Abstract TP278: Positive Impact of a Stroke Bundle Program

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Deborah Murphy ◽  
Colleen Boyle ◽  
Elissa Della Monica ◽  
Heather Peiritsch ◽  
Laura Schmidt ◽  
...  
Keyword(s):  
Care Coordination ◽  
Positive Impact ◽  
Hospital Readmissions ◽  
Transitions Of Care ◽  
Hospital Length Of Stay ◽  
Care Process ◽  
Full Time ◽  
Stroke Patients ◽  
Nurse Navigator ◽  
The Impact

Introduction: There are limited comparative data on the impact of a stroke bundle program on patient outcomes. We aimed to assess the magnitude of change that could occur during transitions of care process by implementation of a stroke bundle program. Methods: Six skilled nursing facilities (SNF) participated with a Joint Commission certified Comprehensive Stroke Center to implement a Bundled Payment Care Initiative (BPCI) program. The stroke leadership developed a charter and additional support teams (care coordination and SNF). Three smart goals were identified and reflected organizational strategic goals: reduction of the number of stroke patients that are admitted to a SNF by 5% (baseline 27.9%); reduction of preferred provider SNF days for stroke patients by 10% (baseline 35.5%) and reduction of hospital readmissions for stroke by 5% (baseline 31.5%). A strong infrastructure supported the care coordination teams including the hiring of a full time stroke nurse navigator. The kick off for the program was October 1, 2015. Several strategic and operational initiatives were developed and successfully implemented at SNFs: utilization of stroke clinical practice guidelines: stroke education programs; stroke summit for all SNF administrators, physicians and staff; bi-monthly, face to face/conference call meetings with SNF administrators and bundle team leadership; case reviews between caregivers at acute setting and SNF; SharePoint site to enhance communication; stroke nurse navigator interaction with patients, families, SNF staff, 90 day follow up and readmission case reviews. Results: Smart goal achievement over a 6 month period demonstrated: reduction of the number of stroke patients that were admitted to SNF by .4% (21.9%); reduction of preferred provider SNF days for stroke patients by 16% (16%) and reduction of hospital readmissions for stroke by 7% (23.3%). Comparison of hospital length of stay variance between bundle (3.78) and non-bundle patients (5.08) patients was 1.3%. Conclusions: A stroke bundle program impacts positively on transitions of care at preferred provider SNF facilities. Standardization of care and a unified care team attributes to stroke patients returning to their life at home in a much more efficient and timely manner.

scholarly journals Transitions of Care Coordination Intervention Identifies Barriers to Discharge in Hospitalized Stroke Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
William Denney Zimmerman ◽  
Rachel E. Grenier ◽  
Sydney V. Palka ◽  
Kelsey J. Monacci ◽  
Amanda K. Lantzy ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Usual Care ◽  
Acute Ischemic Stroke ◽  
Transitions Of Care ◽  
Hospital Length Of Stay ◽  
Care Hospital ◽  
Stroke Patients ◽  
Significant Difference ◽  
Nurse Navigator ◽  
Prolonged Hospital

Background: Prolonged hospital lengths of stay increase costs, delay rehabilitation, and expose acute ischemic stroke patients to hospital-acquired infections. We designed and implemented a nurse-driven transitions of care coordinator (TOCC) program to facilitate the transition of care from the acute care hospital setting to rehabilitation centers and home.Methods: This was a single-blinded, prospective, randomized pilot study of 40 participants to evaluate the feasibility of implementing a TOCC program led by a stroke nurse navigator in hospitalized acute ischemic stroke patients. The intervention consisted of a stroke nurse navigator completing eight specific tasks, including meeting with stroke patients and their families, facilitating communication between team members at multi-disciplinary rounds, assisting with referrals to rehabilitation facilities, providing stroke education, and arranging stroke clinic follow-up appointments, which were confirmed to be completed by independent study personnel. The primary outcome was to assess the feasibility of the program. The secondary outcomes included comparing hospital length of stay (LOS) and patient satisfaction between the TOCC and usual care groups. We also explored the association between patient-level variables and LOS.Results: The TOCC program was feasible with all pre-specified components completed in 84.2% (95% CI: 60.4–96.6%) and was not significantly different from the assumed completion rate of 75% (p = 0.438). There was no significant difference in median LOS between the two groups [TOCC 5.95 days (4.02, 9.57) vs. usual care 4.01 days (2.00, 10.45), false discovery rate (FDR)-adjusted p = 0.138]. There was a trend toward higher patient median satisfaction in the TOCC group [TOCC 35.00 (33.00, 35.00) vs. usual care 30 (26.00, 35.00), FDR-adjusted p = 0.1] as assessed by a questionnaire at 30 days after discharge. The TOCC study allowed us to identify patient variables (gender, insurance, stroke severity, and discharge disposition) that were significantly associated with longer hospital LOS.Conclusion: A TOCC program is feasible and can serve as a guide for future allocation of resources to facilitate transitions of care and avoid prolonged hospital stays.

