Introduction/ Objectives: Stroke, the third leading cause of death in Canada, is projected to rise in the next 20 years as the population ages and obesity rates increase. Family caregivers fulfill pertinent roles in providing support for family members who have survived a stroke, from onset to re-integration into the community. However, the transition from rehabilitation to home is a crucial transition for both the stroke survivor and family caregiver. As the stroke survivor transitions home from a rehabilitation facility, family caregivers provide different types of support, including assistance with navigating the stroke rehabilitation system. They also are a constant source of support for the stroke survivor providing them with continuity during the transition. In this exploratory study we examined family caregivers’ perceptions and experiences navigating the stroke rehabilitation system. The theories of continuity care and complex adaptive systems were used to examine the transition home from hospital or stroke rehabilitation facility, and in some cases back to hospital. Methodology: Family caregivers (n=14) who provide care for a stroke survivor were recruited 4-12 weeks following the patient’s discharge from a stroke rehabilitation facility. Interviews were conducted with family caregivers to examine their perceptions and experiences navigating the stroke rehabilitation system. Directed content analysis was used to explore the perceptions of family caregivers as they reflected on the transitions home. The theories of continuity of care and complex adaptive systems were used to interpret their experiences. Results/Conclusions: During the transition home from a rehabilitation facility, family caregivers are a constant source of support, providing the stroke survivor with continuity. Emergent themes highlight the importance of the caregiving role, and barriers and facilitators that impact the role, and influence continuity of care. Also, supports and services in the community were limited or did not meet the specific needs of the family caregiver. The acknowledgment of the unique attributes of each case will ensure supports and services are tailored to the family caregiver’s needs. Mitigation of systemic barriers would also decrease complexity experienced at the micro-level in the stroke rehabilitation system, and better support the family caregiver during the transition home from a stroke rehabilitation facility.

Current status: Although it was developed and published in many studies pointing to the impact of malnutrition and its relationship to the patient and the economy of the health systems, malnutrition remains a silent guide of hospitalized patients. In the year of 2014, the authors of the study group feedM.E. indicate in their articles the worldwide prevalence of malnutrition as a common and a costly (especially for the elderly). The rate of prevalence of malnutrition in a group of hospitalized patients is around 50%, according to this working group. Objectives: The goal of the project was to describe the methods for screening the patients with nutritional needs interventions by the nurses, the continuity of the care for patients in the risk of malnutrition, transmitting the information about the nutritional status of the patient during his hospitalization and delivery of care to another provider of health services and interdisciplinary co-workers involved in the care of patients in the risk of malnutrition. Methods: The research investigation conducted by the method of the qualitative research. The research subject was the process of detecting malnutrition and continuity of nutritional care for recipients of health services from the perspective of persons providing these services. The research method was chosen a depth interview. The sample of respondents was intentional and the file size was determined by saturation of the collected data. For data processing was used open coding and following categorization of the data which was obtained from interviews. The results were interpreted by using the "showdown". Participants: The request to facilitate the initiation of research has been mostly refused and addressed to the health service providers. Selection of interviewees was intentional by the circle of my former colleagues. With research have expressed their consent five nurses and five dietitians, which are working in the Czech Republic. Results: For identification of patients at the risk of malnutrition, all respondents have described the identification of patients at the risk of malnutrition on admission to the hospital by collecting of nursing history. During the interviews, the respondents have reported the problems both with the absence the reports including detection of patients at the risk of malnutrition from some stations at hospitals, as well as the jurisdictional disputes about the role of the dietitians in patient nutrition at intensive care unit, the complications with material and technical equipment of nursing stations and its applicability for use in specific patients. Also expressed the ignorance of screening tools which are used at the sites of all respondents, including dietitians. The inaccurate ideas of some respondents were in the terms of the skills and the competencies of individual professionals which are involved in the care of patients in the risk of malnutrition. Three nurses of the five indicated that information about the nutritional balance of the patient and their needs should affect the assessment of the patient's overall condition and could lead to changes in the nursing care plan or risk assessment (eg. the risk of pressure ulcers, etc.). Conclusion: The method of providing nutritional care in hospitals, in which respondents are employed, is headed toward pursuing the recommendations of the professional associations. In detail, however, they differ and are often close to the boundaries defined as a legal standards. Breaks are noticeable in continuity of the care, or are put excessive approval procedures, which can lead to delay of required nutritional interventions. Here is a lack of information about the various screening tools and their applicability to the certain groups of patients. Therefore I recommend issuing guidelines by professional society, in the direction of the definition of screening tools and their using in the certain groups of patients, for the healthcare providers in

