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Papanikolaou, Frank, and Linda Lee. "Developing a program for pediatric urological care in the community." Canadian Urological Association Journal 11, no. 1-2S (February 16, 2017): 93. http://dx.doi.org/10.5489/cuaj.4335.
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The growth of large metropolitan areas across Canada has fostered the need to provide tertiary care to patients outside of the traditional university-affiliated hospitals. Subspecialty urology care at centres of excellence in the community includes urological oncology, men’s health, community urology, and pediatric urology. The two of us have developed such centres of excellence in pediatric urology in the communitysettings of Mississauga, ON, and Victoria, BC. This article highlights personal experiences in developing these programs and the lessons learned. It is hoped that this can help guide similar undertakings by others to develop centres of excellence in subspecialty urology care so as to bring care closer to patients’ homes.
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Sutcliffe, Simon B., Puneet Bains, Fraser Black, Sandra S. Broughton, Stuart Brown, Simon Colgan, Megan E. Doherty, et al. "The Two Worlds of Palliative Care: Bridging the Gap with Nepal." Nepal Journal of Science and Technology 20, no. 2 (December 31, 2021): 125–30. http://dx.doi.org/10.3126/njst.v20i2.45802.
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Despite past geo-political turbulence, Nepal has made significant progress in societal and economic initiatives, particularly in relation to social determinants of health. These improvements, however, belie the suffering of those with life-limiting disease due to pain, stigma, social and financial distress, consequent upon low patient, caregiver and health professional awareness of the need for, and availability of, appropriate care and support. Two Worlds Cancer Collaboration (INCTR-Canada) has been working with partners in Nepal to build capacity for palliative care by: (a) organizational and administrative support – establishing the Nepal Association of Palliative Care (NAPCare), and the creation of the Nepal Strategy for Palliative Care, approved by government in 2017; (b) “twinning” between 2 hospital palliative care units in Nepal and the Nanaimo Hospice and Victoria Hospice, BC, Canada; (c) sustainable growth of palliative care according to WHO foundational measures, implementing facility-based clinical programs, and home-based care aligned with the cultural, social, and economic environment of Nepal; (d) training of health professionals in adult and paediatricpalliative carethrough interactive on-line “distance learning” (Extension of Community Healthcare Outcomes, ECHO);(e) leveraging palliative care training and expertise across the government health system, and (f) local and international support to build a newfacility for Hospice Nepal to provide more support for more patients in a rural ambience on the outskirts of Kathmandu. Palliative care needs to become standard-of-care, providing peace, comfort and dignity for adults and children. Working collaboratively with partners in Nepal, the collective vision is a capable professional Nepali community leading palliative care services for all in need, wherever in need.
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Mayer, Dorothy “Dale” M., and Charlene A. Winters. "Palliative Care in Critical Rural Settings." Critical Care Nurse 36, no. 1 (February 1, 2016): 72–78. http://dx.doi.org/10.4037/ccn2016732.
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The United States has 1332 critical access hospitals. These hospitals have fewer than 25 beds each and a mean daily census of 4.2 patients. Critical access hospitals are located in rural areas and provide acute inpatient services, ambulatory care, labor and delivery services, and general surgery. Some, but not all, critical access hospitals offer home care services; a few have palliative care programs. Because of the millions of patients living with serious and life-threatening conditions, the need for palliative care is increasing. As expert generalists, rural nurses are well positioned to provide care close to home for patients of all ages and the patients’ families. A case report illustrates the role that nurses and critical access hospitals play in meeting the need for high-quality palliative care in rural settings. Working together, rural nurses and their urban nursing colleagues can provide palliative care across all health care settings.
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Schachter, Michael E., Marc J. Saunders, Ayub Akbari, Julia M. Caryk, Ann Bugeja, Edward G. Clark, Karthik K. Tennankore, and Dan J. Martinusen. "Technique Survival and Determinants of Technique Failure in In-Center Nocturnal Hemodialysis: A Retrospective Observational Study." Canadian Journal of Kidney Health and Disease 7 (January 2020): 205435812097530. http://dx.doi.org/10.1177/2054358120975305.
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Background: Long-duration (7-8 hours) hemodialysis provides benefits compared with conventional thrice-weekly, 4-hour sessions. Nurse-administered, in-center nocturnal hemodialysis (INHD) may expand the population to whom an intensive dialysis schedule can be offered. Objective: The primary objective of this study was to determine predictors of INHD technique failure, disruptions, and technique survival. Design: This study used retrospective chart and database review methodology. Setting: This study was conducted at a single Canadian INHD program operating in Victoria, British Columbia, within a tertiary care hospital. Our program serves a catchment population of approximately 450 000 people. Patients/Sample/Participants: Forty-three consecutive incident INHD patients took part in the INHD program of whom 42 provided informed consent to participate in this study. Methods: We conducted a retrospective observational study including incident INHD patients from 2015 to 2017. The primary outcome was technique failure ≤6 months (TF ≤6). Secondary outcomes included technique survival and reasons for/predictors of INHD discontinuation or temporary disruption. Predictors of each outcome included demographics, comorbidities, and Clinical Frailty Scale (CFS) scoring. Results: Among 42 patients, mean (SD) age, dialysis vintage, CFS score, and follow-up were 63 (16) years, 46 (55) months, 4 (1), and 11 (9) months, respectively. 52% were aged ≥65 years. TF ≤6 occurred in 12 (29%) patients. One-year technique survival censored for transplants and home dialysis transitions was 60%. Discontinuation related to insomnia (32%), medical status change (27%), and vascular access (23%). In unadjusted Cox survival analysis, 1-point increases in CFS score associated with a higher risk of technique failure (hazard ratio: 2.04, 95% confidence interval [CI]: 1.26-3.31). In an adjusted analysis, higher frailty severity also associated with temporary INHD disruptions (incidence rate ratio: 2.64, 95% CI: 1.55-4.50, comparing CFS of ≥4 to 1-3). Limitations: The retrospective, observational design of this study resulted in limited ability to control for confounding factors. In addition, the relatively small number of events observed owing to a small sample size diminished statistical power to inform study conclusions. Use of a single physician to determine the clinical frailty score is another limitation. Finally, the use of a single center for this study limits generalizability to other programs and clinic settings. Conclusions: INHD is a sustainable modality, even among older patients. Higher frailty associates with INHD technique failure and greater missed treatments. Inclusion of a CFS threshold of ≤4 into INHD inclusion criteria may help to identify individuals most likely to realize the long-term benefits of INHD. Trial Registration: Due to the retrospective and observational design of this study, trial registration was not necessary.
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Samaroo, Bethan. "Assessing Palliative Care Educational Needs of Physicians and Nurses: Results of a Survey." Journal of Palliative Care 12, no. 2 (June 1996): 20–22. http://dx.doi.org/10.1177/082585979601200205.
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The Greater Victoria Hospital Society (GVHS) Palliative Care Committee surveyed medical and nursing staff from four hospitals and The Victoria Hospice Society in February, 1993. The purpose of the survey was to identify physicians’ and nurses’ perceived educational needs related to death and dying. Programs that focus on the dying process; patient pain, symptom, and comfort control; and patient and family support were identified as necessary to meet the educational needs of physicians and nurses in providing quality palliative care. Physicians and nurses identified communication skills as being paramount. Communications concerning ethical issues were highlighted as the most difficult to cope with.
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Tilbury, Clare, and June Thoburn. "Children in out-of-home care in Australia: International comparisons." Children Australia 33, no. 3 (2008): 5–12. http://dx.doi.org/10.1017/s1035077200000262.
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As governments increasingly search globally for strategies to improve child welfare outcomes, it is vital to consider how policies and programs developed in other countries are likely to suit local conditions. Routinely collected child welfare administrative data can provide contextual information for cross-national comparisons. This article examines out-of-home care in Australia compared to other developed countries, and explores possible explanations for differences in patterns and trends. In doing so, it also examines the similarities and differences between NSW, Victoria and Queensland. It is argued that a sound understanding of how out-of-home care is used, the profile of children in care and the influences on data can assist policy makers to match proposed solutions to clearly understood current problems. The imperative is to plan and implement policies and programs that locate out-of-home care within a range of child welfare services that meet the diverse needs of children and families within local contexts.
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Oliveira, Ana Railka de Souza, Thelma Leite de Araujo, Alice Gabrielle de Sousa Costa, Huana Carolina Candido Morais, Viviane Martins da Silva, and Marcos Venicios de Oliveira Lopes. "Evaluation of patients with stroke monitored by home care programs." Revista da Escola de Enfermagem da USP 47, no. 5 (October 2013): 1143–49. http://dx.doi.org/10.1590/s0080-623420130000500019.
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The purpose of this study was to evaluate the patient with a stroke in home treatment, investigating physical capacity, mental status and anthropometric analysis. This was a cross-sectional study conducted in Fortaleza/CE, from January to April of 2010. Sixty-one individuals monitored by a home care program of three tertiary hospitals were investigated, through interviews and the application of scales. The majority of individuals encountered were female (59%), elderly, bedridden, with a low educational level, a history of other stroke, a high degree of dependence for basic (73.8%) and instrumental (80.3 %) activities of daily living, and a low cognitive level (95.1%). Individuals also presented with tracheostomy, gastric feeding and urinary catheter, difficulty hearing, speaking, chewing, swallowing, and those making daily use of various medications. It was concluded that home care by nurses is an alternative for care of those individuals with a stroke.
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Otto, Ann-Kathrin, Laura L. Bischoff, and Bettina Wollesen. "Work-Related Burdens and Requirements for Health Promotion Programs for Nursing Staff in Different Care Settings: A Cross-Sectional Study." International Journal of Environmental Research and Public Health 16, no. 19 (September 25, 2019): 3586. http://dx.doi.org/10.3390/ijerph16193586.
