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Results for “Transitional Care”

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At least 307 records · Page 17Linked to original sources
PubMed2003

Understanding the role of health care providers during the transition of adolescents with disabilities and special health care needs.

PURPOSE: To evaluate the role of health care providers in the transition from pediatric to adult health care for adolescents with disabilities and special health care needs (SHCN) from both the families' and providers' perspectives. METHODS: A total of 753 parents of adolescents with SHCN (e.g. developmental, physical, behavioral/emotional, learning, or health-related disabilities) were surveyed by questionnaire to assess their perceptions of their health care provider's level of involvement in various transition activities and the extent to which they felt it was the provider's responsibility to assist in a particular activity. One hundred forty-one health care providers (primarily pediatricians) completed a parallel survey to assess their level of participation in the same transition activities and the extent to which they felt it was their responsibility to assist with each transition activity. The questionnaire listed 13 different transition activities health providers may engage in to help young people prepare for adulthood and also asked questions about areas such as employment and health insurance. To investigate whether parents and providers share the same views regarding the involvement and responsibility of providers across the 13 transition activities, two sets of Student's t-tests were calculated. RESULTS: There were significant differences between providers and parents concerning both the level of provider involvement and the extent to which it was the provider's responsibility to assist in various transition activities (e.g., health providers reported significantly more involvement than did parents for 11 of the 13 transition activities and, compared with parents, providers reported that it was more within their role to assist in these 11 transition activities). CONCLUSIONS: The findings suggest a need for health care providers and parents to have open discussions about the nature and extent to which providers assist families in key transition activities.

Adolescent↗
PubMed1997

Admission to care: facilitating role transition amongst family carers.

Admission to care after a period of family care-giving has been the focus of much recent research. Rather than being seen as an end in itself, admission is part of a process. This article concentrates on 'reaching the end' of family care-giving and the 'new beginning' of entering residential care. A cross-national study conducted in the USA and the UK is discussed, and similarities and differences in the two cultures are highlighted. Decisions to enter a nursing home were often taken hurriedly and with lack of information in both countries. Issues of quality of care and emotional responses by former carers were also important in both settings.

Aged↗
PubMed1998

[Organization of health care and health protection in the transitional phase of health care reform and under new legal regulations].

In Federation of Bosnia and Hercegovina, Health Reform is brought up, dictated after newly created post-war policy; fundamental laws in health are brought up, and changes in constitutional sense, brought the country in the phase of transition. Organization of health protection and health business had many disadvantages, what impacted its realisation in direction of satisfying needs and requirement of the population. This paper-work tries to connect existing situation and practice in organization of health care and health business, by using relevant rules which were not adequately and completely realised, and were without possibility of evaluation. The paper tries, by using new Law regulations in Health and Reform to come, to offer organizational solutions which could be more acceptable and realisable in this transitional period.

Bosnia and Herzegovina↗
PubMed1997

Cardiac surgical patients' telephone calls use of a decision-making algorithm.

CARDIAC SURGERY, ALTHOUGH becoming relatively common, still poses a significant life stress for patients. As a result of managed care contracting, length of stay has decreased to an average of 4-6 days. The Transitional Care Model was the framework used in identifying a way to bridge the gap between home and hospital. Providing patients with the unit's telephone number and encouraging them to call with questions was the means established toward this end. Algorithms were developed around the seven most frequently occurring problems so that nurses would be able to offer interventions consistent with our program. Approximately 300 telephone calls have been logged in annually. Weekly review of the log revealed compliance with the algorithms and appropriate recommendations made by nurses.

Algorithms↗
PubMed2002

Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes.

