A Health Service Transition to Adult Patient Care for Sickle Cell Disease

This paper explores the challenges related to long-term conditions,focusing on sickle cell disease(SCD)as a case study.Long-term conditions,characterized by the need for ongoing management,present a substantial burden on healthcare systems globally.A careful transition from pediatric to adult healthcare is needed for SCD.The discussion extends to the broader health service transition to adult patient care in SCD,emphasizing the World Health Organization’s definition of care transitions and the necessity for an integrated healthcare service.The emphasis is on a multidisciplinary approach to medical,mental health,and educational problems.A person-centered model of care should be used more consistently to resolve these long-term condition-related challenges.To evaluate the effectiveness of new interventions in improving the transition of care from pediatrics to adult patients with SCD,continuous quality improvement strategies should be implemented and prospectively measured in younger patients.In conclusion,this study highlights the critical importance of an effective transition from pediatric to adult healthcare.The continued research of effective transition practices is essential for the future and there is still a requirement to develop pragmatic approaches to enhance research on the transition to improve the quality of healthcare for patients with long-term conditions.

Barriers in the Transition of Care for Heart Failure Patients Attending Clinics in Mwanza City, Tanzania

Introduction: Transition of care strategies have shown to improve quality of lives of heart failure patients, but it has little implemented in clinical settings. Objective: To evaluate context-specific perceived barriers and experiences of heart failure patients during their admission and after they were discharged from hospital. Methods: A cross-sectional qualitative study was conducted among 13 heart failure patients at two large referral hospitals in northwestern Tanzania. In-depth interviews among heart failure patients, in line with the Consolidated Criteria for Reporting Qualitative research checklist, were used to collect data. Interviews were audio recorded, transcribed, and translated into English. Results: Three key barriers were identified, as well as possible solutions that could improve the transition of care for heart failure patients. These include strengthening healthcare provider communications, organizing medication management, and assisting with follow-up appointments. Conclusion: The barriers identified are real and challenging in clinical resource- limited settings. Findings suggest they can be overcome when realistic and tailor-made interventions are in place.

Development of the Transitional Care Model for nursing care in China's Mainland:A literature review

Background:The Transitional Care Model(TCM)for nursing care has yet to be implemented in China despite its success in Western countries.However,rapid social changes have demanded an upgrade in the quality of nursing care;in 2010,the Chinese government has acknowledged the need to implement the TCM in China.Objective:This study has the following objectives:(1)perform a thorough review of the literature regarding the development and implementation of the TCM in China's Mainland within the past 5 years;(2)provide a comprehensive discussion of the current status,problems,and strategies related to the implementation of the TCM in China's Mainland;and(3)suggest strategies pertaining to the future of the TCM in China.Design:The current pertinent literature is systematically reviewed.Data sources:Systematic and manual searches in computerized databases for relevant studies regarding the TCM led to the inclusion of 26 papers in this review.Review methods:Abstracts that satisfied the inclusion criteria were reviewed independently by the two authors of this manuscript,and discrepancies were resolved through discussion.The same reviewers independently assessed the paper in its entirety for selected abstracts.Results:The present English literature reviewrevealed a paucity of updated information about the development and implementation of the TCM in China's Mainland.Nevertheless,the dramatic growth of the TCM in the past 5 years has had a vital impact within the society and in nursing development.This review also revealed numerous issues regarding the focus of the TCM.Overall implications for practiceandrecommendations for future researchare discussed.Conclusion:Despite the potential of this nursing model to have a successful and beneficial impact in China's Mainland,it remains an under-researched topic.Further research on education and training as well as premium policies for nurses under the TCM are needed.

Transitional care for patients with chronic obstructive pulmonary disease

Objectives:To observe the effects of transitional care on the quality of life of chronic obstructive pulmonary disease(COPD)patients.Methods:A total of 114 COPD patients were recruited from the First Affiliated Hospital,Sun Yat-sen University,Guangzhou,China and divided equally into an intervention group and control group.Following discharge,patients from the intervention group recieved threemonths intervention in addition to regular nursing care,while control group patients received regular nursing care only.Patients’quality of life was measured using the St.George’s respiratory questionnaire(SGRQ),the 12-item General Health Questionnaire(GHQ-12)and body mass index(BMI).Results:The symptoms section score,the activity section score,the impacts section score,the total score and the rate of mental disorders were significantly changed after the intervention while there was no statistical difference in BMI between groups.Conclusions:Transitional care can improve health-related quality of life in COPD patients who have recently suffered an exacerbation.

