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[PMID]:29235781
[Au] Autor:Machledt D
[Ad] Endereço:National Health Law Program (NHeLP).
[Ti] Título:Addressing the Social Determinants of Health Through Medicaid Managed Care.
[So] Source:Issue Brief (Commonw Fund);2017:1-9, 2017 Nov 01.
[Is] ISSN:1558-6847
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Issue: With its emphasis on coordinated care and prevention, managed care should be tailor-made to tackle social determinants of health. But various challenges discourage Medicaid health plans and providers from assisting beneficiaries with nonmedical concerns such as housing insecurity or parenting skills that are integral to improving health outcomes and lowering costs. To better address these social factors, the Centers for Medicare and Medicaid Services (CMS) updated its Medicaid managed care rule in early 2016. Goal: To explore the impact of several provisions of the new regulation that influence states' ability to address social determinants of health through managed care. Findings and Conclusions: Several provisions in the new Medicaid managed care rule signal CMS's intent to increase access to high-value nonmedical interventions. For instance, the regulation financially incentivizes health plans to address these needs by allowing certain nonclinical services to be included as covered services when calculating the capitated rate and medical loss ratios. In addition, the regulation encourages states to improve care coordination, adopt alternative payment models, and provide long-term services and supports in the home and community for beneficiaries with functional limitations.
[Mh] Termos MeSH primário: Programas de Assistência Gerenciada/organização & administração
Medicaid/organização & administração
Determinantes Sociais da Saúde
Apoio Social
[Mh] Termos MeSH secundário: Administração de Caso
Serviços de Saúde Comunitária
Enfermagem Domiciliar
Seres Humanos
Assistência de Longa Duração
Saúde da População
Mecanismo de Reembolso
Reembolso de Incentivo
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180105
[Lr] Data última revisão:
180105
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:28472817
[Au] Autor:Reider KE
[Ad] Endereço:Kersten E. Reider, RN, BSN, CWOCN, WOC Nurse, Reading Health System, West Reading, Pennsylvania.
[Ti] Título:Fistula Isolation and the Use of Negative Pressure to Promote Wound Healing: A Case Study.
[So] Source:J Wound Ostomy Continence Nurs;44(3):293-298, 2017 May/Jun.
[Is] ISSN:1528-3976
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A 54-year-old morbidly obese woman with a small bowel obstruction and large ventral hernia was admitted to hospital. She underwent an exploratory laparotomy, lysis of adhesions, and ventral hernia repair with mesh placement. She subsequently developed an enteroatmospheric fistula; several months of hospital care was required to effectively manage the wound and contain effluent from the fistula. METHODS: Several approaches were used to manage output from the fistula during her hospital course. She was initially discharged to a skilled nursing facility where a fistula management pouch was used for several months to encompass the wound and contain effluent, but this method ultimately proved ineffective. The fistula was then isolated using a collapsible enteroatmospheric fistula isolation device and an ostomy appliance to contain effluent. CONCLUSION: The application of the collapsible enteroatmospheric fistula isolation and effluent containment devices in conjunction with negative-pressure wound therapy produced positive patient outcomes; it improved patient satisfaction with fistula management, promoted wound healing, and diminished cost.
[Mh] Termos MeSH primário: Fístula Intestinal/terapia
Tratamento de Ferimentos com Pressão Negativa/métodos
Complicações Pós-Operatórias/enfermagem
Cicatrização
[Mh] Termos MeSH secundário: Técnicas de Fechamento de Ferimentos Abdominais/enfermagem
Técnicas de Fechamento de Ferimentos Abdominais/normas
Feminino
Enfermagem Domiciliar/métodos
Enfermagem Domiciliar/normas
Seres Humanos
Laparotomia/efeitos adversos
Meia-Idade
Tratamento de Ferimentos com Pressão Negativa/normas
Obesidade Mórbida/complicações
Obesidade Mórbida/enfermagem
Estomia/instrumentação
Nutrição Parenteral Total/enfermagem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170926
[Lr] Data última revisão:
170926
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE
[do] DOI:10.1097/WON.0000000000000329


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[PMID]:28414540
[Au] Autor:Lee G; Pickstone N; Facultad J; Titchener K
[Ad] Endereço:Senior Lecturer, King's College London.
