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Transitions of Care

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1. Impact of medication reconciliation for improving transitions of care. (PubMed)

Impact of medication reconciliation for improving transitions of care. Transitional care provides for the continuity of care as patients move between different stages and settings of care. Medication discrepancies arising at care transitions have been reported as prevalent and are linked with adverse drug events (ADEs) (e.g. rehospitalisation).Medication reconciliation is a process to prevent medication errors at transitions. Reconciliation involves building a complete list of a person's (...) this intervention during care transitions compared to people not receiving medication reconciliation.We searched CENTRAL, MEDLINE, Embase, seven other databases and two trials registers on 18 January 2018 together with reference checking, citation searching, grey literature searches and contact with study authors to identify additional studies.We included only randomised trials. Eligible studies described interventions fulfilling the Institute for Healthcare Improvement definition of medication reconciliation

2018 Cochrane

2. Transition from children's to adults' services for young people using health or social care services

Transition from children's to adults' services for young people using health or social care services T T r ransition from children ansition from children’s to adults’ ’s to adults’ services for y services for young people using health or oung people using health or social care services social care services NICE guideline Published: 24 February 2016 nice.org.uk/guidance/ng43 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice (...) unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Transition from children’s to adults’ services for young people using

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

3. Transition between inpatient mental health settings and community or care home settings

Transition between inpatient mental health settings and community or care home settings T T r ransition between inpatient mental ansition between inpatient mental health settings and community or care health settings and community or care home settings home settings NICE guideline Published: 30 August 2016 nice.org.uk/guidance/ng53 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our (...) of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Transition between inpatient mental health settings and community or care home settings (NG53) © NICE 2019. All rights

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

4. Challenges faced by HIV-positive youth transitioning to adult care and evidence-based practices to address them

Challenges faced by HIV-positive youth transitioning to adult care and evidence-based practices to address them Challenges faced by HIV-positive youth transitioning to adult care and evidence-based practices to address them | The Ontario HIV Treatment Network The Ontario HIV Treatment Network Challenges faced by HIV-positive youth transitioning to adult care and evidence-based practices to address them Challenges faced by HIV-positive youth transitioning to adult care and evidence-based (...) practices to address them , , , , Questions What challenges arise when youth living with HIV transition to adult care? What evidence-based practices and resources facilitate successful transition to adult HIV care? Key take-home messages The barriers to successful transition to adult HIV care include lack of preparation, psychosocial stressors, loss of relationships, stigma, and barriers within the adult health care system (communication, distance to travel, differences from the pediatric environment

2018 Ontario HIV Treatment Network

5. Transitioning the Breastfeeding Preterm Infant from the Neonatal Intensive Care Unit to Home

Transitioning the Breastfeeding Preterm Infant from the Neonatal Intensive Care Unit to Home ABM Protocol ABM Clinical Protocol #12: Transitioning the Breastfeeding Preterm Infant from the Neonatal Intensive Care Unit to Home, Revised 2018 Lawrence M. Noble, 1 Adora C. Okogbule-Wonodi, 2 Michal A. Young, 2 and The Academy of Breastfeeding Medicine A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols, free from commercial interest or in?uence (...) , for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. Introduction and Background T he practice of breastfeeding or providing expressed mother’s milk to preterm infants is promoted because of the considerable bene

2019 Academy of Breastfeeding Medicine

6. Transition between inpatient hospital settings and community or care home settings for adults with social care needs

Transition between inpatient hospital settings and community or care home settings for adults with social care needs T T r ransition between inpatient hospital ansition between inpatient hospital settings and community or care home settings and community or care home settings for adults with social care needs settings for adults with social care needs NICE guideline Published: 1 December 2015 nice.org.uk/guidance/ng27 © NICE 2019. All rights reserved. Subject to Notice of rights (https (...) due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Transition between inpatient

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

7. Psychometric properties of transitional care instruments and their relationships with health literacy: Brief PREPARED and Care Transitions Measure. (PubMed)

