Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 26
Filtrar
Mais filtros

Bases de dados
País/Região como assunto
Tipo de documento
País de afiliação
Intervalo de ano de publicação
1.
Am J Infect Control ; 50(4): 369-374, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35369936

RESUMO

BACKGROUND: Influenza is associated with significant morbidity and mortality for adults aged 65 years and older. Influenza vaccination of health care workers is recommended. There is limited evidence regarding influenza vaccinations among health care workers in the home health care (HHC) setting and their impact on HHC patient outcomes. METHODS: A national survey of HHC agencies was conducted in 2018-2019 and linked with patient data from the Centers for Medicare and Medicaid Services. Adjusted logistic regression models were used to estimate the association between hospital transfers due to respiratory infection during a 60 day HHC episode and staff vaccination policies. RESULTS: Only 26.2% of HHC agencies had staff vaccination requirements and 71.2% agencies had staff vaccination rates higher than 75%. Agency policies for staff influenza vaccination were associated with reduced hospital transfers due to respiratory infection among HHC patients. DISCUSSION: Influenza vaccination rates among HHC staff were low during the 2017-2018 influenza season. Policymakers may consider vaccination mandates to improve health care worker vaccination rates and protect patient safety. CONCLUSIONS: This study sheds light on the potential impact of COVID-19 vaccination among HHC workers on patient outcomes. COVID-19 vaccination mandates could prove to be a vital tool in the fight against COVID-19 variants and infection outbreaks.


Assuntos
COVID-19 , Serviços de Assistência Domiciliar , Influenza Humana , Adulto , Idoso , Vacinas contra COVID-19 , Hospitalização , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Medicare , SARS-CoV-2 , Estados Unidos , Vacinação
2.
Am J Infect Control ; 50(7): 743-748, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34890702

RESUMO

BACKGROUND: Urinary tract infections (UTIs) are a frequent cause of hospital transfer for home healthcare (HHC) patients, particularly among patients with urinary catheters. METHODS: We conducted a cross-sectional, nationally representative HHC agency-level survey (2018-2019) and combined it with patient-level data from the Outcome and Assessment Information Set (OASIS) and Medicare inpatient data (2016-2018) to evaluate the association between HHC agencies' urinary catheter policies and hospital transfers due to UTI. Our sample included 28,205 patients with urinary catheters who received HHC from 473 Medicare-certified agencies between 2016-2018. Our survey assessed whether agencies had written policies in place for (1) replacement of indwelling catheters at fixed intervals, and (2) emptying the drainage bag. We used adjusted logistic regression to estimate the association of these policies with probability of hospital transfer due to UTI during a 60-day HHC episode. RESULTS: Probability of hospital transfer due to UTI during a HHC episode ranged from 5.62% among agencies with neither urinary catheter policy to 4.43% among agencies with both policies. Relative to agencies with neither policy, having both policies was associated with 21% lower probability of hospital transfer due to UTI (P < .05). CONCLUSION: Our findings suggest implementation of policies in HHC to promote best practices for care of patients with urinary catheters may be an effective strategy to prevent hospital transfers due to UTI.


Assuntos
Cateteres Urinários , Infecções Urinárias , Idoso , Cateteres de Demora/efeitos adversos , Estudos Transversais , Atenção à Saúde , Hospitais , Humanos , Medicare , Políticas , Estados Unidos , Cateterismo Urinário/efeitos adversos , Cateteres Urinários/efeitos adversos , Infecções Urinárias/prevenção & controle
3.
Nurs Outlook ; 69(6): 961-968, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34711419

