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Ineffective transitional care programs for ensuring the continuation of care from acute settings to the home settings post discharge can result in rehospitalization of elderly patients with chronic diseases. Usually, transitional care should be time-sensitive, patient-centered services intended to ensure continuity of care and an efficient transition between health care

Ineffective transitional care programs for ensuring the continuation of care from acute settings to the home settings post discharge can result in rehospitalization of elderly patients with chronic diseases. Usually, transitional care should be time-sensitive, patient-centered services intended to ensure continuity of care and an efficient transition between health care settings or home. A patient centered transitional care program was implemented at an outpatient primary care facility to reduce readmission rates. Institutional Review Board approval was obtained.

Twenty adult patients with chronic diseases discharged from an acute setting were identified. A follow up phone call and/or a home visit within 24-72 hours post discharge was employed. The Care Transitions Measure (CTM®) and Medication Discrepancy Tool (MDT®) were utilized to identify quality of care of transition and medication discrepancies. A chart audit collected data on the age of participant, diagnosis for initial hospitalization, CTM score, home visit, and ED visits or re-hospitalizations after 30 days of discharge. The outcome indicated that transitional care within primary care utilizing evidence-based practices is beneficial in reducing readmission rates. A logistic regression showed model significance, p = .002, suggesting that the CTM score was effective for both telephone support (TS) and home visit (HV).

A correlation analysis showed that as age of participants increased, the CTM score decreased, indicating that older adults required more support. A significance p <.001, of a proportional test indicated that readmission rates after the intervention was lower. It is evident that providing a timely and effective transitional care intervention in a primary care setting can reduce hospital readmissions, improve symptom management and quality of life of adult patients with chronic diseases.

ContributorsAnnor, Wilhelmina Sagoe (Author) / Baker, Laurie (Thesis advisor)
Created2020-05-05
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Description
Importance: Idiopathic Pulmonary Fibrosis (IPF) is a worldwide deadly disease with a mortality rate of nearly 100% without lung transplantation (IPF Foundation, 2020). The exact cause of this disease is unclear. Evidence has shown that IPF patients have a high risk of having abnormal acid reflux. Chronic acid reflux can

Importance: Idiopathic Pulmonary Fibrosis (IPF) is a worldwide deadly disease with a mortality rate of nearly 100% without lung transplantation (IPF Foundation, 2020). The exact cause of this disease is unclear. Evidence has shown that IPF patients have a high risk of having abnormal acid reflux. Chronic acid reflux can worsen IPF prognosis. Objective: To assess the effectiveness of an online educational intervention in enhancing clinician’s belief, confidence and readiness in implementing an acid reflux screening protocol in IPF patients. Methods: Physicians and nurse practitioners in primary care and pulmonary specialties within the United States were asked to complete online pre- and post-surveys after reviewing a webpage presenting up-to-date research evidence showing the relationship between IPF and gastroesophageal reflux disease (GERD). Main Outcomes and Measures: Questionnaires adapted from the Evidence-Based Practice Beliefs and Implementation Scales by Melnyk were utilized to evaluate changes in belief, confidence and readiness to implement evidence-based practice recommendations. Results: Percentage of participants who strongly believed in acid reflux screening in IPF increased from 60% pre-survey to 80% post survey (M=4.75, SD=0.58). The percentage of participants who thought they were ready to implement this screening protocol decreased from 60% pre-survey to 50% post survey (M=4.44, SD=0.63). More participants felt strongly confident during the post-survey. The pre-survey had 130 views with a completion rate of 12.3%. Conclusion and Relevance: An online educational tool such as a webpage was an effective way to enhance clinician’s belief and confidence in acid reflux screening in IPF. Keywords: idiopathic pulmonary fibrosis, gastroesophageal reflux disease, abnormal acid reflux screening, evidence-based practice
Created2021-04-27
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Description

Background:
Thirty to fifty percent of cancer patients undergoing chemotherapy will experience
chemotherapy induced nausea and or vomiting (CINV) despite the use of antiemetic prophylaxis Uncontrollable CINV can lead to complications that add extra stress to patients, increase in healthcare costs, and utilization of resources. CINV can lead to chemotherapy dose reductions,

Background:
Thirty to fifty percent of cancer patients undergoing chemotherapy will experience
chemotherapy induced nausea and or vomiting (CINV) despite the use of antiemetic prophylaxis Uncontrollable CINV can lead to complications that add extra stress to patients, increase in healthcare costs, and utilization of resources. CINV can lead to chemotherapy dose reductions, treatment delays, chemotherapy changes, or discontinuation of treatment. Guidelines exist to better prevent and treat CINV. Evidence supports the use of guidelines to prevent CINV, however patients still suffer from CINV often due to a lack of guideline adherence.

Objectives:
The purpose of this project was to increase CINV guideline adherence by increasing knowledge of antiemetic guidelines utilizing an educational intervention for providers and nurses at an outpatient oncology office.

Methods:
A brief educational intervention on CINV and recommended NCCN guidelines was
conducted with providers and nurse (n=6) at an oncology practice in Southwestern United States. An evaluation to assess change in knowledge was performed using a pre and post test format. Statistical analysis was performed using descriptive statistics, McNemar tests and Wicoxan Signed Rank Test.

Findings:
There was a significant effect on knowledge of NCCN antiemetic guidelines (Z=-1.89, p=0.059, mean 2.5) post intervention. There also was a significant impact on likelihood to use guidelines in practice (Z=-1.89, p=0.059, mean 2.5). Increasing awareness and likelihood to CHEMOTHERAPY INDUCED NAUSEA AND VOMITING 3 follow recommended guidelines may improve CINV symptoms in patients undergoing chemotherapy and improve the treatment outcomes for these patients.

ContributorsBarbosa, Jennifer (Author) / Baker, Laurie (Thesis advisor)
Created2018-04-29