scholarly journals Towards a patient journey perspective on causes of unplanned readmissions using a classification framework: results of a systematic review with narrative synthesis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
R. G. Singotani ◽  
F. Karapinar ◽  
C. Brouwers ◽  
C. Wagner ◽  
M. C. de Bruijne
Keyword(s):  
Integrated Care ◽  
Hospital Readmissions ◽  
Self Management ◽  
Complex Nature ◽  
Analysis Tool ◽  
Care Organization ◽  
Patient Journey ◽  
Hospital Department ◽  
Classification Framework ◽  
Insight Into

Abstract Background Several literature reviews have been published focusing on the prevalence and/or preventability of hospital readmissions. To our knowledge, none focused on the different causes which have been used to evaluate the preventability of readmissions. Insight into the range of causes is crucial to understand the complex nature of readmissions. With this review we aim to: 1) evaluate the range of causes of unplanned readmissions in a patient journey, and 2) present a cause classification framework that can support future readmission studies. Methods A literature search was conducted in PUBMED and EMBASE using “readmission” and “avoidability” or “preventability” as key terms. Studies that specified causes of unplanned readmissions were included. The causes were classified into eight preliminary root causes: Technical, Organization (integrated care), Organization (hospital department level), Human (care provider), Human (informal caregiver), Patient (self-management), Patient (disease), and Other. The root causes were based on expert opinions and the root cause analysis tool of PRISMA (Prevention and Recovery Information System for Monitoring and Analysis). The range of different causes were analyzed using Microsoft Excel. Results Forty-five studies that reported 381 causes of readmissions were included. All studies reported causes related to organization of care at the hospital department level. These causes were often reported as preventable. Twenty-two studies included causes related to patient’s self-management and 19 studies reported causes related to patient’s disease. Studies differed in which causes were seen as preventable or unpreventable. None reported causes related to technical failures and causes due to integrated care issues were reported in 18 studies. Conclusions This review showed that causes for readmissions were mainly evaluated from a hospital perspective. However, causes beyond the scope of the hospital can also play a major role in unplanned readmissions. Opinions regarding preventability seem to depend on contextual factors of the readmission. This study presents a cause classification framework that could help future readmission studies to gain insight into a broad range of causes for readmissions in a patient journey. In conclusion, we aimed to: 1) evaluate the range of causes for unplanned readmissions, and 2) present a cause classification framework for causes related to readmissions.

scholarly journals Patient-led use of patient-reported outcome measure in self-Management of a Rotator Cuff Injury

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Maria J. Santana ◽  
Darrell J. Tomkins
Keyword(s):  
Rotator Cuff ◽  
Healthcare Providers ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Self Management ◽  
Care Organization ◽  
Surgical Interventions ◽  
Patient Reported ◽  
Rotator Cuff Injury ◽  
Dash Questionnaire

Abstract Introduction The patient is the person who experiences both the processes and the outcomes of care. Information held by the patient is vital for clinical and self-management, improving health outcomes, delivery of care, organization of health systems, and formulation of health policies. Patient-reported outcome measures (PROMs) play an important role in supporting patient’s self-management. This narrative describes a patient-led use of a PROM to self-manage after a rotator cuff injury. Methods This is a narrative of a patient who tore the supraspinatus tendon in her right shoulder in an accident. The Disabilities of the Arm, Shoulder and Hand, the DASH questionnaire, was used to monitor and self-manage recovery after the accident. The DASH questionnaire is a self-reported questionnaire that measures the difficulty in performing upper extremity activities and pain in the arm, shoulder or hand. It has been widely used in research studies, but here the patient initiated its use for self-management while waiting for and after rotator cuff surgery. The patient created separate sub-scale scores for function and for pain to answer questions from healthcare providers about her recovery. Results There was noticeable improvement over 3 months of conservative treatment, from a high level of disability of 56 to 39 (score changed 17); however, the scores were nowhere near the general population normative score of 10.1. Surgery improved the score from 39 pre-surgery to 28. Post-surgical interventions included physiotherapy, pain management and platelet-riched plasma treatment (PRP). The score was 14 4 weeks post-PRP. Conclusions The patient found the DASH useful in monitoring recovery from a rotator cuff injury (before and after surgery). The DASH contributed to communication with healthcare professionals and supported the clinical management. The DASH questionnaire was able to capture the patient’s experience with the injury and surgical recovery, corroborating an improvement in function while there was persistent post-surgical pain.

