ABSTRACT
After identifying high risk patients or high users of costly services, a rural community hospital implemented a community-based case management program that yielded positive results not only in cost containment but also in client-focused outcomes. The implementation of the program is described, as are the results of the outcomes measures affecting cognition, activities of daily living, instrumental activities of daily living, and nutritional risk. Additionally, use of health care resources and associated cost-savings data are discussed.
Subject(s)
Aftercare/organization & administration , Case Management/organization & administration , Community Health Nursing/organization & administration , Geriatric Nursing/organization & administration , Nurse Clinicians/organization & administration , Rural Health Services/organization & administration , Activities of Daily Living , Aged , Cognition Disorders/nursing , Cognition Disorders/psychology , Cost Control , Cost Savings , Geriatric Assessment , Health Services Research , Hospitals, Community , Humans , Length of Stay/statistics & numerical data , Nursing Assessment , Nursing Evaluation Research , Outcome Assessment, Health Care , Patient Readmission/statistics & numerical data , Program Development , Program EvaluationABSTRACT
Preparatory to a survey by the Joint Commission on Accreditation of Healthcare Organizations, a skilled nursing facility identified a problem with patients who were incontinent and implemented an interdisciplinary practice change described in some detail. Additionally, this practice change was awarded the Innovations in Practice Award by the National Gerontological Nursing Association in 1996.
Subject(s)
Geriatric Nursing/methods , Patient Care Team/organization & administration , Total Quality Management/organization & administration , Urinary Incontinence/nursing , Aged , Humans , Joint Commission on Accreditation of Healthcare Organizations , Program Evaluation , Skilled Nursing Facilities/standards , Urinary Incontinence/etiology , Urinary Incontinence/prevention & controlABSTRACT
Relative enophthalmos is often cited as a causative factor in the development of involutional entropion. However, the association between enophthalmos and involutional entropion is largely anecdotal; no patient population study has been performed to determine if a causal relationship exists. This prospective clinical study compares exophthalmometric values in a population of patients with involutional entropion to an age- and sex-matched control group. Hertel exophthalmometric measurements were obtained on 56 patients with involutional entropion presenting over a 2-year period. Exophthalmometric measurements were also obtained in a group of 53 age- and sex-matched control patients presenting for evaluation and management of unrelated periocular disorders. Fifty-three patients presented with unilateral entropion and three patients presented with bilateral lower lid entropion. The mean of exophthalmometric measurements was within 16.0 mm in the entropion group and 16.15 mm in the control group. Eyes with involutional entropion are no more likely to have enophthalmos than is the uninvolved contralateral eye or normal eyes of an age- and sex-matched control population. Enophthalmos does not appear to play a role in the development of involutional entropion.
Subject(s)
Enophthalmos/complications , Entropion/etiology , Aged , Aged, 80 and over , Enophthalmos/diagnosis , Entropion/diagnosis , Eyelids/pathology , Female , Humans , Male , Middle Aged , Ophthalmology/methods , Orbit/pathology , Prospective StudiesABSTRACT
One of the early steps in the development and implementation of a care coordination program designed to improve the hospital's response to the elderly population of a small, rural hospital was the identification of those elders at "high risk" of institutionalization or who used costly services. This process involved data collection over a 2-year period from multiple entry points into the hospital care delivery system. The subsequent emergency database is used to disseminate patient-centered information to staff, rather than episode-centered. The hospital's efforts are described, giving both methods and results.
Subject(s)
Continuity of Patient Care , Health Services Needs and Demand , Hospitals, Rural , Patient Readmission , Aged , Geriatric Assessment , HumansABSTRACT
Filtration techniques are widely used to assess red blood cell (RBC) deformability and flow behavior of RBC in microcirculation. In this study filtration rates of RBC from 10 very low birth weight infants (24-30 wk gestation), 10 more mature preterm infants (31-36 wk gestation), 10 full-term neonates, and 10 adults were measured by using Nucleopore filters with pore diameters of 5 micron and filtration pressures of 1, 2, 5, and 10 cm H2O. The major results follow: At each of four filtration pressures, filtration rates of washed RBC were significantly (p less than 0.05) lower in the preterm infants than in the term neonates who in turn showed lower values than adults. The differences among the four groups became less as the pressure was increased from 1 to 10 cm H2O. The filtration rates increased with decreasing MCV (r = -0.86). The filter flow resistance (computed as ratio of filtration pressure and filter flow rate) decreased as the filtration pressure was raised from 1 to 10 cm H2O. The largest drop, 31% (p less than 0.05), was observed in the most immature infants, the smallest, 10% (p greater than 0.05), was seen in adults. At a pressure of 1 cm H2O the calculated mean transit time for RBC through the 5-micron pores was on an average 3.7 times longer in the smallest preterm infants than in the adults (19.7 +/- 7.8 and 5.3 +/- 1.4 ms, respectively), whereas the factor was only 2.7 at a pressure of 10 cm H2O (13 +/- 0.4 and 0.5 +/- 0.1 ms, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
