UNASSIGNED: With increasing attention to models of transitional support delivered through multisectoral approaches, third-sector organizations (TSOs) have supported community reintegration and independent living post-hospitalization. This study aimed to identify the core elements of these types of programs, the facilitators, and barriers to service implementation and to understand the perspectives of providers and recipients of their experiences with the programs.
UNASSIGNED: A collective case study collected data from two UK-based \'Home from Hospital\' programs. An inductive thematic analysis generated rich descriptions of each program, and analytical activities generated insights across the cases.
UNASSIGNED: Programs provided a range of personalized support for older adults and addressed many post-discharge needs, including well-being assessments, support for instrumental activities of daily living, psychosocial support, and other individualized services directed by the needs and preferences of the service user. Results suggest that these programs can act as a \'safety net\' and promote independent living. Skilled volunteers can positively impact older adults\' experience returning home.
UNASSIGNED: When the programs under study are considered in tandem with existing evidence, it facilitates a discussion of how TSO services could be made available more widely to support older adults in their transition experiences.

There are long-standing concerns that people experiencing homelessness may not recover well if left unsupported after a hospital stay. This study reports on a study investigating the cost-effectiveness of three different \'in patient care coordination and discharge planning\' configurations for adults experiencing homelessness who are discharged from hospitals in England. The first configuration provided a clinical and housing in-reach service during acute care and discharge coordination but with no \'step-down\' care. The second configuration provided clinical and housing in-reach, discharge coordination and \'step-down\' intermediate care. The third configuration consisted of housing support workers providing in-reach and discharge coordination as well as step-down care. These three configurations were each compared with \'standard care\' (control, defined as one visit by the homelessness health nurse before discharge during which patients received an information leaflet on local services). Multiple sources of data and multi-outcome measures were adopted to assess the cost utility of hospital discharge service delivery for the NHS and broader public perspective. Details of 354 participants were collated on service delivery costs (salary, on-costs, capital, overheads and \'hotel\' costs, advertising and other indirect costs), the economic consequences for different public services (e.g. NHS, social care, criminal justice, housing, etc.) and health utilities (quality-adjusted-life-years, QALYs). Findings were complex across the configurations, but, on the whole, there was promising evidence suggesting that, with delivery costs similar to those reported for bed-based intermediate care, step-down care secured better health outcomes and improved cost-effectiveness (compared with usual care) within NICE cost-effectiveness recommendations.

BACKGROUND: Stroke affects many aspects of life in stroke survivors and their family, and returning home after hospital discharge is a key step for the patient and his or her relatives. Patients and caregivers report a significant need for advice and information during this transition period. Our hypothesis is that, through a comprehensive, individualised and flexible support for patients and their caregivers, a patient-centred post-stroke hospital/home transition programme, combining an Internet information platform and telephone follow-up by a case manager, could improve patients\' level of participation and quality of life.
METHODS: An open parallel-group randomized trial will be conducted in two centres in France. We will recruit 170 adult patients who have had a first confirmed stroke, and were directly discharged home from the stroke unit with a modified Rankin score ≤3. Intervention content will be defined using a user-centred approach involving patients, caregivers, health-care professionals and social workers. Patients randomized to the intervention group will receive telephonic support by a trained case manager and access to an interactive Internet information platform during the 12 months following their return home. Patients randomized to the control group will receive usual care. The primary outcome is patient participation, measured by the \"participation\" dimension score of the Stroke Impact Scale 6 months after discharge. Secondary outcomes will include, for patients, quality of life, activation, care consumption, as well as physical, mental and social outcomes; and for caregivers, quality of life and burden. Patients will be contacted within one week after discharge, at 6 and 12 months for the outcomes collection. A process evaluation alongside the study is planned.
CONCLUSIONS: Our patient-centred programme will empower patients and their carers, through individualised and progressive follow-up, to find their way around the range of available healthcare and social services, to better understand them and to use them more effectively. The action of a centralised case manager by telephone and the online platform will make it possible to disseminate this intervention to a large number of patients, over a wide area and even in cases of geographical isolation.
BACKGROUND: ClinicalTrials NCT03956160 , Posted: May-2019 and Update: September-2021.

