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1.
Rev Gaucha Enferm ; 44: e20210319, 2023.
Article in English, Portuguese | MEDLINE | ID: covidwho-20232534

ABSTRACT

OBJECTIVE: To unveil the experience of ambulance drivers regarding the transfer of suspected or confirmed patients for COVID-19. METHOD: Exploratory study with a qualitative approach conducted in October 2021 with 18 drivers from the Northwestern Mesoregion of the State of Ceará-Brazil. The individual interviews occurred virtually, via Google Meet®, and for data processing the IRAMUTEQ® software was used. RESULTS: Six classes were obtained: Feelings experienced during transfers; Concern about contamination of the work team and family members; Therapeutic itinerary, patients' clinical status and increase in the number of transfers; Disinfection of ambulances between transfers of patients with suspected and/or diagnosed COVID-19; Gowning for patient transfers and Psychospiritual aspects of drivers during the pandemic. CONCLUSION: The experience was marked by challenges in adapting to the new routine and procedures during transfers. It was evidenced feelings of fear, insecurity, tension and anguish in the worker's reports.


Subject(s)
Ambulances , COVID-19 , Humans , COVID-19/epidemiology , Fear , Patient Transfer , Brazil
4.
Am J Manag Care ; 27(11): 461-462, 2021 11.
Article in English | MEDLINE | ID: covidwho-2293422

ABSTRACT

The authors share a model that facilitates patient-centered care and can be adopted by other health systems to encourage successful care transitions for the traveling patient.


Subject(s)
Patient Transfer , Patient-Centered Care , Humans
5.
J Hosp Med ; 17(3): 229-230, 2022 03.
Article in English | MEDLINE | ID: covidwho-2280199
6.
Pediatrics ; 151(Suppl 1)2023 04 01.
Article in English | MEDLINE | ID: covidwho-2272048

ABSTRACT

The transition from pediatric to adult models of care poses many challenges to adolescent and young adult (AYA) patients. Several academic societies have established clinical reports to help providers prepare patients for this transition, facilitate the transfer of care between providers, and integrate patients into adult models of care. Furthermore, several novel care delivery models have been developed to expand health care transition (HCT) services. Despite this, a minority of patients receive transition services meeting the goals of these clinical reports and few data exist on their effectiveness. Given this, ongoing research and clinical innovation in the field are imperative. This article aims to summarize the current landscape of HCT for AYAs, outline the contemporary imperative for its integration into preventive health care given the unique challenges of the COVID-19 pandemic, and expand the current literature by providing a summary of novel emerging strategies being used to meet the health care transition (HCT) needs of adolescent and young adult (AYA) patients.


Subject(s)
COVID-19 , Transition to Adult Care , Young Adult , Humans , Adolescent , Child , Patient Transfer , Pandemics , Delivery of Health Care
7.
Int J Environ Res Public Health ; 20(3)2023 01 18.
Article in English | MEDLINE | ID: covidwho-2242844

ABSTRACT

The outbreak of an epidemic disease may cause a large number of infections and a slightly higher death rate. In response to epidemic disease, both patient transfer and relief distribution are significant to reduce corresponding damage. This study proposes a two-stage multi-objective stochastic model (TMS-PTRD) considering pre-pandemic preparedness measures and post-pandemic relief operations. The proposed model considers the following four objectives: the total number of untreated infected patients, the total transfer time, the overall cost, and the equity distribution of relief supplies. Before an outbreak, the locations of temporary relief distribution centers (TRDCs) and the inventory levels of established TRDCs should be determined. After an outbreak, the locations of temporary hospitals (THs), the locations of designated hospitals (DHs), the transfer plans for patients, and the relief distribution should be determined. To solve the TMS-PTRD model, we address an improved preference-inspired co-evolutionary algorithm named the PICEA-g-AKNN algorithm, which is embedded with a novel similarity distance and three different tailored evolutionary strategies. A real-world case study of Hunan of China and 18 test instances are randomly generated to evaluate the TMS-PTRD model. The finding shows that the PICEA-g-AKNN algorithm is better than some most widely used multi-objective algorithms.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Patient Transfer , Communicable Disease Control , Algorithms , Pandemics/prevention & control
8.
Stroke ; 54(2): 468-475, 2023 Feb.
Article in English | MEDLINE | ID: covidwho-2229559

