Interprofessional Teamwork Innovation Model (ITIM) to promote communication and patient-centred, coordinated care

2018 ◽  
Vol 27 (9) ◽  
pp. 700-709 ◽  
Author(s):  
Jing Li ◽  
Preetham Talari ◽  
Andrew Kelly ◽  
Barbara Latham ◽  
Sherri Dotson ◽  
...  
Keyword(s):  
Hospital Readmissions ◽  
Intervention Group ◽  
Hospital Setting ◽  
Control Group ◽  
Difference In Difference ◽  
Academic Medical Centre ◽  
Difference Analysis ◽  
Interprofessional Teamwork ◽  
Innovation Model ◽  
Ed Visits

BackgroundDespite recommendations and the need to accelerate redesign of delivery models to be team-based and patient-centred, professional silos and cultural and structural barriers that inhibit working together and communicating effectively still predominate in the hospital setting. Aiming to improve team-based rounding, we developed, implemented and evaluated the Interprofessional Teamwork Innovation Model (ITIM).MethodsThis quality improvement (QI) study was conducted at an academic medical centre. We followed the system’s QI framework, FOCUS-PDSA, with Lean as guiding principles. Primary outcomes included 30-day all-cause same-hospital readmissions and 30-day emergency department (ED) visits. The intervention group consisted of patients receiving care on two hospitalist ITIM teams, and patients receiving care from other hospitalist teams were matched with a control group. Outcomes were assessed using difference-in-difference analysis.ResultsTeam members reported enhanced communication and overall time savings. In multivariate modelling, patients discharged from hospitalist teams using the ITIM approach were associated with reduced 30-day same-hospital readmissions with an estimated point OR of 0.56 (95% CI 0.34 to 0.92), but there was no impact on 30-day same-hospital ED visits. Difference-in-difference analysis showed that ITIM was not associated with changes in average total direct costs nor average cost per patient day, after adjusting for all other covariates in the models, despite the addition of staff resources in the ITIM model.ConclusionThe ITIM approach facilitates a collaborative environment in which patients and their family caregivers, physicians, nurses, pharmacists, case managers and others work and share in the process of care.

scholarly journals Assessment of the impact of an opioid-specific education series on rates of medication-assisted treatment for opioid use disorder in veterans

2020 ◽  
Author(s):  
Taylor Kirby ◽  
Robert Connell ◽  
Travis Linneman
Keyword(s):  
Multivariate Analysis ◽  
Hospital Admission ◽  
Intervention Group ◽  
Opioid Use Disorder ◽  
Control Group ◽  
Opioid Use ◽  
Motivation To Change ◽  
Heroin Use ◽  
Ed Visits ◽  
The Impact

Abstract Purpose The impact of a focused inpatient educational intervention on rates of medication-assisted therapy (MAT) for veterans with opioid use disorder (OUD) was evaluated. Methods A retrospective cohort analysis compared rates of MAT, along with rates of OUD-related emergency department (ED) visits and/or hospital admission within 1 year, between veterans with a diagnosis of OUD who completed inpatient rehabilitation prior to implementation of a series of group sessions designed to engage intrinsic motivation to change behavior surrounding opioid abuse and provide education about MAT (the control group) and those who completed rehabilitation after implementation of the education program (the intervention group). A post hoc, multivariate analysis was performed to evaluate possible predictors of MAT use and ED and/or hospital readmission, including completion of the opioid series, gender, age (>45 years), race, and specific prior substance(s) of abuse. Results One hundred fifty-eight patients were included: 95 in the control group and 63 in the intervention group. Rates of MAT were 25% (24 of 95 veterans) and 75% (47 of 63 veterans) in control and intervention groups, respectively (P < 0.01). Gender, completion of the opioid series, prior heroin use, and marijuana use met prespecified significance criteria for inclusion in multivariate regression modeling of association with MAT utilization, with participation in the opioid series (odds ratio [OR], 9.56; 95% confidence interval [CI], 4.36-20.96) and prior heroin use (OR, 3.26; 95% CI, 1.18-9.01) found to be significant predictors of MAT utilization on multivariate analysis. Opioid series participation and MAT use were independently associated with decreased rates of OUD-related ED visits and/or hospital admission (hazard ratios of 0.16 [95% CI, 0.06-0.44] and 0.32 [95% CI, 0.14-0.77], respectively) within 1 year after rehabilitation completion. Conclusion Focused OUD-related education in a substance abuse program for veterans with OUD increased rates of MAT and was associated with a decrease in OUD-related ED visits and/or hospital admission within 1 year.

