Abstract NS15: A Better Understanding of Readmission After Stroke by Including Stroke Survivor and Caregiver Perspectives

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Carole L White ◽  
Tracy L Brady ◽  
Laura L Saucedo ◽  
Deb Motz ◽  
Johanna A Sharp ◽  
...  
Keyword(s):  
Cultural Context ◽  
Recurrent Stroke ◽  
Qualitative Interviews ◽  
Medication Management ◽  
Skilled Nursing Facility ◽  
Stroke Care ◽  
Stroke Survivor ◽  
Structured Interviews ◽  
Skilled Nursing ◽  
Swallowing Problems

Background: At least 30% of stroke survivors (SSs) are readmitted in the first year after stroke. By identifying factors that lead to readmission, we can develop meaningful quality indicators for post-stroke care that target ways to improve health and support the SSs ability to manage at home. Objectives were to: i) estimate readmission rate in a cohort of older SSs at 1 and 6 months after stroke, ii) identify reasons for readmission, and iii) describe the experience of readmission from the perspective of the SS and family caregiver (CG). Methods: This mixed-methods study was undertaken utilizing electronic medical records to track readmissions and qualitative interviews were conducted with SSs and CGs. Older adults (≥ 60 years) with stroke admitted to two hospital systems were enrolled in the cohort and followed for 6 months to capture readmissions. A sample of SSs and CGs were interviewed following readmission to gain their perspective related to discharge after stroke and subsequent readmission. Results: Of the 310 included in the cohort (mean age 76 years, SD 9.8), 10% died prior to discharge. Within one month 10% were readmitted and 25% within 6 months. The main reasons for readmission were recurrent stroke/TIA (19%), pneumonia and urinary tract infection (19%), swallowing problems and dehydration (9%), and cardiac causes (7%). Discharge to a skilled nursing facility (p=.007) and higher Rankin score on discharge (p=.002) were associated with readmission. Semi-structured interviews conducted with 20 SSs and CGs revealed the following themes related to discharge and readmission: discharge preparation that includes their social and cultural context; need for anticipatory guidance on what to expect when home; support for self-management in the community; knowing when to request help; follow-up in the community that could lead to early identification of problems; complexity of medication management; and importance of social support. Conclusions: The perspective of the SS and CG is critical in identifying potential avenues for intervention, aimed at reducing preventable readmissions. Interventions aimed at the transition between hospital and skilled nursing facilities may reduce readmissions.

scholarly journals A Digital Innovation for the Personalized Management of Adherence: Analysis of Strengths, Weaknesses, Opportunities, and Threats

2020 ◽  
Vol 2 ◽  
Author(s):  
Anna-Elisa Hein ◽  
Bernard Vrijens ◽  
Mickael Hiligsmann
Keyword(s):  
Clinical Practice ◽  
Personalized Medicine ◽  
Health Systems ◽  
Swot Analysis ◽  
Digital Health ◽  
Qualitative Interviews ◽  
Medication Management ◽  
Data Generation ◽  
Structured Interviews ◽  
Personalized Management

Introduction: Personalized medicine and management of adherence are potential solutions for the suboptimal use of medicines. Digital medication management innovations currently under development combine both aspects. This research aims to investigate facilitators for and barriers to the translation of digital innovations for personalized medicine and adherence management into clinical practice from the policymaker and regulator perspective.Methods: A mixed-method study was used combining a scoping review to identify main interests, semi-structured interviews (n = 5) with representatives of European health policymaking and regulatory organizations, and a supplementary literature review to investigate key subthemes. The SWOT analysis was used for the qualitative analysis.Results: The literature reviews and the qualitative interviews suggested that digital solutions can facilitate the personalized management of medications and improve quality and safety, especially as the openness for digital health solutions is increasing. Digital solutions may, on the other hand, add complexity to the treatment, which can be perceived as a potential barrier for their uptake. As more multidisciplinary and participative structures are emerging, digital solutions can promote the implementation of new services. Nevertheless, change progresses slowly in the task-oriented structures of health systems. Integration of digital solutions depends on all stakeholders' willingness and abilities to co-create this change. Patients have different capabilities to self-manage their medical conditions and use digital solutions. Personalization of digital health solutions and integration in existing service structures are crucial to ensure equality among population segments. Developments in the digital infrastructure, although they are partly slow and not well-aligned, enable the implementation of innovations in clinical practice leading to further advances in data generation and usage for future innovations.Discussion: This study suggests that digital solutions have the potential to facilitate high-quality medication management and improve adherence to medications, enable new service structures, and are essential to drive further innovations in health care. Nevertheless, increasing the self-responsibility of patients can have undesirable effects on health outcomes, especially within vulnerable population segments. Digital health solutions can be an opportunity to optimize the use of medicines and thus their efficiency. Well-conceived development and implementation processes are needed to also realize improvements in equality and solidarity within health systems.