RESUMO

The purpose of this consensus paper was to convene leaders and scholars from eight Expert Panels of the American Academy of Nursing and provide recommendations to advance nursing's roles and responsibility to ensure universal access to palliative care. Part I of this consensus paper herein provides the rationale and background to support the policy, education, research, and clinical practice recommendations put forward in Part II. On behalf of the Academy, the evidence-based recommendations will guide nurses, policy makers, government representatives, professional associations, and interdisciplinary and community partners to integrate palliative nursing services across health and social care settings. The consensus paper's 43 authors represent eight countries (Australia, Canada, England, Kenya, Lebanon, Liberia, South Africa, United States of America) and extensive international health experience, thus providing a global context for the subject matter. The authors recommend greater investments in palliative nursing education and nurse-led research, nurse engagement in policy making, enhanced intersectoral partnerships with nursing, and an increased profile and visibility of palliative nurses worldwide. By enacting these recommendations, nurses working in all settings can assume leading roles in delivering high-quality palliative care globally, particularly for minoritized, marginalized, and other at-risk populations.


Assuntos
Consenso , Prova Pericial , Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Cuidados Paliativos , Assistência de Saúde Universal , Educação em Enfermagem , Saúde Global , Disparidades em Assistência à Saúde , Humanos , Enfermeiros Administradores , Sociedades de Enfermagem
4.
J Nurs Scholarsh ; 53(5): 552-560, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34060220

RESUMO

PURPOSE: To highlight ongoing and emergent roles of nurses and midwives in advancing the United Nations 17 Sustainable Development Goals by 2030 at the intersection of social and economic inequity, the climate crisis, interprofessional partnership building, and the rising status and visibility of the professions worldwide. DESIGN: Discussion paper. METHODS: Literature review. FINDINGS: Realizing the Sustainable Development Goals will require all nurses and midwives to leverage their roles and responsibility as advocates, leaders, clinicians, scholars, and full partners with multidisciplinary actors and sectors across health systems. CONCLUSIONS: Making measurable progress toward the Sustainable Development Goals is critical to human survival, as well as the survival of the planet. Nurses and midwives play an integral part of this agenda at local and global levels. CLINICAL RELEVANCE: Nurses and midwives can integrate the targets of the Sustainable Development Goals into their everyday clinical work in various contexts and settings. With increased attention to social justice, environmental health, and partnership building, they can achieve exemplary clinical outcomes directly while contributing to the United Nations 2030 Agenda on a global scale and raising the profile of their professions.


Assuntos
Tocologia , Enfermeiras e Enfermeiros , Feminino , Saúde Global , Objetivos , Humanos , Gravidez , Desenvolvimento Sustentável , Nações Unidas
5.
Am J Nurs ; 121(4): 65-68, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33755634

RESUMO

This article is one in a series in which contributing authors discuss how the United Nations (UN) Sustainable Development Goals (SDGs) are linked to everyday clinical issues; national public health emergencies; and other nursing issues, such as leadership, shared governance, and advocacy. The 2030 Agenda for Sustainable Development, a 15-year plan of action to achieve the goals, was unanimously adopted by all UN member states in September 2015 and took effect on January 1, 2016. The Agenda consists of 17 SDGs addressing social, economic, and environmental determinants of health and 169 associated targets focused on five themes: people, planet, peace, prosperity, and partnership. The SDGs build on the work of the UN Millennium Development Goals, which were in effect from 2000 to 2015. The current article highlights SDGs 5 (gender equality), 8 (decent work and economic growth), and 17 (partnerships for the goals), along with the advocacy of these goals by Sigma Theta Tau International Honor Society of Nursing in the UN system.


Assuntos
Equidade de Gênero , Saúde Global/normas , Guias como Assunto , Cuidados de Enfermagem/normas , Objetivos Organizacionais , Saúde Pública/normas , Desenvolvimento Sustentável , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nações Unidas
6.
J Am Geriatr Soc ; 67(3): 503-510, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30506953

