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The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review.

ABSTRACT: BACKGROUND AND AIM:Intermediate care describes services, including transitional care, that support the needs of middle-aged and older adults during care transitions and between different settings. This scoping review aimed to examine the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. DESIGN:A scoping review of the literature was conducted including studies published between 2002 and 2019 with a transitional care and/or intermediate care intervention for adults aged???50. Searches were performed in CINAHL, Cochrane Library, EMBASE, Open Grey and PubMed databases. Qualitative and quantitative approaches were employed for data synthesis. RESULTS:In all, 133 studies were included. Interventions were grouped under four models of care: (a) Hospital-based transitional care (n?=?8), (b) Transitional care delivered at discharge and up to 30 days after discharge (n?=?70), (c) Intermediate care at home (n?=?41), and (d) Intermediate care delivered in a community hospital, care home or post-acute facility (n?=?14). While these models were associated with a reduced hospital stay, this was not universal. Intermediate including transitional care services combined with telephone follow-up and coaching support were reported to reduce short and long-term hospital re-admissions. Evidence for improved ADL function was strongest for intermediate care delivered by an interdisciplinary team with rehabilitation at home. Study design and types of interventions were markedly heterogenous, limiting comparability. CONCLUSIONS:Although many studies report that intermediate care including transitional care models reduce hospital utilisation, results were mixed. There is limited evidence for the effectiveness of these services on function, institutionalisation, emergency department attendances, or on cost-effectiveness.

SUBMITTER: Sezgin D

PROVIDER: S-EPMC7402396 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review.

Sezgin Duygu D O'Caoimh Rónán R Liew Aaron A O'Donovan Mark R MR Illario Maddelena M Salem Mohamed A MA Kennelly Siobhán S Carriazo Ana María AM Lopez-Samaniego Luz L Carda Cristina Arnal CA Rodriguez-Acuña Rafael R Inzitari Marco M Hammar Teija T Hendry Anne A

European geriatric medicine 20200804 6

<h4>Background and aim</h4>Intermediate care describes services, including transitional care, that support the needs of middle-aged and older adults during care transitions and between different settings. This scoping review aimed to examine the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs.<h4>Design</h4>A scoping review of the literature was conducted including studies published betwe ...[more]

PMID: 32754841

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Project description:ObjectiveTemporomandibular joint disorder (TMD) requires long-term management and can be a financial burden for patients. Here, we investigated the treatment received by people diagnosed with TMD and its relevant costs.DesignA descriptive, cross-sectional study.Setting and participantsWe performed secondary data analysis of health insurance claims data provided by the Health Insurance Assessment and Review (HIRA) of the Republic of Korea. We reviewed the records of 10 041 patients who were diagnosed with TMD and who utilised outpatient healthcare service at least once between January and December 2017.Primary and secondary outcome measuresData on use of medical services, hospitalisations, sociodemographic factors, treatment and medication were retrieved and analysed. Cost was defined as the cost of care incurred by a health insurance beneficiary at a care facility.ResultsWe reported the characteristics as medians, frequencies and percentages and found that most TMD patients were outpatients, women (58.9%) and in their 20s (46.4%). For visit type, 85.9% of all patients had an outpatient dental medical visit, with most visiting dental clinics and dental hospitals. Western medicine (WM; 9.8%) was prescribed more often, followed by Korean medicine (KM; 8.2%). The median expense per patient was highest among those in their 20s (58.00, 23.90, 53.40, 65.90 US$ for overall, WM, dental medicine (DM) and KM, respectively). Consultation fees accounted for the greatest percentage (42.8%) of DM and WM care expenses, while injection/non-surgical intervention fees accounted for the greatest percentage of KM care expenses. The most commonly used treatments for TMD were temporomandibular joint stimulation therapy (51.1%) and acupuncture (19.9%), considered as the most basic care for TMD. Psychosomatic agents (86.4%) were the most commonly used medications in outpatients.ConclusionsWhile people with TMD most commonly received temporomandibular stimulation therapy, the costs and duration of treatment varied significantly for these patients.

Project description:IntroductionFaced with costly hospital readmissions of increasingly complex patient populations, transitional care is a priority throughout Ontario, Canada; yet, rural patients have significantly more hospital readmissions and emergency department visits during the first 30 days following hospitalisation than urban patients. Because transitional care (TC) was designed and evaluated with urban patients, addressing urban-rural disparities in TC effectiveness requires increasing the alignment of TC with the needs of patients and families in rural communities and the rural nursing practice context. The study objectives are to (1) determine the perceived acceptability of evidence-based TC interventions targeting postdischarge care management to patients, families and nurses and (2) adapt the interventions to patients' and families' needs and the rural nursing practice context.Methods and analysisThis multimethod study has two phases. In phase I, 32-48 patients and families will rate their level of preparedness for discharge and the acceptability of evidence-based TC interventions. Participants will be engaged in semi-structured interviews about their care management needs, their perspectives on the interventions in fitting those needs and in providing suggestions for adapting the interventions to fit their needs. TC interventions perceived as acceptable to patients and families will be examined in phase II. In phase II, 32-48 hospital and home care nurses will rate the acceptability of the interventions identified by patients and families and attend focus group discussions on the feasibility of providing the interventions. Phase I and II data will be analysed using descriptive statistics and qualitative content analysis.Ethics and disseminationEthics approval was obtained from the Research Ethics Board at York University and participating hospital sites. Findings will be communicated through plain language fact sheets, policy briefs, press-releases and peer-reviewed conference presentations and manuscripts.

