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[PMID]:29320140
[Au] Autor:Amarashingham R; Xie B; Karam A; Nguyen N; Kapoor B
[Ad] Endereço:Pieces Technology, Inc.
[Ti] Título:Using Community Partnerships to Integrate Health and Social Services for High-Need, High-Cost Patients.
[So] Source:Issue Brief (Commonw Fund);2018:1-11, 2018 Jan 01.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Issue: Our health care and social services delivery systems are not well-equipped to effectively manage patients with multiple chronic diseases and complex social needs such as food, housing, or substance abuse services. Community-level efforts have emerged across the nation to integrate the activities of disparate social service organizations with local health care delivery systems. Evidence on the experiences and outcomes of these programs is emerging, and there is much to learn about their approaches and challenges. Goal: Profile and classify burgeoning initiatives, understand common challenges, and surface solutions to address those challenges. Methods: Mixed-methods approach, including literature search, surveys, semistructured interviews with program leaders, and consultation with expert panels. Findings and Conclusions: We categorized cross-sector community partnerships in four dimensions. We also identified five common challenges: inadequate strategies to sustain cost-savings, improvement, and funding; lack of accurate and timely measurement of return on investment; lack of mechanisms to share potential savings between health care and social services providers; lack of expertise to integrate multiple data sources during health care or social services provision; and lack of a cross-sector workflow evidence base.
[Mh] Termos MeSH primário: Serviços de Saúde Comunitária
Relações Comunidade-Instituição
Prestação Integrada de Cuidados de Saúde
Múltiplas Afecções Crônicas/terapia
Apoio Social
[Mh] Termos MeSH secundário: Redes Comunitárias
Necessidades e Demandas de Serviços de Saúde
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180122
[Lr] Data última revisão:
180122
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE


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[PMID]:29190658
[Au] Autor:Marcoux V; Chouinard MC; Diadiou F; Dufour I; Hudon C
[Ad] Endereço:Faculté de Médecine et des Sciences de la Santé de l'Université de Sherbrooke, Université de Sherbrooke, Québec, Canada.
[Ti] Título:Screening tools to identify patients with complex health needs at risk of high use of health care services: A scoping review.
[So] Source:PLoS One;12(11):e0188663, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Many people with chronic conditions have complex health needs often due to multiple chronic conditions, psychiatric comorbidities, psychosocial issues, or a combination of these factors. They are at high risk of frequent use of healthcare services. To offer these patients interventions adapted to their needs, it is crucial to be able to identify them early. OBJECTIVE: The aim of this study was to find all existing screening tools that identify patients with complex health needs at risk of frequent use of healthcare services, and to highlight their principal characteristics. Our purpose was to find a short, valid screening tool to identify adult patients of all ages. METHODS: A scoping review was performed on articles published between 1985 and July 2016, retrieved through a comprehensive search of the Scopus and CINAHL databases, following the methodological framework developed by Arksey and O'Malley (2005), and completed by Levac et al. (2010). RESULTS: Of the 3,818 articles identified, 30 were included, presenting 14 different screening tools. Seven tools were self-reported. Five targeted adult patients, and nine geriatric patients. Two tools were designed for specific populations. Four can be completed in 15 minutes or less. Most screening tools target elderly persons. The INTERMED self-assessment (IM-SA) targets adults of all ages and can be completed in less than 15 minutes. CONCLUSION: Future research could evaluate its usefulness as a screening tool for identifying patients with complex needs at risk of becoming high users of healthcare services.
[Mh] Termos MeSH primário: Necessidades e Demandas de Serviços de Saúde
Serviços de Saúde/utilização
Múltiplas Afecções Crônicas/terapia
[Mh] Termos MeSH secundário: Adulto
Idoso
Seres Humanos
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW; VALIDATION STUDIES
[Em] Mês de entrada:1712
[Cu] Atualização por classe:171229
[Lr] Data última revisão:
171229
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188663


