgroup of mild cognitively impaired, the HOME intervention significantly reduced unplanned hospitalizations (p = 0.027), but the effect did not reach significance in ED visits. While the effect of HOME differed according to support received from family for participation in life roles (p = 0.019), the participation observed in HOME patients with no support was not significantly improved. CONCLUSIONS Findings show that hospitalized older adults with mild cognitive impairment benefit from the HOME intervention, which involves preparation and post-discharge support in the environment, to reduce unplanned re-hospitalizations. Improved discharge outcomes in this at-risk subgroup following an occupational therapist-led intervention may enable best care delivery as patients transition from hospital to home. TRIAL REGISTRATION The trial was registered before commencement (ACTRN12611000615987).
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Affiliation(s)
- Véronique Provencher
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke Research Centre on Aging, 3001 12e Avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Lindy Clemson
- Faculty of Medicine & Health, The University of Sydney, Sydney, 2006, Australia
| | - Kylie Wales
- School of Health Sciences, University of Newcastle, Callaghan, 2308, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Laura N Gitlin
- College of Nursing and Health Professions, Drexel University, 1601 Cherry Street, Philadelphia, PA, 19102, USA
| | - Ariane Grenier
- Research Center on Aging, 1036 Belvédère Sud, Sherbrooke, Québec, Canada
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, 99 Commercial Road, Melbourne, 3004, Australia. .,Alfred Health, 55 Commercial Road, Melbourne, 3004, Australia.
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Cacchione PZ. Innovative care models across settings: Providing nursing care to older adults. Geriatr Nurs 2020; 41:16-20. [DOI: 10.1016/j.gerinurse.2020.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Abstract
AIMS The use of Alzheimer disease medication for the treatment of dementia symptoms has shown significant benefits with regards to functional and cognitive outcomes as well as nursing home placement (NHP) and mortality. Hospitalisations in these patient groups are characterised by extended length of stays (LOS), frequent readmissions, frequent NHP and high-mortality rates. The impact of Alzheimer disease medication on the aforementioned outcomes remains still unknown. This study assessed the association of Alzheimer disease medication with outcomes of hospitalisation among patients with Alzheimer disease and other forms of dementia. METHODS A dynamic retrospective cohort study from 2004 to 2015 was conducted which claims data from a German health insurance company. People with dementia (PWD) were identified using ICD-10 codes and diagnostic measures. The main predictor of interest was the use of Alzheimer disease medication. Hospitalisation outcomes included LOS, readmissions, NHP and mortality during and after hospitalisation across four hospitalisations. Confounding was addressed using a propensity score throughout all analyses. RESULTS A total of 1380 users of Alzheimer disease medication and 6730 non-users were identified. The use of Alzheimer disease medication was associated with significantly shorter LOS during the first hospitalisations with estimates for the second, third and fourth showed a tendency towards shorter hospital stays. In addition, current users of Alzheimer disease medication had a lower risk of hospital readmission after the first two hospitalisations. These associations were not significant for the third and fourth hospitalisations. Post-hospitalisation NHP and mortality rates also tended to be lower among current users than among non-users but differences did not reach statistical significance. CONCLUSIONS Our results indicate that Alzheimer disease medication might contribute to a reduction of the LOS and the number of readmissions in PWD.
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Liebzeit D, Bratzke L, King B. Strategies older adults use in their work to get back to normal following hospitalization. Geriatr Nurs 2019; 41:132-138. [PMID: 31443983 DOI: 10.1016/j.gerinurse.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
Loss of function is a significant concern among hospitalized older adults, and prior research suggests they engage in dedicated work to regain "normal" function following hospitalization. This paper aims to describe the strategies older adults use to return to normal function and the conditions that influence their ability to do so. Recently discharged adults aged 65 and older (N = 14) completed in-depth one-on-one interviews. Data were analyzed using open, axial, and selective coding. Participants described strategies they used to regain their normal function following hospitalization: doing exercises, expanding physical space, resuming activities and daily cares, and tracking improvement with benchmarks. Several conditions, such as presence of informal and formal support, perceived threats, and poor physical or physiologic function, acted as barriers and facilitators to participants' ability to work back to normal function. Findings increase our understanding of patients' work to regain normal function and have important implications for practice.
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Affiliation(s)
- Daniel Liebzeit
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA; Geriatric Research, Education and Clinical Center (11G), William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | - Lisa Bratzke
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA.
| | - Barbara King
- University of Wisconsin-Madison School of Nursing, Madison, WI, USA.