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Nursing staff in all settings have multiple work-related problems due to patient handling and occupational stressors, which result in high stress levels and low back pain. In this context the importance of health promotion becomes apparent. The aim of this study is to analyse whether nursing staff (in elderly care, hospitals, home care, or trainees) show different levels of work-related burdens and whether they require individualized components in health promotion programs. N = 242 German nurses were included in a quantitative survey (Health survey, Screening Scale (SSCS) of Trier Inventory for Chronic Stress, Slesina). The differences were tested using Chi2-Tests, Kruskal–Wallis Test and one-way ANOVA. Nurses differed in stress loads and were chronically stressed (F(3236) = 5.775, p = 0.001). Nurses in home care showed the highest SSCS-values with time pressure as the most important straining factor. The physical strains also placed a particular burden on nurses in home care, whereas they still reported higher physical well-being in contrast to nurses in elderly care (Chi2 = 24.734, p < 0.001). Nurses in elderly care and home care preferred strength training whereas nurses in hospitals and trainees favoured endurance training. Targeted programs are desirable for the reduction of work-related burdens. While nurses in elderly care and home care need a combination of ergonomic and strength training, all nurses require additional stress management. Planning should take into account barriers like perceived additional time consumption. Therefore, health promotion programs for all settings should be implemented during working time at the work setting and should consider the working schedule.
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Mendes, Philip. "Moving from dependence to independence: A study of the experiences of 18 care leavers in a leaving care and after care support service in Victoria." Children Australia 35, no. 1 (2010): 14–21. http://dx.doi.org/10.1017/s1035077200000924.
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Young people leaving state out-of-home care are arguably one of the most vulnerable and disadvantaged groups in society. Many have been found to experience significant health, social and educational deficits. In recent years, most Australian States and Territories have introduced specialist leaving care and after care programs and supports, but there has been only limited examination of the effectiveness of these programs. This paper examines the experiences of a group of young people involved in the leaving care and after care support program introduced by St Luke's Anglicare and Whitelion in the Victorian town of Bendigo. Attention is drawn to the impact of some of the key program initiatives around accommodation, employment and mentoring. Some conclusions are drawn about ‘what works’ in leaving care programs, including particular implications for rural policy and practice.
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Schuchman, Mattan, Mindy Fain, and Thomas Cornwell. "The Resurgence of Home-Based Primary Care Models in the United States." Geriatrics 3, no. 3 (July 16, 2018): 41. http://dx.doi.org/10.3390/geriatrics3030041.
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This article describes the forces behind the resurgence of home-based primary care (HBPC) in the United States and then details different HBPC models. Factors leading to the resurgence include an aging society, improved technology, an increased emphasis on home and community services, higher fee-for-service payments, and health care reform that rewards value over volume. The cost savings come principally from reduced institutional care in hospitals and skilled nursing facilities. HBPC targets the most complex and costliest patients in society. An interdisciplinary team best serves this high-need population. This remarkable care model provides immense provider satisfaction. HBPC models differ based on their mission, target population, geography, and revenue structure. Different missions include improved care, reduced costs, reduced readmissions, and teaching. Various payment structures include fee-for-service and value-based contracts such as Medicare Shared Savings Programs, Medicare capitation programs, or at-risk contracts. Future directions include home-based services such as hospital at home and the expansion of the home-based workforce. HBPC is an area that will continue to expand. In conclusion, HBPC has been shown to improve the quality of life of home-limited patients and their caregivers while reducing health care costs.
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Breman, Rachel, Ann MacRae, and Dave Vicary. "Child-Perpetrated Family Violence in Kinship Care in Victoria." Children Australia 43, no. 3 (June 26, 2018): 192–97. http://dx.doi.org/10.1017/cha.2018.28.
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There is growing evidence to support our understanding of adolescent violence in the home, however, there is a paucity of research about child-perpetrated violence that occurs within the context of kinship care. In 2017, Baptcare commenced research with 101 kinship carers in Victoria to gain a better understanding of how family violence was impacting on children and families. This research included a focus on child-perpetrated violence directed towards carers once the kinship placement commenced. In this context, family violence means any act of physical violence, emotional/psychological violence, verbal abuse and property damage caused by the child. This study utilised an online survey and semi-structured interviews that specifically targeted kinship carers who had direct experience of family violence. Findings demonstrated the disturbing types of child-perpetrated violent and aggressive behaviours kinship carers experienced. The data indicates that incidents of violence occurred early in the placement, they occurred frequently, and carers experienced multiple acts of violence from the child. The impact of the violence on the carer's household is significant in terms of the carer's health, wellbeing and placement stability. Further, the findings highlight the transgenerational nature of family violence in the context of kinship care in Victoria. The study described in this paper is the first step in understanding and exposing this complex issue and draws attention to some of the significant issues confronting Victorian kinship families experiencing family violence. This paper will describe the approach that Baptcare is taking to address family violence in its kinship-care programs.
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Schiller, Gabrielle, Heather Wurtz, Sybil Masse, Abigail Baim-Lance, Alex Federman, Emily Franzosa, Ksenia Gorbenko, and Linda DeCherrie. "HOSPITALIZATION AT HOME MAY ADDRESS SOCIAL DETERMINANTS OF HEALTH: RESULTS FROM A QUALITATIVE STUDY." Innovation in Aging 6, Supplement_1 (November 1, 2022): 656. http://dx.doi.org/10.1093/geroni/igac059.2420.
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Abstract This project evaluated implementation of the Acute Hospital Care at Home (AHCaH) waiver from the U.S. Center for Medicare & Medicaid Services (CMS), launched in November 2020 to ensure availability of acute care as COVID-19 cases overwhelmed hospitals. We interviewed 18 HaH program leaders of 14 programs, from both existing and newly launched HaH programs, about their experiences applying for and implementing HaH under the CMS waiver. A thematic analysis of the interviews was completed. Informants described HaH programs as an opportunity for healthcare professionals to have “eyes in the home,” referring to ways in which the HaH team was able to observe and intervene in aspects of the patient’s life not accessible from traditional in-patient care. Informants described various ways that HaH programs addressed Social Determinants of Health (SDoH) including assessing patients’ ability to obtain healthy foods, reducing potential safety hazards in the home, and providing education and support to patients’ caregivers. Informants also suggested that HaH may reduce anxiety associated with hospital stay and separation from loved ones, helping people already contending with social inequities. Addressing SDoH is important for ensuring quality care and long-term positive changes in the patient’s lifestyle and environment. As CMS shifts their aims to further address the SDoH, our findings suggest that the interdisciplinary care approach of HaH programs may be a model of addressing both social and medical needs.
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Forster, Della A., Heather McKay, Rhonda Powell, Emma Wahlstedt, Tanya Farrell, Rachel Ford, and Helen L. McLachlan. "The structure and organisation of home-based postnatal care in public hospitals in Victoria, Australia: A cross-sectional survey." Women and Birth 29, no. 2 (April 2016): 172–79. http://dx.doi.org/10.1016/j.wombi.2015.10.002.
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Holcomb, William R., Edward Mirilli, and Paul R. Ahr. "Reliability and Concurrent Validity of the Level of Care and Utilization Survey." Psychological Reports 75, no. 2 (October 1994): 779–86. http://dx.doi.org/10.2466/pr0.1994.75.2.779.
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A level-of-care instrument was developed for individuals with severe mental illness. A random sample of 300 patients residing in two state hospitals and a state-operated nursing home was used to test the concurrent validity and reliability of the instrument. Analysis indicated excellent test-retest reliability, good split-half reliability, adequate internal consistency, and reasonable concurrent validity. Thus, the questionnaire may provide a base for clinicians and administrators responsible for designing programs and health-care systems of treatment in the least restrictive environment possible.
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Cassel, Brian, Kathleen Kerr, and Egidio Del Fabbro. "Making the (business) case for outpatient and home-based palliative care for cancer patients." Journal of Clinical Oncology 31, no. 31_suppl (November 1, 2013): 266. http://dx.doi.org/10.1200/jco.2013.31.31_suppl.266.
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266 Background: Randomized controlled trials by Temel (2010) and Brumley (2003, 2007) have demonstrated the positive clinical, psycho-social, and utilization impact of providing early clinic or home-based palliative care (PC) concurrently with standard disease-focused treatment. Despite clear benefits, the growth of outpatient PC has been constrained by lack of clarity about the “business case” for hospitals or health systems to develop and fund PC services outside the inpatient setting. Methods: We will present findings from Virginia Commonwealth University (VCU) that provide a compelling quantification of the risks for hospitals to continue “business as usual” in this changing environment. Our approach measures quality, quantity, and costs of care for patients with cancer over a period of 6-12 months prior to death. Performance on some of these measures impact revenues in the prevailing fee-for-service reimbursement model; others are utilized in national, public ratings of quality; and still others influence organizational ability to compete in the population health management model that rewards quality and efficiency over time. Results: We used these data to highlight VCU Health System’s exposure to financial risks to create a strong business case for outpatient palliative care in which patient-centered and hospital-centered outcomes are aligned. This approach elevated our proposal to be included in a broader strategic initiative by our health system to manage complex care more efficiently, and to manage population health more proactively. Our analytic approach was then replicated by a diverse group of California provider groups who adopted or adapted the VCU model to advance their community-based palliative care programs as part of the California Health Care Foundation’s “Palliative Care Action Community” initiative. Conclusions: Our analytic model and articulation of the business case for community-based palliative care can help others to create and sustain quality-driven, patient-centered, cost-effective PC programs in their own institutions.
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Oberlander, Jonathan. "Between Liberal Aspirations and Market Forces: Obamacare's Precarious Balancing Act." Journal of Law, Medicine & Ethics 42, no. 4 (2014): 431–41. http://dx.doi.org/10.1111/jlme.12166.
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The American health care system long has been distinctive in its embrace of market forces. For-profit private insurers play a major role in providing coverage, though they operate alongside public insurance programs that cover over one-third of the population. Historically, federal and state governments’ regulation of insurance markets was limited, leaving insurers to set premiums and coverage rules largely as they saw fit. Government’s role in controlling health care spending has been even more circumscribed. Purchasing power is fragmented, with each insurer negotiating its own rates with physicians and hospitals. A formidable medical-industrial complex of for-profit providers, from hospitals to home-health care agencies, dialysis facilities, pharmaceutical companies and much more, has arisen to sell services.
