Interventions to Improve Hospital Admission and Discharge Management: An Umbrella Review of Systematic Reviews

Item does not contain fulltextBACKGROUND: The aim of this umbrella review was to summarize the research evidence on programs to improve the transition between ambulatory and hospital care. METHODS: The MEDLINE database and the Cochrane library were searched. Systematic reviews of randomized controlled trials published between January 2000 and September 2018 in English or German were included. Studies were eligible if an assessment or coordination intervention had been evaluated and if patients had been transferred between hospital (defined as internal medicine, surgery, or unspecified hospital setting) and home (defined as any permanent residence). Risk of bias was assessed using the AMSTAR criteria. Results are presented descriptively and in table format. RESULTS: Thirty-nine systematic reviews comprising 492 different studies were included. More than half of these studies were conducted in the United States, the United Kingdom, Canada, and Australia. All studies evaluated strategies to improve discharge management (introduced after patients' arrival at the hospital); no study assessed strategies to improve admission management (initiated in primary care before patients' transition to hospital). The reviews included focused on a specific patient group, a specific intervention type, or a specific outcome. Overall, interventions focusing on elderly patients and high-intensity interventions seemed to be most effective. An overview of classifications of care transition strategies is provided. CONCLUSIONS: Future research should focus on hospital admission management programs

How to fall into a new routine: factors influencing the implementation of an admission and discharge programme in hospitals and general practices

INTRODUCTION: The VESPEERA programme is a multifaceted programme to enhance information transfer between general practice and hospital across the process of hospital admission, stay and discharge. It was implemented in 7 hospitals and 72 general practices in Southern Germany. Uptake was heterogeneous and overall low. A process evaluation aimed at identifying factors associated with the implementation of the VESPEERA programme. METHODS: This was a qualitative study using semi-structured interviews in a purposeful sample of health workers in hospitals and general practices in the VESPEERA programme. Qualitative framework analysis using the Consolidated Framework for Implementation Research was performed and revealed the topic of previous and new routines to be protruding. Inductive content analysis was used for in-depth examination of stages in the process of staying in a previous or falling into a new routines. RESULTS: Thirty-six interviews were conducted with 17 participants from general practices and 19 participants from hospitals. The interviewees were in different stages of the implementation process at the time of the interviews. Four stages were identified: Stage 1,'Previous routine and tension for change', describes the situation in which VESPEERA was to be implemented and the factors leading to the decision to participate. In stage 2,'Adoption of the VESPEERA programme', factors that influenced whether individuals decided to employ the innovation are relevant. Stage 3 comprises 'Determinants for falling into and staying in the new VESPEERA-routine' relates to actual implementation and finally, in stage 4, the participants reflect on the success of the implementation. CONCLUSIONS: The individuals and organisations participating in the VESPEERA programme were in different stages of a process from the previous to the new routine, which were characterised by different determinants of implementation. In all stages, organisational factors were main determinants of implementation, but different factors emerged in different implementation stages. A low distinction between decision-making power and executive, as well as available resources, were beneficial for the implementation of the innovation. TRIAL REGISTRATION: DRKS00015183 on DRKS / Universal Trial Number (UTN): U1111-1218-0992

Gesundheit und medizinische Versorgung Geflüchteter: Konzeption und Evaluation eines multidisziplinären klinischen Wahlfachs für Medizinstudierende

Objective: Caring for refugee patients places special demands on health professionals. To date, medical students in Germany have rarely been systematically prepared for these challenges. This article reports on the development, conceptualisation, implementation, evaluation, and relevance of a multidisciplinary elective for medical students in the clinical study phase.Methodology: The course content was developed based on a needs-assessment among medical students and in cooperation with medical colleagues working in the field of refugee care. The course consisted of a seminar with medical, legal, administrative and socio-cultural learning content as well as a field placement in the medical outpatient clinic of the local reception centre for asylum seekers, which was accompanied by a systematic reflection process. The evaluation concept contained qualitative and quantitative elements. Results: 123 students completed the elective over six semesters (summer 2016 through to winter 2018). It was continuously evaluated and further developed. The students reported learning progress mainly in the following areas: Legal foundations of the asylum procedure and health care entitlements for asylum seekers; multi-perspectivity through multidisciplinarity as well as professional, ethical, interpersonal, and political insights gained through the practical experience.Summary: To prepare students for the complex challenges to be faced in medical care for refugees, a structured, multidisciplinary teaching programme, which combines theory, practice and reflection helps to foster insights into the many facets of this field of activity. The questions students brought to the seminar, the course contents and evaluation results are intended to inspire the design and implementation of similar courses at other universities.Zielsetzung: Die medizinische Versorgung Geflüchteter stellt besondere Anforderungen an Gesundheitsfachkräfte. Medizinstudierende in Deutschland werden bisher kaum systematisch auf diese vorbereitet. Im Beitrag wird über die Entwicklung, Konzeption, Umsetzung, Evaluation und Bedeutung eines multidisziplinären Wahlfachs für Medizinstudierende im klinischen Studienabschnitt berichtet.Methodik: Die Entwicklung der Kursinhalte erfolgte auf Grundlage von Bedarfsanalysen bei Medizinstudierenden und in Kooperation mit in der Flüchtlingsversorgung tätigen ärztlichen Kollegen. Die Lehrveranstaltung bestand aus einem Seminar mit medizinischen, juristischen, administrativen und sozio-kulturellen Lerninhalten sowie einer systematisch reflektierten Hospitation in der medizinischen Ambulanz des lokalen Ankunftszentrums für Asylsuchende. Das Evaluationskonzept enthielt qualitative und quantitative Elemente. Ergebnisse: Ab dem Sommersemester 2016 bis einschließlich Wintersemester 2018 absolvierten 132 Studierende das Wahlfach. Es wurde fortlaufend evaluiert und weiterentwickelt. Mehrheitlich werden vor allem Lernfortschritte in folgenden Bereichen berichtet: Rechtliche Grundlagen des Asylverfahrens und der Versorgung; Mehrperspektivität durch Multidisziplinarität sowie Erkenntnisse durch die Praxiserfahrung im fachprofessionellen, berufsethischen, zwischenmenschlichen und politischen Bereich.Zusammenfassung: Mittels eines strukturierten, multidisziplinären Lehrangebotes, welches Theorie-, Praxis- und Reflexionselemente verknüpft, kann Studierenden ein Einblick in die vielen Facetten der medizinischen Versorgung Geflüchteter ermöglicht werden, um sie auf die komplexen Herausforderungen dieses Handlungsfeldes vorzubereiten. Die Studierendenfragen, Kursinhalte und Auswertungsergebnisse können Anregung für die Implementierung ähnlicher Lehrveranstaltungen geben