Impact of Acute Self-Care Indicators and Social Factors on Medicare Inpatient Readmission Risk

2021 ◽  
Vol 76 (1) ◽  
Author(s):  
Jessica Edelstein ◽  
Addie Middleton ◽  
Rebekah Walker ◽  
Timothy Reistetter ◽  
Stacey Reynolds
Keyword(s):  
Social Support ◽  
Occupational Therapy ◽  
Acute Care ◽  
Social Factors ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Self Care ◽  
Housing Situation ◽  
Cross Sectional

Importance: Readmissions are costly for Medicare and are associated with poor patient outcomes. Objective: To determine whether two domains relevant to acute occupational therapy practice—self-care status and social factors—were associated with readmissions for Medicare patients in the Medicare Hospital Readmissions Reduction Program (HRRP). Design: Cross-sectional, retrospective study. Setting: Single academic medical center. Participants: Medicare inpatients with a diagnosis included in the HRRP (N = 17,618). Outcomes and Measures: Three logistic regression models were estimated to examine the associations among (1) self-care status and 30-day readmission, (2) social support and 30-day readmission, and (3) housing situation and 30-day readmission. Subgroup analyses were conducted for the individual HRRP diagnoses. Results: No associations were found between acute self-care status, social support, or housing situation and 30-day readmission when all HRRP diagnoses were examined together. However, higher levels of independence with self-care were significantly associated with reduced odds of readmission for patients with pneumonia. Conclusions and Relevance: The findings for patients with pneumonia are consistent with those of other studies done in the acute care setting. Deficiencies in acute occupational therapy documentation may have affected the findings for the other HRRP diagnoses. What This Article Adds: This study is the first to examine the association between acute self-care status (as documented by acute care occupational therapy practitioners) and readmission.

Higher Frequency of Acute Occupational Therapy Services Is Associated With Reduced Hospital Readmissions

2021 ◽  
Vol 76 (1) ◽  
Author(s):  
Jessica Edelstein ◽  
Rebekah Walker ◽  
Addie Middleton ◽  
Timothy Reistetter ◽  
Kelli Williams Gary ◽  
...  
Keyword(s):  
Occupational Therapy ◽  
Service Delivery ◽  
Patient Outcomes ◽  
Academic Medical Center ◽  
Hospital Readmissions ◽  
Self Care ◽  
Lower Odds ◽  
Therapy Services ◽  
Care Training ◽  
Therapy Service

Importance: Hospital readmissions are associated with poor patient outcomes, including higher risk for mortality, nutritional concerns, deconditioning, and higher costs. Objective: To evaluate how acute occupational therapy service delivery factors affect readmission risk. Design: Cross-sectional, retrospective study. Setting: Single academic medical center. Participants: Medicare inpatients with a diagnosis included in the Hospital Readmissions Reduction Program (HRRP; N = 17,618). Data were collected from medical records at a large urban hospital in southeastern Wisconsin. Outcomes and Measures: Logistic regression models were estimated to examine the association between acute occupational therapy service delivery factors and odds of readmission. In addition, the types of acute occupational therapy services for readmitted versus not-readmitted patients were compared. Results: Patients had significantly higher odds of readmission if they received occupational therapy services while hospitalized (odds ratio [OR] = 1.18, 95% confidence interval [CI] [1.07, 1.31]). However, patshients who received acute occupational therapy services had significantly lower odds of readmission if they received a higher frequency (OR = 0.99, 95% CI [0.99,1.00]) of acute occupational therapy services. A significantly higher proportion of patients who were not readmitted, compared with patients who were readmitted, received activities of daily living (ADL) or self-care training (p < .01). Conclusions and Relevance: For patients with HRRP-qualifying diagnoses who received acute occupational therapy services, higher frequency of acute occupational therapy services was linked with lower odds of readmission. Readmitted patients were less likely to have received ADL or self-care training while hospitalized. What This Article Adds: Identifying factors of acute occupational therapy services that reduce the odds of readmission for Medicare patients may help to improve patient outcomes and further define occupational therapy’s role in the U.S. quality-focused health care system.