[Ti] Título:The future of community nursing: Hospital in the Home.
[So] Source:Br J Community Nurs;22(4):174-180, 2017 Apr 02.
[Is] ISSN:1462-4753
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:With an increasing ageing population who often have multiple long-term conditions, there is a growing need to provide an alternative type of care to the traditional hospital-based model. 'Hospital in the Home' is a model that provides integrated care for patients in their home. The @home service was established in 2013 by Guy's and St Thomas' NHS Foundation Trust. The service provides health care in patients' home, supporting early discharge from hospital as well as preventing avoidable admissions and readmissions saving valuable hospital bed days and reducing length of stay. This article describes the service available with the use of a case study of a 78-year-old lady who was referred by the London Ambulance Service with exacerbation of chronic obstructive pulmonary disease (COPD). This case study highlights the ability to assess, treat and manage an acutely unwell patient with newly diagnosed heart failure in the community without the need for hospitalisation. This type of integrated care model with a multidisciplinary team is a feasible alternative to the traditional models of care in both the acute and community settings.
[Mh] Termos MeSH primário: Prestação Integrada de Cuidados de Saúde
Insuficiência Cardíaca/enfermagem
Enfermagem Domiciliar/métodos
Pneumonia/enfermagem
Doença Pulmonar Obstrutiva Crônica/enfermagem
[Mh] Termos MeSH secundário: Doença Aguda
Idoso
Antibacterianos/uso terapêutico
Broncodilatadores/uso terapêutico
Clero
Enfermagem em Saúde Comunitária/métodos
Progressão da Doença
Diuréticos/uso terapêutico
Ecocardiografia
Feminino
Furosemida/uso terapêutico
Insuficiência Cardíaca/complicações
Insuficiência Cardíaca/diagnóstico por imagem
Seres Humanos
Avaliação em Enfermagem
Terapia Ocupacional/métodos
Serviço de Farmácia Hospitalar/métodos
Pneumonia/complicações
Pneumonia/diagnóstico por imagem
Doença Pulmonar Obstrutiva Crônica/complicações
Radiografia Torácica
Medicina Estatal
Reino Unido
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Bronchodilator Agents); 0 (Diuretics); 7LXU5N7ZO5 (Furosemide)
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170615
[Lr] Data última revisão:
170615
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:170418
[St] Status:MEDLINE
[do] DOI:10.12968/bjcn.2017.22.4.174


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[PMID]:28232058
[Au] Autor:Shaffer VO; Owi T; Kumarusamy MA; Sullivan PS; Srinivasan JK; Maithel SK; Staley CA; Sweeney JF; Esper G
[Ad] Endereço:Department of Surgery, Emory University, Atlanta, GA. Electronic address: virginia.o.shaffer@emory.edu.
[Ti] Título:Decreasing Hospital Readmission in Ileostomy Patients: Results of Novel Pilot Program.
[So] Source:J Am Coll Surg;224(4):425-430, 2017 Apr.
[Is] ISSN:1879-1190
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Nearly 30% of patients with newly formed ileostomies require hospital readmission from severe dehydration or associated complications. This contributes to significant morbidity and rising healthcare costs associated with this procedure. Our aim was to design and pilot a novel program to decrease readmissions in this patient population. STUDY DESIGN: An agreement was established with Visiting Nurse Health System (VNHS) in March 2015 that incorporated regular home visits with clinical triggers to institute surgeon-supervised corrective measures aimed at preventing patient decompensation associated with hospital readmissions. Thirty-day readmission data for patients managed with and without VNHS support for 10.5 months before and after implementation of this new program were collected. RESULTS: Of 833 patients with small bowel procedures, 162 were ileostomies with 47 in the VNHS and 115 in the non-VNHS group. Before program implementation, VNHS (n = 24) and non-VNHS patients (n = 54) had similar readmission rates (20.8% vs 16.7%). After implementation, VNHS patients (n = 23) had a 58% reduction in hospital readmission (8.7%) and non-VNHS patient hospital readmissions (n = 61) increased slightly (24.5%). Total cost of readmissions per patient in the cohort decreased by >80% in the pilot VNHS group. CONCLUSIONS: Implementation of a novel program reduced the 30-day readmission rate by 58% and cost of readmissions per patient by >80% in a high risk for readmission patient population with newly created ileostomies. Future efforts will expand this program to a greater number of patients, both institutionally and systemically, to reduce the readmission-rate and healthcare costs for this high-risk patient population.
