scholarly journals THE IMPACT OF THE R3 PROGRAM ON SERVICE UTILIZATION, COSTS, AND QUALITY OF LIFE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S777-S777
Author(s):  
Marc A Cohen ◽  
Jennifer Hefele ◽  
Edward Miller ◽  
Pamela Nadash ◽  
Natalie Shellito ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Service Utilization ◽  
Comparison Group ◽  
Skilled Nursing Facility ◽  
Emergency Department Visits ◽  
Fee For Service ◽  
Quasi Experimental ◽  
The Impact

Abstract Relatively few housing with services evaluations employ rigorous multiple group quasi-experimental designs rather than simple before/after research designs. This study employs a pre-post experimental design with a comparison group to analyze whether the R3 program led to reductions in certain key utilization measures, including emergency department visits, inpatient hospitalizations, ambulance usage, and skilled nursing facility admissions, over 18 months. Also examined is whether resident quality of life indicators changed over the period. Data derive from assessments with 410 residents in four intervention sites and 227 residents in five comparison group sites. Also obtained was data on emergency department transfers from first responder services and Medicare fee-for-service data from the local quality improvement organization. Results suggest that the program has positive implications for service utilization, costs, and quality of life. Early detection and intervention inherent in the R3 program may improve resident quality of life while lowering service utilization and costs.

scholarly journals Health, Quality of Life, and Economic Impacts of Home Care Vouchers for Middle-Income Adults With Disabilities

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 78-78
Author(s):  
Joanne Spetz ◽  
Jacqueline Miller ◽  
Connie Kwong ◽  
Laura Wagner
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Economic Analysis ◽  
Home Care ◽  
San Francisco ◽  
Comparison Group ◽  
Financial Stress ◽  
Emergency Department Visits ◽  
Middle Income

Abstract The Support at Home pilot program provided financial support for the purchase of home care services by middle-income adults with disabilities in San Francisco to support aging in place. Enrollees had income below the area median and made copayments based on household income. The mixed-methods evaluation of the program incorporated administrative records, surveys of clients and comparison group members, surveys of unpaid caregivers, surveys of paid care providers, and focus groups with clients and unpaid caregivers. Outcome measures included the Older People’s Quality of Life Questionnaire, Patient Health Questionnaire-2, an adapted Burden Scale for Family Caregivers, and self-reported falls, emergency department visits, and hospitalizations. Analyses included pre-post chi-squared and t-test comparisons between client and comparison groups and multivariate regressions. An economic analysis was conducted to learn whether changes in costs associated with reduced health care utilization were greater than the costs of the program. Results indicated statistically significant positive changes in client ratings of personal and financial stress, but not in the composite quality of life score. There were statistically significant reductions in attendance at medical appointments, falls, emergency department visits, and hospitalizations. Similar changes were not found in the comparison group. The focus group data supported the findings regarding personal and financial stress and indicated that clients and their caregivers perceived quality of life benefits. The economic analysis indicated substantial cost savings from the program due to reduced use of medical services. Due to its positive impacts, San Francisco has made Support at Home a permanent program.

A pragmatic randomized controlled trial of a cardiac hospital-to-home transitional care program in a Singapore academic medical center

2020 ◽  
Vol 25 (2) ◽  
pp. 55-66
Author(s):  
Yanying Chen ◽  
Yi Jin Tan ◽  
Ya Sun ◽  
Cheng Zhan Chua ◽  
Jeffrey Kwang Sui Yoo ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Department ◽  
Transitional Care ◽  
Controlled Trial ◽  
Care Program ◽  
Emergency Department Visits ◽  
Pragmatic Randomized Controlled Trial ◽  
Randomized Controlled ◽  
Hospital To Home

Background Rehospitalizations are common in healthcare. They are costly for hospitals and patients and a substantial percentage are preventable, partly because hospital-to-community transitions are often unmanaged or poorly managed. In this study, we conducted a pragmatic randomized, controlled trial to evaluate the effectiveness of a new nurse–practitioner-led transitional care program called CareHub, piloted in Singapore’s National University Hospital. Methods Study population included all eligible cardiac patients admitted between July 2016 and November 2016. Patients were followed for six months post-discharge. Primary outcomes other than emergency department visits were all cardiac-related: number of readmissions, specialist visits, emergency department visits, and total days readmitted. Secondary outcomes: variables related to quality of life and transitional care. Regression analyses were used to estimate the intent-to-treat effect of CareHub and explore treatment heterogeneity. Results CareHub reduced the mean number of unplanned readmissions by 0.23 (a 39% reduction relative to control mean of 0.60 unplanned readmissions, p < 0.05), mean number of all readmissions by 0.20 (31% reduction relative to control mean of 0.63 readmissions, p = 0.10), mean number of total unplanned days in hospital by 2.2 (56% reduction relative to control mean of 4.0 days, p < 0.05), mean number of total days in hospital by 2.0 (42% reduction relative to control mean of 4.3 days, p < 0.10). Treatment effects varied by pre-admission health and socio-economic status. Conclusion A carefully designed protocolized cardiac hospital-to-home transition program can reduce resource utilization while improving quality of life.

