-
Cleveland Clinic Journal of Medicine 1999The decision about appropriate referral of patients to a subacute care unit is the key to both continuity of care and the financial viability of a hospital's subacute... (Review)
Review
The decision about appropriate referral of patients to a subacute care unit is the key to both continuity of care and the financial viability of a hospital's subacute care unit. Patient selection, subacute care admission criteria, patient education, and financial concerns are discussed.
Topics: Eligibility Determination; Humans; Insurance, Health, Reimbursement; Patient Care Team; Patient Selection; Referral and Consultation; Subacute Care; United States
PubMed: 10410443
DOI: 10.3949/ccjm.66.7.443 -
Geriatrics Jul 1998Subacute programs care for individuals in various stages of acute illness and injury, usually after but sometimes instead of hospitalization for an acute episode.... (Review)
Review
Subacute programs care for individuals in various stages of acute illness and injury, usually after but sometimes instead of hospitalization for an acute episode. Typical reasons why older patients are hospitalized prior to subacute care include life-threatening conditions. Moreover, older patients tend to have one or more comorbidities related or unrelated to their primary acute condition. Therefore, an essential task for the physician is to assess each patient's medical stability within 24 to 48 hours of admission to subacute care. In subacute settings, interdisciplinary providers deliver a coordinated package of care. Physicians coordinate the medical treatments with the observations and input of nurses and providers in other disciplines who are managing patients' functional and psychosocial problems.
Topics: Activities of Daily Living; Aged; Comorbidity; Continuity of Patient Care; Decision Making; Disease Management; Geriatric Assessment; Humans; Patient Care Team; Patient Selection; Physician's Role; Skilled Nursing Facilities; Subacute Care; Time Factors
PubMed: 9672498
DOI: No ID Found -
Australian Health Review : a... Sep 2016Objective The aim of the present study was to systematically review articles describing recent interventions that aimed to improve access and outcomes for older people... (Review)
Review
Objective The aim of the present study was to systematically review articles describing recent interventions that aimed to improve access and outcomes for older people at the interface between health and aged care, with a focus on subacute care programs of palliative care, rehabilitation, geriatric evaluation and management (GEM) and psychogeriatrics. Methods Australian studies published between 2008 and 2013were evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and National Health and Medical Research Council of Australia (NHMRC) guidelines. Included studies were summarised according to focus areas and results discussed in the current Australian subacute health care context. Results Eleven Australian research articles were identified. Three did not achieve any NHMRC rating level because of methodological approach. Focus areas included: discharge planning; information management or communication; rehabilitation; hospital treatment in residential care; screening and intervention; and Telehealth. Interventions were primarily system centred; only three studies featured patient-level outcome measures. Conclusions There is limited high-quality research investigating the effectiveness of interventions at the health and aged care interface of subacute care. Further research is needed. What is known about the topic? Subacute care offers important healthcare programs for older people, operating at the interface between health and aged care. However, for the most part this has not been subject to research scrutiny. What does this paper add? Identified studies were predominantly hospital oriented and designed to avoid hospital admission and associated costs. Locally integrated, collaborative and multidiscipline based interventions improve system-level outcomes. Alternative and individualised models of care, particularly when provided in their home setting, yields positive outcomes for older people. What are the implications for practitioners? Health and aged care reforms and related research agenda must include the perspectives and experiences of patients and/or carers accessing subacute care programs, yet these are under-reported. The present review highlights opportunities to improve the quality of existing evidence and create a research agenda for the future.