scholarly journals Systematic Observation of Corner Kick Strategies in Portuguese Football Players

2022 ◽  
Vol 14 (2) ◽  
pp. 896
Author(s):  
Vítor Gouveia ◽  
João P. Duarte ◽  
Hugo Sarmento ◽  
José Freitas ◽  
Ricardo Rebelo-Gonçalves ◽  
...  
Keyword(s):  
Football Players ◽  
Analysis Tool ◽  
Systematic Observation ◽  
Notational Analysis ◽  
Team Success ◽  
Determining Factors ◽  
Insight Into

Set pieces are important for the success of football teams, with the corner kick being one of the most game defining events. The aim of this research was twofold: (1) to analyze the corner kicks of a senior football amateur team, and (2) to compare the corner kicks of successful and unsuccessful teams (of the 2020/21 sporting season). In total, 500 corners were observed using a bespoke notational analysis tool, using a specific observational instrument tool (8 criteria; 25 categories). Out of the 500 corner kicks, 6% resulted in a goal. A greater number of direct corners using inswing trajectories were performed (n = 54%). Corners were delivered to central and front post areas most frequently (n = 79%). Five attackers were most predominantly used for offensive corners (n = 58%), but defenders won the ball more frequently (n = 44%). Attempts at goal occurred following a corner most commonly from outside of the box (n = 7%). Goals were scored most frequently with the foot (n = 16%) and head (n = 15%). Successful teams are more effective at reaching the attackers and score more goals directly from corners. Unsuccessful teams deliver more corner kicks out of play, the first touch is more frequently from the opposition defenders, and fewe goals are scored from corner kicks. The study provides an insight into the determining factors and patterns that influence corner kicks and success in football matches. This information should be used by coaches to prepare teams for both offensive and defensive corner kicks to increase team success and match outcomes.

scholarly journals Twitter content classification

First Monday ◽  
2010 ◽  
Author(s):  
Stephen Dann
Keyword(s):  
Grounded Theory ◽  
Real World ◽  
Classification Scheme ◽  
Theory Analysis ◽  
The Real ◽  
Real World Application ◽  
Classification Framework ◽  
Content Classification ◽  
Insight Into

This paper delivers a new Twitter content classification framework based sixteen existing Twitter studies and a grounded theory analysis of a personal Twitter history. It expands the existing understanding of Twitter as a multifunction tool for personal, profession, commercial and phatic communications with a split level classification scheme that offers broad categorization and specific sub categories for deeper insight into the real world application of the service.

ChunkSim

2010 ◽  
pp. 131-149
Author(s):  
Pedro Furtado
Keyword(s):  
Performance Analysis ◽  
Simulation Analysis ◽  
System Size ◽  
Analysis Tool ◽  
Data Allocation ◽  
Data Warehouses ◽  
Availability Analysis ◽  
On Demand ◽  
Self Tuning ◽  
Insight Into

Self-tuning physical database organization involves tools that determine automatically the best solution concerning partitioning, placement, creation and tuning of auxiliary structures (e.g. indexes), based on the workload. To the best of our knowledge, no tool has focused on a relevant issue in parallel databases and in particular data warehouses running on common off-the-shelf hardware in a sharednothing configuration: determining the adequate tradeoff for balancing load and availability with costs (storage and loading costs). In previous work, we argued that effective load and availability balancing over partitioned datasets can be obtained through chunk-wise placement and replication, together with on-demand processing. In this work, we propose ChunkSim, a simulator for system size planning, performance analysis against replication degree and availability analysis. We apply the tool to illustrate the kind of results that can be obtained by it. The whole discussion in the chapter provides very important insight into data allocation and query processing over shared-nothing data warehouses and how a good simulation analysis tool can be built to predict and analyze actual systems and intended deployments.