The rising trend in hospital admissions among patients with chronic obstructive pulmonary disease (COPD) is worrying, not only because of the increasing costs, but also because of the worsening quality of life. We aimed to identify the predictive factors of hospital admission, re-admission and mortality of COPD patients through using information exclusively registered in electronic clinical records.
We conducted a population-based case-control study. All data were sourced from the different information systems comprising the Galician Health Service electronic record database. We included in the study patients diagnosed with COPD (code R95 in the medical record), ≥35 years old and with at least one spirometry performed ≤3 years prior inclusion. We fitted three logistic regression models, each one to ascertain the factors that influence the probability of admission, re-admission, and mortality, and calculated odds ratios (OR) with their 95% confidence intervals (95% CI).
COPD patients were admitted due to respiratory causes a mean of 1.51 times across the period December 2016-December 2017, with 55% requiring re-admission in the next 90 days. The factor most closely associated with the re-admission profile was home oxygen therapy (OR 3.06 95% CI 2.42-3.87), followed by male gender (OR 2.01 95% CI 1.48-2.72), a CHA2D-VASc scale score >2 (OR 1.28 95% CI 1.16-1.42), and severity by clinical risk group stratification (OR 1.14 95% CI 1.04-1.26). Male sex (OR 1.47 CI 95% 1.04-2.09), having been readmitted ≥2 times (OR 1.34 CI 95% 1.11-1.61) and being ≥70 years old (OR 1.05 CI 95% 1.03-1.08) increase the probability of dying from COPD during the study period.
These results confirm the complexity of management of COPD exacerbations, and indicate the need to establish strategies that would ensure continuity of care after hospital admission, with the aim of preventing re-admissions and death.

Palliative/end-of-life care is an integral part of the district nursing service. There is increasing demand for palliative care to be delivered in the community setting. Therefore, there is a need for excellent collaboration between staff in primary and secondary care settings to achieve optimum care for patients. This article critically analyses the care delivered for a palliative patient in the hospital setting and his subsequent transition to the community setting. The importance of effective communication, holistic assessment in palliative care, advance care planning, organisational structures and the socio-cultural aspects of caring for patients at the end of life are discussed. Additionally, the article highlights the impact of substandard assessment and communication and the consequent effect on patients and families.

BACKGROUND: Concern has been raised regarding the underreporting of nonmalignant central nervous system tumors. This study addressed this issue with 2 objectives: (1) evaluate the impact of linkage with hospital discharges, as recorded in the Discharge Abstract Database (DAD), on supplementing case ascertainment for brain tumors, and (2) identify potential barriers for initial registration of brain tumors in the Alberta Cancer Registry.
METHODS: All patients with a brain tumor diagnosed and residing in Alberta from 2010 to 2015 were extracted, after the DAD review, from the Alberta Cancer Registry (ACR). Descriptive statistics were compiled by behavior and type of registration (originally registered or identified through DAD). The total number of expected nonmalignant brain tumors was estimated by applying the Central Brain Tumor Registry of the United States (CBTRUS) incidence rates to the Alberta population and this estimate was compared to observed numbers. Phi coefficients and χ2 tests for the homogeneity of proportions were conducted to examine bivariate relationships of the characteristics of interest. Multiple logistic regression was used to summarize the independent effects on the probability of being identified through DAD.
RESULTS: The results show 5% of malignant and 35% of nonmalignant brain tumors were identified through DAD review. When comparing observed to expected number of nonmalignant cases after DAD review, the ACR ultimately captured 76% of those expected. Identification through DAD was statistically significantly (P ≤ .05) associated with patients over 75 years old at diagnosis (odds ratio [OR], 2.5), tumors of benign behavior (OR, 2.6), location at diagnosis in Northern Alberta (OR, 1.5), nonmicroscopically confirmed tumors (OR, 1.3), no visit to a CancerControl Alberta facility (OR, 8.7) and certain histological subtypes, including cranial and spinal nerve tumors (OR, 1.7).
CONCLUSIONS: The use of hospital discharge data significantly improved nonmalignant brain tumor case ascertainment. Therefore, it is recommended that such reviews be instituted annually in provinces while other techniques (such as reminder letters used in Norway or linkages with radiology or other administrative databases) for improving case ascertainment are explored. Those characteristics identified as potential barriers to registration should be investigated to identify possible process improvements in Alberta.

BACKGROUND: Hospital readmissions is an increasingly serious international problem, associated with higher risks of adverse events, especially in elderly patients. There can be many causes and influential factors leading to hospital readmissions, but they are often closely related, making hospital readmissions an overall complex area. In addition, a comprehensive coordination reform was introduced into the Norwegian healthcare system in 2012. The reform changed the premises for readmissions with economic incentives enhancing early transfer from secondary to primary care, making research on readmissions in the municipalities more urgent than ever. General practitioners (GPs) and nursing home physicians, have traditionally held a gatekeepers function in hospital readmissions from the municipal healthcare service, as they are the main decision-makers in questions of hospital readmissions. Still, the GPs\' gatekeeper function is an under-investigated area in hospital readmission research. The aim of the study was to increase knowledge about factors that lead to hospital readmissions among elderly in municipal healthcare, with special attention to GPs\' and nursing home physicians\' decision making.
METHODS: The study was conducted as a comparative case study. Two municipalities affiliated with the same hospital, but with different readmission rates were recruited. Twenty GPs and nursing home physicians from each municipality were recruited and interviewed. Forty hours of observation were conducted during the huddles in one long-term and one short-term nursing home in each municipality.
RESULTS: Seven themes describing how different factors influence physicians\' decision-making in the hospital readmission process in two municipalities were identified. Poor communication, continuity and information flow account for hospital readmissions in both municipalities. Several factors, including nurse staffing and competence, patients and their families, time constraints and experience affected physicians\' decision-making.
CONCLUSIONS: Communication, continuity and information flow contributed to hospital readmissions in both municipalities. The cross-case analysis revealed slight differences between municipalities. More research focusing on GPs\' and nursing home physicians\' decision-making, nursing home nurses and home care nurses\' experience of hospital readmissions and discharges is needed.