scholarly journals Real-world evidence on impact of a pharmacist-led transitional care program on 30- and 90-day readmissions after acute care episodes

2020 ◽  
Vol 77 (7) ◽  
pp. 535-545 ◽  
Author(s):  
Yuna H Bae-Shaaw ◽  
Hyunah Eom ◽  
Robert F Chun ◽  
D Steven Fox
Keyword(s):  
Acute Care ◽  
Transitional Care ◽  
Care Program ◽  
Hospital Length ◽  
Transitions Of Care ◽  
Hospital Length Of Stay ◽  
Care Process ◽  
Chronic Obstructive ◽  
Intervention Site ◽  
The Impact

Abstract Purpose Recent evidence suggests that improving the transitional care process may reduce 30-day readmissions and hospital length of stay (LOS). The objective of this study was to evaluate the impact of a pharmacist-led transitions-of-care (TOC) program on 30- and 90-day all-cause readmissions and LOS for patients discharged from the hospital acute care setting. Methods A retrospective cohort study was conducted using a difference-in-difference (DID) approach. Patients who were at least 18 years old with any of the following primary diagnoses were included: acute myocardial infarction, chronic obstructive pulmonary disease, congestive heart failure (CHF), and pneumonia. Outcome measures were all-cause 30- and 90-day readmission and LOS for the index admission. Results From October 2013 through September 2017, 1,776 patients were discharged from the intervention site, and 2,969 patients were discharged from 3 control sites. Only 33.3% of eligible patients at the intervention site actually received the intervention. The DID analysis showed that the odds ratio (OR) for 30-day readmission was 0.65 [P = 0.035] at the intervention site following TOC program initiation. The OR for 90-day readmission was 0.75 [P = 0.070]. Among all diagnosis groups, the CHF subgroup had the highest proportion of patients who actually received the TOC intervention (57.2%). Within that CHF subgroup, the ORs for 30- and 90-day readmissions were 0.52 [P = 0.056] and 0.47 [P = 0.005], respectively. The mean LOS did not change significantly in either analysis. Conclusion This pharmacist-led transitional care intervention was associated with significantly decreased inpatient readmissions. The analysis indicates that pharmacist interventions can significantly reduce 30-day readmissions for high-risk populations and 90-day readmissions in patients with CHF.

Diabetes Discharge Planning and Transitions of Care: A Focused Review

2019 ◽  
Vol 15 (2) ◽  
pp. 111-117 ◽  
Author(s):  
Robin L. Black ◽  
Courtney Duval
Keyword(s):  
Patient Outcomes ◽  
Hospital Admissions ◽  
Discharge Planning ◽  
Medication Management ◽  
Hospital Readmissions ◽  
The United States ◽  
Transitions Of Care ◽  
Discharge Process ◽  
The Impact ◽  
Diabetes Patients

Background: Diabetes is a growing problem in the United States. Increasing hospital admissions for diabetes patients demonstrate the need for evidence-based care of diabetes patients by inpatient providers, as well as the importance of continuity of care when transitioning patients from inpatient to outpatient providers. Methods: A focused literature review of discharge planning and transitions of care in diabetes, conducted in PubMed is presented. Studies were selected for inclusion based on content focusing on transitions of care in diabetes, risk factors for readmission, the impact of inpatient diabetes education on patient outcomes, and optimal medication management of diabetes during care transitions. American Diabetes Association (ADA) guidelines for care of patients during the discharge process are presented, as well as considerations for designing treatment regimens for a hospitalized patient transitioning to various care settings. Results: Multiple factors may make transitions of care difficult, including poor communication, poor patient education, inappropriate follow-up, and clinically complex patients. ADA recommendations provide guidance, but an individualized approach for medication management is needed. Use of scoring systems may help identify patients at higher risk for readmission. Good communication with patients and outpatient providers is needed to prevent patient harm. A team-based approach is needed, utilizing the skills of inpatient and outpatient providers, diabetes educators, nurses, and pharmacists. Conclusion: Structured discharge planning per guideline recommendations can help improve transitions in care for patients with diabetes. A team based, patient-centered approach can help improve patient outcomes by reducing medication errors, delay of care, and hospital readmissions.