Increasing adherence in therapies and polypharmacy in Europe: EIP on AHA Action Group A1 activities toward integrated care information systems and self-management applications

2016 ◽  
Vol 2 (4) ◽  
pp. 144
Author(s):  
Homer Papadopoulos ◽  
Anna Giardini ◽  
Elisio Costa ◽  
Alessandro Monaco ◽  
Alpana Mair ◽  
...  
Keyword(s):  
Information Systems ◽  
Integrated Care ◽  
Self Management ◽  
Action Group ◽  
Eip On Aha ◽  
Care Information

scholarly journals User-participatory development of FindMyApps; a tool to help people with mild dementia find supportive apps for self-management and meaningful activities

2019 ◽  
Vol 5 ◽  
pp. 205520761882294 ◽  
Author(s):  
Yvonne Kerkhof ◽  
Myrna Pelgrum-Keurhorst ◽  
Floriana Mangiaracina ◽  
Ad Bergsma ◽  
Guus Vrauwdeunt ◽  
...  
Keyword(s):  
Feasibility Study ◽  
Participatory Design ◽  
Participatory Development ◽  
Self Management ◽  
User Friendliness ◽  
Mild Dementia ◽  
Selection Tool ◽  
Navigation Support ◽  
Informal Carers ◽  
Insight Into

Objective There is growing evidence that hand-held touchscreen devices (tablets) can support people with mild dementia to manage their life and engage in meaningful activities. However, as it can be difficult to find apps that match one’s personal needs, wishes and abilities, a person-centred selection tool was developed, called FindMyApps. Method To ensure its usability, the FindMyApps selection tool was developed using a ‘user-participatory design’ in which users (persons with dementia and informal carers), and experts (designers, developers and researchers) closely collaborated. In three short iterative rounds – so called ‘sprints’ – the users were invited to test whether the prototypes harmonised with their needs, wishes and abilities. Results Each sprint provided insight into potential improvements of the tool. The development team gained an understanding of issues regarding usefulness (e.g. meaningful content of (sub)categories for apps in domains of self-management and meaningful activities), as well as issues to increase the user-friendliness (e.g. intuitive design with instructive navigation support). Conclusion The FindMyApps selection tool was conceived as a means to make it easier for people with mild dementia to select apps meeting their needs, wishes and abilities. This provisional end version will be further tested, and, if necessary, improved in a feasibility study.

scholarly journals The journey to total hip or knee replacement

2012 ◽  
Vol 36 (2) ◽  
pp. 130 ◽  
Author(s):  
Julie Lynette Walters ◽  
Shylie Mackintosh ◽  
Lorraine Sheppard
Keyword(s):  
Joint Replacement ◽  
Elective Surgery ◽  
Public Hospitals ◽  
Patient Journey ◽  
Total Hip ◽  
Joint Replacement Surgery ◽  
Replacement Surgery ◽  
Patient Pathway ◽  
Total Knee ◽  
Insight Into