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Akhtar, Saad, Vamshek Srinivasan, Carol Weisse, and Phil DiSorbo. "Characterizing the Financial Value of In-Home Palliative Care for Patients, Payers, and Hospitals." American Journal of Hospice and Palliative Medicine® 37, no. 3 (September 2, 2019): 196–200. http://dx.doi.org/10.1177/1049909119872486.
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Background: The holistic and multidisciplinary approach of in-home palliative care (IHPC) is known to offer high-quality and cost-effective care for patients at the end of life. However, the financial benefits of upstream IHPC programs to hospitals, patients, and payers have not been fully characterized for patients with comorbid chronic conditions. Aim: To characterize the financial benefits that upstream IHPC offers to patients with multiple chronic conditions. Methods: A structured retrospective patient record review was conducted on the number of emergency department (ED) visits, number of inpatient hospitalizations, hospital length of stay (LOS), and payments made to the hospital for all patients (N = 71) enrolled in an IHPC program between January 1, 2016, and June 30, 2016. Discharge history from each patient’s medical record was also assessed. Comparisons were drawn between patients’ LOS on IHPC and an equivalent time period prior to enrollment in IHPC. Results: After patients enrolled in IHPC, average ED and inpatient utilization declined significantly by 41% ( P = .01) and 71% ( P < .001), respectively. The payers for health-care services realized a significant decline of US$2,201 ( P < .001) in hospital payments per patient per month. Inpatient LOS was also significantly lower than expected once patients enrolled in the program ( P = .01). Conclusions: As the need for chronic disease management continues to grow, managers of health systems, managed care organizations, and home health agencies should be cognizant of the financial value that IHPC has to offer.
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Kaufman, Jessica, Kathleen L. Bagot, Monsurul Hoq, Julie Leask, Holly Seale, Ruby Biezen, Lena Sanci, et al. "Factors Influencing Australian Healthcare Workers’ COVID-19 Vaccine Intentions across Settings: A Cross-Sectional Survey." Vaccines 10, no. 1 (December 21, 2021): 3. http://dx.doi.org/10.3390/vaccines10010003.
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Healthcare workers’ COVID-19 vaccination coverage is important for staff and patient safety, workforce capacity and patient uptake. We aimed to identify COVID-19 vaccine intentions, factors associated with uptake and information needs for healthcare workers in Victoria, Australia. We administered a cross-sectional online survey to healthcare workers in hospitals, primary care and aged or disability care settings (12 February–26 March 2021). The World Health Organization Behavioural and Social Drivers of COVID-19 vaccination framework informed survey design and framing of results. Binary regression results adjusted for demographics provide risk differences between those intending and not intending to accept a COVID-19 vaccine. In total, 3074 healthcare workers completed the survey. Primary care healthcare workers reported the highest intention to accept a COVID-19 vaccine (84%, 755/898), followed by hospital-based (77%, 1396/1811) and aged care workers (67%, 243/365). A higher proportion of aged care workers were concerned about passing COVID-19 to their patients compared to those working in primary care or hospitals. Only 25% felt they had sufficient information across five vaccine topics, but those with sufficient information had higher vaccine intentions. Approximately half thought vaccines should be mandated. Despite current high vaccine rates, our results remain relevant for booster programs and future vaccination rollouts.
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Kita, Motoko, and Reiko Yoshida. "Research Trends into Support for Families Coping with Dementia in Japan." International Journal of Studies in Nursing 2, no. 1 (April 6, 2017): 15. http://dx.doi.org/10.20849/ijsn.v2i1.144.
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In Japan, there is a growing need for family support of elderly patients with dementia because the number of sufferers is expected to increase over coming years. We conducted a review of 92 studies into the support provided to the families of patients with dementia in Japan. They were reviewed by care setting, study focus, and study design. Most studies were in home settings, followed by hospital settings, with the fewest in long-term care facilities. A wide range and quality of studies were performed in home settings, including quantitative descriptive and interventional studies; however, qualitative descriptive studies and case studies predominated. We identified a need to perform additional studies to verify support programs at home. Concerning family support in hospitals, studies were mainly performed in relation to early diagnosis of dementia and early discharge from hospital, and we observed a clear need to investigate the development of new support programs. Finally, although the need for family support is estimated to be high in long-term care facilities, we found only a few studies investigating this issue. In particular, more studies are needed on the topic of end-of-life care. To offer support that meets the needs of families in various care settings, there is an urgent need to accumulate evidence about patients and their families in each setting.
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SAHLER, OLLE JANE Z., and JANE GREENLAW. "Pediatrics and the Patient Self-Determination Act." Pediatrics 90, no. 6 (December 1, 1992): 999–1001. http://dx.doi.org/10.1542/peds.90.6.999.
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On December 1, 1991, the requirements of a new federal law, the Patient Self-determination Act (PSDA), went into effect.1 The PSDA requires hospitals, nursing home facilities, hospices, home health care programs, and health maintenance organizations to give adults (in most states, individuals 18 years of age or older) information about their rights under the laws of their state to accept or refuse medical treatment; to prepare an advance directive such as a living will which states the individual's preferences for medical treatment under certain circumstances that might occur in the future, at a time when the patient is no longer able to make decisions; and to appoint a health care agent or proxy, someone to make health care decisions on behalf of the individual if he or she is no longer able to make decisions.
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Zheng, Qishi, Luming Shi, Lixia Zhu, Nana Jiao, Yap Seng Chong, Sally Wai-Chi Chan, Yiong Huak Chan, Nan Luo, Wenru Wang, and Honggu He. "Cost-effectiveness of Web-Based and Home-Based Postnatal Psychoeducational Interventions for First-time Mothers: Economic Evaluation Alongside Randomized Controlled Trial." Journal of Medical Internet Research 24, no. 3 (March 11, 2022): e25821. http://dx.doi.org/10.2196/25821.
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Background The cost-effectiveness of interventions has attracted increasing interest among researchers. Although web-based and home-based psychoeducational interventions have been developed to improve first-time mothers’ postnatal health outcomes, very limited studies have reported their cost-effectiveness. Objective The aim of this study was to evaluate the cost-effectiveness of web-based and home-based postnatal psychoeducational interventions for first-time mothers during the early postpartum period. Methods A randomized controlled 3-group pretest and posttest design was adopted, and cost-effectiveness analysis from the health care’s perspective was conducted. A total of 204 primiparas were recruited from a public tertiary hospital in Singapore from October 2016 to August 2017 who were randomly allocated to the web-based intervention (n=68), home-based intervention (n=68), or control (n=68) groups. Outcomes of maternal parental self-efficacy, social support, postnatal depression, anxiety, and health care resource utilization were measured using valid and reliable instruments at baseline and at 1 month, 3 months, and 6 months after childbirth. The generalized linear regression models on effectiveness and cost were used to assess the incremental cost-effectiveness ratios of the web-based and home-based intervention programs compared to routine care. Projections of cumulative cost over 5 years incurred by the 3 programs at various coverage levels (ie, 10%, 50%, and 100%) were also estimated. Results The web-based intervention program dominated the other 2 programs (home-based program and routine care) with the least cost (adjusted costs of SGD 376.50, SGD 457.60, and SGD 417.90 for web-based, home-based, and control group, respectively; SGD 1=USD 0.75) and the best improvements in self-efficacy, social support, and psychological well-being. When considering the implementation of study programs over the next 5 years by multiplying the average cost per first-time mother by the estimated average number of first-time mothers in Singapore during the 5-year projection period, the web-based program was the least costly program at all 3 coverage levels. Based on the 100% coverage, the reduced total cost reached nearly SGD 7.1 million and SGD 11.3 million when compared to control and home-based programs at the end of the fifth year, respectively. Conclusions The web-based approach was promisingly cost-effective to deliver the postnatal psychoeducational intervention to first-time mothers and could be adopted by hospitals as postnatal care support. Trial Registration ISRCTN registry ISRCTN45202278; https://www.isrctn.com/ISRCTN45202278
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Olorunsaiye, Comfort Z., A.-Mac Harris, and Korede K. Yusuf. "Characteristics of Early Newborn Care: A Descriptive Analysis of Recent Births in Nigeria." International Journal of Maternal and Child Health and AIDS (IJMA) 9, no. 1 (January 12, 2020): 93–102. http://dx.doi.org/10.21106/ijma.324.
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Background or Objectives: The neonatal period, the first 28 days of life, is the most critical period for child survival. In 2017, 214,000 children in Nigeria died during the neonatal period. Newborn care practices play a key role in preventing these deaths. The aim of this study was to examine the association between delivery location and early newborn care in Nigeria.
Methods: Data from the 2013 Nigeria Demographic and Health Survey were analyzed. The main exposure variable was delivery location (home, public hospital, public health center/clinic and private hospital/clinic). The outcomes were early initiation of breastfeeding, breastfeeding support, and cord examination. We used multivariate logistic regression to estimate the odds of newborn care.
Results: We observed that the prevalence of all three outcome indicators was low. After adjusting for confounders, birth in public health facilities, compared to home birth, was associated with early initiation of breastfeeding (public hospitals: OR 1.62, 95% CI: 1.29-2.03; public health centers/clinics OR: 1.28, 95% CI: 1.02-1.61). Breastfeeding support and cord examination were each associated with birth in public hospitals only compared to home birth (OR 1.41, 95% CI: 1.09-1.81 and OR 1.41, 95% CI: 1.11-1.79, respectively).
Conclusion and Global Health Implications: Early newborn care in Nigeria was suboptimal and the quality of this care varied across delivery locations and birth attendants. Public hospitals had the most favorable newborn care outcomes. Policies and programs to enhance the quality of facility-based early newborn care and promote community-based newborn care could improve neonatal outcomes and reduce overall child mortality in resource-challenged settings.