Topics: Aged; Australia; Biomedical Research; Evidence-Based Medicine; Geriatric Assessment; Health Services Accessibility; Health Services for the Aged; Humans; Palliative Care; Subacute Care; Telemedicine
PubMed: 26536066
DOI: 10.1071/AH15005 -
Australian Health Review : a... Nov 2008A review of projection methodologies used to project sub-acute inpatient activity in various international health care jurisdictions was undertaken as part of a project... (Review)
Review
A review of projection methodologies used to project sub-acute inpatient activity in various international health care jurisdictions was undertaken as part of a project to develop subacute inpatient activity projections for the state with the largest population in Australia. The literature search identified nearly 200 articles and found three main groups of projection methodologies: projections with a focus on subacute care; projections with a focus on acute care, but which often included subacute activity in the overall projections; and projections of specific diseases/conditions influencing the demand for subacute care. In terms of the examples in the literature specifically regarding subacute care, the most common method of estimating current or future need was the use of normative benchmark ratios of beds to population. This was mainly to provide a policy basis to encourage development of subacute services, but also because of convenience. In the literature regarding acute activity projection methodologies, many incorporated subacute activity in the overall activity measures of the acute hospital unit. The most common method of acute care activity projection was use of current or trended utilisation rates applied to population projections. It appears that a significant amount of planning and demand projection being undertaken internationally on subacute care takes place within acute care methodologies. In regard to the potential use of specific diseases/conditions that drive demand for subacute care, such as stroke or cancer, it is suggested that the best use of these disease-specific projections is in reality testing the results of other modelling. A number of conclusions are made and issues highlighted regarding projections of subacute inpatient activity.
Topics: Forecasting; Health Services Needs and Demand; Humans; Internationality; Subacute Care
PubMed: 18980574
DOI: 10.1071/ah080778 -
Nursing Case Management : Managing the... 1997The emergence of subacute care, seen as a cost-effective alternative to other, more expensive settings, is an important option for case managers. The current, rapid... (Review)
Review
The emergence of subacute care, seen as a cost-effective alternative to other, more expensive settings, is an important option for case managers. The current, rapid growth of subacute care, the diversity of subacute programs, the differences in patient types, and the lack of consistent standards to define subacute care illustrate the critical need for the case manager's role in balancing quality and cost. The lack of solid clinical outcomes data for patients treated in subacute care make it difficult for case managers to assess quality. Outcomes data, as a measurable dimension of quality, may include clinical effectiveness measures, associated costs, and patient/family satisfaction. Outcomes data can be used as a tool by the case manager to facilitate the coordination of patient care. Although there is an increased consumer interest in outcomes across all health care modalities, there is limited outcomes research available to document the efficacy of subacute care. As the pressure increases for outcomes data on subacute care by consumers and payers, efforts toward facility implementation of outcomes systems to assess subacute care are growing. The unique challenges to outcomes implementation in a skilled nursing facility-based setting are discussed, and strategies for successful implementation are presented. Basic subacute outcomes implementation issues of organizational support, staff participation, and data collection are reviewed. Ideas for case management involvement with facility implementation are discussed.
Topics: Case Management; Humans; Outcome Assessment, Health Care; Program Development; Subacute Care
PubMed: 9205326
DOI: No ID Found -
Journal of the American Medical... Jul 2012
Topics: Continuity of Patient Care; Humans; Length of Stay; Patient Readmission; Quality of Health Care; Skilled Nursing Facilities; Subacute Care; United States; Vulnerable Populations
PubMed: 22748718
DOI: 10.1016/j.jamda.2012.04.013 -
Journal of Infusion Nursing : the... 2001The aging population provides a unique challenge for the initiation and maintenance of infusion therapy. This article will highlight three common but controversial... (Review)
Review
The aging population provides a unique challenge for the initiation and maintenance of infusion therapy. This article will highlight three common but controversial issues that have been observed by this author in the long-term/subacute care realm of infusion therapy: 1) the failure to maintain a sterile dressing over the catheter insertion site; 2) the use of heparin to maintain patency of the peripheral infusion device; and 3) the routine replacement of peripheral i.v. catheters. Several factors that contribute to the controversies will be discussed, along with some associated negative and positive outcomes.
Topics: Anticoagulants; Bandages; Catheterization, Central Venous; Catheterization, Peripheral; Catheters, Indwelling; Clinical Protocols; Heparin; Humans; Infection Control; Long-Term Care; Patient Compliance; Sodium Chloride; Subacute Care; Therapeutic Irrigation
PubMed: 11507788
DOI: 10.1097/00129804-200107000-00009 -
Australian Health Review : a... 2002Subacute and rehabilitation services are likely to play an increasingly important role in the health and long-term care systems, as population ageing increases the...
Subacute and rehabilitation services are likely to play an increasingly important role in the health and long-term care systems, as population ageing increases the prevalence of chronic disease and disability. The role and scope of these services is difficult to assess in the Australian context due to the paucity of standardised definitions and administrative reporting systems. This paper appraises the role of these services and reflects on principles and evidence that might underpin their future development.
