August 7, 2019

Assessing the quality of transitional care: further applications of the care transitions measure

BACKGROUND The Institute of Medicine has identified care transitions as a priority area for performance measurement. OBJECTIVES To examine the performance of the Care Transitions Measure (CTM) in more diverse populations and to introduce a 3-item CTM. RESEARCH DESIGN: Cross-sectional study with purposive sampling of traditionally underserved populations. Confirmatory factor […]
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BACKGROUND The Institute of Medicine has identified care transitions as a priority area for performance measurement. OBJECTIVES To examine the performance of the Care Transitions Measure (CTM) in more diverse populations and to introduce a 3-item CTM. RESEARCH DESIGN: Cross-sectional study with purposive sampling of traditionally underserved populations. Confirmatory factor analyses, internal consistency reliability analyses, and differential item function tests were performed to explore the stability and performance of the 15-item CTM. Regression assessed the ability of the 3-item CTM to predict the 15-item CTM total score. Analysis of variance tests were conducted to explore CTM performance in different populations with respect to health and demographics. SUBJECTS A total of 225 patients age 18-90 who were hospitalized in the past 12 months and were African American, Hispanic American, or rural-dwelling. MEASURES CTM-15, CTM-3, age, gender, education, and health status. RESULTS Mplus confirmatory factor analysis supported the CTM-15 factor structure in more diverse population (Comparative Fit Index [CFI] = 0.954). The 3-item CTM explained 88% of the variance in the 15-item CTM score. Differential item function analysis did not reveal any differential item difficulty by age, gender, education, self-rated health, or group (African American, Hispanic American, and rural-dwelling). CONCLUSIONS Following endorsement by National Quality Forum, findings support use of the CTM in national public reporting efforts. The 3-item CTM closely approximates the 15-item instrument and may be attractive to purchasers and health care organizations that want to assess quality in this area while minimizing cost and response burden.
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http://journals.lww.com/lww-medicalcare/Abstract/2008/03000/Assessing_the_Quality_of_Transitional_Care_.12.aspx

August 7, 2019

CAPS: Talking to Your Doctor or Nurse

A handy list that gives patients and their advocates advice and tips for making the most of their conversations with their doctor or nurse, wherever such conversations occur.
A handy list that gives patients and their advocates advice and tips for making the most of their conversations with their doctor or nurse, wherever such conversations occur.
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http://www.patientsafety.org/file_depot/0-10000000/20000-30000/24986/folder/85204/Talking_to_Your_Doctor.pdf

August 7, 2019

Communities of practice: creating opportunities to enhance quality of care and safe practices

A Communities of Practice (CoPs) approach was used to enhance interprofessional practice in seven clinical sites across Alberta. Participating staff were free to decide the area of practice to focus on and the actions to be implemented. All practice changes implemented by the CoPs related to either improving communications (e.g., […]
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A Communities of Practice (CoPs) approach was used to enhance interprofessional practice in seven clinical sites across Alberta. Participating staff were free to decide the area of practice to focus on and the actions to be implemented. All practice changes implemented by the CoPs related to either improving communications (e.g., introduction of joint care meetings) or information transfer (e.g., streamlining of admission and discharge processes). The practice changes contributed to more effective communication of information and more effective transitions of patients between providers, hence potentially reducing errors. The present study demonstrates that CoPs can enhance interprofessional communication and patient safety in traditional care delivery units. In contrast to more structured safety initiatives, sites were able to choose their area of focus. This ensures buy-in and enhances sustainability, making CoPs an interesting option for patient safety initiatives
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http://www.longwoods.com/content/19654

August 7, 2019

CAPS: Taking Charge of Your Healthcare: Your Path to Being an Empowered Patient

This is a journal-like bi-fold booklet that guides patients and family members to collect their thoughts and ask the right questions. By using this tool, they will have what they need to know and do before leaving the hospital in an easy to use and update format. A cover page […]
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This is a journal-like bi-fold booklet that guides patients and family members to collect their thoughts and ask the right questions. By using this tool, they will have what they need to know and do before leaving the hospital in an easy to use and update format. A cover page allows for the patient to record their thoughts and keep them private
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http://patientsafety.org/file_depot/0-10000000/20000-30000/24986/folder/85204/Booklet.pdf