Continuing Care for Older Patients During the Transitional Period

Background： The world is facing increasing pressure with the continuous growth of the older population. Older patients are usually discharged with complex medical problems, high stress and vulnerability, and these factors place the elderly at risk for poor outcomes. Purpose： The present review summarizes a method for providing appropriate and affordable health services by nursing professionals to meet older patient＇s health care needs during their transitional period which is defined as a period from discharge after hospitalization for a major disorder to recovery in a home setting. Summary： Older patients with chronic diseases need seamless health care during a transitional period-a highly stressful and vulnerable period for them. Nurse professionals can conduct decent discharge planning to assist older patients with transitional problems through continuous healthcare. This review summarized the need of continuing care for older patients during the transitional period, the definition of discharge planning, the conceptual framework of discharge planning, and the professionals involved in discharge planning. It also highlighted the problems of discharge planning and follow-up intervention implementation in the mainland of China. Clinical implications： Inadequate discharge planning and follow-up were leading factors associ- ated with the readmission of discharged older patients. Further nursing-led discharge planning should be reinforced in China.

Transitional care interventions to reduce readmission in patients with chronic obstructive pulmonary disease:A meta-analysis of randomized controlled trials

Objective：To objectively assess the effect of transitional care on readmission for patients with chronic obstructive pulmonary disease.Methods：The PubMed,Science Direct,Web of Science,Cochrane Library,CNKI,and Wanfang databases were searched for relevant randomized controlled trials（RCTs） published from January 1990 through April 2016.The quality of eligible studies was assessed by two investigators.The primary outcome assessed was readmission for COPD and all-cause readmission.The pooled effect sizes were expressed as the relative risk and standard mean difference with 95%confidence intervals.Heterogeneity among studies was assessed using the Cochrane Handbook for Systematic Reviews of Interventions（Version5.1.0） and determined with an I^2 statistic.Results：A total of seven RCTs that included 1879 participants who met the inclusion criteria were analyzed.The results of subgroup analysis showed significant differences in readmission for COPD at the6 month and 18 month time points and all-cause readmission at the 18 month follow-up.Transitional care could reduce readmission for COPD at the 6 month[RR = 0.51,95%CI（0.38,0.68）,P 〈 0.00001]and18 month time points[RR = 0.56,95%CI（0.45,0.69）,P 〈 0.00001,and also reduce all-cause readmission after 18 months[RR = 0.72,95%CI（0.62,0.84）,P 〈 0.0001].The reduction of all-cause readmission between the intervention and control groups in the 2nd year,however,was less than that in the 1st year.Conclusions：Transitional care is beneficial to reducing readmission for patients with COPD.Duration of≥ 6 and ≤ 18 months are more effective,and the effect weakens over intervention time,especially after the end of intervention.Both durations point to the importance of ongoing intervention and reinforcement after the end of intervention.

Application of transitional care model in cancer pain management after discharge: a randomized controlled trial

Objective： We sought to determine any benefits of applying a transitional care model in the continuum of cancer pain management, especially after patients＇ discharge from the hospital. Methods： A total of 156 eligible participants were recruited and randomly assigned into intervention or control groups. The control group received standard care, while the intervention group received extra, specialized transitional care of pain management. Outcomes were measured at weeks 0 and 2-4 and included demographic data, the Brief Pain Inventory, Global Quality of Life Scale, and Satisfaction Degree of Nursing Service. Adequacy of analgesia and severity of pain were assessed with the Pain Management Index and interview findings. Results： After 2-4 weeks of intervention, there was a significant difference in the change in average pain score between intervention and control groups （P 〈 0.05）. Reductions in pain scores were significantly greater in the intervention group than in the control group （difference： 0.98, P 〈 0.05）. Regarding pain management outcomes, there was a significantly better condition in the intervention group compared with the control group; in the intervention group, 79% of patients had adequate opioids, whereas in the control group, only 63% of patients reported having adequate opioids. Furthermore, there was a signif- icant difference between the two groups in quality of life （QOL） scores （P 〈 0.05）; the intervention group had significantly higher quality of life than the control group （difference： 1.06）. Finally, there was a significant difference in the degree of satisfaction with the home nursing service; the intervention group had a significantly higher degree of satisfaction with the home nursing service in three aspects： quality, content, and attitude of service. Conclusions： The application of a transitional care model in cancer pain management after discharge could help patients to improve their cancer pain management knowledge and analgesics compliance. In addition, the continuum of care service will contribute to effective communication between health care providers and patients, which could further improve their relationship.

Acute hospital-community hospital care bundle for elderly orthopedic surgery patients:A propensity score-matched economic analysis