ABSTRACT

BACKGROUND: Our objective is to describe adoption of the posthospitalization behaviors associated with successful transition of care and related baseline characteristics. METHODS: This study includes 550 participants in the Transition of Care Stroke Disparities Study, a prospective observational cohort derived from the Florida Stroke Registry. Participants had an ischemic stroke (2018-2021), discharged home or to rehabilitation, with modified Rankin Scale score=0-3 (44% women, 24% Black, 48% White, 26% Hispanic, 35% foreign-born). We collected baseline sociodemographic and clinical characteristics. A structured telephone interview at 30-day postdischarge evaluated outcomes including medication adherence, medical appointment attendance, outpatient therapy, exercise, diet modification, toxic habit cessation, and a calculated composite adequate transition of care measure. Multivariable analyses assessed the association of baseline characteristics with 30-day behaviors. RESULTS: At 30 days, medication adherence was achieved by 89%, medical appointments by 82%, outpatient therapy by 76%, exercise by 71%, diet modification by 68%, toxic habit cessation by 35%, and adequate transition of care measure by 67%. Successful adequate transition of care participants were more likely to be used full-time (42% versus 31%, P=0.02), live with a spouse (60% versus 47%, P=0.01), feel close to ≥3 individuals (84% versus 71%, P<0.01), have history of dyslipidemia (45 versus 34%, P=0.02), have thrombectomy (15% versus 8%, P=0.02), but less likely to have a history of smoking (17% versus 32%, P<0.001), coronary artery disease (14% versus 21%, P=0.04), and heart failure (3% versus 11%, P<0.01). Multivariable logistic regression analyses revealed that multiple socio-economic factors and prestroke comorbid diseases predicted fulfillment of transition of care measures. There was no difference in outcomes during the Covid-19 pandemic (2020-2021) compared with prepandemic years (2018-2019). CONCLUSIONS: One in 3 patients did not attain adequate 30-day transition of care behaviors. Their achievement varied substantially among different measures and was influenced by multiple socioeconomic and clinical factors. Interventions aimed at facilitating transition of care from hospital after stroke are needed. REGISTRATION: URL: https://clinicaltrials.gov/; Unique identifier: NCT03452813.


Subject(s)
COVID-19 , Ischemic Stroke , Stroke , Humans , Female , Male , Patient Transfer , Aftercare , Pandemics , Treatment Outcome , Patient Discharge , Stroke/therapy , Hospitalization , Thrombectomy
9.
Pediatr Rheumatol Online J ; 20(1): 93, 2022 Oct 21.
Article in English | MEDLINE | ID: covidwho-2139332

ABSTRACT

Adolescents and young adults (AYA) with rheumatologic diseases are at high risk for poor outcomes and gaps in care when transitioning from pediatric to adult care. However, tools for evaluating transition readiness and assessing the impact of transition interventions are limited. We implemented a written transition policy at our pediatric rheumatology center and evaluated preparation for transition among AYA 16 and older before and after distribution. 31 of 77 patients completed the follow-up survey (response rate 40%). Patient report of transition counseling increased following written transition policy implementation, though these results were not statistically significant in our small cohort. Most follow-up respondents (n = 19, 61%) had not yet completed care transfer; 4 (13%) had arranged a visit with an adult rheumatologist and 8 (26%) had fully transitioned to adult care. Those who successfully completed care transfer were older, had completed higher levels of education, and had significantly higher baseline transition preparation scores compared to those with no transfer arranged or planned visit only. Our single-center pilot study demonstrated that longitudinal assessment of transition preparation is feasible and that scores are significantly associated with care transfer outcomes. Tracking transition preparation over time may provide practices with information on areas of highest need for transition guidance and predict successful transfer among AYA with rheumatologic disease.