Self-Medication Management in a Rehabilitation Setting: A Case Study

2021 ◽  
Vol 36 (3) ◽  
pp. 147-151
Author(s):  
Brittany A. Tomlin ◽  
Jennifer M. Roelker ◽  
Taylor Welch ◽  
Pharmd Candidate
Keyword(s):  
Staff Member ◽  
Medication Management ◽  
Skilled Nursing Facility ◽  
Nursing Facilities ◽  
Nursing Administration ◽  
Self Medication ◽  
Nursing Facility ◽  
Medication Knowledge ◽  
Skilled Nursing

Skilled nursing facilities are beginning to introduce Self-Medication Programs (SMP), in which patients meet with a staff member and learn how to manage their own medications throughout their rehabilitation stay. This program allows for patients to keep their medications in their room and take them on their own without direct nursing administration. In the process, it is the goal for patients to regain independence for their medical care prior to discharge from a skilled nursing facility with an outcome of increased adherence and medication knowledge. Herein we describe a veteran, 57 years of age, who participated in the Cincinnati VA SMP in order to regain his independence poststroke.

Abstract WP298: Feasibility of a Large-Scale Teleneurology Network for Thrombolysis Administration in a Heterogeneous Multihospital Population

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Johanna L Morton ◽  
Diamond K Northington ◽  
B. Tilman Jolly
Keyword(s):  
Medical Records ◽  
Large Scale ◽  
Skilled Nursing Facility ◽  
Standard Of Care ◽  
Stroke Care ◽  
Outcome Analysis ◽  
Acute Stroke Care ◽  
Skilled Nursing ◽  
Discharge Data ◽  
Nihss Score

Background: Administration of alteplase is the standard of care for eligible patients presenting with symptoms of acute ischemic stroke (AIS). Telemedicine is increasingly being used to deliver acute stroke care to patients without in-person access to stroke expertise. This study reviews the thrombolysis experience of the largest known teleneurology network spanning 39 states and distributed across a heterogeneous multihospital population throughout the nation. Methods: Data was abstracted from internal medical records systems and relevant medical records obtained from partner hospitals. A retrospective analysis on the prospectively maintained database of patients who have received alteplase was performed. Data was collected from December 1, 2015 to May 31, 2019. Outcome analysis was restricted to those patients with available complete discharge data. Results: The analysis revealed 8,399 patients as having received alteplase during the study period. Of these, 56.7% had discharge information available. The mean patient age was 68.5 years, with a mean age of 70.5 years for females and 66.5 years for males. The median initial NIHSS score was 7, with 31.2% of patients presenting with an initial NIHSS score ≤4, and 8.7% presenting with an initial NIHSS score ≥21. The transfer rate to another facility was 31.0%. There were 2,417 home discharges (48.2%), 1,057 acute rehabilitation discharges (21.1%), and 478 skilled nursing facility discharges (9.5%). There were 28 patients who left against medical advice (0.6%). The symptomatic hemorrhage rate in this population was 1.1% (92), and there were 234 patient deaths (4.7%). Conclusion: A large-scale teleneurology platform for the emergent treatment of patients presenting with AIS symptoms is both safe and feasible. Due to the heterogeneity of this patient and hospital population, higher level refinement of this analysis to include hyperacute metrics, transfer data, and more comprehensive clinical and functional outcomes is warranted.