RESUMO

BACKGROUND/OBJECTIVES: Over a million older patients in the United States are admitted yearly for emergency general surgery (EGS) conditions. Seven procedure types dominate: colon, small bowel, gallbladder, ulcer disease, adhesiolysis, appendix, and laparotomy operations. A higher comorbidity burden is known to increase mortality in this population, but the impact of specific comorbidity combinations is unknown. Our objectives were to (1) characterize the distribution of procedures, comorbidities, and outcomes for older patients undergoing EGS; and (2) apply a data-driven approach (association rule mining) to identify comorbidity combinations associated with disproportionately high mortality. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of patients 65 years and older who underwent one of the seven procedures previously cited, taken from the 2011 Nationwide Inpatient Sample. A total of 280 885 patient encounters were identified. MEASUREMENTS: In-hospital mortality, procedures, and comorbidities based on the Elixhauser Comorbidity Index. RESULTS: Overall mortality was 5.6%. The most common procedures were gallbladder (33.7%), ulcer surgery (21.5%), and adhesiolysis (21.0%). Mortality increased for all procedures as patients aged. Comorbidities associated with the highest mortality included coagulopathy (adjusted odds ratio [aOR] = 3.74; 95% confidence interval [CI] = 3.41-4.11; p < .001), fluid and electrolyte disorders (FED) (aOR = 2.89; 95% CI = 3.66-3.14; p < .001), and liver disease (aOR = 1.89; 95% CI = 1.61-2.22; p < .001). Three-way comorbidity combinations most highly associated with mortality were coagulopathy, FED, and peripheral vascular disease (aOR = 5.10; 95% CI = 4.17-6.24; p < .001), and coagulopathy, FED, and chronic pulmonary disease (aOR = 4.83; 95% CI = 4.00-5.82; p < .001). CONCLUSION: For older patients, combinations of comorbidities portend additional risk beyond single comorbidities, and the associated risk burden is driven by the specific constellation of comorbidities present. Future work must continue to examine the effect of co-occurring diseases to provide personalized and realistic prognostication for older patients undergoing EGS. J Am Geriatr Soc 67:503-510, 2019.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Cirurgia Geral/métodos , Múltiplas Afecções Crônicas/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Risco Ajustado/métodos , Procedimentos Cirúrgicos Operatórios , Fatores Etários , Idoso , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Mortalidade Hospitalar , Humanos , Masculino , Prognóstico , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/classificação , Procedimentos Cirúrgicos Operatórios/mortalidade , Estados Unidos/epidemiologia
7.
Nurse Educ Today ; 73: 83-87, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30550942

RESUMO

BACKGROUND: Despite growing demand for home care nursing, there is a growing home care workforce shortage, due in part to hospital-centric nursing curricula that lead students to undervalue of home care and community practice setting (Van Iersel et al., 2018a, 2018b). OBJECTIVES: Articulate an international vision for the future of home care education, research, practice, and management shared by experienced home care nurses working in leadership roles. DESIGN: Qualitative content analysis. SETTINGS AND PARTICIPANTS: The sample included 50 home care professionals from 17 countries. METHODS: Home care nurse leaders (in education, research, practice, and management roles) were recruited through professional international nursing networks to participate in a structured online survey about priorities for the future of home care in 2014. Responses were open coded by two independent researchers. Preliminary categories and sub-themes were developed by the research team and revised after a modified member-checking process that included presentation and discussion of preliminary findings at three international nursing meetings in 2015 and 2016. RESULTS: Four major themes emerged reflecting international priorities for the future of home care education, research, practice, and management: 1) Build the evidence base for home care; 2) Design better systems of care; 3) Develop leaders at all levels; and 4) Address payment and policy issues. CONCLUSIONS: Collectively, the findings provide a major call to action for nurse educators to re-design existing pre- and post-licensure educational programs to meet the growing demand for home care nurses. Innovations in education that focus on filling gaps in the evidence-base for community nursing practice, and improving access to continuing education and evidence-based resources for practicing home care nurses and nurse managers should be prioritized.


