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1.
Popul Health Manag ; 17(2): 106-11, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24156664

RESUMEN

The specific aim of the PEACE pilot study was to determine the feasibility of a fully powered study to test the effectiveness of an in-home geriatrics/palliative care interdisciplinary care management intervention for improving measures of utilization, quality of care, and quality of life in enrollees of Ohio's community-based long-term care Medicaid waiver program, PASSPORT. This was a randomized pilot study (n=40 intervention [IG], n=40 usual care) involving new enrollees into PASSPORT who were >60 years old. This was an in-home interdisciplinary chronic illness care management intervention by PASSPORT care managers collaborating with a hospital-based geriatrics/palliative care specialist team and the consumer's primary care physician. This pilot was not powered to test hypotheses; instead, it was hypothesis generating. Primary outcomes measured symptom control, mood, decision making, spirituality, and quality of life. Little difference was seen in primary outcomes; however, utilization favored the IG. At 12 months, the IG had fewer hospital visits (50% vs. 55%, P=0.65) and fewer nursing facility admissions (22.5% vs. 32.5%, P=0.32). Using hospital-based specialists interfacing with a community agency to provide a team-based approach to care of consumers with chronic illnesses was found to be feasible. Lack of change in symptom control or quality of life outcome measures may be related to the tools used, as these were validated in populations closer to the end of life. Data from this pilot study will be used to calculate the sample size needed for a fully powered trial.


Asunto(s)
Planificación Anticipada de Atención/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Cuidados a Largo Plazo/organización & administración , Calidad de Vida , Anciano , Anciano de 80 o más Años , Femenino , Anciano Frágil , Evaluación Geriátrica/métodos , Promoción de la Salud , Servicios de Salud para Ancianos/organización & administración , Humanos , Comunicación Interdisciplinaria , Masculino , Ohio , Cuidados Paliativos/organización & administración , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Valores de Referencia , Resultado del Tratamiento
2.
Am J Med Qual ; 27(4): 291-6, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22327023

RESUMEN

The objective of this study was to test the efficacy of a standardized form used during transfers between long-term care facilities (LTCFs) and the acute care setting. The intervention consisted of development and implementation of the transfer form and education about its use. Charts from 26 LTCFs and 1 acute care hospital were reviewed at 1 and 6 months prior to initiation of the transfer form (2007) and at 1 and 6 months after initiation of the transfer form (2008); 210 patient charts were reviewed in 2007 and 172 in 2008. There was 79% concordance between documented LTCF advance directives (ADs) and hospital ADs in 2008-an increase from 66.6% in 2007 (P = .038). Inpatient hospice/palliative care admissions rose from 1.5% in 2007 to 7.7% in 2009 (P = .015). The standardized transfer form improved communication of ADs between LTCFs and the hospital. Secondarily, it may have increased admissions to the acute palliative care unit.


Asunto(s)
Continuidad de la Atención al Paciente , Prioridad del Paciente , Transferencia de Pacientes/organización & administración , Registros , Anciano , Comunicación , Continuidad de la Atención al Paciente/organización & administración , Cuidados Críticos/organización & administración , Femenino , Humanos , Cuidados a Largo Plazo/organización & administración , Masculino
3.
Popul Health Manag ; 15(2): 71-7, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22088165

RESUMEN

Practice guidelines are available for hospice and palliative medicine specialists and geriatricians. However, these guidelines do not adequately address the needs of patients who straddle the 2 specialties: homebound chronically ill patients. The purpose of this article is to describe the theoretical basis for the Promoting Effective Advance Care for Elders (PEACE) randomized pilot study. PEACE is an ongoing 2-group randomized pilot study (n=80) to test an in-home interdisciplinary care management intervention that combines palliative care approaches to symptom management, psychosocial and emotional support, and advance care planning with geriatric medicine approaches to optimizing function and addressing polypharmacy. The population comprises new enrollees into PASSPORT, Ohio's community-based, long-term care Medicaid waiver program. All PASSPORT enrollees have geriatric/palliative care crossover needs because they are nursing home eligible. The intervention is based on Wagner's Chronic Care Model and includes comprehensive interdisciplinary care management for these low-income frail elders with chronic illnesses, uses evidence-based protocols, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. Our model, with its standardized, evidence-based medical and psychosocial intervention protocols, will transport easily to other sites that are interested in optimizing outcomes for community-based, chronically ill older adults.


Asunto(s)
Enfermedad Crónica , Anciano Frágil , Promoción de la Salud/organización & administración , Servicios de Atención de Salud a Domicilio/organización & administración , Personas Imposibilitadas , Planificación de Atención al Paciente/organización & administración , Anciano , Anciano de 80 o más Años , Determinación de la Elegibilidad , Medicina Basada en la Evidencia , Femenino , Evaluación Geriátrica , Humanos , Masculino , Medicaid , Ohio , Cuidados Paliativos , Proyectos Piloto , Pobreza , Proyectos de Investigación , Apoyo Social , Estados Unidos
4.
Popul Health Manag ; 14(3): 137-42, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21323461

RESUMEN

Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n = 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. The primary aim of the AD-LIFE trial is to test a chronic illness management intervention in vulnerable patients who are eligible for Medicare and Medicaid. This model, with its standardized, evidence-based medical and psychosocial intervention protocols, will be easily transportable to other sites interested in optimizing outcomes for chronically ill older adults. If the results of the AD-LIFE trial demonstrate the superiority of the intervention, then this data will be important for health care policy makers.