August 7, 2019

Effectiveness of a medication discharge plan for transitions of care from hospital to outpatient settings

PURPOSE The effect of a medication discharge plan (MDP) on the rate of medication discrepancies between hospital and outpatient settings was evaluated. METHODS In a pragmatic, open, randomized, controlled trial, MDPs were completed for all patients before discharge from the hospital. Patients were then assigned to either an MDP group, […]
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PURPOSE The effect of a medication discharge plan (MDP) on the rate of medication discrepancies between hospital and outpatient settings was evaluated. METHODS In a pragmatic, open, randomized, controlled trial, MDPs were completed for all patients before discharge from the hospital. Patients were then assigned to either an MDP group, for whom MDPs were sent to community pharmacies and treating physicians, or a usual care group, for whom an MDP was not sent. Discrepancies between MDPs and community pharmacy dispensing records and medication use reported by patients during a telephone interview were documented. The percentage of patients with discrepancies and the mean percentage of medications with discrepancies were compared between the two groups. The clinical severity of discrepancies was blindly evaluated. RESULTS A total of 83 patients agreed to participate in the study. The percentage of patients with at least one discrepancy was high and similar in both groups when MDPs were compared with pharmacy dispensing records and patient self-reports. Comparison of MDPs to pharmacy dispensing records revealed discrepancies for 13-15% of medications; more than a third were clinically significant. Comparison of MDPs to patient self-reports revealed discrepancies for 10-12% of medications; 48% were clinically significant. No significant differences were observed between the two groups. CONCLUSION The rate of medication discrepancies was not decreased in patients whose MDP was provided to their community pharmacy and physician at the time of hospital discharge compared with the rate in patients who received usual care.
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http://www.ajhp.org/content/65/15/1451.abstract?sid=b61120f6-431f-4a99-8627-8acfb950c777

August 7, 2019

Addressing the business of discharge: Building a case for an electronic discharge summary

Hospitalists are increasingly involved in implementing quality improvement initiatives around patient safety, clinical informatics, and transitions of care, but may lack expertise in promoting these important interventions. Developing a sound business case is essential to garnering support and resources for any quality improvement initiative. We present a framework for developing […]
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Hospitalists are increasingly involved in implementing quality improvement initiatives around patient safety, clinical informatics, and transitions of care, but may lack expertise in promoting these important interventions. Developing a sound business case is essential to garnering support and resources for any quality improvement initiative. We present a framework for developing a business case using a structured approach to exploring qualitative and quantitative costs and benefits and describe its application in the experience of developing an electronic discharge summary at the University of California San Francisco (UCSF). At our institution, we found that the primary financial benefits are the cost reductions in eliminating transcription needs and decreasing billing delays, as well as reducing the cost of tracking completion of and dissemination of discharge summaries. Costs incurred from a new information technology (IT) infrastructure, programmer time, maintenance and training must also be accounted for. While benefits may be apparent to front line providers (improved communication, efficiency of data transfer, and increased referring physician satisfaction), implementing and sustaining such an innovation depends on articulating a sound business case with a detailed cost-benefit analysis to institutional decision making.
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http://hospitalmedicine.ucsf.edu/downloads/addressing_the_business_case_of_e-discharge_summary.pdf

August 7, 2019

Consumers Advancing Patient Safety: Transitions Toolkit

Hospital discharge is a time during which patients and families are at their most vulnerable. There is so much information they need to know, just when they may be least able to absorb, remember and act on it. It is vital for members of the healthcare team to help patients […]
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Hospital discharge is a time during which patients and families are at their most vulnerable. There is so much information they need to know, just when they may be least able to absorb, remember and act on it. It is vital for members of the healthcare team to help patients leave the hospital with confidence, giving them the tools and information they need to make a smooth transition to their next destination. This toolkit, Taking Charge of your Healthcare: Your Path to Being an Empowered Patient, provides you with these tools
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http://www.patientsafety.org/page/transtoolkit/;jsessionid=3p5dqlgcj2sgp

