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"Care transitions"

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https://www.readbyqxmd.com/read/28815552/connect-home-transitional-care-of-skilled-nursing-facility-patients-and-their-caregivers
#1
Mark Toles, Cathleen Colón-Emeric, Mary D Naylor, Josephine Asafu-Adjei, Laura C Hanson
BACKGROUND: Older adults that transfer from skilled nursing facilities (SNF) to home have significant risk for poor outcomes. Transitional care of SNF patients (i.e., time-limited services to ensure coordination and continuity of care) is poorly understood. OBJECTIVE: To determine the feasibility and relevance of the Connect-Home transitional care intervention, and to compare preparedness for discharge between comparison and intervention dyads. DESIGN: A non-randomized, historically controlled design-enrolling dyads of SNF patients and their family caregivers...
August 16, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28808863/warm-handoffs-a-novel-strategy-to-improve-end-of-rotation-care-transitions
#2
Harry S Saag, Jingjing Chen, Joshua L Denson, Simon Jones, Leora Horwitz, Patrick M Cocks
BACKGROUND: Hospitalized medical patients undergoing transition of care by house staff teams at the end of a ward rotation are associated with an increased risk of mortality, yet best practices surrounding this transition are lacking. AIM: To assess the impact of a warm handoff protocol for end-of-rotation care transitions. SETTING: A large, university-based internal medicine residency using three different training sites. PARTICIPANTS: PGY-2 and PGY-3 internal medicine residents...
August 14, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28803724/implementation-and-outcomes-of-an-evidence-based-precepting-program-for-burn-nurses
#3
Johnnie R Robbins, Krystal K Valdez-Delgado, Nicole W Caldwell, Linda H Yoder, Elizabeth J Hayes, Michaèl G Barba, Hope L Greeley, Colleen Mitchell, Elizabeth A Mann-Salinas
INTRODUCTION: There is significant nationwide interest in transitioning new and new-to-specialty nurses into practice, especially in burn care. Lack of a structured transition program in our Burn Center was recognized as a contributing factor for nursing dissatisfaction and increased turnover compared to other hospital units. Employee evaluations exposed a need for more didactic instruction, hands-on learning, and preceptor support. The goal of this project was to implement an evidence-based transition to practice program specific to the burn specialty...
August 10, 2017: Burns: Journal of the International Society for Burn Injuries
https://www.readbyqxmd.com/read/28794620/spreading-improvements-for-advanced-copd-care-through-a-canadian-collaborative
#4
Graeme M Rocker, Claudia Amar, Wendy L Laframboise, Jane Burns, Jennifer Y Verma
BACKGROUND: A year-long pan-Canadian quality improvement collaborative (QIC) led by the Canadian Foundation for Healthcare Improvement (CFHI) supported the spread of the successful Halifax, Nova Scotia-based INSPIRED COPD Outreach Program™ to 19 teams in the 10 Canadian provinces. We describe QIC results, addressing two main questions: 1) Can the results of the Nova Scotia INSPIRED model be replicated elsewhere in Canada? 2) How did the teams implement and evaluate their versions of the INSPIRED program? METHODS: Collaborative faculty selected measures that were evidence-based, relatively simple to collect, and relevant to local context...
2017: International Journal of Chronic Obstructive Pulmonary Disease
https://www.readbyqxmd.com/read/28793094/therapeutic-nursing-care-transition-in-sexuality-of-the-elderly-caregiving-spouse
#5
Claudia Feio da Maia Lima, Célia Pereira Caldas, Iraci Dos Santos, Liana Amorim Correa Trotte, Bárbara Martins Corrêa da Silva
Objective: To understand the transitions experienced, and the conditions and expected response patterns to changes in sexuality of the spouse-caregiver of the elderly, during progression of the dementia process. Method: A qualitative research study, conducted at the neurogeriatric clinic between May of 2014 and May of 2015. An intensive, individual interview was administered to 12 elderly caregivers. Thematic content analysis was applied, using the theoretical model of Transition Theory...
July 2017: Revista Brasileira de Enfermagem
https://www.readbyqxmd.com/read/28789708/effectiveness-of-person-and-family-centered-care-transition-interventions-a-systematic-review-protocol
#6
Chantal Backman, Julie Chartrand, Orvie Dingwall, Beverley Shea
BACKGROUND: Care transitions from the hospital to home are critical to the sustainability of our health care system. Ineffective care transitions can be caused by high incidences of post-discharge adverse events, by poor communication with patients, and/or by inadequate information transfer between providers from the hospital to home. Any one of these can lead to fragmented care, high readmission rates, increased visits to the emergency department, and ultimately poor patient outcomes...
