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Care management's challenges and opportunities to reduce the rapid rehospitalization of frail community-dwelling older adults
- Authors:
- GOLDEN Adam G., et al
- Journal article citation:
- Gerontologist, 50(4), August 2010, pp.451-458.
- Publisher:
- Oxford University Press
Older people with complex medical and social needs are at great risk for preventable re-hospitalisations. While federal and state regulations in the US address the care transitions between the hospital and nursing home, no such guidelines exist for the much larger population of community-dwelling frail older people. To date, few studies have looked at interventions to prevent re-hospitalisations in this large segment of the older population. The authors argue that standardised disease management approaches that lower hospitalisation of independent adults may not suffice for guiding the care of frail persons. Currently, care management interventions face unique challenges in their attempt to improve the transitional care of community-dwelling older people. However, impending national imperatives aimed at reducing potentially avoidable hospitalisations will soon demand and reward care management strategies that identify frail people early in the discharge process and promote the sharing of critical information among patients, caregivers, and health care professionals. The authors conclude that opportunities to improve the quality of care-related communications must focus on effective training and technology for improving communications vital to successful care transitions.
In and out of hospital: a practical guide to discharge and care of older persons
- Author:
- Positive Publications
- Publisher:
- Positive Publications
- Publication year:
- 1997
- Pagination:
- 26p.
- Place of publication:
- London
Guidance on avoiding unnecessary re-admission to hospital of older people. Contains sections on: past problems; developing teamwork; preparing discharge from hospital; preparing the care plan; and returning home from hospital.
The effects of integrated home care and discharge practice on functional ability and health-related quality of life: a cluster-randomised trial among home care patients
- Authors:
- HAMMAR Teija, PERALA Marja-Leena, RISSANEN Pekka
- Journal article citation:
- International Journal of Integrated Care, 7(3), 2007, Online only
- Publisher:
- International Foundation for Integrated Care
The aim of this study was to evaluate the effects of integrated home care and discharge practice on the functional ability (FA) and health-related quality of life (HRQoL) of home care patients. A cluster randomised trial (CRT) with 22 Finnish municipalities as the units of randomisation. At baseline the sample included 669 patients aged 65 years or over. Data consisted of interviews (at discharge, and at 3-week and 6-month follow-up), medical records and care registers. The intervention was a generic prototype of care/case management-practice. The aim of the intervention was to standardize practices and make written agreements between hospitals and home care administrations, and also within home care and to name a care/case manager pair for each home care patient. The main outcomes were HRQoL and also Activities of Daily Living (ADL). All analyses were based on intention-to-treat. At baseline over half of the patient population perceived their FA and HRQoL as poor. At the 6-month follow-up there were no improvements in FA or in EQ-5D scores, and no differences between groups. In energy, sleep, and pain the NHP improved significantly in both groups at the 3-week and at 6-month follow-up with no differences between groups. In the 3-week follow-up, physical mobility was higher in the trial group. Although the effects of the new practice did not improve the patients' FA and HRQoL, except for physical mobility at the 3-week follow-up, the workers thought that the intervention worked in practice. The intervention standardised practices and helped to integrate services.
Implementing the Evercare Programme: interim report; February 28, 2004
- Author:
- EVERCARE
- Publisher:
- Evercare
- Publication year:
- 2004
- Pagination:
- 58p.
- Place of publication:
- Minneapolis, MN
Evercare is an internationally unique health care improvement programme originally developed for the U.S. government that has successfully improved quality whilst reducing costs of care for 60,000 vulnerable older people. In the United States, Evercare reduced hospitalisations by 50 percent amongst its patients in care facilities whilst achieving high family satisfaction and the same mortality outcomes as compared to a control group. In autumn 2002, the Department of Health in England invited Ovation’s Evercare programme to contribute its tools, techniques, and expertise to help Primary Care Trusts (PCTs) enhance the speed and certainty of achieving the NHS Plan. An eight-week assessment in 10 PCTs was completed in February 2003. Following this, nine PCTs elected to implement the Evercare model of care management to improve the health of frail older people whilst reducing their need for hospitalisations. This interim report provides a midterm review of the 17-month implementation phase of the Evercare project. The implementation phase began in April 2003 and runs through August 2004. We are greatly encouraged by the results achieved to date, which can to attributed to the receptivity and enthusiasm of people within the NHS toward making a transformational change in services for older people.
Inside multi-disciplinary practice: challenges for single assessment
- Authors:
- CORNES Michelle, CLOUGH Roger
- Journal article citation:
- Journal of Integrated Care, 12(2), April 2004, pp.3-13.
- Publisher:
- Emerald
Draws on ethnographic research which tracked older people's journeys through the health and social care system, highlighting some of the key issues which will need to be addressed if the new single assessment process is to become user and carer-friendly. Argues that the concept of the 'whole system' is a misnomer, and a more accurate picture is that of a world at war, with territorial disputes rife and border controls tighter than ever. Suggests that too much emphasis has been placed on IT systems and paperwork and that the real challenge is to cut through the jargon of modernisation and to see things from a wholly different perspective.
Collaborative care
- Author:
- MILLS John
- Journal article citation:
- Nursing Times, 15.11.01, 2001, p.38.
- Publisher:
- Nursing Times
Reports on a project that has improved discharge management for older people in north Essex.
The NHS and Community Care Act 1990: impact on the discharge profile of patients with dementia
- Authors:
- ANGUNAWELA Indra I., BARKER Andrew, NICHOLSON Simon D.
- Journal article citation:
- Psychiatric Bulletin, 24(5), May 2000, pp.177-178.
- Publisher:
- Royal College of Psychiatrists
Examines the impact of the Community Care Act on the discharge profile of dementia in-patients by conducting prospective studies of inpatient discharges from a dementia assessment ward before the Act, and 5 and 41 months after the Act. Results found the proportion of patients discharged to their own homes and to residential/nursing home care remained unaffected by the Act. Placement delay was increased both in 1993 and 1996, but by 1996 the difference was no longer statistically significant. The new care management process by social services was found to be associated with delayed discharges for people with dementia requiring residential/nursing home placements, thus causing pressures on beds and higher in-patient costs.
Home guard
- Author:
- KLEE Deborah
- Journal article citation:
- Health Service Journal, 5.8.99, 1999, p.26.
- Publisher:
- Emap Healthcare
Collaborative care can free beds while offering elderly people their own recovery plans. Looks at the results of the North Essex health and social services collaborative care pilot project.
Shared care provides postoperative help
- Author:
- WALTERS Jacky
- Journal article citation:
- Nursing Times, 24.3.99, 1999, pp.52-54.
- Publisher:
- Nursing Times
Reports on the use of a shared care team in Kingston, Surrey, which was developed to provide tailored care packages for patients who no longer required 24-hour hospital care. The joint initiative was funded to facilitate early discharge and prevent unnecessary admissions.
Getting better: inspection of hospital discharge (care management) arrangements for older people
- Author:
- GREAT BRITAIN. Department of Health. Social Services Inspectorate
- Publisher:
- Great Britain. Department of Health. Social Services Inspectorate
- Publication year:
- 1998
- Pagination:
- 2p.
- Place of publication:
- London
Letter accompanying an inspection report.