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Care transitions

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16 papers 0 to 25 followers
By Jamie Jarmul Md / PhD student at UNC - Chapel Hill, PhD in Health Policy and Management
Jon Arne Søreide, Oddvar M Sandvik, Kjetil Søreide
BACKGROUND: Pancreas surgery has evolved with better diagnostic imaging, changing indications, and improved patient selection. Outside high-volume tertiary centers, the documented effect of evolution in care and volumes are limited. Thus, we aimed to review indications and outcomes in pancreas surgery during the transition from community-based hospital to a university hospital. METHODS: All pancreatic surgeries performed between 1986 and 2012 within a well-defined Norwegian population were identified from the hospital's database...
August 2016: International Journal of Surgery
Melanie S Morris, Laura A Graham, Joshua S Richman, Robert H Hollis, Caroline E Jones, Tyler Wahl, Kamal M F Itani, Hillary J Mull, Amy K Rosen, Laurel Copeland, Edith Burns, Gordon Telford, Jeffery Whittle, Mark Wilson, Sara J Knight, Mary T Hawn
OBJECTIVE: The aim of this study is to understand the relative contribution of preoperative patient factors, operative characteristics, and postoperative hospital course on 30-day postoperative readmissions. BACKGROUND: Determining the risk of readmission after surgery is difficult. Understanding the most important contributing factors is important to improving prediction of and reducing postoperative readmission risk. METHODS: National Veterans Affairs Surgical Quality Improvement Program data on inpatient general, vascular, and orthopedic surgery from 2008 to 2014 were merged with laboratory, vital signs, prior healthcare utilization, and postoperative complications data...
October 2016: Annals of Surgery
Lipika Samal, Patricia C Dykes, Jeffrey O Greenberg, Omar Hasan, Arjun K Venkatesh, Lynn A Volk, David W Bates
BACKGROUND: Health information technology (HIT) could improve care coordination by providing clinicians remote access to information, improving legibility, and allowing asynchronous communication, among other mechanisms. We sought to determine, from a clinician perspective, how care is coordinated and to what extent HIT is involved when transitioning patients between emergency departments, acute care hospitals, skilled nursing facilities, and home health agencies in settings across the United States...
2016: BMC Health Services Research
Elizabeth B McNeely
Heart failure is associated with increased risk of morbidity and mortality, resulting in substantial health-care costs. Clinical pharmacists have an opportunity to reduce health-care costs and improve disease management as patients transition from inpatient to outpatient care by leading interventions to develop patient care plans, educate patients and clinicians, prevent adverse drug reactions, reconcile medications, monitor drug levels, and improve medication access and adherence. Through these methods, clinical pharmacists are able to reduce rates of hospitalization, readmission, and mortality...
April 28, 2016: Journal of Pharmacy Practice
Chris Ploenzke, Tessa Kemp, Todd Naidl, Rebecca Marraffa, Jennifer Bolduc
OBJECTIVES: To improve patient care through the development of a clinical risk stratification tool to identify high-risk patients and implementation of pharmacist-mediated medication management after patient care transitions. SETTING: Minneapolis Veterans Affairs (VA) Health Care System from December 1, 2014, to April 1, 2015. PRACTICE DESCRIPTION: A composite care transition score was developed based on risk factors obtained from a literature review and combined with a national stratification tool unique to the Veterans Health Administration (VHA) primary care population, the Care Assessment Need (CAN) score...
May 2016: Journal of the American Pharmacists Association: JAPhA
Patrick G Clay
No abstract text is available yet for this article.
May 2016: Journal of the American Pharmacists Association: JAPhA
Martha Hsueh, Kathleen Dorcy
Gaps in complex oncology care coordination between inpatient and outpatient settings can result in treatment and monitoring delays and omissions, which can negatively affect patient outcomes. Gaps also exist for patients facing complex treatment modalities and collaborations between multiple care teams working at geographically distant sites. A pilot advanced practice nurse care coordinator 
(APNCC) role to coordinate these complex care transitions and implement processes for safer and more efficient care has shown promise...
June 1, 2016: Clinical Journal of Oncology Nursing
Fredrick OʼNeal, Tracy R Frame, Julia Triplett
Patients in a transition of care are highly susceptible to health and medication errors. In many situations, patients are eager to go home and providers are expected to discharge quickly. It is in this time of documented vulnerability that an increase in adverse effects related to poor health literacy, medication usage, and a lack of documentation occurs. Through the collaboration of Vanderbilt Home Care Services, Inc., and Belmont University College of Pharmacy, pharmacy students are utilized in a capacity that integrates pharmacy students into the home healthcare team to ease transitions of care and reduce medication-related problems in patients...
June 2016: Home Healthcare Now
Jaime E Verastegui, Yukihiro Hamada, David P Nicolau
Acute bacterial skin and skin structure infections (ABSSSI) have evolved over a relatively short period of time to become one of the most challenging medical problems encountered in clinical practice. Notably the high incidence of methicillin-resistant S. aureus (MRSA) across the continuum of care has coincided with increased outpatient failures and higher rates of hospital admissions for parental antibiotic therapy. Consequently the management of ABSSSI constitutes a tremendous burden to the healthcare system in terms of cost of care and consumption of institutional and clinical resources...
