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Results for “Transitional Care”

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At least 379 records · Page 21Linked to original sources

PubMed2006

Older adults discharged from the hospital with delirium: 1-year outcomes.

OBJECTIVES: To compare 1-year institutionalization and mortality rates of patients who were delirious at discharge, patients whose delirium resolved by discharge, and patients who were never delirious in the hospital. DESIGN: Secondary analysis of prospective cohort data from the Delirium Prevention Trial. SETTING: General medicine service at Yale New Haven Hospital, March 25, 1995, through March 18, 1998, with follow-up interviews completed in 2000. PARTICIPANTS: Four hundred thirty-three patients aged 70 and older who were not delirious at admission. MEASUREMENTS: Patients underwent daily assessments of delirium from admission to discharge using the Confusion Assessment Method. Nursing home placement and mortality were determined at 1-year follow up. RESULTS: Of the 433 study patients, 24 (5.5%) had delirium at discharge, 31 (7.2%) had delirium that resolved during hospitalization, and 378 (87.3%) were never delirious. After 1 year of follow-up, 20 of 24 (83.3%) patients discharged with delirium, 21 of 31 (67.7%) patients whose delirium resolved, and 157 of 378 (41.5%) patients who were never delirious were admitted to a nursing home or died. Compared with patients who were never delirious, patients with delirium at discharge had a multivariable adjusted hazard ratio (HR) of 2.64 (95% confidence interval (CI)=1.60-4.35) for nursing home placement or mortality, whereas resolved cases had a HR of 1.53 (95% CI=0.96-2.43). CONCLUSION: Delirium at discharge is associated with a high rate of nursing home placement and mortality over a 1-year follow-up period. Interventions to increase detection of delirium and improvements in transitional care may help reduce these negative outcomes.

Aged↗

PubMed1996

Relationships between the perceived impact of gestational diabetes mellitus and treatment adherence.

OBJECTIVE: To examine the relationship between women's perceptions of the impact of the diagnosis and treatment of gestational diabetes mellitus and treatment adherence. DESIGN: Longitudinal and prospective, extending from the time of diagnosis of gestational diabetes mellitus through delivery. SETTING: An urban university-based tertiary perinatal center in Philadelphia. PARTICIPANTS: A subsample of women enrolled in a larger study of early discharge and nurse specialist transitional care. The 29 women in the sample met the study criteria of diagnosis with gestational diabetes mellitus, English speaking, less than 36 weeks gestation, and telephone access at home. MAIN OUTCOME MEASURE: Perceived impact of gestational diabetes mellitus was measured with the Impact of Event Scale. Treatment adherence included the percentage of recommended blood glucose self-monitoring, incidence of hypo- and hyperglycemia, obstetric visits kept, and dietary adherence. RESULTS: Descriptive and correlational analyses were used. Negative correlations between impact and blood glucose self-monitoring (r = -.38, p = .04) and impact and hypoglycemia (r = -.31, p = .10) were found. Positive correlation between obstetric visits and blood glucose self-monitoring (r = .34, p = .07) was found. CONCLUSIONS: Women who perceive gestational diabetes mellitus to have a great impact on their lives may be less adherent to the behavioral tasks that can influence blood glucose control, potentially increasing risk.

Adolescent↗

PubMedDate not supplied

Developing a unit-specific falls reduction program.

Though an extensive amount of literature addresses the significance of patient falls and mechanisms to identify those at high risk, much less has been written regarding units in which nearly every patient fits the high-risk category. In addition, little information describes specific interventions designed to protect at-risk patients. In response to a record number of falls in the Transitional Care Unit at an acute care facility, an interdisciplinary team was developed to review patient falls, design a unit-specific falls reduction program, and begin its implementation. In the subsequent 6 quarters, the number of patient falls was reduced by 57%.

Accidental Falls↗

PubMed1991

Evaluation of a diagnostic algorithm for heart disease in neonates.