Subject(s)
Arthritis, Rheumatoid , Rheumatology , Transition to Adult Care , Young Adult , Adolescent , Humans , Child , Patient Transfer , Pilot Projects
10.
World Neurosurg ; 144: e710-e713, 2020 12.
Article in English | MEDLINE | ID: covidwho-2096137

ABSTRACT

BACKGROUND: The novel coronavirus disease 2019 (COVID-19) pandemic has set a huge challenge to the delivery of neurosurgical services, including the transfer of patients. We aimed to share our strategy in handling neurosurgical emergencies at a remote center in Borneo island. Our objectives included discussing the logistic and geographic challenges faced during the COVID-19 pandemic. METHODS: Miri General Hospital is a remote center in Sarawak, Malaysia, serving a population with difficult access to neurosurgical services. Two neurosurgeons were stationed here on a rotational basis every fortnight during the pandemic to handle neurosurgical cases. Patients were triaged depending on their urgent needs for surgery or transfer to a neurosurgical center and managed accordingly. All patients were screened for potential risk of contracting COVID-19 prior to the surgery. Based on this, the level of personal protective equipment required for the health care workers involved was determined. RESULTS: During the initial 6 weeks of the Movement Control Order in Malaysia, there were 50 urgent neurosurgical consultations. Twenty patients (40%) required emergency surgery or intervention. There were 9 vascular (45%), 5 trauma (25%), 4 tumor (20%), and 2 hydrocephalus cases (10%). Eighteen patients were operated at Miri General Hospital, among whom 17 (94.4%) survived. Ninety percent of anticipated transfers were avoided. None of the medical staff acquired COVID-19. CONCLUSIONS: This framework allowed timely intervention for neurosurgical emergencies (within a safe limit), minimized transfer, and enabled uninterrupted neurosurgical services at a remote center with difficult access to neurosurgical care during a pandemic.


Subject(s)
Brain Neoplasms/surgery , Craniocerebral Trauma/surgery , Emergencies , Hemorrhagic Stroke/surgery , Hydrocephalus/surgery , Neurosurgery , Neurosurgical Procedures/statistics & numerical data , Patient Transfer/statistics & numerical data , Air Ambulances , Borneo/epidemiology , COVID-19/epidemiology , Central Nervous System Vascular Malformations/surgery , Female , Hospitals, General , Humans , Malaysia/epidemiology , Male , Personal Protective Equipment , Skull Base Neoplasms/surgery , Transportation of Patients , Triage
11.
World Neurosurg ; 166: e915-e923, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2050069

ABSTRACT

OBJECTIVE: Interfacility transfers represent a large proportion of neurosurgical admissions to tertiary care centers each year. In this study, the authors examined the impact of the COVID-19 pandemic on the number of transfers, timing of transfers, demographic profile of transfer patients, and clinical outcomes including rates of surgical intervention. METHODS: A retrospective review of neurosurgical transfer patients at a single tertiary center was performed. Patients transferred from April to November 2020 (the "COVID Era") were compared with an institutional database of transfer patients collected before the COVID-19 pandemic (the "Pre-COVID Era"). During the COVID Era, both emergent and nonemergent neurosurgical services had resumed. A comparison of demographic and clinical factors between the 2 cohorts was performed. RESULTS: A total of 674 patients were included in the study (331 Pre-COVID and 343 COVID-Era patients). Overall, there was no change in the average monthly number of transfers (P = 0.66) or in the catchment area of referral hospitals. However, COVID-Era patients were more likely to be uninsured (1% vs. 4%), had longer transfer times (COVID vs. Pre-COVID Era: 18 vs. 9 hours; P < 0.001), required higher rates of surgical intervention (63% vs. 50%, P = 0.001), had higher rates of spine pathology (17% vs. 10%), and less frequently were admitted to the intensive care unit (34% vs. 52%, P < 0.001). Overall, COVID-Era patients did not experience delays to surgical intervention (3.1 days vs. 3.6 days, P = 0.2). When analyzing the subgroup of COVID-Era patients, COVID infection status did not impact the time of transfer or rates of operation, although COVID-infected patients experienced a longer time to surgery after admission (14 vs. 2.9 days, P < 0.001). CONCLUSION: The COVID-19 pandemic did not reduce the number of monthly transfers, operation rates, or catchment area for transfer patients. Transfer rates of uninsured patients increased during the COVID Era, potentially reflecting changes in access to community neurosurgery care. Shorter time to surgery seen in COVID-Era patients possibly reflects institutional policies that improved operating room efficiency to compensate for surgical backlogs. COVID status affeted time to surgery, reflecting the preoperative care that these patients require before intervention.