Introduction/ Objectives: Stroke, the third leading cause of death in Canada, is projected to rise in the next 20 years as the population ages and obesity rates increase. Family caregivers fulfill pertinent roles in providing support for family members who have survived a stroke, from onset to re-integration into the community. However, the transition from rehabilitation to home is a crucial transition for both the stroke survivor and family caregiver. As the stroke survivor transitions home from a rehabilitation facility, family caregivers provide different types of support, including assistance with navigating the stroke rehabilitation system. They also are a constant source of support for the stroke survivor providing them with continuity during the transition. In this exploratory study we examined family caregivers’ perceptions and experiences navigating the stroke rehabilitation system. The theories of continuity care and complex adaptive systems were used to examine the transition home from hospital or stroke rehabilitation facility, and in some cases back to hospital. Methodology: Family caregivers (n=14) who provide care for a stroke survivor were recruited 4-12 weeks following the patient’s discharge from a stroke rehabilitation facility. Interviews were conducted with family caregivers to examine their perceptions and experiences navigating the stroke rehabilitation system. Directed content analysis was used to explore the perceptions of family caregivers as they reflected on the transitions home. The theories of continuity of care and complex adaptive systems were used to interpret their experiences. Results/Conclusions: During the transition home from a rehabilitation facility, family caregivers are a constant source of support, providing the stroke survivor with continuity. Emergent themes highlight the importance of the caregiving role, and barriers and facilitators that impact the role, and influence continuity of care. Also, supports and services in the community were limited or did not meet the specific needs of the family caregiver. The acknowledgment of the unique attributes of each case will ensure supports and services are tailored to the family caregiver’s needs. Mitigation of systemic barriers would also decrease complexity experienced at the micro-level in the stroke rehabilitation system, and better support the family caregiver during the transition home from a stroke rehabilitation facility.

Indiana University-Purdue University Indianapolis (IUPUI) / Physicians receive multiple CCDs for a single patient encompassing various encounters and medical history recorded in different information systems. It is cumbersome for providers to explore different pages of CCDs to find specific data which can be duplicated or even conflicted. This study describes the steps towards a system that integrates multiple CCDs into one consolidated document for viewing or processing patient-level data. Also, the impact of the system on healthcare providers’ perceived workload is evaluated. A modular system is developed to consolidate and de-duplicate CDA-based documents. The system is engineered to be scalable, extensible and open source. The system’s performance and output has evaluated first based on synthesized data and later based on real-world CCDs obtained from INPC database. The accuracy of the consolidation system along with the gaps in identification of the duplications were assessed. Finally, the impact of the system on healthcare providers’ workload is evaluated using NASA TLX tool. All of the synthesized CCDs were successfully consolidated, and no data were lost. The de-duplication accuracy was 100% based on synthesized data and the processing time for each document was 1.12 seconds. For real-world CCDs, our system de-duplicated 99.1% of the problems, 87.0% of allergies, and 91.7% of medications. Although the accuracy of the system is still very promising, however, there is a minor inaccuracy. Due to system improvements, the processing time for each document is reduced to average 0.38 seconds for each CCD. The result of NASA TLX evaluation shows that the system significantly decreases healthcare providers’ perceived workload. Also, it is observed that information reconciliation reduces the medical errors. The time for review of medical documents review time is significantly reduced after CCD consolidation. Given increasing adoption and use of Health Information Exchange (HIE) to share data and information across the care continuum, duplication of information is inevitable. A novel system designed to support automated consolidation and de-duplication of information across clinical documents as they are exchanged shows promise. Future work is needed to expand the capabilities of the system and further test it using heterogeneous vocabularies across multiple HIE scenarios.

No description available.

No description available.