Key words: • Newborn care • Neonatal mortality • Breastfeeding • Cord care • Nigeria
Copyright © 2020 Olorunsaiye et al. This is an open-access article distributed under the terms of the Creative Com - mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited
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Ward, Bernadette, Julie Ellis, and Karen Anderson. "Barriers to the provision of home and community care services to culturally and linguistically diverse populations in rural Australia." Australian Journal of Primary Health 11, no. 2 (2005): 147. http://dx.doi.org/10.1071/py05033.
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In 2002, qualitative methods in the form of in-depth interviews and focus groups were used to gather data from culturally and linguistically diverse (CALD) population residents, service providers and key stakeholders across rural Victoria, to identify and describe barriers to the effective delivery of home services to people from CALD populations in rural Australia. Barriers to the provision of Home and Community Care (HACC) services to CALD populations in rural areas were not specific to HACC programs. For CALD residents, barriers included lack of information about the range of available services, cultural factors, and negative past and recent experiences in dealing with both the broader community and service providers. Service providers indicated lack of information about the profile of the local CALD population and lack of experience in working with these groups to be barriers. Communication was also an issue both for CALD residents and service providers, in terms of cultural factors and specific communication strategies such as inadequate printed material and under-utilisation of existing resources such as interpreter services. As one of the world?s most ethno-culturally diverse nations, Australia has a responsibility to provide health services that are culturally responsive and acceptable. Greater attention needs to be given to the needs of rural CALD population groups in accessing home services.
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Ofori-Asenso, Richard, Danny Liew, Johan Mårtensson, and Daryl Jones. "The Frequency of, and Factors Associated with Prolonged Hospitalization: A Multicentre Study in Victoria, Australia." Journal of Clinical Medicine 9, no. 9 (September 22, 2020): 3055. http://dx.doi.org/10.3390/jcm9093055.
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Background: Limited available evidence suggests that a small proportion of inpatients undergo prolonged hospitalization and use a disproportionate number of bed days. Understanding the factors contributing to prolonged hospitalization may improve patient care and reduce the length of stay in such patients. Methods: We undertook a retrospective cohort study of adult (≥20 years) patients admitted for at least 24 h between 14 November 2016 and 14 November 2018 to hospitals in Victoria, Australia. Data including baseline demographics, admitting specialty, survival status and discharge disposition were obtained from the Victorian Admission Episode Dataset. Multivariable logistic regression analysis was used to identify factors independently associated with prolonged hospitalization (≥14 days). Cox proportional hazard regression model was used to examine the association between various factors and in-hospital mortality. Results: There were almost 5 million hospital admissions over two years. After exclusions, 1,696,112 admissions lasting at least 24 h were included. Admissions with prolonged hospitalization comprised only 9.7% of admissions but utilized 44.2% of all hospital bed days. Factors independently associated with prolonged hospitalization included age, female gender, not being in a relationship, being a current smoker, level of co-morbidity, admission from another hospital, admission on the weekend, and the number of admissions in the prior 12 months. The in-hospital mortality rate was 5.0% for those with prolonged hospitalization compared with 1.8% in those without (p < 0.001). Prolonged hospitalization was also independently associated with a decreased likelihood of being discharged to home (OR 0.53, 95% CI 0.52–0.54). Conclusions: Patients experiencing prolonged hospitalization utilize a disproportionate proportion of bed days and are at higher risk of in-hospital death and discharge to destinations other than home. Further studies are required to identify modifiable factors contributing to prolonged hospitalization as well as the quality of end-of-life care in such admissions.
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Iris, Madelyn Anne. "The Ethics of Decision Making for the Critically Ill Elderly." Cambridge Quarterly of Healthcare Ethics 4, no. 2 (1995): 135–41. http://dx.doi.org/10.1017/s0963180100005806.
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The ethics of decision making for the critically ill elderly is an area of concern for all those involved in the decision-making process. The number of participants involved in decision making around end-of-life issues may be many: treatment and care decisions often bring together not only the patient and the physician, but the family, an extended medical care team, and impartial members of a hospital or institutional ethics committee. In addition, treatment and care decisions made at the end of life occur in a variety of settings, not just the acute care hospital. Elderly patients who are critically ill, or in the final days or weeks of life, are found in intensive care or medical units of hospitals, in hospital and nursing home based hospice programs, in long-term care settings such as skilled nursing facilities, or at home, where they are tended by family caregivers. Differences in patterns of decision making regarding the care and treatment of critically ill older adults can be found across these settings, and decisions often vary according to the roles of the participants.
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Angelotti, Marietta, Kathryn Bliss, Dana Schiffman, Erin Weaver, Laura Graham, Thomas Lemme, Veronica Pryor, and Foster C. Gesten. "Transforming the Primary Care Training Clinic: New York State’s Hospital Medical Home Demonstration Pilot." Journal of Graduate Medical Education 7, no. 2 (June 1, 2015): 247–52. http://dx.doi.org/10.4300/jgme-d-14-00782.1.
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Abstract Background Training in patient-centered medical home (PCMH) settings may prepare new physicians to measure quality of care, manage the health of populations, work in teams, and include cost information in decision making. Transforming resident clinics to PCMHs requires funding for additional staff, electronic health records, training, and other resources not typically available to residency programs. Objective Describe how a 1115 Medicaid waiver was used to transform the majority of primary care training sites in New York State to the PCMH model and improve the quality of care provided. Methods The 2013–2014 Hospital Medical Home Program provided awards to 60 hospitals and 118 affiliated residency programs (training more than 5000 residents) to transform outpatient sites into PCMHs and provide high-quality, coordinated care. Site visits, coaching calls, resident surveys, data reporting, and feedback were used to promote and monitor change in resident continuity and quality of care. Descriptive analyses measured improvements in these areas. Results A total of 156 participating outpatient sites (100%) received PCMH recognition. All sites enhanced resident education using PCMH principles through patient empanelment, development of quality dashboards, and transforming resident scheduling and training. Clinical quality outcomes showed improvement across the demonstration, including better performance on colorectal and breast cancer screening rates (rate increases of 13%, P ≤ .001, and 11%, P = .011, respectively). Conclusions A 1115 Medicaid waiver is a viable mechanism for states to transform residency clinics to reflect new primary care models. The PCMH transformation of 156 sites led to improvements in resident continuity and clinical outcomes.
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Bambaren, C. "(A2) Strategies to Recover the Health Care Capacity Post Earthquake in Chile." Prehospital and Disaster Medicine 26, S1 (May 2011): s1. http://dx.doi.org/10.1017/s1049023x11000197.
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BackgroundThe earthquake that struck Chile on February 27th, 2010 produced profound damage of hospital services with 4249 bed lost especially in the regions of Maule and Bio. The capacity of the health was critically reduced in ability to assure health access to affected people by the disaster.Discussion of InterventionsThe first strategy to maintain health services was the deployment of 18 field hospitals from Chilean organizations (Army and Air Force), international organizations and foreign governments. This measure allowed for 533 beds and 16 surgical blocks in the first weeks. There were 14 field hospitals until November. Taking into account the beginning of the winter season, the national government set up another sort of strategy to increase the capacity of the health care facilities: § Strengthening of hospitals without damage that were close to the disaster area. These hospitals were used as referral centers. § Purchasing of 708 beds from the private health sector. § Habilitation of free spaces to be used for inpatients. § Increasing the capacity of home care health programs to release beds. § Construction of some small temporary units to admit patients. § Small-scale interventions to repair damages in hospitals. § Extending the work time until 16 hours in the primary health care facilities. § Improving of the efficient of the using of human and physical resources. § Restructuration of the hospital network that allowed adding 300 new beds.ResultsThe ministry of health recovered more than 94% of loss beds and 92% of surgical blocks through July. However, it is necessary to identify US$ 2720 million for reconstruction program and to establish a national strategy of safe hospitals in order to reduce the future costs of the recovery of damaged health care facilities. *Based on information from PAHO – Chile.
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Haun, Courtney N., Zachary B. Mahafza, Chassidy L. Cook, and Geoffrey A. Silvera. "A Study Examining the Influence of Proximity to Nurse Education Resources on Quality of Care Outcomes in Nursing Homes." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 55 (January 1, 2018): 004695801878769. http://dx.doi.org/10.1177/0046958018787694.
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This examination seeks to determine the influence of proximal density to nurse education resources (nursing schools) on nursing home care quality outcomes in Alabama. Motivated by the social network theory, which highlights the influence of relational closeness on shared resources and values, we hypothesize that nursing homes that have higher levels of nursing education resources within a close proximity will exhibit significantly higher nursing home quality outcomes. As proximal density to nurse education resources increases, the opportunity for nursing homes to build closer, stronger ties increase, leading to higher quality outcomes. We examine this hypothesis via ordered logistic regressions of proximal density measures developed through geographic information systems (GIS) software, nurse education resource data from Johnson & Johnson’s Campaign for Nursing’s Future (n = 37), and nursing home quality outcome data from Centers for Medicare and Medicaid Services’s (CMS) Nursing Home Compare from 2016 (n = 226). The results find that increases in proximal density to nurse education resources have a negative and significant association with nursing home quality outcomes in Alabama. Additional sensitivity analysis, which examines the degree to which the nature of this relationship is sensitive to health care facilities’ location in high-density areas, is offered and confirms principal findings. Because nursing programs generally have stronger ties with hospitals, the findings suggest that the nursing homes in areas with higher nurse education resources may actually face greater competition for nurses.
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Lara, Brenda, Janey Kottler, Abigail Olsen, Andrew Best, Jessica Conkright, and Karen Larimer. "Home Monitoring Programs for Patients Testing Positive for SARS-CoV-2: An Integrative Literature Review." Applied Clinical Informatics 13, no. 01 (January 2022): 203–17. http://dx.doi.org/10.1055/s-0042-1742370.