115 The Impact of Burn Injury on Upper Extremity Prosthesis Users

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S77-S77
Author(s):  
Jill M Cancio ◽  
Matthew Borgia ◽  
Leopoldo C Cancio ◽  
Linda Resnik
Keyword(s):  
Quality Of Life ◽  
Upper Extremity ◽  
Performance Testing ◽  
Hospital Length Of Stay ◽  
Shoulder Abduction ◽  
Phantom Pain ◽  
Assessment Procedure ◽  
Full Time ◽  
The Impact

Abstract Introduction Burns with upper extremity (UE) amputation present a unique rehabilitation challenge. The purpose of this study of UE amputees who are active prosthesis users was to compare outcomes for those with and without burns. Methods This is part of a larger nationwide study of U.S. military members and veterans with UE amputations. In-person data were collected at 5 sites. An therapist measured passive and active range of motion (PROM, AROM); administered the Quick Disability of the Arm, Shoulder, and Hand; Community Reintegration of Injured Service Members-Computer Adaptive-Test; Trinity Amputation and Prosthetic Experience Scale; health-related quality of life (VR-12); Activities Measure for Upper Extremity Amputees; Southampton Assessment Procedure; 9-Hole Peg Test; and Jebsen-Taylor Hand Function Test (JTHF); and recorded residual and phantom pain; timing of prosthesis receipt; and current prosthesis use. The IRB approved this study. Results Data were collected on 126 individuals with UE amputation, of whom 105 had data on etiology and were included. Of these, 13 (12.4%) had burns (B) vs non-burn (NB). The majority were unilateral amputees (69% B, 90% NB). Most were transradial (TR) amputees (B 84.6%, NB 66.3%) as opposed to transhumeral (TH). A minority received their prosthetics within the first 3 months post-amputation (11.1% B, 28.8% NB) (p=0.15). Average age was 57.6 (SD 15.6) years for NB and 53.0 (20.6) years for B. Mean time since amputation was 22.5 (18.0) years for NB and 25.2 (17.3) years for B. The following non-significant differences in outcomes between B and NB were observed. Thirty-nine percent of B were employed full-time vs 18.9% of NB (p=0.15). The primary prosthesis was, for NB, a body-powered prosthesis (66.7%); for B, myoelectric (50%) or body-powered (50%). For unilateral UE amputees, there were no differences between B and NB on performance testing for dexterity and functional tasks or in self-reported disability, quality of life or prevalence or intensity of pain. B trended towards more moderate to severe PROM deficits with shoulder forward flexion (TH B 50%, TH NB 23.1% [p=0.444]; TR B 20%, TR NB 5.6% [p=0.197]) and shoulder abduction (TH B 50%, TH NB 26.9% [p=0.497]; TR B 30%, TR NB 16.4% [p=0.376]). Also, TR amputees with burns trended towards more PROM deficits with elbow flexion (B 20%, NB 6.9% [p=0.212]) and elbow extension (B 20%, NB 8.6% [p=0.272]). AROM deficits also trended greater in B. Conclusions We did not observe differences in physical function, pain levels, or quality of life between those with and without burns. Further studies with larger samples are needed, to include analysis of burn location, burn size, hospital length of stay, and rehabilitation care.

scholarly journals Perceptions of the impact of job rotation on employees, productivity, the organization and on job security

2014 ◽  
Vol 11 (4) ◽  
pp. 682-691
Author(s):  
Dayanath Dhanraj ◽  
Sanjana Brijball Parumasur
Keyword(s):  
Positive Impact ◽  
Job Security ◽  
Small Population ◽  
Employee Perceptions ◽  
Organizational Level ◽  
Time Shift ◽  
Full Time ◽  
Job Rotation ◽  
High Degree ◽  
The Impact