Subject(s)
COVID-19 , Neurosurgery , COVID-19/epidemiology , Humans , Pandemics , Patient Transfer , Retrospective Studies , Tertiary Care Centers
12.
Health Expect ; 25(6): 2862-2875, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2037986

ABSTRACT

INTRODUCTION: Patients discharged following hospitalization for COVID-19 require clear discharge protocols, information resources and communications to adequately prepare them to safely and successfully transition from hospital to home. Our study focuses on the patients' transition to recovering at home including their hospital discharge preparation and hospital experiences. METHODS: A qualitative descriptive study design involved interviewing patients who had been hospitalized for COVID-19 in one urban Alberta, Canada centre. Purposive sampling was used to select patients from a centralized COVID-19 hospital patient database stratified by month between March 2020 and February 2021. Other inclusion criteria (e.g., sex and age) were also considered. Semi-structured interviews with patients were recorded, transcribed and analysed using thematic analysis. Data sufficiency and saturation were determined. RESULTS: Twelve patients shared their lived experiences and recovery journey from COVID-19. Themes were reported under three main areas as framed by the study aim-the current status of patients recovering at home, including the supports they used to manage; their discharge process and preparation to go home; and their various hospital-related experiences. Suggestions for improving aspects of the patient journey were also captured. CONCLUSION: Findings provided details of the needs, information gaps and what matters most to patients when they are recovering from COVID-19 at home, including their preparation to safely and successfully transition from hospital to home (i.e., feeling well prepared to go home, including being adequately assessed and having clear discharge protocols and communication). Key learnings were applied to improve or develop patient discharge and transition resources. PATIENT OR PUBLIC CONTRIBUTION: A patient/family advisor and patient experience partners were involved throughout the study, codeveloping all aspects, from the study design to the reporting and application of the findings. Leading into the study, patient experiences and feedback regarding the home from hospital recovery journey informed multiple aspects, including the codevelopment of the interview guide.


Subject(s)
COVID-19 , Patient Discharge , Humans , Patient Transfer , COVID-19/epidemiology , Qualitative Research , Hospitals
13.
Prehosp Disaster Med ; 37(5): 600-608, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2036717

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic challenged health care systems in an unprecedented way. Due to the enormous amount of hospital ward and intensive care unit (ICU) admissions, regular care came to a standstill, thereby overcrowding ICUs and endangering (regular and COVID-19-related) critical care. Acute care coordination centers were set up to safely manage the influx of COVID-19 patients. Furthermore, treatments requiring ICU surveillance were postponed leading to increased waiting lists. HYPOTHESIS: A coordination center organizing patient transfers and admissions could reduce overcrowding and optimize in-hospital capacity. METHODS: The acute lack of hospital capacity urged the region West-Netherlands to form a new regional system for patient triage and transfer: the Regional Capacity and Patient Transfer Service (RCPS). By combining hospital capacity data and a new method of triage and transfer, the RCPS was able to effectively select patients for transfer to other hospitals within the region or, in close collaboration with the National Capacity and Patient Transfer Service (LCPS), transfer patients to hospitals in other regions within the Netherlands. RESULTS: From March 2020 through December 2021 (22 months), the RCPS West-Netherlands was requested to transfer 2,434 COVID-19 patients. After adequate triage, 1,720 patients with a mean age of 62 (SD = 13) years were transferred with the help of the RCPS West-Netherlands. This concerned 1,166 ward patients (68%) and 554 ICU patients (32%). Overcrowded hospitals were relieved by transferring these patients to hospitals with higher capacity. CONCLUSION: The health care system in the region West-Netherlands benefitted from the RCPS for both ward and ICU occupation. Due to the coordination by the RCPS, regional ICU occupation never exceeded the maximal ICU capacity, and therefore patients in need for acute direct care could always be admitted at the ICU. The presented method can be useful in reducing the waiting lists caused by the delayed care and for coordination and transfer of patients with new variants or other infectious diseases in the future.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Hospitals , Humans , Intensive Care Units , Middle Aged , Patient Transfer
14.
J Surg Res ; 281: 130-142, 2023 01.
Article in English | MEDLINE | ID: covidwho-2004292

