Inaugural Commonwealth Nurses Conference Our health: our common wealth 10-11 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
A nurse-managed telephone follow up and home visit program for patients with high risk of unscheduled readmissions - A randomized control trial
SINGAPORE
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.
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 2008. First Magnet hospital in Asia (2010).
High unscheduled readmission rates 6
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
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.
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
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
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)
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
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
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 0.92. 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)
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-36v2 1-14 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-36v2 15-30 days after discharge No Intervention 15-30 days after discharge 1 call (on day 29) & 1 visit on 4 weeks post-discharge 30 days after discharge Repeat SF-36v2
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
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
Demographic Data Gender 26% 74% Male Female
Demographic Data Occupation 13% 4% 9% employed unemployed ret ired housewif e 74%
Demographic Data Education Level 17% 0% 17% Illiterate Primary Education Secondary Education Tertiary Education 66%
Demographic Data Age 100 90 80 70 60 50 40 Age Average 30 20 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Patient Number
PCS Physical Component in SF36 Physical Component Score Across Time 60 50 40 30 20 Treatment Control 10 0 PCS1 PCS2 PCS3 Time Points
MCS Mental Component in SF36 Mental Component Score Across Time 60 50 40 30 20 Treatment Control 10 0 MCS1 MCS2 MCS3 Time Points
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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