August 7, 2019

Enabling joint commission medication reconciliation objectives with the HL7 / ASTM Continuity of Care Document standard

We sought to determine how well the HL7/ASTM Continuity of Care Document (CCD) standard supports the requirements underlying the Joint Commission medication reconciliation recommendations. In particular, the Joint Commission emphasizes that transition points in the continuum of care are vulnerable to communication breakdowns, and that these breakdowns are a common […]
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We sought to determine how well the HL7/ASTM Continuity of Care Document (CCD) standard supports the requirements underlying the Joint Commission medication reconciliation recommendations. In particular, the Joint Commission emphasizes that transition points in the continuum of care are vulnerable to communication breakdowns, and that these breakdowns are a common source of medication errors. These transition points are the focus of communication standards, suggesting that CCD can support and enable medication related patient safety initiatives. Data elements needed to support the Joint Commission recommendations were identified and mapped to CCD, and a detailed clinical scenario was constructed. The mapping identified minor gaps, and identified fields present in CCD not specifically identified by Joint Commission, but useful nonetheless when managing medications across transitions of care, suggesting that a closer collaboration between the Joint Commission and standards organizations will be mutually beneficial. The nationally recognized CCD specification provides a standards-based solution for enabling Joint Commission medication reconciliation objectives.
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http://proceedings.amia.org/1amojs/1?highlightText=Enabling%20joint%20commission%20medication%20reconciliation%20objectives%20with%20the%20HL7%20%2F%20ASTM%20Continuity%20of%20Care%20Document%20standard&

August 7, 2019

Failure at the transition of care: challenges in the discharge of the vulnerable elderly patient

The case of an elderly patient with mild dementia and severe depression is reviewed including analysis of the barriers to successful transition that led to readmission. Situations likely to result in failed transitions include poor social support, discharge during times when ancillary services are unavailable, uncertain medication reconciliation, depression, and […]
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The case of an elderly patient with mild dementia and severe depression is reviewed including analysis of the barriers to successful transition that led to readmission. Situations likely to result in failed transitions include poor social support, discharge during times when ancillary services are unavailable, uncertain medication reconciliation, depression, and patients' cognitive limitations. Evidence suggests deficits in communication by hospital physicians to primary care providers occur commonly but this is only one of many systems barriers to successful discharge. Review of the literature reveals interventions such as involvement of advance practice nurses or family members in the transition may overcome some of the difficulties inherent in discharge of the vulnerable geriatric patient. Weekend discharges present unique challenges and potential solutions are explored. This case offers the opportunity to review the elements necessary for success and insight into the systems limitations which underlie failed transitions.
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http://onlinelibrary.wiley.com/doi/10.1002/jhm.304/abstract

August 7, 2019

Reducing Unnecessary Admissions Related to 1-day Stays: A Collaborative Effort

Purpose: To reduce the rate of inappropriate admissions to acute care inpatient prospective payment system hospitals Primary Practice Setting: Acute care hospitals. Methodology and Sample: The study involved 3 measurement periods. A statistically valid sample of Medicare discharge claims with a 1-day length of stay (LOS for diagnosis-related groups 132, […]
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Purpose: To reduce the rate of inappropriate admissions to acute care inpatient prospective payment system hospitals Primary Practice Setting: Acute care hospitals. Methodology and Sample: The study involved 3 measurement periods. A statistically valid sample of Medicare discharge claims with a 1-day length of stay (LOS for diagnosis-related groups 132, 141, 143, 182, and 183 was obtained from each participating hospital. Claims with discharge dispositions of 02 (transfers), 07 (left against medical advice), 20 (expired), and 66 (transferred to a critical access hospital) were excluded. Results: Seventeen acute care hospitals in Indiana collaborated with the quality improvement organization in reducing unnecessary admissions for the focused 1-day LOS admissions. The study resulted in a 2.6% relative improvement from baseline to remeasurement with an estimated overpayment of $1,494,294. In addition, there was a 42.6% decrease from baseline to remeasurement in the total number of claims meeting the study criteria. Implications for Case Management Practice: In many instances, case management can impact the following findings: * Medical records sampled for this study, focusing on 1-day LOS, lacked documentation to support medical necessity for an inpatient admission. * Diagnosis-related groups related to symptoms, such as DRG 143 (chest pain), are at high risk for not meeting admission necessity. * The majority of patients admitted to an inpatient stay with complaints of chest pain-like symptoms were admitted through the emergency department. * Lack of medical necessity for an acute inpatient admission is a potential risk for denial, impacting the revenue cycle and patient satisfaction. * Outpatient observation should be utilized when evaluating an unconfirmed diagnosis
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http://journals.lww.com/professionalcasemanagementjournal/Abstract/2008/11000/Reducing_Unnecessary_Admissions_Related_to_1_day.6.aspx