Abstract P52: Absence of Dysphagia is a Stronger Predictor of Favorable Discharge Disposition than Stroke Severity: Insights from the UTHSC Houston Stroke Registry

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Nneka I Jones ◽  
Nusrat Harun ◽  
Elizabeth Noser ◽  
James Grotta
Keyword(s):  
Skilled Nursing Facility ◽  
Inpatient Rehabilitation ◽  
Stroke Care ◽  
Level Of Care ◽  
Stroke Severity ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Stroke Registry ◽  
Post Stroke ◽  
Discharge Disposition

Introduction: Dysphagia is one of the most common post-stroke complications. The use of feeding tubes to provide nutrition requires increased acuity of care for management, which affects costs. This care is provided at all levels, including Inpatient Rehabilitation (IR), Skilled Nursing Facility (SNF) or Sub-acute (Sub). There are limited studies of the role of dysphagia as a predictor of post-stroke disposition. Hypothesis: Low NIHSS is a predictor of higher function. We assessed the hypothesis that the absence of tube feeds as an indicator of dysphagia is a predictor of post-stroke disposition to a similar functional level. Methods: All patients admitted to the UT Stroke Service between January 2004 and October 2009 were included. Stratification occurred for age >65, NIHSS and stroke risk factors. Using multivariate logistic regression, the data was analyzed to determine if differences in post-stroke disposition were present among patients not receiving tube feeds as an indicator of dysphagia. Results: Home vs. Other Level of Care Of 3389 patients, 1668 were discharged home, 1721 to another level of care. Patients without tube feeds are 14.6 times more likely to be discharged home (P = <.0001, OR 14.66, 95% CI 8.05 to 26.69) Patients with NIHSS < 8 are 10.9 times more likely to be discharged home. IR vs. SNF Of 1546 patients, 983 were discharged to acute IR, 563 to SNF. Patients without tube feeds are 6.1 times more likely to be discharged to IR (P = <.0001, OR 6.118, 95% CI 4.34 to 8.63). Patients with NIHSS < 8 are 2.5 times more likely to be discharged to IR. SNF vs. Sub Of 738 patients, 563 were discharged to SNF, 175 to Sub. Patients without tube feeds are 3 times more likely to be discharged to SNF (P = <.0001, OR 2.999, 95% CI 2.048 to 4.390). Patients with NIHSS < 8 are 2 times more likely to be discharged to SNF. Conclusions: The absence of tube feeds as an indicator of dysphagia is a predictor of improved post-stroke disposition, with a correlation stronger than NIHSS. This study is limited by its retrospective nature and unmeasured psychosocial factors related to discharge. Prospective studies should focus on early diagnosis, therapeutic intervention and caregiver involvement in dysphagia education to improve outcomes and decrease the cost of post-stroke care.

scholarly journals Evaluating the Experience of Organizations Implementing Medication Management Services Using a Variety of Implementation Strategies

2021 ◽  
Vol 12 (1) ◽  
pp. 12
Author(s):  
Deborah L. Pestka ◽  
Todd D. Sorensen
Keyword(s):  
Qualitative Interviews ◽  
Medication Management ◽  
Implementation Strategies ◽  
Structured Interviews ◽  
Learning Collaborative ◽  
Management Learning ◽  
Evaluation Approach ◽  
Key Stakeholders ◽  
Learning Collaboratives ◽  
Management Services

Purpose: The purpose of this project was to evaluate the experience of organizations who participated in a medication management learning collaborative and their perceptions of the different implementation strategies that were employed. Methods: Using a utilization-focused evaluation approach, qualitative interviews were conducted with former participants (clinicians, managers, or other key stakeholders) of medication management learning collaboratives organized and delivered by Alliance for Integrated Medication Management (AIMM). The purpose of the learning collaboratives was to provide structure and facilitation to accelerate the implementation of medication management services. One-on-one semi-structured interviews were carried out with a lead member of 11 different organizations that participated in an AIMM collaborative about their experience in the collaborative and the different implementation strategies that were used. Results: Three themes emerged: (1) perspectives on the implementation strategies, (2) external facilitators, and (3) additional benefits of being in the collaborative. Certain implementation strategies used by AIMM, such as coaching, were considered beneficial by almost everyone while other strategies, such as webinars, had mixed opinions. Participants also highlighted the importance of external facilitators, like dedicated time to work on implementation strategies, as well as the additional benefits like the professional development that comes from being in a learning collaborative and learning different implementation strategies. Conclusion: Implementation strategies may help accelerate the adoption and expansion of medication management services within and across organizations. The results of this evaluation shed light on the experiences of different organizations using select implementation strategies in their medication management implementation efforts. The perspectives of participants in this study may help other organizations in selecting and developing similar implementation strategies.