This study assesses employee perceptions of the impact of job rotation on employees, production, the organization and on job security. Biographical influences (gender, age, marital status, division, organizational level, tenure) regarding these impacts were also assessed. The study was undertaken in an operations environment of a textile company in KwaZulu-Natal, South Africa. The population includes 77 full time shift employees in the organization and due to the small population size consensus sampling was used. Data was collected using a self-developed, pre-coded, self-administered questionnaire whose reliability was assessed using Cronbach’s Coefficient Alpha. Data was analyzed using descriptive and inferential statistics. The findings reflect that employees perceive that job rotation has a high degree of positive impact on employees, productivity, job security and on the organization respectively. Recommendations have been presented that have the potential to enhance and sustain the positive impact of job rotation in the workplace

Abstract WP356: Unbundling Care Transitions and Cost After Stroke: Results From the BPCI-Advanced Program

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Geri Sanfillippo ◽  
Brian Olkowski ◽  
Hermann Christian Schumacher ◽  
David Dafilou ◽  
Colleen Bowski ◽  
...  
Keyword(s):  
Acute Care ◽  
Resource Utilization ◽  
Care Coordination ◽  
Program Implementation ◽  
Care Transitions ◽  
Inpatient Rehabilitation ◽  
Hospital Length Of Stay ◽  
Early Supported Discharge ◽  
The Impact ◽  
Post Acute Care

Introduction: The Centers for Medicare and Medicaid Services bundled payment for care improvement advanced (BPCI-A) program incentivizes providers to better coordinate care, reduce expenses, and improve quality. The purpose of this study was to determine the impact of improving post-acute care coordination after stroke on quality and resource utilization in the BPCI-A program. Methods: Capital Health collaborated with post-acute providers to improve communication, identify criteria for early supported discharge to the community, expedite home health and outpatient services, reduce readmissions, and initiate advanced care planning. The redesigned post-acute care coordination program was implemented at Capital Health’s primary and comprehensive stroke center. Quality outcomes and resource utilization measures for patients enrolled in the BCPI-A program were compared to BPCI-A eligible patients prior to program implementation. Results: Forty-three patients enrolled in the BCPI-A program were compared to 77 patients eligible for enrollment. Clinical and demographic characteristics were similar (p>.05). After program implementation, 21.5% fewer patients were discharged to an inpatient rehabilitation facility (p=.024) and 14% more patients were discharged to inpatient hospice (p<.001). On average, post-acute cost decreased $16,608 per patient (p=.007) resulting in a $16,820 reduction in the 90-day cost per episode (p=.011). The 90-day hospital readmission rate decreased insignificantly by 14.1% from 23.4% to 9.3% (p=.056). Hospital cost, hospital length of stay and the 90-day mortality rate were unchanged (p>.05). Conclusion: The coordination of post-acute services facilitates care transitions after stroke. The identification of patients meeting criteria for early supported discharge to the community or admission to inpatient hospice helped reduce post-acute cost without increasing 90-day readmission or mortality.

Is management education preparing future leaders for sustainable business?

2020 ◽  
Vol 21 (2) ◽  
pp. 372-392 ◽  
Author(s):  
Gaurav Manohar Marathe ◽  
Tanusree Dutta ◽  
Sayantan Kundu
Keyword(s):  
Management Education ◽  
Positive Impact ◽  
Cognitive Empathy ◽  
Business Environment ◽  
Affective Empathy ◽  
Full Time ◽  
Content Type ◽  
Sustainability Initiatives ◽  
Management Curriculum ◽  
The Impact

Purpose The study aims to examine whether management education can successfully cultivate the competency of empathy that is needed in future corporate leaders to promote sustainability initiatives catering to diverse stakeholders. Design/methodology/approach The research highlights the impact of management education on cognitive and affective empathy by analysing the interpersonal reflectivity scores of entering students enrolled in a two-year, full-time MBA programme and the scores of the same students at graduation. Findings The findings show that management education has a positive impact on cognitive empathy, while it reduces affective empathy and general empathy. Further, findings show that the management curriculum brings cognitive and affective empathy to an equilibrium level that is needed for a competitive business environment. Research limitations/implications The research focussed only on the change in empathy of the participants (students) during management education and not during actual corporate work. Practical implications The research infers that current management education creates future executives with higher cognitive empathy. It argues that they would care more about the sustainability of the business in terms of profit or access to capital rather than care and concern for all the stakeholders, society and the environment. A new paradigm in management education also needs to be focussed around inculcating how to empathise affectively. Originality/value The study presents an empirical analysis suggesting that management education is opening the mind but not the heart. It raises a significant concern that higher management curriculum is not developing future executives who can lead the sustainability initiatives.