Project description:BACKGROUND:Homelessness is a growing concern as it affects a large number of people worldwide. Individuals and families experiencing homelessness are vulnerable in terms of health and underutilise health services. Despite being a global problem, not much is known about the range and breath of literature exploring health problems and health care service utilisation among homeless adults in Africa. OBJECTIVES:To identify the nature and scope of existing evidence on physical and mental health, and health service utilisation among homeless adults in Africa. The review aimed to examine how research is conducted, identify gaps, guide future research, and make recommendations for development and implementation of policies and practices. METHODS:A search of articles and reports involving six databases: Scopus, MEDLINE, CINAHL, PubMed, African Journal Online, and Google Scholar was conducted from June 2018 to February 2019. Studies published between 1980 and 2019 that examined the health problems and health service utilisation among homeless adults in Africa were considered. Manual search in reference lists and grey literature was also done to add reports. Data was extracted manually using a charting developed. A descriptive analysis and narrative synthesis were performed. RESULTS:Of 761 records found, 14 satisfied the pre-determined inclusion and exclusion criteria. Three themes emerged from the studies: Physical health problems, mental health problems; and healthcare services utilisation. Of the 14 included studies, nine studied and reported physical health problems such as sexually transmitted infections, injuries and disabilities, respiratory and cardiac diseases. Five studies explored mental health problems such as psychotic disorders, mood disorders, self-harm and suicidal behaviour. Only five studies investigated utilisation of different types of health care services among homeless people. CONCLUSIONS:Evidence shows that homeless adults suffered from a range of physical and mental health problems, and underutilisation of health care services. However, there is lack of information on the complex interrelationship between homelessness and health, as well as differences in prevalence of health problems among the various sub-groups of homeless. There is also lack of information regarding utilisation other important healthcare services such as mental health services, alcohol and drugs services, and accident and emergency service, and future researches should address that. Also, attention should be given to intervention models for complex and effective physical and psychiatric care as well as social support to address the homeless people's health vulnerabilities.

Project description:BackgroundHeart failure (HF) imposes a substantial burden on patients and healthcare systems. Hospital-to-home transitional care, involving time-limited interventions delivered predominantly by nurses, was introduced to lighten this burden. This study aimed to examine the effectiveness and dose-response of nurse-led transitional care interventions (TCIs) on healthcare utilization among patients with HF.MethodsHealth-related databases were systematically searched for articles published from January 2000 to June 2020. We included randomized controlled trials (RCTs) that compared nurse-led TCIs with usual care for adults hospitalized with HF and reported the following healthcare utilization outcomes: all-cause readmissions, HF-specific readmissions, emergency department visits, or length of hospital stay. Random-effects meta-analysis, meta-regression analysis, and dose-response analysis were performed to estimate the treatment effects and explain the heterogeneity.ResultsTwenty-five RCTs including 8422 patients with HF were included. Nurse-led TCIs for patients with HF resulted in a mean 9% (RR = 0.91; 95% CI = 0.82 to 0.99; p = 0.04; I2 = 46%) and 29% (RR = 0.71; 95% CI = 0.60 to 0.84; p < 0.0001; I2 = 0%) reduction in all-cause and HF-specific readmission risks respectively compared to usual care. The interventions were also effective in shortening the length of hospital stay (MD = -2.37; 95% CI = -3.16 to -1.58; p < 0.0001; I2 = 14%). However, no significant reduction was found for emergency department visits (RR = 0.96; 95% CI = 0.84 to 1.10; p = 0.58; I2 = 0%). The effect of meta-regression coefficients on all-cause and HF-specific readmissions was not statistically significant for any prespecified trial-level characteristic. Dose-response analysis revealed that the HF-specific readmission risk decreased in a dose-dependent manner with the complexity and intensity of nurse-led TCIs.ConclusionsNurse-led TCIs were effective in decreasing all-cause and HF-specific readmission risks, as well as in reducing the length of hospital stay; however, the interventions were not effective in reducing the frequency of emergency department visits.

Project description:Background:In democracies, voting is an important action through which citizens engage in the political process. Although elections are only one aspect of political engagement, voting sends a signal of support or dissent for policies that ultimately shape the social determinants of health. Social determinants subsequently influence who votes and who does not. Our objective is to examine the existing research on voting and health and on interventions to increase voter participation through healthcare organizations. Methods:We conducted a scoping review to examine the existing research on voting, health, and interventions to increase voter participation through healthcare organizations. We carried out a search of the indexed, peer-reviewed literature using Ovid MEDLINE (1946-present), PsychINFO (1806-present), Ebsco CINAHL, Embase (1947-present), Web of Science, ProQuest Sociological Abstracts, and Worldwide Political Science Abstracts. We limited our search to articles published in English. Titles and abstracts were reviewed, followed by a full-text review of eligible articles and data extraction. Articles were required to focus on the connection between voting and health, or report on interventions that occurred within healthcare organizations that aimed to improve voter engagement. Results:Our search identified 2041 citations, of which 40 articles met our inclusion criteria. Selected articles dated from 1991-2018 and were conducted primarily in Europe, the USA, and Canada. We identified four interrelated areas explored in the literature: (1) there is a consistency in the association between voting and health; (2) differences in voter participation are associated with health conditions; (3) gaps in voter participation may be associated with electoral outcomes; and (4) interventions in healthcare organizations can increase voter participation. Conclusion:Voting and health are associated, namely people with worse health tend to be less likely to engage in voting. Differences in voter participation due to social, economic, and health inequities have been shown to have large effects on electoral outcomes. Research gaps were identified in the following areas: long-term effects of voting on health, the effects of other forms of democratic engagement on health, and the broader impact that health providers and organizations can have on voting through interventions in their communities.

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The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review.

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The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review.

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