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"Transitions of care"

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https://www.readbyqxmd.com/read/28639550/the-role-of-nurse-leaders-in-advancing-carer-communication-needs-across-transitions-of-care-a-call-to-action
#1
Sonia A Udod, Michelle Lobchuk
This paper focuses on the central role of senior nurse leaders in advancing organizational resources and support for communication between healthcare providers and carers that influences patient and carer outcomes during the transition from hospital to the community. A Think Tank (Lobchuk 2012) funded by the Canadian Institutes of Health Research (CIHR) gathered interdisciplinary and intersectoral stakeholders from local, national and international levels to develop a Family Carer Communication Research Collaboration...
2017: Nursing Leadership
https://www.readbyqxmd.com/read/28639225/the-development-and-implementation-of-a-patient-continuity-conference-in-a-psychiatry-residency-program
#2
Claire Garber, Marianne Bernadino, Joshua Tomaskek, Katharine J Nelson
OBJECTIVE: A resident-led patient continuity case conference was initiated with the goals of improving communication among providers and increasing cohesion among residents. METHODS: A monthly case conference focusing on patient continuity of care was held over the course of the academic year. Residents were surveyed for feedback about the role of the conference in both improving their competency in navigating transitions of care and building cohesion among residents...
June 21, 2017: Academic Psychiatry
https://www.readbyqxmd.com/read/28638566/necessity-is-the-mother-of-invention-an-innovative-hospitalist-resident-initiative-for-improving-quality-and-reducing-readmissions-from-skilled-nursing-facilities
#3
Sunny Petigara, Mahesh Krishnamurthy, David Livert
Background: Hospital readmissions have been a major challenge to the US health system. Medicare data shows that approximately 25% of Medicare skilled nursing facility (SNF) residents are readmitted back to the hospital within 30 days. Some of the major reasons for high readmission rates include fragmented information exchange during transitions of care and limited access to physicians round-the-clock in SNFs. These represent safety, quality, and health outcome concerns. Aim: The goal of the project was to reduce hospital readmission rates from SNFs by improving transition of care and increasing physician availability in SNFs (five to seven days a week physical presence with 24/7 accessibility by phone)...
March 2017: Journal of Community Hospital Internal Medicine Perspectives
https://www.readbyqxmd.com/read/28624064/assessing-written-communication-during-interhospital-transfers-of-emergency-general-surgery-patients
#4
Felicity N R Harl, Megan C Saucke, Caprice C Greenberg, Angela M Ingraham
BACKGROUND: Poor communication causes fragmented care. Studies of transitions of care within a hospital and on discharge suggest significant communication deficits. Communication during transfers between hospitals has not been well studied. We assessed the written communication provided during interhospital transfers of emergency general surgery patients. We hypothesized that patients are transferred with incomplete documentation from referring facilities. METHODS: We performed a retrospective review of written communication provided during interhospital transfers to our emergency department (ED) from referring EDs for emergency general surgical evaluation between January 1, 2014 and January 1, 2016...
June 15, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28617022/reducing-hospital-readmission-through-team-based-primary-care-a-7-week-pilot-study-integrating-behavioral-health-and-pharmacy
#5
Lauren N DeCaporale-Ryan, Nabila Ahmed-Sarwar, Robbyn Upham, Karen Mahler, Katie Lashway
INTRODUCTION: A team-based service delivery model was applied to provide patients with biopsychosocial care following hospital discharge to reduce hospital readmission. Most previous interventions focused on transitions of care occurred in the inpatient setting with attention to predischarge strategies. These interventions have not considered psychosocial stressors, and few have explored management in primary care settings. METHOD: A 7-week team-based service delivery model was implemented in a family medicine practice emphasizing a biopsychosocial approach...
June 2017: Families, Systems & Health: the Journal of Collaborative Family Healthcare
https://www.readbyqxmd.com/read/28611515/transition-of-pediatric-to-adult-care-in-inflammatory-bowel-disease-is-it-as-easy-as-1-2-3
#6
REVIEW
Anita Afzali, Ghassan Wahbeh
Inflammatory bowel disease (IBD) is a heterogeneous group of chronic diseases with a rising prevalence in the pediatric population, and up to 25% of IBD patients are diagnosed before 18 years of age. Adolescents with IBD tend to have more severe and extensive disease and eventually require graduation from pediatric care toadult services. The transition of patients from pediatric to adult gastroenterologists requires careful preparation and coordination, with involvement of all key players to ensure proper collaboration of care and avoid interruption in care...
May 28, 2017: World Journal of Gastroenterology: WJG
https://www.readbyqxmd.com/read/28602223/is-enhanced-recovery-enough-for-reducing-30-d-readmissions-after-surgery
#7
Anne C Fabrizio, Michael C Grant, Zishan Siddiqui, Yewande Alimi, Susan L Gearhart, Christopher Wu, Jonathan E Efron, Elizabeth C Wick
BACKGROUND: Few enhanced recovery pathways (ERPs) include processes related to the hospital to home transfer. Little has been reported regarding readmissions in enhanced recovery programs. This study evaluates readmissions and identifies areas to optimize ERPs to prevent readmissions. METHODS: We conducted an observational, retrospective study at a single tertiary care center. Patients in an ERP for colorectal surgery were compared with a similar cohort who underwent surgery before protocol implementation...