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[PMID]:29065071
[Au] Autor:Anderson EW; Frazer MS; Schellinger SE
[Ad] Endereço:Author Affiliations: Principal Investigator (Dr Anderson), Senior Research Scientist (Dr Frazer), Clinical Coinvestigator (Ms Schellinger), Division of Applied Research, Allina Health, Minneapolis, Minnesota.
[Ti] Título:Combining Best Practices and Patient, Caregiver, and Healthcare Provider Perspectives for Late-Life Supportive Care: LifeCourse.
[So] Source:J Nurs Adm;47(11):551-557, 2017 Nov.
[Is] ISSN:1539-0721
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Healthcare systems seek effective ways to support and treat the growing number of individuals living with serious illness. The nature of these care episodes challenges delivery systems to attain proficiency in dealing with the multiplicity of chronic conditions in individuals and populations through understanding and attending to patients' medical and nonmedical aspects of health. This article describes LifeCourse, a healthcare approach that provides palliative care practices to patients with serious illness years prior to death.
[Mh] Termos MeSH primário: Cuidadores/psicologia
Saúde Holística/normas
Múltiplas Afecções Crônicas/terapia
Cuidados Paliativos/normas
Assistência Centrada no Paciente/normas
Qualidade de Vida
[Mh] Termos MeSH secundário: Cuidadores/normas
Saúde Holística/tendências
Seres Humanos
Cuidados Paliativos/tendências
Preferência do Paciente
Assistência Centrada no Paciente/organização & administração
Assistência Centrada no Paciente/tendências
Relações Profissional-Família
Relações Profissional-Paciente
Apoio Social
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM; N
[Da] Data de entrada para processamento:171025
[St] Status:MEDLINE
[do] DOI:10.1097/NNA.0000000000000542


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[PMID]:28863719
[Au] Autor:Mihailoff M; Deb S; Lee JA; Lynn J
[Ad] Endereço:1 Winchester Medical Center, VA, USA.
[Ti] Título:The Effects of Multiple Chronic Conditions on Adult Patient Readmissions and Hospital Finances: A Management Case Study.
[So] Source:Inquiry;54:46958017729597, 2017 Jan 01.
[Is] ISSN:1945-7243
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Medicare and other payers have launched initiatives to reduce hospital utilization, especially targeting readmissions within 30 days of discharge. Hospital managers have traditionally contended that hospitals would prosper better by ignoring the penalties for high readmission rates and keeping the beds more full. We aimed to test the financial effects of admissions and readmissions by persons with and without specified chronic conditions in one regional hospital. This is a management case study with a descriptive brief report. This study was conducted at Winchester Memorial Hospital, a general hospital in a largely rural area of Virginia, 2010-2015. The total margin per admission varied by diagnosis, with the average patient diagnosed with chronic obstructive pulmonary disease, heart failure, pneumonia, or chronic renal disease having negative margins. The largest per-patient losses were in diagnostic categories coinciding with the highest readmission rates. The margin declined into substantial losses with an increasing number of chronic conditions, which also corresponded with higher readmission rates. Patients with 5 or more clinical conditions had highest risk of readmission within 30 days (24.8%) and had an average total loss of $865 per admission in 2015. The adverse financial effects worsened between 2010 and 2015. This hospital might improve its finances by investing in strategies to reduce chronic illness hospitalizations, especially those with multiple chronic conditions and high risk of readmission. These findings counter the common claim that the hospital would do better to fill beds rather than to work on efficient utilization. Other hospitals could replicate these analyses to understand their situations.
[Mh] Termos MeSH primário: Ocupação de Leitos/economia
Hospitais Gerais/economia
Hospitais Rurais/economia
Múltiplas Afecções Crônicas/economia
Readmissão do Paciente/economia
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170912
[Lr] Data última revisão:
170912
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170903
[St] Status:MEDLINE
[do] DOI:10.1177/0046958017729597


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[PMID]:28851739
[Au] Autor:Lail J; Fields E; Schoettker PJ
[Ad] Endereço:James M. Anderson Center for Health Systems Excellence and jennifer.lail@cchmc.org.
[Ti] Título:Quality Improvement Strategies for Population Management of Children With Medical Complexity.
[So] Source:Pediatrics;140(3), 2017 Sep.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: Children with medical complexity require the expertise of specialists and hospitals but may lack primary care to provide preventive, acute, and chronic care management. The Complex Care Center (CCC) at Cincinnati Children's Hospital Medical Center employed quality improvement methodologies in 3 initiatives to improve care for this fragile population. METHODS: Improvement activities focused on 3 main areas: population identification and stratification for care support, reliable delivery of preventive and chronic care, and planned care to identify and coordinate needed services. RESULTS: The percent of patients who attended a well-child care visit in the previous 13 months increased 91% and was sustained for the next year. The median monthly no-show rate remained unchanged. Within 10 months of implementing the interventions, >90% of CCC patients <7 years of age were receiving all recommended vaccines. Seventy-two percent of all CCC patients received their annual influenza vaccine. A sustained 98% to 100% of children with a complex chronic disease received previsit planning (PVP) for their well-child care and chronic condition management visits, whereas only 1 new patient did not receive PVP. CONCLUSIONS: Children with medical complexity require adaptations to typical primary care processes to support preventive health practices, chronic and acute care management, immunization, and collaborative care with their multiple specialists and support providers. We used quality improvement methodology to identify patients with the highest needs, reliably deliver appropriate preventive and chronic care, and implement PVP.
[Mh] Termos MeSH primário: Múltiplas Afecções Crônicas/terapia
Atenção Primária à Saúde/normas
Melhoria de Qualidade
[Mh] Termos MeSH secundário: Criança
Prestação Integrada de Cuidados de Saúde/normas
Seres Humanos
Imunização
Planejamento de Assistência ao Paciente
Atenção Primária à Saúde/métodos
Prevenção Primária
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170831
[St] Status:MEDLINE


