Effects of a System-Wide Fracture Care Program to Enhance Access and Follow-Up for Orthopedics

2012 ◽  
Vol 28 (7) ◽  
pp. 680-683 ◽  
Author(s):  
Michael W. Sauer ◽  
Daniel A. Hirsh ◽  
Harold K. Simon ◽  
Michael L. Schmitz ◽  
Jesse J. Sturm
Keyword(s):  
Care Program ◽  
Fracture Care

Feasibility of hybrid telerehabilitation as component of a novel comprehensive care program after acute myocardial infarction in a one-year follow-up preliminary experience of a single center

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
E Piotrowicz ◽  
P Orzechowski ◽  
I Kowalik ◽  
R Piotrowicz
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Acute Myocardial Infarction ◽  
Heart Rate ◽  
Functional Capacity ◽  
Care Program ◽  
Comprehensive Care ◽  
Monitoring Center ◽  
One Year

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Health Fund Background. A novel comprehensive care program after acute myocardial infarction (AMI) „KOS-zawał" was implemented in Poland. It includes acute intervention, complex revascularization, implantation of cardiovascular electronic devices (in case of indications), rehabilitation or hybrid telerehabilitation (HTR) and scheduled outpatient follow-up. HTR is a unique component of this program. The purpose of the pilot study was to evaluate a feasibility, safety and patients’ acceptance of HTR as component of a novel care program after AMI and to assess mortality in a one-year follow-up. Methods The study included 55 patients (LVEF 55.6 ± 6.8%; aged 57.5 ± 10.5 years). Patients underwent a 5-week HTR based on Nordic walking, consisting of an initial stage (1 week) conducted within an outpatient center and a basic stage (4-week) home-based telerehabilitation five times weekly. HTR was telemonitored with a device adjusted to register electrocardiogram (ECG) recording and to transmit data via mobile phone network to the monitoring center. The moments of automatic ECG registration were pre-set and coordinated with exercise training. The influence on physical capacity was assessed by comparing changes in functional capacity (METs) from the beginning and the end of HTR. Patients filled in a questionnaire in order to assess their acceptance of HTR at the end of telerehabilitation. Results HTR resulted in a significant improvement in functional capacity and workload duration in exercise test (Table). Safety: there were neither deaths nor adverse events during HTR. Patients accepted HTR, including the need for interactive everyday collaboration with the monitoring center. Prognosis all patients survived in a one-year follow-up. Conclusions Hybrid telerehabilitation is a feasible, safe form of rehabilitation, well accepted by patients. There were no deaths in a one-year follow-up. Outcomes before and after HTR Before telerehabilitation After telerehabilitation P Exercise time [s] 381.5 ± 92.0 513.7 ± 120.2 <0.001 Maximal workload [MET] 7.9 ± 1.8 10.1 ± 2.3 <0.001 Heart rate rest [bpm] 68.6 ± 12.0 66.6 ± 10.9 0.123 Heart rate max effort [bpm] 119.7 ± 15.9 131.0 ± 20.1 <0.001 SBP rest [mmHg] 115.6 ± 14.8 117.7 ± 13.8 0.295 DBP rest [mmHg] 74.3 ± 9.2 76.2 ± 7.3 0.079 SBP max effort [mm Hg] 159.5 ± 25.7 170.7 ± 25.5 0.003 DBP max effort [mm Hg] 84.5 ± 9.2 87.2 ± 9.3 0.043 SBP systolic blood pressure, DBP diastolic blood pressure.

Abstract WMP95: A Transition of Care Program to Reduce Stroke Related Hospital Readmissions

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Heather Khan ◽  
Hebah M Hefzy
Keyword(s):  
Risk Factors ◽  
Readmission Rate ◽  
Stroke Risk ◽  
Community Hospital ◽  
Hospital Readmissions ◽  
Care Program ◽  
Transition Of Care ◽  
Stroke Risk Factors ◽  
Risk Patients

