Transitions of Care

Brown, Mallory McClester

doi:10.1007/978-3-319-71812-5_30

Cited by 16 publications

(12 citation statements)

References 19 publications

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“…While family participation in care, sometimes termed collaboration, engagement or involvement is increasingly acknowledge as desirable in healthcare settings, the concept remains unclear within the adult acute care literature . Further, this lack of clarity regarding what represents meaningful participation from the perspective of patients and family members in this context has meant the uptake of practices that foster family involvement has been slow . Similarly, little is known about the barriers and facilitators to family participation in patient care within the adult hospital setting.…”

Section: Introductionmentioning

confidence: 99%

Patient and family members’ perceptions of family participation in care on acute care wards

Mackie

Mitchell

Marshall

2018

Scandinavian Caring Sciences

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Background Hospital leaders, policymakers and healthcare professionals are realising the benefits of delivering care that promotes family participation because it is known to enhance the quality of care, and improve patient satisfaction. Aim The aim of this study was to explore, from the perspective of patients and family members within an adult acute care ward: (a) their beliefs and attitudes towards family participation in patient care and (b) staff behaviours that support or hinder family participation in patient care. Design and methods A naturalistic approach with an exploratory sequential design was used in a medical assessment and planning unit of a regional referral hospital in Australia. Purposeful maximum variation sampling was used to recruit patients and family members who differed in age, ethnicity, relationship to patient and gender. Observer‐as‐participant observation data and semi‐structured interviews were undertaken. Following separate inductive content analysis, data were triangulated. Results Thirty‐two patients and 26 family members were recruited. Thirty hours of observational data were gathered. Eighteen patients and 15 family members were interviewed. Analysis uncovered two contrasting categories: (a) disconnected communication and (b) family influence quality. Conclusion The findings of our study demonstrated that most patients and families perceived staff communication as disconnected and inadequate, which constrained them from engaging in care processes or decision‐making. However, when family felt empowered and participated in patient care, the quality of health care was enhanced. Healthcare professionals can use these findings to make informed evidence‐based changes to the way they practice and communicate to ensure family participation in patient care is optimised in the acute care setting.

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Section: Introductionmentioning

confidence: 99%

Patient and family members’ perceptions of family participation in care on acute care wards

Mackie

Mitchell

Marshall

2018

Scandinavian Caring Sciences

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“…Transitions of care have been defined as the set of actions taken to ensure that care is coordinated as patients are transferred from one clinical setting to another (Brown, 2018). These transitions are vulnerable periods for all patients and especially so for older adults with multiple comorbidities, prior hospitalizations, poor social or family support, high medication burden, and lower health literacy (Farrell et al, 2015).…”

Section: Creating Ideal Processes To Improve Transitions Of Care In Kmentioning

confidence: 99%

“…These transitions are vulnerable periods for all patients and especially so for older adults with multiple comorbidities, prior hospitalizations, poor social or family support, high medication burden, and lower health literacy (Farrell et al, 2015). Brown (2018) reported that in the 30-day posthospital discharge period, 60% of Medicare beneficiaries made one transfer, 18% made two, 9% made three, and 4% made four or more. Each time a patient transitions from one postacute care environment to another, the potential for fragmentation in communication occurs, which can result in loss of critical information and fractionation of care planning.…”

Section: Creating Ideal Processes To Improve Transitions Of Care In Kmentioning

confidence: 99%

“…Several studies of transitional care programs have found reductions in readmission rates up to 45%. These programs incorporated several processes, including collaborative discharge planning with detailed, patient-centered discharge summaries; postdischarge telephone calls; home visits; primary care follow-up; and medication reconciliation (Albert, 2016;Brown, 2018;Coleman et al, 2006;Farrell et al, 2015;Hamar et al, 2016). Leland et al (2019) identified five frequently implemented care transition processes, four of which were used in 74% of the studies: medication self-management; scheduling of follow-up care; postdischarge telephone calls; and medical selfmanagement, which includes interventions, training, and skills by which patients can effectively take care of themselves or leave to others.…”

Section: Creating Ideal Processes To Improve Transitions Of Care In Kmentioning

confidence: 99%

“…Patient and family education and care transition coaching were included in 60% of the studies (Leland et al, 2019). The literature supports that single interventions have limited impact on hospital readmission rates and that using a comprehensive, bundled intervention approach has led to reductions in rehospitalization, emergency care, and health care costs and improvements in quality of life and patient, family, and provider satisfaction (Albert, 2016;Brown, 2018).…”

Section: Creating Ideal Processes To Improve Transitions Of Care In Kmentioning

confidence: 99%

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Occupational Therapy’s Value in Provision of Quality Care to Prevent Readmissions

Roberts

Robinson

Furniss

et al. 2020

The American Journal of Occupational Therapy

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Health care systems are prioritizing the quality of outcomes over the quantity of services provided, and health care payers and other stakeholders are focusing on preventing hospital readmissions. This priority supports the effort to reduce the cost of health care by avoiding the most expensive care type and improving the quality of health care by promoting sustained return to the community and remaining in the community. Occupational therapy practitioners have expertise that is critically important in this effort. Occupational therapy places a unique and immediate focus on patients' functional and social needs, which can be important drivers of readmissions if they are not addressed. By addressing activities of daily living, instrumental activities of daily living, functional cognition, psychosocial needs, vision, fear of falling, and safety, occupational therapy practitioners can be a valuable addition to the effort to keep people out of the hospital and participating in their lives. This article reviews the literature supporting the role of occupational therapy in each of these key areas. T he Quadruple Aim is the new normal in health and health care. Organizations across the country now support the four noble goals of reducing health care costs, improving the patient experience, improving the health of people, and preventing practitioner burnout (Rathert et al., 2018). Addressing the first three of these goals (known collectively as the Triple Aim) is challenging, especially given the fragmented systems and payers in the United States. Although no single way to measure progress exists in these areas, hospital readmission rates are often used as a proxy for overall care. Occupational therapy has an extremely important role to play in preventing readmissions to hospitals and promoting optimal participation in the community. National Trends and Policies Influencing Quality Measure Reporting The Patient Protection and Affordable Care Act (ACA; Pub. L. 111-148) has moved Medicare providers to a world of accountability and quality (Lowell & Bertko, 2010). One provision affecting acute care hospitals is § 3025, the Hospital Readmission Reduction program, which was implemented initially as part of the fiscal year 2012 inpatient prospective payment system final rule (Centers for Medicare and Medicaid Services, 2011). In addition, § 3026 of the ACA describes the Community Care Transitions program, which provides funds for implementation of evidence-based care transition interventions for adults at risk for readmissions. More recently, quality measures for readmissions have been added through the value-based purchasing program in postacute care settings. These quality measures compare facilities on the basis of the risk-adjusted number of readmissions to the hospital after discharge. The best performing facilities receive bonus (upward adjusted) payments that are balanced by worst performing facilities receiving penalty (downward adjusted) payments. Skilled nursing facilities saw the first bonus and penalty payments in ...

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Post-acute Care

Leung

2021

Encyclopedia of Gerontology and Population Aging

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Transitions of Care

Cited by 16 publications

References 19 publications

Patient and family members’ perceptions of family participation in care on acute care wards

Patient and family members’ perceptions of family participation in care on acute care wards

Occupational Therapy’s Value in Provision of Quality Care to Prevent Readmissions

Post-acute Care

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