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Richardson A, Blenkinsopp A, Downs M, Lord K. Stakeholder perspectives of care for people living with dementia moving from hospital to care facilities in the community: a systematic review. BMC Geriatr 2019; 19:202. [PMID: 31366373 PMCID: PMC6668086 DOI: 10.1186/s12877-019-1220-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 07/22/2019] [Indexed: 11/23/2022] Open
Abstract
Background People living with dementia in care homes are regularly admitted to hospital. The transition between hospitals and care homes is an area of documented poor care leading to adverse outcomes including costly re-hospitalisation. This review aims to understand the experiences and outcomes of care for people living with dementia who undergo this transition from the perspectives of key stakeholders; people living with dementia, their families and health care professionals. Methods A systematic search was conducted on the CINAHL, ASSIA, EMBASE, MEDLINE, PsychINFO, and Scopus databases without any date restrictions. We hand searched reference lists of included papers. Papers were included if they focused on people living with dementia moving from hospital to a short or long term care setting in the community including sub-acute, rehabilitation, skilled nursing facilities or care homes. Titles, abstracts and full texts were screened. Two authors independently evaluated study quality using a checklist. Themes were identified and discussed to reach consensus. Results In total, nine papers reporting eight studies met the inclusion criteria for the systematic review. A total of 257 stakeholders participated; 37 people living with dementia, 95 family members, and 125 health and social care professionals. Studies took place in Australia, Canada, United Kingdom (UK), and the United States of America (US). Four themes were identified as factors influencing the experience and outcomes of the transition from the perspectives of stakeholders; preparing for transition; quality of communication; the quality of care; family engagement and roles. Conclusion This systematic review presents a compelling case for the need for robust evidence to guide best practice in this important area of multi-disciplinary clinical practice. The evidence suggests this transition is challenging for all stakeholders and that people with dementia have specific needs which need attention during this period. Trial registration PROSPERO Registration Number: CRD42017082041.
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Policy Flight Simulators: Accelerating Decisions to Adopt Evidence-Based Health Interventions. J Healthc Manag 2019; 64:231-241. [PMID: 31274814 DOI: 10.1097/jhm-d-18-00114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY In this study, the authors used simulation to explore factors that might influence hospitals' decisions to adopt evidence-based interventions. Specifically, they developed a simulation model to examine the extent to which hospitals would benefit economically from the transitional care model (TCM). The TCM is designed to transition high-risk older adults from hospitals back to communities using interventions focused on preventing readmissions.The authors used qualitative methods to identify and validate simulation facets. Four simulation experiments explored the economic impact of the TCM on more than 3,000 U.S. hospitals: (1) magnitude of readmission penalty, (2) application to specific diagnosis-related groups, (3) level of cost sharing between payer and provider, and (4) capitated versus fee-for-service payments. The simulator projected hospital-specific economic effects. The authors used Monte Carlo methods for the simulations, which were parameterized with public data sets from the Centers for Medicare & Medicaid Services (CMS) and TCM data from randomized controlled trials and comparative effectiveness studies.Under current conditions, the simulation indicated that only 10 of more than 3,000 Medicare-certified hospitals would benefit financially from the TCM. If current readmission penalties were doubled, the number of hospitals projected to benefit would increase to 300. Targeting selected diagnosis cohorts would also increase the number of hospitals to 300. If payers reimbursed providers for 100% of the TCM costs, 2,000 hospitals would benefit financially. Under a capitated payment model, 1,500 hospitals would benefit from the TCM.Current CMS penalties-or reasonable increases-have little economic effect on the TCM. In the current environment, two strategies are likely to facilitate adoption: (1) persuading payers to reimburse TCM costs and (2) focusing on hospitals with higher bed occupancies and higher revenue patients.
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The Discharge Companion Program: An Interprofessional Collaboration in Transitional Care Model Delivery. PHARMACY 2019; 7:pharmacy7020068. [PMID: 31248090 PMCID: PMC6631279 DOI: 10.3390/pharmacy7020068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
To reduce readmission rates and avoid financial penalties from the Centers for Medicare and Medicaid Services, hospitals are seeking to implement innovative transitions of care (TOC) programs. This retrospective study evaluated the Discharge Companion Program (DCP), a pharmacist- and nurse-coordinated interprofessional, collaborative TOC program. Adult patients (18 years and older) from a single hospital, discharged with at least one qualifying diagnosis, were eligible for this service. The hospital transitional care coordinator nurse referred qualified patients to the DCP nurse coordinator, who scheduled telephonic medication therapy management (MTM) reviews with the DCP pharmacist at one- and three-weeks postdischarge. Hospital records and DCP documentation were reviewed to describe respective interventions and assess the impact on 30-day readmissions. A total of 456 patients were referred to the DCP between 31 August, 2015 and 7 September, 2016. Of the 340 patients who participated (DCP group), 44 (13%) compared to 17% (n = 20) of the usual care, were readmitted within 30-days postdischarge. The DCP pharmacists conducted 1242 clinical interventions with participants, demonstrating the benefits of an interprofessional TOC model involving multiple, pharmacist-delivered MTM intervention touchpoints within 30 days post-hospital discharge.
