Results for 'hospitals'
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PUGH Jacqueline, et al
Background: 30-day hospital readmissions are an indicator of quality of care; hospitals are financially penalized by Medicare for high rates. Numerous care transition processes reduce readmissions in clinical trials. The objective of this study was to examine the relationship between the number of evidence-based transitional care processes used and the risk standardized readmission rate (RSRR). Methods: Design: Mixed method, multi-stepped observational study. Data collection occurred 2014–2018 with data analyses completed in 2021. Setting: Ten VA hospitals, chosen for 5-year trend of improving or worsening RSRR prior to study start plus documented efforts to reduce readmissions. Participants: During five-day site visits, three observers conducted semi-structured interviews (n = 314) with staff responsible for care transition processes and observations of care transitions work (n = 105) in inpatient medicine, geriatrics, and primary care. Exposure: Frequency of use of twenty recommended care transition processes, scored 0–3. Sites’ individual process scores and cumulative total scores were tested for correlation with RSRR. Outcome: best fit predicted RSRR for quarter of site visit based on the 21 months surrounding the site visits. Results: Total scores: Mean 38.3 (range 24–47). No site performed all 20 processes. Two processes (pre-discharge patient education, medication reconciliation prior to discharge) were performed at all facilities. Five processes were performed at most facilities but inconsistently and the other 13 processes were more varied across facilities. Total care transition process score was correlated with RSRR (R2 = 0..61, p < 0.007). Conclusions: Sites making use of more recommended care transition processes had lower RSRR. Given the variability in implementation and barriers noted by clinicians to consistently perform processes, further reduction of readmissions will likely require new strategies to facilitate implementation of these evidence-based processes, should include consideration of how to better incorporate activities into workflow, and may benefit from more consistent use of some of the more underutilized processes including patient inclusion in discharge planning and increased utilization of community supports. Although all facilities had inpatient social workers and/or dedicated case managers working on transitions, many had none or limited true bridging personnel (following the patient from inpatient to home and even providing home visits). More investment in these roles may also be needed.
STEVENTON Adam, BARDSLEY Martin
The impact of telehealth on hospital use, patient admission and mortality were evaluated in three trial sites in England. The sites were from the Department of Health’s Whole System Demonstrator pilots. The evaluation focused on the use of telehealth to people with chronic obstructive pulmonary disease, diabetes or heart failure. It used a large randomised controlled trial which included over 3,000 participants (1,584 control and 1,570 intervention) in which groups of patients either received the telehealth intervention or acted as controls by receiving their usual care. Statistically significant differences in rates of emergency hospital admission and mortality were found during the twelve months of the trial between control and intervention groups. For intervention patients, the overall costs of hospital care (including emergency admissions, elective admissions and outpatient attendances) were £188 per patient less than those for controls. However, this cost difference was not statistically significant. As well as summarising the main findings the research summary highlights the limitations of the research and other issues that need to be considered in relation to the findings.
CARE AND REPAIR CYMRU
An evaluation of the Hospital to a Healthier Home pilot scheme, delivered by Care and Repair, which ran from 11 hospitals between January and March 2019. The scheme aimed to support older people to be safely and more quickly discharged from hospitals to their homes and prevent them being re-admitted by making their homes safe and more accessible. This evaluation describes how the Hospital to a Health Home case worker service started, what type of interventions have been provided to patients and hospital staff, costs, benefits and the difference it has made to patient well-being, quicker safe discharges, and preventing re-admissions. The pilot involved dedicated Care and Repair case workers based at each hospital to facilitate practical improvements to a patient’s home and offer practical support on issues such as benefits entitlements. During the evaluation period: 626 patients were referred through Hospital to a Healthier Home service; 508 patients received work that helped quicker safe discharge. Based on a local assessment of bed day savings, the evaluation found that service costs are fully substantiated, and return £2.80 for every £1 invested (both revenue and capital). NHS frontline staff interviewed for the evaluation study also felt the service was of significant benefit and had the potential to deliver more.
KELLY Timothy B., et al
An independent evaluation of the Crisis Prevention Programme, which comprised four individual pilot projects operating in four NHS board areas in Scotland and aimed to get support and advice for carers at an early stage, offer them a carer's assessment, reduce the pressure on their health, get them involved in discharge planning and train health and social care professionals in carer awareness. The evaluation found that the programme resulted in many improvements in hospitals, including: professionals were more likely to identify carers at an early stage and put support for them in place at an earlier stage; there were changes to ways of working which benefited carers; carers reported feeling that professionals had more recognition of their expertise in caring and understood their needs as a carer; carers felt more able to have a say in shaping the services they, or the person they cared for, received; and carers were provided with more information, such as being told of their right to a carer's assessment. The evaluation recommended that funding for carer support workers in hospitals continues and that carer awareness training should be mandatory for all healthcare professionals.
DOUGHTY Kevin, MULVIHILL Patrick
Purpose: The purpose of this paper is to consider the importance of digital healthcare through telecare and portable assistive devices in supporting the reengineering of healthcare to deal with the needs of an older and more vulnerable population wishing to remain in their own homes.
Design/methodology/approach: It supports the importance of the assessment process to identify hazards associated with independent living, and the possible consequences of accidents. By measuring and prioritising the risks, appropriate management strategies may be introduced to provide a safer home environment.
Findings: A process for assessing and managing these risks has been developed. This can be applied to a wide range of different cases and yields solutions that can support independence.
Research limitations/implications: The developed digital reablement process can be used to provide vulnerable people with a robust form of risk management.
Practical implications: If telecare services follow the process described in this paper then they will improve the outcomes for their users.
Originality/value: The process described in this paper is the first attempt to produce a robust assessment process for introducing telecare services in a reablement context.
BOEX Will, BOEX Sam
The concept of well-being is now well established, both in ordinary language and in UK Government policy. There is now a growing interest in looking at the effects on environmental design on well-being. The aim of this paper is to explore current interest in the concept of well-being, and to trace the growing use of design ideas in healthcare settings to reduce stress and maximise efficiency. The potential in this approach is illustrated with some examples of design approaches applied in healthcare. The patient journey through the healthcare setting is considered in terms of ‘touch points’ such as the car park, the entrance, corridors, and the work area. These design concepts and approaches seem also to promise similar benefits in community settings where issues in managing the health and well-being of vulnerable individuals are equally relevant. They may be especially useful in current efforts towards creating dementia-friendly homes and communities, or ‘psychologically informed environments’ in services for marginalised and excluded individuals.
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