Continuing care for older patients during the transitional period

Wang, Siyuan; Zhao, Yue; Zang, Xiaoying

doi:10.1016/j.cnre.2014.11.001

Cited by 9 publications

(8 citation statements)

References 82 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…-Patients who have high care needs that are not met -Patients who are dissatisfied with the current method of care -Patients who are hospitalized due to recurrent disease -Patients who have suffered a lot of overhead costs (6,12,19).…”

Section: Literature Review In Transitional Care Modelmentioning

confidence: 99%

Transitional care model: managing the experience of hospital at home

Rezapour-Nasrabad

2018

Electron J Gen Med

View full text Add to dashboard Cite

Introduction: Design and use of effective strategies to improve care and achieve better results for patients with chronic diseases, reduce the frequency and cost of hospitalization is necessary for these patients. Transitional care model is a new model that have been effective in meeting the needs of these patients. The aim of this mini review study is investigating and describing the various aspects of transitional care model, benefits and core components. Design: The present investigation is a mini review study that conducted with library reading for data collecting. Methods: Scientific database (ISI, Pubmed, Scopus, Sciencedirect) were reviewed for articles related to the transitional care model literature. A total of 80 articles were obtained. Following applying the inclusion criteria (published between 2000 and 2017 in English language among peer-review journals), 5 articles were retained. These articles propose core components of the transitional care model and its benefits. Results: Transitional care model has some benefits, 8 main elements and 7 core components including:

show abstract

Section: Literature Review In Transitional Care Modelmentioning

confidence: 99%

Transitional care model: managing the experience of hospital at home

Rezapour-Nasrabad

2018

Electron J Gen Med

View full text Add to dashboard Cite

show abstract

“…However, only 20–60% patients in China comply with antihypertensive drugs [ 42 ]. Nearly half of patients with diabetes and hypertension are likely to discontinue their medication treatment in the first 6 months after discharge or when their symptoms diminish [ 2 , 42 ]. Among the patients who adhere to medications, 50% of them take their medications in an incorrect way [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…It is estimated that one third of adults (over 100 million) with type 2 diabetes around the world live in China [ 1 ]. One third of the Chinese population are expected to be aged 60 years and older (430 million people) by the year 2050 [ 2 ]. The continuous growth of the older population will inevitably increase the incidence of hypertension and diabetes in this population group, resulting in an increased burden on the healthcare system.…”

Section: Introductionmentioning

confidence: 99%

“…Factors associated with uncontrolled hypertension among older people with diabetes include patient factors (i.e., the lack of knowledge, skill and resources to perform self-care) and healthcare system factors (i.e., the lack of continuity of care and collaboration between different care providers) [ 2 , 10 , 11 ]. Poor communication and collaboration between hospitals and community health service centers exists in many low and middle-income countries which leads to fragmented healthcare delivery for discharged patients [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hypertension management for community-dwelling older people with diabetes in Nanchang, China: study protocol for a cluster randomized controlled trial

Xiao

Ullah

et al. 2018

Trials

View full text Add to dashboard Cite

BackgroundAlthough China has a large number of older people living with diabetes and hypertension, the primary care system is underdeveloped and so management of these conditions in community care settings is suboptimal. Studies have shown that the collaborative care model across care settings that address both pharmacology and nonpharmacology interventions can achieve hypertension control for older people with diabetes. Barriers to implementing and evaluating this model of care are widely recognized in low and middle-income countries including China.This study will therefore test the hypothesis that a hypertension management program built on collaboration between hospitals and community health service centers in China can improve blood pressure control in people aged 60 years and older with diabetes as compared to usual care.MethodsA cluster randomized controlled trial will randomly allocate 10 wards from four hospitals in Nanchang to either an intervention group (N = 5) or a usual care group (N = 5). At least 27 participants will be recruited from each ward and the estimated sample size will be 135 patients in each group. The intervention includes individualized self-care education prior to discharge and 6-month follow-up in community health service centers. Health professionals from both hospitals and community health service centers will be resourced to collaborate on the implementation of the postdischarge interventions that reinforce self-care. The primary outcome is systolic blood pressure at 6-month follow-up adjusted for baseline value. Secondary outcomes are self-care knowledge, treatment adherence, HbA1c and lipid levels, quality of life, the incidence of adverse events and the incidence of unplanned hospital readmission at 6-month follow-up adjusted for baseline value. A multilevel mixed-effect linear regression model will be used to compare the changes in health outcomes between the intervention and usual care groups.DiscussionThis study will determine whether collaborative care among health professionals between hospitals and community health service centers will improve hypertension management for older people with diabetes in the study sites. The program, if effective, will have an immediate application to hypertension management in the healthcare system in China.Trial registrationAustralia New Zealand Clinical Trials Registry, ACTRN12617001352392. Retrospectively registered on 26 September 2017.Electronic supplementary materialThe online version of this article (10.1186/s13063-018-2766-5) contains supplementary material, which is available to authorized users.

show abstract

“…For example, for the age group of 75 years and older (OR 1.81, 95% CI 1.72–1.91), the probability of being discharged to a facility nearly doubled compared with the age group of younger than 64 years (OR 1.00, Reference). Because it is hard for them to take care of their own health, 26 they must rely on systematic and careful management from the facility. Furthermore, as patients with stroke age, their caregivers may have a different condition and may be unable to provide adequate support for them.…”

Section: Discussionmentioning

confidence: 99%

Hospital Discharge Disposition of Stroke Patients in Tennessee

Cho

Fell

et al. 2017

Southern Medical Journal

View full text Add to dashboard Cite

Objectives Early determination of hospital discharge disposition status at an acute admission is extremely important for stroke management and the eventual outcomes of patients with stroke. We investigated the hospital discharge disposition of patients with stroke residing in Tennessee and developed a predictive tool for clinical adoption. Our investigational aims were to evaluate the association of selected patient characteristics with hospital discharge disposition status and predict such status at the time of an acute stroke admission. Methods We analyzed 127,581 records of patients with stroke hospitalized between 2010 and 2014. Logistic regression was used to generate odds ratios and 95% confidence intervals to examine the factor outcome association. An easy-to-use clinical predictive tool was built by using integer-based risk scores derived from coefficients of multivariable logistic regression. Results Among the 127,581 records of patients with stroke, 86,114 (67.5%) indicated home discharge and 41,467 (32.5%) corresponded to facility discharge. All considered patient characteristics had significant correlations with hospital discharge disposition status. Patients were at greater odds of being discharged to another facility if they were women; older; black; patients with a subarachnoid or intracerebral hemorrhage; those with the comorbidities of diabetes mellitus, heart disease, hypertension, chronic kidney disease, arrhythmia, or depression; those transferred from another hospital; or patients with Medicare as the primary payer. A predictive tool had a discriminatory capability with area under the curve estimates of 0.737 and 0.724 for derivation and validation cohorts, respectively. Conclusions Our investigation revealed that the hospital discharge disposition pattern of patients with stroke in Tennessee was associated with the key patient characteristics of selected demographics, clinical indicators, and insurance status. These analyses resulted in the development of an easy-to-use predictive tool for early determination of hospital discharge disposition status.

show abstract

Continuing care for older patients during the transitional period

Cited by 9 publications

References 82 publications

Transitional care model: managing the experience of hospital at home

Transitional care model: managing the experience of hospital at home

Hypertension management for community-dwelling older people with diabetes in Nanchang, China: study protocol for a cluster randomized controlled trial

Hospital Discharge Disposition of Stroke Patients in Tennessee

Contact Info

Product

Resources

About