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Thorsteinsdottir B, Peterson SM, Naessens JM, McCoy RG, Hanson GJ, Hickson LJ, Chen CYY, Rahman PA, Shah ND, Borkenhagen L, Chandra A, Havyer R, Leppin A, Takahashi PY. Care Transitions Program for High-Risk Frail Older Adults is Most Beneficial for Patients with Cognitive Impairment. J Hosp Med 2019; 14:329-335. [PMID: 30794142 PMCID: PMC6546541 DOI: 10.12788/jhm.3112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although posthospitalization care transitions programs (CTP) are highly diverse, their overall program thoroughness is most predictive of their success. OBJECTIVE To identify components of a successful homebased CTP and patient characteristics that are most predictive of reduced 30-day readmissions. DESIGN Retrospective cohort. PATIENTS A total of 315 community-dwelling, hospitalized, older adults (≥60 years) at high risk for readmission (Elder Risk Assessment score ≥16), discharged home over the period of January 1, 2011 to June 30, 2013. SETTING Midwest primary care practice in an integrated health system. INTERVENTION Enrollment in a CTP during acute hospitalization. MEASUREMENTS The primary outcome was all-cause readmission within 30 days of the first CTP evaluation. Logistic regression was used to examine independent variables, including patient demographics, comorbidities, number of medications, completion, and timing of program fidelity measures, and prior utilization of healthcare. RESULTS The overall 30-day readmission rate was 17.1%. The intensity of follow-up varied among patients, with 17.1% and 50.8% of the patients requiring one and ≥3 home visits, respectively, within 30 days. More than half (54.6%) required visits beyond 30 days. Compared with patients who were not readmitted, readmitted patients were less likely to exhibit cognitive impairment (29.6% vs 46.0%; P = .03) and were more likely to have high medication use (59.3% vs 44.4%; P = .047), more emergency department (ED; 0.8 vs 0.4; P = .03) and primary care visits (4.0 vs 3.0; P = .018), and longer cumulative time in the hospital (4.6 vs 2.5 days; P = .03) within 180 days of the index hospitalization. Multivariable analysis indicated that only cognitive impairment and previous ED visits were important predictors of readmission. CONCLUSIONS No single CTP component reliably predicted reduced readmission risk. Patients with cognitive impairment and polypharmacy derived the most benefit from the program.
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Affiliation(s)
- Bjorg Thorsteinsdottir
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota
- Corresponding Author: Bjorg Thorsteinsdottir, MD: E-mail: thorsteinsdottir. ; Telephone: 507-774-5944
| | - Stephanie M Peterson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - James M Naessens
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota
| | - Rozalina G McCoy
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Gregory J Hanson
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - LaTonya J Hickson
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Christina YY Chen
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Parvez A Rahman
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Nilay D Shah
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Lynn Borkenhagen
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Anupam Chandra
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rachel Havyer
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Aaron Leppin
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
| | - Paul Y Takahashi
- Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Fox MT, Sidani S, Butler JI, Skinner MW, Alzghoul M. Protocol of a multimethod descriptive study: adapting hospital-to-home transitional care interventions to the rural healthcare context in Ontario, Canada. BMJ Open 2019; 9:e028050. [PMID: 31129595 PMCID: PMC6537978 DOI: 10.1136/bmjopen-2018-028050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Faced with costly hospital readmissions of increasingly complex patient populations, transitional care is a priority throughout Ontario, Canada; yet, rural patients have significantly more hospital readmissions and emergency department visits during the first 30 days following hospitalisation than urban patients. Because transitional care (TC) was designed and evaluated with urban patients, addressing urban-rural disparities in TC effectiveness requires increasing the alignment of TC with the needs of patients and families in rural communities and the rural nursing practice context. The study objectives are to (1) determine the perceived acceptability of evidence-based TC interventions targeting postdischarge care management to patients, families and nurses and (2) adapt the interventions to patients' and families' needs and the rural nursing practice context. METHODS AND ANALYSIS This multimethod study has two phases. In phase I, 32-48 patients and families will rate their level of preparedness for discharge and the acceptability of evidence-based TC interventions. Participants will be engaged in semi-structured interviews about their care management needs, their perspectives on the interventions in fitting those needs and in providing suggestions for adapting the interventions to fit their needs. TC interventions perceived as acceptable to patients and families will be examined in phase II. In phase II, 32-48 hospital and home care nurses will rate the acceptability of the interventions identified by patients and families and attend focus group discussions on the feasibility of providing the interventions. Phase I and II data will be analysed using descriptive statistics and qualitative content analysis. ETHICS AND DISSEMINATION Ethics approval was obtained from the Research Ethics Board at York University and participating hospital sites. Findings will be communicated through plain language fact sheets, policy briefs, press-releases and peer-reviewed conference presentations and manuscripts.
