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Factors associated with 30-day hospital readmissions among participants in a care transition quality improvement program
- Authors:
- PARK Juyoung, et al
- Journal article citation:
- Journal of the Society for Social Work and Research, 3(4), 2012, Online only
- Publisher:
- Society for Social Work and Research
Discharge from hospital to home is a vulnerable period for older adults who have multiple care needs. The Safe Transitions for Elderly People (STEP) program is a care transition program for Medicare fee-for-service patients in the United States 75 years and older discharged to home from a community hospital. This quality improvement project (a) compares 30-day hospital readmission rates between 498 STEP participants and 722 patients eligible for STEP but not participating in the program, and (b) determines factors associated with readmissions during STEP. The STEP participants received intervention in 1 of 2 formats: 395 received a telephone-only intervention and 103 received a telephone plus home visit intervention. STEP participants had a lower 30-day hospital readmission rate than nonparticipants. Two variables were significant predictors of readmissions: for the group of all STEP participants and the telephone-only intervention group, the (a) hospitalization within the previous year predicted readmission; for the telephone plus home visit group, the (b) degree of assistance needed with ambulation predicted readmission. Given the multifactor nature of readmissions, interdisciplinary teams should develop tailored interventions based on individual’s psychosocial and medical assessments. (Edited publisher abstract)
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.
The home-visiting process for older people in the in-patient intermediate care services
- Author:
- HIBBERD Jane
- Journal article citation:
- Quality in Ageing, 9(1), March 2008, pp.13-23.
- Publisher:
- Pier Professional
- Place of publication:
- Brighton
Within the current constraints on health and social care services, it is essential that interventions such as home visits for older people can be seen to be appropriately deployed resources for facilitating their safe and timely discharge home. This paper discusses the findings of an evaluation project undertaken in 2003/04 with two in-patient intermediate care services. The service provided a short-term intervention for older people, with an emphasis on rehabilitation to enable a safe return to their own home environment.
For the sake of their health: older service users' requirements for social care to facilitate access to social networks following hospital discharge
- Authors:
- McLEOD Eileen, et al
- Journal article citation:
- British Journal of Social Work, 38(1), January 2008, pp.73-90.
- Publisher:
- Oxford University Press
Facilitating older service users’ requirements for access to or re-engagement in social networks following hospital discharge is recognized in social care analysis and policy as critically important. This is because of the associated benefits for restoring physical health and psychological well-being. However, it tends to be a neglected dimension of current social care/intermediate care. This paper draws on a qualitative study of voluntary sector hospital aftercare social rehabilitation projects in five UK localities, which focused on addressing this issue. Through examining older service users’ feedback and experience, the study confirms the health benefits of social care facilitating access to social networks at this crucial juncture. By providing sensitive interpersonal interaction, advocacy and ‘educational’ assistance, social care workers supported older service users’ re-engagement in a variety of networks. These included friendship, recreational and family groups, health care treatment programmes and locality based contacts and organizations. As a result, material, interpersonal and health care resources were accessed, which contributed to restoring and sustaining physical health and psychological well-being. The process of such social care also emerged as critical. This included ensuring that objectives reflected service users’ priorities; integrating ‘low-level’ home care; offering befriending; and challenging the pre-set time frame of intermediate care.
Buying Time I: a prospective, controlled trial of a joint health/social care residential rehabilitation unit for older people on discharge from hospital
- Authors:
- TRAPPES-LOMAX Tessa, et al
- Journal article citation:
- Health and Social Care in the Community, 14(1), January 2006, pp.49-62.
- Publisher:
- Wiley
The study's objective was to determine the effectiveness of a joint NHS/Social Services rehabilitation unit (a form of intermediate care) for older people on discharge from community hospital, compared with 'usual' community services. This was a controlled clinical trial in a practice setting. The intervention was 6 weeks in a rehabilitation unit where individuals worked with care/rehabilitation assistants and occupational therapists to regain independence. Controls went home with the health/social care services they would ordinarily receive. Participants were from two matched geographical areas in Devon: one with a rehabilitation unit, one without. Recruitment was from January 1999 to October 2001 in 10 community hospitals. Study eligibility was assessed using the unit's inclusion/exclusion criteria: 55 years or older and 'likely to benefit from a short-term rehabilitation programme' ('potential to improve', 'realistic and achievable goals' and 'motivation to participate'). Ninety-four people were recruited to the intervention and 112 to the control. The mean (standard deviation) age was 81.8 (8.0) years. The main outcome measure was prevention of institutionalisation assessed by the number of days from baseline interview to admission to residential/nursing care or death ('survival-at-home time'). Secondary outcome measures were time to hospital re-admission over 12 months, quality of life and coping ability. There were no significant differences between the groups on any outcome measure. The findings suggest a stay in a rehabilitation unit is no more effective than 'usual' care at diverting older people from hospital/long-term care. Alternative service configurations may be as effective, having implications for tailoring services more specifically to individual need and/or user preferences. However, the unit did appear to facilitate earlier discharges from community hospital.
