Leveraging technology to improve wound care delivery and care transitions

Abstract Background The purpose of this study was to develop and administer surveys that assess patient and caregiver experience with care transitions and examine the psychometric properties of the surveys. The surveys were designed to include the transitional care services or components of care, provided in the hospital and at home, that matter most to patients and their family caregivers, as well as their assessments of the overall quality of the transitional care they received. Methods Patients were recruited prior to discharge from 43 U.S. hospitals. The analysis dataset included responses from 9,282 patients, 1,245 Time 1 caregivers (who helped the patient in the hospital), and 1,749 Time 2 caregivers (who helped the patient at home). The psychometric properties of the survey items and composite measures were examined for each of the three surveys, including (1) item response variability and missing data, (2) exploratory factor analysis, (3) internal consistency and site-level reliability, and (4) correlations among the outcome composite measures and with other survey items. Items that performed poorly across multiple analyses were dropped from the final instruments. Results Overall, the final patient and caregiver surveys had acceptable psychometric properties, with a few exceptions. Exploratory factor analyses supported the composite measures, which had acceptable internal consistency reliability—Overall Quality of Transitional Care (patient and caregiver surveys), Patient Overall Health (patient survey) and Caregiver Effort/Stress (caregiver surveys). All surveys had acceptable site-level reliability except when the sample sizes needed to achieve 0.70 site-level reliability were higher than the actual sample sizes in the dataset. In all surveys, the Overall Quality of Transitional Care composite measure was significantly correlated with other composite measures and most of the survey items. Conclusions The final patient, T1 caregiver, and T2 caregiver surveys are psychometrically sounds and can be used by health systems, hospitals, and researchers to assess patient and caregiver experience with care transitions. Results from these surveys can be used as the basis for making improvements to transitional care delivery that are centered on what matters most to patients and their family caregivers.

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Abstract T P277: Time Out: Safe Patient Transition Pre-Hospital to Hospital

Stroke ◽

10.1161/str.45.suppl_1.tp277 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Tony Nunn ◽

Bradley Barth ◽

David Bram ◽

Janice Sandt ◽

Seamus Murphy ◽

...

Keyword(s):

Medical History ◽

Best Practice ◽

Care Delivery ◽

Care Transitions ◽

Final Analysis ◽

Hospital Staff ◽

Communication Tool ◽

Frontline Staff ◽

Hand Off ◽

Standardized Method

Background and Purpose: Historically, Emergency Medical Services (EMS) and Emergency Department (ED) nursing staff have had no standardized method of hand-off reporting, and documentation of the communication has been difficult to locate in the medical record. Comprehensive Stroke Centers (CSC) are called to collaborate and communicate with all care delivery partners, including providers from transferring facilities. A standardized method of communication and documentation sets the stage for safe patient care transitions. Methods: Regional community discussion began in 2011. Proposals were made and no early adopters came forward. Internal discussion was readdressed. A team was assembled consisting of researchers and frontline staff from ED, EMS and the CSC. A hand-off communication tool was developed using Situation, Background, Assessment, and Treatments format. The tool includes stroke specific data points important to care and pilot data will be collected during fourth quarter of 2013. Metrics include compliance of tool use and an accurate medical history with home medications. Three EMS providers representing urban, suburban and rural services have been recruited. Each Paramedic-RN team involved in a hand-off will receive an electronic survey measuring engagement and satisfaction. Results: A standardized method for communicating important hand-off information was developed and will be demonstrated. Final analysis of the data at the end of the quarter will provide direction to further improve the tool with the goal of permanent implementation within the region. Ongoing data analysis will be communicated to all providers monthly via electronic communication. Sharing the story with the region on a regular basis presents a road-map for successful safe patient transitions. Conclusions: The development of consistent standardized hand-off communication between pre-hospital and hospital staff is essential to patient safety. Collaboration empowers best practice solutions. Accurate medical history assists in rapid emergent evaluation. Engaged pre-hospital and hospital personnel using standardized tools are likely to provide consistent safe patient transitions. Safe hand-off communication is paramount for all CSC partners.

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Health professionals' perspectives on delivering patient-focused wound management: a qualitative study

Journal of Wound Care ◽

10.12968/jowc.2019.28.sup7.s4 ◽

2019 ◽

Vol 28 (Sup7) ◽

pp. S4-S13 ◽

Cited By ~ 1

Author(s):

Janet L. Kuhnke ◽

David Keast ◽

Sue Rosenthal ◽

Robyn Jones Evans

Keyword(s):

Health Care ◽

Health Professionals ◽

Best Practice ◽

Care Delivery ◽

Wound Care ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Wound Management ◽

