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Reducing Potentially Avoidable Acute Care Transfers from Long-Term Care Homes: Developing A Taxonomy of Interventions and Improving Approaches to Evaluate Intervention Effectiveness.

Record Type:	Electronic resources : Monograph/item
Title/Author:	Reducing Potentially Avoidable Acute Care Transfers from Long-Term Care Homes: Developing A Taxonomy of Interventions and Improving Approaches to Evaluate Intervention Effectiveness./
Author:	Sahin, Deniz.
Published:	Ann Arbor : ProQuest Dissertations & Theses, : 2023,
Description:	244 p.
Notes:	Source: Dissertations Abstracts International, Volume: 85-05, Section: B.
Contained By:	Dissertations Abstracts International85-05B.
Subject:	Revisions. -
Online resource:	https://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=30718440
ISBN:	9798380706834

Reducing Potentially Avoidable Acute Care Transfers from Long-Term Care Homes: Developing A Taxonomy of Interventions and Improving Approaches to Evaluate Intervention Effectiveness.
Sahin, Deniz.

Reducing Potentially Avoidable Acute Care Transfers from Long-Term Care Homes: Developing A Taxonomy of Interventions and Improving Approaches to Evaluate Intervention Effectiveness. - Ann Arbor : ProQuest Dissertations & Theses, 2023 - 244 p.

Source: Dissertations Abstracts International, Volume: 85-05, Section: B.

Thesis (Ph.D.)--McGill University (Canada), 2023.

Potentially avoidable emergency department (ED) transfers and hospitalizations from long-term care (LTC) homes, providing 24-hour nursing care, represent an important quality of care challenge. These events are defined as those stemming from clinical conditions that theoretically could be managed onsite with appropriate primary care. They may occur contrary to residents' advance directives, expose residents to serious adverse events, and represent inefficiencies in healthcare systems. There are important limitations of research investigating interventions aimed at reducing transfers from LTC. These limitations make it challenging to adapt any proposed intervention to the needs and preferences of transfer decision-makers, mainly, primary care physicians, other front-line staff, LTC residents and their family members.The primary aim of this dissertation was to conduct a series of methodological and substantive substudies to advance knowledge about potentially avoidable acute care transfers from LTC homes and the interventions aimed at their reduction. The secondary aim was to inform the design of future studies such that they can assess the impact of an exposure of interest that exists under regular conditions (non-experimental) on reducing a meaningful and contextually relevant outcome using causal inference methods.In the first manuscript, I addressed the challenges related to the complexity of interventions that aimed at reducing ED transfers and/or hospitalizations among LTC residents experiencing an acute change in their health. Given the inconsistencies and confusion in the literature regarding intervention terminology, I conducted a systematic scoping review to propose a cohesive taxonomy of such interventions. In synthesizing 90 studies, I identified six intervention categories (e.g., advance care planning, transitional care), and four intervention components (i.e., human resources, training, technology, tools).In the second manuscript, I tackled the shortcomings in the literature surrounding measurement of acute care transfers from LTC. Using real-world data pertaining to a sample of Quebec LTC residents who received care in a tertiary hospital ED, I measured proportions of potentially avoidable ED transfers and hospitalizations associated with conditions manageable onsite and compared these proportions with those reported for the rest of Canada. A total of 1,233 transfers by 692 residents were recorded, among which 36.3% were classified as being potentially avoidable. Potentially avoidable ED transfers with or without hospitalizationsaccounted for 95% of potentially avoidable transfers, and hence, were identified as an important LTC quality measure. Proportions of all outcomes in Quebec were comparable to those from the rest of Canada.In the third manuscript, using acute care transfers from the LTC setting as a motivating example, I illustrated the usefulness of conceptualizing a causal diagram that encodes known or suspected associations between measured and unmeasured factors, the exposure of interest (advance care planning) and the primary study outcome (potentially avoidable ED transfers). I demonstrated how encoded information representing realistic study scenarios can be used to design and implement the Monte-Carlo simulation analyses using standard statistical software for repeated simulation.This dissertation has implications for future research, clinical practice, and primary care policy-making. Findings provide important insights into proactive models of person-centred care in LTC homes. The proposed taxonomy of interventions can inform successful intervention designs and allow to draw meaningful conclusions about their effectiveness/efficacy in future literature reviews which would be necessary for eventual policy change. The results from these three dissertation manuscripts will inform future observational studies, including that of my research group which plans to conduct further investigation.

ISBN: 9798380706834Subjects--Topical Terms:

3681635
Revisions.

Reducing Potentially Avoidable Acute Care Transfers from Long-Term Care Homes: Developing A Taxonomy of Interventions and Improving Approaches to Evaluate Intervention Effectiveness.
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520 $a Potentially avoidable emergency department (ED) transfers and hospitalizations from long-term care (LTC) homes, providing 24-hour nursing care, represent an important quality of care challenge. These events are defined as those stemming from clinical conditions that theoretically could be managed onsite with appropriate primary care. They may occur contrary to residents' advance directives, expose residents to serious adverse events, and represent inefficiencies in healthcare systems. There are important limitations of research investigating interventions aimed at reducing transfers from LTC. These limitations make it challenging to adapt any proposed intervention to the needs and preferences of transfer decision-makers, mainly, primary care physicians, other front-line staff, LTC residents and their family members.The primary aim of this dissertation was to conduct a series of methodological and substantive substudies to advance knowledge about potentially avoidable acute care transfers from LTC homes and the interventions aimed at their reduction. The secondary aim was to inform the design of future studies such that they can assess the impact of an exposure of interest that exists under regular conditions (non-experimental) on reducing a meaningful and contextually relevant outcome using causal inference methods.In the first manuscript, I addressed the challenges related to the complexity of interventions that aimed at reducing ED transfers and/or hospitalizations among LTC residents experiencing an acute change in their health. Given the inconsistencies and confusion in the literature regarding intervention terminology, I conducted a systematic scoping review to propose a cohesive taxonomy of such interventions. In synthesizing 90 studies, I identified six intervention categories (e.g., advance care planning, transitional care), and four intervention components (i.e., human resources, training, technology, tools).In the second manuscript, I tackled the shortcomings in the literature surrounding measurement of acute care transfers from LTC. Using real-world data pertaining to a sample of Quebec LTC residents who received care in a tertiary hospital ED, I measured proportions of potentially avoidable ED transfers and hospitalizations associated with conditions manageable onsite and compared these proportions with those reported for the rest of Canada. A total of 1,233 transfers by 692 residents were recorded, among which 36.3% were classified as being potentially avoidable. Potentially avoidable ED transfers with or without hospitalizationsaccounted for 95% of potentially avoidable transfers, and hence, were identified as an important LTC quality measure. Proportions of all outcomes in Quebec were comparable to those from the rest of Canada.In the third manuscript, using acute care transfers from the LTC setting as a motivating example, I illustrated the usefulness of conceptualizing a causal diagram that encodes known or suspected associations between measured and unmeasured factors, the exposure of interest (advance care planning) and the primary study outcome (potentially avoidable ED transfers). I demonstrated how encoded information representing realistic study scenarios can be used to design and implement the Monte-Carlo simulation analyses using standard statistical software for repeated simulation.This dissertation has implications for future research, clinical practice, and primary care policy-making. Findings provide important insights into proactive models of person-centred care in LTC homes. The proposed taxonomy of interventions can inform successful intervention designs and allow to draw meaningful conclusions about their effectiveness/efficacy in future literature reviews which would be necessary for eventual policy change. The results from these three dissertation manuscripts will inform future observational studies, including that of my research group which plans to conduct further investigation.
520 $a Les transferts potentiellement evitables vers les departements d'urgence et les hopitaux en provenance des etablissements de soins de longue duree (SLD), qui offrent des soins infirmiers 24 heures sur 24, representent un defi important de qualite des soins. Ces transferts potentiellement evitables sont definis comme ceux qui decoulent de conditions cliniques qui peuvent etre gerees sur place avec des soins primaires appropries. La recherche sur les interventions visant a diminuer ces transferts presente des limitations importantes.Le but principal de cette these etait de mener une serie d'etudes methodologiques et substantielles afin de faire progresser les connaissances sur les transferts potentiellement evitables vers les hopitaux en provenance des etablissements de SLD, et sur les interventions permettant de reduire ces transferts. Le but secondaire etait d'informer la conception de futures etudes afin qu'elles puissent evaluer l'impact d'une exposition d'interet qui existe dans des conditions normales (non experimentales) sur la reduction d'un resultat significatif et contextuellement pertinent en utilisant des methodes d'inference causale.Dans le premier manuscrit, compte tenu des incoherences et de la confusion dans la litterature concernant la terminologie des interventions visant a reduire les transferts vers les urgences et/ou les hospitalisations chez les residents en SLD, j'ai effectue une revue systematique de la portee afin de proposer une taxonomie coherente de ces interventions. En synthetisant 90 etudes, j'ai identifie six categories d'intervention (par ex., la planification prealable des soins, soins transitoires) et quatre composantes d'intervention (ressources humaines, formation, technologie, outils).Dans le deuxieme manuscrit, l'etude s'appuie sur des donnees reelles relatives a un echantillon de residents en SLD du Quebec qui ont recu des soins dans un departement d'urgence situe dans un hopital tertiaire. J'ai mesure les proportions de transferts potentiellement evitables vers les urgences et hopitaux associes a des conditions gerables en SLD. 1233 transferts de 692 residents ont ete enregistres, dont 36,3 % ont ete classes comme potentiellement evitables. Les transferts aux urgences potentiellement evitables, avec ou sans hospitalisation, representaient 95% des transferts potentiellement evitables et ont donc ete identifies comme une mesure importante de la qualite des soins en etablissement de SLD. Les proportions de tous les resultats au Quebec etaient comparables a celles du reste du Canada.Dans le troisieme manuscrit, j'ai illustre l'utilite de la conceptualisation d'un diagramme causal qui code les associations connues ou suspectees entre les facteurs mesures et non mesures, un exposant d'interet (la planification prealable des soins) et un resultat principal (transferts potentiellement evitables vers les urgences avec ou sans hospitalisation), en utilisant un exemple motivant. J'ai demontre comment les informations codees qui representent des scenarios d'etude realistes peuvent etre utilisees pour concevoir et implementer les analyses de simulation de MonteCarlo a l'aide d'un logiciel statistique standard qui permet la simulation repetee.Cette dissertation a des implications pour la recherche future, pratiques cliniques et l'elaboration de politiques en soins primaires. Les resultats fournissent des pistes de reflexion importantes sur les modeles proactifs de soins centres sur la personne en etablissements de SLD. La taxonomie d'interventions proposee peut servir de base a la conception et a la reussite d'interventions et tirer des conclusions significatives sur leur efficacite ou leur efficience dans les futures revues de la litterature, qui seraient necessaires pour un eventuel changement de politique. Les resultats de ces trois manuscrits de these eclaireront de futures etudes d'observation, y compris celle de mon groupe de recherche qui prevoit de mener une enquete plus approfondie.
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