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Affiliation(s)
- Mary T Fox
- School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, York University, Toronto, Ontario, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Ontario, Canada
| | | | - Mark W Skinner
- School of the Environment, Trent University, Peterborough, Ontario, Canada
| | - Manal Alzghoul
- School of Nursing, Lakehead University, Thunder Bay, Ontario, Canada
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Abstract
PURPOSE/OBJECTIVES The purpose of this article is to highlight how scientists have assessed all components of functional status in older adults transitioning from hospital to home to date, discuss ways of improving assessment of functional status, and discuss implications for case management research and practice. PRIMARY PRACTICE SETTING(S) This article focuses on case management of older adults transitioning from hospital to home. FINDINGS/CONCLUSIONS There any many ways to assess functional status, including basic activities of daily living (BADL), instrumental activities of daily living (IADL), and other nonphysical domains of function such as leisure, social, and productive activities. However, assessment of function in older adults transitioning from hospital to home is primarily limited to BADL. Nonphysical domains of functional status have been linked to important outcomes in community-dwelling older adults and could give clinicians and researchers a better understanding of how older adults are functioning, as well as allow for earlier recognition of those who are beginning to experience functional decline. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE In case management, it is important to ask older adults about goals regarding their functional status and how they think about their functioning in the hospital and at home. Early identification of older adults' functional goals while in the hospital is the first step toward regaining their ideal or premorbid function after discharge to home. To best determine baseline functional status, we may need to consider assessments that can measure multiple domains of functioning in older adults, such as the Sickness Impact Profile. Gaining a more comprehensive understanding and assessment of functional status for hospitalized older adults would help inform discharge destinations and improve transitions in care.
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Hirschman KB, Hodgson NA. Evidence-Based Interventions for Transitions in Care for Individuals Living With Dementia. THE GERONTOLOGIST 2018; 58:S129-S140. [PMID: 29361067 DOI: 10.1093/geront/gnx152] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Indexed: 12/30/2022] Open
Abstract
Background and Objectives Despite numerous, often predictable, transitions in care, little is known about the core elements of successful transitions in care specifically for persons with dementia. The paper examines available evidence-based interventions to improve the care transitions for persons with dementia and their caregivers. Research Design and Methods A state-of-the-art review was conducted for research published on interventions targeting transitions in care for persons living with dementia and their caregivers through January 2017. Results Our review revealed seven evidence-based interventions to postpone/prevent or reduce care transitions specific to persons living with dementia. Effective approaches appear to be those that involve the individual and caregiver in establishing goals of care, educate the individual and caregiver about likely transitions in care; provide timely communication of information about the individual, create strong inter professional teams with competencies in dementia care, and implement evidence-based models of practice. Discussion and Implications Five essential features for consistent and supported care transitions for persons with dementia and their caregivers are recommended. Findings reinforce the need for additional research and adaptation of evidence-based transitions in care interventions.
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Avoidable readmissions seem to be reduced by early follow-up visits for geriatric patients discharged from hospital. Eur Geriatr Med 2018; 9:613-621. [PMID: 34654216 DOI: 10.1007/s41999-018-0078-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE The aim of this study was to look specifically at patients readmitted in our previously published study. We wanted to assess the percentage of avoidable readmissions among patients receiving an early geriatric follow-up visit compared to a control group receiving usual care. METHOD The original population was geriatric patients primarily admitted to hospital with one of nine medical diagnoses and included in a quasi randomized controlled trial. They received either an early geriatric follow-up visit or usual care after hospital discharge. Only patients with an unplanned readmission were included in this subgroup analysis. Medical records of the readmitted patients were assessed by two reviewers. Each readmission was classified as either avoidable or unavoidable. An avoidable readmission was defined as being clinically related to index admissions. RESULTS Between June 2014 and November 2015, 2076 patients were included in the original study. Of these, 216 patients were readmitted. Almost half of avoidable readmissions happened during the first week after hospital discharge. Thirty-four (41%) of 83 readmissions in the intervention group were assessed as avoidable compared to 72 (54%) of 133 readmissions in the control group (p = 0.06). CONCLUSION An early follow-up visit after hospital discharge seems to reduce avoidable readmissions among geriatric patients.