Psychometric properties of transitional care instruments and their relationships with health literacy: Brief PREPARED and Care Transitions Measure. To assess the psychometric properties of the Brief PREPARED (B-PREPARED) and the Care Transitions Measure (CTM) in patients discharged from hospitals in Korea, and examine their relationships with health literacy.A cross-sectional study with a follow-up telephone survey 4 weeks post-discharge.Six medical and surgical wards in a tertiary hospital (...) variables, those with inadequate health literacy had lower scores on all instruments.Although the three instruments had acceptable validity and reliability, they showed limited criterion validity. Patients with limited health literacy should be supported to ensure the quality of transitional care.© The Author(s) 2019. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions

2019 International Journal for Quality in Health Care

8. Transition of care for adolescents from paediatric services to adult health services. (PubMed)

Transition of care for adolescents from paediatric services to adult health services. There is evidence that the process of transition from paediatric (child) to adult health services is often associated with deterioration in the health of adolescents with chronic conditions.Transitional care is the term used to describe services that seek to bridge this care gap. It has been defined as 'the purposeful, planned movement of adolescents and young adults with chronic physical and medical (...) conditions from child-centred to adult-oriented health care systems'. In order to develop appropriate services for adolescents, evidence of what works and what factors act as barriers and facilitators of effective interventions is needed.To evaluate the effectiveness of interventions designed to improve the transition of care for adolescents from paediatric to adult health services.We searched The Cochrane Central Register of Controlled Trials 2015, Issue 1, (including the Cochrane Effective Practice

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2016 Cochrane

9. Measuring care transitions in Sweden: validation of the care transitions measure. (PubMed)

Measuring care transitions in Sweden: validation of the care transitions measure. To translate and assess the validity and reliability of the original American Care Transitions Measure, both the 15-item and the shortened 3-item versions, in a sample of people in transition from hospital to home within Sweden.Translation of survey items, evaluation of psychometric properties.Ten surgical and medical wards at five hospitals in Sweden.Patients discharged from surgical and medical (...) wards.Psychometric properties of the Swedish versions of the 15-item (CTM-15) and the 3-item (CTM-3) Care Transition Measure.We compared the fit of nine models among a sample of 194 Swedish patients. Cronbach's alpha was 0.946 for CTM-15 and 0.74 for CTM-3. The model indices for CTM-15 and CTM-3 were strongly indicative of inferior goodness-of-fit between the hypothesized one-factor model and the sample data. A multidimensional three-factor model revealed a better fit compared with CTM-15 and CTM-3 one factor

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2018 International Journal for Quality in Health Care

10. PharmD Transitions of Care Program (PHARMD-TOC): A Community Pharmacy Transitions of Care Program

PharmD Transitions of Care Program (PHARMD-TOC): A Community Pharmacy Transitions of Care Program PharmD Transitions of Care Program (PHARMD-TOC): A Community Pharmacy Transitions of Care Program - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove (...) one or more studies before adding more. PharmD Transitions of Care Program (PHARMD-TOC): A Community Pharmacy Transitions of Care Program The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. of clinical studies and talk to your health care provider before participating. Read our for details. ClinicalTrials.gov Identifier: NCT03617380 Recruitment Status

2018 Clinical Trials

11. Health Care Transition Experiences of Males with Childhood-onset Duchenne and Becker Muscular Dystrophy: Findings from the Muscular Dystrophy Surveillance Tracking and Research Network (MD STARnet) Health Care Transitions and Other Life Experiences Survey (PubMed)

Health Care Transition Experiences of Males with Childhood-onset Duchenne and Becker Muscular Dystrophy: Findings from the Muscular Dystrophy Surveillance Tracking and Research Network (MD STARnet) Health Care Transitions and Other Life Experiences Survey Introduction: As the proportion of males with Duchenne muscular dystrophy (DMD) surviving into adulthood increases, more information is needed regarding their health care transition planning, an essential process for adolescents and young (...) adults with DMD. The objective of this study was to describe the health care transition experiences of a population of males living with Duchenne or Becker muscular dystrophy (DBMD). Methods: The eligible participants, identified through the Muscular Dystrophy Surveillance Tracking and Research Network (MD STARnet) surveillance project, were 16-31 years old and lived in Arizona, Colorado, Georgia, Iowa, or western New York (n=258). The MD STARnet Health Care Transitions and Other Life Experiences

