Converting Theory into Practice Using a Telephonic Transitional Care Model for Older Adults The purpose of the Naylor, et.al., (2013) study was to evaluate the impact of integrating a Transitional Care Model for older adults into a large healthcare plan. Key findings included short-term reductions in monthly healthcare costs and improved health status and quality of life measures for participants post-intervention. The researchers used a conceptual framework as the basis for this study. This framework included determining whether the clinical and economic outcomes observed in National Institutes of Health-funded RCTs could be replicated in the ‘real world’ of clinical practice and health plan financing. The study methodology was a quasi-experimental …show more content…
Primary health problems at the time of enrolment into the TCM were 43% heart failure, 25% ischemic heart disease, 13% chronic obstructive pulmonary disease, 7% diabetes and 12% other conditions. To compare ordinal data, the Wilcoxon sum tests were used, and t-tests were used for interval or ratio data. Propensity modelling was used to ensure the control and experimental groups were equally represented in demographics, socio-economic status and geographical characteristics. Study findings confirm earlier results regarding the effectiveness of the TCM in enhancing health outcomes and satisfaction with care among chronically ill older …show more content…
el., (2011) attempted to identify factors related to distance that impede access to care for rural veterans. A total of 101 veterans consented of which 96 completed quantitative surveys and 42 completed in-depth interviews. Additionally, 114 clinic staff and providers consented, with 88 completing quantitative surveys and 42 completing in-depth Researchers used a Mixed-methods approach including surveys, in-depth interviews and focus groups to gather data. Using a coding system to quantify qualitative data they were able to identify that barriers centered around distance were work related, travel costs and functional impairments Assessing the Studies Most of the researchers used a mixed method of qualitative and quantitative research methods. Quantitative research was primarily used when gathering demographic data, surveys or telephonic monitoring. However, in these same studies, more qualitative methods such as focus groups and team meetings were also used. It was noted mixed methods of research design was also reflective of the conceptual frameworks guiding most of the studies since their conceptual approaches to study were built from mostly theoretical ideas. Tsai et.al. (2014) reviewed medical records of over 19,000 participants but their research design methods were based in observational study samples and telephonic surveys. Buzza et.al (2011) also used a mixed research design for their study including
The first, focus groups, interviews conducted with 8 to 10 people with a trained moderator following an interview guide, a common useful approach for acquiring health care information. Also, useful in examining a wide range of sensitive health care issues. Second, probability sampling, units selected by chance, the sample’s reliability, and does not require detailed information about the population surveyed. The third option, mail surveys, inexpensive way to contact individuals over a large geographical area, provide anonymity to the respondent, and eliminate interviewer bias.
The systematic review indicated (1) ‘Case management interventions were associated with reduction in all-cause mortality at 12 months follow up, but not at six months’. (Takenda, et al, 2012) The systematic review also went on to state that while case management interventions were not associated with reduced mortality, case management interventions were indicated to reduce the occurrence of patients presenting to hospital with exasperations of chronic heart failure. The benefits of case management based interventions were apparent after 12 months had lapsed. Six of the twenty five studies assessed (2) heart failure clinics, and the evidence for this intervention was less convincing with the review stating ‘there was no real difference in all-cause mortality, readmissions for HF or between patients who attended a clinic and those who received usual care’. (Takenda, et al., 2012)
The first cause of poor transitional outcomes, cost, affects those who most commonly suffer from economic social determinants of health. Those with no insurance or with gaps in coverage are less likely to receive transitional care in comparison to those with adequate insurance due to inability to pay for necessary medical care (McManus et al., 2013). The issue is additionally compounded by the fact that up to 30% of CSHCN lack insurance coverage
“Factors Affecting Health Care” (50-55) Demonstrates the sacrifices and how difficult it is for veterans to receive healthcare from the Department of Veteran Affairs.
For decades, individuals living in rural areas have been considered medically underserved. Access to healthcare is a problem that has been increasing for individuals in rural America due to aging populations, declining economies, rural hospital closures, rising healthcare costs, healthcare provider shortages and difficulties attracting and retaining healthcare personnel and physicians (Bauer, 2002). This population experience more health disparities than t...