Evidence Based ◽

Venous Leg Ulcer

Objective: This study examined the perspectives of health professionals on the barriers and solutions to delivery of patient-focused wound management and outcomes. Methods: A qualitative, descriptive study design was used. Participants were health-care managers, clinical leaders, nurses and allied health members who are part of wound care services. Open-ended surveys were distributed to participants in a series of learning workshops, and data analysed to identify leading themes. Results: A total of 261 participants took part and 194 surveys were returned (response rate: 74%). From the analysis five themes emerged: patient/family wound-related education; health professional wound-related education; implementation of evidence-based wound care and dissemination of evidence-based wound information across professions and contexts; teamwork and respectful communication within teams; and a higher value and priority placed on wound care through collaborative teams by managers, leaders and policymakers. Conclusion: Findings suggest that ongoing, system-wide education is needed to improve prevention, assessment, treatment and management of four wound types: venous leg ulcer (VLU), diabetic foot ulcer (DFU), pressure ulcer (PU) and surgical wounds. Health professionals are committed to delivering best practice in wound care. Participants identified that effective patient-focused, evidence-based wound care involves having a health-care system with a clear mandate to ensure wound care is a priority. A high value placed on wound care by managers and clinical leadership could transform the present systems. Additionally, effective and widespread dissemination of evidenced-informed practice information is crucial to positive patient outcomes. Education and team commitment for consistent and respectful communication would improve care delivery.

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PROVIDER AND SYSTEM IMPACTS OF THE UW ECHO IN RURAL AND FRONTIER CARE TRANSITIONS

Innovation in Aging ◽

10.1093/geroni/igz038.1083 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S294-S295

Author(s):

Catherine Carrico ◽

Tonja Woods ◽

Robin A Barry ◽

Kevin Franke ◽

Christine McKibbin

Keyword(s):

Best Practices ◽

Patient Care ◽

Online Community ◽

Care Delivery ◽

Care Transitions ◽

Healthcare Team ◽

Strong Impact ◽

Community Resources ◽

Project Echo ◽

The Impact

Abstract Background: The Project ECHO model utilizes a hub and spoke approach through which a team of experts co-mentors local providers in the management of complex cases while disseminating information about best practices and evidence-based care. Project ECHO is a promising model for improving patient care through transformation of the care delivery system. The UW ECHO in Rural and Frontier Care Transitions created an online community of practice comprised of local care coalitions dedicated to improving care transitions in Wyoming and Montana. This ECHO network provided a unique opportunity to support system- and provider-level implementation of best practices in care transitions. Methods: Semi-structured interviews were conducted with thirty ECHO attendees following participation in an ECHO session as either a participant or case presenter. Thematic analysis was used to analyze interview data. Results: Two overarching themes emerged 1) impact of the ECHO on the provider or healthcare team and 2) impact on the system. Participants indicated that the impact on the provider/healthcare team included an increased sense of community, increased awareness of community resources, increased knowledge of care transition strategies, and increased confidence in implementing best practices. Additionally, providers indicated increased utilization of community resources. Systemic impacts included increased involvement of interprofessional team members in patient care and utilization of ECHO recommendations to present systemic interventions and changes to colleagues, administration, and leadership. Conclusions: This ECHO network had a particularly strong impact on the provider and healthcare team as participants increased their knowledge, confidence, and use of best practices in care transitions.

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Barriers to the Delivery of Timely, Guideline-Adherent Adjuvant Therapy Among Patients With Head and Neck Cancer

JCO Oncology Practice ◽

10.1200/op.20.00271 ◽

2020 ◽

Vol 16 (12) ◽

pp. e1417-e1432

Author(s):

Evan M. Graboyes ◽

Chanita Hughes Halbert ◽

Hong Li ◽

Graham W. Warren ◽

Anthony J. Alberg ◽

...

Keyword(s):

Health Care ◽

Head And Neck ◽

Conceptual Model ◽

Care Delivery ◽

Care Transitions ◽

Health Care Team ◽

Organizational Level ◽

Structured Interviews ◽

Postoperative Radiation Therapy ◽

Oncology Providers

PURPOSE: Delays initiating guideline-adherent postoperative radiation therapy (PORT) in head and neck squamous cell carcinoma (HNSCC) are common, contribute to excess mortality, and are a modifiable target for improving survival. However, the barriers that prevent the delivery of timely, guideline-adherent PORT remain unknown. This study aims to identify the multilevel barriers to timely, guideline-adherent PORT and organize them into a conceptual model. MATERIALS AND METHODS: Semi-structured interviews with key informants were conducted with a purposive sample of patients with HNSCC and oncology providers across diverse practice settings until thematic saturation (n = 45). Thematic analysis was performed to identify the themes that explain barriers to timely PORT and to develop a conceptual model. RESULTS: In all, 27 patients with HNSCC undergoing surgery and PORT were included, of whom 41% were African American, and 37% had surgery and PORT at different facilities. Eighteen clinicians representing a diverse mix of provider types from 7 oncology practices participated in key informant interviews. Five key themes representing barriers to timely PORT were identified across 5 health care delivery levels: (1) inadequate education about timely PORT, (2) postsurgical sequelae that interrupt the tight treatment timeline (both intrapersonal level), (3) insufficient coordination and communication during care transitions (interpersonal and health care team levels), (4) fragmentation of care across health care organizations (organizational level), and (5) travel burden for socioeconomically disadvantaged patients (community level). CONCLUSION: This study provides a novel description of the multilevel barriers that contribute to delayed PORT. Interventions targeting these multilevel barriers could improve the delivery of timely, guideline-adherent PORT and decrease mortality for patients with HNSCC.