August 8, 2017: Systematic Reviews
https://www.readbyqxmd.com/read/28774652/hospital-discharge-preparedness-for-patients-with-limited-english-proficiency-a-mixed-methods-study-of-bedside-interpreter-phones
#7
Jonathan S Lee, Anna Nápoles, Sunita Mutha, Eliseo J Pérez-Stable, Steven E Gregorich, Jennifer Livaudais-Toman, Leah S Karliner
OBJECTIVE: Assess effects of a bedside interpreter-phone intervention on hospital discharge preparedness among patients with limited English proficiency (LEP). METHODS: Mixed-methods study compared patient-reported discharge preparedness and knowledge of medications and follow-up appointments among 189 Chinese- and Spanish-speakers before (n=94) and after (n=95) bedside interpreter-phone implementation, and examined nurse and resident-physician interpreter-phone utilization through focus groups...
July 24, 2017: Patient Education and Counseling
https://www.readbyqxmd.com/read/28759896/an-analysis-of-diagnoses-that-drive-readmission-what-can-we-learn-from-the-hospitals-in-southern-new-england-with-the-highest-and-lowest-readmission-performance
#8
Blake Morphis, Rouba Youssef, Rebekah Gardner, Elizabeth M Goldberg
T Background: The Hospital Readmission Reduction Program was instituted by the Centers for Medicare & Medicaid Services in 2012 to incentivize hospitals to reduce readmissions. OBJECTIVE: To examine the most common diagnoses driving readmissions among fee-for-service Medicare beneficiaries in the hospitals with the highest and lowest readmission performance in Southern New England from 2014 to 2016. METHODS: This is a retrospective observational study using publicly available Hospital Compare data and Medicare Part A claims data...
August 1, 2017: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/28756965/drug-related-problems-in-geriatric-rehabilitation-patients-after-discharge-a-prevalence-analysis-and-clinical-case-scenario-based-pilot-study
#9
Johanna Freyer, Lucie Hueter, Lysann Kasprick, Thomas Frese, Ralf Sultzer, Susanne Schiek, Thilo Bertsche
BACKGROUND: Geriatric patients bear a high risk for having drug-related problems (DRPs). Transitions of care are especially susceptible to these DRPs. OBJECTIVE: To highlight the prevalence of DRPs in geriatric patients' post-discharge medication lists and to assess physicians' ability to identify DRPs by using clinical case scenarios. METHODS: A sequential prospective mixed-method study was performed. In a DRP prevalence analysis, an expert panel of clinical pharmacists analyzed DRPs in post-discharge medication lists of long-term hospitalized patients from a German inpatient geriatric rehabilitation center...
July 25, 2017: Research in Social & Administrative Pharmacy: RSAP
https://www.readbyqxmd.com/read/28754584/adolescent-to-adult-hiv-health-care-transition-from-the-perspective-of-adult-providers-in-the-united-states
#10
Amanda E Tanner, Morgan M Philbin, Alice Ma, Brittany D Chambers, Sharon Nichols, Sonia Lee, J Dennis Fortenberry
PURPOSE: The HIV Care Continuum highlights the need for HIV-infected youth to be tested, linked, and maintained in lifelong care. Care engagement is important for HIV-infected youth in order for them to stay healthy, maintain a low viral load, and reduce further transmission. One point of potential interruption in the care continuum is during health care transition from adolescent- to adult-centered HIV care. HIV-related health care transition research focuses mainly on youth and on adolescent clinic providers; missing is adult clinic providers' perspectives...
July 25, 2017: Journal of Adolescent Health: Official Publication of the Society for Adolescent Medicine
https://www.readbyqxmd.com/read/28734149/discharge-management-strategies-and-post-discharge-care-interventions-for-depression-systematic%C3%A2-review-and-meta-analysis
#11
REVIEW
F Holzinger, S Fahrenkrog, S Roll, F Kleefeld, M Adli, C Heintze
BACKGROUND: Patients with depression require treatment continuity when discharged from inpatient care. Interventions aimed at optimizing transition into outpatient care may be effective in preventing symptom deterioration and readmission. We aimed to evaluate the effectiveness of care transition interventions for patients with depression after psychiatric hospitalization. METHODS: Systematic review and random-effects meta-analysis of controlled trials. Primary outcomes were readmissions and symptoms of depression...
July 11, 2017: Journal of Affective Disorders
https://www.readbyqxmd.com/read/28724511/apps-for-health-related-education-in-pharmacy-practice-needs-assessment-survey-among-patients-within-a-large-metropolitan-area
#12
Sean M Mirk, Nicole Marie Wegrzyn
BACKGROUND: Patient education resources are crucial to the effectiveness of prescribed pharmacotherapy. However, user interest and patient preference for these materials is lacking. Regardless of the field, nearly every article on designing mHealth apps references the lack of end-user involvement as a key flaw to sustainable design. The traditional paper-based methods of patient education are difficult to tailor to a patient's specific needs and learning styles, but a customizable app might be beneficial...
July 19, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28719775/health-and-health-care-transitions-in-vietnam-evidence-from-the-chililab-health-and-demographic-surveillance-system-chililab-hdss
#13
Hoang Van Minh, Do Van Dung, Nguyen Viet Hung, Osman Sankoh
No abstract text is available yet for this article.
