Mr NASRIFUDIN BIN NAJUMUDIN

Transcription

1 Inaugural Commonwealth Nurses Conference Our health: our common wealth March 2012 London UK Mr NASRIFUDIN BIN NAJUMUDIN A nurse managed telephone follow up and home visit program for patients with high risk of unscheduled readmissions In collaboration with the 9 th CNF Europe Region Conference Supported by the Royal College of Nursing UK

2 A nurse-managed telephone follow up and home visit program for patients with high risk of unscheduled readmissions - A randomized control trial

3 SINGAPORE

4 SINGAPORE 5 million people live in Singapore, of whom 2.91 million were born locally. Mostly are of Chinese, Malay and Indian. There are four languages: English, Mandarin, Malay and Tamil.

5 Singapore General Hospital (SGH) Established in 1821, largest acute tertiary hospital and national referral centre. 1,559 beds, 8,143 staff strength. Attained the Joint Commission International standards of safety and quality in healthcare in First Magnet hospital in Asia (2010).

6 High unscheduled readmission rates 6

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8 Naylor (2004) Randomized, controlled trial with follow up 3 months post index hospital discharge of patients with heart failure APN-directed discharged planning and home follow up protocol Result It show significant reduced readmission rates in the intervention group

9 Wong et al (2008) Randomized control trial was used to compare an intervention group receiving home visits by community nurses within 30 days of hospital discharge Result There were no statistically significant differences in reducing readmission rates in intervention group.

10 Singapore Little is known about the impact of nursemanaged telephone follow-up and home visit programs in reducing hospital readmission rates In SGH, medical wards account for the greatest percentage of unscheduled readmissions

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12 Significance of the Proposed Research and Implications for Clinical Practice Long Term Benefits Reducing hospital readmission rate Facilitate more efficient utilization of hospital beds Improve caregiver and patient s quality of life

13 The effect of a specific intervention Quantitative Random Control Trial Use of control group The researcher assigns subjects to a control or experimental group on a random basis (Table of random numbers)

14 Basic socio-demographic data Katz Index asks questions related to independence in Activities of Daily Living (ADL) Medical Outcome Study Short Form Questionnaire (SF- 36v2) questions related to healthcare and quality of life Omaha System healthcare-focused assessment tool designed to document client care

15 Unscheduled readmission rates for both the intervention and control groups will be tracked at 30 days and 3 month after discharge via inpatient data record system Potential biases: our tools are tested reliable & validated to minimize data collection biases

16 Medical Outcome Study Short Form Questionnaire (SF-36v2) Estimates of the SF-36 with a sample of 3,445 in the medical outcomes survey demonstrated coefficients ranging from 0.77 to Omaha System (Ware, 1993) Well-established tool for community health nursing (Elfrink & Martin, 1996; Martin & Scheet, 1995) One of the six [American Nursing Association (ANA)] recognized nursing languages (Bowles, 1999; Erci, 2005) Valid and reliable nursing classification and quality management system (Daryl et al., 2008)

17 Assessment for Eligibility (n=400) Randomization (n=400) Allocation to control group (n=200) Allocation to intervention group (n=200) Demographic data, Katz Index & SF-36v days after discharge No Intervention 1-14 days after discharge 3 calls (on day 1, 7, 14) & 1 home visit 7 days post-discharge 14 days after discharge Repeat SF-36v days after discharge No Intervention days after discharge 1 call (on day 29) & 1 visit on 4 weeks post-discharge 30 days after discharge Repeat SF-36v2

18 Definition Nurse managed telephone follow up 4 follow-up phone calls will be made to patients or their primary caregiver Scheduled at 1 day, 7 days, 14 days and 30 days post-discharge Home visit program 2 home visits Scheduled to take place at first week and last week post-discharge Inclusion criteria A history of readmission 1 time in the last one year with a discharge diagnosis related to respiratory, cardiac, renal condition Age 65 and above Discharge to home only

19 General Ethical Considerations Consent the study involves research and is voluntary purpose of the research and estimated time commitment are descript procedures, risks and benefits are explained anonymity and confidentiality are assured a contact person for questions regarding the research are provided non-participation or discontinuance will not penalize or lessen any care rendered to the patient

