Search results for ‘Subject term:"intermediate care"’ Sort:
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Negotiating the transition from acute hospital care to home: perspectives of patients with traumatic brain injury, caregivers and healthcare providers
- Authors:
- OYESANYA Tolu O, et al
- Journal article citation:
- Journal of Integrated Care, 29(4), 2021, pp.414-424.
- Publisher:
- Emerald
Purpose: The purpose is to explore experiences transitioning home from acute hospital care from perspectives of younger traumatic brain injury (TBI) patients, family caregivers and healthcare providers (HCPs). Design/methodology/approach: The authors conducted 54 qualitative interviews (N = 36: 12 patients, 8 caregivers, 16 HCPs) and analyzed data using conventional content analysis. Findings: The transition from hospital to home was described as a negotiation, finding a way through these obstacles: (1) preparing for discharge home during acute hospital care; (2) navigating transitions in healthcare and health; (3) addressing recovery concerns, and (4) setting goals to return to normal. Factors influencing the negotiation process included social support, health-related knowledge or training, coping mechanisms, financial stability, and home environment stability. Originality/value: Younger TBI patients and caregivers have unique needs during the transition home from the hospital. Needed support from HCPs was inconsistently provided. Findings are foundational for integrated care research and practice with TBI. (Edited publisher abstract)
Care transition for complex patients: a framework to analyse and develop the operating centres for transition
- Authors:
- ZAZZERA Angelica, FERRARA Lucia, TOZZI Valeria Domenica
- Journal article citation:
- Journal of Integrated Care, 29(4), 2021, pp.425-438.
- Publisher:
- Emerald
Purpose: Transitional care (TC) models emerged to ensure healthcare coordination and continuity, as at-risk patients transfer between different settings or different levels of care within the same setting. TC models have been developed in many countries as well as within different healthcare service delivery models and organizations. This paper aims to focus on a TC model developed in Italy called Operating Centre for Transition (OCT), in order to (1) explore its distinctive features by establishing a framework of analysis, (2) apply the framework to study two OCTs and (3) provide recommendations on how to use the framework to evaluate and develop new OCTs in the future. Design/methodology/approach: The authors adopted a grounded theory method to develop and validate the framework of analysis. The authors employed several qualitative methods following four iterative and recursive steps: (1) desk analysis of relevant documents, (2) in-depth interviews to key informants, (3) three meetings of an expert working group and (4) application of the framework to two case studies. Findings: The framework of analysis identifies three core dimensions that are always present in any OCT: the service model, the functions and the organizational features. Moreover, for every dimension several variables that capture and understand OCTs’ nature, role and development level are identified. Originality/value: The results of the study highlight the key elements of the OCT model in Italy and show that the proposed framework can be useful both to analyse existing OCTs and to support health managers and policy makers to create new OCTs or develop those already active. (Edited publisher abstract)
Intermediate care: developing capacity in step up and step down beds
- Author:
- JOINT IMPROVEMENT TEAM
- Publisher:
- Joint Improvement Team
- Publication year:
- 2015
- Pagination:
- 15
- Place of publication:
- Edinburgh
Reports the results of a short online survey designed to provide a 'snapshot' of step up and step down beds as part of intermediate care activity in Scotland at August 2014. Step up beds are defined as those were people are admitted from home as an alternative to acute hospital admission and as step down beds as a transfer from acute hospital for people who require additional time and rehabilitation to recover but are unable to have this provided at home. The survey aimed to: describe the range of step up and step down services provided; explore perceived barriers and solutions for scaling up this care; identify themes for improvement support; and signpost to examples of good practice. A total of 31 health and care partnerships responded to the survey, with 26 currently providing or commissioning step up or step down beds. Locations of bed provision include independent and council care homes, housing with care and community hospitals. Survey results also briefly report on how services are evaluated, multidisciplinary support provided and use of technology. Annexes include definitions of terms used and a list of key principles that underpin intermediate care. (Edited publisher abstract)
The national standard for intermediate care
- Author:
- GREENWOOD Lynne
- Journal article citation:
- Health Service Journal, 3.12.09, 2009, pp.24-25.
