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PubMed2025

Healthcare transition readiness in an adolescent and young adult urologic population: The ADHERENT study.

INTRODUCTION: There is a paucity of research regarding transition to adult services within pediatric and adolescent urology. Several recent articles have discussed the barriers in transitioning urologic patients from pediatric to adult health care, but empiric data that may drive intervention are lacking. This study proposes to begin to address this gap in literature and to provide information that may lead to improved understanding of how best to support transition in urologic care. OBJECTIVES: 1) to identify modifiable and non-modifiable factors related to transition readiness as measured by Transition Readiness Assessment Questionnaire (TRAQ) scores in a congenital urologic population and 2) to evaluate the relationships between TRAQ scores (a validated questionnaire measuring transition readiness) and scores measuring anxiety levels related to transition (using an adapted, non-validated questionnaire). STUDY DESIGN: This is a cross-sectional study of adolescent and young adult patients with complex congenital urologic diagnoses. Subjects were electronically administered the validated TRAQ and a study-developed ADHERENT survey, which assesses anxiety and worry surrounding transition. Regression models for the outcomes of the TRAQ and ADHERENT scales were developed to assess multivariable associations with variables of clinical importance. RESULTS: The youngest subgroup (14-17 years of age) compared to the oldest subgroup (21-25 years of age) had significantly lower TRAQ scores [regression estimate = 12.3 (95 % CI: 2.9, 21.7), p = 0.010]. Additionally, single participants versus those in a stable relationship had significantly lower TRAQ scores [estimate = 8.7 (95 % CI: 1.9, 15.4), p = 0.012]. The Spearman correlation coefficient between TRAQ and ADHERENT scores was 0.52 (p = <0.001), indicating a positive, moderate relationship between the two measures, suggesting more readiness correlated with less anxiety. DISCUSSION: This study found that age, higher education, and stable relationship status were associated with higher measures of transition readiness. There was a correlation found between more transition readiness and less anxiety surrounding transition. This finding can be used to inform future research and emphasizes the need for multidisciplinary support throughout the transition process. CONCLUSION: Early discussion of transition of care and education around transition readiness are not the only solution to improving transition success. The second phase of ADHERENT seeks to understand the patient experience and to include adolescents and young adults in shaping effective healthcare transition strategies.

Humans↗
PubMed1993

The closure of a mental hospital in Sweden. 5 years of transition to district-based long-term care.

A political decision to decentralize psychiatric care in a county of Sweden was made in October 1984. This will lead to the closure of the county's only large psychiatric hospital. Short-term psychiatric care will be provided by three smaller hospitals in the county, while long-term care in hospital will cease completely and be replaced by district-based psychiatric services. All patients (n = 199) in the large hospital's long-term unit were studied over 5 years of the transition period. The results showed that 42% of patients were discharged during the period, mainly to other institutions. Only 8 patients were provided with alternative types of care, such as group homes. Sixty-eight per cent of all patients died, most of them before being discharged (80% of the organically demented patients and 51% of the others). The mortality rate for patients with severely impaired activities of daily living (ADL functioning) was 92% for those who were also organically demented and 84% for the others. The patients who survived the 5-year period were mainly (80%) nondemented patients with relatively well-preserved ADL functioning, but with behavioural disturbances.

Activities of Daily Living↗
PubMed2003

Tiredness in Dutch family practice. Data on patients complaining of and/or diagnosed with "tiredness".

