1,142 research outputs found

    Identifying keys to success in reducing readmissions using the ideal transitions in care framework

    Get PDF
    Background: Systematic attempts to identify best practices for reducing hospital readmissions have been limited without a comprehensive framework for categorizing prior interventions. Our research aim was to categorize prior interventions to reduce hospital readmissions using the ten domains of the Ideal Transition of Care (ITC) framework, to evaluate which domains have been targeted in prior interventions and then examine the effect intervening on these domains had on reducing readmissions. Methods: Review of literature and secondary analysis of outcomes based on categorization of English-language reports published between January 1975 and October 2013 into the ITC framework. Results: 66 articles were included. Prior interventions addressed an average of 3.5 of 10 domains; 41% demonstrated statistically significant reductions in readmissions. The most common domains addressed focused on monitoring patients after discharge, patient education, and care coordination. Domains targeting improved communication with outpatient providers, provision of advanced care planning, and ensuring medication safety were rarely included. Increasing the number of domains included in a given intervention significantly increased success in reducing readmissions, even when adjusting for quality, duration, and size (OR per domain, 1.5, 95% CI 1.1 - 2.0). The individual domains most associated with reducing readmissions were Monitoring and Managing Symptoms after Discharge (OR 8.5, 1.8 - 41.1), Enlisting Help of Social and Community Supports (OR 4.0, 1.3 - 12.6), and Educating Patients to Promote Self-Management (OR 3.3, 1.1 - 10.0). Conclusions: Interventions to reduce hospital readmissions are frequently unsuccessful; most target few domains within the ITC framework. The ITC may provide a useful framework to consider when developing readmission interventions

    Predictors of Re-Hospitalization for Home Healthcare Patients

    Get PDF
    The overall purpose of this study was to examine the predictive capability of OASIS admission data for acute care re-hospitalization of home healthcare patients. Secondary data analysis using logistic regression was conducted on retrospective data from OASIS collected during the time period of July 1, 2006 to June 30, 2007. This study was conducted in a Medicare certified Home Health organization that is part of the largest public health system in California. The sample of 1802 patients with complete episodes of care was derived from a data set of 5,523 patients. All patients were included in the analysis and logistic regression model and the disease specific independent variables included patients with a primary or secondary diagnosis of diabetes and an open skin lesion or wound. The OASIS variables examined in the logistic regression model that showed significance as predictors of acute care re-hospitalization included a diagnosis of diabetes, overall prognosis, rehabilitation prognosis, existing dyspnea, existing urine and bowel incontinence, impairment in currently dressing the upper body and the ability to take own oral medications. These findings apply to all patients in the OASIS database as the logistic regression model included all patients. An interesting finding was that the presence of a lesion or open wound was not significant as a predictor of acute care re-hospitalization. Also of interest was the occurrence of re-hospitalization of 15% that is lower than that reported in the literature as well as the occurrence of diabetes of 14% which is lower than the population in the community. The study methodology related to the backwards method of logistic regression modeling was useful in being able to examine a large number of variables and their relationship to a dichotomous dependent variable. Since this design and method has not been described in the literature prior to this study it has interesting implications for future research using OASIS

    Organizing for Higher Performance: Case Studies of Organized Delivery Systems

    Get PDF
    Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access

    Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis

    Get PDF
    The expansion of primary care and community-based service delivery systems is intended to meet emerging needs, reduce the costs of hospital-based ambulatory care and prevent avoidable hospital use by the provision of more appropriate care. Great emphasis has been placed on the role of self-management in the complex process of care of patient with long-term conditions. Several studies have determined that nurses, among the health professionals, are more recommended to promote health and deliver preventive programs within the primary care context. The aim of this systematic review and meta-analysis is to assess the efficacy of the nurse-led self-management support versus usual care evaluating patient outcomes in chronic care community programs. Systematic review was carried out in MEDLINE, CINAHL, Scopus and Web of Science including RCTs of nurse-led self-management support interventions performed to improve observer reported outcomes (OROs) and patients reported outcomes (PROs), with any method of communication exchange or education in a community setting on patients >18 years of age with a diagnosis of chronic diseases or multi-morbidity. Of the 7,279 papers initially retrieved, 29 met the inclusion criteria. Meta-analyses on systolic (SBP) and diastolic (DBP) blood pressure reduction (10 studies-3,881 patients) and HbA1c reduction (7 studies-2,669 patients) were carried-out. The pooled MD were: SBP -3.04 (95% CI -5.01--1.06), DBP -1.42 (95% CI -1.42--0.49) and HbA1c -0.15 (95% CI -0.32-0.01) in favor of the experimental groups. Meta-analyses of subgroups showed, among others, a statistically significant effect if the interventions were delivered to patients with diabetes (SBP) or CVD (DBP), if the nurses were specifically trained, if the studies had a sample size higher than 200 patients and if the allocation concealment was not clearly defined. Effects on other OROs and PROs as well as quality of life remain inconclusive

