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Social work with transport disabled persons: a wayfinding perspective in health care.

Transport disabled persons confront extensive architectural and psychosocial barriers during their travel to community based health care services by mass transit. The current health care reform movement affords social work an opportunity to consolidate its expertise with this population. The Certificate of Need program is a method with which social work can provide service to people with transportation disabilities. Social work can also continue its use of the Americans with Disabilities Act and the Urban Mass Transportation Act to assist people with transport disabilities to access community based health care services.

Delivery of Health Care↗

The electronic immediate discharge document: experience from the South West of Scotland.

BACKGROUND: Communication and transfer of information between healthcare professionals are essential to a seamless healthcare process, and are vital for ensuring that there is smooth transition of care for patients. Throughout the National Health Service (NHS) Scotland, there is a wide variability in the quality and quantity of information provided in the immediate discharge document (IDD). AIMS: To analyse general practitioner (GP) attitudes and responses on the quality and efficacy of an electronic IDD (e-IDD). SETTING: All GPs in Dumfries and Galloway. METHODS: GPs communicating electronically with the hospital were sent a survey questionnaire at the end of an 18-month pilot. An amended questionnaire surveying potential interest was sent to the remaining GPs in the region. RESULTS: The overall response rate was 70%. Eighty-one percent of practices connected received the e-IDD regularly, but the majority still used it in conjunction with its postal equivalent. Seventy percent complained of inadequacies in content relating to medication and follow-up information. Eighty percent agreed that it was faster and 68% felt significant cost savings could be made. Eighty-eight percent wanted a multidisciplinary input. Concerns were raised about funding, need for adequate training and back-up systems. Ninety-six percent were optimistic that in future other forms of clinical communications could be sent electronically. CONCLUSION: Discharge content is more important than delivery method. Emphasis should be placed on ensuring standards are met on the quality and quantity of current e-discharge documents. Further clarification is required on patient confidentiality issues and legal validity of electronic patient records. E-health is to play a larger and ever-increasing role in the NHS in Scotland.

Attitude to Computers↗

Managing depressed patients with comorbidities and dual-eligibility benefit status.

OBJECTIVE: To discuss the challenges and requirements in developing and implementing strategies for the appropriate management of depression in a subpopulation of dual-eligible patients with comorbidities. SUMMARY: Treating patients with comorbidities who are dually eligible for Medicare and Medicaid services is challenging. In this vulnerable population, condition management strategies should address new patient cost-sharing responsibilities, improve or minimize the disruptions in access to medications, monitor for potential adherence issues, and, most importantly, strive to maintain, if not improve, overall health outcomes. Complicating these essential strategies are concerns about defining who is responsible for providing treatment to dual-eligible patients and the potential loss of vital services at various levels, including transition of care or the possible discontinuation of or severe limitations on reimbursement for key services. CONCLUSION: Condition management strategies should be developed to deal with the unique needs of the dual-eligible population to ensure continuity of care. Additionally, an organizational infrastructure is necessary to give providers useful tools to help them deliver better-coordinated care to the dual-eligible population that struggles with depression.

Comorbidity↗

Pathophysiology of neonatal respiratory distress syndrome: implications for early treatment strategies.

Neonatal respiratory distress syndrome (RDS) remains one of the major causes of neonatal mortality and morbidity despite advances in perinatal care. The initial management of infants with RDS has almost become 'too routine' with little thought about the pathophysiological processes that lead to the disease and how the clinician can use the existing therapeutic interventions to optimize care. The transition from fetus to infant involves many complex adaptations at birth; the most important is the function of the lungs as a gas exchange organ. Preterm surfactant-deficient infants are less well equipped to deal with this transition. Optimum gas exchange is achieved through matching of ventilation and perfusion. In RDS, ventilation may be affected by homogeneity of the airways with atelectasis and over distension, as hyaline membranes block small airways. In turn this contributes to the inflammation that becomes bronchopulmonary dysplasia. Exogenous surfactant given early, particularly with positive end-expiratory pressure and, where necessary, gentle ventilation, would seem to be the optimum way to prevent atelectasis. How this can be achieved in neonates after surfactant therapy is explored through a review of the normal physiology of the newborn lung and how this is affected by RDS. The therapeutic interventions of resuscitation, exogenous surfactant, ventilation and inhaled nitric oxide are discussed in relation to their effects and what are currently the optimum ways to use these. It is hoped that with a better understanding of the normal physiology in the newborn lung, and the effects of both disease and interventions on that physiology, the practising clinician will have a greater appreciation of management of preterm infants with, or at risk of, RDS.

Humans↗

Making the transition to restraint-free care.

When implementing a change to restraint-free care, education and communication at all levels of the organization are powerful strategies to overcome resistance. Within each facility, there are at least six identifiable groups, with attitudes based on their educational background, life experiences and perceptions that are targets for change. An anonymous attitudinal survey and sensitivity session serve as effective "unfreezing" tools for all levels of staff to express concerns regarding physical restraints and to recognize the need for change. Change requires a slow, methodical system where specific alternatives are gradually introduced. Success with the easier cases encourages staff to continue efforts with more challenging cases.

Accidental Falls↗

Outcomes, clinical models and the redesign of behavioral healthcare.