A case study was conducted in 2016 to evaluate the effectiveness of an innovation to enable people with \"complex\" care requirements to be discharged from hospital to an appropriate service for their care, without using the NHS England Continuing Health Care (CHC) assessment. The setting was a rural district general hospital in England, where the quality outcomes and cost-effectiveness of the CHC assessment being conducted in hospital were giving cause for concern. The NHS CHC Framework advocates conducting these assessments in the community where a more accurate indication of long-term care can be determined. The \"5Q Care Test\" was collaboratively developed with health and social care partners, care providers, and CHC interest groups, including users of the services. It was implemented as a tool to support moving the CHC assessment into the community, as it enabled practitioners to swiftly determine patients\' appropriate initial care pathway out of hospital. A full economic impact analysis was conducted 7 months after the tool was introduced. The results showed significant improvement in the quality and cost-effectiveness of the \"5Q Care Test,\" with a reduction in the hospital length of stay, which is known to be associated with improved outcomes for patients and financial savings.

Medical hospitalization is a high risk period for suicide. It is important to understand system-level factors that may be associated with suicide after a medical hospitalization.
Retrospective study of root-cause analysis (RCA) reports of suicide occurring within three months of Veterans Administration (VA) medical hospitalization, 2002-2015. We collected patient and system-level factors to characterize events.
There were 96 RCA reports pertaining to suicide within three months of medical hospitalization. A total of 168 root causes for suicide were identified and fell into three major themes including: management of known suicide risk (N=73, 43%), decision making to monitor suicide risk (N=48, 29%), and patient engagement in treatment (N=47, 28%). RCA reports raised concerns that medical teams did not provide mental health treatment when indicated and lacked a standardized process for assessing psychological well-being in patients with a serious medical illness. In 25 cases, patients declined recommended treatment and in 15 cases, patients left against medical advice (AMA).
Challenges with patient engagement in treatment and lack of standardized processes for assessing and managing suicide risk may play an important role in suicide risk after medical hospitalization. Additional high quality studies are needed to confirm our findings.

BACKGROUND: Efforts to mitigate costs while improving surgical care quality have received much scrutiny. This includes the challenging issue of readmission subsequent to hospital discharge. Initiatives attempting to preclude readmission after surgery require planned and unified efforts extending throughout the perioperative continuum. Patient optimization prior to discharge, enhanced disease monitoring, and seamless coordination of care between hospitals and community providers is integral to this process. The perioperative surgical home (PSH) has been proposed as a model to improve the delivery of perioperative healthcare via patient-centered risk stratification strategies that emphasize value and evidence-based processes.
RESULTS: This case report seeks to specifically describe implementation of readmission reduction strategies via a PSH paradigm during total joint arthroplasty (TJA) procedures at the University of California Irvine (UCI) Health. An orthopedic surgeon open to collaborate within a PSH paradigm for TJA procedures was recruited to UCI Health in October of 2012. Institution specific data was then prospectively collected for 2 years post implementation of the novel program. A total of 328 unilateral, elective primary TJA (120 hip, 208 knee) procedures were collectively performed. Demographic analysis reveals the following: mean age of 64 ± 12; BMI of 28.5 ± 6.2; ASA Score distribution of 0.3 % class 1, 23 % class 2, 72 % class 3, and 4.3 % class 4; and 62.5 % female patients. In all, a 30-day unplanned readmission rate of 2.1 % (95 % CI 0.4-3.8) was observed during the study period. As a limitation of this case report, this reported rate does not reflect readmissions that may have occurred at facilities outside UCI Health.
CONCLUSIONS: As healthcare evolves to emphasize value over volume, it is integral to invest efforts in longitudinal patient outcomes including patient disposition subsequent to hospital discharge. As outlined by this case management report, the PSH provides an institution-led means to implement a series of care initiatives that optimize the important metric of readmission following TJA, potentially adding further value to patients, surgical colleagues, and health systems.