BACKGROUND: Research including patients from the entire tiredness spectrum in family practice is needed. OBJECTIVES: Our aim was to provide routine family practice data on (i) relationships between the RFE (reason for encounter) and the diagnosis "tiredness"; (ii) duration, number of encounters and family physician's (FP's) interventions in episodes of care of tiredness; and (iii) sex/age and co-morbidity of patients diagnosed with "tiredness". METHODS: Routine episode of care data from the Transition Project, coded comprehensively with the International Classification of Primary Care (ICPC), were used. (i) A 16 year database (1985-2000, 58 FPs, 504 145 episodes of care, 168 550 patient years) for calculating "prior probabilities" with (diagnostic) odds ratios. (ii) A "basic population" extracted from that 16 year database of patients listed for an entire 4 year period (1997-2000; n = 12 292). RESULTS: The RFE tiredness resulted in a variety of diagnoses, but most frequently (43%) in "tiredness". Most odds ratios were low or negative. Of episodes of care of tiredness, 90% started with the RFE tiredness; 72% required one encounter only, and 90% lasted <6 months. In the 4 year period, 21% of patients first presented with tiredness, and 12% were diagnosed with tiredness; both groups were skewed towards women. Average co-morbidity in tired patients (16.6) was higher than in other visiting patients (10.4), and contained more tiredness-related conditions. FPs' interventions were mainly blood test, physical exam and advice; few referrals occurred. CONCLUSIONS: For many diagnoses, the RFE tiredness hardly contributes to the Bayesian posterior probability. FPs react differently to the RFE tiredness in cases in which they diagnose the patient with "tiredness" from how they react in other cases. The characteristics of ICPC and the Dutch health care system resulted in a full integration of tiredness as an RFE and as a freestanding episode of care in the context of family practice.

Adolescent↗
PubMed1999

The converging roads of HIM and managed care.

The authors explore the definition of managed care and how the health information manager's skills apply to a managed care setting. In addition, HIM professionals who have made the transition to the managed care setting share their experiences.

Career Mobility↗
PubMed1998

Retention of clients in service under two models of home health care for HIV/AIDS.

OBJECTIVE: To determine if a Transprofessional, care-management approach (experimental group) produces different patterns of retention in home treatment as compared to a Traditional treatment approach (control group). The care-management approach utilizes an interdisciplinary mix of allied health professionals who adhere to a service delivery protocol based on active medical, surgical treatment (curative services) as well as on pain, symptoms, and emotional care (palliative services). Initially, the Transprofessional Model should lead to a greater retention rate in the program as patients bond to blended care managers, but in later stages clients needing hospice should be moved off-services resulting in lower retention rates in the medical-surgical home care venue. DATA SOURCES AND STUDY SETTING: Data were collected from 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). Demographic and disease-specific data were collected from admitting records; service-utilization data were collected from the VNA-LA's computerized data system. STUDY DESIGN: Upon admission for home-care services, patients were randomly assigned to an experimental (Transprofessional) or control (Traditional) treatment group. Service levels were comparable. PRIMARY FINDING: In the earliest stages, Transprofessional patients tend to be more likely to stay in treatment, probably due to the greater bonding to the program. After about one year, the Transprofessional patients are more likely to leave the program as they are transitioned into hospice care. CONCLUSIONS: An integrated model of service delivery, which is based on interdisciplinary care-management and blended modalities of service, provides a quality of life enhancing and a cost-effective method in the provision of home-care services for terminally ill AIDS patients.

Continuity of Patient Care↗
PubMed2006

Decay of Loschmidt echo enhanced by quantum criticality.

We study the transition of a quantum system from a pure state to a mixed one, which is induced by the quantum criticality of the surrounding system E coupled to it. To characterize this transition quantitatively, we carefully examine the behavior of the Loschmidt echo (LE) of E modeled as an Ising model in a transverse field, which behaves as a measuring apparatus in quantum measurement. It is found that the quantum critical behavior of E strongly affects its capability of enhancing the decay of LE: near the critical value of the transverse field entailing the happening of quantum phase transition, the off-diagonal elements of the reduced density matrix describing S vanish sharply.

Journal Article↗
PubMedDate not supplied

Family caregiving and the use of formal community support services: a qualitative case study.

The aim of this qualitative case study was to describe a family caregiver's experience with the use of formal community support services. The emotional responses to caregiving and to the gradual relinquishing of the caregiving role also are described. A 76-year-old wife caring for her husband who had Alzheimer's disease was interviewed over a 3-month period. Two of the caregiver's providers of formal services also were interviewed. Four themes emerged from analysis of transcribed interviews describing the caregiver's experience with formal services. These themes reflected the caregiving needs that precipitated service use and the effects of formal support, including their roles in the transition from home care to residential care. The findings, in this case, suggested that formal support played an influential role in "giving permission" for the caregiver to place her husband in institutional care. Implications for nurses, other health professionals, policy makers, and for further research are drawn from these findings.