Quality healthcare in the more rural areas of the United States is not only getting more difficult to obtain, but difficult to afford. American citizens living in rural areas have the highest rates of chronic disease, higher poverty populations, less health insurance, and there is less access to primary care physicians. When the economy is at its lowest point it causes an increase in a number of access and health issues that have already had prior problems in communities and in rural areas, therefore the main goal of the national health care tax of 2010 was to allow coverage to all residents of the United States, and also by transferring necessary health care to places that were farther away, such as the rustic areas of the United States (HealthReform.Gov, 2012).
In efforts to address the health care needs of an individual with MCC, health care systems benefit from using the Chronic Care Model (CCM) and Transitional Care Model (TCM) when developing a patient care plan. The CCM predicts an increase in patients with self-management skills and tracking systems, by streamlining medical care through partnerships between health systems and local community assets (Mackey, Parchman, & et al., 2012). The TCM “emphasizes recognition of patient's’ health goals, coordination and continuity of care during acute episodes of illness, and development of streamlined plan of care to prevent future hospitalizations” ("Transitional Care Model," 2014, para. 1). Both models are successful with active participation of
The two major components of Medicare, the Hospital Insurance Program (Part A of Medicare) and the supplementary Medical Insurance program (Part B) may be exhausted by the year 2025, another sad fact of the Medicare situation at hand (“Medicare’s Future”). The burden brought about by the unfair dealings of HMO’s is having an adverse affect on the Medicare system. With the incredibly large burden brought about by the large amount of patients that Medicare is handed, it is becoming increasingly difficult to fund the system in the way that is necessary for it to function effectively. Most elderly people over the age of 65 are eligible for Medicare, but for a quite disturbing reason they are not able to reap the benefits of the taxes they have paid. Medicare is a national health plan covering 40 mi...
support medical practice in rural/remote regions: what are the conditions for success? Implement Sci. 2006 Aug 24;1:18.
Applicability to DNP project. The use of outcome indicators emphasizes the areas that are needed for a successful transition. Upon evaluation of the outcomes of CSHCN who have and have not receive transitional care it is apparent that the outcome indicators identified by transitions theory are commonly used in the research that measures evaluation of patient outcomes (Bloom et al., 2012; Celona, 2015; McDonagh, 2005; Oswald et al., 2013). Furthermore, outcome indicators can also be used in the project’s design of the evaluation. Through measuring the outcomes identified by transitions theory the success of patients’ transitions can be determined within the context of the theory.
Shugarman, L. R. & Whitenhill, K. (2011). The affordable care act proposes new provisions to build a stronger continuum of care. Journal of the American Society on Aging, 35(1).
Moreover, advanced management of chronic illnesses results in longer life expectancy in older adults. Healthcare organizations use the care map integrated with the trajectory of illness. Many studies have exhibited lower hospital readmissions and length of stays while leading to improvement in quality, safety, communication and efficiency (Dubuc et al., 2013). Even though use of care maps result in positive health outcomes, the effectiveness of care maps in older adults remains controversial (American Geriatrics Society Expert Panel, 2012; Mutasingwa et al.,
It is a society responsibility to help our veterans get appropriate healthcare benefits and care. Most veterans for healthcare are using the Veterans Health Administration (VHA) and relying on no-VHA providers as well, because of poor quality and access to the care. The dual usage makes difficult for VHA to ensure continuity of care, however, veterans in the majority of cases how no choice other than seek to help outside the VHA. Numerous examples of veterans’
As Leech and Onwuegbusie (2009) explain, mixed methods involves carrying out the whole research project, including collecting, analyzing, and interpreting quantitative and qualitative data in the same study (p. 265). However these authors contend that the
There are many qualitative methods which are developed to have an in depth and extensive understanding of the issues by means of their textual interpretation and the most common types are interviewing and observation(Creswell 2012). The process of research involves empirical work being carried out with the collection of data which can concur, refute or contest theories which in turn allows for understanding and clarification for different observations(May 1997). Whereas the unstructured interview is conducted in conjunction with the collection of observational data, semi-structured interviews are often the sole data source for a qualitative research project(Adams et al. 2002). Semi-structured in-depth interviews are the most widely used interviewing format for qualitative research and can occur