Asunto(s)
Continuidad de la Atención al Paciente , Anciano Frágil , Alta del Paciente , Proyectos de Investigación , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Técnicas de Apoyo para la Decisión , Medicina Basada en la Evidencia , Promoción de la Salud , Humanos , Masculino , Modelos Teóricos , Médicos de Atención Primaria , Pobreza/economía , Pobreza/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Autocuidado/métodos , Estados Unidos
5.
Pharmacotherapy ; 28(2): 225-34, 2008 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-18225968

RESUMEN

Pharmacists in both ambulatory and institutional settings are often in a position to help optimize the drug regimens of patients who are experiencing falls. Supplementation with vitamin D is an important emerging therapy for the prevention of falls. Numerous investigators have recently studied or reviewed the association between vitamin D supplementation and decreased risk of falls in elderly patients, yet little of this information is available in the pharmacy literature. A MEDLINE search was conducted to collect relevant articles about the role of vitamin D in preventing falls among elderly patients; recently published meta-analyses and randomized controlled trials were identified and reviewed. The studies indicated a statistically significant positive relationship between vitamin D supplementation with either cholecalciferol 700 IU/day or greater or ergocalciferol 800 IU/day or greater and decreased risk of falls. Other practical issues, including who should receive vitamin D replacement, what form of vitamin D should be used, and what dosage is required to prevent falls, are discussed.


Asunto(s)
Accidentes por Caídas/prevención & control , Vitamina D/uso terapéutico , Vitaminas/uso terapéutico , Accidentes por Caídas/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Calcio/administración & dosificación , Calcio/uso terapéutico , Colecalciferol/administración & dosificación , Colecalciferol/uso terapéutico , Ergocalciferoles/administración & dosificación , Ergocalciferoles/uso terapéutico , Humanos , Educación del Paciente como Asunto , Servicios Farmacéuticos , Vitamina D/administración & dosificación , Vitaminas/administración & dosificación
6.
BMC Geriatr ; 6: 15, 2006 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-17038177

RESUMEN

BACKGROUND: The use of indwelling urinary catheters (IUCs) is thought to be the most significant risk factor for developing nosocomial urinary tract infections (UTIs). However, it is unclear how many elderly patients have preexisting bacteriuria prior to IUC placement. The purpose of this study was to determine 1) the frequency and appropriateness of IUC use in the Emergency Department (ED) in elderly patients admitted to our acute care hospital, 2) the percentage of elderly patients with an IUC who were discharged from the hospital with a diagnosis of UTI, 3) the percentage of patients with IUCs who were diagnosed and treated for UTI in the ED or who had admission bacteriuria > or =105 organisms/ml indicating preexisting UTI, and 4) the percentage of patients with no indication of UTI on admission who had inappropriately placed IUCs and subsequently were diagnosed with a UTI. METHODS: Retrospective chart review. Chi square used to test significance of differences in proportions. RESULTS: Seventy three percent of patients who received an IUC in the ED were elderly (> or =65 years old). During the study period, 277 elderly patients received an IUC prior to admission. Of these, 77 (28%) were diagnosed with UTI during their hospitalization. Fifty three (69%) of those diagnosed with a UTI by discharge either had the UTI diagnosed in the ED or had bacteriuria > or =105 organisms/ml prior to IUC placement. Of the 24 elderly patients who developed a catheter-associated UTI (i.e., 9% of the elderly population who received an IUC), 11 of the IUCs were placed inappropriately. Thus, 4% of elderly patients with no indication of UTI on admission who received an inappropriate IUC in the ED had a primary or secondary diagnosis of UTI by discharge. The overall rate of nosocomial UTI due to an inappropriately placed IUC was the same in males and females. CONCLUSION: This study indicates that the strong association between IUC use and UTI may be partly explained by the high prevalence of preexisting UTI prior to IUC placement. Further prospective studies are needed to clarify the true risk vs benefit ratio for IUC use in acutely ill elderly patients.


Asunto(s)
Catéteres de Permanencia/efectos adversos , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/normas , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Anciano , Cuidados Críticos , Femenino , Humanos , Masculino , Estudios Retrospectivos
7.
J Am Geriatr Soc ; 51(11): 1660-7, 2003 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-14687400

RESUMEN

The Acute Care for Elders (ACE) model of care is a multicomponent intervention that improves outcomes for older patients hospitalized for acute medical illnesses. Likewise, stroke units improve outcomes for patients with acute stroke, yet the descriptions of their structure and approach to stroke management are heterogeneous. The purpose of this article is to describe how implementing the ACE model of care, using a continuous quality-improvement process, can serve as a foundation for a successful stroke unit aimed at improving stroke care. The ACE intervention (a prepared environment, interdisciplinary team management, patient-centered nursing care plans, early discharge planning, and review of medical care) was amplified in a community teaching hospital for stroke-specific care by creating a stroke interdisciplinary team, evidence-based stroke orders and protocols, and a redesigned environment. Administrative data show that the ACE model can be successfully adapted to create a disease-specific program for stroke patients, having the potential to improve the process of care and clinical stroke outcomes.


Asunto(s)
Unidades Hospitalarias/organización & administración , Accidente Cerebrovascular/terapia , Anciano , Femenino , Unidades Hospitalarias/normas , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto , Accidente Cerebrovascular/mortalidad , Resultado del Tratamiento
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