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Abstract Background The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic threatened to oversaturate hospitals worldwide, necessitating rapid patient discharge to preserve capacity for the most severe cases. This need, as well as the high risk of SARS-CoV-2 transmission, led many hospitals to implement remote patient monitoring (RPM) programs for SARS-CoV-2 positive patients in an effort to provide care that was safe and preserve scarce resources. Objective The aim of this study is to provide an integrative review of peer-reviewed literature on different RPM programs that were implemented for SARS-CoV-2 positive patients including their strengths and challenges. Methods A search was conducted for peer reviewed literature using PubMed, CINAHL, OVID, and Google Scholar. Peer-reviewed studies written in English or Spanish and published between 2019 and 2021 on RPM of SARS-CoV-2-positive patients were considered. Information was extracted according to a qualitative content analysis method, informed by the Comparison of Mobile Patient Monitoring Systems Framework. Results Of 57 retrieved articles, 10 publications were included. The sample sizes ranged from 75 to 48,290 and the monitoring length ranged from 7 to 30 days. Information regarding the comparison framework was summarized. Main strengths of using RPM for SARS-CoV-2 positive patients was participant acceptance, feasibility, safety, and resource conservation. Main limitations were the lack of information on patient data security measures, robust outcomes testing, and identification of the most effective biomarkers to track SARS-CoV-2 decompensation. Conclusion Different RPM programs for SARS-CoV-2 were implemented, from sending home participants with a pulse oximeter and collecting readings via call to modifying existing mobile applications and sending holistic health questionnaires to participants. This review determined that RPM is beneficial to SARS-CoV-2 positive patients; however, its effectiveness can be improved by further research. Mainly, identifying what patient data are most effective at tracking SARS-CoV-2 decompensation by utilizing advanced technology already in the market.
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Commiskey, Patricia, Arash Afshinnik, Elizabeth Cothren, Toby Gropen, Ifeanyi Iwuchukwu, Bethany Jennings, Harold C. McGrade, et al. "Description of a novel telemedicine-enabled comprehensive system of care: drip and ship plus drip and keep within a system of stroke care delivery." Journal of Telemedicine and Telecare 23, no. 3 (March 16, 2016): 428–36. http://dx.doi.org/10.1177/1357633x16637967.
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United States (US) and worldwide telestroke programs frequently focus only on emergency room hyper-acute stroke management. This article describes a comprehensive, telemedicine-enabled, stroke care delivery system that combines “drip and ship” and “drip and keep” models with a comprehensive stroke center primary hub at Ochsner Medical Center in New Orleans, advanced stroke-capable regional hubs, and geographically-aligned, “stroke-ready” spokes. The primary hub provides vascular neurology expertise via telemedicine and monitors care for patients remaining at regional hubs and spokes using a multidisciplinary team approach. By 2014, primary hub telestroke consults grew to ≈1000/year with 16 min average door to consult initiation and 20 min to completion, and 29% of ischemic stroke patients received recombinant tissue-type plasminogen activator (rtPA), increasing 275%. Most patients remained in hospitals close to home, but neurointensive care and interventional procedures were common reasons for primary hub transfer. Given the time sensitivity and expert consultation needed for complex acute stroke care delivery paradigms, telestroke programs are effective for fulfilling unmet care needs. Combining drip and ship and drip and keep management allows more patients to stay “local,” limiting primary hub transfer unless more advanced services are required. Post admission telestroke management at spokes increases personnel efficiency and can positively impact stroke outcomes.
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Nathoo, Tasnim, Nancy Poole, Margaret Bryans, Lynda Dechief, Samantha Hardeman, Lenora Marcellus, Elizabeth Poag, and Marliss Taylor. "Voices from the community: Developing effective community programs to support pregnant and early parenting women who use alcohol and other substances." First Peoples Child & Family Review 8, no. 1 (September 9, 2020): 93–106. http://dx.doi.org/10.7202/1071409ar.
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Since the 1990s, many communities in Canada have worked to develop specialized programs to meet the needs of pregnant and early parenting women who use alcohol and other substances. These programs provide a range of services under one roof (a “single-access” or “one-stop shop” model), address women’s needs from a holistic perspective, provide practical and emotional support, and strive to reduce barriers to accessing care and support. Over the years, these programs have trialed new approaches to working with indigenous and non-indigenous women, their families, and their communities. In this paper, we describe the development of single-access programs in four different communities in Canada, discuss some of the elements of what makes these programs successful, and share our "lessons learned" over the years. We use examples from four different programs, including the Maxxine Wright Place Project in Surrey, BC; the Healthy, Empowered, Resilient (H.E.R) Pregnancy Program in Edmonton, AB; HerWay Home in Victoria, BC; and Manito Ikwe Kagiikwe in Winnipeg, MB. All four programs are based upon the "best practices" elements of: (1) engagement and outreach, (2) harm reduction, (3) cultural safety (4) supporting mother and child, and (5) partnerships. In addition to serving First Nations, Métis, Inuit and other indigenous women and their families, these programs have drawn upon indigenous knowledge in their program design, values, and philosophy and have collaborated with indigenous women in evaluation and research to track the successes of these programs and to improve service delivery.
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Jones, Aaron, Fabrice I. Mowbray, Lindsey Falk, Nathan M. Stall, Kevin A. Brown, Kamil Malikov, Sarah L. Malecki, et al. "Variations in long-term care home resident hospitalizations before and during the COVID-19 pandemic in Ontario." PLOS ONE 17, no. 11 (November 4, 2022): e0264240. http://dx.doi.org/10.1371/journal.pone.0264240.
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Objectives To examine how the COVID-19 pandemic affected the demographic and clinical characteristics, in-hospital care, and outcomes of long-term care residents admitted to general medicine wards for non-COVID-19 reasons. Methods We conducted a retrospective cohort study of long-term care residents admitted to general medicine wards, for reasons other than COVID-19, in four hospitals in Toronto, Ontario between January 1, 2018 and December 31, 2020. We used an autoregressive linear model to estimate the change in monthly admission volumes during the pandemic period (March-December 2020) compared to the previous two years, adjusting for any secular trend. We summarized and compared differences in the demographics, comorbidities, interventions, diagnoses, imaging, psychoactive medications, and outcomes of residents before and during the pandemic. Results Our study included 2,654 long-term care residents who were hospitalized for non-COVID-19 reasons between January 2018 and December 2020. The crude rate of hospitalizations was 79.3 per month between March-December of 2018–2019 and 56.5 per month between March-December of 2020. The was an adjusted absolute difference of 27.0 (95% CI: 10.0, 43.9) fewer hospital admissions during the pandemic period, corresponding to a relative drop of 34%. Residents admitted during the pandemic period had similar demographics and clinical characteristics but were more likely to be admitted for delirium (pandemic: 7% pre-pandemic: 5%, p = 0.01) and were less likely to be admitted for pneumonia (pandemic: 3% pre-pandemic: 6%, p = 0.004). Residents admitted during the pandemic were more likely to be prescribed antipsychotics (pandemic: 37%, pre-pandemic: 29%, p <0.001) and more likely to die in-hospital (pandemic:14% pre-pandemic: 10%, p = 0.04) Conclusions and implications Better integration between long-term care and hospitals systems, including programs to deliver urgent medical care services within long-term care homes, is needed to ensure that long-term care residents maintain equitable access to acute care during current and future public health emergencies.
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Jones, David E., Chris C. Clatterbuck, Janet Marquis, H. Rutherford Turnbull, and Rebecca L. Moberly. "Educational Placements for Children Who are Ventilator Assisted." Exceptional Children 63, no. 1 (October 1996): 47–57. http://dx.doi.org/10.1177/001440299606300105.
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As mechanical ventilation becomes more portable and home nursing care more available, children who rely on ventilators for life support are leaving hospitals and returning to their homes and schools. The authors surveyed 77 families during 1990–1991 to obtain information on the educational placements of these children and parental satisfaction with services. Interviews were conducted with a subsample of 22 families with differing levels of satisfaction and advocacy. Results suggest that barriers to the integration of these children into school-based programs are attitudinal more than technological. Parent satisfaction with services increased with the number of years the student was placed in school.
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Shamieh, O., A. Mansour, R. Harding, M. Tarawneh, and S. Payne. "National Home Care Initiative in Jordan: A Demonstration Project." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 242s. http://dx.doi.org/10.1200/jgo.18.97300.
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Background and context: The home healthcare market in Jordan is nascent with little service offered. It suffers from a highly fragmented and underregulated landscape. The limited access to qualified trustworthy home care services, lack of professional home care training, and lack of home health care insurance coverage have added to the heavy in-patient bed demand and delayed hospital discharges especially for disabled or terminally ill patients. Aim: To establish a comprehensive national home care program to improve the delivery of palliative and home care services in Jordan, and to conduct a situational analysis and generate policy recommendations. Strategy/Tactics: We used multiple strategies to reach our objectives. 1. Expansion of home care services at King Hussein Cancer Center (KHCC) to create a local demonstration project. 2. Building health care professional capacity by offering variety of educational programs. 3. Improving quality of service delivery by generating clinical practice guidelines, such as standards operating procedures and patient and family educational materials. 4. Use the pilot operational and financial data to generate an economic model to inform the development of similar home health care units in hospitals across Jordan. 5. National advocacy and building effective partnership with all related stakeholders to advance national policy. Program/Policy process: Between May 2016 and May 2017, 7818 home care visits were conducted by KHCC. For capacity building; 678 health care professionals were trained in palliative and home care, out of which 366 participants were females (54%). Palliative care was successfully recognized as a specialty by the Jordan Nursing Council and recognized as a subspecialty by the Jordan Medical Council. The palliative and home care standards of practice were included in the health care accreditation council. The analysis of economic evaluation data suggested that home care services decreased in-patient utilization and costs which is advantageous to a country with limited resources. As a result of the advocacy stream and a collaborative network, the national palliative and home care strategic framework was generated, and endorsed by the Ministry of Health. Outcomes: The NHCI resulted in a very successful pilot project and achieved specialty and subspecialty recognition. Furthermore, we were able to build the capacity of health care professionals and policy makers in the palliative and home care sector from public, private and academic institutions. In the advocacy and policy dimension, the Minister of Health officially approved and adapted the palliative and home care strategic framework that was developed by this initiative. What was learned: Cross-sector collaboration and effective partnership resulted in system change and policy advancement. Developing effective economic systems is essential in low resourced countries. The initiative was supported by a joint grant from the USAID and KHCC.