Admission hyperglycemia has been associated with increased hospital mortality in critically ill patients; however, it is not known whether hyperglycemia in patients admitted to general hospital wards is associated with poor outcome. The aim of this study was to determine the prevalence of in-hospital hyperglycemia and determine the survival and functional outcome of patients with hyperglycemia with and without a history of diabetes. We reviewed the medical records of 2030 consecutive adult patients admitted to Georgia Baptist Medical Center, a community teaching hospital in downtown Atlanta, GA, from July 1, 1998, to October 20, 1998. New hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dl (7 mmol/liter) or more or a random blood glucose level of 200 mg/dl (11.1 mmol/liter) or more on 2 or more determinations. Hyperglycemia was present in 38% of patients admitted to the hospital, of whom 26% had a known history of diabetes, and 12% had no history of diabetes before the admission. Newly discovered hyperglycemia was associated with higher in-hospital mortality rate (16%) compared with those patients with a prior history of diabetes (3%) and subjects with normoglycemia (1.7%; both P < 0.01). In addition, new hyperglycemic patients had a longer length of hospital stay, a higher admission rate to an intensive care unit, and were less likely to be discharged to home, frequently requiring transfer to a transitional care unit or nursing home facility. Our results indicate that in-hospital hyperglycemia is a common finding and represents an important marker of poor clinical outcome and mortality in patients with and without a history of diabetes. Patients with newly diagnosed hyperglycemia had a significantly higher mortality rate and a lower functional outcome than patients with a known history of diabetes or normoglycemia.

Blood Glucose↗
PubMed2004

Communication about the ending of anticancer treatment and transition to palliative care.

BACKGROUND: Communication about the ending of anticancer treatment and transition to palliative care is a difficult task for oncologists. The primary aims of this study were to clarify family-reported degree of emotional distress and the necessity for improvement in communication methods when communicating about the ending of anticancer treatment, and to identify factors contributing to the levels of emotional distress and the necessity for improvement. METHODS: A multi-center questionnaire survey was conducted on 630 bereaved family members of cancer patents who received specialized palliative care in Japan. A total of 318 responses were analyzed (effective response rate, 62%). RESULTS: Thirty-nine percent of the bereaved family members reported that they were 'very distressed' in receiving information about the ending of anticancer treatment, and 19% reported 'considerable' or 'much' improvement was necessary in the communication methods. High-level emotional distress was significantly associated with younger patient age, female family gender, the experience of the physician stating she/he could do nothing for the patient, the physician's unwillingness to explore their feelings, and prognostic disclosure of definite survival periods without probabilities or ranges. High levels of perceived necessity for improvement in the communication methods were significantly associated with the experience of the physician stating she/he could do nothing for the patient, physicians not explaining treatment goals in specific terms, physicians not pacing the explanation with the state of family preparation, physicians not being knowledgeable about the most advanced treatments, and the atmosphere not being relaxing enough to ask questions. CONCLUSIONS: In receiving the information about ending anticancer treatment, a considerable number of families experienced high levels of emotional distress and felt a need for improvement of the communication methods. The strategies to alleviate family distress could include: (i) assuring that physicians will do their best to achieve specific goals, without saying that they can do nothing for the patient; (ii) providing information, including estimated prognosis, in careful consideration of families' preparation and the uncertainty for each patient; (iii) exploring families' emotions and providing emotional support; (iv) acquiring knowledge about advanced treatments; and (v) making the atmosphere relaxing enough to allow families to ask questions.

Aged↗
PubMedDate not supplied

Converting case managers from MD/service to unit-based assignments: a before and after comparison.

An ongoing dilemma in acute care case management is whether to assign case managers to a unit or MD/Service-based assignment. There are strong logical arguments to be made on both sides of the decision. There are also strong political reasons why organizations opt for one or the other. This article describes one hospital's rationale and experience in converting from care manager assignments made on the basis of partnering with the MDs/Service, to serving both the point of care nursing unit and the physicians. Of note, the unit-based assignment structure has (1) saved 90 min a day in each care manager's time; (2) allowed care managers to help nursing better plan, pace, and trace care; (3) helped the hospital accommodate a 9% increase in admissions with an additional 140 more referrals to the Transitional Care Unit; and (4) ensured the consistent management of the observation level of care.

Attitude of Health Personnel↗
PubMed1989

Developing a program grant for use in model testing.

Early discharge is becoming a practice as well as a goal for the acute care institution. It is essential that nursing investigate the effects of this shift in the care delivery site from the acute care institution to the home and community. Brooten et al. describe a research model designed to do just that. Transitional care, as this team calls it, may soon become familiar jargon in community health care.

Clinical Nursing Research↗
PubMedDate not supplied

Taking the pulse of health care systems: experiences of patients with health problems in six countries.