ABSTRACT

INTRODUCTION: With the expected surge of adult patients with COVID-19, the Children's Hospital Association recommended a tiered approach to divert children to pediatric centers. Our objective was understanding changes in interfacility transfer to Pediatric Trauma Centers (PTCs) during the first 6 mo of the pandemic. METHODS: Children aged < 18 y injured between January 1, 2016 and September 30, 2020, who met National Trauma Databank inclusion criteria from 9 PTCs were included. An interrupted time-series analysis was used to estimate an expected number of transferred patients compared to observed volume. The "COVID" cohort was compared to a historical cohort (historical average [HA]), using an average across 2016-2019. Site-based differences in transfer volume, demographics, injury characteristics, and hospital-based outcomes were compared between cohorts. RESULTS: Twenty seven thousand thirty one/47,382 injured patients (57.05%) were transferred to a participating PTC during the study period. Of the COVID cohort, 65.4% (4620/7067) were transferred, compared to 55.7% (3281/5888) of the HA (P < 0.001). There was a decrease in 15-y-old to 17-y-old patients (10.43% COVID versus 12.64% HA, P = 0.003). More patients in the COVID cohort had injury severity scores ≤ 15 (93.25% COVID versus 87.63% HA, P < 0.001). More patients were discharged home after transfer (31.80% COVID versus 21.83% HA, P < 0.001). CONCLUSIONS: Transferred trauma patients to Level I PTC increased during the COVID-19 pandemic. The proportion of transferred patients discharged from emergency departments increased. Pediatric trauma transfers may be a surrogate for referring emergency department capacity and resources and a measure of pediatric trauma triage capability.


Subject(s)
COVID-19 , Wounds and Injuries , Adult , Child , Humans , COVID-19/epidemiology , Pandemics , Interrupted Time Series Analysis , Patient Transfer , Trauma Centers , Injury Severity Score , Retrospective Studies , Wounds and Injuries/epidemiology , Wounds and Injuries/therapy
15.
Am J Emerg Med ; 61: 68-73, 2022 11.
Article in English | MEDLINE | ID: covidwho-1995944

ABSTRACT

OBJECTIVES: We sought to assess if a state-wide lockdown implemented due to COVID-19 was associated with increased odds of being a potentially avoidable transfer (PAT). METHODS: We conducted a retrospective observational analysis using hospital administrative data of interfacility ED-to-ED transfers to a single, quaternary care adult ED after "Safer at Home" orders were issued March 23rd, 2020 in [Blinded for submission]. Using the PAT classification to identify transfers rapidly discharged from the ED or hospital and may not require in-person care, we used a multivariable logistic regression model to examine the association of the lockdown order with odds of a transfer being a PAT. We compared the period January 1, 2018 to March 23, 2020 with March 24, 2020 to September 30, 2020, adjusting for seasonality, patient, and situational factors. RESULTS: There were 20,978 ED-to-ED transfers from during this period that were eligible and 4806 (23%) that met PAT criteria. While the first month post-lockdown saw a decrease in PATs (28%), this was not sustained. In the multivariable model there was a significant seasonal effect; May through September had the highest number of transfers as well as PATs. After adjusting for seasonality, the lockdown was not associated with PATs (adjusted odds ratio [aOR] 0.99, 95% CI 0.2, 5.2) and PATs decreased over time. CONCLUSIONS: We did not find an effect of the COVID-19 lockdown on PATs though there was a considerable seasonal effect and an overall downward trend in PATs over time.