Introduction: Readmission to the hospital after discharge following a stroke or TIA remains a nation-wide problem. While the CMS national benchmark was approximately 12% in 2015, our hospital Medicare stroke readmission rate rose from approximately 12% at the end of 2014 to 28.6% in February 2015. Our goal was a reduction in stroke readmission rates to below the national benchmark of 12% by December 2015. Hypothesis: We hypothesized that implementing a transition of care program at our 200 bed community hospital would reduce hospital stroke-related readmissions. Methods: In March 2015, a random sample of forty stroke/TIA patients that were discharged home between December of 2014 and February of 2015 were interviewed. The patients were asked about barriers to discharge, what could have improved the discharge experience, and what problems they encountered that could have resulted in a readmission. Based on their answers, risk factors were identified using an inverse Pareto graph and a transition of care program was implemented which included the following work flow: 1) daily rounding to query patients regarding insight into stroke risk factors, environmental concerns, and social impacts to discharge in the stroke unit by the stroke coordinator (a registered nurse); 2) a discharge telephone call within two business days to high risk patients identified during rounds focusing on review of the discharge summary, re-education regarding stroke risk factors, and ensuring that follow-up appointments were in place; 3) an outpatient follow-up appointment with a board certified vascular neurologist within two weeks of discharge. Results: Our transition of care program resulted in an improvement of 82.5%, with a Medicare stroke re-admission rate of 5% in December 2015. As of May 2016, our year-to-date hospital stroke readmission rate is 8.1%, while the current CMS national average is 12.7%. Conclusions: A transition of care program is implementable in a community hospital setting, and results in reduced stroke-related hospital readmissions. Its success emphasizes the importance of identifying high risk patients and assessing individual drivers of readmission risk.

scholarly journals Cohort study of serum total cholesterol and in-hospital incidence of infectious diseases

1998 ◽  
Vol 121 (2) ◽  
pp. 335-347 ◽  
Author(s):  
C. IRIBARREN ◽  
D. R. JACOBS ◽  
S. SIDNEY ◽  
A. J. CLAXTON ◽  
K. R. FEINGOLD
Keyword(s):  
Nervous System ◽  
Urinary Tract ◽  
Total Cholesterol ◽  
Cox Regression ◽  
Care Program ◽  
Inverse Association ◽  
Kaiser Permanente ◽  
Multiethnic Cohort ◽  
Tract Infections

A multiethnic cohort of adult members of the Kaiser Permanente Medical Care Program (55300 men and 65271 women) was followed for 15 years (1979–93) to assess the association between total cholesterol and risk of infections (other than respiratory and HIV) diagnosed in the in-patient setting. Using multivariate Cox regression, total cholesterol was inversely and significantly related to urinary tract, venereal, musculo-skeletal, and all infections among men; and to urinary tract, all genito-urinary, septicaemia or bacteraemia, miscellaneous viral site unspecified, and all infections among women. The reduction of risk of all infections associated with a 1 s.d. increase in total cholesterol was 8% in both men (95% CI, 4–12%) and women (95% CI, 5–11%). For urinary tract infections among men, as for septicaemia or bacteraemia and nervous system infections among women, the risk relation was restricted to persons aged 55–89 years. Nervous system infections were positively related to total cholesterol among women aged 25–54. In both genders, the significant inverse association with all infections persisted after excluding the first 5 years of follow-up. Collectively, these data are suggestive of an inverse association, although not entirely consistent, between total cholesterol and incidence of infections either requiring hospitalization or acquired in the hospital. Further research is needed to elucidate whether these associations are biologically plausible or represent uncontrolled confounding by unmeasured risk factors.

The Life Tape Project, an existential intervention for cancer patients: A report on perceived benefits and changes in quality of life

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 8604-8604
Author(s):  
E. H. Rosenbaum ◽  
R. W. Garlan ◽  
A. L. Siegel ◽  
S. Henderson ◽  
N. Hirschberger ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Personal Growth ◽  
Life Story ◽  
Care Program ◽  
Structured Interview ◽  
Repeated Measure ◽  
Perceived Benefits ◽  
Symbolic Immortality

8604 Background: Facing cancer, most patients struggle with mortality and threats to their emotional equilibrium and that of their families. Families may become closer, but often communication difficulties and isolation increase. The Life Tape Project (LTP) is an intervention—involving a two hour video-taped genealogy and life story in the presence of family—designed to help patients and families confront this existential crisis. An important aspect is the cultivation of Symbolic Immortality—that some important part of the person continues to exist symbolically, even after death—helping patients identify with things greater and more enduring than themselves, and providing a sense of what will remain with the family after they are gone. Observation and pilot data suggested patients receive substantial benefits from the LTP. Results from an ongoing study designed to quantify and extend these observations are reported. Method: Adults with any cancer diagnosis are recruited from the general population. Patients complete baseline questionnaires before the LT interview and follow-up packets two and ten weeks after. Measures include the FACT-G for Quality of Life (QOL) and a Perceived Benefits Questionnaire covering eight themes suggested by previous research. A final semi-structured interview probes for unwanted effects. Results: At first follow-up (N = 23 as of 1/8/06) repeated measure t-tests revealed significant increases in FACT-G Functional and QOL (Total) scales; and a majority of patients reported substantial benefits (endorsing “very” or “extremely true for me”) in at least one theme. Final interviews revealed no unwanted effects. Conclusions: The LTP is a powerful, safe, and accessible intervention that can improve family communication and connectedness, promote personal growth, and reduce existential anxiety through the creation of symbolic immortality. Requiring minimal equipment and time, it would make an excellent addition to any supportive care program. [Table: see text] No significant financial relationships to disclose.