OBJECTIVE: To develop, test, and validate an algorithm for diagnosing disease in neonates during an over the telephone referral to a specialist cardiac centre. DESIGN: A draft algorithm requiring only data available to a referring paediatrician was generated. This was modified in the light of a retrospective review of case records. A questionnaire to elicit all the data required by the algorithm was then generated. There followed a prospective three phase evaluation during consecutive over the telephone referrals. This consisted of (a) a conventional phase with unstructured referral consultations, (b) a phase with referrals structured around the questionnaire but independent of the algorithm, and (c) a validation phase with the algorithm (and its previous errors) available during the referral consultation. SETTING: 59 paediatric centres in south east England and a central specialist paediatric cardiology unit. PATIENTS: Consecutive neonates (aged less than 31 days) referred with suspected heart disease. The retrospective review was of records of 174 neonates from 1979. In the prospective evaluation (1987-90) the conventional phase comprised 71 neonates (over 5.5 months), the structured phase 203 neonates (over 14 months), and the validation phase 195 neonates (over 12 months). MAIN OUTCOME MEASURES: Diagnostic accuracy (assigning patients to the correct diagnostic category (out of 27)), of the referring paediatrician, the specialist after the referral consultation, and the algorithm as compared with the definitive diagnosis by echocardiography at the specialist centre, and score for the appropriateness of management in transit. RESULTS: Simply structuring the consultation by questionnaire (that is, proceeding from the conventional phase to the structured phase) improved the diagnostic accuracy of both paediatricians (from 34% (24/71 cases) to 48% (97/203) correct) and specialists (from 54% (38/71 cases) to 64% (130/203) correct). The algorithm (structured phase) would have been even more accurate (78% (158/203 cases); p less than 0.01). Management scores in the structured phase were also better than in the conventional phase (80%(162/203 cases)v 58% (41/71) appropriate; p less than 0.01). Management scores would have improved to 91% appropriate (185/203; p less than 0.001) had the algorithmic diagnoses dictated management. The superiority of the algorithm was maintained but not bettered in the validation phase. CONCLUSIONS: Applying the algorithm should reduce the morbidity and mortality of neonates with critical heart disease by aiding clinicians in therapeutic decisions for in transit care.

Algorithms↗

PubMed2000

Community Participation in Nutrition Communication: Models and Linkage Systems for Management.

New models of community participation, nutrition communication, and management linkages have been proposed. Changes in the health care sector have forced a major restructuring of facilities and a shifting of focus from traditional institution-based health care to a more community-based delivery of services, and from treatment to health promotion and disease prevention. These changes have also led to a redefinition of community clients and a review of the social processes whereby community members can participate actively in their health care. Challenges for health and nutrition professionals are to create manageable environments for meaningful dialogues, and to communicate action-oriented nutrition messages that reflect the community's values and realities. Some theories on learning and behaviour change can be applied to and aid in nutrition communication. At the same time, facilitators of and barriers to community participation in nutrition communication programs must be identified and addressed. In addition, during this time of health care transition, dietitians and nutritionists must position themselves as leaders in health and nutrition communication so that the community will act on their messages. Partnerships or linkages between organizations at the local, national, and international levels can assist in the effective delivery of nutrition information.

Journal Article↗

PubMedDate not supplied

Reporting outcomes for stage IV pressure ulcer healing: a proposal.

OBJECTIVES: To calculate the average daily healing rate for Stage IV pressure ulcers. To create and analyze wound healing curves. DESIGN: Retrospective analysis of healing rates of Stage IV pressure ulcers. SETTING: Veterans Affairs Transitional Care Unit at the VA North Texas Health Care System. PARTICIPANTS: Nine residents with pelvic Stage IV pressure ulcers that were fully healed. INTERVENTIONS: A sodium chloride-impregnated gauze or calcium alginate was the primary dressing, followed by a hydrocolloid or foam dressing. Eschar was removed by sharp, mechanical debridement, and fibrous necrotic tissue was removed with wet-to-dry dressings. MAIN OUTCOME MEASURES: Wounds were measured weekly using linear length and width in centimeters; measurements were multiplied to obtain wound area. The end of treatment was considered to be full epithelialization of the wound. RESULTS: Wound area reduction in square centimeters per day generally increased as initial wound area increased. However, the reduction in pressure ulcer area did not occur at a strict linear rate. The wound healing curves demonstrated the granulation, contraction, and epithelialization phases of wound healing. CONCLUSIONS: Calculation of an average daily healing rate is a useful method for determining pressure ulcer healing outcomes. Averaging together wound healing curves would enable health care providers to more accurately predict future healing times and quickly assess delays in healing. A standardized method for reporting healing rates would also help establish a baseline rate of pressure ulcer healing.

