August 7, 2019

Personal Health Record

Coleman E. The Care Transitions Program®. Personal Health Record. http://www.caretransitions.org/documents/phr.pdf [No date specified]. Accessed 7/10/14.
Coleman E. The Care Transitions Program®. Personal Health Record. http://www.caretransitions.org/documents/phr.pdf [No date specified]. Accessed 7/10/14.
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http://www.caretransitions.org/documents/phr.pdf

August 7, 2019

One Patient, Numerous Healthcare Providers, and Multiple Care Settings: Addressing the Concerns of Care Transitions Through Case Management

Care transitions are a natural occurrence in our healthcare delivery system. During a single episode of illness, patients are cared for in multiple care settings and by healthcare professionals of varied specialties and disciplines. Such dynamic events increase the risk of patients experiencing poor quality of care, especially as a […]
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Care transitions are a natural occurrence in our healthcare delivery system. During a single episode of illness, patients are cared for in multiple care settings and by healthcare professionals of varied specialties and disciplines. Such dynamic events increase the risk of patients experiencing poor quality of care, especially as a result of medical errors and unsafe situations. Care coordination has been emphasized recently as a strategy for enhancing the effectiveness of care during such necessary transitions. This article describes the issue of care transitions and suggests how case management, through care coordination, can play an important role in ensuring safe and effective care transitions.
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http://journals.lww.com/professionalcasemanagementjournal/Abstract/2007/01000/One_Patient,_Numerous_Healthcare_Providers,_and.8.aspx

August 7, 2019

Effective Interventions to Reduce Hospitalizations: A Compendium of 15 Promising Interventions

Boutwell A, Griffin F, Hwu S, Shannon D. Institute for Healthcare Improvement. Effective Interventions to Reduce Hospitalizations: A Compendium of 15 Promising Interventions. http://ah.cms-plus.com/files/STAAR_A_Compendium_of_Promising_Interventions.pdf. 2009 . Accessed June 30, 2012. This document is intended to provide a sampling of the range of effective programs underway to reduce hospitalizations.
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Boutwell A, Griffin F, Hwu S, Shannon D. Institute for Healthcare Improvement. Effective Interventions to Reduce Hospitalizations: A Compendium of 15 Promising Interventions. http://ah.cms-plus.com/files/STAAR_A_Compendium_of_Promising_Interventions.pdf. 2009 . Accessed June 30, 2012. This document is intended to provide a sampling of the range of effective programs underway to reduce hospitalizations.
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http://ah.cms-plus.com/files/STAAR_A_Compendium_of_Promising_Interventions.pdf

August 7, 2019

AMDA Universal Transfer Form

AMDA. Universal Transfer Form. Tool. http://www.amda.com/tools/universal_transfer_form.pdf. Published 2007. Accessed July 24, 2014. AMDA has developed and recommends the use of the Universal Transfer Form (UTF) to facilitate the transfer of necessary patient information from one care setting to another. Patient transfers are fraught with the potential for errors stemming from […]
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AMDA. Universal Transfer Form. Tool. http://www.amda.com/tools/universal_transfer_form.pdf. Published 2007. Accessed July 24, 2014. AMDA has developed and recommends the use of the Universal Transfer Form (UTF) to facilitate the transfer of necessary patient information from one care setting to another. Patient transfers are fraught with the potential for errors stemming from the inaccurate or incomplete transfer of patient information. Use of the UTF can help to minimize the occurrence of such errors by ensuring that patient information is transmitted fully and in a timely fashion.
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http://www.amda.com/tools/universal_transfer_form.pdf

August 7, 2019

Multidisciplinary approach to inpatient medication reconciliation in an academic setting