The importance of farmers' markets for West Virginia direct marketers

2007 ◽  
Vol 22 (1) ◽  
pp. 20-29 ◽  
Author(s):  
Cheryl Brown ◽  
Stacy M. Miller ◽  
Deborah A. Boone ◽  
Harry N. Boone ◽  
Stacy A. Gartin ◽  
...  
Keyword(s):  
West Virginia ◽  
Household Income ◽  
Positive Impact ◽  
Ordinary Least Squares ◽  
Lower Percentage ◽  
Farmers Markets ◽  
Full Time ◽  
Farmers Market ◽  
Part Time ◽  
The Impact

AbstractIn the winter of 2004–2005, over 300 of West Virginia's farmers' market vendors were surveyed with regard to sales levels, promotional techniques and operational characteristics such as hours worked, types of products produced and length of season. Vendors were categorized based on part-time, full-time or retired status, and full-time farmers, both with and without off-farm jobs, were found to be distinct from part-time and retired vendors with respect to 2004 total farmers' market sales and the percentage of household income from farmers' markets. Econometric analysis [ordinary least squares (OLS)] was performed to identify the impact of explanatory variables on total farmers' market sales, percentage of household income from farmers' market sales and amount of household income from farmers' market sales. Independent variables such as bargaining, cost-plus pricing, selling at markets outside West Virginia and providing print materials were found to have a positive impact on annual sales. The number of products produced, distance traveled to market and number of weeks at market were also positively related to the percentage of income obtained from farmers' market sales. Both part-time and retired producers received a lower percentage of household income from farmers' markets relative to full-time producers. Retired and part-time, along with limited-resource vendors (with annual household income less than $20,000) were also found to have lower total sales in the 2004 season. Identifying the characteristics associated with greater farmers' market sales and a higher reliance on such sales for household income will help in the sustained success of markets as engines of economic development and small farm viability.

scholarly journals An empirical impact analysis of Agribusiness Development Project of Bangladesh

2017 ◽  
Vol 15 (1) ◽  
pp. 62-72
Author(s):  
PK Sarma ◽  
SK Raha
Keyword(s):  
Economic Development ◽  
Urban Areas ◽  
Impact Analysis ◽  
Agricultural Land ◽  
Negative Impact ◽  
Positive Impact ◽  
Poor People ◽  
Full Time ◽  
Project Objectives ◽  
The Impact

The aim of the study was to identify the extent of the project objectives are implemented and the impact of the project. The sample size was determinate by using cluster sampling techniques with considering the design effect which was covered 1281 sample from ASA 518, BRAC 347and TMSS 415. Data was collected by pre-determine interview schedule, FGD, KII and observation methods in the year 2016. The collected data were analyzed by descriptive statistics and econometric model using the SPSS software. The result revealed that the project beneficiaries homestead, garden ponds and land on the amount of positive and negative impact on the amount of agricultural land and created employment of 2320 person in the beneficiary entrepreneurs 2104 people full-time and part-time jobs have been created. According to both the groups jobs have been created due to project activities in project area. The project has created 33432 agribusiness entrepreneurs and about three times a job was generated by them and 90524 person’s employment in rural and semi-urban areas. It help to increase monthly income on an average 30.07% which contribute to socio-economic development of the area and economy through providing support to rural poor people and creation rural entrepreneurs. The credit diversion of producers, processors, marketers and input suppliers of beneficiary group was less by 8.09%, 29.01%, 20.37% and 17.80%, respectively. This study has been undertaken as an examining to assess the role and significance of agribusiness in Bangladesh along with the present situation and future prospective. Agribusiness plays a vital role to the increased income realized by the farmers. The study recommended that the agribusiness has positive impact on income of the farmers, increased commercialization and economic development in Bangladesh.J. Bangladesh Agril. Univ. 15(1): 62-72, January 2017

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