Self-Care Practices Among Adult Type 2 Diabetes Patients With and Without Peripheral Neuropathy: A Cross-Sectional Study at Tertiary Healthcare Settings in Ethiopia

2021 ◽  
pp. 084456212110206
Author(s):  
Mezgebu Gode ◽  
Fekadu Aga ◽  
Aklil Hailu
Keyword(s):  
Social Support ◽  
Peripheral Neuropathy ◽  
Self Care ◽  
Cross Sectional Study ◽  
Care Practice ◽  
Cross Sectional ◽  
Glucose Testing ◽  
Blood Glucose Testing ◽  
Care Practices

Background Type 2 diabetes mellitus (T2D) has become a global health challenge. Diabetic peripheral neuropathy (DPN) is one of the common comorbidities of T2D that may affect the ability to perform diabetes self-care. Purpose To compare self-care practices between adult T2D patients with and without comorbid DPN and identify factors predicting self-care practices. Methods In this cross-sectional study, conducted at tertiary hospitals in Ethiopia, a total of 216 (108 with DNP and 108 without DNP) participants completed an interviewer-administered questionnaire including measures of diabetes self-care practices, self-evaluated peripheral neuropathy, self-efficacy, diabetes knowledge, and social support. Results Adult T2D patients with comorbid DPN had lower dietary (P< 0.001), exercise (P< 0.001), blood glucose testing (P = 0.001), and foot (P = 0.007) self-care practice than those without DPN. Social support is a significant predictor of dietary self-care in both groups while predicting foot self-care and blood glucose testing in those with comorbid DPN. Moreover, occupation, education, and having a glucometer are significant predictors of diabetes self-care practice in both groups. Conclusion This study found that adult T2D patients with comorbid DPN have poorer diabetes self-care practice than those without comorbid DPN. Interventions should focus on addressing social support and access to a glucometer in order to improve diabetes self-care practices in adult T2D patients with comorbid DPN.

Accessibility and Openness to Diabetes Management Support via Mobile Phones: A Survey of People with Type 1 Diabetes Using Advanced Diabetes Technologies (Preprint)

2022 ◽  
Author(s):  
Yu Kuei Lin ◽  
Caroline Richardson ◽  
Iulia Dobrin ◽  
Rodica Pop-Busui ◽  
Gretchen Piatt ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Interactive Voice Response ◽  
Medical Center ◽  
Academic Medical Center ◽  
Text Messages ◽  
Management Support ◽  
Cross Sectional Survey ◽  
Cross Sectional

BACKGROUND Little is known about the feasibility of mobile health (mHealth) support among people with type 1 diabetes (T1D) using advanced diabetes technologies including continuous glucose monitors (CGMs) and hybrid closed-loop insulin pumps (HCLs). OBJECTIVE To evaluate patient access and openness to receiving mHealth diabetes support in people with T1D using CGMs/HCLs. METHODS We conducted a cross-sectional survey among T1D patients using CGMs or HCLs managed in an academic medical center. Participants reported information regarding their mobile device usage, cellular call/text message/internet connectivity, and openness to various channels of mHealth communication (smartphone applications or “apps”, text messages, and interactive voice response calls or IVR calls). Participants’ demographic characteristics and CGM data were collected from medical records. Analyses focused on differences in openness to mHealth and mHealth communication channels across groups defined by demographic variables and measures of glycemic control. RESULTS Among all participants (n=310; 64% female; mean age: 45 (SD:16)), 98% reported active cellphone use, and 80% were receptive to receiving mHealth support to improve glucose control. Among participants receptive to mHealth support, 98% were willing to share CGM glucose data for mHealth diabetes self-care assistance. Most (71%) were open to receiving messages via apps, 56% were open to text messages, and 12% were open to IVR calls. Older participants were more likely to prefer text messages (P=0.009) and IVR (P=0.03) than younger participants. CONCLUSIONS Most people with T1D who use advanced diabetes technologies have access to cell phones and are receptive to receiving mHealth support to improve diabetes control. CLINICALTRIAL Not applicable

scholarly journals Static Ankle Dorsiflexion and Hip and Pelvis Kinematics During Forward Step-Down in Patients With Hip-Related Groin Pain

2020 ◽  
pp. 1-8
Author(s):  
Stefanie N. Foster ◽  
Michael D. Harris ◽  
Mary K. Hastings ◽  
Michael J. Mueller ◽  
Gretchen B. Salsich ◽  
...  
Keyword(s):  
Pelvic Tilt ◽  
Groin Pain ◽  
Medical Center ◽  
Weight Bearing ◽  
Academic Medical Center ◽  
Ankle Dorsiflexion ◽  
Future Research ◽  
Cross Sectional ◽  
Anterior Pelvic Tilt ◽  
Step Down