Objectives. Despite the incidence of joint replacements in Australia, there is a paucity of information regarding how patients progress from their referral to their surgery. The aim of this study was to describe a patient pathway from referral to receipt of total hip replacement (THR) or total knee replacement (TKR) surgery in South Australian public hospitals. Methods. Patient perspectives of the pathway to THR and TKR surgery were obtained via a postal survey (n = 450) and hospital employee perspectives were attained via semi-structured interviews (n = 19). Survey data were analysed using descriptive statistics and interview data were analysed thematically. Results. A typical patient pathway to THR and TKR surgery can be divided into two distinct phases; referral-to-initial appointment (9–24 months), and initial appointment-to-surgery (12–15 months). This gives an overall waiting period between 2 and 3 years for THR or TKR surgery. Conclusions. Waiting times for THR and TKR surgery reported in this study were longer than other reports in the literature. Current Australian health policy does not consider the first (and longest) phase of the patient pathway. Excluding this initial phase could be generating an erroneous perception of the patient pathway to THR or TKR surgery, possibly leading to poorly considered health reforms. What is known about the topic? Meeting the demand for elective surgery services in public hospitals is an ongoing challenge for governments and health systems alike. The persistent mismatch between supply and demand has resulted in the development of waiting lists for elective total hip replacement (THR) and total knee (TKR) replacement surgery in Australia. Current state-level health policies such as the Policy Framework and Associated Procedural Guidelines for Elective Surgery Services in South Australia or the Elective Surgery Access Policy in Victoria, outline a generic pathway consisting of a few linear steps that occur immediately before receipt of surgery, without consideration of the early stages of the journey. Aside from these types of policies, we were unable to identify any published literature outlining the patient journey from referral to receipt of THR or TKR surgery. As such, our understanding of the issue is inadequate due the paucity of existing research evidence. What does this paper add? Our current understanding of the patient journey to THR and TKR surgery is limited to the perspective of the policy-makers, whose focus is the organisation of waiting lists and the systematic progression of an individual through the elective surgery system. This perspective reinforces the assumption that it is a simple, linear process and may lead to erroneous judgements regarding the impact that the patient pathway has on an individual and the time it takes to progress along that pathway. This study presents the patient pathway from the perspective of individuals working within the systems responsible for delivering THR and TKR surgery and from patients who have received a joint replacement in a South Australian public hospital. As such, this paper provides new insight into the length, impact and features of the entire patient journey, rather than a snap-shot of the final stages. What are the implications for practitioners? This study is the first step towards better understanding of the patient pathway to joint replacement surgery in Australian public hospitals. Greater understanding of the complete pathway and identification of areas of congestion within the pathway, as evidenced by longer waiting periods, offers insight into areas with the potential for effective reforms. Should the patient pathway be significantly altered, the experience of practitioners responsible for the interim and postoperative management of patients undergoing THR and TKR surgery will also be changed. Additionally, practitioners currently frustrated by the long delays experienced by their patients who are in need of elective surgery in Australian public hospitals, could have that frustration abated by system improvements that reduce the length and complexity of the pathway to joint replacement surgery.

scholarly journals Living With the Burden of Pseudobulbar Affect: A Qualitative Analysis of the Effects of Education on Patient Experience

2020 ◽  
Vol 7 (6) ◽  
pp. 1324-1330 ◽  
Author(s):  
Wendy Turell ◽  
Anne Roc ◽  
Erik Pioro ◽  
Alexandra Howson
Keyword(s):  
Neurological Diseases ◽  
Qualitative Interviews ◽  
Virtual Education ◽  
Self Management ◽  
Effective Mechanism ◽  
Pseudobulbar Affect ◽  
Neurological Conditions ◽  
The Impact ◽  
Education Symposium ◽  
Insight Into

Pseudobulbar affect (PBA) is associated with several neurological diseases and is underrecognized in clinical practice; however, PBA symptoms are often attributed to psychiatric or mood disorders rather than to neurological etiology. Until recently, there were no US Food and Drug Administration therapies approved for treating this condition, and there are currently few resources to support patients in the recognition and self-management of PBA symptoms. We evaluated the impact of a virtual education symposium on patient knowledge and self-efficacy via qualitative interviews. This evaluation of education impact provides unique insight into the experience of managing PBA symptoms; suggests that there is extensive need for educational resources to support patients with PBA and enable them to engage effectively with their providers; and affirms that online learning is an effective mechanism for delivering education to patients that enables them to more effectively self-manage symptoms in the context of chronic neurological conditions such as PBA.

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