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Development of a Complex Care Transition Team to Improve the Transition of Patients With Complex Care Needs to the Community
No full textPurpose: Health care systems have historically struggled to provide adequate care for patients with complex care needs that often result in overuse of hospital and emergency department resources. Patients with complex care needs generally have increased expenses, longer length of hospital stays, an increased need for care management resources during hospitalization, and high readmission rates. Mayo Clinic in Arizona aimed to ensure successful transitions for hospitalized patients with complex care needs to the community by developing a complex care transition team (CCTT) program. With typical care management models, patients are assigned to registered nurse case managers and social workers according to the inpatient nursing unit rather than patient care complexity. Patients with complex care needs may not receive the amount of time needed to ensure an efficient and effective transition to the community setting. Furthermore, after transitioning to the community, patients with complex care needs often do not have access to care management resources if further care coordination needs arise. Primary Practice Setting: Acute care hospital in the US Southwest. Methodology and Sample: The CCTT was composed of a registered nurse case manager, social worker, and care management assistant, with physician advisor support. The CCTT followed patients with complex care needs during their hospitalization and transition to the community for 90 days after discharge. The number of inpatient admissions and hospital readmission rates were compared between 6 months before and after enrollment in the CCTT program. Cost savings for decreased hospital length of stay, emergency department visits, and hospital readmissions were also determined. Results: The CCTT selected patients according to a complex care algorithm, which identified patients who required high use of the health care system. The CCTT then followed this cohort of patients for an average of 90 days after discharge. A total of 123 patients were enrolled in the CCTT program from July 1, 2019, to April 30, 2021, and 80 patients successfully graduated from the program. Readmission rates decreased from 51.2% at 6 months before the intervention to 22.0% at 6 months after the intervention. This reduced readmission rate resulted in a cost savings of more than $1 million. Implications for Case Management Practice: The outcomes resulting from implementation of the multidisciplinary CCTT highlight the need for a patient-specific approach to transitioning care to the outpatient setting. The patient social determinants of health that often contributed to overuse of health care resources included poor access to outpatient specialists, difficulty navigating the health care system due to illness or poor health literacy, and limited social support. The success of the CCTT program prompted the implementation of other specialty-specific pilot programs at Mayo Clinic in Arizona. The investment of time and resources, including dedicated personnel to follow patients with high hospital service usage, allows health care systems to reduce emergency department visits and hospital admissions and to provide patients with the best opportunity for success as they transition from the inpatient to outpatient setting
Immunotherapy-Induced Type 1 Diabetes Mellitus Causing Diabetic Ketoacidosis: A Case Report and Review of Current Guidelines
No full textBackground: Immune checkpoint inhibitors (ICIs) are becoming more frequently used in the treatment of many types of malignant cancers by disinhibiting T-cell activation, which promotes the destruction of cancer cells. This disinhibition can also result in autoimmune conditions, like endocrinopathies. Case: We report a case of a 78-year-old male patient with malignant mesothelioma treated with combination ICI therapy who presented with diabetic ketoacidosis (DKA) with no history of diabetes mellitus or hyperglycemia. The patient was admitted to the intensive care unit and treated with intravenous (IV) fluid repletion and IV insulin for DKA. The patient was diagnosed with new-onset type 1 diabetes mellitus (T1DM) induced by ICI therapy. Discussion: Approximately 75% of patients diagnosed with ICI-induced T1DM initially present with DKA. This, along with the rapid onset of hyperglycemia in this patient, suggests current guidelines for monitoring blood glucose are inadequate. Current guidelines recommend monitoring blood glucose at the following times: baseline, at the initiation of each cycle for 12 weeks, and then every 3–6 weeks thereafter. We propose the following schedule for monitoring blood glucose in patients receiving ICI therapy: baseline, twice weekly for the first six cycles, and then once weekly thereafter. This proposed update is supported by our patient\u27s rapid onset of hyperglycemia and other case reports and reviews showing that most patients with this diagnosis have an initial presentation of DKA. Detecting hyperglycemia and starting treatment early is important in the prevention of acute complications from uncontrolled T1DM, like DKA. Conclusion: This case adds to the existing body of literature and provides support for more frequent monitoring of blood glucose in patients receiving ICI therapy. Blood glucose monitoring is a simple, reliable, low risk, and inexpensive laboratory test that should be used in patients receiving ICI therapy to ensure prompt diagnosis and treatment of T1DM
Epidemiology of Shoulder Dislocations Presenting to Emergency Departments in the United States, 2007–2020
No full textContext: Shoulder dislocations are the most commonly treated joint dislocation in the emergency department. Zacchilli and Owens previously reported on the epidemiology of shoulder dislocations presenting to the emergency department in the United States from 2002 to 2006. At the time of data collection and analysis, no epidemiological report had been published to update these findings. Purpose: The purpose of our study was to provide an updated epidemiological report from 2007 to 2020. Results: A total of 26,203 shoulder dislocations were recorded in the National Electronic Injury Surveillance System database from 2007 to 2020. The highest rates occurred in males (71.4%, n = 18,722) and patients aged 20–29 years old (28.2%, n = 7,292). The most common mechanism of injury was sports involvement (48.6%, n = 12,735). Interpretation: Our findings suggest that rates of shoulder dislocations have remained consistent with previous research on this topic, indicating no significant changes over the past 19 years. More effective prevention strategies are needed, especially for at-risk populations
Applying the National Institute on Minority Health and Health Disparities Research Framework to Social Determinants of Health in the Context of Sport-Related Concussion: A Clinical Commentary
