BACKGROUND Medical errors often occur when patients move between care settings. Physicians generally receive little formal education on improving patient care transitions. OBJECTIVE To develop a sustainable and effective Transition in Care Curriculum (TICC). Specific goals were to increase student confidence in and knowledge of skills necessary during care transitions at the time of hospital discharge, and to quantify the frequency of student-identified medication discrepancies during a post-discharge home visit. DESIGN TICC was delivered to 136 3rd-year medical students during their required inpatient medicine clerkship at six urban Denver hospitals. TICC consists of small and large group interactive sessions and self-directed learning exercises to provide foundational knowledge of care transitions. Experiential learning occurs through direct patient care at the time of discharge and during a follow-up home, hospice, or skilled nursing visit. Students completed a pre-post confidence measure, short answer and multiple choice questions, a post-clerkship satisfaction survey, and a standardized medication discrepancy tool. MAIN RESULTS Overall combined confidence in transitional care skills improved following the TICC from an average score of 2.7 (SD 0.9) to 4.0 (SD 0.8) (p < 0.01) on a 5-point confidence scale. They scored an average of 77% on the written discharge plan portion of the final exam. Students rated the usefulness of TICC at a mean of 3.1 (SD 0.7), above the combined mean of 2.7 for project work in all required clerkships. Students identified medication discrepancies during 43% of post-discharge visits (58 of 136). The most common reasons for discrepancies were patient lack of understanding of instructions and intentional non-adherence to medication plan. CONCLUSION TICC represents a feasible and effective program to teach evidence-based transitional care.

August 7, 2019

Toward safe hospital discharge: a transitions in care curriculum for medical students

BACKGROUND Medical errors often occur when patients move between care settings. Physicians generally receive little formal education on improving patient care transitions. OBJECTIVE To develop a sustainable and effective Transition in Care Curriculum (TICC). Specific goals were to increase student confidence in and knowledge of skills necessary during care transitions […]
Read More
BACKGROUND Medical errors often occur when patients move between care settings. Physicians generally receive little formal education on improving patient care transitions. OBJECTIVE To develop a sustainable and effective Transition in Care Curriculum (TICC). Specific goals were to increase student confidence in and knowledge of skills necessary during care transitions at the time of hospital discharge, and to quantify the frequency of student-identified medication discrepancies during a post-discharge home visit. DESIGN TICC was delivered to 136 3rd-year medical students during their required inpatient medicine clerkship at six urban Denver hospitals. TICC consists of small and large group interactive sessions and self-directed learning exercises to provide foundational knowledge of care transitions. Experiential learning occurs through direct patient care at the time of discharge and during a follow-up home, hospice, or skilled nursing visit. Students completed a pre-post confidence measure, short answer and multiple choice questions, a post-clerkship satisfaction survey, and a standardized medication discrepancy tool. MAIN RESULTS Overall combined confidence in transitional care skills improved following the TICC from an average score of 2.7 (SD 0.9) to 4.0 (SD 0.8) (p < 0.01) on a 5-point confidence scale. They scored an average of 77% on the written discharge plan portion of the final exam. Students rated the usefulness of TICC at a mean of 3.1 (SD 0.7), above the combined mean of 2.7 for project work in all required clerkships. Students identified medication discrepancies during 43% of post-discharge visits (58 of 136). The most common reasons for discrepancies were patient lack of understanding of instructions and intentional non-adherence to medication plan. CONCLUSION TICC represents a feasible and effective program to teach evidence-based transitional care.
Read Less
http://www.springerlink.com/content/r5786258h364u188/

August 7, 2019

The role of nurse practitioners in reinventing primary care

Nurse practitioners are the principal group of advanced-practice nurses delivering primary care in the United States. We reviewed the current and projected nurse practitioner workforce, and we summarize the available evidence of their contributions to improving primary care and reducing more costly health resource use. We recommend that nurse practice […]
Read More
Nurse practitioners are the principal group of advanced-practice nurses delivering primary care in the United States. We reviewed the current and projected nurse practitioner workforce, and we summarize the available evidence of their contributions to improving primary care and reducing more costly health resource use. We recommend that nurse practice acts--the state laws governing how nurses may practice--be standardized, that equivalent reimbursement be paid for comparable services regardless of practitioner, and that performance results be publicly reported to maximize the high-quality care that nurse practitioners provide.
Read Less
http://content.healthaffairs.org/content/29/5/893.abstract

August 7, 2019

Interventions to improve transitional care between nursing homes and hospitals: a systematic review