Assuntos
Competência Clínica/normas , Enfermagem em Saúde Comunitária/métodos , Atenção à Saúde/normas , Assistência Domiciliar/educação , Internacionalidade , Educação em Enfermagem , Humanos , Pesquisa em Educação em Enfermagem , Pesquisa Qualitativa , Inquéritos e Questionários
8.
J Health Hum Serv Adm ; 38(4): 509-28, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27079058

RESUMO

The aim of this descriptive study was to establish and describe the national incidence, cost, and outcomes of patients that undergo medical transfer. Using discharge data from the Nationwide Inpatient Sample 2011, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, the dataset was analyzed using weighted frequency distribution. Approximately 1.6 million patients are transferred yearly. Transferred patients experience a mean length of stay of 9.3 days (std dv 13.5) versus 4.3 days for patients not transferred (std dv 6.0), and cost more than twice as much (mean $19,234) versus those not transferred (mean $9,469). Additionally, patients who undergo inter-facility transfer cost an additional $15.8 billion annually. Interhospital patient transfers require closer scrutiny regarding appropriateness and future policy implications.


Assuntos
Hospitalização/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Hospitalização/economia , Humanos , Incidência , Lactente , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos
9.
Int J Med Inform ; 90: 40-7, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27103196

RESUMO

INTRODUCTION: The proliferation and use of electronic medical records (EMR) in the clinical setting now provide a rich source of clinical data that can be leveraged to support research on patient outcomes, comparative effectiveness, and health systems research. Once the large volume and variety of data that robust clinical EMRs provide is aggregated, the suitability of the data for research purposes must be addressed. Therefore, the purpose of this paper is two-fold. First, we present a stepwise framework capable of guiding initial data quality assessment when matching multiple data sources regardless of context or application. Then, we demonstrate a use case of initial analysis of a longitudinal data repository of electronic health record data that illustrates the first four steps of the framework, and report results. METHODS: A six-step data quality assessment framework is proposed and described that includes the following data quality assessment steps: (1) preliminary analysis, (2) documentation-longitudinal concordance, (3) breadth, (4) data element presence, (5) density, and (6) prediction. The six-step framework was applied to the Transport Data Mart-a data repository that contains over 28,000 records for patients that underwent interhospital transfer that includes EMRs from the sending hospitalization, transport, and receiving hospitalization. RESULTS: There were a total of 9557 log entries of which 8139 were successfully matched to corresponding hospital encounters. 2832 were successfully mapped to both the sending and receiving hospital encounters (resulting in a 93% automatic matching rate), with 590 including air medical transport EMR data representing a complete case for testing. Results from Step 2 indicate that once records are identified and matched, there appears to be relatively limited drop-off of additional records when the criteria for matching increases, indicating the a proportion of records consistently contain nearly complete data. Measures of central tendency used in Step 3 and 4 exhibit a right skewness suggesting that a small proportion of records contain the highest number of repeated measures for the measured variables. CONCLUSIONS: The proposed six-step data quality assessment framework is useful in establishing the metadata for a longitudinal data repository that can be replicated by other studies. There are practical issues that need to be addressed including the data quality assessments-with the most prescient being the need to establish data quality metrics for benchmarking acceptable levels of EMR data inclusiveness through testing and application.


Assuntos
Registros Eletrônicos de Saúde/normas , Pesquisa Biomédica/métodos , Pesquisa Biomédica/normas , Confiabilidade dos Dados , Documentação/normas , Humanos , Armazenamento e Recuperação da Informação/normas , Metadados/normas
11.
J Appl Gerontol ; 33(4): 474-93, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24781967

RESUMO

Acute care hospitalization during or immediately following a Medicare home health care (HHC) episode is a major adverse outcome, but little has been published about HHC patient-level risk factors for hospitalization. The authors determined risk factors at HHC admission associated with subsequent acute care hospitalization in a nationally representative Medicare patient sample (N = 374,123). Hospitalization was measured using Medicare claims data; risk factors were measured using Outcome Assessment and Information Set data. Seventeen percent of sample members were hospitalized. Multivariate logistic regression analysis found that the most influential risk factors (all p < .001) were skin wound as primary HHC diagnosis, clinician-judged guarded rehabilitation prognosis, congestive heart failure as primary HHC diagnosis, presence of depressive symptoms, dyspnea severity, and Black, compared to White. HHC initiatives that minimize chronic condition exacerbations and actively treat depressive symptoms might help reduce Medicare patient hospitalizations. Unmeasured reasons for higher hospitalization rates among Black HHC patients deserve further investigation.