Context: The authors hypothesized that in people with hip-related groin pain, less static ankle dorsiflexion could lead to compensatory hip adduction and contralateral pelvic drop during step-down. Ankle dorsiflexion may be a modifiable factor to improve ability in those with hip-related groin pain to decrease hip/pelvic motion during functional tasks and improve function. Objective: To determine whether smaller static ankle dorsiflexion angles were associated with altered ankle, hip, and pelvis kinematics during step-down in people with hip-related groin pain. Design: Cross-sectional Setting: Academic medical center. Patients: A total of 30 people with hip-related groin pain (12 males and 18 females; 28.7 [5.3] y) participated. Intervention: None. Main Outcome Measures: Weight-bearing static ankle dorsiflexion with knee flexed and knee extended were measured via digital inclinometer. Pelvis, hip, and ankle kinematics during forward step-down were measured via 3D motion capture. Static ankle dorsiflexion and kinematics were compared with bivariate correlations. Results: Smaller static ankle dorsiflexion angles were associated with smaller ankle dorsiflexion angles during the step-down for both the knee flexed and knee extended static measures. Among the total sample, smaller static ankle dorsiflexion angle with knee flexed was associated with greater anterior pelvic tilt and greater contralateral pelvic drop during the step-down. Among only those who did not require a lowered step for safety, smaller static ankle dorsiflexion angles with knee flexed and knee extended were associated with greater anterior pelvic tilt, greater contralateral pelvic drop, and greater hip flexion. Conclusions: Among those with hip-related groin pain, smaller static ankle dorsiflexion angles are associated with less ankle dorsiflexion motion and altered pelvis and hip kinematics during a step-down. Future research is needed to assess the effect of treating restricted ankle dorsiflexion on quality of motion and symptoms in patients with hip-related groin pain.

scholarly journals A Study on Knowledge Towards Brain Death among Residents in Indonesia

2020 ◽  
Vol 56 (2) ◽  
pp. 140
Author(s):  
Asra Al Fauzi ◽  
Christrijogo Sumartono Waloejo ◽  
Abdulloh Machin ◽  
Muhammad Ja'far Shodiq
Keyword(s):  
Brain Death ◽  
Medical Center ◽  
Academic Medical Center ◽  
Cross Sectional Study ◽  
Research Subjects ◽  
Cross Sectional ◽  
Academic Medical ◽  
Center Hospital ◽  
Level 3 ◽  
Level 2

This research was conducted to evaluate the knowledge and diagnosis of brain death among resident in Indonesia. This study used an observational analytic study with a cross-sectional study design using a questionnaire. The research subjects consisted of 132 level 2 (after 2 years of residency) and level 3 (after 4 years of residency) residents, the total sampling for which was taken from the departments of Neurosurgery, Anesthesiology, and Neurology at Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia. Data were taken from November 2018 to January 2019. A total of 132 residents of Neurosurgery, Neurology, and Anesthesiology participated in this study. From the series of studies, residents’ knowledge of the concept of brain death was in the sufficient category (41.7%), residents’ knowledge of the technical diagnosis of brain death was in the good category (40.2%), residents’ knowledge of brain death examination was in the less category (43.2%), and finally, it was found that the resident's knowledge of brain death was in a good category (35.6%). There were also significant differences in knowledge of brain death between Neurosurgery, Neurology, and Anesthesiologist Resident (P <0.001) and knowledge of brain death between level 2 and level 3 residents (P=0.032). In general, the Indonesian resident doctors’ knowledge of brain death is adequate, but knowledge of the clinical examination of brain death is still lacking. Further research must be carried out to promote knowledge of brain death in residents as well as professional doctors/specialists, so that the number of organ transplants, especially in Indonesia, will increase.

Health-Related Stigma, Social Support, Self-Efficacy, and Self-Care Actions Among Adults With Sickle Cell Disease in Oman

2021 ◽  
pp. 105477382110467
Author(s):  
Huda Al Raqaishi ◽  
Mohammad Al Qadire ◽  
Omar Alzaabi ◽  
Omar Al Omari
Keyword(s):  
Social Support ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Self Efficacy ◽  
Self Care ◽  
Care Seeking ◽  
Cell Disease ◽  
Cross Sectional ◽  
Related Stigma ◽  
Health Related

Stigma contributes to the burden of individuals and families affected by Sickle cell disease (SCD) and causes delay in appropriate care seeking. The aim of this study is to examine the levels and associations between stigma, social support, self-efficacy, and self-care actions among adult patients with SCD in Oman using a cross-sectional, correlational design. Of the 264 participants, 56.1% ( n = 148) were males, with mean age of 30.1 years ( SD 7.7). Half of the participants were married, and 88.3% had no other associated diseases. The results demonstrate that patients in Oman suffer from health-related stigma. However, social support, self-efficacy, and self-care actions were reported to be high and correlated with several clinical and demographic variables. Based on the results, effective, low-cost interventions such as psycho-educational groups, individual counseling, or group therapies might be developed. They can promote belief in enhanced efficacy and improved SCD adaptation, thereby increasing patient, and provider satisfaction.