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Izumi S(S, Basin B, Presley M, McCalmont J, Furuno JP, Noble B, Baggs JG, Curtis JR. Feasibility and Acceptability of Nurse-Led Primary Palliative Care for Older Adults with Chronic Conditions: A Pilot Study. J Palliat Med 2018; 21:1114-1121. [PMID: 29792733 PMCID: PMC6916529 DOI: 10.1089/jpm.2017.0666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Many older adults live with serious illness for years before their death. Nurse-led primary palliative care could improve their quality of life and ability to stay in their community. OBJECTIVES To assess feasibility and acceptability of a nurse-led Transitional Palliative Care (TPC) program for older adults with serious illness. METHODS The study was a pilot trial of the TPC program in which registered nurses assisted patients with symptom management, communication with care providers, and advance care planning. Forty-one older adults with chronic conditions were enrolled in TPC or standard care groups. Feasibility was assessed through enrollment and attrition rates and degree of intervention execution. Acceptability was assessed through surveys and exit interviews with participants and intervention nurses. RESULTS Enrollment rate for those approached was 68%, and completion rate for those enrolled was 71%. The TPC group found the intervention acceptable and helpful and was more satisfied with care received than the control group. However, one-third of participants perceived that TPC was more than they needed, despite the number of symptoms they experienced and the burdensomeness of their symptoms. More than half of the participants had little to no difficulty participating in daily activities. CONCLUSION This study demonstrated that the nurse-led TPC program is feasible, acceptable, and perceived as helpful. However, further refinement is needed in selection criteria to identify the population who would most benefit from primary palliative care before future test of the efficacy of this intervention.
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Affiliation(s)
| | - Basilia Basin
- Oregon Health and Science University School of Nursing, Portland, Oregon
| | - Margo Presley
- Department of Multnomah County Health, Portland, Oregon
| | | | - Jon P. Furuno
- Department of Pharmacy Practice, OSU/OHSU College of Pharmacy, Portland, Oregon
| | - Brie Noble
- Department of Pharmacy Practice, OSU/OHSU College of Pharmacy, Portland, Oregon
| | - Judith G. Baggs
- Oregon Health and Science University School of Nursing, Portland, Oregon
| | - J. Randall Curtis
- Division of Pulmonary and Critical Care Medicine, University of Washington, Harborview Medical Center, Seattle, Washington
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Developing a Policy Flight Simulator to Facilitate the Adoption of an Evidence-Based Intervention. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE-JTEHM 2018; 6:4800112. [PMID: 29805921 PMCID: PMC5957263 DOI: 10.1109/jtehm.2018.2833847] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 03/13/2018] [Accepted: 04/24/2018] [Indexed: 11/17/2022]
Abstract
While the use of evidence-based interventions (EBIs) has been advocated by the medical research community for quite some time, uptake of these interventions by healthcare providers has been slow. One possible explanation is that it is challenging for providers to estimate impacts of a specific EBI on their particular organization. To address that concern, we developed and evaluated a type of simulation called a policy flight simulator to determine if it could improve the adoption decision about a specific EBI, the transitional care model (TCM). The TCM uses an advanced practice nurse-led model of care to transition older adults with multiple chronic conditions from a hospitalization to home. An evaluation by a National Advisory Committee, made up of senior representatives from various stakeholders in the U.S. healthcare system, found the policy flight simulator to be a useful tool that has the potential to better inform adoption decisions. This paper describes the simulation development effort and documents lessons learned that may be useful to the healthcare modeling community and those interested in using simulation to support decisions based on EBIs.
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Naef R, Ernst J, Bürgi C, Petry H. Quality of acute care for persons with cognitive impairment and their families: A scoping review. Int J Nurs Stud 2018; 85:80-89. [PMID: 29859348 DOI: 10.1016/j.ijnurstu.2018.05.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/14/2018] [Accepted: 05/15/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND An increasing number of older persons with cognitive impairment use inpatient services for co-occurring acute illness. Research has demonstrated that persons with cognitive impairment face more adverse health outcomes during hospitalization than their age counterparts without cognitive impairment. As hospitals tend to be ill equipped to meet the complex care needs of this population, various initiatives underscore the need to better utilize existing evidence to improve quality of care. OBJECTIVES To map the extent of knowledge about quality of acute care in inpatient settings, and to synthesize knowledge on strategies to improve quality care for persons with cognitive impairment and their families. DESIGN A scoping review using Arksey and O'Malley's methodological framework. DATA SOURCES CINAHL and Medline were searched and reference lists of pertinent articles screened to identify publications regarding acute care for persons with cognitive impairment. REVIEW METHODS Two reviewers independently screened and identified publications based on eligibility criteria. Publications were included if they targeted acute care issues relating to persons with cognitive impairment 65 years or older, their family members, or health professionals caring for them, and were published after 2000 in English or German. Publications were read and data were extracted using a predefined template. Thematic analysis was conducted by two reviewers. RESULTS Of the 1445 identified publications, 66 were included. Quality of acute inpatient services