Assuntos
Doença Crônica , Hospitalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , População Negra/psicologia , População Negra/estatística & dados numéricos , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Doença Crônica/psicologia , Depressão/diagnóstico , Feminino , Avaliação Geriátrica , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/terapia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Masculino , Medicare/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
12.
Arch Gerontol Geriatr ; 54(3): e300-6, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-21899899

RESUMO

PURPOSE: Functional capacity is widely recognized as a key factor in maintaining the ability of older people to live independently and safely at home. Promoting functional capacity is an important priority particularly in HHC. The purpose of the study was to examine predictors of functional capacity change among HHC patients with HF. MATERIALS AND METHODS: Clinical and administrative data from 2005 from the Medicare Chronic Conditions Warehouse were linked at the population level for HHC patients with a primary diagnosis of HF. The primary outcome was change in functional capacity score from HHC admission to HHC discharge. RESULTS: Over the course of the episode (M=44 days), most (70%) patients improved, 15.6% stayed the same, and 14.4% declined in activities of daily living (ADL) scores. The mean change score was modest (mean=-0.74, SD=1.11) with a median change of -0.58. Multivariate analyses (R(2)=0.23) showed that the largest influence was the admission ADL score followed by receiving any physical therapy (PT), admission ability to manage oral medications, cognitive functioning, rehabilitation prognosis, and urinary incontinence. DISCUSSION: There is a modest rate of improvement from admission to discharge that likely represents the progressive nature of HF and/or the short time frames over which HHC is provided. Providers may want to use the predictive factors to identify patients most at risk for functional decline.


Assuntos
Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/reabilitação , Serviços de Assistência Domiciliar/estatística & dados numéricos , Medicare/estatística & dados numéricos , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Transtornos Cognitivos/epidemiologia , Feminino , Avaliação Geriátrica/estatística & dados numéricos , Insuficiência Cardíaca/psicologia , Humanos , Masculino , Modelos Biológicos , Estados Unidos/epidemiologia , Incontinência Urinária/epidemiologia
13.
Heart Lung ; 41(3): 244-54, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22054724

RESUMO

OBJECTIVE: This study sought to evaluate the contributions of symptom recognition and clinical factors to delays in care-seeking. METHODS: A descriptive correlational study design was used to study 75 patients (mean age, 74.7 years; SD, 10.86 years; range, 40 to 96 years) admitted to a tertiary-care medical center with recurrent symptoms (New York Heart Association classes 2 to 4). The sample was 52% male and 85.3% white. The Heart Failure Somatic Perception Scale (HFSPS) was used to examine symptoms, and additional data were collected on physiologic, social, and demographic factors. RESULTS: The mean HFSPS score was 37.52 (range, 2 to 74; possible range, 0 to 90). Subjects reported 2 to 16 out of 18 possible symptoms. Durations of individual symptoms ranged from 5 minutes to 8 years, with individual patients describing a variety of symptom combinations and multiple time frames, depending on the specific symptom. Most subjects (80%) reported a mixture of acute and chronic symptoms. A pattern of chronic vs. acute symptoms was associated with proactive vs. emergent care-seeking, respectively. The HFSPS scores did not correlate with care-seeking behavior. CONCLUSION: Symptom recognition is a complex phenomenon, and few factors differentiate emergent from proactive care-seeking.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Insuficiência Cardíaca/psicologia , Hospitalização , Adulto , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estatística como Assunto , Fatores de Tempo
14.
Home Health Care Serv Q ; 29(4): 155-70, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21153996