[Mh] Termos MeSH primário: Assistência ao Convalescente/métodos
Enfermagem Domiciliar/métodos
Ileostomia
Readmissão do Paciente/estatística & dados numéricos
Cuidados Pós-Operatórios/métodos
Melhoria de Qualidade
Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Assistência ao Convalescente/economia
Assistência ao Convalescente/organização & administração
Seguimentos
Enfermagem Domiciliar/economia
Enfermagem Domiciliar/organização & administração
Custos Hospitalares/estatística & dados numéricos
Seres Humanos
Ileostomia/economia
Readmissão do Paciente/economia
Projetos Piloto
Cuidados Pós-Operatórios/economia
Cuidados Pós-Operatórios/normas
Melhoria de Qualidade/economia
Melhoria de Qualidade/organização & administração
Indicadores de Qualidade em Assistência à Saúde/economia
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170225
[St] Status:MEDLINE


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[PMID]:28216284
[Au] Autor:Wohland T; Holstein JD; Patzer OM; Mende M; Tiemann T; Koch-Tessarek C; Kovacs P; Holstein A
[Ad] Endereço:Leipzig University Medical Center, IFB AdiposityDiseases, Leipzig, Germany. Electronic address: Tobias.Wohland@medizin.uni-leipzig.de.
[Ti] Título:New risk and protective factors for severe hypoglycaemia in people with type 1 diabetes.
[So] Source:Nutr Metab Cardiovasc Dis;27(5):407-414, 2017 May.
[Is] ISSN:1590-3729
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:AIMS: To evaluate risk factors for severe hypoglycaemia (SH) in patients with type 1 diabetes (T1DM). METHODS AND RESULTS: Retrospective observational and comparative study. All SH occurring between 2007 and 2014 in a German population (Lippe-Detmold) were captured. Characteristics of patients with T1DM and SH were compared with a control group being equivalent concerning age, diabetes duration, HbA1c, comorbidity, and ß-blocker treatment. SH was defined as a symptomatic event requiring treatment with intravenous glucose or glucagon administration and being confirmed by a blood glucose measurement of <2.8 mmol/l. Predictive factors for SH were analysed by a multivariable regression model. As many as 405 cases of SH in T1DM occurred in 206 subjects; 50% of episodes were related to 31 patients who experienced ≥3 SH. Need for nursing care (OR 4.88), treatment with NPH (OR 3.68), and impaired hypoglycaemia awareness (OR 2.06) were the strongest risk factors for SH (all p < 0.05, all p -adjusted < 0.10; false discovery rate (FDR)). Depression (OR 0.14), treatment with CSII (OR 0.39) and short-acting insulin analogues (OR 0.31) appeared to be protective (all p < 0.10; FDR-adjusted). The probability of SH onset was significantly higher in patients who had previously experienced recurrent SH episodes. ß-Blocker treatment did not appear to be a risk factor. CONCLUSION: The complex risk for SH in people with T1DM can be reduced by treatment with CSII and short-acting analogues. Future structures of diabetes care will be challenged by the need of treating increasingly geriatric subjects with T1DM having a high risk of SH.