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[PMID]:28817334
[Au] Autor:Kangovi S; Mitra N; Grande D; Huo H; Smith RA; Long JA
[Ad] Endereço:Shreya Kangovi, David Grande, Hairong Huo, Robyn A. Smith, and Judith A. Long are with Perelman School of Medicine, University of Pennsylvania, Division of General Internal Medicine, Philadelphia. Nandita Mitra is with Perelman School of Medicine, University of Pennsylvania, Department of Biostatist
[Ti] Título:Community Health Worker Support for Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial.
[So] Source:Am J Public Health;107(10):1660-1667, 2017 Oct.
[Is] ISSN:1541-0048
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To determine whether a community health worker (CHW) intervention improved outcomes in a low-income population with multiple chronic conditions. METHODS: We conducted a single-blind, randomized clinical trial in Philadelphia, Pennsylvania (2013-2014). Participants (n = 302) were high-poverty neighborhood residents, uninsured or publicly insured, and diagnosed with 2 or more chronic diseases (diabetes, obesity, tobacco dependence, hypertension). All patients set a disease-management goal. Patients randomly assigned to CHWs also received 6 months of support tailored to their goals and preferences. RESULTS: Support from CHWs (vs goal-setting alone) led to improvements in several chronic diseases (changes in glycosylated hemoglobin: -0.4 vs 0.0; body mass index: -0.3 vs -0.1; cigarettes per day: -5.5 vs -1.3; systolic blood pressure: -1.8 vs -11.2; overall P = .08), self-rated mental health (12-item Short Form survey; 2.3 vs -0.2; P = .008), and quality of care (Consumer Assessment of Healthcare Providers and Systems; 62.9% vs 38%; P < .001), while reducing hospitalization at 1 year by 28% (P = .11). There were no differences in patient activation or self-rated physical health. CONCLUSIONS: A standardized CHW intervention improved chronic disease control, mental health, quality of care, and hospitalizations and could be a useful population health management tool for health care systems. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01900470.
[Mh] Termos MeSH primário: Agentes Comunitários de Saúde/organização & administração
Saúde Mental
Múltiplas Afecções Crônicas/terapia
Pobreza
Populações Vulneráveis
[Mh] Termos MeSH secundário: Adulto
Idoso
Pressão Sanguínea
Índice de Massa Corporal
Feminino
Hemoglobina A Glicada/análise
Nível de Saúde
Seres Humanos
Masculino
Meia-Idade
Philadelphia
Qualidade da Assistência à Saúde/organização & administração
Método Simples-Cego
Fumar/epidemiologia
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Glycated Hemoglobin A)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE
[do] DOI:10.2105/AJPH.2017.303985


