[Transitional care--a nursing concept from Vienna. No fear for brain deterioration in old age].
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Activities of Daily Living↗
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Results for “Transitional Care”
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Nursing Mirror midwifery forum. The case for transitional care.
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Humans↗
[3 years of transitional care at the Wagner-Jauregg Neurological County Hospital of Upper Austria].
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Austria↗
Transition of care provided for adolescents with special health care needs. American Academy of Pediatrics Committee on Children with Disabilities and Committee on Adolescence.
This policy statement describes how the pediatrician can work closely with patients with special health care needs and their families as an advocate and educator to help them adapt positively to an adult-focused system of health care. Issues in health care transitions including independence and dependence, education and vocational issues, insurance issues and limitations, Social Security, and hospitalization are outlined.
Adolescent↗
Reporting the outcomes of care: effecting the transition from caring to comparing.
Accountability in health care has taken on new dimensions with the drive to base contracting and provider of care selection upon data driven "report cards." The measurement and development of reportable outcomes are driving providers to move their organizations from a focus not only on "caring" but to one highly cognizant of "comparing" in order to maintain market position and meet regulatory requirements. This article defines the areas of organizational transition required for reporting, and profiles the actions taken by three health care providers moving to an organizational style ready for "comparative" competition.
Academic Medical Centers↗
[Analysis of the health care system transition: what the health care users think].
The project "Analysis of transition of health care system in Croatia" was started in order to research the effects of health care system changes. The aim was to research specific characteristics of transitional period through evaluation of health status, quality of life, and quality of health care. Total of 331 general practitioners, 2,252 patients and 5,048 inhabitants were included in the research. The Croatian version of SF-36 questionnaire was licensed to Andrija Stampar School of Public Health in order to assess health-related quality of life. Men, younger and better-educated respondents achieved higher scores in SF-36 quality of life assessment. Quality of life is lower in Croatia than in Western European countries. 85.3% of respondents were satisfied with physicians' behaviour. Two components of physician's behaviour were obtained--competence/expertise and empathy. These results could contribute to better understanding of health care reform effects.
Adolescent↗
Transitions in care during the end of life: changes experienced following enrolment in a comprehensive palliative care program.
BACKGROUND: Transitions in the location of care and in who provides such care can be extremely stressful for individuals facing death and for those close to them. The objective of this study was to describe the distribution of transitions in care experienced by palliative care patients following admission to a comprehensive palliative care program (PCP). A better understanding of these transitions may aid in reducing unnecessary change, help predict care needs, enhance transitions that improve quality of life, guide health care system communication links and maximize the cost-effective utilization of different care settings and providers. METHODS: Transition and demographic information pertaining to all patients registered in the PCP at the Queen Elizabeth II Health Sciences Centre (QEII), Halifax, Nova Scotia, Canada between January 1, 1998 and December 31, 2002 and who died on or prior to December 31, 2002 was extracted from the PCP database and examined. A transition was defined as either: (1) a change in location of where the patient was cared for by the PCP or, (2) a change in which clinical service provided care. Descriptive analysis provided frequencies and locations of transitions experienced from time of PCP admission to death and during the final two and four weeks of life, an examination of patient movement and a summary of the length of stay spent by patients at each care location. RESULTS: Over the five year period, 3974 adults admitted to the QEII PCP experienced a total of 5903 transitions (Mean 1.5; standard deviation 1.8; median 1). Patients with no transitions (28%) differed significantly from those who had experienced at least one transition with respect to survival time, age, location of death and diagnosis (p < 0.0001). The majority of patients were admitted to the PCP from various acute care units (66%). Although 54% of all transitions were made to the home, only 60% of these moves included care provided by PCP staff. During the last four weeks of life, 47% of patients experienced at least one transition; 36% during the final two weeks of life. Shorter stays in each location were evident when care was actively provided by the PCP. CONCLUSION: A relatively small number of patients under the care of the PCP at the end of life, made several transitions in care setting or service provider. These particular patients need closer scrutiny to understand why such transitions take place so that clinical programs may be designed or modified to minimize the transitions themselves or the impact transitions have on patients and families.
Journal Article↗
Problems and pitfalls of transition from paediatric to adult renal care.
Transition is a generic issue for subspecialties dealing with chronic illness and has received little attention to date. Transfer to adult care occurs at the end of a transition process that must be individualised for each patient and takes into account all aspects of growth and development, which may be variably impaired. Good communication with the young person, family and adult nephrologist is essential so that the anxieties of all are properly addressed. Non-compliance with treatment, particularly prevalent in adolescents, requires attention to psychological and social issues as well as medical factors. The young person must have sufficient self-management skills (which should be assessed) and there should be plans for long-term social support before transfer. Transition should be a positive process and models need to be evaluated.
Adolescent↗
Transitioning the paediatric IBD patient to adult care.