Aged↗

PubMedDate not supplied

Coagulase-negative Staphylococcus bacteremia--a rising threat in the newborn infant.

Based on a three year surveillance in the neonatal intensive and transitional care nurseries (NICU) at the Hospital of the University of Pennsylvania (HUP), an analysis of all cases of nosocomial bacteremia was made. From January 1982 to September 1984, a total of 57 nosocomial bacteremic episodes were identified. This gave a rate of 3.6 episodes per 100 NICU admissions or 6.5 per 1000 live hospital births. While coagulase-negative staphylococci (CNS) accounted for approximately 40 percent of all positive blood cultures, it was responsible for 73 and 66 percent of the nosocomial bacteremias in 1982 and 1983, respectively. In 1984, coagulase-negative staphylococcus was the responsible pathogen for 92 percent of all nosocomial bacteremic episodes. Of 139 infants weighing less than or equal to 1250 g at birth, 30 (22 percent) developed CNS bacteremia. The risk of coagulase-negative staphylococcus bacteremia was associated with low birth weight, respiratory distress, prolonged hyperalimentation, and multiple supportive measures. Infants were treated with vancomycin hydrochloride, as most of the CNS were resistant to methicillin and/or gentamicin. There were no deaths related to coagulase-negative staphylococcal septicemia.

Coagulase↗

PubMed1993

Nosocomial adenovirus infection: molecular epidemiology of an outbreak.

Nosocomial transmission of adenovirus type 3 associated with fatalities in infants has not been frequently reported. This report describes the nosocomial spread of adenovirus types 2 and 3 among infants with bronchopulmonary dysplasia in a chronic (transitional) care facility. The index case developed pneumonia with a clinical deterioration in respiratory status 8 days after admission. Within the next 10 to 30 days 9 other infants and 2 health care personnel became ill with respiratory symptoms. Three of these 10 infants had progressive respiratory failure and 2 of them died. All of these infants had underlying chronic lung disease of bronchopulmonary dysplasia. The overall attack rate was 30% (10 of 33). Further spread of adenovirus was prevented by using barrier precautions and masks while performing tracheostomy care. Adenovirus isolates were serotyped as Ad3 in 4 patients and 1 staff member, as Ad2 in 3 patients, and as a combination of Ad2 and Ad3 in 1 patient. Two fatalities were associated with Ad3 infection. Three isolates from 2 patients and 1 staff member were not available for typing. Restriction endonuclease analysis was performed on all of these isolates of Ad3 and Ad2. There was no genetic heterogeneity in the isolates, suggesting a common source.

Adenovirus Infections, Human↗

PubMedDate not supplied

Frequency, timing, and diagnoses of antenatal hospitalizations in women with high-risk pregnancies.

OBJECTIVE: To examine the frequency, time of gestation, and reasons for antenatal hospitalizations in women with medically high-risk pregnancies. STUDY DESIGN: This secondary analysis reports all antenatal hospitalizations from a clinical trial testing transitional care to women with high-risk pregnancies. Data were collected from 1992 to 1996. Pregnant women with pregestational (n = 16) or gestational diabetes (n = 21), hypertension (n = 29), and diagnosed (n = 47) or at high risk for preterm labor (n = 37) were included. Diagnoses for each hospitalization and lengths of stay were collected from chart review and validated by attending physicians. Gestation was determined via ultrasonography. The sample (N = 150) consisted of predominantly African-American women, never married, between the ages of 15 and 40 with Medicaid insurance. RESULTS: Eighty-three percent (n = 125) of the women had one or more antenatal hospitalization with a mean length of stay of 123 hours. All women with diabetes were hospitalized at least once. Women with pregestational diabetes had the greatest number of hospitalizations whereas those with gestational diabetes had the least. Major reasons for hospitalizations were preterm labor, glucose control, premature cervical dilation, and preeclampsia. CONCLUSION: Some hospitalizations could potentially be avoided or reduced through expanded patient education, improved screening, and more aggressive monitoring for early signs and symptoms of impending complications.