August 2016: Expert Review of Clinical Pharmacology
Aubrie Rafferty, Sheri Denslow, Elizabeth Landrum Michalets
BACKGROUND: Medication management during transitions of care (TOC) impacts clinical outcomes. Published literature on TOC implementation is increasing, but data remains limited regarding the optimal role for the inpatient pharmacist, particularly in the community health setting. OBJECTIVE: To evaluate the impact of a dedicated inpatient TOC pharmacist on re-presentations following discharge. METHODS: This is a prospective study with historical control...
August 2016: Annals of Pharmacotherapy
Zoebia Islam, Tamsin Ford, Tami Kramer, Moli Paul, Helen Parsons, Katherine Harley, Tim Weaver, Susan McLaren, Swaran P Singh
Aims and method The Transitions of Care from Child and Adolescent Mental Health Services to Adult Mental Health Services (TRACK) study was a multistage, multicentre study of adolescents' transitions between child and adult mental health services undertaken in England. We conducted a secondary analysis of the TRACK study data to investigate healthcare provision for young people (n = 64) with ongoing mental health needs, who were not transferred from child and adolescent mental health services (CAMHS) to adult mental health services mental health services (AMHS)...
June 2016: BJPsych Bulletin
Josep Comín-Colet, Cristina Enjuanes, Josep Lupón, Miguel Cainzos-Achirica, Neus Badosa, José María Verdú
Despite advances in the treatment of heart failure, mortality, the number of readmissions, and their associated health care costs are very high. Heart failure care models inspired by the chronic care model, also known as heart failure programs or heart failure units, have shown clinical benefits in high-risk patients. However, while traditional heart failure units have focused on patients detected in the outpatient phase, the increasing pressure from hospital admissions is shifting the focus of interest toward multidisciplinary programs that concentrate on transitions of care, particularly between the acute phase and the postdischarge phase...
June 6, 2016: Revista Española de Cardiología
Nghi B Ha, Katherine Yang, Sarah Hanigan, Brian Kurtz, Michael P Dorsch, Hannah Mak, Jerod Nagel
BACKGROUND: Drug-drug interactions (DDIs) with warfarin and antimicrobial agents are a common cause of international normalized ratio (INR) instability, which can affect the risk for bleeding and thrombotic events. OBJECTIVE: The purpose of this study was to assess the impact of a comprehensive guideline for the management of warfarin-antimicrobial DDIs across transitions of care. The guideline emphasizes improving identification of significant antimicrobial-warfarin DDIs during hospitalization, empirical warfarin dose modification based on DDI and baseline INR, patient education, documentation of the DDI, communication with outpatient providers regarding the DDI and anticipated antimicrobial stop date, and warfarin dose adjustment on discontinuation of antimicrobial...
September 2016: Annals of Pharmacotherapy
Jennifer R Frost, Rebecca K Cherry, Suzette O Oyeku, Elissa Z Faro, Lori E Crosby, Maria Britto, Lisa K Tuchman, Ivor B Horn, Charles J Homer, Anjali Jain
INTRODUCTION: Transitions between inpatient and outpatient care and pediatric to adult care are associated with increased mortality for sickle cell disease (SCD) patients. As accurate and timely sharing of health information is essential during transitions, a health information technology (HIT)-enabled tool holds promise to improve care transitions. METHODS: From 2012 through 2014, the team conducted and analyzed data from an environmental scan, key informant interviews, and focus groups to inform the development of an HIT-enabled tool for SCD patients' use during care transitions...
July 2016: American Journal of Preventive Medicine
Israel Green Hopkins, Kelly Dunn, Fabienne Bourgeois, Jayne Rogers, Vincent W Chiang
The purpose of this case study was to investigate opportunities to electronically enhance the transitions of care for both patients and providers and to describe the process of development and implementation of such tools. We describe the current challenges and fragmentation of care for pediatric patients and families being discharged from inpatient stays, and review barriers to change in practice. Care transitions vary in the complexity of the clinical and social scenarios and no one-size-fits-all approach works for every patient, provider or hospital system...
June 2016: Healthcare
Chad Kessler, Nicholas Elias Tsipis, David Seaberg, Garth N Walker, Kathryn Andolsek
In the practice of modern emergency medicine (EM), transitions of care (TOC) have taken a prominent role, and during this time of healthcare reform, TOC has become a focal point of improvement initiatives across the continuum of care. This review includes a comprehensive examination of various regulatory, accreditation, and policy-based elements with which EM physicians interact in their daily practice. The content is organized into five domains: Accreditation Council for Graduate Medical Education (ACGME), The Joint Commission, Affordable Care Act, National Quality Forum (NQF), and accountable care organizations...
May 2016: Journal of Healthcare Management / American College of Healthcare Executives
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