August 7, 2019

Potential risk of medication discrepancies and reconciliation errors at admission and discharge from an inpatient medical service

BACKGROUND Medication discrepancies, defined as unexplained variations among drug regimens at care transitions, are common. Some are unintended and cause reconciliation errors that are potentially detrimental for patients. OBJECTIVE To determine the prevalence of medication discrepancies and reconciliation errors at admission and discharge in hospitalized patients and explore risk factors […]
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BACKGROUND Medication discrepancies, defined as unexplained variations among drug regimens at care transitions, are common. Some are unintended and cause reconciliation errors that are potentially detrimental for patients. OBJECTIVE To determine the prevalence of medication discrepancies and reconciliation errors at admission and discharge in hospitalized patients and explore risk factors for reconciliation errors and their potential clinical impact. METHODS An observational prospective study was conducted at a general teaching hospital. Patients who were admitted to the internal medicine service and were receiving chronic preadmission treatment were included in the study. Preadmission treatment was compared with the treatment prescribed on admission (first 48 hours) and at hospital discharge, and discrepancies and reconciliation errors were identified. The primary endpoint was the presence of reconciliation errors at admission and/or discharge. Potential risk factors (patient-, medication-, and system-related) for reconciliation errors were analyzed using a multivariate logistic regression model. RESULTS Of the 120 patients enrolled in the study between April and August 2009, 109 (90.8%) showed 513 discrepancies. The prevalence of patients with reconciliation errors was 20.8% (95% CI 13.6 to 28.1). Intended medication discrepancies were more frequent at admission (96.6%) than at discharge (75.5%), while reconciliation errors were more frequent at discharge (24.5%) than at admission (3.4%). The prevalence ratio (admission vs discharge) was 2.4 (95% CI 1.9 to 3.0) for discrepancies and 0.65 (95% CI 0.32 to 1.32) for reconciliation errors. The logistic regression analysis revealed an association between the number of discrepancies at admission (OR 1.21; 95% CI 1.01 to 1.44) and age (OR 1.05; 95% CI 0.99 to 1.10) and an increased risk of reconciliation errors. CONCLUSIONS Medication reconciliation strategies should focus primarily on avoiding errors at discharge. Since medication discrepancies at admission may predispose patients to reconciliation errors, early detection of such discrepancies would logically reduce the risk of reconciliation errors. Medication reconciliation programs must implement a process for gathering accurate preadmission drug histories and must submit this information to a critical assessment of patients' needs.
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20923946

August 7, 2019

Hospitalists and care transitions: the divorce of inpatient and outpatient care

We interviewed hospitalist and nonhospitalist respondents as part of the Community Tracking Study site visits to examine how the growing use of hospitalists has affected care delivery systems. The growth of hospitalist programs contributes to a loss of physicians’ participation on hospital medical staffs, which increases the burden of coordination […]
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We interviewed hospitalist and nonhospitalist respondents as part of the Community Tracking Study site visits to examine how the growing use of hospitalists has affected care delivery systems. The growth of hospitalist programs contributes to a loss of physicians' participation on hospital medical staffs, which increases the burden of coordination and blurs accountability for the quality of postdischarge care. Arrangements where companies and multispecialty medical groups employ hospitalists are more likely than others to establish routines for ensuring coordinated transitions upon hospital admission and discharge. Policymakers could support the development of guiding principles for care coordination, greater reliance on nonphysicians, and reintegration of inpatient and outpatient providers.
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http://content.healthaffairs.org/content/27/5/1315.abstract