scholarly journals P101: Quality of life in patients discharged from the emergency department with atrial fibrillation or flutter (AF/AFL): a prospective cohort study

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S112
Author(s):  
S. Patrick ◽  
P. Duke ◽  
K. Lobay ◽  
M. Haager ◽  
B. Deane ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Emergency Department ◽  
Short Form ◽  
Bodily Pain ◽  
Emergency Physicians ◽  
Health Related Qol ◽  
Health Related ◽  
The Impact

Introduction: Following an emergency department (ED) presentation for acute atrial fibrillation and/or flutter (AF/AFL), patients often experience anxiety, depression and impaired health-related quality of life (QoL). Emergency physicians may prescribe appropriate thrombo-embolic (TE) prophylaxis upon discharge; however, the QoL of these patients is unclear. This study measured the QoL of patients with AF/AFL following discharge to determine the factors associated with QoL. Methods: Patients ≥18 years of age identified by the attending physician as having a diagnosis of acute AF/AFL confirmed by ECG were prospectively enrolled from three Edmonton, AB EDs. Using standardized enrollment forms, trained research assistants collected data on patient demographics factors and management both in the ED and at discharge. Patients’ health-related QoL was assessed up to 20 days after their initial ED visit by a telephone interview based on six domains of the short-form 8 health survey. Results: From a total of 196 enrolled patients, 121 (62%) were male and the mean age was 63 years (standard deviation ±14). Most patients had previous history of AF/AFL (71%), and emergency physicians had the opportunity to treat or revise TE prevention therapy in 19% of the patients. The majority (89%) were discharged with prescriptions for antiplatelet or anticoagulant agents, and 188 (96%) were contacted by telephone at a median of 7 days. Most patients rated their overall health between good and excellent (70%); however, 30% assessed their health as fair or very poor. Many also reported having physical limitations (54%), difficulties completing their daily work (42%), bodily pain (32%) and limitations in social activities (32%). Finally, some patients reported having low energy (25%). At follow up, patients receiving adequate TE prevention rated their health to be similar to those without adequate TE prevention (30% vs 23%; p=0.534). Conclusion: Overall, patients with acute, symptomatic AF/AFL seen in the ED have impairments in health-related QoL following discharge from the ED. Many factors contribute to this impairment; however, providing patients with appropriate TE prophylaxis at discharge did not explain these findings. Further research is required to explore the impact of AF/AFL on patient’s health-related QoL after discharge from the ED.

O25. The Impact of a Community Based Intervention for People with Arthritis on Quality of Life and Health Service Utilization

Rheumatology ◽  
2014 ◽  
Vol 53 (suppl_1) ◽  
pp. i40-i40
Author(s):  
Chandrika Gordon ◽  
Rebecca J. Stack ◽  
Marilyn Robinson ◽  
Karim Raza ◽  
Ishraga Awad ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Service ◽  
Service Utilization ◽  
Health Service Utilization ◽  
Community Based ◽  
The Impact

Impact of Comprehensive Nurse-Managed Transitional Care

2001 ◽  
Vol 10 (3) ◽  
pp. 295-313 ◽  
Author(s):  
Ruth M. Tappen ◽  
Rosemary F. Hall ◽  
Susan L. Folden
Keyword(s):  
Daily Living ◽  
Transitional Care ◽  
Comparison Group ◽  
Skilled Nursing Facility ◽  
Design Data ◽  
Nursing Facility ◽  
Care Environment ◽  
Skilled Nursing ◽  
Quasi Experimental

The purpose of this study was to test the effectiveness of nurse-managed transitional care on the quality of care and functional ability of individuals following discharge from subacute units. Registered nurses employed on subacute units in a skilled nursing facility provided the nurse-managed transitional care. Using a quasi-experimental design, data were collected on admission to the subacute unit, at the time of discharge, 1 week following discharge, and 3 months following discharge on 242 treatment and comparison participants. The treatment group participants' overall function and quality of the care environment were significantly higher than the comparison group at 1 week and 3 months following discharge. Participants did not differ significantly on basic activities of daily living or number of readmissions.

scholarly journals Quality of Life in Patients with Multiple Sclerosis after Autologous Hematopoietic Stem Cell Transplantation

