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Clinical Microbiology and Infection :... Jun 2020Use of isolation precautions (IP) may represent a trade-off between reduced transmission of infectious pathogens and reduced patient satisfaction with their care. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Use of isolation precautions (IP) may represent a trade-off between reduced transmission of infectious pathogens and reduced patient satisfaction with their care.
OBJECTIVE
To perform a systematic literature review and meta-analysis to identify if and how IPs impact patients' care experiences.
DATA SOURCES
Medline, ClinicalTrials.gov, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PsychInfo, HSRProj and Cochrane Library databases.
STUDY ELIGIBILITY CRITERIA
Interventional and observational studies published January 1990 to May 2019 were eligible for inclusion.
PARTICIPANTS
Patients admitted to an acute-care facility.
INTERVENTIONS
IPs versus no IPs.
METHODS
Six reviewers screened titles, abstracts and full text. Experience of care reported by patients using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was assessed as the outcome for the meta-analysis. Pooled odds ratios were calculated using the random-effects model. Heterogeneity was assessed using the I value.
RESULTS
After screening 7073 titles and abstracts, 15 independent studies were included in the review. Pooling of unadjusted estimates from the HCAHPS survey demonstrated that IP patients were less likely to give top scores on questions pertaining to respect, communication, receiving assistance and cleanliness compared to the no-IP patients. Patients under IP with longer length of stay appeared to have more negative experiences with the care received during their stay compared to no IP.
CONCLUSIONS
Patients under IP were more likely to be dissatisfied with several aspects of patient care compared to patients not under IP. It is crucial to educate patients and healthcare workers in order to balance successful implementation of IP and patient care experiences, particularly in healthcare settings where it may be beneficial.
Topics: Communicable Diseases; Health Personnel; Hospitalization; Humans; Patient Care; Patient Isolation; Patient Satisfaction
PubMed: 32006691
DOI: 10.1016/j.cmi.2020.01.022 -
Journal of Nursing Care Quality 2015This article reports results from a systematic review used to inform the development of a best practice guideline to assist nurses in understanding their roles and... (Review)
Review
This article reports results from a systematic review used to inform the development of a best practice guideline to assist nurses in understanding their roles and responsibilities in promoting safe and effective client care transitions. A care transition is a set of actions designed to ensure safe and effective coordination and continuity of care as clients experience a change in health status, care needs, health care providers, or location.
Topics: Communication; Continuity of Patient Care; Evidence-Based Practice; Humans; Nurse's Role; Nursing Care; Patient Safety
PubMed: 25470233
DOI: 10.1097/NCQ.0000000000000097 -
Health & Social Care in the Community Jan 2022Relational continuity of care (COC) is becoming an important concept related to improving healthcare quality, reducing medical costs and increasing patient satisfaction... (Review)
Review
Relational continuity of care (COC) is becoming an important concept related to improving healthcare quality, reducing medical costs and increasing patient satisfaction with primary care. While community pharmacy (CP) has a considerable role in primary care, there are few reports dedicated to the role of relational COC in CP. This study reviewed the existing evidence of relational COC in CP and its effect on patients. PubMed, Embase, CINAHL, Cochrane Library CENTRAL and Google Scholar were used to search for relevant studies from the date of database inception through to January 2021, which were appraised according to eligibility criteria. There were no limitations on the primary outcome or language. Case reports and studies without control groups were excluded. The Newcastle-Ottawa quality assessment scale was used to assess the quality of the studies. Database searches identified 13 records. Relational COC measures in the included studies were grouped in three kinds; pharmacy-visiting pattern, Continuity of Care Index and loyalty. The assessed outcomes were medication adherence behaviour (e.g., the proportion of days covered, medication possession ratio), adverse drug reactions, potentially inappropriate drug prescribing and clinical outcomes. The odds of patients adhering to their medication regimen were about 1.1~2.5 times higher among those who consistently visited a single pharmacy compared to patients visiting multiple pharmacies. Additionally, the care provision with a high level of relational continuity could lower inappropriate drug use by 21~32 per cent and the use of other costly services by 12~29 per cent. This study suggests that a high degree of relational COC in CP could improve safe use of medications among patients. Future research is needed to employ more rigorous methods to reduce heterogeneity and to measure effects on clinical outcomes.