Millennials Seeking Healthcare: Examining the Degree to Which Patients Utilize Online Resources (Preprint)

2021 ◽  
Author(s):  
Landon Arensberg ◽  
Jessica Kalender-Rich ◽  
Jaehoon Lee ◽  
Cheryl Gibson
Keyword(s):  
Medical Care ◽  
Baby Boomers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Age Groups ◽  
Online Reviews ◽  
Online Resources ◽  
Cross Sectional ◽  
Academic Medical ◽  
Us Census

BACKGROUND According to the 2020 US Census, a Silver Tsunami is looming with more than 75.4 million persons aged 57-75 (known as “Baby Boomers”) expected to need more costly medical care. Future estimates, however, indicate a much larger wave of individuals is imminent, given the 83.1 million Millennials approaching adulthood who will be seeking medical care. Because Millennials differ from Baby Boomers in several ways, it is important to understand how this population finds their physician to gain insight into what might influence this decision. OBJECTIVE To determine the extent and influence online resources and reviews have on the younger generation as compared to elder generations. METHODS Between the months of May and July 2020 a cross-sectional paper-based survey was conducted at primary care and geriatric clinics located within a large urban academic medical center in the Midwest. RESULTS A sample of 284 patients completed the survey (44.35 ± 17.54 yrs old [range=18-90], 60.6% female, 57.4% white). Of Millennials (respondents aged 22-38 yrs), 67.2% read online reviews before choosing a physician. Millennials were significantly more likely to read online reviews before choosing a physician (P=0.004) and utilize online resources to search for a new physician (P<.001) than older patients. The majority of millennials were likely to be influenced by both negative reviews (59%) and positive reviews (71.3%). Female patients were more likely to read online reviews and use online resources compared to men, but the differences were not significant. CONCLUSIONS Overall, Millennials are much more likely to research online reviews before choosing a physician. Other generations also use online resources to an extent but tend to use personal referrals. Across all age groups, negative online reviews were less influential in decision-making compared to positive ones. Therefore, a presence on review websites and search engines seems to only benefit one’s medical practice to capture the new wave of patients.

scholarly journals Variability of Antibiotic Prescribing in a Large Healthcare Network Despite Adjusting for Patient-Mix: Reconsidering Targets for Improved Prescribing

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Sophia Jung ◽  
Mary Elizabeth Sexton ◽  
Sallie Owens ◽  
Nathan Spell ◽  
Scott Fridkin
Keyword(s):  
Antibiotic Prescription ◽  
Medical Center ◽  
Academic Medical Center ◽  
Primary Care Clinic ◽  
Multivariable Logistic Regression Analysis ◽  
Comorbid Condition ◽  
Antibiotic Prescribing ◽  
Cross Sectional ◽  
Care Clinic ◽  
The Impact

Abstract Background In the outpatient setting, the majority of antibiotic prescriptions are for acute respiratory infections (ARIs), but most of these infections are viral and antibiotics are unnecessary. We analyzed provider-specific antibiotic prescribing in a group of outpatient clinics affiliated with an academic medical center to inform future interventions to minimize unnecessary antibiotic use. Methods We conducted a cross-sectional study of patients who presented with an ARI to any of 15 The Emory Clinic (TEC) primary care clinic sites between October 2015 and September 2017. We performed multivariable logistic regression analysis to examine the impact of patient, provider, and clinic characteristics on antibiotic prescribing. We also compared provider-specific prescribing rates within and between clinic sites. Results A total of 53.4% of the 9600 patient encounters with a diagnosis of ARI resulted in an antibiotic prescription. The odds of an encounter resulting in an antibiotic prescription were independently associated with patient characteristics of white race (adjusted odds ratio [aOR] = 1.59; 95% confidence interval [CI], 1.47–1.73), older age (aOR = 1.32, 95% CI = 1.20–1.46 for patients 51 to 64 years; aOR = 1.32, 95% CI = 1.20–1.46 for patients ≥65 years), and comorbid condition presence (aOR = 1.19; 95% CI, 1.09–1.30). Of the 109 providers, 13 (12%) had a rate significantly higher than predicted by modeling. Conclusions Antibiotic prescribing for ARIs within TEC outpatient settings is higher than expected based on prescribing guidelines, with substantial variation in prescribing rates by site and provider. These data lay the foundation for quality improvement interventions to reduce unnecessary antibiotic prescribing.