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5708-5708
Author(s):  
Juan Carlos Olivares-Gazca ◽  
Iván Murrieta-Álvarez ◽  
Jesús Mauricio Olivares-Gazca ◽  
Yarely Itzayana García-Navarrete ◽  
Yahveth Cantero-Fortiz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Cell Transplantation ◽  
Hematopoietic Cell Transplantation ◽  
Conflicts Of Interest ◽  
Hematopoietic Stem ◽  
Before And After ◽  
Quasi Experimental ◽  
The Impact

Introduction Multiple sclerosis (MS) is an inflammatory, demyelinating and neurodegenerative disease of the central nervous system (CNS) that causes a whole spectrum of neurological disorders associated with a profound decrease in the quality of life of affected patients. Currently, autologous hematopoietic cell transplantation (ASCT) is a validated therapeutic approach and has been shown to be superior to new immunomodulatory agents. However, the impact of these therapies on the quality of life of patients with MS is unknown. Objective Identify the impact on the quality of life in patients with multiple sclerosis after ASCT at our center. Methods A quasi-experimental, longitudinal, prospective and single-center study was conducted in which the quality of life was determined in patients with MS before and after ASCT. Patients who could not answer the questionnaire themselves were excluded and incomplete questionnaires were eliminated. The quality of life was determined by applying the MS-QoL 29 instrument which is validated instrument for this pathology (Cronbach 0.88-0.90 and Pearson with high correlation with MS-QoL56). The variables related to the physical and mental components of the instrument as well as demographic characteristics were studied. The statistical analysis of the data included measures of central tendency as well as inferential for the comparison of means and proportions (NC 95%, p <0.05). Results We included 52 patients prospectively from October 2018 to June 2019, 71% of the patients were women and the remaining 29% men. The median of age of the subset is 50 years (Interval 27-65). Of the selected patients, 45% has PPMS, 39% has SPMS and 16% has PPMS. Twenty six patients were followed at 3 months and seventeen were followed 6 months after ASCT. The statistical differences between the quality of life in the patients prior to the ASCT and the follow-up at 3 and 6 months in both the physical and mental components was analyzed. In the physical component the differences at 3 months (A) were significant (p = 0.019, 95% NC) as well as the differences at 6 months (b) after ASCT (p = 0.0024, 95% NC). In the mental component the differences were significant at 3 months (C) (p = 0.0012, NC 95%) as well as the differences at 6 months (D) after ASCT (p = 0.0007, NC 95%). Conclusions The study suggests that ASCT is a feasible and safe therapeutic alternative to improve the quality of life in patients with multiple sclerosis. Figure Disclosures No relevant conflicts of interest to declare.

scholarly journals Dynamics of quality of life in patients with morbid obesity after biliopancreatic diversion and sleeve gastrectomy

2018 ◽  
Vol 22 (3) ◽  
pp. 548-552
Author(s):  
O.V. Perekhrestenko
Keyword(s):  
Quality Of Life ◽  
Bariatric Surgery ◽  
Morbid Obesity ◽  
Sleeve Gastrectomy ◽  
Surgical Treatment ◽  
Biliopancreatic Diversion ◽  
Comparison Group ◽  
Main Group ◽  
The Impact

The rapid progress of obesity surgery dictates the necessity to study the quality of life of patients after bariatric procedures. The aim of the study is to assess the dynamics of quality of life of patients with morbid obesity after biliopancreatic diversion in the modification of Hess-Marceau and the sleeve gastrectomy in order to improve the results of surgical treatment of the specified category of patients. The results of surgical treatment of 205 patients with morbid obesity who performed sleeve gastrectomy (main group — 105 patients) or biliopancreatic diversion by Hess-Marceau (comparison group — 100 patients) were analyzed. The study of the dynamics of quality of life of patients was performed in according the Moorehead-Ardelt II method. Statistical data processing was performed using the methods of variational and descriptive statistic using Statistica 6.0 statistical analysis package. Installed that biliopancreatic diversion by Hess-Marceau and sleeve gastrectomy allowed to significantly improve the quality of life of patients with an increase of the quality of life index with -1.5±0.7 in the comparison group and -1.6±0,6 in the main group up to 1.8±0.3 and 2.0±0.4 respectively (p<0.05 compared to pre-operative data) 60 months after surgery. A more pronounced positive dynamics of quality of life in patients of the main group in the time interval of 12–24 months after the operation was achieved due to the absence of severe late metabolic complications and undesirable side effects of biliopancreatic diversion and laparoscopic access for sleeve gastrectomy in 54.3% of patients. Thus, the quality of life of patients with morbid obesity before performing bariatric surgery is critically low and significantly improved after biliopancreatic diversion by Hess-Marceau as well as sleeve gastrectomy. The impact of bariatric surgery on the duration and quality of life of patients requires further multicenter randomized trials.

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