PURPOSE The effectiveness of a multidisciplinary medication reconciliation process was studied in an inpatient family medicine unit of an academic hospital center. METHODS In phase 1 of this two-phase study, nurses, pharmacists, and physicians used an admission medication reconciliation form to reconcile patients’ home medications on admission. The form was […]
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PURPOSE The effectiveness of a multidisciplinary medication reconciliation process was studied in an inpatient family medicine unit of an academic hospital center. METHODS In phase 1 of this two-phase study, nurses, pharmacists, and physicians used an admission medication reconciliation form to reconcile patients' home medications on admission. The form was then reviewed by the pharmacist on the unit and by the attending physician, who reconciled the discharge medication list. The discharge medication list was compared against the patient's home medications list, inpatient medication profile, and prescriptions documented in the electronic medical record to investigate any medication discrepancies. Pharmacists participating in the study documented and categorized medication discrepancies by the potential severity of the error. In phase 2, family medicine medical residents and staff were instructed to include reconciled admission and discharge medication lists in the hospital summary. RESULTS A total of 102 patients formed the study sample. There was no significant difference between phase 1 and phase 2 patients in mean age, sex, and length of hospital stay. Totals of 432 and 367 admission medications required reconciliation during phase 1 and phase 2, respectively. The mean number of admission medication discrepancies decreased from 0.5 per patient in phase 1 to 0 per patient in phase 2. The mean number of discharge medication discrepancies decreased from 3.3 per patient in phase 1 to 1.8 per patient in phase 2. CONCLUSION The mean number of medication discrepancies occurring during admission and discharge decreased after a multidisciplinary medication reconciliation process was implemented in an inpatient family medicine unit of an academic hospital center.
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http://www.ncbi.nlm.nih.gov/pubmed/17420202?dopt=AbstractPlus

August 7, 2019

Defining and disseminating the hospital-at-home model CMAJ January 20, 2009 180:156-157

The hospital, which is the “gold standard” for the delivery of acute medical care, is not an ideal care environment for many patients. Iatrogenic events such as nosocomial infections, pressure sores, falls and delirium are common. New functional impairment commonly occurs during hospital stay. Suboptimal transitions in care at the […]
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The hospital, which is the "gold standard" for the delivery of acute medical care, is not an ideal care environment for many patients. Iatrogenic events such as nosocomial infections, pressure sores, falls and delirium are common. New functional impairment commonly occurs during hospital stay. Suboptimal transitions in care at the time of hospital discharge also occur, contributing, ironically, to readmission to hospital. Furthermore, hospital care is very expensive. In this issue, Shepperd and colleagues present a meta-analysis of the effectiveness of "hospital-at-home programs."
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http://www.cmaj.ca/cgi/content/full/180/2/156

August 7, 2019

Challenges in transitional care between nursing homes and emergency departments

OBJECTIVE To obtain opinions of knowledgeable professionals involved in the emergency care of nursing home (NH) residents. DESIGN Structured focus group interviews. PARTICIPANTS Five provider categories, including NH staff, NH physicians and nurse practitioners, emergency medical services (EMS) providers, emergency department (ED) nurses, and ED physicians. SETTING Two NHs, 2 […]
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OBJECTIVE To obtain opinions of knowledgeable professionals involved in the emergency care of nursing home (NH) residents. DESIGN Structured focus group interviews. PARTICIPANTS Five provider categories, including NH staff, NH physicians and nurse practitioners, emergency medical services (EMS) providers, emergency department (ED) nurses, and ED physicians. SETTING Two NHs, 2 EDs, and a county-wide EMS system. ANALYSIS Audiotaped discussions were transcribed and analyzed independently by 2 authors. RESULTS Themes included barriers to providing high-quality care, data needed when residents are transported in both directions between EDs and NHs, and possible solutions to improve care. Communication problems were the most frequently cited barrier to providing care. Residents are often transported in both directions without any written documentation; however, even when communication does occur, it is often not in a mode that is useable by the receiving provider. ED personnel need a small amount of organized, written information. When residents are released from the ED, NH personnel need a verbal report from ED nurses as well as written documentation. All groups were optimistic that communication can be improved. Ideas included use of (1) fax machines or audiotape cassette recorders to exchange information, (2) an emergency form in residents’ charts that contains predocumented information with an area to write in the reason for transfer, and (3) brief NH-to-ED and ED-to-NH transfer forms that are accepted and used by local NHs and EDs. CONCLUSION The transitional care of NH residents is laden with problems but has solutions that deserve additional development and investigation. KEYWORDS: Nursing homes, emergency service, hospital, emergency medical services, patient transfer
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http://www.jamda.com/article/S1525-8610(06)00174-5/abstract

