Article Database

Effects of Introducing a Fee for “Inpatient Overstays” on the Rate of Death and Readmissions Across Municipalities in Norway

Abstract:

The Norwegian healthcare coordination reform (Samhandlingsreformen) was implemented from January 1, 2012. In addition to providing municipalities with funding to strengthen their health infrastructure, it required municipalities to pay hospitals a daily fee for patients who, having been declared ready for discharge and in need of municipal health services, were not received by the municipalities on time. This study examines the effects of the reform on the rate of death and readmissions occurring within 60 days of hospitalization. We use aggregated municipal data for years 2009, 2010, 2012–2014 (N = 1646) for Norwegian patients (age 18+) hospitalized in the same years for COPD/asthma, heart failure, hip fracture, and stroke. We stratify our analyses of the municipal data by these patient groups. Our linear regression models test for moderated (interaction) effects whereby associations between the reform and the rate of death and readmissions vary by whether or not patients were classified as ready for discharge and in need of follow-up care in the municipality. The models adjust for municipal sociodemographic and health characteristics. We found no statistically significant moderated effects of the reform across the patient groups, except for patients with stroke (b =.027, SE = 0.109, p <.05). Specifically, compared to the pre-reform period (2009–2010), the post-reform period (2012–2014) was associated with a higher rate of readmissions at high predicted values of needing follow-up care. Even though our analyses of municipal data suggest that patients with stroke are vulnerable to the reform and its incentive scheme, there is no strong evidence overall to suggest that the Norwegian healthcare coordination reform is functioning in a manner that exacerbates the risk of death and readmissions.

Addressing Safety in Integrated Care Programs for Older People Living at Home: A Systematic review

Abstract:

Introduction: The topic of patient safety, which is traditionally viewed as preventing harm stemming from healthcare treatment, has been extensively researched in hospital and institutional settings. However, less attention has been given to addressing safety at home even though an increasing number of older people receive care and support at home, for example through integrated care programs. Care provided in the context of integrated programs for older people living at home differs from care in institutional settings in that it takes place in less controlled environments and often involves multiple health and social care providers as well as informal caregivers. Knowledge on safety in relation to integrated care is scarce. Therefore, this review aims to provide insight into how safety is currently being addressed in integrated care programs for older people living at home. Methods: This review adopted a multidimensionalperspective on safety, operationalised as reducing health risks by preventing predictable harm. These risks exist in various domains (e.g. patient characteristics and behaviour, patients’ physical or social environments, health and social care delivery). Papers describing integrated care programs where at least one intervention component explicitly aimed at safety were included in the review. Data were extracted on the safety components of the interventions and the domains they focused on. Results: Ten integrated care programs were included in the review. The extent to which these programs addressed safety varied. Programs addressed risks related to patient characteristics and behaviour (e.g. falls, substance abuse, medication adherence), or health and social care management (e.g. polypharmacy, care transitions). Several tools and interventions were used to promote safety, such as needs assessments, evidence based care plans, medication reviews and case management methods. There was generally less attention to risks related to patients’ physical and social environment, although one program specifically addressed home safety by providing a handyman. Discussion: The identified programstarget a variety of safety risks at different domains, and they differ in the extent to which safety is addressed from a multidimensional perspective. Currently, attention to safety is primarily focused on risks related to health care management and patient characteristics and behaviour, while risks related to people’s physical and social environments are less often addressed. Additional interventions, targeting specific safety risks, could be incorporated in integrated care programs in order to address safety more comprehensively. Conclusions and lessons learned: Only a few of the many integrated care programs for older people at home that are described in literature explicitly address safety. Within these programs, more attention is needed for the risks related to people’s physical and social environments. Limitations: Our review only included programs that explicitly addressed safety, as documented in the research literature. Therefore, we may have missed some programs that addressed safety if this was not clearly described in the literature. Suggestions for future research: Future research might focus on the effects of integrated care programs on the multiple domains of safety.

Improving Person-Centredness in Integrated Care for Older People: Experiences from Thirteen Integrated Care Sites in Europe

Abstract:

Introduction:
Although person-centredness is a key principle of integrated care, successfully embedding and improving person-centred care for older people remains a challenge. In the context of a cross-European project on integrated care for older people living at home, the objective of this paper is to provide insight at an overarching level, into activities aimed at improving person-centredness within the participating integrated care sites. The paper describes experiences with these activities from the service providers’ and service users’ perspectives.

Methods:
A multiple embedded case study design was conducted that included thirteen integrated care sites for older people living at home.

Results:
Service providers were positive about the activities that aimed to promote person-centred care and thought that most activities (e.g. comprehensive needs assessment) positively influenced person-centredness. Experiences of service users were mixed. For some activities (e.g. enablement services), discrepancies were identified between the views of service providers and those of service users.

Discussion and conclusion:
Evaluating activities aimed at promoting person-centredness from both the service providers’ and service users’ perspectives showed that not all efforts were successful or had the intended consequences for older people. Involvement of older people in designing improvement activities could ensure that care and support reflect their needs and preferences, and build positive experiences of care and support.