Adult↗

PubMed1998

Gaining strength: supplements revised.

Responding to concerns for weight loss and nutritional status of its patients, a Transitional Care Unit (TCU) began an intensive Medication Pass Supplement Program. It involves nurses administering a dietitian-reviewed and approved nutritional supplement for specified residents with every medication pass. As a result, 94% of discharged patients lost less than 5% of their admission weight.

Dietary Supplements↗

PubMed2006

The experience of role transition in acute care nurse practitioners in Taiwan under the collaborative practice model.

The role of the acute care nurse practitioner in Taiwan has changed significantly since the 1990s due in significant part to a shortage of interns and resident physicians in acute care settings. The first year of professional practice represents an important transitional year during which new professionals develop their competency to provide high-quality care to hospitalized patients. As the actual experience of individuals undergoing this transitional process into their new role has yet to be fully explored, this research studied and categorized the experiences of acute care nurse practitioners during their first year of role transition under the collaborative model of practice. We used a qualitative inquiry method with in-depth interviews to investigate the relevant experiences of 10 acute care nurse practitioners working at a medical center in Taiwan. Results show that the experience of expert nurses in their transition to acute care nurse practitioners passed through three phases during the first year under the collaborative practice model. These phases include the role ambiguity, role acquisition, and role implementation phases. Each phase contained a set of sub-themes which describe the multiple dimensions of this experience. This study highlights the experiences, stresses and accomplishments of acute care nurse practitioners during their initial year of advanced practice.

Acute Disease↗

PubMed2001

The experience of transition to palliative care services: perspectives of patients and nurses.

The care of patients whose illnesses cannot be cured places many stresses on health professionals (both generalist and specialist), and more importantly on patients and families. The complexities for all concerned in the process of referral to palliative care services should not be underestimated, however there is evidence that the referral process could be better handled by all health professionals. With greater understanding of the dynamics of care, the crisis of living with an incurable illness and dying can be lessened for patients. This article reports on a qualitative research project undertaken at a large metropolitan palliative care service and its referring public hospital. Patients and nurses were interviewed to identify issues relating to the care of patients and families newly referred to palliative care. The findings of this research identify themes in relation to the transition of patients from acute curative to palliative care services, e.g. pace and timing of the transition, fear and (mis)understanding, accepting palliative care, information and education on palliative care, and peer support and supervision for palliative care nurses.

Adult↗

PubMed1993

The transition from quality assurance to continuous quality improvement in ambulatory care.

The transition of quality assurance to continuous quality improvement (CQI) in ambulatory care organizations requires careful planning and consideration of efficiency. Ambulatory care organizations must maintain indicators to measure activities, sample the multiple encounters of ambulatory care, and truly change their internal culture. This article provides practical information that persons involved in quality management can use to plan CQI processes in ambulatory care.

Ambulatory Care↗

PubMed2003

Perspectives of patients with cystic fibrosis on preventive counseling and transition to adult care.

The purpose of this study was to investigate how adolescents and adults with cystic fibrosis (CF) view preventive counseling and their transition to adult-centered care within a children's hospital. Thirty-two patients >/=16 years old diagnosed with CF were recruited from a pediatric tertiary care setting. During face-to-face interviews, patients were asked 27 structured questions and completed a 30-item self-administered questionnaire on preventive counseling by healthcare providers and on transition issues. The median age of patients was 25.5 years (range, 16-43 years); 69% of patients identified a pulmonologist as their "main doctor," even though 78% had a primary care provider. Participants felt that 13-16 years of age was the best time for them to begin spending time alone with their main doctor. Less than half of the participants recalled receiving preventive counseling during the previous 12 months, and more patients wanted to discuss issues than actually did. Qualitative data emphasized the importance of independence in making decisions in healthcare and establishing relationships with providers, and many patients did not desire to transfer care to an adult hospital. Participants identified adult-focused services such as inpatient rooms, discussion groups, work options, and social service support that would enhance care. In conclusion, the majority of adolescent/young adult patients with CF receiving care in a pediatric institution reported satisfaction with their healthcare. However, patients identified preventive issues that they desired to be more regularly addressed, starting in early adolescence, and changes in the delivery of services to enhance transition to adult-oriented care. This study underscored the understanding of the integration of transition planning into the facilitation of healthcare decision-making by the adolescent in issues of self-care, sexuality, education, and finances. Future initiatives to enhance the care of patients with CF should provide training of pulmonologists in preventive care and increased attention to helping patients utilize appropriate primary-care services during the adult years. In addition, prospective studies are needed to compare outcomes of CF patients who have transitioned and transferred to adult hospitals and those transitioning to adult-oriented services in a pediatric institution.