August 7, 2019

Role of pharmacist counseling in preventing adverse drug events after hospitalization

BACKGROUND Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of […]
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BACKGROUND Hospitalization and subsequent discharge home often involve discontinuity of care, multiple changes in medication regimens, and inadequate patient education, which can lead to adverse drug events (ADEs) and avoidable health care utilization. Our objectives were to identify drug-related problems during and after hospitalization and to determine the effect of patient counseling and follow-up by pharmacists on preventable ADEs. METHODS We conducted a randomized trial of 178 patients being discharged home from the general medicine service at a large teaching hospital. Patients in the intervention group received pharmacist counseling at discharge and a follow-up telephone call 3 to 5 days later. Interventions focused on clarifying medication regimens; reviewing indications, directions, and potential side effects of medications; screening for barriers to adherence and early side effects; and providing patient counseling and/or physician feedback when appropriate. The primary outcome was rate of preventable ADEs. RESULTS Pharmacists observed the following drug-related problems in the intervention group: unexplained discrepancies between patients' preadmission medication regimens and discharge medication orders in 49% of patients, unexplained discrepancies between discharge medication lists and postdischarge regimens in 29% of patients, and medication nonadherence in 23%. Comparing trial outcomes 30 days after discharge, preventable ADEs were detected in 11% of patients in the control group and 1% of patients in the intervention group (P = .01). No differences were found between groups in total ADEs or total health care utilization. CONCLUSIONS Pharmacist medication review, patient counseling, and telephone follow-up were associated with a lower rate of preventable ADEs 30 days after hospital discharge. Medication discrepancies before and after discharge were common targets of intervention.
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http://archinte.ama-assn.org/cgi/content/abstract/166/5/565

August 7, 2019

“Interventions to Improve Transitional Care Between Nursing Homes and Hospitals.” (Journal of the American Geriatrics Society, volume 58, number 4, pp 777-782)

Transitions between healthcare settings are associated with errors in communication of information and treatment plans for frail older patients, but strategies to improve transitional care are lacking. A systematic review was conducted to identify and evaluate interventions to improve communication of accurate and appropriate medication lists and advance directives for […]
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Transitions between healthcare settings are associated with errors in communication of information and treatment plans for frail older patients, but strategies to improve transitional care are lacking. A systematic review was conducted to identify and evaluate interventions to improve communication of accurate and appropriate medication lists and advance directives for elderly patients who transition between nursing homes and hospitals. MEDLINE, ISIWeb, and EBSCO Host (from inception to June 2008) were searched for original, English-language research articles reporting interventions to improve communication of medication lists and advance directives. Five studies ultimately met all inclusion criteria. Two described interventions that enhanced transmission of advance directives, two described interventions that improved communication of medication lists, and one intervention addressed both goals. One study was a randomized controlled trial, whereas the remaining studies used historical or no controls. Study results indicate that a standardized patient transfer form may assist with the communication of advance directives and medication lists and that pharmacist-led review of medication lists may help identify omitted or indicated medications on transfer. Although preliminary evidence supports adoption of these methods to improve transitions between nursing home and hospital, further research is needed to define target populations and outcomes measures for high-quality transitional care.
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http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.02776.x/abstract

August 7, 2019

White Space or Black Hole: What Can We Do To Improve Care Transitions?

An emerging consortium of nine leading medical specialty societies – with the support of the ABIM Foundation, AHRQ, IHI, NCQA and others – has recently begun developing principles and initial standards to enhance care transitions. By defining ways to change medical culture, establishing agreed–upon practices, and eventually identifying related measures, […]
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An emerging consortium of nine leading medical specialty societies – with the support of the ABIM Foundation, AHRQ, IHI, NCQA and others – has recently begun developing principles and initial standards to enhance care transitions. By defining ways to change medical culture, establishing agreed–upon practices, and eventually identifying related measures, this consortium – the Stepping Up to the Plate (SUTTP) Alliance – is focused on designing a system of coordination between sites of care with the goal of reducing errors, gaps in care and waste.
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http://www.abimfoundation.org/~/media/Files/Publications/F06-05-2007_6.ashx