We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their be...We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their bedding, after ruling out insomnia and dementia. The incidence of delirium was 28.6%;delirium onset occurred within an average of 2.7 (SD = 12) days after the start of home care among those whose care environment was changed due to hospital discharge or moving. Increased interrupted sleep and activity during sleep indicated that sleep fragmentation occurred before delirium onset. In conclusion, individuals aged ≥65 years and those whose care environment has changed should be screened for delirium because the time to delirium onset is short. Further, interventions to monitor the sleep status and prevent delirium onset should be implemented from the day home care begins.展开更多
Perioperative home （PH） or perioperative surgical home （PSH） is a patient centered medical service or primary care provider aimed at share decision-making and seamless continuity of care for the surgical patient. ...Perioperative home （PH） or perioperative surgical home （PSH） is a patient centered medical service or primary care provider aimed at share decision-making and seamless continuity of care for the surgical patient. The goal is to improve operational efficiency, decrease resource utilization, reduce length of hospital/intensive care unit （ICU） stay and readmission, and to decrease complication and mortality rates. PH is an innovative model of delivering health care during the entire patient surgical/procedural experience. This model is centered around patient from the time of the decision for surgery till the patients have recovered and returned to the care of themselves.展开更多
Objective:The Accountable Care Organization(ACO)model of health care delivery is based on new payment models for general practice to reward improved quality and decreased cost of care.Methods:Banner Health Network(BHN...Objective:The Accountable Care Organization(ACO)model of health care delivery is based on new payment models for general practice to reward improved quality and decreased cost of care.Methods:Banner Health Network(BHN)is one of the original CMS Pioneer ACO programs and implemented a comprehensive disease management program based on the collaborative care model.Key performance indicators for CMS reflected quality and cost of care.Results:BHN has demonstrated both improved quality and cost savings in the first two years of the pilot program.The disease management program based on the collaborative care model appears to have improved patient health outcomes based on quality improvement measures.In addition the program has reduced emergency department and hospital utilization,resulting in cost savings.Conclusions:The BHN quality improvement program is the platform for analyzing and improving on the BHN ACO model.This model appears to have excellent application to the China health care system that is also focused on prevention and improvement of chronic disease and cost-effectiveness.展开更多
文摘We aimed to clarify the sleep status before delirium onset among older adults receiving home care. The sleep status of 21 participants aged ≥65 years was monitored while they slept with a sensor placed under their bedding, after ruling out insomnia and dementia. The incidence of delirium was 28.6%;delirium onset occurred within an average of 2.7 (SD = 12) days after the start of home care among those whose care environment was changed due to hospital discharge or moving. Increased interrupted sleep and activity during sleep indicated that sleep fragmentation occurred before delirium onset. In conclusion, individuals aged ≥65 years and those whose care environment has changed should be screened for delirium because the time to delirium onset is short. Further, interventions to monitor the sleep status and prevent delirium onset should be implemented from the day home care begins.
基金supported by the University of California Davis Health System Department of Anesthesiology and Pain Medicine,and NIH grant UL1 TR000002
文摘Perioperative home （PH） or perioperative surgical home （PSH） is a patient centered medical service or primary care provider aimed at share decision-making and seamless continuity of care for the surgical patient. The goal is to improve operational efficiency, decrease resource utilization, reduce length of hospital/intensive care unit （ICU） stay and readmission, and to decrease complication and mortality rates. PH is an innovative model of delivering health care during the entire patient surgical/procedural experience. This model is centered around patient from the time of the decision for surgery till the patients have recovered and returned to the care of themselves.
文摘Objective:The Accountable Care Organization(ACO)model of health care delivery is based on new payment models for general practice to reward improved quality and decreased cost of care.Methods:Banner Health Network(BHN)is one of the original CMS Pioneer ACO programs and implemented a comprehensive disease management program based on the collaborative care model.Key performance indicators for CMS reflected quality and cost of care.Results:BHN has demonstrated both improved quality and cost savings in the first two years of the pilot program.The disease management program based on the collaborative care model appears to have improved patient health outcomes based on quality improvement measures.In addition the program has reduced emergency department and hospital utilization,resulting in cost savings.Conclusions:The BHN quality improvement program is the platform for analyzing and improving on the BHN ACO model.This model appears to have excellent application to the China health care system that is also focused on prevention and improvement of chronic disease and cost-effectiveness.
