Biomedical subjects
Publications and source records attributed to M D Mezey.
The benefits and risks for older adults with dementia executing advance directives are discussed. Salient issues related to decision-specific capacity and models for advance planning and end-of-life decisions by cognitively impaired older adults are presented.
CONTEXT: Comprehensive discharge planning by advanced practice nurses has demonstrated short-term reductions in readmissions of elderly patients, but the benefits of more intensive follow-up of hospitalized elders at risk for poor outcomes after discharge has not been studied. OBJECTIVE: To examine the effectiveness of an advanced practice nurse-centered discharge planning and home follow-up intervention for elders at risk for hospital readmissions. DESIGN: Randomized clinical trial with follow-up at 2, 6, 12, and 24 weeks after index hospital discharge. SETTING: Two urban, academically affiliated hospitals in Philadelphia, Pa. PARTICIPANTS: Eligible patients were 65 years or older, hospitalized between August 1992 and March 1996, and had 1 of several medical and surgical reasons for admission. INTERVENTION: Intervention group patients received a comprehensive discharge planning and home follow-up protocol designed specifically for elders at risk for poor outcomes after discharge and implemented by advanced practice nurses. MAIN OUTCOME MEASURES: Readmissions, time to first readmission, acute care visits after discharge, costs, functional status, depression, and patient satisfaction. RESULTS: A total of 363 patients (186 in the control group and 177 in the intervention group) were enrolled in the study; 70% of intervention and 74% of control subjects completed the trial. Mean age of sample was 75 years; 50% were men and 45% were black. By week 24 after the index hospital discharge, control group patients were more likely than intervention group patients to be readmitted at least once (37.1 % vs 20.3 %; P<.001). Fewer intervention group patients had multiple readmissions (6.2% vs 14.5%; P = .01) and the intervention group had fewer hospital days per patient (1.53 vs 4.09 days; P<.001). Time to first readmission was increased in the intervention group (P<.001). At 24 weeks after discharge, total Medicare reimbursements for health services were about $1.2 million in the control group vs about $0.6 million in the intervention group (P<.001). There were no significant group differences in post-discharge acute care visits, functional status, depression, or patient satisfaction. CONCLUSIONS: An advanced practice nurse-centered discharge planning and home care intervention for at-risk hospitalized elders reduced readmissions, lengthened the time between discharge and readmission, and decreased the costs of providing health care. Thus, the intervention demonstrated great potential in promoting positive outcomes for hospitalized elders at high risk for rehospitalization while reducing costs.
This article reports on a new instrument, the Geriatric Institutional Assessment Profile (GIAP), developed to assess (1) hospital workers' knowledge, attitudes, and perceptions regarding care of geriatric patients, and (2) the perceived adequacy of an institutional environment to serve geriatric patients' needs. Findings are reported from 303 questionnaires completed by health care employees from a 658-bed academic medical center. Internal consistency estimates were consistently high for the various components of the GIAP. Factor analysis was performed to examine underlying dimensions of knowledge and institutional environment. The GIAP has the potential to narrow the gap between actual and best practice in geriatric care by identifying staff information needs and concerns, as well as institutional barriers and facilitators to providing quality geriatric hospital care.
Explore the source record for details and available documents.
Increased patient acuity, relative absence of professional providers, and isolation of nursing homes from the mainstream of health care precipitated the initiation of Teaching Nursing Home Programs (TNHP). The Robert Wood Johnson Foundation TNHP provided funding for 11 schools of nursing in collaboration with 12 nursing homes for the purpose of upgrading clinical care in nursing homes, creating an environment supportive of education, and promoting clinical research. A complete evaluation of a TNHP requires consideration of outcome, process, and structure. Quality of care and professional decision making are discussed as two of four areas by which TNHPs were evaluated.
Explore the source record for details and available documents.
Because blacks make up a small proportion of the hip fracture population, little is known about how blacks' experience following hip fracture compares to that of whites. This study, a retrospective review of the medical records of 119 community residing subjects, 60 years of age and older, 37% of whom were black, admitted with a diagnosis of hip fracture to a large urban teaching hospital, investigated differences between black and white patients in factors associated with outcome following hip fracture and outcomes at time of hospital discharge. Blacks were significantly more likely than whites to exhibit a high total number of diagnoses, urinary incontinence following surgery, low admission hemoglobins and mental impairment. Blacks experienced significantly longer hospitalizations than whites, were significantly more likely to be nonambulatory at discharge and showed different patterns of discharge destination. Multiple regression and logistic regression indicated that the greater amount of illness of blacks is a consistent significant predictor of these differences in outcomes, but that race, delays to surgery and non-surgical treatment also make independent significant contributions. These findings indicate the importance of planning for the in-hospital care of black hip fracture patients, and the examination of the financial consequences of DRG's for hospitals serving black or poor populations.
Mental impairment recorded at admission, following surgery and at discharge was assessed by studying the hospital records of 98 community residing persons, 60 years and older (mean age 76.2), hospitalized for a hip fracture and discharged alive. Of the total sample, the proportion mentally impaired following surgery was 33%. In a subsample of 74 patients for whom data were known at admission and after surgery, 15% were identified as persistently mentally impaired at admission and post-surgery, 26% were impaired only post-surgically and 59% had no recorded impairment either at admission or after surgery. Length of hospitalization (LOS) differed significantly among these three impairment groups, with persistently impaired having significantly longer stays (mean number of days = 53) than the never impaired (mean number of days = 24) and the newly impaired (mean number of days = 38) falling in between (p less than 0.005). Mental impairment continued to exhibit a significant and independent relationship with length of stay even when age and total diagnoses were held constant. The substantial prevalence of mental impairment during hospitalization, coupled with the increased length of stay in patients exhibiting impairment persisting from time of admission or newly evident after surgery, underscore the importance of mental status for recovery. Findings suggest that assessing the progression of mental impairment over the course of a hospital stay yields more accurate information about the relationship of mental status to recovery indicators and that accurate assessment of impairment at admission identifies a patient group at high risk for increased lengths of stay.(ABSTRACT TRUNCATED AT 250 WORDS)
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.