Subject(s)
COVID-19 , Patient Transfer , Humans , Adult , Retrospective Studies , COVID-19/epidemiology , Communicable Disease Control , Emergency Service, Hospital
16.
J Med Internet Res ; 24(8): e38792, 2022 08 03.
Article in English | MEDLINE | ID: covidwho-1974537

ABSTRACT

BACKGROUND: Both clinicians and patients have increasingly turned to telemedicine to improve care access, even in physical examination-dependent specialties such as dermatology. However, little is known about whether teledermatology supports effective and timely transitions from inpatient to outpatient care, which is a common care coordination gap. OBJECTIVE: Using mixed methods, this study sought to retrospectively evaluate how teledermatology affected clinic capacity, scheduling efficiency, and timeliness of follow-up care for patients transitioning from inpatient to outpatient dermatology care. METHODS: Patient-level encounter scheduling data were used to compare the number and proportion of patients who were scheduled and received in-clinic or video dermatology follow-ups within 14 and 90 days after discharge across 3 phases: June to September 2019 (before teledermatology), June to September 2020 (early teledermatology), and February to May 2021 (sustained teledermatology). The time from discharge to scheduling and completion of patient follow-up visits for each care modality was also compared. Dermatology clinicians and schedulers were also interviewed between April and May 2021 to assess their perceptions of teledermatology for postdischarge patients. RESULTS: More patients completed follow-up within 90 days after discharge during early (n=101) and sustained (n=100) teledermatology use than at baseline (n=74). Thus, the clinic's capacity to provide follow-up to patients transitioning from inpatient increased from baseline by 36% in the early (101 from 74) and sustained (100 from 74) teledermatology periods. During early teledermatology use, 61.4% (62/101) of the follow-ups were conducted via video. This decreased significantly to 47% (47/100) in the following year, when COVID-19-related restrictions started to lift (P=.04), indicating more targeted but still substantial use. The proportion of patients who were followed up within the recommended 14 days after discharge did not differ significantly between video and in-clinic visits during the early (33/62, 53% vs 15/39, 38%; P=.15) or sustained (26/53, 60% vs 28/47, 49%; P=.29) teledermatology periods. Interviewees agreed that teledermatology would continue to be offered. Most considered postdischarge follow-up patients to be ideal candidates for teledermatology as they had undergone a recent in-person assessment and might have difficulty attending in-clinic visits because of competing health priorities. Some reported patients needing technological support. Ultimately, most agreed that the choice of follow-up care modality should be the patient's own. CONCLUSIONS: Teledermatology could be an important tool for maintaining accessible, flexible, and convenient care for recently discharged patients needing follow-up care. Teledermatology increased clinic capacity, even during the pandemic, although the timeliness of care transitions did not improve. Ultimately, the care modality should be determined through communication with patients to incorporate their and their caregivers' preferences.


Subject(s)
COVID-19 , Dermatology , Telemedicine , Aftercare , Dermatology/methods , Humans , Inpatients , Outpatients , Patient Discharge , Patient Transfer , Retrospective Studies , Telemedicine/methods
17.
Int J Environ Res Public Health ; 19(11)2022 05 24.
Article in English | MEDLINE | ID: covidwho-1924224

ABSTRACT

The aim of this brief report is to present the protocol and preliminary findings of a systematic review on key aspects of care provision that affect care transition of older adults 60+ within the long-term care systems. This brief report describes and classifies the relevant literature found in the review with the purpose to provide a base for further full systematic reviews, and to outlines a model of organizational and financing aspects that affect care transition. Our search was conducted in MEDLINE, Embase and CINAHL on 2 March 2020, before the COVID-19 pandemic. The protocol was registered at the International Prospective Register of Systematic Reviews (number: CRD42020162566). Ultimately, 229 full-text records were found eligible for further deliberation. We observed an increase in the number of publications on organizational and financial aspects of care transition since 2005. Majority of publications came from the United States, United Kingdom and Australia. In total, 213 (92%) publications discussed organizational aspects and only 16 (8%) publications were related to financial aspects. Records on organizational aspects were grouped into the following themes: communication among involved professional groups, coordination of resources, transfer of information and care responsibility of the patient, training and education of staff, e-health, education and involvement of the patient and family, social care, and opinion of patients. Publications on financial aspects were grouped into provider payment mechanisms, incentives and penalties. Overall, our search pointed out various care provision aspects being studied in the literature, which can be explored in detail in subsequent full systematic reviews focused on given aspects. We also present a model based on our preliminary findings, which enables us to better understand what kind of provision aspects affect care transition. This model can be tested and validated in subsequent research. Understating factors that affect care transition is crucial to improve the quality of transitions and ultimately the outcomes for the patients.


