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Using qualitative research in systematic reviews: older people's views of hospital discharge
- Authors:
- SOCIAL CARE INSTITUTE FOR EXCELLENCE, FISHER Mike, et al
- Publisher:
- Social Care Institute for Excellence
- Publication year:
- 2006
- Pagination:
- 68p.
- Place of publication:
- London
Systematic reviews are usually restricted to quantitative studies. This report demonstrates how the review process can be extended to a synthesis of qualitative studies using the example of older people’s views on hospital discharge. There were two kinds of evidence about the potential effectiveness of discharge arrangements – the review by Parker showing that support could be successfully provided to older people discharged from hospital, and international evidence from Sweden, where a similar reform had been implemented. Closer examination of this evidence provided some of the key reasons why this qualitative synthesis of older people’s views of hospital discharge was undertaken.
Hospital discharge of older people with cognitive impairment to care homes
- Author:
- BRITISH GERIATRICS SOCIETY
- Publisher:
- British Geriatrics Society
- Publication year:
- 2006
- Pagination:
- 2p.
The scope of this document is confined to the safe and appropriate discharge of older people with cognitive impairment from hospital to a care home. It is a given, within the context of this document, that discharge to any other care setting has been deemed inappropriate as the result of a comprehensive geriatric assessment (CGA). A separate British Geriatrics Society (BGS) compendium document deals with the wider context of hospital discharge of frail older people.
Contribution of secondary caregivers to post-acute home care for elderly patients
- Authors:
- LI Hong, MORROW-HOWELL Nancy, PROCTOR Enola
- Journal article citation:
- Journal of Social Service Research, 33(1), 2006, pp.39-46.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This study examined the contribution of secondary caregivers to the elderly patients' use of informal services and use of formal services, and the adequacy of care provided to the elderly patients in the period following acute hospitalization in a large midwestern hospital in the United States. A sample of 149 elderly patients diagnosed with congestive heart failure (CHF) were interviewed at their home two weeks after their hospital discharge. Nearly three quarters of the elderly patients had one or more secondary caregivers. Findings from ordinary least squares (OLS) regression analyses indicate that the involvement of secondary caregivers was not significantly related to elderly patients' use of informal services, formal services, or the adequacy of care. These findings may be relevant to the practice of discharge planners by suggesting that the involvement of secondary caregivers may not reduce elderly patients' need for informal services and/or formal services. Furthermore, the involvement of secondary caregivers may not improve the adequacy of care provided to the elderly patients. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Long-term effects of outpatient geriatric evaluation and management on health care utilization, cost, and survival
- Authors:
- ENGELHARDT Joseph B., et al
- Journal article citation:
- Research on Social Work Practice, 16(1), January 2006, pp.20-27.
- Publisher:
- Sage
In this American study the long-term effectiveness and efficiency of an outpatient geriatric evaluation and management (GEM) program was compared to usual primary care (UPC). A randomized controlled group design was used. Health care utilization, cost of care, and survival were assessed during a 48-month period among a sample of 160 male veterans age 55 and over who were above-average users of outpatient services. The results indicate that GEM patients incurred significantly lower overall health care costs than UPC patients by 24 months and that cost savings plateaued during the 24- to 48-month period. Cost savings were due primarily to fewer hospital days of care. No significant differences were found in survival. Results of this follow-up study suggest that outpatient GEM offers a specialized health delivery option for frail older persons that may reduce costs over the long term without having a negative impact on survival rates.
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.
Effective partnership working: a case study of hospital discharge
- Author:
- HENWOOD Melanie
- Journal article citation:
- Health and Social Care in the Community, 14(5), September 2006, pp.400-407.
- Publisher:
- Wiley
This paper examines partnership working between health and social care by exploring the specific issues which this case study of hospital discharge provides. The analysis highlights the importance of understanding the dynamics of partnership working on the ground. It also underlines the need for a new relationship between central government and local agencies when old-style models of command and control are no longer fit for purpose. A new approach is required that addresses the complex and multiple relationships which characterise the new partnership agenda.
Post-acute dispositions of older adults hospitalized for depression
- Authors:
- MORROW-HOWELL N. L., et al
- Journal article citation:
- Aging and Mental Health, 10(4), July 2006, pp.352-361.
- Publisher:
- Taylor and Francis
This study addressed factors associated with six-month post-acute dispositions (continuous community stay, medical hospitalization, psychiatric rehospitalization, nursing home placement, death) for older adults hospitalized for depression and discharged to the community. The sample included 199 older adults; and data were collected via medical records, interviews with discharge planners, patients, and family members. Over half of the sample remained in the community throughout the observation period; 23% experienced psychiatric re-admission and 10% entered a nursing home. Several factors associated with nursing home placement were identified: less improvement in depression during the hospitalization, lower Global Assessment of Functioning (GAF) scores at discharge; and less mental health service use in the post-acute period. Those at higher risk of psychiatric re-admission had more previous psychiatric hospitalizations and were marginally more likely to be married and have lower Brief Psychiatric Rating Scale (BPRS) scores at discharge. Differentiating those at risk for nursing home placement may be easier than differentiating those at risk of psychiatric readmission.
Older people
- Author:
- MANTHORPE Jill
- Journal article citation:
- Research Matters, April 2006, pp.59-64.
- Publisher:
- Community Care
The article reports on a selection of research which examines the physical and mental risks in later life as well as the early detection of them.
Buying Time II: an economic evaluation of a joint NHS/Social Services residential rehabilitation unit for older people on discharge from hospital
- Authors:
- ELLIS Annie, et al
- Journal article citation:
- Health and Social Care in the Community, 14(2), March 2006, pp.95-106.
- Publisher:
- Wiley
The study's aim was to investigate the cost-effectiveness of an NHS/Social Services short-term residential rehabilitation unit (a form of intermediate care) for older people on discharge from community hospital compared with 'usual' community services. An economic evaluation was conducted alongside a prospective controlled trial, which explored the effectiveness of a rehabilitation unit in a practice setting. The aim of the unit was to help individuals regain independence. A matched control group went home from hospital with the health/social care services they would ordinarily receive. The research was conducted in two matched geographical areas in Devon: one with a rehabilitation unit, one without. Participants were recruited from January 1999 to October 2000 in 10 community hospitals and their eligibility determined using the unit's strict inclusion/exclusion criteria, including 55 years or older and likely to benefit from a short-term rehabilitation programme: potential to improve, realistic, achievable goals, motivation to participate. Ninety-four people were recruited to the intervention and 112 to the control group. Details were collated of the NHS and Social Services resources participants used over a 12-month follow-up. The cost of the resource use was compared between those who went to the unit and those who went straight home. Overall, costs were very similar between the two groups. Aggregated mean NHS/Social Services costs for the 12 months of follow-up were £8542.28 for the intervention group and £8510.68 for the control. However, there was a clear 'seesaw' effect between the NHS and Social Services: the cost of the unit option fell more heavily on Social Services (£5011.56, whereas £3530.72 to the NHS), the community option more so on the NHS (£5146.74, whereas £3363.94 to Social Services). This suggests that residential rehabilitation for older people is no more cost-effective over a year after discharge from community hospital than usual community services. The variability in cost burden between the NHS and Social Services has implications for 'who pays' and being sure that agencies share both pain and gain.
Who recommends long-term care matters
- Authors:
- KANE Robert L., BERSHADSKY Boris, BERSHADSKY Julie
- Journal article citation:
- Gerontologist, 46(4), August 2006, pp.474-482.
- Publisher:
- Oxford University Press
Making good consumer decisions requires having good information. This American study compared long-term-care recommendations among various types of health professionals. The authors gave randomly varied scenarios to a convenience national sample of 211 professionals from varying disciplines and work locations. For each scenario, the professional was asked to recommend the appropriate forms of long-term care. Although the professional respondents used the full spectrum of options offered to them, some professionals tended to favour the sector they worked in. Advanced practice nurses recommended day care and homemaking more and adult foster care less. Gerontologists used skilled nursing-facility placement more actively and rehabilitation, homemaking, and home health care less actively. Geriatricians and primary care physicians both favoured rehabilitation and skilled nursing-facility care and were both less enthusiastic about assisted living, homemaking, and informal care, but the geriatricians favoured day care more than did the primary care physicians. Registered nurses were highly supportive of assisted living, adult foster care, homemaking, and home health care, and they opposed skilled nursing-facility care. Social workers were less likely than other participants to endorse rehabilitation and adult foster care. Implications: Because consumer preference should be a major factor in making long-term-care decisions, many consumers need information about what options may best fit their situation. In the absence of empirical data on which types of long-term care work best for whom, consumers have to rely on expert judgment - but that judgment varies. Clients should be aware that an expert's background (as defined by discipline and work situation) may affect his or her recommendations. Each discipline appears to have its own set of experiences and beliefs that may influence recommendations.