Impact of a pharmacy team–led intervention program on the readmission rate of elderly patients with heart failure

2018 ◽  
Vol 75 (4) ◽  
pp. 183-190 ◽  
Author(s):  
Pamela M. Moye ◽  
Pui Shan Chu ◽  
Teresa Pounds ◽  
Maria Miller Thurston
Keyword(s):  
Heart Failure ◽  
Older Patients ◽  
Readmission Rate ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
Historical Control Group ◽  
Historical Control ◽  
Control Group ◽  
Patients With Heart Failure

Purpose The results of a study to determine whether pharmacy team–led postdischarge intervention can reduce the rate of 30-day hospital readmissions in older patients with heart failure (HF) are reported. Methods A retrospective chart review was performed to identify patients 60 years of age or older who were admitted to an academic medical center with a primary diagnosis of HF during the period March 2013–June 2014 and received standard postdischarge follow-up care provided by physicians, nurses, and case managers. The rate of 30-day readmissions in that historical control group was compared with the readmission rate in a group of older patients with HF who were admitted to the hospital during a 15-month intervention period (July 2014–October 2015); in addition to usual postdischarge care, these patients received medication reconciliation and counseling from a team of pharmacists, pharmacy residents, and pharmacy students. Results Twelve of 97 patients in the intervention group (12%) and 20 of 80 patients in the control group (25%) were readmitted to the hospital within 30 days of discharge (p = 0.03); 11 patients in the control group (55%) and 7 patients in the intervention group (58%) had HF-related readmissions (p = 0.85). Conclusion In a population of older patients with HF, the rate of 30-day all-cause readmissions in a group of patients targeted for a pharmacy team–led postdischarge intervention was significantly lower than the all-cause readmission rate in a historical control group.

A RANDOMIZED TRIAL TO MEASURE THE OPTIMAL ROLE OF THE PHARMACIST IN PROMOTING EVIDENCE-BASED ANTIBIOTIC USE IN ACUTE CARE HOSPITALS

2001 ◽  
Vol 17 (2) ◽  
pp. 171-180 ◽  
Author(s):  
George Dranitsaris ◽  
Diana Spizzirri ◽  
Monique Pitre ◽  
Allison McGeer
Keyword(s):  
Acute Care ◽  
Broad Spectrum ◽  
Randomized Clinical Trials ◽  
Intervention Group ◽  
Hospital Setting ◽  
Control Group ◽  
Evidence Based ◽  
Care Hospital ◽  
Broad Spectrum Antibiotics ◽  
The Impact

Background: There is a considerable gap between randomized clinical trials and implementing the results into practice. This is particularly relevant in the use of broad-spectrum antibiotics in hospitals. Hospital pharmacists can be effective vehicles for bridging this gap and promoting evidence-based medicine. To determine the most effective way of using the pharmacist in this role, a prospective cefotaxime intervention study was conducted with randomization incorporated into the design as well as patient-related therapeutic outcomes.Methods: A total of 323 patients who were prescribed cefotaxime were randomized into an intervention or nonintervention group where only the former was challenged by pharmacists for inappropriate cefotaxime usage relative to hospital guidelines. The primary outcome was the appropriateness of cefotaxime prescribing between groups. Logistic regression analysis was then used to identify factors that were associated with successful clinical response.Results: Overall, 94% of orders in the intervention group met cefotaxime dosage criteria compared with 86% in the control group (p = .018). However, there was no impact with respect to promoting cefotaxime use for an appropriate indication (81% vs. 80%; p = .67). There was a trend for improved clinical outcomes in patients who received cefotaxime within hospital guidelines (OR = 1.73; p = .31).Conclusions: The pharmacist as a vehicle for promoting the appropriate use of broad-spectrum antibiotics in the acute care hospital setting can improve the dosing of such agents. However, several barriers to optimizing the impact of the pharmacist were implied by the data. Removing these barriers could increase the pharmacists' utility as an agent for improved patient care.