scholarly journals High Risk Infants Follow-Up: A Case Study in Iran

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mohammad Heidarzadeh ◽  
Behzad Jodeiry ◽  
Mohammad Baqer Hosseini ◽  
Kayvan Mirnia ◽  
Forouzan Akrami ◽  
...  
Keyword(s):  
High Risk ◽  
Clinical Evaluation ◽  
Care Program ◽  
Maternity Hospital ◽  
Control Group ◽  
High Risk Infant ◽  
Maternity Hospitals ◽  
Follow Up Care ◽  
High Risk Infants

Background. A follow-up program for high risk infants was initiated in Alzahra Maternity Hospital in Tabriz city, Iran, in 2013. The aim of this paper is to give a brief report of the program.Material and Methods. Two groups of high risk neonates were studied. The first group comprising 509 infants received services in Alzahra Maternity Hospital implemented by the follow-up program. This included a full package for family to look after high risk infant and periodic clinical evaluation at two and four weeks after birth and then two, three, four, five, and six months later again. The second group including 131 infants in Taleqani Maternity Hospital received routine services after birth with no specific follow-up care.Results. Some anthropometric indices showed a significant improvement in the intervention hospital compared to control group. These included the following: head circumference at first and second months; weight in the first, fourth, fifth, and sixth months; and height in sixth month only. Clinical evaluation of infants showed an improvement for some of the medical conditions.Conclusion. Follow-up care program for a minimum of six months after discharge from maternity hospitals may help to avoid adverse and life threatening consequences in high risk infants.

Child Welfare and the Disabled — Is the Battle for Justice Really Being Fought?

1987 ◽  
Vol 11 (2-3) ◽  
pp. 5-7
Author(s):  
Barbara Szwarc
Keyword(s):  
Foster Care ◽  
Child Welfare ◽  
Care Program ◽  
Respite Care ◽  
Holiday Period ◽  
The Disabled

AbstractThis paper is based on the latest findings of the Children's Bureau of Australia recently released study entitled Particular Care Reconsidered by Barbara Szwarc. The Study, being a follow-up to the 1979 Report by N.J. Smith and G. Gregory entitled Particular Care was based on an Australia wide survey conducted in June 1984 on all children living in Non-Government Childrens Homes and Foster Care. Particular concentration in the study has been given to children in disadvantageous positions.Also referred to in this paper is another report by Barbara Swarcz on A Study Into The Victorian Children's Aid Society Respite Care Program During the 1985-86 Holiday Period. This report was based primarily on the perceptions of parents of the children who used the program.Of particular concern in this paper is the amount of undue injustice and inequality that such children and their families suffer just because their children are disabled.

Towards a follow‐up care program for ad hoc translations

1973 ◽  
Vol 25 (6) ◽  
pp. 220-226 ◽  
Author(s):  
C.M.A. Knul
Keyword(s):  
Ad Hoc ◽  
Care Program ◽  
Follow Up Care

scholarly journals Implementation of a Large System-Wide Hepatitis C Virus Screening and Linkage to Care Program for Baby Boomers

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Mariana Castrejón ◽  
Kara W. Chew ◽  
Marjan Javanbakht ◽  
Romney Humphries ◽  
Sammy Saab ◽  
...  
Keyword(s):  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Baby Boomers ◽  
Linkage To Care ◽  
Care Program ◽  
Hcv Rna ◽  
Care Coordinator ◽  
Hcv Antibody ◽  
Hcv Screening