[Mh] Termos MeSH primário: Glicemia/efeitos dos fármacos
Diabetes Mellitus Tipo 1/tratamento farmacológico
Hipoglicemia/induzido quimicamente
Hipoglicemia/prevenção & controle
Hipoglicemiantes/efeitos adversos
Insulina/efeitos adversos
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Idoso
Biomarcadores/sangue
Glicemia/metabolismo
Diabetes Mellitus Tipo 1/sangue
Diabetes Mellitus Tipo 1/diagnóstico
Esquema de Medicação
Composição de Medicamentos
Feminino
Alemanha
Hemoglobina A Glicada/metabolismo
Enfermagem Domiciliar
Seres Humanos
Hipoglicemia/sangue
Hipoglicemia/diagnóstico
Hipoglicemiantes/administração & dosagem
Insulina/administração & dosagem
Estimativa de Kaplan-Meier
Modelos Logísticos
Masculino
Meia-Idade
Análise Multivariada
Casas de Saúde
Razão de Chances
Modelos de Riscos Proporcionais
Fatores de Proteção
Recidiva
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Índice de Gravidade de Doença
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Nm] Nome de substância:
0 (Biomarkers); 0 (Blood Glucose); 0 (Glycated Hemoglobin A); 0 (Hypoglycemic Agents); 0 (Insulin); 0 (hemoglobin A1c protein, human)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170221
[St] Status:MEDLINE


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[PMID]:28186012
[Au] Autor:Borycki EM; Griffith J; Monkman H; Reid-Haughian C
[Ad] Endereço:School of Health Information Science, University of Victoria, Canada.
[Ti] Título:Isolating the Effects of a Mobile Phone on the Usability and Safety of eHealth Software Applications.
[So] Source:Stud Health Technol Inform;234:37-41, 2017.
[Is] ISSN:0926-9630
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Mobile phones are used in conjunction with mobile eHealth software applications. These mobile software applications can be used to access, review and document clinical information. The objective of this research was to explore the relationship between mobile phones, usability and safety. Clinical simulations and semi-structured interviews were used to investigate this relationship. The findings revealed that mobile phones may lead to specific types of usability issues that may introduce some types of errors.
[Mh] Termos MeSH primário: Telefone Celular/instrumentação
Telemedicina/métodos
[Mh] Termos MeSH secundário: Telefone Celular/utilização
Feminino
Enfermagem Domiciliar/métodos
Seres Humanos
Meia-Idade
Enfermeiras e Enfermeiros
Software
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171116
[Lr] Data última revisão:
171116
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:170211
[St] Status:MEDLINE


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[PMID]:27861858
[Au] Autor:Adamakidou T; Kalokerinou-Anagnostopoulou A
[Ad] Endereço:Nursing Department of Technological Educational Institute of Athens, Athens, Greece.
[Ti] Título:Home health nursing care services in Greece during an economic crisis.
[So] Source:Int Nurs Rev;64(1):126-134, 2017 Mar.
[Is] ISSN:1466-7657
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: The purpose of this review was to describe public home healthcare nursing services in Greece. BACKGROUND: The effectiveness and the efficiency of home healthcare nursing are well documented in the international literature. In Greece, during the current financial crisis, the development of home healthcare nursing services is the focus and interest of policymakers and academics because of its contribution to the viability of the healthcare system. SOURCES OF EVIDENCE: A review was conducted of the existing legislation, the printed and electronic bibliography related to the legal framework, the structures that provide home health care, the funding of the services, the human resources and the services provided. RESULTS: The review of the literature revealed the strengths and weaknesses of the existing system of home health care and its opportunities and threats, which are summarized in a SWOT analysis. CONCLUSION: There is no Greek nursing literature on this topic. The development of home health nursing care requires multidimensional concurrent and combined changes and adjustments that would support and strengthen healthcare professionals in their practices. Academic and nursing professionals should provide guidelines and regulations and develop special competencies for the best nursing practice in home health care. IMPLICATIONS FOR NURSING AND HEALTH POLICY: At present, in Greece, which is in an economic crisis and undergoing reforms in public administration, there is an undeniable effort being made to give primary health care the position it deserves within the health system. There is an urgent need at central and academic levels to develop home healthcare services to improve the quality and efficiency of the services provided.