scholarly journals Effects of a Dementia Screening Program on Healthcare Utilization in South Korea: A Difference-In-Difference Analysis

2019 ◽  
Vol 16 (20) ◽  
pp. 3837 ◽  
Author(s):  
Su Jung Lee ◽  
Hyun-Ju Seo ◽  
Dong Young Lee ◽  
So-Hyun Moon
Keyword(s):  
Screening Program ◽  
Drug Prescription ◽  
Healthcare Services ◽  
Control Group ◽  
Difference In Difference ◽  
Difference Analysis ◽  
Screening Programs ◽  
Dementia Screening ◽  
People With Dementia ◽  
Prescription Rates

To determine whether Seoul’s dementia screening program increased the rate of diagnosis and the appropriate use of healthcare services for people with dementia, a retrospective data analysis was conducted based on administrative data from the Health Insurance Review and Assessment Service. Two cohorts were constructed to represent the year before Seoul’s dementia screening program began (2007) (control group) and the year after the implementation of the program (2009) (treatment group). A difference-in-difference analysis was used to compare the diagnosis rates, number of clinic visits, and dementia-related drug prescription rates for 4 districts that implemented dementia screening programs between 2007 and 2009 and 14 areas that did not. After the introduction of the program, there was a 55.4% increase in physician-diagnosed dementia. The “average drug cost per patient” increased by 52.2% (Exp(β) = 1.522, p = 0.0264), the “average outpatient visits per patient” tended to increase by 13.5% (Exp(β) = 1.135, p = 0.1852), and the “average outpatient treatment fees per visit per patient” tended to increase by 24.4% (Exp(β) = 1.244, p = 0.0821). The implementation of dementia screening programs led to an increase in healthcare service utilization. Therefore, this program was found to be an effective strategy for reducing undiagnosed dementia cases and encouraging patients to use adequate healthcare services.

scholarly journals Prevention of alcohol and other drug use using motivational interviewing among young adults in the Ukraine

2016 ◽  
Vol 1 (1) ◽  
pp. 010111 ◽  
Author(s):  
Svitlana Polshkova ◽  
Diana Voloshina ◽  
Rebecca Cunningham ◽  
Robert Zucker ◽  
Maureen Walton
Keyword(s):  
Alcohol Consumption ◽  
Drug Use ◽  
Emerging Adults ◽  
Brief Intervention ◽  
Intervention Group ◽  
Hospital Setting ◽  
World Health ◽  
Control Group ◽  
Risky Drinking ◽  
National Medical

Background World Health Organization data shows alarming rates of alcohol consumption among those ages 15 and older in the Ukraine. This study examined the feasibility and initial efficacy of a brief intervention to reduce risky drinking among emerging adults (ages 18-25) in the Ukraine. Methods Emerging adults presenting to two settings were screened for risky drinking (Railway Clinical Hospital and Kiev National Medical University), with those screening positive on the AUDIT-C (>5) enrolled in the study: 59 participants from the hospital setting (mean age = 22.6 (2.1), 55.9% male) and 61 participants from the university setting (mean age = 20.1(2.3), 55.7% male). After self-administering a computerized baseline assessment, participants were randomized to receive an in-person brief intervention with telephone booster or to a control condition; participants self-administered a computerized follow-up at 3 months. Results Regression analyses were conducted, separately for each setting, predicting alcohol outcomes (alcohol consumption and consequences); models controlled for baseline alcohol levels and condition assignment (brief intervention or control). In both settings, the brief intervention group showed significantly less alcohol consumption and consequences at 3-months as compared to the control group (p<.001); however, the groups did not significantly differ on other drug use (DAST-10 score). Conclusion Findings suggest that brief motivational interventions are promising for reducing risky drinking among emerging adults in the Ukraine in both inpatient hospital and university settings. Future studies are needed to replicate these findings and extend these effects to reduce other drug use among young people in the Ukraine.

scholarly journals “Brown Bag Clinic”: A Pharmacist-led Approach to Reduce Heart Failure Hospital Readmission