August 7, 2019

Preventing the Preventable: Reducing Rehospitalizations Through Coordinated, Patient-Centered Discharge Processes

Objectives: Growing literature suggests that a significant proportion of rehospitalizations could be prevented if systems were put in place aimed at identifying and addressing some of the underlying issues that cause them. This article highlights key risk factors for unplanned rehospitalizations and illustrates a project that has successfully addressed many […]
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Objectives: Growing literature suggests that a significant proportion of rehospitalizations could be prevented if systems were put in place aimed at identifying and addressing some of the underlying issues that cause them. This article highlights key risk factors for unplanned rehospitalizations and illustrates a project that has successfully addressed many of the underlying issues that contribute to them. Primary Practice Setting(s): The study illustrated herein took place at an inner-city academic teaching hospital. Findings/Conclusions: Proactively identifying patient-, clinician-, and system-associated barriers to successful discharge transitions is critical for effective transitions of care for patients leaving the hospital setting. This process represents a culture change, requires a multidisciplinary approach to care, and mandates clear delineation of roles and responsibilities in the process, with ultimate and clear process ownership being defined. With such steps in place in a system of care, it is reasonable to expect a reduction in preventable rehospitalizations.
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http://journals.lww.com/professionalcasemanagementjournal/Abstract/2009/05000/Preventing_the_Preventable__Reducing.5.aspx

August 7, 2019

Medicare home health patients’ transitions through acute and post-acute care settings

OBJECTIVES To describe Medicare beneficiaries’ transitions through home health care within the context of other acute and post-acute services, and to examine agreement between administrative claims and Outcome and Assessment Information Set (OASIS) measures of health services use. DATA SOURCES The 2004 Chronic Condition Data Warehouse, including the Medicare 5% […]
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OBJECTIVES To describe Medicare beneficiaries' transitions through home health care within the context of other acute and post-acute services, and to examine agreement between administrative claims and Outcome and Assessment Information Set (OASIS) measures of health services use. DATA SOURCES The 2004 Chronic Condition Data Warehouse, including the Medicare 5% standard analytic file and OASIS. Study participants were 66,510 Medicare beneficiaries with a home health start of care assessment between January 15, 2004 and July 15, 2004 who were discharged before December 1, 2004. RESULTS Home health patients frequently incurred acute and post-acute services during the 14 days preceding admission and the 30 days after discharge, predominantly in acute hospitals. Substantial differences were observed in beneficiaries' health and functioning across living arrangements; patients living alone were less medically complex, less disabled, and received less assistance than those living with others. Agreement between OASIS and administrative claims was uniformly low with regard to inpatient hospital, inpatient rehabilitation, and skilled nursing facility use in the 14 days preceding the home health start of care. Agreement between OASIS and administrative claims was uneven for the period after discharge from home health care; it was determined to be near perfect for inpatient hospital (kappa = 0.85), but was lower for inpatient rehabilitation and hospice (kappa = 0.22 and 0.10, respectively). CONCLUSIONS Findings reinforce the potential merit of patient-specific rather than setting-specific measures of quality, but underscore practical challenges to constructing measures that span data sources and episodes of care.
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http://journals.lww.com/lww-medicalcare/Abstract/2008/11000/Medicare_Home_Health_Patients__Transitions_Through.10.aspx

August 7, 2019

The role of the hospitalist in quality improvement: systems for improving the care of patients with acute coronary syndrome