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Wilson, Traci, Suzanne Kunkel, Amanda Brewster, Jane Straker, Elizabeth Blair, and Marisa Scala-Foley. "Evidence for the Effectiveness of Health and Social Services Partnerships." Innovation in Aging 4, Supplement_1 (December 1, 2020): 225–26. http://dx.doi.org/10.1093/geroni/igaa057.727.
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Abstract Integration of health and social services is touted as a key method to address social needs and improve population health. We will share the latest evidence on how Area Agency on Aging (AAA) partnerships with health care entities and other organizations improve health outcomes for older adults, while reducing health care costs. AAAs are community leaders in cross-sectoral partnerships that effectively address social determinants of health for older adults, who account for a substantial share of overall health care spending. Results of a longitudinal study (2008 – 2016) which links data from four waves of the National Surveys of AAAs to data on county-level health outcomes show that AAA–health care partnerships and programs reduced health care utilization and costs. AAA partnerships with hospitals reduced Medicare spending by $136 per beneficiary. AAA involvement in evidence-based health promotion programs decreased potentially avoidable nursing home use by nearly one percentage point (representing a change of 6.5%). Finally, we will describe the prevalence and nature of contracting relationships between community-based organizations and health care entities, based on data from the 2020 CBOs and Health Care Contracting Request for Information, the third national RFI of AAAs, Centers for Independent Living, and other aging and disability community-based organizations.
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Amin, Reshma, Aarti Sayal, Faiza Syed, Cathy Daniels, Andrea Hoffman, Theo J. Moraes, and Peter Cox. "How Long Does it Take to Initiate a Child on Long-Term Invasive Ventilation? Results From A Canadian Pediatric Home Ventilation Program." Canadian Respiratory Journal 22, no. 2 (2015): 103–8. http://dx.doi.org/10.1155/2015/107914.
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OBJECTIVE: To assess the length of stay required to initiate long-term invasive ventilation at the authors’ institution, which would inform future interventional strategies to streamline the in-hospital stay for these families.METHODS: A retrospective chart review of children initiated on invasive long-term ventilation via tracheostomy at the authors’ acute care centre between January 2005 and December 2013 was performed.RESULTS: Thirty-five children were initiated on long-term invasive ventilation via tracheostomy at the acute care hospital; 19 (54%) were male. The median age at time of admission was 0.52 years (interquartile range [IQR] 0.06 to 9.58 years). Musculoskeletal disease (n=11 [31%]) was the most common reason for tracheostomy insertion. Two children died during the hospital admission. Fifteen children were discharged home directly from the acute care hospital and 18 were moved to the rehabilitation hospital. Six are current inpatients of the rehabilitation centre and were never discharged home. Combining the length of stay at the acute care and rehabilitation hospitals for the entire cohort, the median length of stay was 162.0 days (IQR 98.0 to 275.0 days) and 97.0 days (IQR 69.0 to 210.0 days), respectively, from the time of tracheostomy insertion.CONCLUSIONS: The median length of stay from the initiation of invasive long-term ventilation to discharge home from the rehabilitation hospital was somewhat long compared with other ventilation programs worldwide. Additionally, approximately 20% of the cohort never transitioned home. There is a timely need to benchmark across the country and internationally, to identify and implement strategies for cohesive, coordinated care for these children to decrease overall length of stay.
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Huntsman, Dorothy Day, and Grzegorz Bulaj. "Healthy Dwelling: Design of Biophilic Interior Environments Fostering Self-Care Practices for People Living with Migraines, Chronic Pain, and Depression." International Journal of Environmental Research and Public Health 19, no. 4 (February 16, 2022): 2248. http://dx.doi.org/10.3390/ijerph19042248.
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The benefits of biophilic interior design have been recognized by healthcare facilities, but residential environments receive relatively less attention with respect to improving the health of people living with chronic diseases. Recent “stay-at-home” restrictions due to the COVID-19 pandemic further emphasized the importance of creating interior spaces that directly and indirectly support physical and mental health. In this viewpoint article, we discuss opportunities for combining biophilic interventions with interior design, fostering disease-specific self-care. We provide examples of designing residential spaces integrating biophilic interventions, light therapy, relaxation opportunities, mindfulness meditation, listening to music, physical activities, aromatherapy, and quality sleep. These modalities can provide the clinical benefits of reducing migraine headaches and chronic pain, as well as improving depressive symptoms. The disease-specific interior environment can be incorporated into residential homes, workplaces, assisted-living residences, hospitals and hospital at home programs. This work aims to promote a cross-disciplinary dialogue towards combining biophilic design and advances in lifestyle medicine to create therapeutic interior environments and to improve healthcare outcomes.
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Mundy, Linda, and Kaye Hewson. "Thinking outside the system: the integrated care experience in Queensland, Australia." Australian Journal of Primary Health 25, no. 4 (2019): 303. http://dx.doi.org/10.1071/py18161.
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Health policy-makers are faced with a demand for health care that exceeds supply, driven in part by an ageing population and an increased prevalence of chronic disease. An integrated ‘people-centred’ model of care across primary, secondary and tertiary health care can strengthen the health system by streamlining services to improve the patient journey and outcomes. Integrated care offers an opportunity to reduce admissions and re-admissions to hospitals, reduce presentations to emergency departments and improve the capacity of outpatient clinics while delivering better outcomes to patients. Queensland’s $35 million Integrated Care Innovation Fund (ICIF) has provided seed funding to 24 projects covering a wide spectrum of chronic disease management and complex disease. Programs such as the ICIF offer an opportunity to provide a new approach to caring for vulnerable populations such as the frail and elderly; children with behavioural and developmental issues; children in out-of-home care; rural and remote populations; and people with mental health issues, whose care runs the risk of ‘falling through the cracks’ with conventional healthcare approaches.
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Stupak, V. S., E. S. Feduleeva, A. A. Ishutin, and L. S. Zolotareva. "Palliative medical care for children at the federal and regional levels: analysis of expert opinions and new challenges to the healthcare system." Voprosy praktičeskoj pediatrii 17, no. 5 (2022): 36–42. http://dx.doi.org/10.20953/1817-7646-2022-5-36-42.
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The Resolution on Palliative Care (PC) adopted by the World Health Assembly in 2014 implies PC integration into healthcare at all levels. In the Russian Federation, PC management and improvement are regulated by territorial health development programs. Objective. To analyze expert opinions on the quality of PC in various regions of the Russian Federation to optimize pediatric PC. Materials and methods. This prospective cohort study was conducted in 80 regions of the Russian Federation in October–December 2020. We interviewed 276 chief consultants, top healthcare executives, heads of healthcare institutions, pediatric departments, neonatology departments, and gynecological departments. Results. Respondents reported high quality of PC and equipment in healthcare institutions. However, they also marked limited territorial accessibility and volume of PC. They believe that PC in Russia requires better funding and expansion of home care, medical care in day hospitals and regular hospitals, and improvement of legal protection of patients. Conclusion. PC in the Russian Federation is one of the top priorities in healthcare. Several regulatory documents (including orders No 345n/372n and No 348n, resolution No 813, orders for the Moscow Region No 4-r and No 87-r) have been implemented. However, organizational problems still exist in some regions, which requires the improvement of the regulatory framework. Key words: pediatric palliative care, children, hospice and palliative care, medical and organizational measures, quality of life, suffering alleviation
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Ayton, Darshini, Renée O'Donnell, Dave Vicary, Catherine Bateman, Chris Moran, Velandai K. Srikanth, Julie Lustig, et al. "Psychosocial volunteer support for older adults with cognitive impairment: development of MyCare Ageing using a codesign approach via action research." BMJ Open 10, no. 9 (September 2020): e036449. http://dx.doi.org/10.1136/bmjopen-2019-036449.
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Background and objectivesOlder adults with cognitive impairment are vulnerable to frequent hospital admissions and emergency department presentations. The aim of this study was to use a codesign approach to develop MyCare Ageing, a programme that will train volunteers to provide psychosocial support to older people with dementia and/or delirium in hospital and at home when discharged from hospital.SettingMelbourne, Victoria, Australia.Research designThis study adopts an action research methodology. We report on two co-design workshops with keystakeholders: Workshop 1: identification of components from three existing programmes to inform the development of the MyCare Ageing program logic and, Workshop 2: identification of implementation strategies.ParticipantsThe key stakeholders and workshop participants included clinicians (geriatricians, nurses and allied health), hospital staff (volunteer coordinators and hospital executives), Baptcare staff, a consumer, researchers and implementation experts and project staff.ResultsWorkshop 1 identified the components from three existing programmes—the Volunteer Dementia and Delirium Care programme, Home-Start and MyCare for inclusion in MyCare Ageing. In workshop 2, the p implementation plan was developed taking into consideration hospital-specific processes, training and support needs of volunteers and safety and risk management processes.Discussion and conclusionThe codesign process was successfully applied to develop the MyCare Ageing programme to provide volunteer support to patients with dementia and/or delirium in hospital and their transition home. MyCare Ageing is an innovative programme that meets an identified need from hospitals and consumers to support patients with dementia and/or delirium to improve psychosocial outcomes on discharge from hospital.
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MacFadgen, S. Lynne. "The Care of Irreversible Dementia Sufferers in the Toronto and Peel Regions: Perceptions of Service Providers." Canadian Journal on Aging / La Revue canadienne du vieillissement 6, no. 4 (1987): 271–89. http://dx.doi.org/10.1017/s071498080000756x.
