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Transitional Care of Adults with Chronic Diseases Post-Discharge from Acute Settings

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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,

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.

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  • 2020-05-05

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Andean Social Identities: Analyses of Community, Gender, and Age Identities at Chiribaya Alta, Peru

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Social identities are fundamental to the way individuals and groups define themselves. Archaeological approaches to social identities in the Andes emphasize the importance of group identities such as ethnicity and

Social identities are fundamental to the way individuals and groups define themselves. Archaeological approaches to social identities in the Andes emphasize the importance of group identities such as ethnicity and community identity, but studies of gender and age identities are still uncommon. In this dissertation, I build on these earlier approaches to Andean social identities and consider community, gender, and age identities at the site of Chiribaya Alta using case studies.

The coastal Ilo Chiribaya polity is associated with the Andean Late Intermediate Period in the lower Osmore drainage of southern Peru. Previous analyses indicate that Chiribaya sites in this area formed a señorío, an Andean chiefdom with separate occupational groups of fishers and farmers. The most complex excavated Chiribaya site in this region is Chiribaya Alta. At this time, excavations have sampled nine of the cemeteries present at the site. Two of these cemeteries, four and seven, have the most elaborate burials at the site and are each associated with different occupational communities.

This dissertation examines community, gender, and age identities at Chiribaya Alta through the use of three case studies. The first case study argues that the iconographic designs on coca bags interred with the dead signified occupational community identities. Coca bags buried in cemetery four have designs relating to mountains and farming, whereas those from cemetery seven have symbols associated with water. These designs correspond to the occupational community groups associated with each of these cemeteries. The second case study uses grave good presence and absence to examine the nature of gender roles and identity at Chiribaya Alta. Multiple correspondence analysis indicates that normative gender roles are reflected in grave good assemblages, but that gender identity was flexible at the individual level. The final case study presents newly generated age-at-death estimations using transition analysis combined with mortuary analyses to explore the manner in which gender and age intersect for older individuals at Chiribaya Alta. This final paper argues that there is an elderly identity present amongst individuals at Chiribaya Alta and that gender and age intersect to impact the lives of older men and women differently.

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  • 2019