Topics: Continuity of Patient Care; Databases, Factual; Drug Prescriptions; Humans; Medication Adherence; Pharmacies
PubMed: 34060170
DOI: 10.1111/hsc.13428 -
Anaesthesia Apr 2022Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess... (Meta-Analysis)
Meta-Analysis Review
Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to the English language. Two reviewers independently applied eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. The primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3-21.2%) at 30 days; 31.0% (95%CI: 24.3-38.6%) at 90 days; 29.6% (95%CI: 24.5-35.2%) at six months; and 53.3% (95%CI: 44.4-62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factors were associated with excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection after hospital discharge. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.
Topics: Critical Care; Critical Illness; Hospitalization; Hospitals; Humans; Patient Readmission
PubMed: 34967011
DOI: 10.1111/anae.15644 -
Psychiatric Services (Washington, D.C.) Apr 2015Research investigating the association between continuity of care (CoC) and patient outcomes in mental health care is limited. A previous review (1970-2002) concluded... (Review)
Review
OBJECTIVE
Research investigating the association between continuity of care (CoC) and patient outcomes in mental health care is limited. A previous review (1970-2002) concluded that evidence for an association between CoC and outcomes was inconsistent and limited. This systematic review, conducted a decade later, provides an update.
METHODS
Searches (1950-2014) were conducted on MEDLINE and PsycINFO. Included studies used a clearly identified measure of CoC and examined its relation to an outcome among adults (ages 18-65). Only English-language publications were included.
RESULTS
A total of 984 studies were identified that measured CoC. Eighteen met inclusion criteria, and 13 found an association between CoC and an outcome. As found in the previous review, studies reported conflicting results for the most frequently examined outcomes (hospitalization, symptom severity, social functioning, and service satisfaction). Little consistency was found between studies in choice of CoC measures and outcomes. Studies varied markedly in quality. Two of the three studies rated as good quality reported significant associations between CoC and social functioning. Compared with older studies, studies published since the previous systematic review (2002-2014) found a larger proportion of significant associations.
CONCLUSIONS
Little consistency was found in the way CoC was measured, which made it difficult to compare studies. Therefore, clear evidence about the association between CoC and outcomes remains limited. Results in regard to social functioning are encouraging. However, in order for conclusions to be made, researchers need to be more consistent with the measures they choose to allow comparison of studies.
Topics: Continuity of Patient Care; Humans; Mental Disorders; Outcome Assessment, Health Care
PubMed: 25828980
DOI: 10.1176/appi.ps.201400178 -
Clinical Journal of Oncology Nursing Jun 2015Nurse practitioners should become more active in patient navigation and its subcomponent, care coordination, because research has shown that these roles are influential... (Review)
Review
BACKGROUND
Nurse practitioners should become more active in patient navigation and its subcomponent, care coordination, because research has shown that these roles are influential in improving patient care at all levels of an organization. Well-defined process and outcome measures, as well as educational initiatives, are critical to these programs because they serve as the structure for program evaluation.
OBJECTIVES
This article aims to assess and define metrics that nurse practitioners in the oncology setting can use to evaluate navigation programs, which is essential for the evolution of research pertaining to the navigation field.
METHODS
The current article is a systematic review that describes oncology nurse practitioner navigation metrics using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) format for the systematic literature review process. These metrics are then compared to current standards of care.
FINDINGS
Seven studies met the criteria for this review. Research is emerging that shows benefit in using an oncology nurse practitioner navigator for ensuring timely care and patient and staff satisfaction. These metrics are in line with expert consensus recommendations. The need for more research identifying sound research tools that have been rigorously tested has been identified.
Topics: Humans; Job Satisfaction; Nurse Practitioners; Oncology Nursing; Patient Navigation; Patient Satisfaction; Time-to-Treatment
PubMed: 26000581
DOI: 10.1188/15.CJON.308-313 -
Work (Reading, Mass.) 2017Variability in patient care settings and the range of patient handling tasks present challenges in developing and evaluating safe patient handling and mobilization... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Variability in patient care settings and the range of patient handling tasks present challenges in developing and evaluating safe patient handling and mobilization (SPHM) programs.
OBJECTIVE
We performed a systematic meta-analysis of SPHM program evaluations.
METHODS
Systematic literature review identified published SPHM program evaluations. Injury Rate Ratios (IRR), pre- to post-intervention, were used to estimate intervention effects and to examine the influence of patient care level, program components, and follow-up time using meta-regression.