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ABSTRACTIn this study, the system of care for 4907 irreversible dementia (ID) sufferers in Metropolitan Toronto and the Region of Peel was investigated. Mail survey data were compiled from senior administrative personnel (data include observation ratings by clinical and direct service staff) within 41 long-term care facilities, 15 acute care hospitals, and 30 community services. Consistent with the results of other descriptive studies, the findings reveal that: 1) long-term care facilities had the highest average proportion of ID sufferers; 2) the majority of ID sufferers were 75 years and older and predominantly female; and 3) ID sufferers on community service caseloads were less impaired than those in long-term care facilities. The study findings also indicate that the following factors may be important in assessing the care and management of ID sufferers within long-term care facilities and acute care hospitals: type of facility, admission criteria, arrangements for accommodation, number and nature of special programs, extent of inservice training, levels of staffing, and number and nature of family support services. In addition to these variables, the location and size of the catchment area and eligibility criteria may be important factors in similar community service assessments. The findings pertaining to the frequently used inpatient and community resources, additional resources required, and unmet needs of ID sufferers and family are discussed with respect to health care and senior support service planning and implementation within the outlined regions.
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Hammond, Gmerice, E. John Orav, Jie Zheng, Arnold M. Epstein, and Karen E. Joynt Maddox. "Changes in Racial Equity Associated With Participation in the Bundled Payments for Care Improvement Advanced Program." JAMA Network Open 5, no. 12 (December 5, 2022): e2244959. http://dx.doi.org/10.1001/jamanetworkopen.2022.44959.
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ImportanceThe Medicare alternative payment models are designed to incentivize cost reduction and quality improvement, but there are no requirements established for evaluating the outcomes of the Medicare populations.ObjectiveTo examine whether participation in the Medicare Bundled Payments for Care Improvement Advanced (BPCI-A) program was associated with narrowing or widening of Black and White racial inequities in outcomes and access.Design, Setting, and ParticipantsRetrospective cohort alternative payment models on equity and quality for disadvantaged populations were studied between April 6, 2021, and August 28, 2022, in US hospitals. Black and White Medicare beneficiaries admitted for any of the 29 inpatient conditions in the BPCI-A program between January 1, 2017, and September 31, 2019, were included.ExposuresBPCI-A participation implemented in 2018.Main Outcomes and MeasuresNinety-day readmission and mortality, healthy days at home, and proportion of Black patients hospitalized. Segmented regression models were used to examine quarterly changes in slopes for each outcome.ResultsThe sample included 6 690 336 episodes (6 019 359 White patients, 670 977 Black patients). The population comprised approximately 43% men, 57% women, 17% individuals younger than 65 years, 47% between ages 65 and 80 years, and 36% older than 80 years. Prior to implementation of the BPCI-A program, compared with episodes for White patients, Black patients had higher 90-day readmissions (36.3% vs 29.6%), similar 90-day mortality (12.3% vs 13.3%), and fewer healthy days at home (mean, 68.5 vs 69.5 days). BPCI-A participation was not associated with significant changes in the racial gap in readmissions but was associated with a greater gain in heathy days at home (differences by race, −0.07 days per quarter; 95% CI, −0.12 to −0.01 days per quarter). Among Black patients admitted to BPCI-A hospitals vs controls, healthy days at home increased by 0.09 more days/episode per quarter (95% CI, 0.02-0.17 days/episode per quarter). The proportion of Black patients decreased similarly at BPCI-A and control hospitals.Conclusions and RelevanceIn this cohort study, BPCI-A participation was not associated with improvements in racial inequities in clinical outcomes. Black patients in BPCI-A had a slight gain in healthy days at home; there were no changes in access. The findings of this study suggest that more needs to be done if payment policy reform is going to be part of the efforts to address glaring racial inequities in health care quality and outcomes. These findings support a need for payment policy reform specifically targeting equity-enhancing programs.
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Yu, Tsung-Hsien, Kuo-Piao Chung, Yu-Chi Tung, and Hsin-Yun Tsai. "Insight into Patients’ Experiences of Cancer Care in Taiwan: An Instrument Translation and Cross-Cultural Adaptation Study." International Journal of Environmental Research and Public Health 15, no. 8 (August 17, 2018): 1772. http://dx.doi.org/10.3390/ijerph15081772.
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Background: Since Taiwan launched the Cancer Prevention Act in 2003, several prevention strategies and early detection programs have been implemented to reduce the incidence, morbidity and mortality rates of cancer. However, most of the programs have concentrated on healthcare providers. Evaluations from the patient’s perspective have been lacking. Thus, in this study a cancer patient experience questionnaire was developed in the Taiwanese context and a preliminary nationwide investigation was conducted on the status of cancer care from the patient’s perspective. Methods: An extensive literature review was first conducted to collect information on the existing instruments used to measure the cancer patient’s experience. Thereafter, a multidisciplinary expert panel was convened to select an optimal instrument based on the IOM’s six domains for evaluating patient-centered care. The European Organisation for Research and Treatment of Cancer (EORTC) translation procedure was applied to the questionnaire for cross-cultural adaptation. A nationwide field test was then implemented at certificated cancer care hospitals. Results: Fifteen questionnaires were collected for the literature review. The expert panel selected the National Cancer Patient Experience Survey based on the IOM’s recommendations. After cross-cultural translation of the questionnaire, a total of 4000 questionnaires were administered in 19 certificated cancer care hospitals and two major cancer patient associations, with 1010 being returned (25.25% response rate). Most of the respondents were middle-aged, and 70% were female. The respondents reported they had a good experience with cancer care, except for “Home care and support” and “Finding out what was wrong with you”. Stratified analysis was conducted, with the results showing that the cancer patients’ experiences varied depending on their sociodemographic and cancer-related characteristics. Conclusions: A Taiwanese version of the cancer patient experience survey questionnaire was developed. Its results showed that the cancer patient’s experiences varied, depending on the patient’s age, cancer type, and cancer history. This study can be used as a basis to establish a patient-centered care model for cancer care in Taiwan.
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Peck, Blake, Daniel Terry, and Kate Kloot. "The Socioeconomic Characteristics of Childhood Injuries in Regional Victoria, Australia: What the Missing Data Tells Us." International Journal of Environmental Research and Public Health 18, no. 13 (June 30, 2021): 7005. http://dx.doi.org/10.3390/ijerph18137005.
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Background: Injury is the leading cause of death among those between 1–16 years of age in Australia. Studies have found that injury rates increase with socioeconomic disadvantage. Rural Urgent Care Centres (UCC) represent a key point of entry into the Victorian healthcare system for people living in smaller rural communities, often categorised as lower socio-economic groups. Emergency presentation data from UCCs is not routinely collated in government datasets. This study seeks to compare socioeconomic characteristics of children aged 0–14 attending a UCC to those who attend a 24-h Emergency Departments with an injury-related emergency presentation. This will inform gaps in our current understanding of the links between socioeconomic status and childhood injury in regional Victoria. Methods: A network of rural hospitals in South West Victoria, Australia provide ongoing detailed de-identified emergency presentation data as part of the Rural Acute Hospital Data Register (RAHDaR). Data from nine of these facilities was extracted and analysed for children (aged 0–14 years) with any principal injury-related diagnosis presenting between 1 February 2017 and 31 January 2020. Results: There were 10,137 injury-related emergency presentations of children aged between 0–14 years to a participating hospital. The relationship between socioeconomic status and injury was confirmed, with overall higher rates of child injury presentations from those residing in areas of Disadvantage. A large proportion (74.3%) of the children attending rural UCCs were also Disadvantaged. Contrary to previous research, the rate of injury amongst children from urban areas was significantly higher than their more rural counterparts. Conclusions: Findings support the notion that injury in Victoria differs according to socioeconomic status and suggest that targeted interventions for the reduction of injury should consider socioeconomic as well as geographical differences in the design of their programs.
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Reddy, PG Pranav. "Literature Survey for Telemedicine – Portable IoT System to Check Vitals Remotely." International Journal for Research in Applied Science and Engineering Technology 10, no. 1 (January 31, 2022): 1557–66. http://dx.doi.org/10.22214/ijraset.2022.40118.
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Abstract: IOT has been taking over every aspect of this current world. It is being implemented in various everyday things such as traffic management, smart home, agriculture, manufacturing, health care etc. IOT in health care can make the complete system much faster and save lives by reducing the quality time where health care could have been implemented. Telemedicine can be one aspect of health care which can bring great usage to a country like India. Telemedicine can bring health care remotely and even to places with no hospitals. Vitals can be captured and sent to a doctor for healthcare. Due to the remote capabilities of the system health care can be taken to places where roads don’t even go. For the development of country medical services, a few government programs have been started, however yet accessibility of value medical services for everything is as yet a fantasy, with quality and number of specialists per capita falling great beneath worldwide normal. Telemedicine as another innovation has offered extraordinary expectation in making medical care open to everything except it has not seen as more extensive acknowledgment. In this paper, we have done a broad review by visiting PHCs in various states, analyzed the existing telemedicine framework on the lookout.
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Cankurtaran, Eylem Sahin, Ibrahim Kutluer, Murat Senturk, Gulten Bircan Erzin, Devrim Gursoy, and Eray Tombak. "Psychiatric consultations for nursing home residents: a perspective from Turkey and the implications for comparable countries." International Psychogeriatrics 20, no. 4 (August 2008): 752–63. http://dx.doi.org/10.1017/s1041610207006679.
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ABSTRACTBackground: No specialized geriatric psychiatry consultation services are available for elderly people in the institutional care system in Turkey. Our aim was to evaluate psychiatric consultations among the residents of three homes for the elderly in a country with a rapidly aging population, and to investigate possible problems regarding psychiatric consultations.Methods: The residents of three homes for the elderly, which served partially as “care and rehabilitation centers” (equivalent to nursing homes), were chosen for the study. Data on the use of psychiatric services (mainly patient consultations with a visiting psychiatrist) were collected and analyzed.Results: The percentage of patients in the three homes for the elderly who had psychiatric consultations between 2005 and 2007 was 31.8% (172/540). The main reasons for referral were forgetfulness (61%), depressive symptoms (37.7%), agitation and disruptive behavior (29.6%), and psychotic symptoms (27.9%). Of these patients, 46.5% were diagnosed with dementia, 20.9% with depression, 20.5% with behavioral and psychotic symptoms of dementia, and 18.6 % with primary psychotic disorders such as schizophrenia.Conclusion: Homes for the elderly in Turkey are not adequate in terms of consultations for psychiatric problems. Integration of these institutions with hospitals and organizing routine consultation visits from the psychiatry units would enhance the mental health of the elderly. Supporting the staff, maintaining good cooperation between them, and organizing educational programs in the field of mental health of the elderly are also required.