RESUMO

Elderly, chronically ill patients' ability to stay at home is dependent on their capacity to perform activities of daily living (ADLs). The Outcome and Assessment Information Set (OASIS) defines ADLs and can be evaluated in various ways. The purpose of this research was to evaluate these approaches and make recommendations for use in research. Several different approaches to the evaluation of functional status were done using ADLs (ambulation, bathing, dressing lower body, dressing upper body, feeding, grooming, toileting, and transferring) scored individually and as indices. Each approach has advantages and disadvantages depending on the research question being asked. The ADL change index score provided the most comprehensive analysis of functional status change although the categorical scores are useful for simple approaches.


Assuntos
Atividades Cotidianas/classificação , Insuficiência Cardíaca/reabilitação , Serviços de Assistência Domiciliar/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Autocuidado/estatística & dados numéricos , Autoeficácia , Idoso , Idoso de 80 Anos ou mais , Centers for Medicare and Medicaid Services, U.S. , Coleta de Dados/métodos , Pessoas com Deficiência , Feminino , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Estados Unidos
15.
Home Health Care Serv Q ; 28(1): 45-57, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19266370

RESUMO

This study evaluated the criterion validity of the Outcome and Assessment Instrument Set (OASIS) items that measure activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive functioning, and depression. A convenience sample of patients (n = 203) from five home care agencies participated in the study. Patient OASIS items were compared to data collected using gold standard instruments. Correlations range from .44 to .69 for ADLs and .20 to .68 for IADLs. A correlation of .62 was found for cognitive functioning while correlations for depressive symptoms are .36 and .26. OASIS ADLs and cognitive status items are sufficiently valid, but the OASIS depression item is not sufficiently sensitive to the prevalence of these conditions.


Assuntos
Atividades Cotidianas , Transtornos Cognitivos/diagnóstico , Coleta de Dados/métodos , Depressão/diagnóstico , Serviços de Assistência Domiciliar , Avaliação de Resultados em Cuidados de Saúde/métodos , Idoso , Transtornos Cognitivos/epidemiologia , Enfermagem em Saúde Comunitária/organização & administração , Coleta de Dados/normas , Depressão/epidemiologia , Feminino , Avaliação Geriátrica/métodos , Serviços de Assistência Domiciliar/organização & administração , Humanos , Masculino , Medicaid/organização & administração , Medicare/organização & administração , Avaliação em Enfermagem/métodos , Pesquisa em Avaliação de Enfermagem , Ohio/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/normas , Admissão do Paciente , Prevalência , Mecanismo de Reembolso/organização & administração , Sensibilidade e Especificidade , Estados Unidos
16.
J Clin Nurs ; 17(7B): 253-9, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18578801

RESUMO

AIMS AND OBJECTIVES: Patients with heart failure represent a common patient population in home health care, yet little is known about their outcomes. BACKGROUND: Patients with heart failure, regardless of site of care, experience substantial numbers of rehospitalisations in the United States. Home health care is a common postacute care service for patients with heart failure. DESIGN: Retrospective analysis. METHODS: The study employed a large administrative data base from 2003 - the Outcomes and Assessment Information Set, which is required for all US Medicare and Medicaid patients receiving home health care. PARTICIPANTS: There were 145 191 patients with a primary diagnosis of heart failure represented in the data set. The outcomes of interest were the trajectory of care (point of entry and discharge from home health care), hospitalisation, length of stay and change in functional status. RESULTS: Almost three-quarters (73.9%) of patients entered home health care following a hospital stay. Nearly two-thirds (64%) remained at home at discharge from home health care. Approximately 15% of patients are hospitalised during the home health care episode, most often for symptoms consistent with exacerbation of the heart failure, if a reason could be identified. The average length of stay in home health care was 44 days. There was only a small improvement in functional status: 0.50 points for activities of daily living and 0.57 points for instrumental activities of daily living. Similar small improvement occurred in depressive symptoms, 0.68. RELEVANCE TO CLINICAL PRACTICE: There may be room for improvement in these outcomes with more recent evidence that suggests strategies for reducing hospitalisation and improving patient functional status abilities. Yet, the chronic progressive nature of heart failure may also provide a limiting factor in the outcomes that can be attained.