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Advanced Telecare for Wound Care Delivery

Home Healthcare Nurse ◽

10.1097/00004045-200207000-00012 ◽

2002 ◽

Vol 20 (7) ◽

pp. 457-461 ◽

Cited By ~ 3

Author(s):

Audrey Kinsella

Keyword(s):

Care Delivery ◽

Wound Care

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An Innovative Enterostomal Therapy Nurse Model of Community Wound Care Delivery

Journal of Wound Ostomy and Continence Nursing ◽

10.1097/01.won.0000313639.37247.c0 ◽

2008 ◽

Vol 35 (2) ◽

pp. 169-183 ◽

Cited By ~ 13

Author(s):

Connie Harris ◽

Ronald Shannon

Keyword(s):

Care Delivery ◽

Wound Care

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“I’m Dealing With That”: Illness Concerns of African American and White Cancer Patients While Undergoing Active Cancer Treatments

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120969121 ◽

2020 ◽

pp. 104990912096912

Author(s):

Salimah H. Meghani ◽

Kristin Levoy ◽

Kristin Corey Magan ◽

Lauren T. Starr ◽

Liana Yocavitch ◽

...

Keyword(s):

Palliative Care ◽

African American ◽

Cancer Treatment ◽

Cancer Patients ◽

Risk Mitigation ◽

Care Delivery ◽

Care Transitions ◽

Financial Toxicity ◽

Cancer Treatments ◽

Illness Trajectory

Background: National oncology guidelines recommend early integration of palliative care for patients with cancer. However, drivers for this integration remain understudied. Understanding illness concerns at the time of cancer treatment may help facilitate integration earlier in the cancer illness trajectory. Objective: To describe cancer patients’ concerns while undergoing cancer treatment, and determine if concerns differ among African Americans and Whites. Methods: A 1-time, semi-structured qualitative interview was conducted with a purposive subsample of cancer patients participating in a larger study of illness concerns. Eligible patients were undergoing cancer treatments and had self-reported moderate-to-severe pain in the last week. Analysis encompassed a qualitative descriptive approach with inductive thematic analysis. Results: Participants (16 African American, 16 White) had a median age of 53 and were predominantly females (72%) with stage III/IV cancer (53%). Illness concerns were largely consistent across participants and converged on 3 themes: symptom experience (pain, options to manage pain), cancer care delivery (communication, care coordination and care transitions), and practical concerns (access to community and health system resources, financial toxicity). Conclusions: The findings extend the scope of factors that could be utilized to integrate palliative care earlier in the cancer illness trajectory, moving beyond the symptoms- and prognosis-based triggers that typify current referrals to also consider diverse logistical concerns. Using this larger set of concerns aids anticipatory risk mitigation and planning (e.g. care transitions, financial toxicity), helps patients receive a larger complement of support services, and builds cancer patients’ capacity toward a more patient-centered treatment and care experience.

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Abstract NS1: Development of the Preparedness Assessment for the Transition Home After Stroke (PATH-s) Instrument

Stroke ◽

10.1161/str.48.suppl_1.ns1 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Michelle Camicia ◽

Barbara Lutz

Keyword(s):

Care Delivery ◽

Care Transitions ◽

Inpatient Rehabilitation ◽

Stroke Survivor ◽

Assessment Instrument ◽

Cross Sectional ◽

Convenience Sample ◽

Care Plans ◽

National Quality ◽

Transition Home

Introduction: Care transitions from the inpatient rehabilitation facility (IRF) to home after stroke are often ineffective and inefficient, resulting in unmet patient and caregiver needs, increased safety risks, high rates of preventable readmissions, and increased health care costs. There is no assessment instrument specifically designed to evaluate caregiver readiness for this transition. The purpose of this study is to describe the development of the Preparedness Assessment for the Transition Home after Stroke (PATH-s) instrument. Methods: A cross-sectional study was conducted to establish the psychometric properties of the PATH-s instrument using a convenience sample of 60 caregivers of stroke patients with moderate to severe impairment during IRF admission. A sequential, multi-method approach to instrument development beginning with item generation from qualitative research findings followed by (a) review of items by expert case managers, (b) development of an alternative Likert format, (c) selection of the format that provides greatest clarity, and (d) cognitive appraisal interviews with caregivers with associated instrument revision was used to develop a measure of readiness for the transition from IRF to home for stroke caregivers. Results: The novel PATH-s instrument is a 15-item, 4-point scale that has demonstrated validity. Next steps include additional psychometric testing of the PATH-s to understand the predictive validity to stratify the degree of risk of adverse health effects for stroke survivors and caregivers following transition from the IRF to home. Conclusion: The PATH-s may support a primary prevention strategy to identify gaps in preparedness for stroke survivor-caregiver dyads during this high risk transition, with the long-range goal to mitigate the effects of suboptimal preparation and the associated adverse effects associated with this transition on the health of stroke survivor and caregiver. Once gaps are identified, care plans can be tailored to address gaps and better prepare caregivers for the transition home. This optimized approach to transitions management will address the National Quality Strategy “Triple Aim” to improve quality of care, improve health, and reduce costs for the care delivery system.

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