Aged↗
PubMedDate not supplied

Moving toward continuous quality improvement.

Consumers are looking for better quality health care for their dollar. Nursing is challenged with providing excellent care in an age of shrinking resources. After years of chart audits and quality assurance, a new and broader focus is emerging. Continuous quality improvement is the latest theme in the ever-changing area of quality. It seeks to improve care through improving the processes used in delivering the care. A smooth transition from quality assurance to continuous quality improvement is possible through a complete understanding of both concepts, a willingness to work with others in the organization, and the ability to focus on process rather than on people.

Clinical Protocols↗
PubMedDate not supplied

Missed opportunities: a descriptive assessment of teaching and attitudes regarding communication skills in a surgical residency.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requires that "residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients' families, and professional associates." The authors sought to assess current methods of teaching and attitudes regarding communication skills in their surgical residency. METHODS: After obtaining Institutional Review Board (IRB) exemption, voluntary anonymous surveys were completed by a sample of convenience at the Vanderbilt University Medical Center: surgical residents at Grand Rounds and attending surgeons in a faculty meeting. Data were evaluated from 49 respondents (33 of 75 total surgical residents, 16 representative attending surgeons). RESULTS: One hundred percent of respondents rated the importance of communication to the successful care of patients as "4" or "5" of 5. Direct attending observation of residents communicating with patients/families was confirmed by residents and faculty. Residents reported varying levels of comfort with different types of conversations. Residents were "comfortable" or "very comfortable" as follows: obtaining informed consent, 91%; reporting operative findings, 64%; delivering bad news, 61%; conducting a family conference, 40%; discussing do not resuscitate (DNR) orders, 36%; and discussing transition to comfort care, 24%. Resident receptiveness to communication skills education varied with proposed venues: 84% favored teaching in the course of routine clinical care, 52% via online resources, and 46% in workshops. Residents were asked how frequently they received feedback specific to their communication skills during the past 6 months: Most residents reported 0 (39%) or 1 (21%) feedback episode. Only 30% of resident respondents reported receiving feedback that they perceived helpful. Attending surgeons reported that they did provide residents feedback specific to their communication skills. When asked to estimate the number of feedback episodes in the last 6 months, 16 faculty members reported a total of 67 feedback episodes, whereas 33 residents reported a total of only 24 episodes. Most faculty members rated their comfort with providing feedback specific to communication skills as "very comfortable" (56%) or "comfortable" (19%). "Time constraints" was the most frequently cited barrier to teaching communication skills. CONCLUSIONS: Communication skills are valued as integral to patient care by both residents and faculty in this study. Residents are most receptive to teaching of communication skills in the clinical setting. Faculty members report they are providing feedback to residents. Although residents report direct observation by faculty, currently only a minority (30%) are receiving feedback regarding communication that they consider helpful. A need exists to facilitate the feedback process to resolve this discrepancy. The authors propose that an evaluation instrument regarding communication skills may strengthen the feedback process.

Attitude of Health Personnel↗
PubMed2006

Transition of transplant patients with cystic fibrosis to adult care: today's challenges.

One of the most trying ordeals for patients with cystic fibrosis is moving from one care setting to another. When the patient is facing the crisis of failing health and the need for lung transplantation, the transition can seem even more overwhelming. In Toronto, patients are transferred from pediatric to adult care at age 18. Moving a teenager with cystic fibrosis to the adult system presents many challenges, and even greater challenges arise when the patient has received a lung transplant or is awaiting one. Two pediatric and adult cystic fibrosis teams have worked closely with the lung transplant teams to create a smooth transition system. This article outlines both programs and presents a case study to explore the challenges for the teams in deciding the best place to meet the needs of the patients and their families. These families offer us a look at coping with change at a time of great stress and at how we as healthcare providers can support them through the system.

Adolescent↗
PubMed2002

Transcendence and transformation in the life patterns of women living with rheumatoid arthritis.

Considering personal life stories as the context for health transitions can enhance understanding of what is meaningful in living with chronic illness. Informed by Margaret Newman's theory of Health as Expanding Consciousness, this interpretive study described the life patterns of three women with rheumatoid arthritis as a process of expanding consciousness. The women's stories revealed transcendence of self-boundaries and personal transformation as new ways of living, including "simple pleasures" and "being positive." Through understanding life patterns within caring nursing partnerships, transitions in an entire life story can be appreciated as complex processes involving transcendence and transformation.