- Publisher:
- Emap Healthcare
Some of the results from a pilot audit of standards in 116 intermediate care services are briefly presented. The audit was conducted by the British Geriatric Society. The possibility of a comprehensive national audit is also discussed.
Understanding service context: development of a service pro forma to describe and measure elderly peoples' community and intermediate care services
- Author:
- NANCARROW Susan A.
- Journal article citation:
- Health and Social Care in the Community, 17(5), September 2009, pp.434-446.
- Publisher:
- Wiley
The purpose of this paper was to develop a pro forma which classifies the components of service delivery and organization which may impact on the outcomes of elderly peoples' community and intermediate care services. The resulting analytic template provides a basis for comparison between services and may help guide service commissioning and development. A qualitative approach was used in which key evaluations and reports were selected on the basis that they described elderly peoples' community and intermediate care services. These were analysed systematically using a qualitative (template) approach to draw out the key themes used to describe services. Themes were then structured hierarchically into an analytic template. Seventeen key documents were analysed. The initial coding framework classified 334 themes describing intermediate care services. These items were then clustered into 78 categories, which were reduced to 17 subcategories, then six overall groupings to describe the services, namely; (1) context; (2) reason for the service; (3) service-users; (4) access to the service; (5) service structure; and (6) the organization of care. The resulting analytic template has been developed into a 'service pro forma' which can be used as a basis to describe and compare a range of services. It is proposed that all service evaluations should describe, in detail, their context in a comparable way, so that other services can learn from and/or apply the findings from these studies.
Prevalence of depression and anxiety symptoms in elderly patients admitted in post-acute intermediate care
- Authors:
- YOHANNES A. M., BALDWIN R. C., CONNOLLY M. J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 23(11), November 2008, pp.1141-1147.
- Publisher:
- Wiley
Depression and anxiety symptoms are common in medically ill older patients. This study investigated the prevalence and predictors of depression and anxiety symptoms in older patients admitted for further rehabilitation in a post acute intermediate care unit, in the North West of England. One hundred and seventy-three older patients (60 male), aged mean (SD) 80 (8.1) years, referred for further rehabilitation to intermediate care. Depression and anxiety symptoms were assessed by the Hospital Anxiety and Depression Scale, and severity of depression examined by the Montgomery Asberg Depression Rating Scale. Physical disability was assessed by the Nottingham Extended ADL Scale and quality of life by the SF-36. Sixty-five patients (38%) were identified with depressive symptoms, 29 (17%) with clinical depression, 73 (43%) with anxiety symptoms, and 43 (25%) with clinical anxiety. 15 (35%) of the latter did not have elevated depression scores (9% of the sample). Of those with clinical depression, 14 (48%) were mildly depressed and 15 (52%) moderately depressed. Longer stay in the unit was predicted by severity of depression, physical disability, low cognition and living alone. Clinical depression and anxiety are common in older patients admitted in intermediate care. Anxiety is often but not invariably secondary to depression and both should be screened for. Depression is an important modifiable factor affecting length of stay. The benefits of structured management programmes for anxiety and depression in patients admitted in intermediate care are worthy of evaluation.
Costs and health outcomes of intermediate care: results from five UK case study sites
- Authors:
- KAAMBWA Billingsley, et al
- Journal article citation:
- Health and Social Care in the Community, 16(6), December 2008, pp.573-581.
- Publisher:
- Wiley
The objectives of this study were to explore the costs and outcomes associated with different types of intermediate care (IC) services, and also to examine the characteristics of patients receiving such services. Five UK case studies of 'whole systems' of IC were used, with data collected on a sample of consecutive IC episodes between January 2003 and January 2004. Statistical differences in costs and outcomes associated with different IC services and patient groups were explored. Factors associated with variation in IC episode outcomes were explored using an econometric framework. Data were available for 2253 episodes of IC. In terms of Department of Health criteria, a large proportion of patients (up to 47% of those for whom data were available) in this study were inappropriately admitted to IC services. As regards service function, compared to supported discharge, admission avoidance services were associated with both lower costs and greater health and functional gains. These gains appear to be driven, in part, by illness severity (more dependent patients tended to gain most benefit). In addition, these gains appear to be larger where the admission was appropriate. This study suggests a need for the development and application of robust and reliable clinical criteria for admission to IC, and close co-operation between hospital and community service providers over selection of patients and targeting of IC and acute care services to meet defined clinical need.