There has been a recent trend towards increasing accountability of mental health care providers through the use of treatment outcome measures, in order to reduce spending and improve patient care. This qualitative study utilized focus groups to elicit input regarding the need and possible content involved in creating an improved outcome measure specifically designed for severe emotionally disturbed (SED) children and adolescents. We conducted 60-90 minute focus groups with each of the following three separate constituent groups who are regularly involved in the care of SED youth at the Utah State Hospital (USH), including a) hospital clinical staff, b) affiliated education staff, and c) parents/primary caregivers; as well as clinical staff at a community mental health youth outpatient clinic, the Wasatch Mental Health (WMH) Youth Outpatient Program. While the groups agreed that a new unified system of tracking outcomes could be beneficial as an aid in improving outcomes, their greater concern is about a lack of communication between disciplines and between levels of care. Six broad domains were divided between two sections of Internal versus External Locus of Control (Internal: Behavior, Social/Emotional, Academic/Cognitive, and Strength-Based Assessment; External: Collaboration among Care Providers and Family) and 23 subdomains were generated based on themes identified from the focus groups' responses. We also compared these domains and subdomains to ones previously generated by a USH pilot study and found some overarching similarities, but also some notable differences and both should be considered in any future outcome measure created. However, the most prevalent theme we found was a desire for an increase in collaboration and communication between constituencies and throughout levels of care, which is vitally important to improve care and long-term outcomes of SED youth.

I Sverige är det ovanligt med barnmorskeledda kontinuitetsmodeller inom mödra- och förlossningsvård. Studier har visat att ungefär hälften av gravida kvinnor i Sverige skulle vilja ha kontinuitet med samma barnmorska genom hela graviditeten eller en för dem känd barnmorska med under förlossningen. Kontinuitetsmodeller har använts i olika delar av världen och det har visat sig vara fördelaktigt för den gravida kvinnan med bland annat färre komplikationer under förlossningen och har fler medicinska fördelar. Vårdkontinuitetsmodellen främjar även relationen mellan barnmorskan och kvinnan vilket ökar möjligheten för kvinnan att berätta om symtom och oro för sin barnmorska.  Syftet med denna litteraturöversikt var att belysa kvinnors upplevelse av barnmorskeledd kontinuitet under graviditet, förlossning- och eftervård. En litteraturöversikt genomfördes utifrån studiens syfte. Litteraturöversikten inkluderade kvalitativa samt kvantitativa forskningsartiklar. Artikelsökning gjordes i databaserna CINAHL och PubMed. Totalt inkluderades 17 vetenskapliga artiklar. Datamaterialet analyserades med integrerad analysmetod och tre teman med tillhörande subteman identifierades.  Teman var: Relationen till barnmorskan, Kontinuitetens påverkan på vården under graviditet och postpartum och Faktorer som påverkar kvinnans förlossningsupplevelse. Resultatet visade att majoriteten av kvinnorna var positiva till barnmorskeledd kontinuitetsvård. Relationen som kvinnan och barnmorskan skapade bidrog till en trygghet hos kvinnan med ökad självtillit. Vårdmodellen gav kvinnan tid för att beskriva sina önskemål inför förlossningen. Tydlig information och kunskap var en betydande faktor för kvinnorna, då de erhöll en större förståelse om graviditet och förlossning. Detta gjorde att de var väl förberedda inför förlossningen. Att ha sin barnmorska närvarande gav kvinnor ett ökat självförtroende att ta sig igenom förlossningsprocessen, eftersom barnmorskan kände till kvinnans önskemål redan innan. Slutsatsen är att kvinnorna upplevde kontinuitetsvården som tillgänglig, stöttande och säker. Barnmorskeledd kontinuitetsvård under graviditet, förlossning och eftervård kan bidra till en nära relation till barnmorskan, öka tillgängligheten till barnmorskan under graviditet och eftervård och förbättra förlossningsupplevelsen. / In Sweden midwife-led continuity models of care during pregnancy, childbirth and postpartum care is unusual. Studies have shown that about half of the pregnant women in Sweden would like to have continuity with the same midwife throughout pregnancy and childbirth. Continuity models of midwifery care have been tested and implemented in different parts of the world and has proven to be beneficial for the pregnant woman as there are fewer complications during childbirth and has more medical benefits. The continuity model promotes the relationship between the midwife and the woman, which enhance the possibility for the woman to talk about symptoms and worries with her midwife.  The purpose of the literature review was to highlight women´s experience of midwife-led continuity during pregnancy, childbirth- and postpartum care.  A literature review was conducted based on the purpose of the study. The literature review included qualitative and quantitative research articles. The search for articles was done in the databases CINAHL and PubMed. A total of 17 scientific articles were included. The data material was analyzed with an integrated analysis method. Following a compilation of the included articles, three themes were identified with associated subthemes.    The themes were: The relationship with a midwife, The impact of continuity of care during pregnancy and postpartum and Factors affecting woman’s childbirth experience. The results showed that a majority of all women were positive towards midwife-led continuity of care. The midwife-woman relationship brought a sense of security for the woman with increased self-confidence. With the continuity model of care the woman had more time to describe her wishes facing the birth. Clear information and knowledge were a significant factor for the women, as they gained a greater understanding of pregnancy and childbirth. This meant that they were well prepared for the birth. Having a known midwife present gave women an increased self-confidence to go through the process of childbirth because the midwife already knew the woman´s wishes. The woman felt that the continuous midwife-led care was accessible, supportive and safe.   Midwife-led continuity of care during pregnancy, childbirth and postpartum care can contribute to a close relationship with the midwife, increase the accessibility of the midwife during pregnancy and postpartum care and improve the childbirth experience.