April 22, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28601329/predictors-of-readmission-in-nonagenarians-analysis-of-the-american-college-of-surgeons-national-surgical-quality-improvement-project-dataset
#8
Zachary Hothem, Dustin Baker, Christina S Jenkins, Jason Douglas, Rose E Callahan, Catherine C Shuell, Graham W Long, Robert J Welsh
BACKGROUND: Increased longevity has led to more nonagenarians undergoing elective surgery. Development of predictive models for hospital readmission may identify patients who benefit from preoperative optimization and postoperative transition of care intervention. Our goal was to identify significant predictors of 30-d readmission in nonagenarians undergoing elective surgery. METHODS: Nonagenarians undergoing elective surgery from January 2011 to December 2012 were identified using the American College of Surgeons National Surgical Quality Improvement Project participant use data files...
June 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28599821/review-of-successful-hospital-readmission-reduction-strategies-and-the-role-of-health-information-exchange
#9
REVIEW
Bita A Kash, Juha Baek, Elise Davis, Tiffany Champagne-Langabeer, James R Langabeer
CONTEXT: The United States has invested substantially in technologies that enable health information exchange (HIE), which in turn can be deployed to reduce avoidable hospital readmission rates in many communities. With avoidable hospital readmissions as the primary focus, this study profiles successful hospital readmission rate reduction initiatives that integrate HIE as a strategy. We hypothesized that the use of HIE is associated with decreased hospital readmissions beyond other observed population health benefits...
August 2017: International Journal of Medical Informatics
https://www.readbyqxmd.com/read/28599601/effect-of-pharmacy-supported-transition-of-care-interventions-on-30-day-readmissions-a-systematic-review-and-meta-analysis
#10
Claire R Rodrigues, Amanda R Harrington, Nicole Murdock, John T Holmes, Eliza Z Borzadek, Kristin Calabro, Jennifer Martin, Marion K Slack
OBJECTIVE: To describe pharmacy-supported transition-of-care (TOC) interventions and determine their effect on 30-day all-cause readmissions. DATA SOURCES: MEDLINE/PubMed, EMBASE, International Pharmaceutical Abstracts, ABI Inform Complete, PsychINFO, Web of Science, Academic Search Complete, CINHAL, Cochrane library, OIASTER, ProQuest Dissertations & Theses, ClinicalTrials.gov , and relevant websites were searched from January 1, 1995, to December 31, 2015. STUDY SELECTION AND DATA EXTRACTION: PICOS+E criteria were utilized...
June 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28599028/transitioning-the-allergy-immunology-patient-from-childhood-to-adulthood
#11
Flavia C L Hoyte
Allergic disorders and immunodeficiencies are generally chronic and even lifelong conditions, often changing over time, making the cautious transition of care from childhood to adulthood particularly important. Many, but not all, patients can continue to receive their care from the same physician as they transition through adolescence and emerging adulthood, made possible because allergy/immunology training programs require cross-training in the care of both pediatric and adult patients. Although keeping the same physician makes the transition easier for many allergy/immunology patients, even these patients face psychosocial issues unique to adolescents and emerging adults, including increased autonomy, risk-taking behavior, and medical self-management...
June 1, 2017: Pediatric Annals
https://www.readbyqxmd.com/read/28576955/health-care-systems-and-transitions-of-care-implication-on-interdisciplinary-pharmacy-services
#12
Paul W Bush, Rowell Daniels
Effective medication management is critical to successful patient outcomes. Pharmacists and pharmacy technicians working within North Carolina Health Systems provide a variety of services that aid in those successful outcomes. By leveraging the North Carolina Clinical Pharmacist Practitioner designation along with integrated health records, health system pharmacists are uniquely positioned to provide expert clinical support to patients. Services such as medication history collection, discharge medication dispensing and counseling, post discharge clinic engagement, and drug therapy management are all components of an even larger number of strategic health system pharmacy assets that aid in the care of patients whether they are admitted to hospitals, seen in clinics, or cared for in the community...
May 2017: North Carolina Medical Journal
https://www.readbyqxmd.com/read/28570334/safety-considerations-during-transitions-of-care-from-inpatient-to-outpatient-settings
#13
Marcus Ponce de Leon, Anna D Hohler
Hospital admissions are times of intense change. New medications are started, treatment regimens are modified, and care plans that will continue in the outpatient setting are initiated. After discharge, most patients receive care from different providers than those seen in the hospital. This situation will increase as inpatient-based practice patterns, such as neurohospitalist practices, become more prevalent. Communication failures during the transition from hospital to clinic increase the risk of adverse events...