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2018 PLoS currents

12. Improving health care transition and longitudinal care for adolescents and young adults with hydrocephalus: report from the Hydrocephalus Association Transition Summit. (PubMed)

Improving health care transition and longitudinal care for adolescents and young adults with hydrocephalus: report from the Hydrocephalus Association Transition Summit. The health care needs of children with hydrocephalus continue beyond childhood and adolescence; however, pediatric hospitals and pediatric neurosurgeons are often unable to provide them care after they become adults. Each year in the US, an estimated 5000-6000 adolescents and young adults (collectively, youth) with hydrocephalus (...) must move to the adult health care system, a process known as health care transition (HCT), for which many are not prepared. Many discover that they cannot find neurosurgeons to care for them. A significant gap in health care services exists for young adults with hydrocephalus. To address these issues, the Hydrocephalus Association convened a Transition Summit in Seattle, Washington, February 17-18, 2017.The Hydrocephalus Association surveyed youth and families in focus groups to identify common

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2018 Journal of Neurosurgery

13. Partners at Care Transitions: exploring healthcare professionals' perspectives of excellence at care transitions for older people. (PubMed)

Partners at Care Transitions: exploring healthcare professionals' perspectives of excellence at care transitions for older people. Hospital admissions are shorter than they were 10 years ago. Notwithstanding the benefits of this, patients often leave hospital requiring ongoing care. The transition period can therefore be risky, particularly for older people with complex health and social care needs. Previous research has predominantly focused on the errors and harms that occur during (...) transitions of care. In contrast, this study adopts an asset-based approach to learn from factors that facilitate safe outcomes. It seeks to explore how staff within high-performing ('positively deviant') teams successfully support transitions from hospital to home for older people.Six high-performing general practices and six hospital specialties that demonstrate exceptionally low or reducing 30-day emergency hospital readmission rates will be invited to participate in the study. Healthcare staff from

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2018 BMJ open

14. Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000-2015. (PubMed)

Site of Death, Place of Care, and Health Care Transitions Among US Medicare Beneficiaries, 2000-2015. End-of-life care costs are high and decedents often experience poor quality of care. Numerous factors influence changes in site of death, health care transitions, and burdensome patterns of care.To describe changes in site of death and patterns of care among Medicare decedents.Retrospective cohort study among a 20% random sample of 1 361 870 decedents who had Medicare fee-for-service (2000 (...) , 2005, 2009, 2011, and 2015) and a 100% sample of 871 845 decedents who had Medicare Advantage (2011 and 2015) and received care at an acute care hospital, at home or in the community, at a hospice inpatient care unit, or at a nursing home.Secular changes between 2000 and 2015.Medicare administrative data were used to determine site of death, place of care, health care transitions, which are changes in location of care, and burdensome patterns of care. Burdensome patterns of care were based

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2018 JAMA

15. Experiences of non-specialist nurses caring for patients and their significant others undergoing transitions during palliative end-of-life cancer care: a systematic review. (PubMed)

Experiences of non-specialist nurses caring for patients and their significant others undergoing transitions during palliative end-of-life cancer care: a systematic review. Non-specialist nurses, who are providing palliative end-of-life cancer care to patients and significant others undergoing psychosocial and existential transitions, may experience dissatisfaction, frustration and sorrow. On the other hand, they may also experience happiness, increased knowledge and personal growth.What (...) are non-specialist nurses' experiences when providing palliative end-of-life cancer care that involves the psychosocial and existential transitions of their patients and significant others?The current review considered studies that included a description of the experiences of non-specialist trained registered nurses (RNs) working in non-specialist wards.The current review considered studies that investigated experiences of RNs when providing palliative end-of-life cancer care that involves

2017 JBI database of systematic reviews and implementation reports

16. Quantitative?other: A transitional care model for low-income older adults does not reduce readmission rates or emergency department visits during care transitions