pertained to structural (such as staff capacity and knowledge) and process dimensions (such as forming a caring relationship, assessing and intervening). Strategies identified to improve care quality included interventions at the point of care, such as specific tools and specialist roles to improve patient outcomes, as well as educational and training interventions to enable staff to care for this patient group. CONCLUSIONS There is a discrepancy between clearly defined best practice for persons with cognitive impairment utilising inpatient services, and the quality of care actually experienced by patients, family members, and staff. Research reveals a sobering picture of inadequate care and manifold challenges encountered by this patient group, family members and staff alike. Promising strategies to improve care quality target health professionals' knowledge and capacity to work with this group and include specific tools and models of care, such as specialist roles and units. Organisation-wide efforts to ensure quality care for this patient group are needed, as is further research to determine which implementation and intervention strategies achieve the most beneficial outcomes for all involved.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
| | - Jutta Ernst
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Catherine Bürgi
- Division of Abdomen-Metabolism, University Hospital Zurich, Zurich, Switzerland
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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Abstract
Older adults with multiple chronic conditions (MCCs) typically have risk factors (e.g., functional deficits, social barriers) that complicate the management of their healthcare, often with devastating human and economic consequences. Finding new ways to provide patient-centered care to community-based older adults with MCCs is essential. Two current models of care, the Patient-Centered Medical Home (PCMH) and the Transitional Care Model (TCM), have demonstrated improvements in the outcomes of high-risk older adults at different points on the chronic illness trajectory. However, neither care management approach has optimally engaged vulnerable patients to address needs throughout both acute and more stable transitions in health. In this article, we summarize the development of the PCMH plus TCM (hereafter, PCMH + TCM), an innovative approach to care, and the experience of the providers involved in testing the feasibility of implementing the PCMH + TCM. Using content analyses to code open-ended survey responses from transitional care nurses and PCMH clinical leaders', two major themes, collaboration and communication, emerged as critical to the process of implementing the PCMH + TCM. Barriers and facilitators to implementing the PCMH + TCM are presented. Findings support that the TCM can be adapted and integrated into the PCMH with meticulous planning and implementation.
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Measurement of function in older adults transitioning from hospital to home: an integrative review. Geriatr Nurs 2017; 39:336-343. [PMID: 29249631 DOI: 10.1016/j.gerinurse.2017.11.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/07/2017] [Accepted: 11/13/2017] [Indexed: 12/27/2022]
Abstract
Older adults often experience decline in functional status during the transition from hospital to home. In order to determine the effectiveness of interventions to prevent functional decline, researchers must have instruments that are reliable and valid for use with older adults. The purpose of this integrative review is to: (1) summarize the research uses and methods of administering functional status instruments when investigating older adults transitioning from hospital to home, (2) examine the development and existing psychometric testing of the instruments, and (3) discuss gaps and implications for future research. The authors conducted an integrative review of forty research studies that assessed functional status in older adults transitioning from hospital to home. This review reveals important gaps in the functional status instruments' psychometric testing, including limited testing to support their validity and reliability when administered by self-report and limited evidence supporting their ability to detect change over time.
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ED Utilization and Self-Reported Symptoms in Community-Dwelling Older Adults. J Emerg Nurs 2017; 43:57-69. [PMID: 28131350 DOI: 10.1016/j.jen.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 09/27/2016] [Accepted: 10/01/2016] [Indexed: 01/29/2023]
Abstract
The rise in ED utilization among older adults is a nursing concern, because emergency nurses are uniquely positioned to have a positive impact on the care of older adults. Symptoms have been associated with ED utilization; however, it remains unclear whether symptoms are the primary reason for ED utilization. The purpose of this study was to describe the self-reported symptoms of community-dwelling older adults prior to accessing the emergency department and to examine the differences in self-reported symptoms among those who did and did not utilize the emergency department. METHODS A prospective longitudinal design was used. The sample included 403 community-dwelling older adults aged 75 years and older. Baseline in-home interviews were conducted followed by monthly telephone interviews over 15 months. RESULTS Commonly reported symptoms at baseline included pain, feeling tired, and having shortness of breath. In univariate analysis, pain, shortness of breath, fair/poor well-being, and feeling tired were significantly correlated with ED utilization. In multivariable models, problems with balance and fair/poor well-being were significantly associated with ED utilization. DISCUSSION Several symptoms were common among this cohort of older adults. However, no significant differences were found in the types of symptoms reported by older adults who utilized the emergency department compared with those who did not utilize the emergency department. Based on these findings, it appears that symptoms among community-dwelling older adults may not be the primary reason for ED utilization.