Quality improvement (QI) initiatives for systems of care are vital to deliver quality care for patients with acute coronary syndrome (ACS) and hospitalists are instrumental to the QI process. Core hospitalist competencies include the development of protocols and outcomes measures that support quality of care measures established for ACS. The […]
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Quality improvement (QI) initiatives for systems of care are vital to deliver quality care for patients with acute coronary syndrome (ACS) and hospitalists are instrumental to the QI process. Core hospitalist competencies include the development of protocols and outcomes measures that support quality of care measures established for ACS. The hospitalist may lead, coordinate, or participate in a multidisciplinary team that designs, implements, and assesses an institutional system of care to address rapid identification of patients with ACS, medication safety, safe discharge, and meeting core measures that are quality benchmarks for ACS. The use of metrics and tools such as process flow mapping and run charts can identify quality gaps and show progress toward goals. These tools may be used to assess whether critical timeframes are met, such as the time to fibrinolysis or percutaneous coronary intervention (PCI), or whether patients receive guideline-recommended medications and counseling. At the institutional level, Project BOOST (Better Outcomes for Older Adults Through Safe Transitions) is an initiative designed to improve outcomes in elderly patients who are at higher risk for adverse events during the transition from inpatient to outpatient care. BOOST offers resources related to project management and data collection, and tools for patients and physicians. Collection and analysis of objective data are essential for documenting quality gaps or achievement of quality benchmarks. Through QI initiatives, the hospitalist has an opportunity to contribute to an institution's success beyond direct patient care, particularly as required for public disclosure of institutional performance and financial incentives promoted by regulatory agencies.
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20842745

August 7, 2019

Variables That Discriminate Length of Stay and Readmission Within 30 Days Among Heart Failure Patients

The purpose of this study was to determine which variables may discriminate between a short length of stay (LOS) and a long LOS and readmission within 30 days among heart failure (HF) patients discharged from a hospital. The charts of 188 patients who were discharged with diagnostic related group 127 […]
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The purpose of this study was to determine which variables may discriminate between a short length of stay (LOS) and a long LOS and readmission within 30 days among heart failure (HF) patients discharged from a hospital. The charts of 188 patients who were discharged with diagnostic related group 127 during September 30, 1997, until October 31, 1998, were retrospectively reviewed to examine the association between LOS and readmission among 12 variables. It was discovered that an increased number of physicians involved during the patient's hospitalization (p = 0.000) and case management involvement (p = 0.007) were discriminating variables for those patients with a longer LOS. The variables of serum sodium (p = 0.032) and higher NYHA classification (p = 0.018) approached significance in discriminating a longer LOS. HF patients who were readmitted within 30 days were significantly found to have an increased NYHA class (p = 0.002) and no specific follow-up plan arranged related to the patients' HF diagnosis (p = 0.005). The results of this study indicate several variables that significantly discriminate LOS and readmission within 30 days among HF patients that case managers can employ to improve care to this population.
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http://journals.lww.com/professionalcasemanagementjournal/Abstract/2001/11000/Variables_That_Discriminate_Length_of_Stay_and.5.aspx

August 7, 2019

Hand-off communication: a requisite for perioperative patient safety

Transitions from one care provider to another put patients at increased risk of injuries and errors. A standardized approach to hand-off communication helps minimize these risks. One recognized approach to addressing this concern is the SBAR (ie, situation, background, assessment, recommendation) communication technique. Reference cards with the SBAR communication approach […]
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Transitions from one care provider to another put patients at increased risk of injuries and errors. A standardized approach to hand-off communication helps minimize these risks. One recognized approach to addressing this concern is the SBAR (ie, situation, background, assessment, recommendation) communication technique. Reference cards with the SBAR communication approach can be used by all staff members during hand offs in the preoperative, intraoperative, and postoperative phases of surgical patient care.
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http://www.aornjournal.org/article/S0001-2092(08)00519-X/abstract

August 7, 2019

Transitioning the patient with acute coronary syndrome from inpatient to primary care