<p><strong>Background and Objectives: </strong>Previous research has examined the effect of family physician continuity of care within end-of-life care cancer patients and its association with reduced use of acute care services. However, such research has not been examined in the end of life homecare cancer population.<strong> Objectives: </strong>To investigate the association of family physician continuity with location of death, hospital and emergency room (ER) visits in the last 2 weeks of life in end of life homecare cancer patients.<strong> Research Design: </strong>Retrospective study involving secondary data analysis of 7 linked databases<strong>. Subjects: </strong>All those who died of cancer between January 1, 2006 to December 31, 2006 in Ontario who had at least 1 visit to a family physician and enrolled in homecare for at least 2 weeks.<strong> Methods: </strong>The relationship of family physician continuity of care and location of death, and hospital and ER visits in the last 2 weeks of life was examined using logistic regression.<strong> Results: </strong>The Usual Provider of Care (UPC) measure demonstrated a dose response relationship with increasing continuity resulting in decreased odds of dying in the hospital and visiting the hospital and ER in the last 2 weeks of life. The Family Physician visits per week measure demonstrated a threshold effect relationship with location of death and hospital visits and dose response relationship with ER visits in the last 2 weeks of life. <strong>Conclusions:</strong> These results demonstrate an association between family physician continuity of care and location of death and visits to the hospital and ER in the last 2 weeks of life. This indicates the need for more involvement of family physicians in end of life cancer care.</p> / Master of Science (MSc)

Background Our objective was to identify and validate clinical and continuity of care variables associated with Oral anticoagulant (OAC)-related adverse events within 30 days of hospital discharge amongst seniors. Methods and Analysis This was a population-based retrospective cohort study of all adults aged 66 years or older who were discharged from hospital on an OAC from September 2010 to March 2015 in Ontario, Canada. The primary outcome was a composite of the time to first hospitalization or Emergency Department visit for a hemorrhage or thromboembolic event or mortality within 30 days of hospital discharge. A Cox proportional hazards model was used to determine the association between the composite outcome and a set of prespecified covariates. A split sample method was applied to validate the final model. Results We included 120 721 Ontario seniors of which 5423 suffered one of the primary adverse events. Patients discharged on a direct-acting oral anticoagulant (DOAC); dispensed the same OAC in the past 12 months; who had a history of a thromboembolic event; had a recent joint replacement or major surgery; had a cardiologist, hematologist or orthopedic surgeon as compared to a family medicine physician as the physician prescribing the OAC at discharge had a lower risk for the composite outcome. Though continuity of care was a variable in the final multivariate Cox model, it was not significant. The Cox model was stable with acceptable discrimination but poor goodness-of-fit. Conclusion In this study, we found that continuity of care as measured by outpatient follow-up in the 7 days post-discharge was not significantly associated with the composite outcome. Further exploration to improve the current model’s calibration and interpretation are required. / Thesis / Master of Science (MSc) / Background Oral anticoagulants (OACs) are associated with serious adverse events, with high rates immediately post-hospitalization. We aimed to identify and validate clinical and continuity of care variables in seniors discharged from hospital on an OAC, which are associated with OAC-related harm in the short-term high-risk period following hospitalization. Methods Data from administrative health databases in Ontario were used to identify and validate risk factors associated with time to first OAC-related serious events including hospitalization or emergency department visit for a bleeding or thromboembolic event, and mortality. Cox proportional hazards model and split-sample methods were utilized. Results We included 120,721 seniors of which 5423 suffered one of the primary events. Patient-, physician- and index hospitalization-characteristics were all associated with time to the composite outcome. Though continuity of care risk factor was part of the final model, it was not a significant predictor for the outcome. Conclusion Exploration of this model through sensitivity analysis is required.