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[PMID]:28809384
[Au] Autor:Elmunzer BJ; Noureldin M; Morgan KA; Adams DB; Coté GA; Waljee AK
[Ad] Endereço:Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
[Ti] Título:The Impact of Cholecystectomy After Endoscopic Sphincterotomy for Complicated Gallstone Disease.
[So] Source:Am J Gastroenterol;112(10):1596-1602, 2017 Oct.
[Is] ISSN:1572-0241
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Cholecystectomy after endoscopic sphincterotomy (ES) is associated with improved outcomes compared to ES alone, however randomized trials have included mainly fit surgical candidates. Our objective was to assess the impact of cholecystectomy after ES among elderly patients, in whom the perceived risks of surgery may be increased and the prevailing bias may be to defer cholecystectomy. METHODS: We performed adjusted analyses comparing clinical outcomes in patients ≥65 years of age who did and did not undergo follow-up cholecystectomy after endoscopic sphincterotomy for choledocholithiasis, ascending cholangitis, or gallstone pancreatitis. We also compared adverse events between the two groups. RESULTS: In the ES alone group, 39.3% of patients experienced a recurrent complication compared with 18.0% in the ES and cholecystectomy group. After adjusting for comorbidities using multivariable regression, cholecystectomy in addition to ES was associated with a reduced risk of recurrent choledocholithiasis (OR 0.38, 95%CI 0.34-0.42, P<0.001), ascending cholangitis (OR 0.28, 95%CI 0.23-0.34, P<0.001), and gallstone pancreatitis (OR 0.35, 95%CI 0.24-0.49, P<0.001) compared to ES alone. This benefit was preserved after propensity score adjustment, in patients ≥75 years of age, and in those with major comorbidities including cancer, heart failure, and liver disease. Serious post-operative complications such as myocardial infarction, pulmonary embolism, and pneumonia were not more common in the cholecystectomy group. CONCLUSIONS: Among older patients, including those with serious comorbidities, cholecystectomy after endoscopic sphincterotomy was associated with a significant and clinically important reduction in recurrent complications compared to sphincterotomy alone. This benefit did not appear to be outweighed by surgical complications, highlighting the importance of cholecystectomy, even in elderly patients whose lifespans may be limited by unrelated conditions.
[Mh] Termos MeSH primário: Colangite
Colecistectomia
Pancreatite
Complicações Pós-Operatórias
Esfinterotomia Endoscópica
[Mh] Termos MeSH secundário: Idoso
Colangite/etiologia
Colangite/prevenção & controle
Colecistectomia/efeitos adversos
Colecistectomia/métodos
Coledocolitíase/diagnóstico
Coledocolitíase/epidemiologia
Coledocolitíase/cirurgia
Estudos de Coortes
Feminino
Seres Humanos
Masculino
Múltiplas Afecções Crônicas/epidemiologia
Pancreatite/etiologia
Pancreatite/prevenção & controle
Avaliação de Resultados da Assistência ao Paciente
Complicações Pós-Operatórias/epidemiologia
Complicações Pós-Operatórias/prevenção & controle
Pontuação de Propensão
Recidiva
Estudos Retrospectivos
Risco Ajustado/métodos
Fatores de Risco
Esfinterotomia Endoscópica/efeitos adversos
Esfinterotomia Endoscópica/métodos
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170816
[St] Status:MEDLINE
[do] DOI:10.1038/ajg.2017.247


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[PMID]:28765381
[Au] Autor:Peltz A; Samuels-Kalow ME; Rodean J; Hall M; Alpern ER; Aronson PL; Berry JG; Shaw KN; Morse RB; Freedman SB; Cohen E; Simon HK; Shah SS; Katsogridakis Y; Neuman MI
[Ad] Endereço:Robert Wood Johnson Foundation Clinical Scholars Program and alon.peltz@yale.edu.
[Ti] Título:Characteristics of Children Enrolled in Medicaid With High-Frequency Emergency Department Use.
[So] Source:Pediatrics;140(3), 2017 Sep.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVES: Some children repeatedly use the emergency department (ED) at high levels. Among Medicaid-insured children with high-frequency ED use in 1 year, we sought to describe the characteristics of children who sustain high-frequency ED use over the following 2 years. METHODS: Retrospective longitudinal cohort study of 470 449 Medicaid-insured children appearing in the MarketScan Medicaid database, aged 1-16 years, with ≥1 ED discharges in 2012. Children with high ED use in 2012 (≥4 ED discharges) were followed through 2014 to identify characteristics associated with sustained high ED use (≥8 ED discharges in 2013-2014 combined). A generalized linear model was used to identify patient characteristics associated with sustained high ED use. RESULTS: A total of 39 945 children (8.5%) experienced high ED use in 2012, accounting for 25% of total ED visits in 2012. Sixteen percent of these children experienced sustained high ED use in the following 2 years. Adolescents (adjusted odds ratio [aOR]: 1.4 [95% confidence interval: 1.3-1.5]), disabled children (aOR: 1.3 [95% confidence interval: 1.1-1.5]), and children with 3 or more chronic conditions (aOR: 2.1, [95% confidence interval: 1.9-2.3]) experienced the highest likelihood for sustaining high ED use. CONCLUSIONS: One in 6 Medicaid-insured children with high ED use in a single year experienced sustained high levels of ED use over the next 2 years. Adolescents and individuals with multiple chronic conditions were most likely to have sustained high rates of ED use. Targeted interventions may be indicated to help reduce ED use among children at high risk.
[Mh] Termos MeSH primário: Serviço Hospitalar de Emergência/utilização
Medicaid
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Feminino
Seres Humanos
Lactente
Estudos Longitudinais
Masculino
Múltiplas Afecções Crônicas/terapia
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171015
[Lr] Data última revisão:
171015
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170803
[St] Status:MEDLINE