Patients with acute coronary syndrome (ACS) undergo several transitions in care throughout the hospital stay, from prehospitalization to the postdischarge period when patients return to primary care. Hospitalist core competencies promote safe transitions in care for patients with ACS, including hospital discharge. These competencies also highlight the central role of […]
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Patients with acute coronary syndrome (ACS) undergo several transitions in care throughout the hospital stay, from prehospitalization to the postdischarge period when patients return to primary care. Hospitalist core competencies promote safe transitions in care for patients with ACS, including hospital discharge. These competencies also highlight the central role of the hospitalist in facilitating the continuity of care and as a key link between the patient and the primary care provider (PCP). Core competencies address key decision points and processes that occur during hospitalization for ACS including the initial evaluation and risk stratification, medication reconciliation, and discharge planning. Discharge is a crucial transition and one where hospitalists can both facilitate the transition to primary care and improve adherence to quality measures established for ACS. Poor communication during discharge reportedly results in postdischarge adverse events, most often related to medications and lack of follow-up related to pending test results. Standards for a safe discharge such as Project RED (Re-Engineered Discharge), initiatives to improve outcomes after discharge like Project BOOST (Better Outcomes for Older Adults Through Safe Transitions), and adaptive tools including the ACS Transitions Tool support timely and accurate communication of complex information between the hospitalist, the PCP, and the patient. While the role of hospitalists is evolving, it is clear that they have a central role in ensuring safe transitions in care for ACS.
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http://onlinelibrary.wiley.com/doi/10.1002/jhm.829/pdf

August 7, 2019

Health status transitions in community-living elderly with complex care needs: a latent class approach

BACKGROUND For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly […]
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BACKGROUND For older persons with complex care needs, accounting for the variability and interdependency in how health dimensions manifest themselves is necessary to understand the dynamic of health status. Our objective is to test the hypothesis that a latent classification can capture this heterogeneity in a population of frail elderly persons living in the community. Based on a person-centered approach, the classification corresponds to substantively meaningful groups of individuals who present with a comparable constellation of health problems. METHODS Using data collected for the SIPA project, a system of integrated care for frail older people (n = 1164), we performed latent class analyses to identify homogenous categories of health status (i.e. health profiles) based on 17 indicators of prevalent health problems (chronic conditions; depression; cognition; functional and sensory limitations; instrumental, mobility and personal care disability) Then, we conducted latent transition analyses to study change in profile membership over 2 consecutive periods of 12 and 10 months, respectively. We modeled competing risks for mortality and lost to follow-up as absorbing states to avoid attrition biases. RESULTS We identified four health profiles that distinguish the physical and cognitive dimensions of health and capture severity along the disability dimension. The profiles are stable over time and robust to mortality and lost to follow-up attrition. The differentiated and gender-specific patterns of transition probabilities demonstrate the profiles' sensitivity to change in health status and unmasked the differential relationship of physical and cognitive domains with progression in disability. CONCLUSION Our approach may prove useful at organization and policy levels where many issues call for classification of individuals into pragmatically meaningful groups. In dealing with attrition biases, our analytical strategy could provide critical information for the planning of longitudinal studies of aging. Combined, these findings address a central challenge in geriatrics by making the multidimensional and dynamic nature of health computationally tractable.
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http://rd.springer.com/article/10.1186/1471-2318-9-6

August 7, 2019

A Systematic Review of Nurse-Assisted Case Management to Improve Hospital Discharge Transition Outcomes for the Elderly

Purpose: This article reviews 15 clinical trials of nurse-assisted case management intended to improve posthospital transitions of elderly patients to other settings. Primary Practice Setting(s): Hospitals. Methodology and Sample: The trials were selected after a systematic search of the PubMed database for the period 1996 to 2006. Results: Eight of […]
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Purpose: This article reviews 15 clinical trials of nurse-assisted case management intended to improve posthospital transitions of elderly patients to other settings. Primary Practice Setting(s): Hospitals. Methodology and Sample: The trials were selected after a systematic search of the PubMed database for the period 1996 to 2006. Results: Eight of the 15 interventions showed reduced hospital readmission rates and/or fewer hospital days. These findings were observed across patients with all cause and heart failure, a variety of hospital types, and variations in the intervention. Reductions in the use of emergency departments were observed in 3 of the 11 studies investigating this. Lower expenditures were reported by all 6 studies reporting such comparisons. Implications for CM Practice: Home visits/continuous contact with patients, early postdischarge and frequent contacts, patient education, and the use of specialized nurses who could offer appropriate training and coaching were often credited as program strengths.
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http://journals.lww.com/professionalcasemanagementjournal/Abstract/2007/11000/A_Systematic_Review_of_Nurse_Assisted_Case.5.aspx