The effectiveness of transition interventions to support older patients from hospital to home: a systematic scoping review
- Authors:
- O’DONNELL Renee, et al
- Journal article citation:
- Journal of Applied Gerontology, early cite 6 November 2020,
- Publisher:
- Sage
Background: Interventions supporting older adults’ transition from hospital to home can address geriatric needs. Yet this evidence base is fragmented. This review describes transitional interventions that provide pre- and post-discharge support for older adults and evaluates their implementation and effectiveness in improving health and well-being. Method: Articles were included if they examined the extent to which transitional interventions were effective in improving health and well-being outcomes and reducing hospital readmission rates among older adults. Results: Twenty studies met the inclusion criteria. Four types of interventions were identified: education-based (10/20); goal-oriented (4/20); exercise (4/20); and social support interventions (2/20). Education and goal-oriented interventions were effective in improving health and well-being outcomes. The impact of interventions on mitigating hospital readmissions was inconclusive. Only five studies examined implementation. Discussion: Older adults transitioning from hospital to home would benefit from tailored education and goal-oriented interventions that promote their capacity for self-care. (Edited publisher abstract)
British Red Cross 'Support at Home' hospital discharge scheme. A small-scale social care intervention: economic evidence
- Authors:
- KNAPP Martin, et al
- Publisher:
- London School of Economics and Political Science, Care Policy and Evaluation Centre
- Publication year:
- 2019
- Pagination:
- 4
- Place of publication:
- London
This case summary presents economic evidence on British Red Cross 'Support at Home' hospital discharge scheme. Through the scheme volunteers offer short-term (4–12 week) practical and emotional support for older people recently discharged from the hospital. A British Red Cross evaluation of the schemes effectiveness identified benefits such as enabling safe discharge, supporting carers and enabling patient advocacy. The intervention costs an average £169 per person, including volunteer time. The programme led to savings from older people needing less help with daily activities and improvements in wellbeing. These savings amounted to £884 per person on average (costs are at 2011 price levels). The summary notes that the quality of evidence on the evaluation was not high due to a lack of control group. (Edited publisher abstract)
An evaluation of Age UK's Person Centred Discharge Pathfinder programme
- Authors:
- BASHIR Nadia, et al
- Publisher:
- Sheffield Hallam University. Centre for Regional Economic and Social Research
- Publication year:
- 2019
- Pagination:
- 49
- Place of publication:
- Sheffield
The findings of a small-scale evaluation of Age UK's Person Centred Discharge (PCD) Pathfinder which supported older people at risk of extended length of hospital stay, both with the transition from hospital back home and some support at home afterwards. It set out to improve the quality of life for older people and improve experience of health and social care for both older people and staff. This report presents evaluation findings based largely on one area, highlights some of the challenges encountered by the Programme and provides learning for future. Overall, there is indicative evidence to suggest that the PCD Pathfinder Programme has led to positive change, including: improved wellbeing for older people, improved opportunities for developing new ways of working and informing service development within the GP surgery in which it operated. The findings also suggest that the involvement of Age UK Age UK Personal Independence Coordinators (PICs) facilitated better communication eg between GPs and hospitals, helps the discharge process take account of the older person’s preferences, and improves the wellbeing of older people once they are out of hospital in a sustainable way. (Edited publisher abstract)
Supported discharge teams for older people in hospital acute care: a randomised controlled trial
- Authors:
- PARSONS Matthew, et al
- Journal article citation:
- Age and Ageing, 47(2), 2018, pp.288-294.
- Publisher:
- Oxford University Press
Background: Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for disease-specific interventions to less favourable results for generic services. Objective: To determine whether older people referred to a Supported Discharge Team have: (i) reduced length-of-stay in hospital; (ii) reduced risk of hospital readmission; and (iii) reduced healthcare costs. Methods: Randomised controlled trial with follow-up to 6 months; 103 older women and 80 men (n = 183) (mean age 79), in hospital, were randomised to receive either Supported Discharge Team or usual care. Home-based rehabilitation was delivered by trained Health Care Assistants up to four times a day, 7 days a week, under the guidance of registered nurses, allied health and geriatricians for up to 6 weeks. Results: Participants randomised to the Supported Discharge Team spent less time in hospital during the index admission (mean 15.7 days) in comparison to usual care (mean 21.6 days) (mean difference 5.9: 95% CI 0.6, 11.3 days: P = 0.03) and spent less time in hospital in the 6 months following discharge home. Supported discharge group costs were calculated at mean NZ$10,836 (SD NZ$12,087) compared to NZ$16,943 (SD NZ$22,303) in usual care. Conclusion: A Supported Discharge Team can provide an effective means of discharging older people home early from hospital and can make a cost-effective contribution to managing increasing demand for hospital beds. (Publisher abstract)
In and out of hospital
- Author:
- BRITISH RED CROSS
- Publisher:
- British Red Cross
- Publication year:
- 2018
- Pagination:
- 16
- Place of publication:
- London
This report gathers the views of health and social care workers and people using services to show how many hospital admissions could be easily avoidable. It identifies missed opportunities to prevent a person’s health from deteriorating and from preventing their problems from reoccurring once they are discharged from hospital. Staff express concerns about delayed discharge, inappropriate discharge, and the importance of in-home assessments in ending the cycle of hospital readmissions. The report also identifies some of the challenges facing people who use home from hospital and support at home services. It suggests a number of simple interventions that could make a difference to both people and ‘patient flow’ by making older people feel safe at home, avoid unnecessary hospital admission, and to help people home from hospital. These include automatic home assessments for older and vulnerable people who are often admitted to hospital, more multi-disciplinary teams to work with people at risk of being admitted to hospital. The report also lists 10 simple steps used by the British Red Cross to help get people home from hospital. (Edited publisher abstract)