Strengthening Resident, Proxy, and Staff Engagement in Injury Prevention in Skilled Nursing Facilities

2021 ◽  
Author(s):  
Tingzhong Michelle Xue ◽  
Cathleen S Colón-Emeric ◽  
Laurie Herndon ◽  
Emily J Hecker ◽  
Sarah D Berry ◽  
...  
Keyword(s):  
Injury Prevention ◽  
Skilled Nursing Facility ◽  
Interdisciplinary Teams ◽  
Nursing Assistants ◽  
Time Constraints ◽  
Active Listening ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Open Communication ◽  
Skilled Nursing

Abstract Background and Objectives Engaging residents, their proxies, and skilled nursing facility (SNF) staff through effective communication has potential for improving fall-related injury prevention. The purpose of this study was to understand how multiple stakeholders develop and communicate fall-related injury prevention plans to enhance sustained implementation. Research Design and Methods Descriptive qualitative study using framework analysis applied to open-ended semi-structured interviews (n=28) regarding experiences of communication regarding fall-related injury prevention, guided by the Patient and Family Engaged Care framework. Participants included residents at high risk of injury and their proxies, nursing assistants, nurses, and a nurse practitioner from three SNFs in the Eastern U.S. (Massachusetts and North Carolina). Results Interdisciplinary teams were viewed as essential for injury prevention. However, the roles of the interdisciplinary team members were sometimes unclear. Communication structures were often hierarchical, which reduced engagement of nursing assistants and frustrated proxies. Practices that enhanced engagement included knowing the residents, active listening skills, and use of strategies for respecting autonomy. Engagement was inhibited by time constraints, lack of proactive communication among staff, and by challenges eliciting the perspectives of residents with dementia. Resident barriers included desire for autonomy, strong preferences, and language differences. Discussion and Implications Strengthening team meeting processes and cultivating open communication and collaboration could facilitate staff, resident, and proxy engagement in injury prevention planning and implementation. Skill building and targeting resources to improve communication can address barriers related to staff practices, resident characteristics, and time constraints.

A Retrospective Review of Patients With Acute Stroke With and Without Palliative Care Consultations

2018 ◽  
Vol 36 (1) ◽  
pp. 60-64 ◽  
Author(s):  
Molly T. Williams ◽  
Eli Zimmerman ◽  
Megan Barry ◽  
Lindsay Trantum ◽  
Mary S. Dietrich ◽  
...  
Keyword(s):  
Palliative Care ◽  
Skilled Nursing Facility ◽  
Stroke Care ◽  
Future Research ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Patient Demographics ◽  
Significant Disability ◽  
Future Events ◽  
Stroke Type

Despite advances in stroke care, patients continue to incur significant disability, are at risk for future events, and are inconsistently comanaged with palliative care (PC) specialty teams. The purpose of this study was to review patients with stroke admitted to our institution, comparing patients with and without PC consultation. We retrospectively reviewed medical record data of all patients with stroke admitted to our neurosciences ICU (NICU) in July 2014 to June 2015 with and without PC consultation. Review focused on stroke type, patient demographics, median days to discharge and death, and posthospitalization discharge. Of 463 patients admitted to the NICU with a stroke diagnosis, 27% (125/463) had (PC) consultation. A higher percentage of the patients with PC consult presented with hemorrhagic stroke than those without PC consult (38% vs 21%, P < .001). Patients with PC consult had longer median days to discharge and death ( P < .001) and a higher percentage of mortality (32% vs 11%). Of the 301 patients without PC consult who discharged (89.1%), 36.5% discharged to inpatient rehab while 10% discharged to a skilled nursing facility. In comparison, of the patients with PC consultation who discharged alive (41.1%), 15.7% discharged to inpatient rehab whereas 39% discharged to skilled nursing ( P < .001). The uncertainty of which patients with stroke benefit most from specialty PC is highlighted in that although sicker patients are referred to PC, a substantial portion (41%) of these patients discharge alive, of which 39.2% discharged to skilled nursing. Future research should focus on which patients with stroke would benefit from specialty PC.