[Mh] Termos MeSH primário: Assistência à Saúde/economia
Recessão Econômica/estatística & dados numéricos
Financiamento Governamental/economia
Financiamento Governamental/legislação & jurisprudência
Política de Saúde/economia
Serviços de Assistência Domiciliar/economia
Enfermagem Domiciliar/economia
[Mh] Termos MeSH secundário: Assistência à Saúde/legislação & jurisprudência
Recessão Econômica/legislação & jurisprudência
Grécia
Política de Saúde/legislação & jurisprudência
Serviços de Assistência Domiciliar/legislação & jurisprudência
Enfermagem Domiciliar/legislação & jurisprudência
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171002
[Lr] Data última revisão:
171002
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:161119
[St] Status:MEDLINE
[do] DOI:10.1111/inr.12329


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[PMID]:27787296
[Au] Autor:Vilstrup DL; Madsen EE; Hansen CF; Wind G
[Ad] Endereço:Author Affiliation: Metropolitan University College, Copenhagen, Denmark.
[Ti] Título:Nurses' Use of iPads in Home Care-What Does It Mean to Patients?: A Qualitative Study.
[So] Source:Comput Inform Nurs;35(3):140-144, 2017 Mar.
[Is] ISSN:1538-9774
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Although the use of technology is growing, little is known about how patients perceive technology in the form of tools used by health professionals. The prevailing view in the literature is that technology is cold, compared with the warm hands of nurses, but research regarding nurses' use of technology such as tablets is scarce. Even scarcer is research on how patients perceive the use of technological tools. This study examines patients' perspectives on the use of iPads by home care nurses. Semistructured interviews were conducted with seven participants who were receiving home care in Denmark, aged 62 to 90 years, with different backgrounds and experiences with technology. Participants viewed nurses' use of iPads as an everyday occurrence, reflecting societal growth in the use of technology, and some perceived it as a sign of professionalism with the potential to enhance care. Their perceptions varied somewhat according to their baseline knowledge and experience with the technology. Although nurses may view technology as cold, the findings suggest that patients have a slightly warmer view of it. More patient-centered research into the use of technology in healthcare is needed.
[Mh] Termos MeSH primário: Atitude Frente aos Computadores
Computadores de Mão/utilização
Enfermagem Domiciliar
Papel do Profissional de Enfermagem
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Dinamarca
Feminino
Seres Humanos
Entrevistas como Assunto
Masculino
Meia-Idade
Informática em Enfermagem
Pesquisa Qualitativa
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170417
[Lr] Data última revisão:
170417
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:161028
[St] Status:MEDLINE
[do] DOI:10.1097/CIN.0000000000000304


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[PMID]:27631112
[Au] Autor:Dingley CE; Clayton M; Lai D; Doyon K; Reblin M; Ellington L
[Ad] Endereço:Author Affiliations: University of Nevada, Las Vegas (Dr Dingley); University of Utah, Salt Lake City (Drs Clayton and Ellington and Mss Lai and Doyon); and Moffitt Cancer Center, Tampa, Florida (Dr Reblin).
[Ti] Título:Caregiver Activation and Home Hospice Nurse Communication in Advanced Cancer Care.
[So] Source:Cancer Nurs;40(5):E38-E50, 2017 Sep/Oct.