Subject(s)
COVID-19 , Long-Term Care , Aged , COVID-19/epidemiology , Humans , Pandemics , Patient Transfer , Systematic Reviews as Topic , United States
18.
Can J Public Health ; 113(6): 846-866, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1912376

ABSTRACT

OBJECTIVES: The COVID-19 pandemic and response has highlighted existing strengths within the system of care for urban underserved populations, but also many fault lines, in particular during care transitions. The objectives of this study were to describe COVID-19 response policies for urban underserved populations in three Canadian cities; examine how these policies impact continuity of care for urban underserved populations; determine whether and how urban underserved community members were engaged in policy processes; and develop policy and operational recommendations for optimizing continuity of care for urban underserved populations during public health crises. METHODS: Using Walt & Gilson's Policy Triangle framework as a conceptual guide, 237 policy and media documents were retrieved. Five complementary virtual group interview sessions were held with 22 front-line and lived-experience key informants to capture less well-documented policy responses and experiences. Documents and interview transcripts were analyzed inductively for policy content, context, actors, and processes involved in the pandemic response. RESULTS: Available documents suggest little focus on care continuity for urban underserved populations during the pandemic, despite public health measures having disproportionately negative impacts on their care. Policy responses were largely reactive and temporary, and community members were rarely involved. However, a number of community-based initiatives were developed in response to policy gaps. Promising practices emerged, including examples of new multi-level and multi-sector collaboration. CONCLUSION: The pandemic response has exposed inequities for urban underserved populations experiencing care transitions; however, it has also exposed system strengths and opportunities for improvement to inform future policy direction.


RéSUMé: OBJECTIFS: La pandémie et la riposte au COVID-19 ont mis en évidence les forces existantes au sein du système de soins pour les populations urbaines mal desservies, mais aussi de nombreuses faillites, en particulier lors des transitions de soins. Les objectifs de cette étude étaient de décrire les politiques de réponse au COVID-19 pour les populations urbaines mal desservies dans trois villes canadiennes; examiner l'impact de ces politiques sur la continuité des soins pour les populations urbaines mal desservies; déterminer si et comment les membres de la communauté urbaine mal desservie ont été impliqués dans les processus politiques; et développer des recommandations politiques et opérationnelles pour optimiser la continuité des soins pour les populations urbaines mal desservies pendant les crises de santé publique. MéTHODES: Utilisant le cadre Policy Triangle de Walt et Gilson comme guide conceptuel, 237 documents politiques et des médias ont été récupérés. Cinq séances d'entrevues de groupe virtuelles complémentaires ont été organisées avec 22 informateurs clés de première ligne et d'expérience vécue pour saisir des réponses et des expériences politiques moins bien documentées. Les documents et les transcriptions des entrevues ont été analysés de manière inductive pour le contenu politique, le contexte, les acteurs et les processus impliqués dans la riposte à la pandémie. RéSULTATS: Les documents disponibles suggèrent que l'accent est peu mis sur la continuité des soins pour les populations urbaines mal desservies pendant la pandémie, malgré les mesures de santé publique ayant des impacts négatifs disproportionnés sur leurs soins. Les réponses politiques étaient en grande partie réactives et temporaires, et les membres de la communauté étaient rarement impliqués. Cependant, un certain nombre d'initiatives communautaires ont été élaborées en réponse aux lacunes des politiques. Des pratiques prometteuses ont émergé, y compris des exemples de nouvelles collaborations multiniveaux et multisectorielles. CONCLUSION: La réponse à la pandémie a révélé des inégalités pour les populations urbaines mal desservies qui subissent des transitions de soins, mais elle a également exposé les forces du système et les possibilités d'amélioration pour éclairer l'orientation future des politiques.