No full textSport-related concussion (SRC) is a prevalent injury. Significant disparities in SRC outcomes exist across racial and ethnic groups. These disparities may be attributed to the unequal distribution of political power (or influence) and resource allocation in various communities, shaping individuals\u27 social determinants of health (SDOH). However, the influence of SDOH on SRC outcomes remains understudied. In this clinical commentary, we use the National Institute on Minority Health and Health Disparities Research Framework and describe how its application can help address gaps in our understanding of SDOH and SRC. This framework provides a comprehensive approach to investigating and addressing health disparities by considering SDOH along multiple levels and domains of influence. Using this framework, athletic trainers can identify areas requiring intervention and better understand how SDOH influence SRC outcomes. This understanding can help athletic trainers develop tailored interventions to promote equitable care for patients with SRC
Discharge to Success: A life skills manual developed by OTs for transitioning individuals with SMI from forensic hospitals
Get PDFThis research project examined the development of and staff training using a discharge manual aimed at improving transition outcomes for individuals with serious mental illness (SMI) within a forensic psychiatric setting. The manual, tailored to the needs of patients at Arizona State Hospital (ASH), addresses barriers to community reintegration through the provision of occupation-based interventions and resources. Occupational therapists (OTs) played a central role in the project, emphasizing the importance of meaningful activities in promoting independence and well-being among individuals with SMI in an effort to reduce recidivism. Interdisciplinary collaboration among healthcare professionals underscored the holistic approach to mental health care. While statistical analysis did not yield significant results, the rise in mean scores observed in pre- and post-training surveys among participants suggests that the manual was perceived as effective in addressing patient needs. Limitations, including a small sample size and potential bias, are acknowledged, suggesting avenues for future research. Overall, this study highlights the crucial role of tailored interventions and interdisciplinary collaboration in improving discharge outcomes for individuals with SMI in forensic psychiatric settings
The Effects of a Training Module on OT\u27s Self-Efficacy in Montessori Settings
Get PDFBackground. The Montessori method is a non-traditional education setting that uses child-directed learning with practical life materials to foster natural learning patterns in students. Montessori students have been shown to display increased cognitive, academic, and psychological skills that continue to impact an individual through their adulthood. Due to the traditional ways of the Montessori method, related services, such as occupational therapy (OT), are not always viewed as a valuable addition to a student’s learning environment. Lack of familiarity and education regarding the Montessori method may impact the self-efficacy an occupational therapist has when providing services to Montessori students. Methods. A national needs assessment (NNA) was used to examine the presence of OT in Montessori environments and to gather information on education occupational therapists have regarding the Montessori method. Additionally, the NNA was used as a recruitment tool to gather participants to participate in the training module, Montessori for the OT. The training module included pre- and post-module surveys that measured the occupational therapists’ self-efficacy towards providing services in a Montessori setting using Montessori materials before and after completing a training module. Results. Results from the NNA suggest occupational therapists lack education regarding the Montessori method as it is not offered in OT programs. The pre- and post-module surveys indicate that a training module could positively influence the confidence occupational therapists have when providing services to Montessori students. Discussion. Although a training module may have positive impacts on self-efficacy in some areas, other areas may negatively be impacted due to the level of self-awareness discovered
National Athletic Trainers’ Association Bridge Statement: Management of Sport-Related Concussion
No full textObjective: To provide athletic trainers and team physicians with updated recommendations to the 2014 National Athletic Trainers’ Association (NATA) concussion position statement regarding concussion management, specifically in the areas of education, assessment, prognostic factors, mental health, return to academics, physical activity, rest, treatment, and return to sport. Background: Athletic trainers have benefited from the 2 previous NATA position statements on concussion management, and although the most recent NATA position statement is a decade old, knowledge gains in the medical literature warrant updating several (but not all) recommendations. Furthermore, in various areas of the body of literature, current evidence now exists to address items not adequately addressed in the 2014 statement, necessitating the new recommendations. This document therefore serves as a bridge from the 2014 position statement to the current state of concussion evidence, recommendations from other organizations, and discrepancies between policy and practice. Recommendations: These recommendations are intended to update the state of the evidence concerning the management of patients with sport-related concussion, specifically in the areas of education; assessment advances; prognostic recovery indicators; mental health considerations; academic considerations; and exercise, activity, and rehabilitation management strategies
Variables associated with days of school missed following concussion: results from the Sport Concussion Outcomes in PEdiatrics (SCOPE) study
No full textObjective: To understand factors associated with missed academic time after concussion to improve support for patients. Our goal was to assess patient-specific predictors of total school time lost after pediatric/adolescent concussion. Study Design: We performed a prospective cohort study of children and adolescents (8–18 years of age) seen within 14 days of concussion from seven pediatric medical centers across the United States. We collected outcomes via the Concussion Learning Assessment & School Survey (CLASS) and constructed a multivariable predictive model evaluating patient factors associated with school time loss. Results: 167 patients participated (mean age = 14.5 ± 2.2 years; 46% female). Patients were assessed initially at 5.0 ± 3.0 days post-injury and had a final follow-up assessment 24.5 ± 20.0 days post-concussion. Participants missed a median of 2 days of school (IQR = 0.5–4), and 21% reported their grades dropped after concussion. Higher initial symptom severity rating (β = 0.06, 95% CI = 0.03–0.08, p \u3c 0.001) and perception of grades dropping after concussion (β = 1.37, 95% CI = 0.28–2.45, p = 0.01) were significantly associated with more days of school time missed after concussion. Those who reported their grades dropping reported missing significantly more school (mean = 5.0, SD = 4.7 days missed of school) than those who reported their grades did not drop (mean = 2.2, SD = 2.6 days missed of school; p \u3c 0.001; Cohen’s d = 0.87). Conclusions: Children and adolescents reported missing a median of 2 days of school following concussion, and more missed school time after a concussion was associated with more severe concussion symptoms and perception of grades dropping. These findings may support recommendations for minimal delays in return-to-learn after concussion