BACKGROUND While Singapore attains good health outcomes,Singapore’s healthcare system is confronted with bed shortages and prolonged stays for elderly people recovering from surgery in acute hospitals.An Acute Hospital-Community Hospital(AHCH)care bundle has been developed to assist patients in postoperative rehabilitation.The core concept is to transfer patients out of AHs when clinically recommended and into CHs,where they can receive more beneficial dedicated care to aid in their recovery,while freeing up bed capacities in AHs.AIM To analyze the AH length of stay(LOS),costs,and savings associated with the AH-CH care bundle intervention initiated and implemented in elderly patients aged 75 years and above undergoing elective orthopedic surgery.METHODS A total of 8621:1 propensity score-matched patients aged 75 years and above who underwent elective orthopedic surgery in Singapore General Hospital(SGH)before(2017-2018)and after(2019-2021)the care bundle intervention period was analyzed.Outcome measures were AH LOS,CH LOS,hospitalization metrics,postoperative 30-d mortality,and modified Barthel Index(MBI)scores.The costs of AH inpatient hospital stay in the matched cohorts were compared using cost data in Singapore dollars.RESULTS Of the 862 matched elderly patients undergoing elective orthopedic surgery before and after the care bundle intervention,the age distribution,sex,American Society of Anesthesiologists classification,Charlson Comorbidity Index,and surgical approach were comparable between both groups.Patients transferred to CHs after the surgery had a shorter median AH LOS(7 d vs 9 d,P<0.001).The mean total AH inpatient cost per patient was 14.9%less for the elderly group transferred to CHs(S$24497.3 vs S$28772.8,P<0.001).The overall AH U-turn rates for elderly patients within the care bundle were low,with a 0%mortality rate following orthopedic surgery.When elderly patients were discharged from CHs,their MBI scores increased significantly(50.9 vs 71.9,P<0.001).CONCLUSION The AH-CH care bundle initiated and implemented in the Department of Orthopedic Surgery appears to be effective and cost-saving for SGH.Our results indicate that transitioning care between acute and community hospitals using this care bundle effectively reduces AH LOS in elderly patients receiving orthopedic surgery.Collaboration between acute and community care providers can assist in closing the care delivery gap and enhancing service quality.

The home healthcare nursing services provided to the elderly patients: a systematic review

Background:Home healthcare(HHC)services entail quality and transitional care offered to patients.Doctors recommend HHC to the elderly patients to manage conditions and improve outcomes outside inpatient setting.The systematic review aimed to assess the home health care nurse services to elderly patients.The question of this study is“what are the home nursing care services provided to the elderly patient.Methods:A systematic review methodology was adopted.A search was conducted on PubMed,MEDLINE,and ScienceDirect using keywords such as“home healthcare”,“nurse services”,“home nurses”,“elderly patients”.The search generated 1829 articles,but 16 were selected for qualitative synthesis for meeting the eligibility criteria.Joana Briggs Institute’s critical appraisal tools helped in the assessment of the primary studies.A data extraction matrix generated themes,while a narrative synthesis presented the studies.Results:The review found administration of HHC nursing services in different settings.The studies confirmed varied nature of HHC,types of HHC services,transitional care,challenges,or barriers of offering HHC,relationships,and decision-making process in offering care to the patients and family.The studies presented HHC as a multifaceted component with diverse impact on the patients and family.The analysis revealed that HHC nurses services served elderly persons as the main target group.HHC faces different challenges,barriers,or obstacles such as work,role conflict,organization,elderly patients,and decision-making.Conclusion and Future Research:The assessment of the HHC nursing services provided to the elderly patients reveals different facets of the healthcare process that reduce readmissions and hospital costs.Further studies could explore the provision of care to other target groups such as middle-aged patients to understand the impact of the services.

Development and pilot implementation of a patient-oriented discharge summary for critically Ill patients

BACKGROUND Patients leaving the intensive care unit(ICU)often experience gaps in care due to deficiencies in discharge communication,leaving them vulnerable to increased stress,adverse events,readmission to ICU,and death.To facilitate discharge communication,written summaries have been implemented to provide patients and their families with information on medications,activity and diet restrictions,follow-up appointments,symptoms to expect,and who to call if there are questions.While written discharge summaries for patients and their families are utilized frequently in surgical,rehabilitation,and pediatric settings,few have been utilized in ICU settings.AIM To develop an ICU specific patient-oriented discharge summary tool(PODS-ICU),and pilot test the tool to determine acceptability and feasibility.METHODS Patient-partners(i.e.,individuals with lived experience as an ICU patient or family member of an ICU patient),ICU clinicians(i.e.,physicians,nurses),and researchers met to discuss ICU patients’specific informational needs and design the PODS-ICU through several cycles of discussion and iterative revisions.Research team nurses piloted the PODS-ICU with patient and family participants in two ICUs in Calgary,Canada.Follow-up surveys on the PODS-ICU and its impact on discharge were administered to patients,family participants,and ICU nurses.RESULTS Most participants felt that their discharge from the ICU was good or better(n=13;87.0%),and some(n=9;60.0%)participants reported a good understanding of why the patient was in ICU.Most participants(n=12;80.0%)reported that they understood ICU events and impacts on the patient’s health.While many patients and family participants indicated the PODS-ICU was informative and useful,ICU nurses reported that the PODS-ICU was“not reasonable”in their daily clinical workflow due to“time constraint”.CONCLUSION The PODS-ICU tool provides patients and their families with essential information as they discharge from the ICU.This tool has the potential to engage and empower patients and their families in ensuring continuity of care beyond ICU discharge.However,the PODS-ICU requires pairing with earlier discharge practices and integration with electronic clinical information systems to fit better into the clinical workflow for ICU nurses.Further refinement and testing of the PODS-ICU tool in diverse critical care settings is needed to better assess its feasibility and its effects on patient health outcomes.