LaMantia MA, Scheunemann LP, Viera AJ, et al. Interventions to Improve Transitional Care Between Nursing Homes and Hospitals: A Systematic Review. J Am Ger Soc. 2010;58(4):777-782.http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.02776.x/abstract. Accessed September 25, 2014. Transitions between healthcare settings are associated with errors in communication of information and treatment plans for frail older patients, but […]
Read More
LaMantia MA, Scheunemann LP, Viera AJ, et al. Interventions to Improve Transitional Care Between Nursing Homes and Hospitals: A Systematic Review. J Am Ger Soc. 2010;58(4):777-782.http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.02776.x/abstract. Accessed September 25, 2014. 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.
Read Less
http://onlinelibrary.wiley.com/doi/10.1111/j.1532-5415.2010.02776.x/abstract

August 7, 2019

Inappropriate prescribing in the hospitalized elderly patient: defining the problem, evaluation tools, and possible solutions

Potentially inappropriate medication (PIM) prescribing in older adults is quite prevalent and is associated with an increased risk for adverse drug events, morbidity, and utilization of health care resources. In the acute care setting, PIM prescribing can be even more problematic due to multiple physicians and specialists who may be […]
Read More
Potentially inappropriate medication (PIM) prescribing in older adults is quite prevalent and is associated with an increased risk for adverse drug events, morbidity, and utilization of health care resources. In the acute care setting, PIM prescribing can be even more problematic due to multiple physicians and specialists who may be prescribing for a single patient as well as difficulty with medication reconciliation at transitions and limitations imposed by hospital formularies. This article highlights critical issues surrounding PIM prescribing in the acute care setting such as risk factors, screening tools, and potential strategies to minimize this significant public health problem.
Read Less
http://www.ncbi.nlm.nih.gov/mwg-internal/de5fs23hu73ds/progress?id=CLqW+nejWj&dl

August 7, 2019

The relationship between patient safety culture and the implementation of organizational patient safety defenses at emergency departments

OBJECTIVE The objective of this study was to investigate the association between 11 patient safety culture dimensions and the implementation of 7 organizational patient safety defenses. DESIGN Data were gathered within a cross-sectional, retrospective survey. SETTING Emergency departments (EDs) in the Netherlands. PARTICIPANTS Thirty-three EDs of non-academic hospitals, which belong […]
Read More
OBJECTIVE The objective of this study was to investigate the association between 11 patient safety culture dimensions and the implementation of 7 organizational patient safety defenses. DESIGN Data were gathered within a cross-sectional, retrospective survey. SETTING Emergency departments (EDs) in the Netherlands. PARTICIPANTS Thirty-three EDs of non-academic hospitals, which belong to the clientele of Dutch largest medical liability insurer. MAIN OUTCOME MEASURES Implementation of the separate organizational patient safety defenses (0 = insufficient/sufficient, 1 = good). RESULTS Analyses showed that several culture dimensions were negatively or positively associated with the implementation of the patient safety defenses. A culture in which hospital handoffs and transitions were perceived adequate was related to less frequent implementation of four of seven organizational patient safety defenses, whereas a culture with well-perceived hospital management support for patient safety predicted more frequent implementation of four of seven organizational patient safety defences. CONCLUSIONS Results suggest that well-perceived culture dimensions might inhibit improvements by lack of a sense of urgency as well as facilitate improvements by inducing feelings of support for organizational changes and improvements. The influence of patient safety culture appeared to be not always as straightforward as it seems to be in advance.
Read Less
http://intqhc.oxfordjournals.org/content/22/3/162.short

August 7, 2019

The future of health information technology in the patient-centered medical home

Most electronic health records today need further development of features that patient-centered medical homes require to improve their efficiency, quality, and safety. We propose a road map of the domains that need to be addressed to achieve these results. We believe that the development of electronic health records will be […]
Read More
Most electronic health records today need further development of features that patient-centered medical homes require to improve their efficiency, quality, and safety. We propose a road map of the domains that need to be addressed to achieve these results. We believe that the development of electronic health records will be critical in seven major areas: telehealth, measurement of quality and efficiency, care transitions, personal health records, and, most important, registries, team care, and clinical decision support for chronic diseases. To encourage this development, policy makers should include medical homes in emerging electronic health record regulations. Additionally, more research is needed to learn how these records can enhance team care.
Read Less
http://www.cimit.org/images/events/ciw/IT-in-Patient-Centered-Medical-Home.pdf