2021 ◽  
Vol 12 (4) ◽  
pp. 11
Author(s):  
Maggie N. Faraj ◽  
Ileana L. Piña ◽  
Candice Garwood
Keyword(s):  
Heart Failure ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
The United States ◽  
Control Group ◽  
Post Discharge ◽  
Academic Medical ◽  
The Impact

Objectives: Heart failure (HF) affects approximately 6 million in the United States and despite guideline-directed medical therapy (GDMT), still more than 20% of patients are readmitted within 30 days.1,2 This study evaluated the impact of a “pharmacist-led HF Brown Bag Clinic” (BBC) on HF patient outcomes including readmissions and mortality. Methods: This retrospective study, conducted at an academic medical center, included adult patients 18 to 89 years old with HF presenting to the BBC 7-14 days post HF hospitalization. Those failing to attend the BBC within 30 days of hospital discharge were in the control group. Our electronic medical records were used to capture patients’ baseline characteristics and describe pharmacists’ interventions. Thirty- and ninety-day post-discharge HF readmission and all-cause mortality were evaluated. Results: A total of 32 patients met the inclusion criteria; 15 receiving intervention and 17 controls. A total of 18 HF hospital readmissions occurred, 4 (22%) readmissions in the intervention group and 14 (78%) in the control group (p= 0.06). Hospital readmissions within 30 days and 90 days were greater in the control group compared with the intervention group (18% vs. 7% and 41% vs. 21% respectively). Conclusion: A pharmacist-led post-discharge clinic demonstrated numerically fewer HF hospital readmissions compared with a scheduled but “no show” control group.

scholarly journals Does an mHealth system reduce health service use for asthma?

2020 ◽  
Vol 6 (3) ◽  
pp. 00340-2019
Author(s):  
Teresa To ◽  
M. Diane Lougheed ◽  
Rachel McGihon ◽  
Jingqin Zhu ◽  
Samir Gupta ◽  
...  
Keyword(s):  
Health Services ◽  
Intervention Group ◽  
External Control ◽  
Control Group ◽  
Health Services Use ◽  
Physician Visits ◽  
Asthma Patients ◽  
Ed Visits ◽  
The Impact ◽  
Services Use

BackgroundBreathe is a mobile health (mHealth) application developed for the self-management of asthma in adults. There is evidence to suggest that mHealth interventions can be used for asthma control; however, their effects on the use of health services remain poorly understood. We sought to determine whether Breathe reduces health services use amongst asthma patients who used the app compared to controls who did not.MethodsThe impact of Breathe on health services use was estimated using a quasi-experimental approach. Two groups of subjects who had participated in a previous randomised clinical trial were included: an intervention group of asthma patients who used the app for 12 months, and a group of controls who did not use the app but received equivalent quality asthma care. A third, external control group of asthma patients were matched to the intervention participants. Generalised linear mixed models were used to determine relative changes in rates of asthma hospitalisations, emergency department (ED) visits, outpatient physician visits and completion of pulmonary function tests (PFTs) over time.ResultsA total of 677 individuals with asthma were included in the study: 132 in the intervention group, and 149 and 396 in the internal and external control groups, respectively. There were no statistically significant differences in the change of asthma hospitalisations, ED visits, physician office visits or completion of PFTs between the intervention group and either control group.ConclusionsUse of the Breathe app is not associated with changes in health services use in adults with asthma.

scholarly journals Spin-off and market share in the Indonesian Islamic banking industry: a difference in difference analysis

2017 ◽  
Vol 12 (4) ◽  
pp. 540-551 ◽  
Author(s):  
M. Nur Rianto Al Arif
Keyword(s):  
Market Share ◽  
Banking Industry ◽  
Control Group ◽  
Islamic Banking ◽  
Islamic Banks ◽  
Difference In Difference ◽  
Difference Analysis ◽  
Business Units ◽  
Conventional Banks ◽  
The Impact