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[PMID]:28555750
[Au] Autor:Tisminetzky M; Bayliss EA; Magaziner JS; Allore HG; Anzuoni K; Boyd CM; Gill TM; Go AS; Greenspan SL; Hanson LR; Hornbrook MC; Kitzman DW; Larson EB; Naylor MD; Shirley BE; Tai-Seale M; Teri L; Tinetti ME; Whitson HE; Gurwitz JH
[Ad] Endereço:Meyers Primary Care Institute, A Joint Endeavor of University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts.
[Ti] Título:Research Priorities to Advance the Health and Health Care of Older Adults with Multiple Chronic Conditions.
[So] Source:J Am Geriatr Soc;65(7):1549-1553, 2017 Jul.
[Is] ISSN:1532-5415
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions (MCCs). DESIGN: Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCCs. SETTING: Survey conducted through the Health Care Systems Research Network (HCSRN) and Claude D. Pepper Older Americans Independence Centers (OAICs) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAICs. PARTICIPANTS: Individuals affiliated with the HCSRN or OAICs and national MCC experts, including individuals affiliated with funding agencies having MCC-related grant portfolios. MEASUREMENTS: A "top box" methodology was used, counting the number of respondents selecting the top response on a 5-point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics. RESULTS: The highest-ranked research topics relevant to the health and healthcare of older adults with MCCs were health-related quality of life in older adults with MCCs; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision-making to enhance care planning; and tools to improve clinical decision-making. CONCLUSION: Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this "high-need, high-cost" population and the healthcare delivery systems responsible for serving it.
[Mh] Termos MeSH primário: Doença Crônica
Assistência à Saúde
Múltiplas Afecções Crônicas/terapia
Pesquisa
[Mh] Termos MeSH secundário: Cuidadores
Interações Medicamentosas
Pesquisa sobre Serviços de Saúde
Seres Humanos
Avaliação de Processos e Resultados (Cuidados de Saúde)
Qualidade de Vida/psicologia
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170807
[Lr] Data última revisão:
170807
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170531
[St] Status:MEDLINE
[do] DOI:10.1111/jgs.14943


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[PMID]:28548914
[Au] Autor:Lindley LC; Keim-Malpass J
[Ad] Endereço:Assistant Professor, College of Nursing, University of Tennessee, Knoxville, TN.
[Ti] Título:Quality of paediatric hospice care for children with and without multiple complex chronic conditions.
[So] Source:Int J Palliat Nurs;23(5):230-237, 2017 May 02.
[Is] ISSN:1357-6321
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Hospice care for children with multiple complex chronic conditions (MCCC) is complicated given their unique health at the end of life (EOL). Little is known about the quality of the hospice care MCCC children receive and how that might differ from children without MCCC. OBJECTIVE: To compare the quality of hospice care (i.e., structures, processes, outcomes) between children with and without MCCC. METHODS: This retrospective, comparative study used data from the National Home and Hospice Care Survey, which included a nationally representative sample of paediatric hospice patients. The Pearson chi-square and Wald tests for comparisons were used. RESULTS: MCCC children enrolled in hospice care for over 2 months with multiple visits by hospice staff. They had low symptom burden with minimal discontinuity of care at EOL. Children without MCCC had short length of stays in hospice with few visits by nurses and other clinicians. These children had high symptom burden and significant disenrollment from hospice care to receive more aggressive treatment. CONCLUSIONS: The findings revealed significant differences in paediatric hospice care between MCCC and non-MCCC children, which provides critical insight into the quality of hospice care.
[Mh] Termos MeSH primário: Cuidados Paliativos na Terminalidade da Vida
Múltiplas Afecções Crônicas
Avaliação de Processos e Resultados (Cuidados de Saúde)
Assistência Terminal
[Mh] Termos MeSH secundário: Adolescente
Estudos de Casos e Controles
Criança
Pré-Escolar
Disfunção Cognitiva
Anormalidades Congênitas
Feminino
Seres Humanos
Tempo de Internação
Masculino
Neoplasias
Qualidade da Assistência à Saúde
Doenças Respiratórias
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170803
[Lr] Data última revisão:
170803
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170527
[St] Status:MEDLINE
[do] DOI:10.12968/ijpn.2017.23.5.230



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