A Survey of Hospitals That Participated in a Statewide Collaborative to Implement and Sustain Rapid Response Teams

To determine the level of sustainability of Rapid Response Teams (RRTs) among a group of hospitals that participated in a statewide collaborative to implement and sustain RRTs

The Cost of Healthy Eating

Background Annually in the US, 15-20% of 1,000,000 Emergency Department visits for acute Heart Failure (HF) result in discharge, and patients often experience adverse health outcomes. The study, Get With the Guidelines in Emergency Department Patients With Heart Failure, utilized ‘Self-Care Coaches’ who meet participants via telehealth calls to discuss self-care maintenance after discharge; and offer provisions of resources, including a cookbook. During calls, we observed gaps in self-care for retired older adults, living alone, and receiving food stamps from the federal SNAP program, who expressed struggles with affording an HF-friendly diet. Objective To investigate if the target population in Portland/Hillsboro can afford an HF-friendly diet on the monthly SNAP income. Methods Using the cookbook, we created three sets of meal plans. Utilizing the Fred Meyer website, the cost of ingredients for each meal was collected/aggregated to determine meal plan costs. Results SNAP one-person household monthly allotment: $291. Randomly-selected, least-expensive, and most-expensive meal plan costs in each city, respectively. Portland:$1,679.10, $498.90,$3,927.90. Hillsboro: $1,676.10,$495.90, $3,924.90. Conclusion We found that all meal plans exceeded the SNAP monthly allotment. However, we assumed full-sized items were purchased, likely overestimating costs. Further investigation is needed to assess the affordability of healthy eating

The Cost of Healthy Eating

Abstract Background Each year in the United States, 15-20% of 1 million visits to the Emergency Department for Acute Heart Failure result in home discharge, with patients often experiencing adverse health outcomes within 30 days. The study, Get With the Guidelines in Emergency Department Patients With Heart Failure (GUIDED-HF), utilized ‘Self-Care Coaches’ who meet participants via telehealth calls to discuss self-care maintenance after discharge as a strategy to mitigate adverse health outcomes; and offer provisions of resources, including a cookbook by the American Association for Heart Failure Nurses (AAHFN). During the calls, we observed gaps in self-care for retired older adults (62+), living alone, and receiving food stamps from the federal Supplemental Nutrition Assistance Program (SNAP), who expressed struggles with affording a Heart Failure (HF) friendly diet. Objective To investigate if the target population in Portland or Hillsboro can afford an HF-friendly diet on the monthly SNAP income. Methods Using the cookbook, we created three sets of meal plans. Utilizing the Fred Meyer website, the cost of ingredients for each meal was collected and aggregated to determine meal plan costs. Results SNAP monthly allotment for a one-person household: $291. Costs of the randomly-selected, least-expensive, and most-expensive meal plans in each city, respectively. Portland:$1,679.10, $498.90, and$3,927.90. Hillsboro: $1,676.10,$495.90, and $3,924.90. Conclusion We found that all meal plans exceeded the SNAP monthly allotment. However, we assumed full-sized items were purchased, likely overestimating costs. Further investigation is needed to assess the affordability of healthy eating

Implementation strategies in the context of medication reconciliation: a qualitative study

Abstract Background Medication reconciliation (MedRec) is an important patient safety initiative that aims to prevent patient harm from medication errors. Yet, the implementation and sustainability of MedRec interventions have been challenging due to contextual barriers like the lack of interprofessional communication (among pharmacists, nurses, and providers) and limited organizational capacity. How to best implement MedRec interventions remains unclear. Guided by the Expert Recommendations for Implementing Change (ERIC) taxonomy, we report the differing strategies hospital implementation teams used to implement an evidence-based MedRec Toolkit (the MARQUIS Toolkit). Methods A qualitative study was conducted with implementation teams and executive leaders of hospitals participating in the federally funded “Implementation of a Medication Reconciliation Toolkit to Improve Patient Safety” (known as MARQUIS2) research study. Data consisted of transcripts from web-based focus groups and individual interviews, as well as meeting minutes. Interview data were transcribed and analyzed using content analysis and the constant comparison technique. Results Data were collected from 16 hospitals using 2 focus groups, 3 group interviews, and 11 individual interviews, 10 sites’ meeting minutes, and an email interview of an executive. Major categories of implementation strategies predominantly mirrored the ERIC strategies of “Plan,” “Educate,” “Restructure,” and “Quality Management.” Participants rarely used the ERIC strategies of finance and attending to policy context. Two new non-ERIC categories of strategies emerged—“Integration” and “Professional roles and responsibilities.” Of the 73 specific strategies in the ERIC taxonomy, 32 were used to implement the MARQUIS Toolkit and 11 new, and non-ERIC strategies were identified (e.g., aligning with existing initiatives and professional roles and responsibilities). Conclusions Complex interventions like the MARQUIS MedRec Toolkit can benefit from the ERIC taxonomy, but adaptations and new strategies (and even categories) are necessary to fully capture the range of approaches to implementation