Pharmacist-led program to improve transitions from acute care to skilled nursing facility care

2020 ◽  
Vol 77 (12) ◽  
pp. 979-984
Author(s):  
Maria Achilleos ◽  
Jordan McEwen ◽  
Megan Hoesly ◽  
Mark DeAngelo ◽  
Tim Jennings
Keyword(s):  
Acute Care ◽  
Readmission Rate ◽  
Medication Management ◽  
Skilled Nursing Facility ◽  
Medication Administration ◽  
Pilot Program ◽  
Order Entry ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Transferred Patients

Abstract Purpose A pharmacist-led process to improve medication management in transitions from acute care to skilled nursing facility (SNF) care is described. Summary The process of transitioning patients from an acute care facility to a SNF involves multiple steps, with the potential for delays in medication administration. As part of a health system’s effort to evaluate barriers to timely first-dose administration after hospital-to-SNF transfers, a multidisciplinary team was tasked with defining the frequency of missed doses of high-risk medications and identifying reasons for medication administration delays. A retrospective review was conducted to evaluate medication orders for patients discharged from a community hospital and admitted to a SNF from January through June 2017 (the baseline period). This review found that 60% of first doses of high-risk medications were given after the scheduled administration time. One major barrier identified was a delay in entering medication orders in the SNF electronic medical record after SNF admission. It was also observed that 30-day readmission rates for transferred patients exceeded established readmission rate targets. To address identified process barriers, a pharmacist-led pilot program was developed. The program focused on process improvements at the same 2 hospitals and SNF sites during the period of March through May 2018. The pharmacist reviewed, reconciled, and entered medication orders prior to patient arrivals to the SNF. After pharmacist implementation, order entry delays were eliminated, and the mean delay from medication due time to administration was decreased by 68% relative to baseline data. The discharge summaries of 51% of transferred patients were found to contain medication errors, most of which were clarified and resolved prior to SNF admission. It was observed that the 30-day all-cause readmission rate after SNF transfers during the pilot program was 10.4% lower than during the same timeframe of the previous year. Conclusion By implementing a pharmacist-led process for medication management in transitions from acute care to SNF care, major barriers such as delayed medication administration and medication order entry were reduced. In addition, discharge medication errors were addressed and resolved prior to patients’ admission to the SNF.

scholarly journals P.065 Physician Approaches to Anti-thrombotic Therapies for Acutely Symptomatic Carotid Stenosis: Insights from the Hot Carotid Qualitative Study

2021 ◽  
Vol 48 (s3) ◽  
pp. S37-S37
Author(s):  
B Beland ◽  
A Ganesh ◽  
G Jewett ◽  
DJ Campbell ◽  
M Varma ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Antiplatelet Therapy ◽  
Qualitative Content Analysis ◽  
Recurrent Stroke ◽  
Stroke Care ◽  
Plaque Morphology ◽  
Structured Interviews ◽  
Carotid Disease ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

Background: Whereas the beneficial effect of antiplatelet therapy for recurrent stroke prevention is well-established, uncertainties remain regarding the optimal anti-thrombotic regimen for acutely symptomatic carotid stenosis (“hot carotid”), particularly as patients await revascularization. We sought to explore the approaches of stroke physicians to peri-procedural anti-thrombotic management of patients with “hot carotids”. Methods: We conducted semi-structured interviews regarding “hot carotid” management with purposive sampling of 20 stroke physicians from 14 centres in North America, Europe, Asia, and Australia. We identified key themes using conventional qualitative content analysis. Results: Important themes revealed from our discussion included limitations of existing clinical trial evidence, competing surgeon versus neurologist/internist preferences, and single vs dual antiplatelet therapy (DAPT) while awaiting revascularization. Areas of uncertainty included the management of stroke while on aspirin, implications of non-stenotic features of carotid disease (intraluminal thrombus, plaque morphology), the role of newer anti-platelet agents or anticoagulants, platelet aggregation testing, and how soon to start DAPT. Conclusions: Our qualitative analysis revealed themes that were important to stakeholders in stroke care. Teams designing international trials will have to accommodate identified variations in anti-thrombotic practice patterns and take into consideration areas of uncertainty, such as newer anti-thrombotic agents, and the implication of non-stenotic features of carotid disease.

Sign in / Sign up

Export Citation Format

Share Document