Assuntos
Recursos em Saúde/estatística & dados numéricos , Insuficiência Cardíaca/reabilitação , Serviços de Assistência Domiciliar/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Atividades Cotidianas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Depressão/epidemiologia , Depressão/etiologia , Feminino , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Hospitalização/estatística & dados numéricos , Visita Domiciliar/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/organização & administração , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos/epidemiologia
17.
Home Healthc Nurse ; 25(3): 191-7, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17353712

RESUMO

Patient safety has taken on increasing importance in the American healthcare system, yet there is little information on patient safety in home healthcare. The current study aimed to describe the most frequent adverse events defined by the Centers for Medicare & Medicaid Services among the national population of patients receiving home healthcare in 2003, and to compare characteristics between patients who experience adverse events and those who do not. The findings show that 13% of all home healthcare patients had an adverse event, with 80% experiencing only 1 adverse event. More than three fourths of the adverse events were associated with discharge to the community and required continued assistance. Patients who experienced adverse events were older, had more depressive symptoms and behavioral problems, and were more functionally impaired. Women had a slightly lower relative risk of an adverse event (.98), whereas patients of minority ethnicity had a slightly higher relative risk (1.06). These findings suggest that home healthcare agencies may need to spend more time on discharge planning after home healthcare and work with existing community providers. The findings also raise questions regarding the appropriateness of these adverse events and whether there are additional adverse events that warrant monitoring and follow-up evaluation.


Assuntos
Enfermagem em Saúde Comunitária/organização & administração , Serviços de Assistência Domiciliar/organização & administração , Erros Médicos/estatística & dados numéricos , Atividades Cotidianas , Distribuição por Idade , Idoso , Estudos de Casos e Controles , Centers for Medicare and Medicaid Services, U.S. , Feminino , Avaliação Geriátrica , Necessidades e Demandas de Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Erros Médicos/métodos , Erros Médicos/mortalidade , Erros Médicos/prevenção & controle , Avaliação em Enfermagem , Avaliação de Resultados em Cuidados de Saúde , Alta do Paciente , Polimedicação , Vigilância da População , Prevalência , Medição de Risco , Fatores de Risco , Gestão da Segurança/organização & administração , Distribuição por Sexo , Estados Unidos/epidemiologia
19.
West J Nurs Res ; 28(8): 902-17, 2006 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17099104

RESUMO

This study determined factors associated with an increased risk of ending Medicare home health care because of hospitalization and examined specific types of and reasons for hospitalization. Sample members (N = 922) were followed from admission to discharge as they received home care from Ohio Medicare-certified home care agencies between December 1999 and March 2002. Potential patient-level risk factors were predisposing, enabling, or need variables, and an agency-level variable denoting hospital affiliation or free-standing status was examined as a second-level risk factor. Among those hospitalized (18.3%), more than 80.0% experienced emergency hospitalizations, mostly for acute exacerbations of chronic diseases. Statistically significant risk factors for hospitalization included dyspnea severity, functional disability level, skin or wound problems, diabetes, case mix score, and guarded rehabilitation prognosis. Home care agencies might reduce hospitalizations by using clinical prognosis as a key resource for team communication and by helping patients and families anticipate potential acute exacerbations of chronic diseases and manage these events at home.


Assuntos
Serviços de Assistência Domiciliar , Hospitalização , Medicare , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Ohio , Admissão do Paciente , Fatores de Risco , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA