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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)
Medical patients' experiences of inreach occupational therapy: continuity between hospital and home
- Authors:
- BROWN Sarah, CRADDOCK Deborah, GREENYER Corinne Hutt
- Journal article citation:
- British Journal of Occupational Therapy, 75(7), July 2012, pp.330-336.
- Publisher:
- Sage
Patients moving from hospital to the community can be at risk of experiencing poorly coordinated care, despite the current NHS emphasis on a whole system approach. Inreach services are community based and the same member of staff provides intervention in hospital and after discharge. This qualitative study examined medical patients' experiences of inreach occupational therapy. Semi-structured interviews were conducted with a convenience sample of seven older people living in southern England, following their discharge from a medical inreach occupational therapy service (four women, average age 81 years). Thematic analysis was used to explore findings. There was uncertainty about the role of occupational therapy and concern that participants did not feel involved in their hospital discharge. However the inreach occupational therapy service and its staffing continuity increased some patients’ confidence and provided reassurance during the discharge period and their return home; for other participants accurate information sharing between staff was particularly important at discharge. The authors conclude that all participants valued a seamless service between occupational therapy in hospital and at home. They suggest that patients’ needs could be better met by flexible referral points across the hospital and community interface.
Right care, first time: services supporting safe hospital discharge and preventing hospital admission and readmission
- Author:
- AGE UK
- Publisher:
- Age UK
- Publication year:
- 2012
- Pagination:
- 28p.
- Place of publication:
- London
Older people represent the main in-patient group, at any one time occupying more than two-thirds of acute hospital in-patient beds. Providers and commissioners need to put in place cost-effective, community based services, which can both prevent the need for hospital admission and safely reduce length of stay for older people. A hospital admission can occur when an older person has reached breaking point because of a combination of problems that have been building up before admission: social circumstances (such as living alone or having caring responsibilities) or general frailty. The aim of this publication is to disseminate examples of positive practice in avoiding hospital admission, supporting safe discharge and preventing readmission for older people. This publication highlights 5 examples of local Age UK services, charting the ‘pathway’ of prevention from identifying older people in the local community who may be at risk, to supporting people who are in A&E, and ensuring that discharge from in-patient care is safe and well co-ordinated.
Hospital2future caring options
- Authors:
- HENDERSON Mary, comp.
- Publisher:
- Dargan Publications; Care2Share NI
- Publication year:
- 2012
- Place of publication:
- Newtownabbey
This booklet provides information for carers on the hospital discharge process and what this might mean for their caring role and future options for care. The first section looks at key issues to consider leading up to hospital discharge. The second section looks at the caring role, including the pressure carers can face and the support strategies they can use. The third section looks at choosing a care home, including emotional and practical considerations. The final section looks at consulting on financial and legal affairs. It is one of a series of three booklets developed specifically for carers of friends or relatives and those working in the caring profession. The series aims to help meet the challenges of caring, whilst also balancing these responsibilities with a carers own wellbeing.
Older adults' experiences of occupational therapy predischarge home visits: a systematic thematic synthesis of qualitative research
- Authors:
- ATWAL Anita, et al
- Journal article citation:
- British Journal of Occupational Therapy, 75(3), March 2012, pp.118-127.
- Publisher:
- Sage
The authors believe that, despite predischarge home visits by occupational therapists being common in practice, there has been a tendency to neglect users' perceptions and experiences when evaluating whether this intervention is clinically and cost effective. A qualitative literature review was undertaken as a basis for systematic thematic synthesis of older adults' perceptions and experiences of predischarge home visits. Electronic database search were searched, conference proceedings hand searched and universities and occupational therapy professional bodies within Europe, Australia and North America contacted. Forty-four studies were initially identified, of which 13 studies (7 published, 6 unpublished) were selected for detailed screening. Only three qualitative studies met the inclusion criteria. Two main themes emerged: older adults' perceptions of home visits, and acceptance of occupational therapy. Although, in general, older adults are satisfied with predischarge home visits, the experience may provoke anxiety for some patients. Older people felt that they were not always involved in the decision making process during the visit, which may result in no-acceptance of the occupational therapy recommendations. The authors conclude that insufficient attention has been paid to older adults' perceptions of predischarge home visits. They believe that further work is necessary to determine their effectiveness from a user’s perspective.
Can post-acute care programmes for older people reduce overall costs in the health system? A case study using the Australian Transition Care Programme
- Authors:
- HALL C. J., et al
- Journal article citation:
- Health and Social Care in the Community, 20(1), January 2012, pp.97-102.
- Publisher:
- Wiley
Community-based post-acute care discharge services for older people have been developed as a method of reducing length of stay in hospital and preventing readmissions in order to reduce pressure and costs in the hospital system. This article considers whether they reduce overall episode cost or expenditure in the health system at a more general level. It uses the Australian Transition Care Programme (TCP) as a case study. The TCP provides flexible care to older patients at the conclusion of a hospital episode including home help, personal care, and rehabilitation. An economic model was developed to identify the maximum potential benefits and the likely cost savings for participants of TCP from the reduced use of health services from earlier discharge from hospital, accelerated recovery, reduced likelihood of readmission to hospital and delayed entry into permanent institutional care. The findings show that, even assuming the best case scenario, the TCP is still unlikely to be cost saving to the healthcare system. Further research is needed to determine if the service can be demonstrated to offer additional health benefits such as quality of life which would make it cost-effective when compared with other community healthcare programmes.
Reasons for redesigning care for older people
- Author:
- PHILP Ian
- Journal article citation:
- Health Service Journal, 29.11.12, 2012, pp.30-32.
- Publisher:
- Emap Healthcare
South Warwickshire Foundation Trust has transformed its acute and community services to meet the needs of older people. A review of evidence about interventions to improve productivity and outcomes in older people's health and care led the Trust to focus on four main principles: get in early; invest in alternatives to acute hospital care; provide acute care by old age specialists; and discharge to assess. The principles have been put into practice in a number of linked projects. These include: using a single assessment instrument. EASY-Care, to be used by the health, social care and the third sector; close partnership working with adult social care and primary care services to provide alternatives to hospital care; and expansion of old-age specialist care teams.
On the pulse: housing routes to better health outcomes for older people
- Author:
- LENG Gill
- Publisher:
- National Housing Federation
- Publication year:
- 2012
- Pagination:
- 28
- Place of publication:
- London
This report features analysis of current health and care priorities, focusing on quality of care, innovation, productivity and prevention. It explores how housing associations can work with health and social care commissioners to enable older people to manage changes in their health; help people live as independently as possible; and reduce the need for more costly care. The report includes six case studies describing some innovative solutions which Federation members have developed. These reflect the diverse ways in which housing providers are responding to both the needs of older people at critical points in their lives and NHS priorities. The services featured in the report deliver one or more of the following health and care outcomes: they help older people to recover their independence after illness, stroke, injury or trauma; get people home from hospital quickly, while preventing hospital admissions and readmissions; delay the need for more intensive care and support; reduce the likelihood of emergency admissions help to stabilise and manage chronic conditions such as dementia; enable people to remain in their homes to the end of their lives; and maximise the benefits of technology, such as telecare. (Edited publisher abstract)