RESULTS
27 articles reported evaluations from 44 sites. Combined effect estimate for all SPHM programs was 0.44 (95% CI 0.36, 0.54), reflecting substantial injury reductions after program implementation. While specific program components were not associated with greater effectiveness, longer follow-up duration was associated with greater injury rate reduction (p = 0.01) and intervention effects varied by level of care (p = 0.01), with the greatest effect in intensive care unit interventions (IRR 0.14; 95% CI 0.07, 0.30).
CONCLUSIONS
SPHM programs appear to be highly effective in reducing injuries. More research is needed to identify the most effective interventions for different patient care levels.
Topics: Humans; Moving and Lifting Patients; Musculoskeletal Diseases; Occupational Health; Occupational Injuries; Program Evaluation
PubMed: 29036857
DOI: 10.3233/WOR-172608 -
Occupational and Environmental Medicine Feb 2023Studies have demonstrated an association between doctors' perceived working conditions, and their psychological well-being and patient care. However, few have examined... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Studies have demonstrated an association between doctors' perceived working conditions, and their psychological well-being and patient care. However, few have examined inter-relationships among these three domains, and even fewer using longitudinal designs. Using meta-analytical structural equation modelling, we tested longitudinal relationships among doctors' perceived working conditions, their psychological well-being and patient care. We further tested if doctors' psychological well-being mediates the relationship between perceived working conditions and patient care.
METHODS
We carried out a systematic review using Academic Search Premier, Business Source Premier, PsycInfo, PsycArticles and Medline for the 20-year period between January 2000 and the start of the pandemic (January 2020). We included studies with practising doctors as participants, and that reported a quantifiable bivariate effect size between at least two of the three constructs of interest-perceived working conditions (ie, job demands, job resource), psychological well-being (ie, emotional exhaustion, work engagement) and patient care (ie, clinical care, patient safety). We pooled relationship effect sizes using random-effects meta-analysis, before testing for indirect effects using two-stage structural equation modelling.
RESULTS
Twenty-three samples from 11 countries representing 7275 doctors were meta-analysed. The results indicated that job resources predicted work engagement (ρ=0.18; 95% CI 0.11 to 0.24) and emotional exhaustion (ρ=-0.21; 95% CI -0.31 to -0.11), while job demands predicted emotional exhaustion (ρ=0.27; 95% CI 0.17 to 0.36). Better clinical care was also associated with higher levels of job resources (ρ=0.16; 95% CI 0.04 to 0.29), and lower levels of emotional exhaustion (ρ=-0.21; 95% CI -0.37 to -0.12) and job demands (ρ=-0.27; 95% CI -0.43 to -0.10). Both factors of the work environment were associated with clinical care through doctors' emotional exhaustion, but there were insufficient studies to test the indirect effects for work engagement or patient safety.
CONCLUSION
Our results demonstrate the need for a systems perspective to address working conditions to support both doctors' psychological well-being and patient care. Interventions should target doctors' job resources as they are more strongly associated with psychological well-being. However, given that job demands were strongly associated with emotional exhaustion, and in turn, clinical care, there is a need to better manage doctors' workload, conflict and pressure to support the current psychological well-being crises among this occupational group.
PROSPERO REGISTRATION NUMBER
CRD42020189070.
Topics: Humans; Working Conditions; Burnout, Professional; Job Satisfaction; Surveys and Questionnaires; Longitudinal Studies; Workload; Patient Care
PubMed: 36635099
DOI: 10.1136/oemed-2022-108486 -
Annals of Behavioral Medicine : a... Aug 2017According to a landmark study by the Institute of Medicine, patients with cancer often receive poorly coordinated care in multiple settings from many providers. Lack of... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
According to a landmark study by the Institute of Medicine, patients with cancer often receive poorly coordinated care in multiple settings from many providers. Lack of coordination is associated with poor symptom control, medical errors, and higher costs.
PURPOSE
The aims of this systematic review and meta-analysis were to (1) synthesize the findings of studies addressing cancer care coordination, (2) describe study outcomes across the cancer continuum, and (3) obtain a quantitative estimate of the effect of interventions in cancer care coordination on service system processes and patient health outcomes.
METHODS
Of 1241 abstracts identified through MEDLINE, EMBASE, CINAHL, and the Cochrane Library, 52 studies met the inclusion criteria. Each study had US or Canadian participants, comparison or control groups, measures, times, samples, and/or interventions. Two researchers independently applied a standardized search strategy, coding scheme, and online coding program to each study. Eleven studies met the additional criteria for the meta-analysis; a random effects estimation model was used for data analysis.