Transitioning an adolescent patient to an internist/gastroenterologist's care requires an understanding of the specific issues and challenges involved in the diagnosis and management of paediatric inflammatory bowel disease (IBD). Even though diagnostic criteria, as well as methods are the same in children and adults, younger patients may experience more insidious presentations. A high level of suspicion is necessary for an early and accurate diagnosis. Management of IBD in the paediatric population begins with the assessment of disease extent and activity as well as the identification of potentially serious complications (such as malnutrition, growth/sexual retardation and osteoporosis), which are often present at the time of diagnosis. Treatment includes not only medical, nutritional or surgical therapy but also a multidisciplinary or holistic approach taking into consideration the psychological as well as social impact of the disease on the patient and family.
Adolescent↗
How do we organize smooth, effective transfer from paediatric to adult diabetes care?
Transition from paediatric to adult care is a major milestone in the life of a young person with diabetes, yet it is commonly poorly done. This finding is supported by the dearth of publications in the literature that particularly relate to transition in diabetes care. Other transitions occur at this time of life, for example: from parental supervision to growing independence and from secondary school to post-school options. Health professionals know, from anecdotal evidence, that this is the period when young people with diabetes 'drop out' of the system. They often have no specialist follow-up and attend only the primary care physician for insulin prescriptions. Then, inevitably, a problem occurs that cannot be managed by the family doctor, such as diabetic ketoacidosis or pregnancy, and the patient is finally referred to an adult unit. There are many contributing factors to poor transition but two major reasons are that members of this age group are classic non-attenders and, importantly, they have not been well prepared for the transition. Preparation is the key to success and this must include parents as well as the young person. Components of transition preparation include: self-advocacy, independent health care behaviours, sexual health, psychosocial support, education and vocational planning, and health and lifestyle (drugs, alcohol, etc.). Considerable differences exist between many of the paediatric and adult services, and this cultural shift has significant impact on the success or otherwise of transition. Paediatric care is often multidisciplinary, family focused, prescriptive and requires parental direction and consent. Adult care is often provided by a single doctor, is patient focused, more investigational and requires autonomous, independent skills on the part of the user. Young people and their families, unless well prepared, become confused and disillusioned with the adult system. To avoid this situation, there is a variety of solutions, including adolescent transition clinics attended by both paediatric and adult teams, a transition coordinator who is responsible for making the transfer as smooth as possible, etc. Unfortunately, the very nature of the group in question means that none of these solutions is perfect. In reality, transition is a process that takes place over a number of years and should not be considered an event. The transition process needs to begin in early adolescence, to foster independence and communication skills, and to incorporate health education.
Aging↗
[Mental health care in transition. We work with depsychiatrization. Care is drug-free. Interview by Elisabet Forslind].
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Day Care, Medical↗
Transition of cognitively delayed adolescent organ transplant recipients to adult care.
Transition from pediatric to adult health care is a complicated process that goes far beyond transfer of care. The young person who is intellectually impaired or who must struggle to master daily living skills faces more challenges in this process than other adolescents. Physicians, nurses, social workers, occupational therapists, and other health care providers must work with adolescents, their parents, and teachers to assess abilities and transition needs. Communication skills, capacity for decision making, adherence, vocational and educational issues, sexuality, and relationships should be addressed. Interventions may include the creation of an individualized transition plan, skills training, family counseling, a lengthened transition process, involvement in a support group, health promotion, and teaching of self-care skills. The summary for the adult provider should include information about how best to communicate with the young person and an assessment of capacity to make decisions and self-management skills.
Adolescent↗
Transition of care for hospitalized elderly patients--development of a discharge checklist for hospitalists.
BACKGROUND: Discharge from the hospital is a critical transition point in a patient's care. Incomplete handoffs at discharge can lead to adverse events for patients and result in avoidable rehospitalization. Care transitions are especially important for elderly patients and other high-risk patients who have multiple comorbidities. Standardizing the elements of the discharge process may help to address the gaps in quality and safety that occur when patients transition from the hospital to an outpatient setting. METHODS: The Society of Hospital Medicine's Hospital Quality and Patient Safety committee assembled a panel of care transition researchers, process improvement experts, and hospitalists to review the literature and develop a checklist of processes and elements required for ideal discharge of adult patients. The discharge checklist was presented at the Society of Hospital Medicine's Annual Meeting in April 2005, where it was reviewed and revised by more than 120 practicing hospitalists and hospital-based nurses, case managers, and pharmacists. The final checklist was endorsed by the Society of Hospital Medicine. RESULTS: The finalized checklist is a comprehensive list of the processes and elements considered necessary for optimal patient handoff at hospital discharge. This checklist focused on medication safety, patient education, and follow-up plans. CONCLUSIONS: The development of content and process standards for discharge is the first step in improving the handoff of care from the inpatient to the posthospital setting. Refining this checklist for patients with specific diagnoses, in specific age categories, and with specific discharge destinations may further improve information transfer and ultimately affect patient outcomes.
Aged↗
Transitional health care for offenders being released from United States prisons.