20 Demographic Data Gender 26% 74% Male Female

21 Demographic Data Occupation 13% 4% 9% employed unemployed ret ired housewif e 74%

22 Demographic Data Education Level 17% 0% 17% Illiterate Primary Education Secondary Education Tertiary Education 66%

23 Demographic Data Age Age Average Patient Number

24 PCS Physical Component in SF36 Physical Component Score Across Time Treatment Control 10 0 PCS1 PCS2 PCS3 Time Points

25 MCS Mental Component in SF36 Mental Component Score Across Time Treatment Control 10 0 MCS1 MCS2 MCS3 Time Points

26 Preliminary Results At the time of this report, 23 (11: intervention, 12: control) patients have completed the study. Most were male (74%), retired (74%), had primary school education (66%) and have enough income for daily living (78%); with a mean age of 77 years. Based on the preliminary results, there were no statistically significant differences between the demographics of the intervention and control groups. The mean physical component scores and mental component scores of both groups showed a slight increasing trend over time. However, there was no significant difference in the QoL scores for the two groups.

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28 References: Anderson, M.A., Tyler, D., Heme, L.B., Hanson, K.S., & Sparbei. K.J.H. (2005). Hospital readmission from a transitional care unit: Journal of Nursing care Quality Ashton, C.M., Del Junco, D.J., Souchek, J., Wray, N.P., and Mansuyr, C.L. "The Association between the Quality of Inpatient Care and Early Readmission, a Meta-Analysis of the Evidence." Medical Care 35, no. 10 (1997): Bowles, K.H., & Cater, J.R. (2003). Screening for risk of re-ospitalisation from home care: use of the outcomes assessment information set and the probability of readmission instrument. Research in Nursing and Health 26, Burns, N. & Grove, S.K. (1993). The practice of nursing research: Conduct, critique and utilization. (2 nd e.d.). Philadelphia: W.B. Saunders Company. Daryl, C., Mao, C.L., Marian.Y., Phylis, C. & Elizabeth. (2008).The Omaha System and Quality Measurement in Academic Nurse- Managed Centers: Ten Steps for Implementation Journal of Nursing Education. 47(3), Elfrink, V.L., & Martin, K. (1996). Educating for community nursing practice: Point of care technology. Healthcare Information Management, 10(2), Erci, B.(2005). Impact of Case Management on Client Outcomes Lippincott s Case Management. 10 (1), Franklin, P. D., Noetscher, C. M., Murphy, M. E.M.S,. Lagoe, & Ronald. (1999). Using Data To Reduce Hospital Readmissions. Journal of Nursing Care Quality 14, Kee, C.C., & Borchers, L.M. (1998). Reducing Readmission Rates Through Discharge Interventions. Clinical Nurse Specialist A Journal for Advanced Nursing Practice. 12(5),

29 References: Marcantonio, E., McKean, S., Goldfinger, M., Kleefield, S., Yurkofsky,M., & Brennan, T.A.(1999). Factors associated with unplanned hospital readmission among patients 65 years of age and older in a medicare managed care plan. The American Journal of Medicine Martin,K.S., & Scheet, N.J. (1995). The Omaha System: Nursing diagnosis, interventions, and outcomes. In Nursing Data Systems: The emerging framework (p. 14). Washington, DC: American Nurses Publishing. Naylor, M. D., Brooten, D., Campbell, R. L., Maislin, G., McCauley, K. M., & Schwartz, J. S. (2004).Transitional Care of Older Adults Hospitalized with Heart Failure: A randomized, Controlled Trial. Journal of American Geriatrics Society. 52(5), Phillips, C., Wright, S. M., & Kern, D.E. (2004). Comprehensive discharge planning and post discharge support reduces readmission rate for older people with congestive heart failure Evidence-based health care and Public health ELSEVIER. Shu, E., Mirmina, Z., & Nystrom, K.(1996)Telephone reassurance programme for ederly home care clients after discharge Home Healthc nursing 14: Sinclair, A. J., Conroy, S. P., Davies, M., & Bayer, A. J. (2005). Post-discharge home-based support for older cardiac patients: A randomized controlled trial. Age Ageing, 34(4), Wai. K.C., & Robert, N. (2007). A Systematic Review of Nurse-assisted Case Management to Improve Hospital Discharge Transition Outcomes for Elderly. Professional Case Management. 12 (6), Wong, F.K.Y., Chow, S., Chung, K., Chan, T., Lee, W. M., & Lee,R.(2008). Can Home Visits Help Reduce Hospital Readmission? Randomized Controlled Trial. Journal of Advanced Nursing. 62 (5),