The role of team climate in improving the quality of chronic care delivery: a longitudinal study among professionals working with chronically ill adolescents in transitional care programmes

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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The Role of Monitor Technicians in Enhancing Alarm Response

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857913021023 ◽

2013 ◽

Vol 2 (1) ◽

pp. 116-122 ◽

Cited By ~ 1

Author(s):

Beth Crandall ◽

Elizabeth Lerner Papautsky ◽

Anna Grome ◽

Kathy Dressman ◽

James Greenberg ◽

...

Keyword(s):

Human Factors ◽

Transitional Care ◽

Medical Center ◽

Cognitive Task ◽

Care Center ◽

Healthcare Organizations ◽

Alarm Response ◽

Respiratory Therapists

We report a study of monitor alarm response conducted in the newly designed Transitional Care Center (TCC) at Cincinnati Children’s Hospital Medical Center. A key component of the new TCC design has been the development and implementation of a Monitor Technician (MT) position. We examined the MT role from a human factors perspective, with particular focus on the MT’s coordination and communication with nurses (RNs) and respiratory therapists (RTs). We conducted observations and Cognitive Task Analysis interviews of MTs, RNs, and RTs. In this paper, we describe the value of the MT’s role and define the challenges associated with the MT’s responsibilities. MTs serve an important support function, but they face challenges in locating RNs/RTs to respond to alarms and at times, may be the only “eyes on” the patients, making training and preparation a critical aspect of the MT’s function. In response to findings, CCHMC has taken a number of steps to improve alarm and alert responses and provide further support to the MT’s role. The current study serves as a demonstration of the principles and methods that human factors can offer to healthcare organizations to support patient safety and quality of care.

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Perspectives on Opportunities and Challenges for Medicare Advantage Plans to Address Social Determinants of Health via the CHRONIC Care Act

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/0046958019862120 ◽

2019 ◽

Vol 56 ◽

pp. 004695801986212

Author(s):

Melony E. Sorbero ◽

Ashley M. Kranz

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

Chronic Care ◽

Chronically Ill ◽

Determinants Of Health ◽

Medicare Advantage ◽

Eligibility Criteria ◽

Funding Sources ◽

First Time

There is increasing recognition of the role of social determinants of health (SDOH) in the ability of Medicare Advantage (MA) enrollees to obtain needed care. The 2018 CHRONIC Care Act established Special Supplemental Benefits for the Chronically Ill (SSBCI), which for the first time gives MA plans the flexibility to provide supplemental benefits to enrollees to address SDOH. Given the role of SDOH in chronic disease, this represents an opportunity for MA plans to address underlying issues not strictly health care related with which MA enrollees struggle and that affect their overall health. MA plans have experimented with different approaches to address SDOH but have been limited by the lack of ability to offer services as part of covered benefits and reliance on partnerships, grants, and other funding sources to support the provision of these services. The effect of this policy and how it may evolve before implementation begins in 2020 remains uncertain as we wait to see how MA plans will interpret eligibility criteria and services offered without any additional allotted funding.

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Primary Nursing in a Short-Stay Unit

Creative Nursing ◽

10.1891/1078-4535.21.1.26 ◽

2015 ◽

Vol 21 (1) ◽

pp. 26-29 ◽

Cited By ~ 1

Author(s):

Jane Baynton

Keyword(s):

Care Delivery ◽

Patient Relationship ◽

Short Stay ◽

Model Of Care ◽

Care Model ◽

Primary Nursing ◽

Hospital Units ◽

Primary Nurse

Primary Nursing is a model of care delivery that has been shown to improve the quality of care provided to patients and enhance the nurse–patient relationship. Although there is considerable attention in the literature on Primary Nursing concerning inpatient hospital units, there has been no discussion of Primary Nursing in short-stay units. Our hospital aimed to introduce Primary Nursing into all the units including short-stay. Staff were educated about the role of the primary nurse using Koloroutis’s (2004) Relationship-Based Care model, comprising three crucial relationships: care provider’s relationship with patients and families, with self, and with colleagues. The primary nurse develops the plan of care for individual patients based on their therapeutic relationship, which is sustained for the patient’s length of stay in the unit.

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Correction: Reciprocal relationship between psychosocial work stress and quality of life: the role of gender and education from the longitudinal study of the Survey of Health, Ageing and Retirement in Europe

BMJ Open ◽

10.1136/bmjopen-2018-027051corr1 ◽

2019 ◽

Vol 9 (8) ◽

pp. e027051corr1

Keyword(s):

Quality Of Life ◽

Longitudinal Study ◽

Work Stress ◽

Reciprocal Relationship ◽

Psychosocial Work ◽

Gender And Education ◽

Psychosocial Work Stress

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The trainee assistant in nursing: a pilot exercise in building and retaining a workforce

Australian Health Review ◽

10.1071/ah09641 ◽

2010 ◽

Vol 34 (1) ◽

pp. 41 ◽

Cited By ~ 4

Author(s):

Diane Deshong ◽

Amanda Henderson

Keyword(s):

Nursing Education ◽

Care Delivery ◽

Princess Alexandra Hospital ◽

Successful Development ◽

Skilled Nursing ◽

Nursing Role ◽

Innovative Solutions ◽

Workforce Strategies

With increasing pressures on the skilled nursing workforce, strategies need to be developed to maximise the value of the existing workforce without impacting on the quality of care delivery. This paper reports on the introduction of a Commonwealth and State subsidised program for assistants-in-nursing (AINs) to assist in addressing the global nursing shortage. The program – which has included education sessions with registered nurses about the role of the AIN, delegation and supervision, and has also sustained support to the participants throughout the duration of their employment – has delivered benefits locally to the Princess Alexandra Hospital (PAH) and, broadly, to the nursing profession. Most of the participants completing the program have chosen to continue their employment at PAH or pursue further studies in nursing. What is known about the topic?The shortage of skilled nurses means there is a need for innovative solutions to support the existing workforce. What does this paper add?The development of an assistant-in-nursing role was seen as a successful development for a Queensland hospital. What are the implications for practitioners?The trained assistants have largely remained employed in the area and 68% have gone on to further nursing education.

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