Challenges, benefits and weaknesses of intermediate care: results from five UK case study sites
- Authors:
- REGEN Emma, et al
- Journal article citation:
- Health and Social Care in the Community, 16(6), December 2008, pp.629-637.
- Publisher:
- Wiley
The authors explore the views of practitioners and managers on the implementation of intermediate care for elderly people across England, including their perceptions of the challenges involved in its implementation, and their assessment of the main benefits and weaknesses of provision. Qualitative data were collected in five case study sites (English primary care trusts) via semi structured interviews (n = 61) and focus group discussions (n = 21) during 2003 to 2004. Interviewees included senior managers, intermediate care service managers, clinicians and health and social care staff involved in the delivery of intermediate care. The data were analysed thematically using an approach based on the 'framework' method. Workforce and funding shortages, poor joint working between health and social care agencies and lack of support/involvement on the part of the medical profession were identified as the main challenges to developing intermediate care. The perceived benefits of intermediate care for service-users included flexibility, patient centeredness and the promotion of independence. The 'home-like' environment in which services were delivered was contrasted favourably with hospitals. Multidisciplinary team working and opportunities for role flexibility were identified as key benefits by staff. Insufficient capacity, problems of access and awareness at the interface between intermediate care and 'mainstream' services combined with poor co-ordination between intermediate care services emerged as the main weaknesses in current provision. Despite reported benefits for service-users and staff, the study indicates that intermediate care does not appear to be achieving its full potential for alleviating pressure within health and social care systems. The strengthening of capacity and workforce, improvements to whole systems working and the promotion of intermediate care among doctors and other referrers were identified as key future priorities.
Independent review of delayed transfers of care in Wales
- Authors:
- LONGLEY Marcus, et al
- Publisher:
- Welsh Institute for Health and Social Care
- Publication year:
- 2008
- Pagination:
- 242p., bibliog.
- Place of publication:
- Pontypridd
The ‘next stage of care’ covers all appropriate destinations within and outside the National Health Service (NHS), so delayed transfer of care applies to those patients who are unable to be discharged from NHS care, and those who are unable to be transferred within the NHS to a more appropriate bed. The date on which the patient is ready to move on to the next stage of care is the ready-for-transfer-of-care date. This is determined by the clinician responsible for the inpatient care, in consultation with colleagues in the hospital multi-disciplinary health care team and all agencies involved in planning the patient’s transfer of care (both NHS and non-NHS). Thus the patient is ready for transfer of care, but the transfer is delayed, for one or more of the following reasons: healthcare reasons, social care reasons, patient/carer/family-related reasons.
The organisation, form and function of intermediate care services and systems in England: results from a national survey
- Authors:
- MARTIN Graham P., et al
- Journal article citation:
- Health and Social Care in the Community, 15(2), March 2007, pp.146-154.
- Publisher:
- Wiley
This paper reports the results of a postal survey of intermediate care coordinators (ICCs) on the organisation and delivery of intermediate care services for older people in England, conducted between November 2003 and May 2004. Questionnaires, which covered a range of issues with a variety of quantitative, tick-box and open-ended questions, were returned by 106 respondents, representing just over 35% of primary care trusts (PCTs). The authors discuss the role of ICCs, the integration of local systems of intermediate care provision, and the form, function and model of delivery of services described by respondents. Using descriptive and statistical analysis of the responses, they highlight in particular the relationship between provision of admission avoidance and supported discharge, the availability of 24-hour care, and the locations in which care is provided, and relate their findings to the emerging evidence base for intermediate care, guidance on implementation from central government, and debate in the literature. Whilst the expansion and integration of intermediate care appear to be continuing apace, much provision seems concentrated in supported discharge services rather than acute admission avoidance, and particularly in residential forms of post-acute intermediate care. Supported discharge services tend to be found in residential settings, while admission avoidance provision tends to be non-residential in nature. Twenty-four-hour care in non-residential settings is not available in several responding PCTs. These findings raise questions about the relationship between the implementation of intermediate care, and the evidence for and aims of the policy as part of National Health Service modernisation, and the extent to which intermediate care represents a genuinely novel approach to the care and rehabilitation of older people.