July 2017: Asia-Pacific Journal of Public Health
https://www.readbyqxmd.com/read/28711070/female-adolescents-with-chronic-or-end-stage-kidney-disease-and-strategies-for-their-care
#14
Maria E Diaz-Gonzalez De Ferris, Ana Catalina Alvarez-Elías, Michael Ted Ferris, Mara Medeiros
The prevalence of chronic or end-stage kidney disease in pediatric girls is lower than in boys, however, girls have unique morbidities that can have great effect on their quality of life. For female adolescents, creatinine excretion peaks at approximately 14 years of age and is significantly less than males, owing to lower muscle mass. Females have higher nitric oxide activity, and estrogens may contribute to lower blood pressure. Females excrete less growth hormone during the prepubertal and pubertal years...
July 2017: Seminars in Nephrology
https://www.readbyqxmd.com/read/28706095/elucidating-the-information-exchange-during-interfacility-care-transitions-insights-from-a-qualitative-study
#15
Lianne Jeffs, Marianne Saragosa, Madelyn Law, Kerry Kuluski, Sherry Espin, Jane Merkley, Chaim M Bell
OBJECTIVE: To explore the perceptions of patients, their caregivers and healthcare professionals associated with the exchange of information during transitioning from two acute care hospitals to one rehabilitation hospital. DESIGN: An exploratory qualitative study using semi-structured interviews and observation. PARTICIPANTS AND SETTING: Patients over the age of 65 years admitted to an orthopaedic unit for a non-elective admission, their caregivers and healthcare professionals involved in their care...
July 12, 2017: BMJ Open
https://www.readbyqxmd.com/read/28690696/nurses-attitudes-and-behaviors-on-patient-medication-education
#16
Jane F Bowen, Melissa E Rotz, Brandon J Patterson, Sanchita Sen
BACKGROUND: Medication education is vital for positive patient outcomes. However, there is limited information about optimal medication education by nurses during hospitalization and care transitions. OBJECTIVE: Examine nurses' attitudes and behaviors regarding the provision of patient medication education. The secondary objectives were to determine if nurses' medication education attitudes explain their behaviors, describe nurses' confidence in patient medication knowledge and abilities, and identify challenges to and improvements for medication education...
April 2017: Pharmacy Practice
https://www.readbyqxmd.com/read/28686486/exploring-challenges-in-the-patient-s-discharge-process-from-the-internal-medicine-service-a-qualitative-study-of-patients-and-providers-perceptions
#17
Vincent Pinelli, Heather L Stuckey, Jed D Gonzalo
In hospital-based medicine units, patients have a wide range of complex medical conditions, requiring timely and accurate communication between multiple interprofessional providers at the time of discharge. Limited work has investigated the challenges in interprofessional collaboration and communication during the patient discharge process. In this study, authors qualitatively assessed the experiences of internal medicine providers and patients about roles, challenges, and potential solutions in the discharge process, with a phenomenological focus on the process of collaboration...
July 7, 2017: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/28685850/return-on-investment-roi-analyses-of-an-inpatient-lay-health-worker-model-on-30-day-readmission-rates-in-a-rural-community-hospital
#18
Roberto Cardarelli, Gregory Bausch, Joan Murdock, Michelle Renee Chyatte
PURPOSE: The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. METHODS: The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs)...
July 7, 2017: Journal of Rural Health
https://www.readbyqxmd.com/read/28685482/hospital-readmissions-among-commercially-insured-and-medicare-advantage-beneficiaries-with-diabetes-and-the-impact-of-severe-hypoglycemic-and-hyperglycemic-events
#19
Rozalina G McCoy, Kasia J Lipska, Jeph Herrin, Molly M Jeffery, Harlan M Krumholz, Nilay D Shah
BACKGROUND: Hospital readmission is common among patients with diabetes. Some readmissions, particularly for hypoglycemia and hyperglycemia, may be avoidable with better care transitions and post-discharge management. OBJECTIVE: To ascertain the most common reasons and risk factors for readmission among adults with diabetes, with specific consideration of severe dysglycemia. DESIGN: Retrospective analysis of data from the OptumLabs Data Warehouse, an administrative data set of commercially insured and Medicare Advantage beneficiaries across the U...
July 6, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28682095/the-role-of-the-psychologist-with-disorders-of-consciousness-in-inpatient-pediatric-neurorehabilitation-a-case-series
#20
Sarah Lahey, Cynthia Beaulieu, Karen Sandbach, Angela Colaiezzi, Staci Balkan
PURPOSE/OBJECTIVE: The psychologist in an inpatient pediatric neurorehabilitation setting provides a vital role in the assessment, treatment, and management of pediatric patients with disorders of consciousness (DoC). Competencies are drawn from several specialty areas of professional psychology, including rehabilitation psychology, pediatric neuropsychology, and pediatric psychology. This specialized knowledge forms the basis for tailoring assessment and treatment plans specific to the individual brain injury profile, with the goals of enhancing diagnosis, prognosis, and care transition decision...
July 6, 2017: Rehabilitation Psychology
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