This paper reports on a 2005 survey of sicker adults in Australia, Canada, Germany, New Zealand, the United Kingdom, and the United States. Sizable shares of patients in all six countries report safety risks, poor care coordination, and deficiencies in care for chronic conditions. Majorities in all countries report that mistakes occurred outside the hospital. The United States often stands out for inefficient care and errors and is an outlier on access/cost barriers. Yet no country consistently leads or lags across survey domains. Deficiencies in transition care during hospital discharge and coordination failures among patients seeing multiple physicians underscore shared challenges of improving performance across sites of care.

Delivery of Health Care↗
PubMed1993

Issues of transition to adult care.

A survey was carried out on adolescents with insulin dependent diabetes mellitus, aged 15 to 18 years, to elicit their views on the process of transfer from paediatric to adult care. The survey provided information on what they expected from a health service during this period of their life, their views on the role of specialist physicians and other health professionals and their preferred age for transfer from a paediatric to an adult service. Young people value continuity of care by a physician whom they trust. They expect confidentiality and privacy, some degree of informality and optimal waiting room conditions when they attend for consultation. Almost all suggested that transfer of care should be after the age of 17 years. An understanding of the views and expectations of young people with a chronic illness such as diabetes should assist those who are responsible for the development of health care. It is recommended that transition services for young people with a chronic illness be developed at those children's and adult hospitals that provide specialist care for them.

Adolescent↗
PubMed2002

"Oh, that's a bit of a nuisance": community-dwelling clients ' perspectives of urinary continence health service provision.

OBJECTIVE: This study explored clients' perspectives of urinary continence service provision for community-dwelling people from a primary health care perspective. DESIGN: For this interpretive study, data were collected from 11 clients via in-depth interviews and a questionnaire eliciting demographic details and written comment. A focus group was also held with 7 people belonging to an existing continence self-help group. RESULTS: Clients indicated that appropriate and acceptable continence care was accessible, affordable, and based on accurate knowledge. They valued practitioners who were empathetic, interested, had good networks, and could assist in practical ways. They looked for explanation, information, and discussion, often finding this when they accessed continence specialists. However, they often found it difficult to access this type of care, with many clients finding that urinary incontinence was treated as a secondary issue or a nuisance by generalist health practitioners. Clients believed that many health practitioners lacked knowledge and/or interest in urinary incontinence. In particular, there was very poor transitional care between hospital and community. The cost of consulting a health practitioner was seen as secondary to the cost of continence equipment and aids. CONCLUSIONS: This study found that the principles of primary health care were not being realized in generalist continence care. Client- centered services that address individual needs, relationships, psychological factors, emotional needs, financial circumstances, social contexts, and lifestyle factors, particularly in transition between sectors, are needed.

Adolescent↗
PubMed1990

Life beyond pediatrics. Transition of chronically ill adolescents from pediatric to adult health care systems.

Transition from pediatric to adult health care is fraught with difficulties. On the one hand, the adult care system is not properly prepared to receive patients who are survivors of the so-called childhood disorders. On the other hand, patients and families have difficulty leaving the protective environment created by pediatric caregivers, who in turn may have mixed feelings about letting the patients go. Normalization of development and social adaptation for chronically ill adolescents, however, should include a change in the environment in which health care is received. This article examines some of the issues surrounding transition and transfer from pediatric to adult health care systems and propose some avenues toward implementation of such programs.

Adolescent↗
PubMed1998

Medicaid's transition into managed care. Real or imaginary?

Medicaid provides health coverage for America's poorest citizens. The number of persons enrolled in Medicaid represents 15% of America's population. The percentage of the Medicaid population in managed-care organisations has risen from 8% in 1990 to 50% in 1996. However, only 8% of the Medicaid programme expenditures on pharmaceuticals is directed to the 50% of the Medicaid population in managed care. Furthermore, more than half of this 8% occurs in loosely organised managed-care organisations that do not have formularies or other significant restrictions on pharmaceutical utilisation generally found in health maintenance organisations. The reason that a larger proportion of Medicaid programme expenditures does not occur in managed-care organisations relates to the difficulty of enrolling the elderly and disabled in such organisations. Barring significant new Federal legislative changes, less than 24% of Medicaid programme expenditures will be in managed-care organisations by the year 2000. Medicaid's transition into managed care is therefore more imaginary than real when one focuses on expenditures.

Health Maintenance Organizations↗