June 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28557873/utilization-of-the-health-care-system-of-community-case-management-patients
#14
Sarah Armold
PURPOSE OF STUDY: The has reduced payments to hospitals that have excessive readmissions. This mandate has made it imperative for hospitals to implement a plan to manage readmissions and transitions of care for patients they serve. The purpose of this study was to ascertain whether an advanced practice, nurse-led, community-based model is effective in reducing acute health care utilization. PRIMARY PRACTICE SETTING: The community case management (CCM) program was created more than 20 years ago to assess and manage care of patients demanding frequent emergency department (ED) visits and frequent hospitalizations, by providing in-home visits and care coordination by an advanced practice nurse or masters-prepared nurse...
July 2017: Professional Case Management
https://www.readbyqxmd.com/read/28557775/nonemergency-acute-care-when-it-s-not-the-medical-home
#15
Gregory P Conners, Susan J Kressly, James M Perrin, Julia E Richerson, Usha M Sankrithi
The American Academy of Pediatrics (AAP) affirms that the optimal location for children to receive care for acute, nonemergency health concerns is the medical home. The medical home is characterized by the AAP as a care model that "must be accessible, family centered, continuous, comprehensive, coordinated, compassionate, and culturally effective." However, some children and families use acute care services outside the medical home because there is a perceived or real benefit related to accessibility, convenience, or cost of care...
May 2017: Pediatrics
https://www.readbyqxmd.com/read/28557375/identifying-metrics-of-success-for-transitional-care-practices-in-childhood-cancer-survivorship-a-qualitative-study-of-survivorship-providers
#16
Karim Thomas Sadak, Joseph P Neglia, David R Freyer, Eileen Harwood
BACKGROUND: Long-term survival in childhood cancer is excellent. Most survivors will have a therapy-related chronic condition, yet very few receive survivor-focused care as they transition from adolescence to young adulthood. The purpose of this study is to identify indicators of success in current transitional care practices for young adult survivors of childhood cancer as defined by all members of survivorship care teams. PROCEDURE: An exploratory, phenomenologic qualitative study was conducted with key informants from medical teams involved in transitional care of childhood cancer survivors...
May 30, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28550700/optimizing-transitions-of-care-hospital-to-community
#17
Emily Sheridan, Christine Thompson, Tania Pinheiro, Nicole Robinson, Karen Davies, Nancy Whitmore
Discharging patients from the hospital is a complex process, and preventing avoidable readmissions has the potential to improve both the quality of life for patients and the financial sustainability of the healthcare system (Alper et al. 2016). Improving the discharge process is one method to mitigate readmission to the hospital. Historically, St. Thomas Elgin General Hospital (STEGH) consistently experienced higher-than-expected readmission rates, and only 41% of discharge summaries were sent from the hospital to the community primary care within 48 hours...
2017: Healthcare Quarterly
https://www.readbyqxmd.com/read/28549765/improving-patient-centered-transitional-care-after-complex-abdominal-surgery
#18
Alexandra W Acher, Stephanie A Campbell-Flohr, Maria Brenny-Fitzpatrick, Kristine M Leahy-Gross, Sara Fernandes-Taylor, Alexander V Fisher, Suresh Agarwal, Amy J Kind, Caprice C Greenberg, Pascale Carayon, Sharon M Weber
BACKGROUND: Poor-quality transitions of care from hospital to home contribute to high rates of readmission after complex abdominal surgery. The Coordinated Transitional Care (C-TraC) program improved readmission rates in medical patients, but evidence-based surgical transitional care protocols are lacking. This pilot study evaluated the feasibility and preliminary effectiveness of an adapted surgical C-TraC protocol. STUDY DESIGN: The intervention includes in-person enrollment of patients...
May 18, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28537853/dermatology-discharge-continuity-clinic-enhances-resident-autonomy-and-insight-into-transitions-of-care-competencies-a-cross-sectional-survey-study
#19
Jasmine Rana, Arash Mostaghimi
Dermatology residents perform consults on hospitalized patients, but are often limited in their ability to follow-up with these patients after discharge, leading to inadequate follow-up and understanding of post-discharge transitions of care. In 2013, a discharge continuity clinic (DCC) staffed by the inpatient consult dermatology resident and attending dermatologist was established at one of the four adult hospital sites residents rotate through in the Harvard Combined Dermatology Residency Program. Resident perceptions about the DCC and their educational experience on inpatient consult rotations with a DCC and without a DCC were obtained using a cross-sectional survey instrument in June 2016...
May 15, 2017: Dermatology Online Journal
https://www.readbyqxmd.com/read/28530068/-newborn-discharge-letter-as-a-communication-document-for-continuity-of-care
#20
Jacob Urkin, Zachi Grossman, Gil Chapnick, Daniella Landau
AIMS: To check information items in newborn discharge letters from various delivery rooms and compare them to the expectations of community pediatricians. BACKGROUND: The newborn discharge letter is the document that supports the transition of care from the hospital stay to life at home and in the community. It usually summarizes medical information related to the baby's family, maternal pregnancies, delivery and the stay in hospital until discharge. It is primarily a communication tool between healthcare professionals...
November 2016: Harefuah
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