RESULTS
Cancer care coordination approaches led to improvements in 81 % of outcomes, including screening, measures of patient experience with care, and quality of end-of-life care. Across the continuum of cancer care, patient navigation was the most frequent care coordination intervention, followed by home telehealth; nurse case management was third in frequency. The meta-analysis of a subset of the reviewed studies showed that the odds of appropriate health care utilization in cancer care coordination interventions were almost twice (OR = 1.9, 95 % CI = 1.5-3.5) that of comparison interventions.
CONCLUSIONS
This review offers promising findings on the impact of cancer care coordination on increasing value and reducing healthcare costs in the USA.
Topics: Delivery of Health Care; Humans; Neoplasms; Outcome and Process Assessment, Health Care; Patient Care
PubMed: 28685390
DOI: 10.1007/s12160-017-9876-2 -
The Cochrane Database of Systematic... Mar 2024Admission avoidance hospital at home provides active treatment by healthcare professionals in the patient's home for a condition that would otherwise require acute... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Admission avoidance hospital at home provides active treatment by healthcare professionals in the patient's home for a condition that would otherwise require acute hospital inpatient care, and always for a limited time period. This is the fourth update of this review.
OBJECTIVES
To determine the effectiveness and cost of managing patients with admission avoidance hospital at home compared with inpatient hospital care.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and CINAHL on 24 February 2022, and checked the reference lists of eligible articles. We sought ongoing and unpublished studies by searching ClinicalTrials.gov and WHO ICTRP, and by contacting providers and researchers involved in the field.
SELECTION CRITERIA
Randomised controlled trials recruiting participants aged 18 years and over. Studies comparing admission avoidance hospital at home with acute hospital inpatient care.
DATA COLLECTION AND ANALYSIS
We followed the standard methodological procedures expected by Cochrane and the Effective Practice and Organisation of Care (EPOC) Group. We performed meta-analysis for trials that compared similar interventions, reported comparable outcomes with sufficient data, and used individual patient data when available. We used the GRADE approach to assess the certainty of the body of evidence for the most important outcomes.
MAIN RESULTS
We included 20 randomised controlled trials with a total of 3100 participants; four trials recruited participants with chronic obstructive pulmonary disease; two trials recruited participants recovering from a stroke; seven trials recruited participants with an acute medical condition who were mainly older; and the remaining trials recruited participants with a mix of conditions. We assessed the majority of the included studies as at low risk of selection, detection, and attrition bias, and unclear for selective reporting and performance bias. For an older population, admission avoidance hospital at home probably makes little or no difference on mortality at six months' follow-up (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.68 to 1.13; P = 0.30; I = 0%; 5 trials, 1502 participants; moderate-certainty evidence); little or no difference on the likelihood of being readmitted to hospital after discharge from hospital at home or inpatient care within 3 to 12 months' follow-up (RR 1.14, 95% CI 0.97 to 1.34; P = 0.11; I = 41%; 8 trials, 1757 participants; moderate-certainty evidence); and probably reduces the likelihood of living in residential care at six months' follow-up (RR 0.53, 95% CI 0.41 to 0.69; P < 0.001; I = 67%; 4 trials, 1271 participants; moderate-certainty evidence). Hospital at home probably results in little to no difference in patient's self-reported health status (2006 patients; moderate-certainty evidence). Satisfaction with health care received may be improved with admission avoidance hospital at home (1812 participants; low-certainty evidence); few studies reported the effect on caregivers. Hospital at home reduced the initial average hospital length of stay (2036 participants; low-certainty evidence), which ranged from 4.1 to 18.5 days in the hospital group and 1.2 to 5.1 days in the hospital at home group. Hospital at home length of stay ranged from an average of 3 to 20.7 days (hospital at home group only). Admission avoidance hospital at home probably reduces costs to the health service compared with hospital admission (2148 participants; moderate-certainty evidence), though by a range of different amounts and using different methods to cost resource use, and there is some evidence that it decreases overall societal costs to six months' follow-up.
AUTHORS' CONCLUSIONS
Admission avoidance hospital at home, with the option of transfer to hospital, may provide an effective alternative to inpatient care for a select group of older people who have been referred for hospital admission. The intervention probably makes little or no difference to patient health outcomes; may improve satisfaction; probably reduces the likelihood of relocating to residential care; and probably decreases costs.
Topics: Humans; Health Facilities; Hospitalization; Hospitals; Inpatients; Patient Discharge; Home Care Services
PubMed: 38438116
DOI: 10.1002/14651858.CD007491.pub3