Activities of Daily Living↗
PubMed1996

Analyzing practice costs utilizing Relative Value Units (RVUs).

"As Medicare pays based upon Relative Value Units and many managed care plans are transitioning their payment systems to an RVU-based system, it should be a long-term goal of the practice to eventually have the practice cost per RVU be at or below the Medicare conversion factor."

Costs and Cost Analysis↗
PubMed1989

Life transition theory: the resolution of uncertainty.

Nurses care for many people undergoing major life transitions, developmental or health related. Selder's life transition theory helps us crawl into their skins and understand what goes on as they face the awesome task of creating a new life and finding meaning in it.

Adaptation, Psychological↗
PubMedDate not supplied

The hospital-sponsored ambulatory dental services program, Part II: An evaluation of dental services.

This paper examines the appropriateness and continuity of dental care rendered by the 25 hospital facilities participating in the Hospital-Sponsored Ambulatory Dental Services Program, a $10 million effort established by the Robert Wood Johnson Foundation from 1979 to 1983. Record review data on 5,200 patients in 13 of the hospitals show that a substantially greater number of patients entered as episodic users of the system in the final phase of the evaluation than in the baseline visit; fewer of these episodic patients made the transition to initial care in the final phase. A followup study on baseline patients indicates that only 28% of the sample had a visit after the year of first contact. The trend toward episodic care is reflected in a reduced amount of preventive and operative services from baseline to final assessments. Compared with a study of private practices in California, the emphasis on surgery in the hospitals is dramatic: a dental patient accessing a hospital clinic will lose approximately one tooth as compared with a half tooth in private practice. Private practices also perform more crown and fixed partial denture services and more services across-the-board than the hospital clinics. Telephone interviews show that overall patient satisfaction with the hospital dental services remained high during the study (87% to 89%). Fewer patient in the final sample, however, planned to return to the hospital for all or part of their care. These findings reveal that continuity of care is a problem for hospital dental clinics. The preponderance of episodic care raises questions as to the breadth of experience offered by these hospitals to general practice residents.

Continuity of Patient Care↗
PubMed2000

Strike a balance with decentralized housekeeping.

Housekeeping staff join patient-care teams to improve patient care, but the transition can cause problems of its own. Read how one hospital minimized the negative effects and improved staff productivity and patient satisfaction.

California↗
PubMed2002

The coronary heart disease in-patient experience questionnaire (I-PEQ (CHD)): results from the survey of National Health Service patients.

OBJECTIVE: Analysis of data from the National Survey of Coronary Heart Disease patients to develop a core measure of patient experiences of health care. A secondary purpose was to determine whether a single summary index figure could be generated from the instrument. DESIGN: The data reported here comes from the survey of coronary heart disease (CHD) patients, which was the second in the programme of National Surveys of National Health Service (NHS) patients. It took place during 1999. After an in-patient episode for CHD, questionnaires were mailed out to patients with a covering letter and a pre-paid stamped addressed envelope. Those patients who did not reply within two weeks of the initial mailing were sent a reminder letter and, if this elicited no reply within two weeks, they were sent another copy of the questionnaire. SAMPLE: Of the 116,872 patients who were sent questionnaires, 3399 proved to be ineligible or out-of scope to the survey. Responses were gained from 84,310 (74.3% of eligible respondents). RESULTS: Reliability analysis supported the existence of seven dimensions which seem to be tapping distinct underlying phenomena: hospital environment, information and communication, patient involvement, coordination of care, discharge and transition, and pain. Higher order factor analysis indicated these dimensions constituted one factor and, consequently, can be summed to create an index figure. The construct validity of the measure was assessed, and it distinguished between groups as was hypothesised. CONCLUSIONS: The dimensions of the questionnaire have high internal reliability. Both the dimensions of the instrument and the index score were found to have high construct validity. The instrument provides a core set of issues that should be covered when assessing the quality of care for hospital patients with coronary heart disease.

Adult↗