Adolescent↗

PubMed2006

[Transition in health care from youth to adulthood for disabled people].

Most children born with a chronic health condition or disability are expected to live more than 20 years. Health care is provided for these children in paediatric units until they are 18 years old, and the transition to the adult health care system is difficult because of poor collaboration between specialists and families who sometimes wonder if the adult specialist will be competent, although young disabled people need specialised follow-up. This report discusses U.S. and English models in the transition in health care. Coordination between paediatricians and adult services is necessary. The neuromuscular disorders clinic is cited as an example.

Adolescent↗

PubMed2005

Consensus statement on the management of the GH-treated adolescent in the transition to adult care.

The European Society for Paediatric Endocrinology held a consensus workshop in Manchester, UK in December 2003 to discuss issues relating to the care of GH-treated patients in the transition from paediatric to adult life. Clinicians experienced in the care of paediatric and adult patients on GH treatment, from a wide range of countries, as well as medical representatives from the pharmaceutical manufacturers of GH participated.

Adolescent↗

PubMed1998

The health care reform in Italy: transition or turmoil.

Health care reform in Italy is transforming its centrally planned, vertically integrated National Health Service into a market-oriented system in which public funders contract directly with individual providers. A model is envisaged in which a plurality of public and private care providers compete for contracts with capitated health agencies responsible for assuring uniform levels of services for geographically defined populations. The ultimate goal of the reform is to guarantee universal coverage and secure global spending limits while, at the same time, promoting efficiency in the delivery of care and enhancing responsiveness to consumers. The emphasis upon incentives for the individual provider which will be introduced should, however, be considered against the quest for equity in health care which was the central tenet of the 1978 reform and is yet to be attained. The fragmentation of the National Health Service into many separate, competing delivery units might well damage the ability to plan strategically for addressing the substantial inequities in health status, health care utilization, and health service availability which still exist across the country. Competition between a plurality of providers and fee-for-service payment schemes add additional concerns about unnecessary care and supplier-induced demand. It creates the need for developing rules to make competition manageable and providing sound clinical and financial information that make enforcement possible. The poor record scored in managing the contractual relationships between the LHUs and the strong private health sector suggests that massive investment in promoting managerial skills and developing appropriate clinical and financial information systems are required. Careful experimentation in implementing the reform and continuous monitoring of its impact on the health care system are, therefore, the imperatives of the next two years.

Capitation Fee↗

PubMed1997

Closer to home (or home alone?) The British Columbia long-term care system in transition.

Finding ways to organize and deliver long-term care that provides for quality of life at an affordable price is of increasing importance as the population ages, family size decreases, and women enter the workforce. For the past 2 decades, British Columbia has provided a model system that has apparently avoided disruptive conflicts. Although formal users' complaints are rare, this study--based on focus groups and interviews with users, their families, and advocates--identified problems users encountered toward resolving concerns about the structure, process, and outcome of long-term care. We present these findings in the context of British Columbia's current devolution from provincial to regional control that aims to save costs and keep disabled elderly persons in the community. British Columbia may be continuing to lead the way in meeting the needs of its burgeoning elderly population for long-term care. Study findings have implications for the development of US long-term care policy by pointing to the value of obtaining users' views of long-term care to identify both obvious and more subtle trouble spots.

Aged↗