August 7, 2019

Translating research into practice: transitional care for older adults

RATIONALE Over the last decade, in order to close the safety and health care quality chasm, there has been a growing imperative to translate evidence-based research into practice. AIMS AND OBJECTIVES This study examines the major facilitators and barriers of implementing in a large US insurance organization – Aetna Corporation […]
Read More
RATIONALE Over the last decade, in order to close the safety and health care quality chasm, there has been a growing imperative to translate evidence-based research into practice. AIMS AND OBJECTIVES This study examines the major facilitators and barriers of implementing in a large US insurance organization - Aetna Corporation - an evidence-based model of care, the Transitional Care Model, which has been rigorously tested over the past twenty years by a multidisciplinary team at the University of Pennsylvania. METHODS Semi-structured interviews of 19 project leaders, case managers, and transitional care nurses were conducted during two phases of translation - start-up and roll out. Qualitative analysis was used to identify more than a dozen key barriers to and facilitators of translation in these two critical phases. Results Six facilitators and seven barriers that are consistent with the literature were identified during and categorized as either start-up or roll-out. CONCLUSION The combined results have important practical implications for other, subsequent translational efforts and for assisting providers, policy makers, payers, and other change agents in integrating evidence-based practice with "real world" management.
Read Less
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2753.2009.01308.x/abstract

August 7, 2019

Health care providers’ opinions on communication between nursing homes and emergency departments

OBJECTIVES To characterize the beliefs and opinions of nursing home (NH) and emergency medicine providers about communication between NH and emergency departments (ED) during transitions of care of NH residents. DESIGN: A cross-sectional study using a mailed and Internet survey. PARTICIPANTS AND SETTING Physicians, nurse practitioners, physicians assistants, and nurses […]
Read More
OBJECTIVES To characterize the beliefs and opinions of nursing home (NH) and emergency medicine providers about communication between NH and emergency departments (ED) during transitions of care of NH residents. DESIGN: A cross-sectional study using a mailed and Internet survey. PARTICIPANTS AND SETTING Physicians, nurse practitioners, physicians assistants, and nurses who practice in ED settings and NH settings, affiliated with hospitals of an academic medical center in Rochester, New York. MEASUREMENTS Opinions on communication; beliefs about frequency of information transmission; opinions on how often verbal communication should occur. RESULTS A total of 155 nurses and medical providers participated in the survey for a response rate of 32.2% (155/481). Of the survey participants, 63.0% and 56.8% had been more than 5 years in their position and facility, respectively. Most respondents felt that important information was lost during patient transfers between NH and ED settings. Providers from ED and NH settings had different opinions on the likelihood that key information would be readily identifiable at patient transfer and that care would include requested tests and follow-up. Providers from both sites of care supported verbal communication at their position when NH residents are transferred to the other setting. CONCLUSION Nurses and medical providers from both emergency and NH settings agree that transitional communication is poor between NHs and EDs and support a role for verbal communication during the ED transitions of care of NH residents.
Read Less
http://www.sciencedirect.com/science/article/pii/S1525861009003016

August 7, 2019

Further application of the care transitions intervention: results of a randomized controlled trial conducted in a fee-for-service setting

The study objective was to test whether a self-care model for transitional care that has been demonstrated to improve outcomes in Medicare Advantage populations–The Care Transitions Intervention–could also improve outcomes in a Medicare fee-for-service population. Intervention patients were less likely to be readmitted to a hospital in general and for […]
Read More
The study objective was to test whether a self-care model for transitional care that has been demonstrated to improve outcomes in Medicare Advantage populations--The Care Transitions Intervention--could also improve outcomes in a Medicare fee-for-service population. Intervention patients were less likely to be readmitted to a hospital in general and for the same condition that prompted their index hospitalization at 30, 90, and 180 days versus control patients. Coaching chronically ill older patients and their caregivers to ensure that their needs are met during care transitions may reduce the rate of subsequent rehospitalization in a Medicare fee-for-service population.
Read Less
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=20182958

August 7, 2019

Care Continuum Alliance

We believe the highest achievable health status is attained through the promotion and alignment of population health improvement by: • Promoting a proactive, patient-centric focus across the care continuum; • Convening health care professionals across the care continuum to share and integrate practice models; • Emphasizing the importance of both […]
Read More
We believe the highest achievable health status is attained through the promotion and alignment of population health improvement by: • Promoting a proactive, patient-centric focus across the care continuum; • Convening health care professionals across the care continuum to share and integrate practice models; • Emphasizing the importance of both healthful behaviors and evidence-based care in preventing and managing chronic conditions; • Promoting high quality standards for and definitions of key components of wellness, disease and, where appropriate, case management, and care coordination programs as well as support services and materials; • Identifying, researching, sharing and encouraging innovative approaches and best practices care delivery and reimbursement models; • Establishing consensus-based outcomes measures and demonstrating health, satisfaction, and financial improvements achieved through wellness, disease and case management, and care coordination programs; • Supporting delivery system models that assure appropriate care for chronic conditions and coordination among all health care providers including strategies such as the Chronic Care Model, the physician-led medical home concept, and the disease management model; • Encouraging the widespread adoption and interoperability of health information technologies; • Advocating the principles and benefits of population health improvement to public health officials, including state and federal government entities; • Underscoring the level of commitment to population health improvement and timeframes necessary to realize the full benefits.
Read Less
http://www.carecontinuum.org/