Indiana University-Purdue University Indianapolis (IUPUI) / Hospital costs are the largest contributor to US health expenditures, making them a common target for cost containment policies. Policies that reduce fragmentation in health care and related systems could increase the value of these expenditures while improving outcomes. Efforts to address fragmentation of health care services, such as Accountable Care Organizations, have typically been enacted at the scale of health systems. However, coordination within health care facilities should also be explored. In three essays, I analyze the role of coordination in several forms. First, I examine the introduction of interdisciplinary care teams within a hospital. This analysis features care coordination within a health care facility with the potential to reduce resource utilization through improved communication between team members and between patients and their care providers. I find that care coordination reduced length of stay for some patients while maintaining care quality. This combination results in higher value care for patients and hospitals. Second, I explore whether these interdisciplinary care teams impact resource utilization and patient flow throughout the hospital. The primary outcome is reduction in patient transfers to the ICU. Here, care coordination includes interdisciplinary teams as well as coordination between interdisciplinary teams and intensivists in ICUs. Findings from this analysis suggest that ICU transfers were unaffected by care coordination. Finally, I examine coordination on a larger scale. I leverage data from a national database of trauma patients to compare mortality among adolescent patients with isolated traumatic brain injury between adult trauma centers and pediatric trauma centers. Previous work has shown that younger pediatric patients with this injury benefit from treatment at pediatric trauma centers. However, it is unclear whether this benefit extends to older pediatric patients on the cusp of adulthood. I find that, after adjusting for differences in injury severity, adolescent patients have no difference in mortality risk when treated at adult or pediatric trauma centers. This finding supports the current regionalized model of trauma care where severely injured patients are taken to the nearest trauma center, regardless of designation as pediatric or adult. / 2023-07-01

A deficiency of care coordination and delayed discharge planning has contributed to increased lengths of stay for telemetry patients and has pressed staff to discharge patients expeditiously, potentially leading to increased 30-day readmissions. Rushing the discharge process on the day of discharge has resulted in breakdowns in communication and lack of collaboration amongst the health care team of this study, contributing to extended lengths of stay, increased readmissions, and low Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPHS) scores. This project highlighted a patient-centered care coordination team approach with 2 clinical registered nurses and a social worker who coordinated the discharge plan with the patients on admission. Discharge planning on admission and daily briefings involving care coordination and bedside staff reduced the length of stay, improved HCAPHS scores, and reduced 30-day readmissions by fostering better communication and collaboration. A 1-group pretest and posttest were utilized to compare data before care coordination and after care coordination. These findings yielded a length of stay reduction of 2.04 days, a 50% reduction in 30-day readmissions, and HCAPHS communication composite scores above the 50th percentile. The care coordination team exposed various programs and community resources that assisted with medications and durable medical equipment and suggested that companionship alleviated potential anxiety post discharge for those financially and socially burdened. The implications of a patient-centered team-based approach to discharge planning on admission eliminated barriers to discharge, improved patient knowledge of disease management, and provided a positive hospital experience.

Over the course of the past three decades, largely due to advances in technology, there has been growth in the fields of early intervention (EI) and pediatrics for infants/toddlers with special health care needs (SHCN). This growth has also brought about a change in the relationship between pediatricians and EI service coordinators, creating an increased need for communication and collaboration between these groups of professionals. In order to address these changes, the American Academy of Pediatrics (AAP) presented recommendations for care coordination and stressed the placement of care coordination practices in the medical and developmental plans of infants/toddlers with SHCN. There have also been recommendations about communication and collaboration strategies from experts in the EI field. The medical home framework and Part C (EI) of the Individuals with Disabilities Education Act (IDEA) seek to establish care coordination systems with a family-centered focus of care. The purpose of this study is to examine care coordination within the context of the pediatric medical home and EI service coordination. Eighty- two pediatricians (n=1746, 4.7%) and 52 service coordinators (n=468, 11.1%) returned The Care Coordination Survey. Responses to the 40-item quantitative survey were analyzed using descriptive statistics and independent sample t-tests. Results indicated that pediatricians and service coordinators are implementing a number of key care coordination practices such as being available to clients/patients at their convenience. However, it was also found that both groups of professionals are not consistently providing a number of recommended care coordination practices such as sharing information between disciplines (e.g., contact information, assessment results). The results also offer implications across disciplines and reveal a need for future research in areas, such as training models across disciplines and developing a care coordination model to fit both disciplines.

No description available.

BACKGROUND:The Affordable Care Act of 2010 proposed maximum penalty equal to 1% of regular Medicare reimbursements which prompted change in how hospitals regard 30-day readmissions. While several hospital to home transitional care models demonstrated a reduction in readmissions and cost savings, programs adapted to population needs and existing resources was essential.METHODS:Focusing on process and outcomes evaluation, a retrospective analysis of a modified community based care transitions program was conducted.RESULTS:In addition to high levels of patient satisfaction with the care transitions program, participants' confidence with self care was significantly improved. Further, the program evaluation demonstrated a 73% reduction in readmissions and an actual Medicare cost savings during the 9-month study period of $214,192, excluding the cost to administer the program.CONCLUSIONS:While there are several transitional care programs in existence, a customized approach is desirable and often required as the most cost effective way to manage care transitions and employ evidence based policy making. This study established some of the pitfalls when implementing a community-based transitional care program and demonstrated encouraging outcomes.