    Decreasing Thirty-Day Readmissions for Heart Failure Patients

    Get PDF
    Heart failure (HF) patients have a 20-25% hospital readmission rate within the first month of discharge. Patients experiencing HF often have a decline in health resulting in frequent hospitalizations and encumbering symptoms including dyspnea, fluid retention, and orthopnea. HF is a common condition in nursing homes and accounts for a significant proportion of resident transfers to emergency departments. HF is considered one of the costliest diagnoses in the United States, estimated to cost the healthcare system billions of dollars annually. The purpose of this systematic review was to provide a synthesis of evidence-based literature on the current recommendations and strategies for reducing 30-day readmission for nursing home HF patients and to recommend effective strategies to address the problem. Kurt Lewin’s force field theory was used to frame this project. A review of CINAHL, Medline, and ProQuest Nursing & Allied Health Source resulted in 7 evidence-based articles. Evidence was appraised and graded according to the levels of evidence identified by Fineout-Overholt and colleagues. Results of this systematic review demonstrated that home telemonitoring was unable to reduce HF readmission within 30-days of discharge. The strategies of utilizing structured home visits, improving nurse-physician communication, and improving staff knowledge on HF showed a reduction of HF patient readmission within 30-days of discharge. Recommendations from this SR can improve the quality of life of HF patients and their families, and reduce the high financial burden to patients, their families and the healthcare system

    Community Paramedicine in Rural Areas: State and Local Findings and the Role of the State Flex Program (Policy Brief #35)

    Get PDF
    This study examined the evidence base for community paramedicine in rural communities, the role of community paramedics in rural healthcare delivery systems, the challenges faced by states in implementing community paramedicine programs, and the role of the state Flex programs in supporting development of community paramedicine programs. Additionally, the study provides a snapshot of community paramedicine programs currently being developed and/or implemented in rural areas. Another FMT briefing paper describes these same findings in detail. Highlights: Many rural community paramedicine programs are in pilot stages. Most community paramedics work within an expanded role rather than an expanded scope of practice, the latter requiring legislative or regulatory change. Funding and reimbursement for community paramedicine services are major challenges for the sustainability of community paramedicine programs. Data collection is vital for community paramedicine programs to be able to show value, including shared saving and patient outcomes. Collaboration at local and state levels is essential for buy-in, and partnering with the State Office of Rural Health is especially helpful in the early development and outreach efforts for rural community paramedicine programs

    Montefiore Medical Center: Integrated Care Delivery for Vulnerable Populations

    Get PDF
    Describes a system of hospitals and community- and school-based clinics tailored to low-income patients through systemwide strategies, high-quality specialty and hospital care, and integrated care delivery via care management and information technology

    Using System Level Quality Measures to Improve Home and Community-based Services in Maine

    Get PDF
    The purpose of this project was to identify a set of quality measures that could be used to profile the performance of Maine’s home and community based care (HCBS) system. The long term care system in Maine has been significantly restructured in the last five years. Funding for home care services has more than doubled and now represents approximately 20% of Medicaid and State funding for LTC. This has led to increased interest in assuring the quality of services that are being provided and developing ways to improve the delivery of services and outcomes for consumers. Using assessment data from the Maine MECARE system, residential care facilities and nursing facilities, an initial set of potential indicators was examined. Key stakeholders identified priority areas for quality improvement. The Bureau of Elder and Adult Services identified, prevalence of falls, as the first area to initiate a quality improvement activity. The Bureau of Elder and Adult Services convened a multi-disciplinary group of professionals in Maine to learn more about existing fall evaluation and prevention programs. Using practice guidelines published in the Annals of Internal Medicine, the Bureau is currently examining a number of fall intervention and prevention strategies. This project represented a first step in using long term care assessment data to improve the quality of home and community based services in Maine. Recommendations for future work include: Continue to build support for quality measures through the involvement of key opinion leaders and stakeholder groups. Identify a short list of quality indicators that represent multiple dimensions of quality. Identify at least one chronic condition for a quality improvement activity. Develop, pilot and make available consumer friendly reports to the public on Maine’s home and community based care system Develop a plan to maintain a sustainable and qualified workforce of people who provide home and community based services
    • …
    corecore