"missing pieces" - Functional, social, and environmental barriers to recovery for vulnerable older adults transitioning from hospital to home

Journal of the American Geriatrics Society

Volumn 62, Issue 8, 2014, Pages 1556-1561

  Greysen, S Ryan ^a   Hoi Cheung, Doug ^b   Garcia, Veronica ^a   Kessell, Eric ^a   Sarkar, Urmimala ^a   Goldman, Lauren ^a   Schneidermann, Michelle ^a   Critchfield, Jeffrey ^a   Pierluissi, Edgar ^a   Kushel, Margot ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

Author keywords

discharge care; qualitative methods; transitions of care; vulnerable seniors

Indexed keywords

DISCHARGE CARE; QUALITATIVE METHODS; TRANSITIONS OF CARE; VULNERABLE SENIORS;

AGED; AGED, 80 AND OVER; CONTINUITY OF PATIENT CARE; ENVIRONMENT DESIGN; FEMALE; HOME CARE SERVICES; HOSPITALS, TEACHING; HOSPITALS, URBAN; HUMANS; MALE; MIDDLE AGED; PATIENT DISCHARGE; POVERTY; QUALITATIVE RESEARCH; RECOVERY OF FUNCTION; RISK FACTORS; SAFETY-NET PROVIDERS; SOCIAL SUPPORT; VULNERABLE POPULATIONS;

EID: 84906078764     PISSN: 00028614     EISSN: 15325415     Source Type: Journal    
DOI: 10.1111/jgs.12928     Document Type: Article

References (30)

1. Jencks SF, Williams MV, Coleman EA,. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med 2009; 360: 1418-1428.
2. Forster AJ, Harvey MJ, Peterson JF, et al. The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med 2003; 138: 161-167.
3. Moore C, Wisnivesky J, Williams S, et al. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med 2003; 18: 646-651.
4. Jack BW, Chetty VK, Anthony D, et al. A reengineered hospital discharge program to decrease rehospitalization. Ann Intern Med 2009; 150: 178-187.
5. Coleman EA, Parry C, Chalmers S, Min SJ,. The care transitions intervention: Results of a randomized controlled trial. Arch Intern Med 2006; 166: 1822-1828.
6. Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home follow-up of hospitalized elders: A randomized clinical trial. JAMA 1999; 281: 613-620.
7. Coleman EA, Smith JD, Frank JC, et al. Preparing patients and caregivers to participate in care delivered across settings: The care transitions intervention. J Am Geriatr Soc 2004; 52: 1817-1825.
8. Raven MC, Billings JC, Goldfrank LR, et al. Medicaid patients at high risk for frequent hospital admission: Real-time identification and remediable risks. J Urban Health 2009; 86: 230-241.
9. Englander H, Kansagara D,. Planning and designing the care transitions innovation (C-Train) for uninsured and Medicaid patients. J Hosp Med 2012; 7: 524-529.
10. Hansen LO, Young RS, Hinami K, et al. Interventions to reduce 30-day rehospitalization: A systematic review. Ann Intern Med 2011; 155: 520-528.
11. Kangovi S, Barg FK, Carter T, et al. Challenges faced by patients with low socioeconomic status during the post-hospital transition. J Gen Intern Med 2014; 29: 283-289.
12. Cain CH, Neuwirth E, Bellows J, et al. Patient experiences of transitioning from hospital to home: An ethnographic quality improvement project. J Hosp Med 2012; 7: 382-387.
13. Support from Hospital to Home for Elders (SHHE): A randomized-controlled study [on-line]. Available at http://clinicaltrials.gov/show/NCT01221532 Accessed May 19, 2014.
14. Glaser BG, Strauss AL,. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago, IL: Aldine Publishing Company, 1967.
15. Patton MQ,. Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage Publications, 2002.
16. Morse JM,. The significance of saturation. Qual Health Res 1995; 5: 147-149.
17. Crabtree BF, Miller WL, eds. Doing Qualitative Research (Research Methods for Primary Care). Thousand Oaks, CA: Sage Publications, 1999.
18. Curry LA, Nembhard IM, Bradley EH,. Qualitative and mixed methods provide unique contributions to outcomes research. Circulation 2009; 119: 1442-1452.
19. Bradley EH, Curry LA, Devers KJ,. Qualitative data analysis for health services research: Developing taxonomy, themes, and theory. Health Serv Res 2007; 42: 1758-1772.
20. Miles MB, Huberman M,. Qualitative Data Analysis. Thousand Oaks, CA: Sage Publications, 1994.
21. Verbrugge LM, Jette AM,. The disablement process. Soc Sci Med 1994; 38: 1-14.
22. Covinsky KE, Palmer RM, Fortinsky RH, et al. Loss of independence in activities of daily living in older adults hospitalized with medical illnesses: Increased vulnerability with age. J Am Geriatr Soc 2003; 51: 451-458.
23. Jha AK,. BOOST and readmissions: Thinking beyond the walls of the hospital. J Hosp Med 2013; 8: 470-471.
24. Arbaje AI, Wolff JL, Yu Q, et al. Postdischarge environmental and socioeconomic factors and the likelihood of early hospital readmission among community-dwelling Medicare beneficiaries. Gerontologist 2008; 48: 495-504.
25. Joynt KE, Jha AK,. Thirty-day readmissions-Truth and consequences. N Engl J Med 2012; 366: 1366-1369.
26. Kangovi S, Grande D,. Hospital readmissions-Not just a measure of quality. JAMA 2011; 306: 1796-1797.
27. California Department of Social Services, In-Home Supportive Services [on-line]. Available at http://www.cdss.ca.gov/agedblinddisabled/PG1296.htm Accessed November 6, 2013.
28. Kaiser Family Foundation. Status of state action on the Medicaid expansion decision, as of October 23, 2013 [on-line]. Available at http://kff.org/health-reform/state-indicator/state-activity-around-expanding- medicaid-under-the-affordable-care-act/ Accessed November 6, 2013.
29. Centers for Medicare and Medicaid Services Innovation Center. Community-based care transitions programs [on-line]. Available at http://innovation.cms.gov/initiatives/CCTP/ Accessed November 6, 2013.
30. Doran KM, Ragins KT, Gross CP, et al. Medical respite programs for homeless patients: A systematic review. J Health Care Poor Underserved 2013; 24: 499-524.