Subject(s)
COVID-19 , Transition to Adult Care , Humans , COVID-19/epidemiology , Pandemics , Vulnerable Populations , Patient Transfer , Cities , Canada/epidemiology
19.
Res Gerontol Nurs ; 15(4): 172-178, 2022.
Article in English | MEDLINE | ID: covidwho-1903575

ABSTRACT

Preventing acute care transfers from skilled nursing facilities (SNFs) is a challenge secondary to residents' associated debilitated status and comorbidities. Acute care transfers often result in serious complications and unnecessary health care expenditure. Literature implies that approximately two thirds of these acute care transfers could be prevented using proactive interventions. The purpose of the current study was to identify the predictors of acute care transfers for SNF residents in developing relevant prevention strategies. A retrospective chart review using multivariate logistic regression analysis showed increased odds of SNF hospitalization was significantly associated with impaired cognition, chronic obstructive pulmonary disease, and chronic kidney disease, whereas decreased odds of hospitalization was identified among non-Hispanic White residents. Study recommendations include prompt assessment of comorbid symptomatology among SNF residents for the timely management and prevention of unnecessary acute care transfers. [Research in Gerontological Nursing, 15(4), 172-178.].


Subject(s)
Hospitalization , Medical Overuse , Patient Transfer , Skilled Nursing Facilities , Aged , Cognitive Dysfunction/epidemiology , Hospitalization/statistics & numerical data , Humans , Medical Overuse/prevention & control , Medical Overuse/statistics & numerical data , Patient Discharge , Patient Transfer/statistics & numerical data , Pulmonary Disease, Chronic Obstructive/epidemiology , Renal Insufficiency, Chronic/epidemiology , Retrospective Studies , Skilled Nursing Facilities/statistics & numerical data , United States/epidemiology
20.
Endocr Pract ; 28(6): 615-621, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1828470

ABSTRACT

OBJECTIVE: Continuous glucose monitoring (CGM) has demonstrated benefits in managing inpatient diabetes. We initiated this single-arm pilot feasibility study during the COVID-19 pandemic in 11 patients with diabetes to determine the feasibility and accuracy of real-time CGM in patients who underwent cardiac surgery and whose care was being transitioned from the intensive care unit. METHODS: A Clarke error grid analysis was used to compare CGM and point-of-care measurements. The mean absolute relative difference (MARD) of the paired measurements was calculated to assess the accuracy of CGM for glucose measurements during the first 24 hours on CGM, the remaining time on CGM, and for different chronic kidney disease (CKD) strata. RESULTS: Overall MARD between point-of-care and CGM measurements was 14.80%. MARD for patients without CKD IV and V with an estimated glomerular filtration rate (eGFR) of ≥20 mL/min/1.73 m2 was 12.13%. Overall, 97% of the CGM values were within the no-risk zone of the Clarke error grid analysis. For the first 24 hours, a sensitivity analysis of the overall MARD for all patients and those with an eGFR of ≥20 mL/min/1.73 m2 was 15.42% ± 14.44% and 12.80% ± 7.85%, respectively. Beyond the first 24 hours, overall MARD for all patients and those with an eGFR of ≥20 mL/min/1.73 m2 was 14.54% ± 13.21% and 11.86% ± 7.64%, respectively. CONCLUSION: CGM has shown great promise in optimizing inpatient diabetes management in the noncritical care setting and after the transition of care from the intensive care unit with high clinical reliability and accuracy. More studies are needed to further assess CGM in patients with advanced CKD.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Diabetes Mellitus , Renal Insufficiency, Chronic , Blood Glucose , Blood Glucose Self-Monitoring , Humans , Intensive Care Units , Pandemics , Patient Transfer , Pilot Projects , Reproducibility of Results
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