Ex-offender managed health care can enhance post-release continuity of care by increasing access, decreasing acute-care episodes, controlling the spread of communicable diseases, and reducing the financial impact on public health-care systems. This study describes transitional health care for inmates with AIDS, tuberculosis (TB), hepatitis, mental illness, and substance abuse. The relationship between size of prison system and coordination of care was also investigated. A mail survey was completed by 33 chief medical officers of prison systems in the United States. Transitional health-care programs for ex-offenders vary widely and no significant relationship was found between number of inmates released per state annually and state coordination of transitional health care for supervised ex-offenders. All respondents reported some type of transitional health-care planning, usually either 1 month or 6 months prior to release. This included provision of post-release medication, referral to community health agencies, scheduling of appointments, and instruction in prevention of transmission. The majority of respondents reported that transitional health-care planning was coordinated by registered nurses. Specific measures for inmates with HIV/AIDS,TB, mental illness, and substance abuse were reported. Information about existing transitional health-care programs can help nurses and other health-care providers identify trends in transitional health-care planning and ensure continuity of care for released offenders.
Communicable Disease Control↗
Improving transition: a qualitative study examining the attitudes of young people with chronic illness transferring to adult care.
Transition is a process that attends to the medical, psychosocial and educational needs of young people as they transfer to adult-orientated care. With a growing population of adolescents surviving with chronic illness well into adulthood, it is remarkable that empirical research has paid little attention to transition. This qualitative study examined the attitudes of young people with chronic illness who were facing transition, considering what young people wanted from a transition service and the ways in which provision could be improved from a service-user's perspective. A purposive sample of seven adolescents (aged 14-17) attending a hospital youth club were interviewed. To increase the likelihood of successful transition, strategies need to be informal, flexible, highly individualized and prepare adolescents steadily for adult services.
Adolescent↗
Rehabilitation for elderly patients with cancer asthenia: making a transition to palliative care.
The transition from curative to palliative care for elderly patients with cancer-related asthenia presents complex challenges to oncologists. A result of this complexity is a lack of regard for the maintenance of physical and mental function. This study examined the effects of comprehensive, multidisciplinary, inpatient rehabilitation on the physical and mental function of elderly cancer patients with asthenia. We found that both physical and mental function improved following inpatient rehabilitation. However, it is difficult to predict which patients benefit most from rehabilitation. Nevertheless, functional improvement following rehabilitation may allow medical caregivers to better distribute the type and intensity of care, and reduce the caregiver burden experienced by family members in the home.
Aged↗
Implementation of an interdisciplinary Behavior Management Program.
OBJECTIVE: To describe the establishment and utilization of an interdisciplinary Behavior Management Program in a Transitional Care Unit as a new model of Geriatrics Practice. DESIGN: Descriptive Study. SETTING: A 50-bed Transitional Care Unit in a Veterans Affairs Medical Center in Syracuse, New York. PARTICIPANTS: All residents admitted to the Transitional Care Unit were observed for a 6-month period under the Behavior Management Program. PROGRAM STRUCTURE: The Behavior Management Program involved an interdisciplinary team approach to the management of behavioral disturbances. This included development of a Behavior Team and a comprehensive Behavior Observation Record, which readily assisted caregivers in determining and monitoring target behaviors that required modification. Both nonpharmacological and pharmacological interventions were employed to assist in the modification of behavioral disturbances. RESULTS: The Behavior Management Program enhanced the overall care of Transitional Care Unit residents with behavioral disturbances. The more appropriate use of medications for specific target behaviors led to a reduction in behavioral disturbance episodes and increased the earlier diagnosis and treatment of depression. The interdisciplinary nature of the Behavior Management Program promoted educational efforts and camaraderie among staff and created a stronger liaison between the Transitional Care Unit and the Psychiatry Service. In addition, several management improvements were identified as a result of the implementation of the Behavior Management Program. CONCLUSIONS: An interdisciplinary Behavior Management Program can prove to be a valuable asset in the management of behaviors for people with dementia, psychiatric illness, and other medical illnesses. More effective use of nonpharmacological and psychopharmacological interventions enhances the quality of life in a frail older population. This approach has strong potential for successful use in a variety of clinical settings by providers and caregivers alike.
Aged↗
Nutrition support for patients in long-term acute care and subacute care facilities.
Long-term acute care and subacute care facilities (also transitional care facilities) have evolved from the need to decrease costs associated with acute care in the hospital. As the length of stay in many medical centers has been reduced, patients are admitted to transitional care facilities to continue recovery and rehabilitation. Rehabilitation and recovery can be enhanced with the provision of optimal medical nutrition therapy. Nutrition screening is essential in identifying patients who are at risk of malnutrition or are malnourished. Nutrition assessment verifies the risk or presence of malnutrition followed by the development, implementation, and monitoring of nutrition intervention. Nutrition screening and intervention promote recovery from illness, minimize morbidity and mortality, and enhance quality of life. The goals of nutrition support are to prevent starvation-associated malnutrition, preserve lean tissue mass, support metabolic functions, and improve clinical outcomes. Oral nutrition is the preferred method of nourishment; however, specialized nutrition support is considered for patients unable to meet their nutrient requirements adequately. Enteral nutrition support is recommended when providing nutrition support however, parenteral nutrition support is used when the gastrointestinal tract can not be safely used. With appropriate intention, administration, and monitoring, nutrition support can be safely administered.
Acute Disease↗