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Montalto, Michael, Simon Shay, and Andy Le. "Evaluation of a mobile X-ray service for elderly residents of residential aged care facilities." Australian Health Review 39, no. 5 (2015): 517. http://dx.doi.org/10.1071/ah15059.
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Objective The Royal Melbourne Hospital established a mobile X-ray service (MXS) in 2013. The goal of the MXS is to address the radiology needs of frail, elderly or demented residents of residential aged care facilities (RACFs) who would otherwise require transportation to attend for X-ray. The present study describes the activity of the MXS, and the impact of the MXS on emergency department (ED) attendances by residents of RACFs. Methods The study is a descriptive study and uses a before-and-after cohort approach. Activity for the first year of operation was collected and described. At the end of the first year of operation, the top 30 RACF users of the MXS were identified. The hospital Department of Radiology database was examined to find all plain X-rays performed on any patient presenting from the same 30 RACFs for the 1 year before commencement of the MXS (1 July 2012–30 June 2013) and for the 1 year period after the commencement of the MXS (1 July 2013–30 June 2014). Attendances were compared. Results The MXS delivered 1532 service attendances to 109 different RACFs. The mean age of patients receiving MXS services was 86 years (range 16–107 years). In all, 1124 services (73.4%) were delivered to patients in high-care RACFs. Most patients (n = 634; 41.4%) were bed or wheelchair bound, followed by those who required assistance to ambulate (n = 457; 29.8%). The most common X-ray examinations performed were chest, hip and pelvis, spine and abdomen. There were 919 service attendances to the top 30 RACFs using the MXS (60.0% of all attendances). There was an 11.5% reduction in ED presentations requiring plain X-ray in the year following the commencement of the MXS (95% confidence interval 0.62–3.98; P = 0.019). Conclusion The present study suggests a reduction in hospital ED attendances for high users of the MXS. This has benefits for hospitals, patients and nursing homes. It also allows the extension of other programs designed to treat patients in their RACFs. Special rebates for home-based radiology service provision should be considered. What is already known about this subject? Digital processing has changed the way radiology delivers services. The Australian community is in the middle of a shift towards an aging population, with a greater numbers of residents in RACFs. It has been suggested in previous studies that mobile X-ray reduces the rate of delirium in patients who require X-ray. What does this paper add? There is an unmet demand for MXS to residents of RACFs. MXS may reduce presentations by elderly residents of RACFs to hospital EDs for X-rays. MXS may assist general practitioners, and other innovative programs, such as Hospital in the Home and Inreach, to better manage care for patients in RACFs. What are the implications for practitioners? Providers of radiology services should examine the opportunities and benefits of establishing MXS. Funders of services should examine ways of rebating MXS to encourage further development. Hospitals (Hospital in the Home and Inreach services), RACFs and general practitioners should use mobile X-ray and integrate these services into their management of aged care delivered in RACFs.
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Moje, Christine, Terri J. Jackson, and Peter McNair. "Adverse events in Victorian admissions for elective surgery." Australian Health Review 30, no. 3 (2006): 333. http://dx.doi.org/10.1071/ah060333.
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Objectives: To investigate a method to identify and understand patterns of adverse events by utilising secondary data analysis; to identify the types of complications associated with elective surgery; to identify any specific ?adverse eventprone? elective procedures; and to consider the implications of these patterns for hospital patient safety programs. Setting: Public hospitals in Victoria. Design: Secondary analysis of data on acute hospital admissions for elective surgery in the period 1 July 2000 to 30 June 2001, for nonobstetric patients older than 15 years (n = 177 533). Main outcome measures: Estimated rates of adverse events for the most commonly performed elective surgery procedures; frequency of the most commonly recorded adverse event types. Results: Of all admissions, 15.5% had at least one complication of care. The most frequent firstrecorded single complication code, in 9.6% of cases with a complication, was ?Haemorrhage and haematoma complicating a procedure?. The most common adverse event categories were cardiac and circulatory complications (23%), symptomatic complications (18%), and surgical and drug-related complications (17%). The procedure blocks most frequently associated with an adverse event were coronary artery bypass surgery (67%), colectomy (52%), hip and knee arthroplasty (42% and 36%, respectively), and hysterectomy (20%). The types of complications associated with the four most adverse eventprone procedures were cardiac arrhythmias, surgical adverse events (haemorrhage or laceration), intestinal obstruction, anaemia, and symptomatic complications. Conclusion: Routinely collected data are valuable in obtaining information on complication types associated with elective surgery. International Classification of Diseases codes and surgical procedure ?blocks? allow very sophisticated investigation of types of complications and differences in complication rates for different surgical approaches. The usefulness of such data relies on good documentation in the medical record, thorough coding and periodic data audit. The limitations of the method described here include the lack of follow-up after discharge, variable coding standards between institutions and over time (potentially distorting information on rates), lack of information on the causative factors for some adverse events, and a limited capacity to support investigation of particular cases. Hospitals should consider monitoring complication rates for individual elective procedures or blocks of similar procedures, and comparing adverse event rates over time and with peer hospitals as an integral part of their patient safety programs.
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Gibson, Nicole Ann, Brandi Pravecek, Linda Burdette, and LeAnn Lamb. "ANEW Project to Develop and Support Rural Primary Practice." Online Journal of Rural Nursing and Health Care 21, no. 1 (May 4, 2021): 85–99. http://dx.doi.org/10.14574/ojrnhc.v21i1.649.
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South Dakota is one of the nation’s most rural and frontier states and has the highest proportion of rural dwellers in the Midwest. Many of the state’s counties suffer from provider shortages, with nurse practitioners increasingly being called upon to fill the role of the primary care provider in clinics and critical access hospitals. However, family nurse practitioner (FNP) education programs are not required to provide the training and skills necessary to meet the unique challenges of rural practice.
An Upper Midwest land grant university prepares both masters and doctoral FNP students to fill primary care provider needs in South Dakota and the surrounding region. The purpose and scope of this two-year Advanced Nursing Education Workforce (ANEW) project was to enhance an existing academic/practice partnership to prepare primary care advanced practice registered nursing (APRN) students for practice in rural and/or underserved settings in the state and region. The ANEW project provided FNP students with a longitudinal primary care clinical traineeship experience in rural clinical settings.
Trainees benefited from traineeship funds, learning advanced procedures and skill concepts through attendance at a series of educational workshops, and job placement efforts postgraduation. The ANEW project also provided for a comprehensive preceptor development collaborative designed to enhance competence and confidence for independent rural practice and facilitate job placement in rural communities after graduation.
This project strengthened the quality of FNP education through an academic/practice partnership which resulted in a symbiotic, synergistic relationship to address rural work force supply and the identification of the knowledge and skills needed for current and future rural healthcare providers.
Keywords: family nurse practitioner, education, preceptor, academic, practice partnership, rural primary healthcare, healthcare provider shortage
DOI: https://doi.org/10.14574/ojrnhc.v21i1.649
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Gupta, Nupur, Adit B. Sanghvi, J. Ryan Bariola, John Mellors, and Rima Abdel-Massih. "612. In-Person vs Tele-Infectious Disease Care: Is One Better?" Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S366—S367. http://dx.doi.org/10.1093/ofid/ofaa439.806.
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Abstract Background Telemedicine (TM) has allowed physicians to expand beyond traditional in-person practice to provide care at remote locations. Initial performance of TM programs in ID has been reported, including favorable outcomes, but limited data exists on how inpatient Tele-ID compares to in-person.1,2 To address this gap, we analyzed data from hospitals that transitioned from in-person ID care to Tele-ID. References Methods Travel time between the 3 rural Pennsylvania hospitals (total 432 inpatient beds) by car is 1 hour 40 minutes. All in-person consults were provided by an independent ID physician who traveled daily between sites. Starting July 2018, all consults were provided by Tele-ID consisting of one full-time equivalent physician. This included live audio-video visits and e-consults. Data were extracted from electronic health record; between 1/1/2018-6/30/2018 for in-person and 7/1/2018-12/30/2018 for Tele-ID. Key outcomes assessed were number of initial encounters, length of stay (LOS) after ID consult, proportions of patients discharged home, transferred to tertiary centers, and ID related readmission at 30 days. Results Study population consisted of 642 encounters with majority being Caucasian, female and average age 67 years (Table 1). Tele-ID had higher comorbidity scores vs in-person ID (Table 1). Total encounters were significantly greater for Tele-ID than in-person ID (Table 2; p=0.018). LOS after ID consult, transfers to tertiary centers, readmissions at 30 days, and discharges home were similar between the two groups (Table 2). Most common diagnosis was “bacteremia;” notably Tele-ID made a broader range of diagnosis (Figure 1). Limitations include a small sample size and possibility of a temporal bias, although the patient characteristics were similar except for higher co-morbidity for the Tele-ID service. Conclusion This comparative study shows that patient outcomes are similar between in-person and Tele-ID, despite higher volume and complexity encountered by Tele-ID. The greater number of consults and broader range of diagnosis made by Tele-ID suggests greater productivity, possibly related to travel time elimination. Tele-ID appears to be a good alternative solution for rural locations that lack in-person access to ID care. Disclosures J. Ryan Bariola, MD, Infectious Disease Connect (Employee)Mayne Pharma (Advisor or Review Panel member)Merck (Research Grant or Support) John Mellors, MD, Abound Bio (Shareholder)Accelevir Diagnostics (Consultant)Co-Crystal Pharmaceuticals (Shareholder)Gilead (Consultant, Grant/Research Support)Merck (Consultant) Rima Abdel-Massih, MD, Infectious Disease Connect (Shareholder, Other Financial or Material Support, Chief Medical Officer)