Quantitative?other: A transitional care model for low-income older adults does not reduce readmission rates or emergency department visits during care transitions A transitional care model for low-income older adults does not reduce readmission rates or emergency department visits during care transitions | Evidence-Based Nursing We use cookies to improve our service and to tailor our content and advertising to you. You can manage your cookie settings via your browser at any time. To learn more (...) about how we use cookies, please see our . Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? Search for this keyword Search for this keyword Main menu Log in using your username and password For personal accounts OR managers of institutional accounts Username * Password * your user name or password? You are here A transitional care model for low-income older adults does not reduce readmission rates

2014 Evidence-Based Nursing

17. Effect of Patient-Centered Transitional Care Services on Clinical Outcomes in Patients Hospitalized for Heart Failure: The PACT-HF Randomized Clinical Trial. (PubMed)

Effect of Patient-Centered Transitional Care Services on Clinical Outcomes in Patients Hospitalized for Heart Failure: The PACT-HF Randomized Clinical Trial. Health care services that support the hospital-to-home transition can improve outcomes in patients with heart failure (HF).To test the effectiveness of the Patient-Centered Care Transitions in HF transitional care model in patients hospitalized for HF.Stepped-wedge cluster randomized trial of 2494 adults hospitalized for HF across 10 (...) hospitals in Ontario, Canada, from February 2015 to March 2016, with follow-up until November 2016.Hospitals were randomized to receive the intervention (n = 1104 patients), in which nurse-led self-care education, a structured hospital discharge summary, a family physician follow-up appointment less than 1 week after discharge, and, for high-risk patients, structured nurse homevisits and heart function clinic care were provided to patients, or usual care (n = 1390 patients), in which transitional care

2019 JAMA

18. Effects of a Transitional Care Practice for a Vulnerable Population: a Pragmatic, Randomized Comparative Effectiveness Trial

Effects of a Transitional Care Practice for a Vulnerable Population: a Pragmatic, Randomized Comparative Effectiveness Trial There is limited experimental evidence on transitional care interventions beyond 30 days post-discharge and in vulnerable populations.Evaluate effects of a transitional care practice (TC) that comprehensively addresses patients' medical and psychosocial needs following hospital discharge.Pragmatic, randomized comparative effectiveness trial.Adults discharged from (...) an initial emergency, observation, or inpatient hospital encounter with no trusted usual source of care.TC intervention included a scheduled post-discharge appointment at the TC practice, where a multidisciplinary team comprehensively assessed patients' medical and psychosocial needs, addressed modifiable barriers, and subsequent linkage to a new primary care source. Routine Care involved assistance scheduling a post-discharge appointment with a primary care provider that often partnered

2019 EvidenceUpdates

19. Improving Transitions to Post-acute Care for Elderly Patients Using a Novel Video-Conferencing Program: ECHO- Care Transitions. (PubMed)

Improving Transitions to Post-acute Care for Elderly Patients Using a Novel Video-Conferencing Program: ECHO- Care Transitions. Within 30 days of hospital discharge to a skilled nursing facility, older adults are at high risk for death, re-hospitalization, and high-cost health care. The purpose of this study was to examine whether a novel videoconference program called Extension for Community Health Outcomes-Care Transitions (ECHO-CT) that connects an interdisciplinary hospital-based team (...) with those in matched skilled nursing facilities delivering usual care. ECHO-CT may improve patient transitions to postacute care at lower overall cost.Copyright © 2017 Elsevier Inc. All rights reserved.

2017 American Journal of Medicine

20. Meeting Medicare requirements for transitional care: Do stroke care and policy align? (PubMed)

Meeting Medicare requirements for transitional care: Do stroke care and policy align? This study (1) describes transitional care for stroke patients discharged home from hospitals, (2) compares hospitals' standards of transitional care with core transitional care management (TCM) components recognized by Medicare, and (3) examines the association of policy and hospital specialty designations with TCM implementation.Hospitals participating in the Comprehensive Post-Acute Stroke Services (COMPASS (...) ) Study provided data on their hospital, stroke patient population, and standards of transitional care. Hospital-reported transitional care strategies were compared with the federal TCM definition (2-day follow-up, 14-day visit, non-face-to-face services). We examined the associations of TCM billing, stroke center certification, and Magnet nursing excellence designation with TCM implementation.Transitional care varied widely among 41 hospitals in North Carolina and no one strategy was universally

2019 Neurology

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