Topics: Aged; Australia; Chronic Disease; Efficiency, Organizational; Frail Elderly; Health Services for the Aged; Humans; Population Dynamics; Quality of Health Care; Rehabilitation; Subacute Care; Treatment Outcome
PubMed: 12474511
DOI: 10.1071/ah020140 -
CMAJ Open 2022As the number of patients with nonemergent conditions who are transported by paramedics continues to increase in Ontario, redirecting specific patients to subacute...
Emergency department interventions that could be conducted in subacute care settings for patients with nonemergent conditions transported by paramedics: a modified Delphi study.
BACKGROUND
As the number of patients with nonemergent conditions who are transported by paramedics continues to increase in Ontario, redirecting specific patients to subacute settings may be more beneficial and suitable for both patients and emergency departments. We aimed to evaluate whether emergency department interventions conducted on patients with nonemergent conditions who are transported by paramedics could be conducted in subacute health centres.
METHODS
We conducted a RAND/UCLA modified Delphi study in Ontario between Oct. 13 and Dec. 19, 2020. We used purposive sampling to recruit practising emergency and primary care physicians for an expert panel. We abstracted interventions given to adult patients with nonemergent conditions (18 yr of age or older) who were transported by paramedics to an emergency department from the National Ambulatory Care Reporting System (NACRS) database (Jan. 1, 2014, to Mar. 31, 2018). Participants in the expert panel rated the suitability of the 150 most frequently recorded emergency department interventions from the NACRS database, for completion in subacute health care centres. We set consensus at 70% agreement.
RESULTS
We invited 25 physician experts, 21 of whom consented to participate; 20 physicians completed round 1, and 18 physicians completed both rounds. After 2 rounds, consensus was reached on 146 (97.3%) interventions; 103 interventions (68.7%) were suitable for subacute centres, 43 (28.7%) for only the emergency department and 4 (2.6%) did not receive consensus. For subacute centres, all 103 interventions were rated for urgent care centres; walk-in medical centres were applicable for 46 (30.6%) interventions and clinics led by nurse practitioners for 47 (31.3%) interventions.
INTERPRETATION
Most interventions provided to patients with nonemergent conditions transported by paramedics to emergency departments were identified as suitable for urgent care clinics, with one-third being suitable for either walk-in medical centres or clinics led by nurse practitioners. This study has potential to inform a patient classification model for paramedic-initiated redirection of patients from emergency departments, although further contextualization is required for this to be implemented in clinical practice.
STUDY REGISTRATION
ID ISRCTN22901977.
Topics: Adult; Allied Health Personnel; Attitude of Health Personnel; Delphi Technique; Emergencies; Emergency Medical Services; Emergency Service, Hospital; Female; Humans; Male; Ontario; Patient Transfer; Physicians; Subacute Care; Triage
PubMed: 35017171
DOI: 10.9778/cmajo.20210148 -
Medicina Clinica Jul 2014The aging of the population and changes in family and social structures have led to increasing care needs for elderly persons following an acute disease or accident,... (Review)
Review
The aging of the population and changes in family and social structures have led to increasing care needs for elderly persons following an acute disease or accident, with consequent concerns regarding costs and sustainability within the public health system. The main objective of postacute care (PAC) is to restore the functional capabilities of the patient after an acute event and contribute to determine the patient's outcome and future healthcare requirements. With this background, we carried out a systematic review of the published literature from 1990 to 2011 focused on the following aspects of PAC: a) objectives; b) estimations of the need and the indicators for access to it, and c) transfer strategies from acute care to PAC. The results of this review indicate that PAC is an efficient approach to improve patients' quality of life and to sustain the public healthcare system. The choice of candidates for PAC should be based on both health and social indicators, and the overall process viewed in a cross-sectional manner in order to avoid increases in total cost.
Topics: Acute Disease; Aftercare; Aged; Bed Conversion; Europe; Health Services Needs and Demand; Home Care Services; Humans; Medicare; Models, Economic; National Health Programs; Quality of Life; Recovery of Function; Subacute Care; United States
PubMed: 23896450
DOI: 10.1016/j.medcli.2013.05.032