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Optimizing a Nurse-led Transitional Home Visit Program in Preparation for a Randomized Control Trial. Pediatr Qual Saf 2017; 2:e012. [PMID: 30229150 PMCID: PMC6132790 DOI: 10.1097/pq9.0000000000000012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/23/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction: The Hospital to Home Outcomes study began with the end goal of evaluating the effectiveness of a single, nurse-led transitional home visit (home visit) program, for acutely ill, pediatric patients, which had been piloted at our institution. As part of the overall study design, building on prior randomized control trials that utilized a run-in period prior to the trial, our study team designed an optimization period to test the home visit and study procedures under real-world conditions. Methods: For this optimization project, there were 3 process improvement goals: to improve the referral process to the home visit, to optimize the home visit content, and to define and operationalize measures of patient- and family-centered outcomes to be used in the subsequent randomized control trial. During the optimization period, a multidisciplinary study team met weekly to review family and stakeholder feedback about the iterative modifications made to the home visit process, content, and outcome measures. Results: Optimization home visits were completed with 301 families across a variety of discharge diagnoses. The outcomes planned for the clinical trial were tested and refined. Feedback from families and stakeholders indicated that the content changes made to the home visits resulted in increased family knowledge of warning signs to monitor postdischarge. Thirty-one percent of families reported that they altered the care of their child after the home visit. Conclusion: Through iterative testing, informed by multistakeholder feedback, we leveraged patient and family engagement to maximize the effectiveness and generalizability of the home visit intervention.
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Cacchione PZ. The 2015 Doris Schwartz Gerontological Nursing Research Award: Mary D. Naylor, PhD, RN, FAAN-Transitional Care Model: A Journey from Evidence to Impact. J Gerontol Nurs 2016; 42:9-11. [PMID: 27898131 DOI: 10.3928/00989134-20161110-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rochester-Eyeguokan CD, Pincus KJ, Patel RS, Reitz SJ. The Current Landscape of Transitions of Care Practice Models: A Scoping Review. Pharmacotherapy 2016; 36:117-33. [PMID: 26799353 DOI: 10.1002/phar.1685] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Transitions of care (TOC) are a set of actions to ensure patient coordination and continuity of care as patients transfer between different locations or levels. During transitions associated with chronic or acute illness, vulnerable patients may be placed at risk with fragmented systems compromising their health and safety. In addition, poor care transitions also have an enormous impact on health care spending. The primary objective of this scoping review is to summarize the current landscape of practice models that deliver TOC services in the United States. The secondary objective is to use the information to characterize the current state of best practice models. A search of the PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, International Pharmaceutical Abstracts, National Center for Biotechnology Information at the U.S. National Library of Medicine, and Cochrane Library databases (January 1, 2000-April 13, 2015) for articles pertaining to TOC models, limited to U.S. studies published in the English language with human subjects, gleaned 1362 articles. An additional 26 articles were added from the gray literature. Articles meeting inclusion criteria underwent a second review and were categorized into four groups: background information, original TOC research articles not evaluating practice model interventions, original TOC research articles describing practice models, and systematic or Cochrane reviews. The reviewers met weekly to discuss the challenges and resolve disagreements regarding literature reviews with consensus before progressing. A total of 188 articles describing TOC practice models met the inclusion criteria. Despite the strengths of several quality TOC models, none satisfied all the components recommended by leading experts. Multimodal interventions by multidisciplinary teams appear to represent a best practice model for TOC to improve patient outcomes and reduce readmissions, but one size does not fit all. Best model TOC services must include services along the TOC continuum: pretransition and posttransition, as well as at home and in outpatient health care settings. Studies clearly show that single-modal interventions are rarely successful in reducing readmissions and that successful TOC services must be multimodal and multidisciplinary, and continue throughout the care transition. Utilizing best practice TOC models described in this article as a starting point, practitioners interested in developing their own TOC program should test these tools in new practice environments and add to the body of literature by publishing their findings.
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Affiliation(s)
| | - Kathleen J Pincus
- Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, Maryland
| | - Roshni S Patel
- Department of Pharmacy Practice, Jefferson College of Pharmacy, Thomas Jefferson University, Philadelphia, Pennsylvania
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Naylor MD, Hirschman KB, Hanlon AL, Bowles KH, Bradway C, McCauley KM, Pauly MV. Effects of alternative interventions among hospitalized, cognitively impaired older adults. J Comp Eff Res 2016; 5:259-72. [PMID: 27146416 DOI: 10.2217/cer-2015-0009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIM Compare within site effects of three interventions designed to enhance outcomes of hospitalized cognitively impaired elders. METHODS Prospective, nonrandomized, confirmatory phased study. In Phase I, 183 patients received one of three interventions: augmented standard care (ASC), resource nurse care (RNC) or Transitional Care Model (TCM). In Phase II, 205 patients received the TCM. RESULTS Time to first rehospitalization or death was longer for the TCM versus ASC group (p = 0.017). Rates for total all-cause rehospitalizations and days were significantly reduced in the TCM versus ASC group (p < 0.001, both). No differences were observed between RNC versus TCM. CONCLUSION Findings suggest the TCM is more effective than ASC. However, potential effects of the RNC relative to the TCM warrant further study.
