Filtering by
- All Subjects: Actuarial
- All Subjects: Elderly
- All Subjects: CCaH
- Creators: Annor, Wilhelmina Sagoe
- Resource Type: Text
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.
We conducted an international survey in which forensic examiners who were members of professional associations described their two most recent forensic evaluations (N=434 experts, 868 cases), focusing on the use of structured assessment tools to aid expert judgment. This study describes:
1. The relative frequency of various forensic referrals.
2. What tools are used globally.
3. Frequency and type of structured tools used.
4. Practitioners’ rationales for using/not using tools.
We provide general descriptive information for various referrals. We found most evaluations used tools (74.2%) and used several (on average 4). We noted the extreme variety in tools used (286 different tools). We discuss the implications of these findings and provide suggestions for improving the reliability and validity of forensic expert judgment methods. We conclude with a call for an assessment approach that seeks structured decision methods to advance greater efficiency in the use and integration of case-relevant information.