Abstract According to The Act No. 21 of 2008 concerning Islamic Banking in Indonesia, the conventional banks are obligated to spun-off their Islamic business units after achieving a certain set of requirements. The spin-off requirements are: (i) reach 50% market share asset of its parents; or (ii) 15 years after the implementation of the Islamic Banking Act. This study emphasizes the impact of Islamic banks' spin-off on market share. The method used in this study is a difference in difference analysis. This technique is a quasi-experiment separate into two groups, such as the treatment groups (four spin-offs' banks) and control group (two fullfledged Islamic banks). This study used quarterly data from 2005 until 2016. The results show that, first, there is a difference in the Islamic banks' market share between pre- and post-spinoff. Second, there is a difference in the market share of spin-offs' banks between pre- and postspin- off. Third, there are there external factors that can affect the Islamic banks' market share, i.e., inflation rate, interest rate, and economic growth rate. The paper is a useful source of information that may provide relevant guidelines in helping the future development of spin-off activity in Islamic banking industry. The finding could be helpful for policymakers to create a supporting strategy to accelerate the development of Islamic banking industry. This result also could be of use for Islamic banking industries in other countries.

scholarly journals Effects of Comfort Education on Maternal Comfort and Labor Pain

2017 ◽  
Vol 26 (2) ◽  
pp. 96-104
Author(s):  
Abby E. Garlock ◽  
Janet B. Arthurs ◽  
Robert J. Bass
Keyword(s):  
Pain Control ◽  
Comparison Group ◽  
Intervention Group ◽  
Hospital Setting ◽  
Labor Pain ◽  
Control Group ◽  
Group Design ◽  
Significant Difference ◽  
Quasi Experimental

ABSTRACTThe effects of providing education regarding comfort options available in the hospital setting on level of maternal comfort and pain during labor were explored in a quasi-experimental pretest/posttest comparison group design (N = 80). No significant difference was found in maternal comfort or pain between the intervention group that received comfort education and the control group. Comfort education did result in change for plans to maintain comfort during labor (p = .000), an increased use of comfort measures during labor (p = .000), and an increased probability of continuation with original plans for pain control during labor. Providing education for maintaining comfort during labor can allow women to make informed choices during labor.

Impact of a Pharmaceutical Care Program at Discharge on Patients at High Risk of Readmission According to the Hospital Score

2021 ◽  
pp. 875512252110476
Author(s):  
María Luisa Ibarra Mira ◽  
Jose Manuel Caro-Teller ◽  
Pedro Pablo Rodríguez Quesada ◽  
Carmen Garcia-Muñoz ◽  
Almudena Añino Alba ◽  
...  
Keyword(s):  
High Risk ◽  
Pharmaceutical Care ◽  
Hospital Readmissions ◽  
Intervention Group ◽  
Control Group ◽  
Drug Related Problems ◽  
Medication Regimen ◽  
Chronic Patients ◽  
Medication Regimen Complexity ◽  
Readmission Risk

Background: A significant percentage of hospital readmissions within 30 days of discharge are a result of avoidable drug-related problems. Stratifying patients according to readmission risk is key to pharmaceutical intervention (PI) design strategies to improve treatment outcomes. Objective: To assess whether a pharmaceutical care (PC) program at discharge in polymedicated patients at high potentially avoidable readmission (PAR) risk, according to the HOSPITAL score, improves 30-day readmission rate (30-dRR). Methods: This prospective controlled, quasi-experimental, 11-month study included 163 chronic polymedicated patients (>5 medications) at high PAR risk according to the HOSPITAL score. We calculated the 30-dRR and number of medication variations and Medication Regimen Complexity Index-E (MRCI-E) after PI. Results were compared with a retrospective cohort of chronic patients at high PAR risk. Results: The 30-dRR was 18.4% in the intervention group and 25.6% in the control group (odds ratio [OR] = 0.66; 95% CI = 0.38 to 1.14). Total medication reduction (−1.28; 95% CI = −1.88 to −0.68), number of high-risk medications in chronic patients (−0.58; 95% CI = −0.9 to −0.26), and MRCI-E (−6.42; 95% CI = −8.07 to −4.76) were statistically significant ( P < .001). The number of medications at discharge was associated with an increased readmission risk (OR = 1.07; 95% CI = 1.01 to 1.14). Conclusions: The degree of polypharmacy and patients’ treatment complexity after hospital discharge significantly reduced as a result of the PC program compared with the control group. This highlights the need for patient selection and prioritization strategies for implementing PIs focused on reducing polypharmacy and preventing drug-related problems that may cause PAR.

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