Outcomes measurement and data-triggered improvements in treatment delivery are formidable challenges, in part because of their inherent interdependence. Outcomes systems need to provide reliable, valid and comparable data that can also guide transitions in care delivery. While there is much empirical support for the efficacy of psychiatric and behavioral healthcare interventions, it is incumbent upon those who know both the literature and clinical practice to participate in setting the future course of behavioral healthcare by stirring together the seemingly immiscible aims of good business and good care. This paper briefly reviews the importance of outcomes measurement systems and their use in redesigning treatment delivery in behavioral healthcare. It then describes a clinical care model now being implemented at Park Nicollet Medical Center, incorporating clinical and operational considerations, clinical outcomes measures and algorithms or decision trees into a framework for redesigning treatment and improving the delivery of appropriate clinical care.

Hospital Restructuring↗

At risk: a look at managing Medicare losses.

On top of declining Medicare payment rates, hospitals face the prospects of increasing numbers of Medicare patients and costs associated with caring for them. Geriatric care management programs can help prevent financial losses by focusing on high-risk patients and costly diagnosis related groups. Under one approach, a geriatric care manager works to improve the efficiency of care, reduce lengths of stay, smooth transitions to alternate care settings, and involve patients and their families in decision making.

Aged↗

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); revisions to the eligibility requirements--DoD. Proposed rule.

This proposed rule revises the comprehensive CHAMPUS regulation pertaining to basic CHAMPUS benefits in accordance with several statutory changes. This proposed rule: sets forth the requirements for reinstatement of CHAMPUS eligibility for beneficiaries under age 65 who would otherwise have lost eligibility for CHAMPUS due to eligibility for Medicare as a result of disability or end-stage renal disease (ESRD); establishes new classes of CHAMPUS eligibles; establishes the Transitional Assistance Management Program which provides transitional health care for members (and their dependents) who served on active duty in support of a contingency operation and for members (and their dependents) who are involuntarily separated from active duty; allows former spouses who buy a conversion health policy to keep CHAMPUS eligibility for twenty-four (24) months for preexisting conditions that are not covered by the conversion policy; and makes minor technical revisions to the double coverage provisions. This proposed rule also adds a new category of eligible beneficiary under the Continued Health Care Benefit Program.

Adult↗

Managing people in change: some implications of the transition from hospital to community care.

Dealing with "managerial" problems resulting from the closure of institutions may be seen as a reactive process in which the task is to deal with the presenting problem. An understanding of some of the key factors which are likely to have caused the problems may help the manager to cope effectively. Ideally, understanding of these factors by those managing the change process would reduce the probability of problems developing.

Health Facility Administration↗

Functional assessment for transitions in patient acuity and care.

This article provides an overview of functional assessment, describes how functional assessment is performed using standardized tools, and discusses the nurse's role in functional assessment and the interdisciplinary rehabilitation practice setting. In addition, a description of the various levels of care used in the provision of rehabilitative services, and examples of how functional assessment may be related to moving a patient to the next level of care and along the continuum of care, are provided.

Activities of Daily Living↗

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); revisions to the eligibility requirements. Department of Defense (DOD), Office of the Secretary of Defense. Final rule.

This final rule revises the comprehensive CHAMPUS regulation pertaining to basic CHAMPUS benefits in accordance with several statutory changes. This final rule: sets forth the requirements for reinstatement of CHAMPUS eligibility for beneficiaries under age 65 who would otherwise have lost eligibility for CHAMPUS due to eligibility for Medicare as a result of disability or end-stage renal disease (ESRD); establishes new classes of CHAMPUS eligibles; establishes the Transitional Assistance Management Program which provides transitional health care for members (and their dependents) who served on active duty in support of a contingency operation and for members (and their dependents) who are involuntarily separated from active duty; allows former spouses who buy a conversion health policy to keep CHAMPUS eligibility for twenty-four (24) months for preexisting conditions that are not covered by the conversion policy; and makes minor technical revisions to the double coverage provisions. In order to expedite compliance with the statutory requirements, all of these provisions have been implemented under interim instructions. This final rule also adds a new category of eligible beneficiary under the Continued Health Care Benefit Program.

Eligibility Determination↗

Implementation of the postdischarge follow-up call in the patient care units.

The Telephone Call Back System was implemented from October 1989 in the Inpatient and Ambulatory Care Units as a postdischarge follow-up and as an evaluation of the patients' hospital experience. Nurses called patients discharged from the Ambulatory Care Unit within 24 hours postdischarge and within 24-48 hours from the Inpatient Unit. Questions asked included present physical status, ocular discomfort, availability of assistance at home, and if there were any questions and concerns. For the year 1990, 77 percent of the patients discharged from the Ambulatory Care Unit were called and 71 percent were contacted. From the Inpatient Unit, 89 percent were called and 68 percent were contacted. Patient response required the following nursing interventions: review of discharge instructions, referral to an ophthalmologist and/or an internist, referral to a patient representative/social worker, reassurance on ocular signs and symptoms consistent with a normal postsurgical period, and patient teaching other than ophthalmic care. Patients discharged from the Inpatient Unit required more nursing intervention than patients discharged from the Ambulatory Care Unit. More than 99% of the patients discharged in both patient care units were satisfied with their hospital care. These results indicate the importance of postdischarge follow-up in the continuity of health care and in the transition from the health care institution to the home setting.

Aftercare↗

Selecting a home care agency.

Selecting a home care agency must be a collaborative effort on the part of families and the discharging facility. Guidelines for selecting home care providers eases the transition from the acute care facility to home.

Child↗