Abstract Background We implemented and evaluated a large health system-wide hepatitis C virus (HCV) screening and linkage to care program for persons born between 1945 and 1965 (“baby boomers”). Methods An electronic health record (EHR) clinical decision support (CDS) tool for HCV screening for baby boomers was introduced in August 2015 for patients seen in the outpatient University of California, Los Angeles healthcare system setting. An HCV care coordinator was introduced in January 2016 to facilitate linkage to HCV care. We compared HCV testing in the year prior (August 2014–July 2015) to the year after (August 2015–July 2016) implementation of the CDS tool. Among patients with reactive HCV antibody testing, we compared outcomes related to the care cascade including HCV ribonucleic acid (RNA) testing, HCV RNA positivity, and linkage to HCV specialty care. Results During the study period, 19606 participants were screened for HCV antibody. Hepatitis C virus antibody screening increased 145% (from 5676 patients tested to 13930 tested) after introduction of the CDS intervention. Screening increased across all demographic groups including age, sex, and race/ethnicity, with the greatest increases among those in the older age groups. The addition of an HCV care coordinator increased follow-up HCV RNA testing for HCV antibody positive patients from 83% to 95%. Ninety-four percent of HCV RNA positive patients were linked to care postimplementation. Conclusions Introduction of an EHR CDS tool and care coordination markedly increased the number of baby boomers screened for HCV, rates of follow-up HCV RNA testing, and linkage to specialty HCV care for patients with chronic HCV infection.

scholarly journals Home respiratory rehabilitation: a purposes literature review focusing on the clinical pathway management

2020 ◽  
Author(s):  
Civitillo Claudio ◽  
Romano Angelo ◽  
Di Lorenzo Luigi
Keyword(s):  
Clinical Pathways ◽  
Clinical Care ◽  
Care Program ◽  
Care Pathways ◽  
Critical Pathways ◽  
Management Plans ◽  
Integrated Care Pathways ◽  
Care Maps ◽  
Respiratory Rehabilitation

Clinical Care pathways, also known as critical pathways, integrated care pathways, case management plans, clinical care pathways or care maps, are used to systematically plan and follow up a patient focused care program. Clinical pathways are used all over the world and so for respiratory rehabilitation pathways (RR) and the importance of knowledge and learning Evidence Based Practice (EBP) is well known and mandatory. However, the EBP acquisitions of the home RR model and the knowledge of Clinical Care Pathways (PCA) are poorly defined.

scholarly journals 1314. HOME CARE: Reaching Our Lost to Follow-up Patients and Overcoming Barriers to Care Utilizing Nontraditional Care Models

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S474-S475
Author(s):  
Erin Goldman ◽  
Sheronda Union ◽  
Tammie McClendon ◽  
Jennifer Veltman
Keyword(s):  
Healthcare Delivery ◽  
Care Program ◽  
Outpatient Setting ◽  
Standards Of Care ◽  
People Living With Hiv ◽  
Virologic Suppression ◽  
Healthcare Delivery System ◽  
Mental Health Barriers ◽  
Care Models

Abstract Background Of the 11098 people living with HIV in southeast Michigan, over 30% are out of care, with transportation being the most commonly identified barriers. To address this barrier and re-engage patients into care, we introduced an HIV homecare program. The objective of this study was to describe the implementation of the homecare program and document the outcomes of patients enrolled. Methods In 2016, WSUPG ID clinic saw 1990 patients and had additional 95 clients who were virally unsuppressed and lost to care for 12 months. We called all 95 of these clients and offered homecare. We also advertised our program internally, to the Detroit Public Health Departments’ Data to Care Program (Link up Detroit), and to community-based organizations. Referred patients were seen by a NP/MA team supervised by an infectious disease attending. HIV medical care delivered in home utilized same standards of care as for outpatient setting, including lab draws and counseling. Patients also had the ability to text/call provider directly on the program cell phone. This project was funding through a Part A Ryan White MAI grant. Results Of the 95 clients out-of-care, 38 (40%) were unreachable, 41 (43%) were reachable and 16 (17%) did not qualify (relocation, incarcerated, deceased, in-care at the time of call). 5 (5%) enrolled in homecare and additional 29 patients were referred to our program. A total of 34 patients enrolled from September 20, 2017 to September 20, 2018. Among the 34 clients, mental health barriers were the most frequently reported (depression in 20, schizophrenia or bipolar in 7, anxiety in 23, and history of trauma in 11). Of the 34 clients, 24 have achieved virologic suppression at least once during their enrollment. Among the 26 clients with 6+ months of follow-up, 17 have achieved virologic suppression. Conclusion Homecare offers a new, innovative healthcare delivery system which is effective at achieving viral suppression in a challenging patient population and is a successful strategy to re-engage patients in care. Disclosures All authors: No reported disclosures.

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