[Is] ISSN:1538-9804
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Activated patients have the skills, knowledge, and confidence to manage their care, resulting in positive outcomes such as lower hospital readmission and fewer adverse consequences due to poor communication with providers. Despite extensive evidence on patient activation, little is known about activation in the home hospice setting, when family caregivers assume more responsibility in care management. OBJECTIVE: We examined caregiver and nurse communication behaviors associated with caregiver activation during home hospice visits of patients with advanced cancer using a prospective observational design. METHODS: We adapted Street's Activation Verbal Coding tool to caregiver communication and used qualitative thematic analysis to develop codes for nurse communications that preceded and followed each activation statement in 60 audio-recorded home hospice visits. RESULTS: Caregiver communication that reflected activation included demonstrating knowledge regarding the patient/care, describing care strategies, expressing opinions regarding care, requesting explanations of care, expressing concern about the patient, and redirecting the conversation toward the patient. Nurses responded by providing education, reassessing the patient/care environment, validating communications, clarifying care issues, updating/revising care, and making recommendations for future care. Nurses prompted caregiver activation through focused care-specific questions, open-ended questions/statements, and personal questions. CONCLUSIONS: Few studies have investigated nurse/caregiver communication in home hospice, and, to our knowledge, no other studies focused on caregiver activation. The current study provides a foundation to develop a framework of caregiver activation through enhanced communication with nurses. IMPLICATIONS FOR PRACTICE: Activated caregivers may facilitate patient-centered care through communication with nurses in home hospice, thus resulting in enhanced outcomes for patients with advanced cancer.
[Mh] Termos MeSH primário: Cuidadores/psicologia
Comunicação
Enfermagem Domiciliar
Enfermagem de Cuidados Paliativos na Terminalidade da Vida
Neoplasias/enfermagem
Relações Enfermeiro-Paciente
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Cuidadores/estatística & dados numéricos
Feminino
Seres Humanos
Masculino
Meia-Idade
Neoplasias/patologia
Estudos Prospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170906
[Lr] Data última revisão:
170906
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:160916
[St] Status:MEDLINE
[do] DOI:10.1097/NCC.0000000000000429


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[PMID]:27940764
[Au] Autor:Gay JC; Thurm CW; Hall M; Fassino MJ; Fowler L; Palusci JV; Berry JG
[Ad] Endereço:Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee; james.gay@vanderbilt.edu.
[Ti] Título:Home Health Nursing Care and Hospital Use for Medically Complex Children.
[So] Source:Pediatrics;138(5), 2016 Nov.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND OBJECTIVE: Home health nursing care (HH) may be a valuable approach to long-term optimization of health for children, particularly those with medical complexity who are prone to frequent and lengthy hospitalizations. We sought to assess the relationship between HH services and hospital use in children. METHODS: Retrospective, matched cohort study of 2783 hospitalized children receiving postdischarge HH services by BAYADA Home Health Care across 19 states and 7361 matched controls not discharged to HH services from the Children's Hospital Association Case Mix database between January 2004 and September 2012. Subsequent hospitalizations, hospital days, readmissions, and costs of hospital care were assessed over the 12-month period after the initial hospitalization. Nonparametric Wilcoxon signed rank tests were used for comparisons between HH and non-HH users. RESULTS: Although HH cases had a higher percentage of complex chronic conditions (68.5% vs 65.4%), technology assistance (40.5% vs 35.7%), and neurologic impairment (40.7% vs 37.3%) than matched controls (P ≤ .003 for all), 30-day readmission rates were lower in HH patients (18.3% vs 21.5%, P = .001). At 12 months after the index admission, HH patients averaged fewer admissions (0.8 vs 1.0, P < .001), fewer days in the hospital (6.4 vs 6.6, P < .001), and lower hospital costs ($22 511 vs $24 194, P < .001) compared with matched controls. CONCLUSIONS: Children discharged to HH care experienced less hospital use than children with similar characteristics who did not use HH care. Further investigation is needed to understand how HH care affects the health and health services of children.
[Mh] Termos MeSH primário: Doença Crônica/epidemiologia
Enfermagem Domiciliar/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Estudos de Casos e Controles
Criança
Pré-Escolar
Estudos de Coortes
Enfermagem Domiciliar/economia
Custos Hospitalares/estatística & dados numéricos
Hospitalização/estatística & dados numéricos
Seres Humanos
Lactente
Recém-Nascido
Readmissão do Paciente/estatística & dados numéricos
Estudos Retrospectivos
Estados Unidos/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170622
[Lr] Data última revisão:
170622
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161213
[St] Status:MEDLINE



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