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Affiliation(s)
- Mary D Naylor
- New Courtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Karen B Hirschman
- New Courtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Alexandra L Hanlon
- New Courtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Kathryn H Bowles
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA.,Center for Integrative Science in Aging (CISA), University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Christine Bradway
- University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA.,Center for Integrative Science in Aging (CISA), University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Kathleen M McCauley
- New Courtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104, USA
| | - Mark V Pauly
- University of Pennsylvania Wharton School, Philadelphia, PA, USA
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Van Cleave JH, Smith-Howell E, Naylor MD. Achieving a High-Quality Cancer Care Delivery System for Older Adults: Innovative Models of Care. Semin Oncol Nurs 2016; 32:122-33. [PMID: 27137469 PMCID: PMC4864983 DOI: 10.1016/j.soncn.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To examine innovative models and other research-based interventions that hold potential to assure high-quality care for the growing older adult population living with cancer as one of multiple chronic conditions. Evidence from these care delivery approaches provides a roadmap for the development of future care models. DATA SOURCES Published peer-reviewed literature, policy analyses, and web-based resources. CONCLUSION Available evidence suggests the need for models that engage patients and their family caregivers, focus on patient's functional capacities, emphasize palliative care, and maximize the contributions of all team members. IMPLICATIONS FOR NURSING PRACTICE Nurses are uniquely positioned to lead or play a major role in the evolution and implementation of care models targeting older adults with cancer, but must increase their knowledge and skills related to both oncology and geriatrics to maximize their contributions.
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Affiliation(s)
- Janet H. Van Cleave
- New York University College of Nursing, 433 First Avenue, New York, NY 10010 U.S.A.
| | - Esther Smith-Howell
- University of Pennsylvania School of Nursing, 3615 Chestnut Street, Ralston-Penn Center RM327, Philadelphia, PA 19104 U.S.A.
| | - Mary D. Naylor
- Director, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, 418 Curie Blvd, Claire M. Fagin Hall RM341, Philadelphia, PA 19104-4217 U.S.A.
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Morrison J, Palumbo MV, Rambur B. Reducing Preventable Hospitalizations With Two Models of Transitional Care. J Nurs Scholarsh 2016; 48:322-9. [PMID: 27074394 DOI: 10.1111/jnu.12210] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2016] [Indexed: 01/04/2023]
Abstract
PURPOSE Transitional care is an emerging model of health care designed to decrease preventable adverse events and associated utilization of health care through temporary follow-up after hospital discharge. This study describes the approaches and outcomes of two distinct transitional care programs serving different populations: one is provided by master's-prepared clinical nurse specialists (CNS) with a chronic disease self-management focus, another by physicians specializing in palliative care (PPCs). Existing research has shown that transitional care programs with intensive follow-up reduce hospitalizations, emergency department (ED) visits, and costs. Few studies, however, have included side-by-side descriptions of the efficacy of transitional care programs varying by healthcare providers or program focus. DESIGN This is a retrospective cohort study comparing the number of ED visits and hospitalizations in the 120 days before and after the intervention for patients enrolled in each transitional care program. Each program included post-hospitalization home visits, but included differences in program focus (chronic disease vs. palliative), assessment and interventions, and population (rural vs. urban). Data from participants in the CNS program (September 2014 to December 2014) were analyzed (n = 98). The average age of participants was 69 years and 65% were female. Data were collected from patients from the PPC program from September 2014 to April 2015 (n = 71). Thirty participants died within 120 days after the intervention and were excluded; the remaining 41 were included in the analysis. Participants had an average age of 81 years and 63% were female. METHODS For the CNS program, a secondary analysis of existing data was performed. For the PPC program, a review of patient charts was done to collect data on encounters. A Wilcoxon matched-pairs signed-rank test was performed to test for significance. FINDINGS Patients in the CNS intervention had significantly fewer ED visits (p < .005) and hospitalizations (p < .005) in the 4 months after the intervention than in the 4 months before the intervention. Patients in the PPC program had a nonsignificant reduction in ED visits (p = .327) and a significant reduction in hospitalizations postintervention (p = .03). CONCLUSIONS Both transitional programs have value in decreasing rehospitalizations. The CNS intervention also significantly reduced ED visits for their target population. Further study with randomized controlled trials is needed to allow for a better understanding of the healthcare workforce best fitted to enhance transitional care outcomes. Future study to examine the cost savings of each of the interventions is also needed. CLINICAL RELEVANCE Transitional care programs have the potential to prevent unnecessary utilization of health care at the critical periods of transition that leave patients vulnerable to adverse events and poor outcomes.
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Affiliation(s)
- Jessica Morrison
- Kappa Tau, Support and Services at Home (SASH) Wellness Nurse, Cathedral Square Corporation, S. Burlington, VT, USA
| | - Mary Val Palumbo
- Associate Professor, Department of Nursing, University of Vermont, Burlington, VT, USA
| | - Betty Rambur
- Professor, Department of Nursing, University of Vermont, Burlington, VT, USA
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