Testing a Conceptual Framework for Diabetes Self-Care Management

2004 ◽  
Vol 18 (4) ◽  
pp. 293-316 ◽  
Author(s):  
Valmi D. Sousa ◽  
Jaclene A. Zauszniewski ◽  
Carol M. Musil ◽  
Patricia E. McDonald ◽  
Sharon E. Milligan
Keyword(s):  
United States ◽  
Social Support ◽  
Self Efficacy ◽  
Care Management ◽  
Care Center ◽  
Self Care ◽  
The United States ◽  
Diabetes Knowledge ◽  
Cross Sectional ◽  
Care Agency

Diabetes is a major source of morbidity, mortality, and economic expense in the United States. The majority of researchers and clinicians believe that diabetes is a self-care management disease, and that patients should be reliable, capable, and sufficiently responsible to take care of themselves. However, individuals with diabetes may or may not have diabetes knowledge, social support, self-care agency (an individual’s capability to perform self-care actions), and self-efficacy (an individual’s beliefs in his or her capability to perform self-care actions) that would help them to engage in diabetes self-care management. Therefore, this study examined the relationship among those factors using a cross-sectional model testing design. A convenient sample of 141 insulin-requiring individuals with either diabetes type 1 or type 2, 21 years old and over, was recruited from an outpatient diabetes care center located in a Southeast region of the United States. Simple linear regression, multiple standard regression, and multiple hierarchical regression were used to analyze the data. Individuals with greater diabetes knowledge had greater self-care agency and self-efficacy. Those with a higher score in social support had greater self-care agency and better diabetes self-care management, and those with greater self-efficacy had better diabetes self-care management. In addition, self-care agency mediated the effects of diabetes knowledge on self-efficacy and the effects of social support on diabetes self-care management. Self-efficacy mediated the effects of self-care agency on diabetes self-care management. Furthermore, the linear combination of diabetes knowledge, social support, self-care agency, and self-efficacy, taken together, positively affected diabetes self-care management. Enhancing an individual’s diabetes knowledge, social support, self-care agency, and self-efficacy may be a strategy which can promote better engagement in diabetes self-care.

scholarly journals Essential Oil Olfactory Test: Comparison of Affordable Rapid Olfaction Measurement Array (AROMA) to Sniffin’ Sticks 12

OTO Open ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 2473974X2096246
Author(s):  
Jennifer Li ◽  
Gracie Palmer ◽  
Suraj Shankar ◽  
Mark R. Villwock ◽  
Alexander G. Chiu ◽  
...  
Keyword(s):  
Essential Oil ◽  
Medical Center ◽  
Low Cost ◽  
Academic Medical Center ◽  
Cross Sectional Study ◽  
Moderate Correlation ◽  
Cross Sectional ◽  
Percent Correct ◽  
Olfactory Testing ◽  
Snot 22

Objectives To further demonstrate the validity of Affordable Rapid Olfaction Measurement Array (AROMA), an essential oil−based smell test, and compare it to the Sniffin’ Sticks 12 Test (SST12). Study Design Prospective cross-sectional study. Setting Academic medical center. Methods Fifty healthy individuals without sinonasal disease were recruited to the study. AROMA has been previously validated against the University of Pennsylvania Smell Identification Test. The current study tests 2 additional higher concentrations to increase the ability to detect olfactory reserve. Healthy participants completed AROMA, SST12, Sino-Nasal Outcome Test (SNOT-22), and Questionnaire of Olfactory Disorders (QoD). Spearman correlations were used to evaluate AROMA, SST, SNOT-22, and QoD. Results AROMA demonstrated strong test-retest reliability ( r = 0.757, P < .01). AROMA showed a moderate correlation to SST12 (ρ = 0.412, P < .01). Age and SNOT-22 were significantly correlated ( P < .05) with AROMA (ρ = −0.547, −0.331, respectively), and age was weakly correlated with SST (ρ = −0.377, P < .01). Median percent correct scores were as follows: SST12 identification, 92%; AROMA detection, 90%; and AROMA identification, 81%. Median correct odor identification of AROMA concentrations at 1×, 2×, 4×, and 8× were 64%, 75%, 92%, and 92%, respectively. Conclusion AROMA has a moderate correlation with SST12. AROMA is more strongly correlated than SST12 to age and SNOT-22. AROMA’s stronger correlation with subjective olfactory status, low cost, and adaptability may help remove barriers to routine olfactory testing in the clinic.

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