BACKGROUND: Stroke survivors fall 7 times more annually than same-aged healthy adults; and most fall within the first 2 to 6 months post stroke after transition of care home from the acute setting. These falls cause hip fractures and other bodily injury, further compounding post-stroke mobility, fear of falling, social isolation, and social dependence while collectively yielding poorer outcomes at greater financial burden. PROBLEM: To date, no fall prevention program has targeted stroke survivors as they prepare for transition of care home from the acute setting. PURPOSE: The purpose of this practice inquiry is to develop an evidence-based fall prevention program aimed at empowering acute stroke survivors preparing for transition of care home from the acute setting. METHODS: An extensive literature review was synthesized to assess post-stroke falls epidemiology, contributing factors, potential consequences, and the current status of ameliorative interventions. A modified conceptual framework based upon the Science of Unitary Human Beings, theories of health empowerment, cognitive plasticity, and cognitive reserve was created to synergistically inform fall prevention program development. Literature review synthesis and modified conceptual framework collectively informed subsequent construction of a mixed theory-outcome-activities approach logic model to systematically guide proposed program implementation and evaluation plans. RESULTS: A novel evidence-based empowerment-focused fall prevention program was developed for acute stroke survivors preparing for transition of care home from the acute setting. CONCLUSION: The multi-interventional Patient Empowerment at Transitions of Care Fall Prevention Program for Stroke Survivors inspires a paradigm shift in the way stroke professionals and survivors view recovery and inherent survivor potential. The proposed fall prevention program is informed by a solid theoretical foundation and rigorous literature review of high-level evidentiary support. Moreover, existing dynamic funding opportunities promote subsequent program implementation and evaluation facilitated by Patient-Centered Outcome Research Institute grant pursuit.

Diabetes has reached epidemic levels, to the currently estimated 29 million individuals who are living with diabetes. Those with diabetes must manage their disease through a combination of medication, physical activity recommendations, and nutritional guidelines. The consequences of non-adherence to recommendations include cardiovascular disease, kidney failure, vision loss, or ultimately, death. Despite the risks of non-adherence, individuals often do not adhere to recommended treatment. Researchers have attempted to identify strategies to promote diabetes self-management adherence, thereby decreasing complications related to the disease. Specific Aims: describe the factors that prohibit individuals from adhering from diabetes self-management behaviors as well as the factors that promote self-management adherence, compare adherence rates of individuals participating in an enhanced diabetes education program with the adherence rates of individuals that participated in enhanced diabetes education and also attended group social support sessions, evaluate the adherence to self-management behaviors of individuals participating in a diabetes care coordination program. Results: A review of research articles from 2009 through 2013 identified barriers to diabetes self-management adherence as complexity of self-management, low health literacy, the financial burden of adherence, availability of resources, and lack of knowledge. Factors that promote diabetes self-management adherence include diabetes self-management education, self-efficacy, social support, and goal setting. A retrospective chart review of participants in an employer-sponsored health program was performed to examine the effectiveness of a social support intervention administered through the health program to promote adherence to recommended diabetes treatment. Results of the study revealed that individuals who participated in the social support intervention, in addition to the employer-sponsored health program, demonstrated increased adherence to recommended diabetes treatment from baseline to 12 months, in comparison to those who participated in only the health program (p = .048). Additional chart review compared participants’ self-management behaviors at baseline with their self-management behaviors at 12 months after entry into the program. There was a significant improvement in adherence to self-management behaviors of receiving an influenza vaccination (p = .036), decreased reported use of alcohol (p = .002) and tobacco (p = .043), and fewer reports of skipped meals (p = .009).

No description available.

Cancer diagnoses affect millions of people in the United States each year. Today, cancer patients face many challenges when trying to navigate the complex healthcare system. Patient navigation programs were developed to address and overcome barriers patients may face as they make their way through the healthcare system. The purpose of this project was to provide an analysis and discussion of the current published literature to provide evidence for improving care coordination and patient satisfaction in the oncology clinical setting with a patient navigator program. The practice-focused question for this project asked if a patient navigator program for adult cancer patients improved patient outcomes. The systematic review, guided by Watson's theory of caring, included 11 studies published between 2010 and 2017 identified through Cochrane Library, CINAHL, ProQuest, PubMed, and Joanna Briggs Institute. Initially a total of 679 articles were identified; however the number reduced by removing duplicates and after review of titles and abstracts. The remaining articles were then evaluated by the level of evidence based on the Manly and Fineout-Overholt's guide on hierarchy of evidence. The results identified in this systematic review showed patient navigation can improve care coordination and patient satisfaction. This review offers findings on the impact of cancer care coordination and patient satisfaction, which may be used by healthcare leaders when determining how to improve cancer care and as a result may provide positive social change. If the organization implements a patient navigator program, it is expected that this change would benefit patients, families, healthcare providers and the organization.

Objectives: The aim of this study was to gain a thorough understanding of parents’ perceptions of and experiences with the care networks surrounding young children (<=12 years) with inherited metabolic diseases (IMDs). Methods: In this mixed methods study, parent participants created a ‘care map’ depicting their child’s network of care providers. We analyzed care maps using social network analysis. A subset of parents participated in a semi-structured interview. We analyzed interviews thematically and integrated quantitative and qualitative results narratively. Results: Sixty parents contributed care maps and 10 participated in interviews. Parent-drawn care networks were large with few connections between providers. Parents felt responsible for creating and maintaining care networks and for coordinating care. They valued providers who trusted them as part of their child’s health care team. Conclusions: Our findings highlight the complexity of care for children with IMDs and can inform the design of interventions to improve care.