Different Contexts, Similar Challenges. SUSTAIN’s Experiences with Improving Integrated Care in Europe

Abstract:

No abstract available.

Addressing Safety Risks in Integrated Care Programs for Older People Living at Home: a Scoping Review

Abstract:

Background:
Many older people live at home, often with complex and chronic health and social care needs. Integrated care programs are increasingly being implemented as a way to better address these needs. To support older people living at home, it is also essential to maintain their safety. Integrated care programs have the potential to address a wide range of risks and problems that could undermine older people’s ability to live independently at home. The aim of this scoping review is to provide insight into how integrated care programs address safety risks faced by older people living at home – an area that is rather underexplored.

Methods:
Safety was conceptualised as preventing or reducing the risk of problems, associated with individual functioning and behaviour, social and physical environments, and health and social care management, which could undermine older people’s ability to live independently at home. For this scoping review a systematic literature search was performed to identify papers describing integrated care programs where at least one intervention component addressed safety risks. Data were extracted on the programs’ characteristics, safety risks addressed, and the activities and interventions used to address them.

Results:
None of the 11 programs included in this review explicitly mentioned safety in their goals. Nevertheless, following the principles of our conceptual framework, the programs appeared to address risks in multiple domains. Most attention was paid to risks related to older people’s functioning, behaviour, and the health and social care they receive. Risks related to people’s physical and social environments received less attention.

Conclusion:
Even though prevention of safety risks is not an explicit goal of integrated care programs, the programs address a wide range of risks on multiple domains. The need to address social and environmental risks is becoming increasingly important given the growing number of people receiving care and support at home. Prioritising a multidimensional approach to safety in integrated care programs could enhance the ability of health and social care systems to support older people to live safely at home.

Childhood Trauma and Suicidal Ideation Among Chinese Female Prisoners: The Mediating Roles of Negative Emotions and Social Support

Abstract:

Suicide is a major public health concern, especially in prisoners. This study aims to investigate the prevalence of current suicidal ideation in a sample of Chinese female prisoners and examine the mediating role of negative emotions and social support in the link between childhood trauma and suicidal ideation. A cross-sectional study was conducted in five main jails of the district of Zhejiang province in China and a total of 626 female prisoners were surveyed by using cluster sampling. Childhood Trauma Questionnaire, Beck Depression Inventory, Beck Anxiety Inventory, Beck Hopelessness Scale and Multidimensional Scale of Perceived Social Support were applied. The estimated prevalence of current suicide ideation among Chinese female prisoners was 33.4%. Structural equation modeling analyses revealed that social support and negative emotions acted as chain mediators between childhood trauma and current suicidal ideation. Results emphasize the importance of stress-diathesis theory of suicidality in understanding the possible mechanisms underlying the relationship between childhood trauma and suicidal ideation among female prisoners.

A Critical Analysis of Acculturation, Sociocultural Pressures, Body Image, and Disordered Eating among Asian Immigrants in Australia, Canada, and the United States

Abstract:

Asian immigrants are an emerging ethnic minority in the United States, Australia, and Canada. Previous literature has examined how immigration to Western countries and the sociocultural pressures associated with a new host country, particularly the United States, impacts Asian immigrants’ body image and dietary regimen. However, there has been less of a focus on the level of acculturation of Asian immigrants in Canada and Australia and its relationship with body image dissatisfaction, disordered eating, and sociocultural pressures. The paucity of cross-cultural analysis and the inconclusive knowledge of how acculturation and sociocultural pressures may serve as predictors of poor body image and disordered eating warrant further investigation. An overview of Asian immigrants’ acculturation experiences and an in-depth analysis of existing literature with regard to acculturation, body image, sociocultural pressures, and disordered eating are provided.

Does Number of Children Moderate the Link between Intimate Partner Violence and Marital Instability among Chinese Female Migrant Workers?

Abstract:

Intimate partner violence is a serious issue affecting migrant workers in China. The present study investigated the prevalence of intimate partner violence in a sample of Chinese female migrant workers and examined the moderating role of number of children in the link between intimate partner violence and marital instability within the framework of social exchange theory. A total of 805 married female migrant workers responded to the Conflict Tactics Scales, the Marital Quality Scale, and a demographic data form. The results revealed that 37% of these women experienced intimate partner violence during last year. Regression analyses found a significant association between intimate partner violence and marital instability. More importantly, this association was moderated by their number of children. Intimate partner violence significantly predicted marital instability for childfree or one-child female migrant workers, but not for female migrant workers with two or more children. These results provide new insights on how having children influences female migrants’ suffering IPV decision-making about whether to terminate their relationship. They also offer insights for intervention programs for victimized women.

Childhood Abuse and Suicidal Behaviors Among Chinese Migrant Workers: The Mediating Role of Alexithymia and Social Support

Abstract:

This study aims to investigate the lifetime prevalence of suicidal behaviors in a sample of Chinese migrant workers. It also examined the mediating role of alexithymia and social support in the link between childhood abuse and suicidal behaviors. A total of 1,563 migrant workers were surveyed by using cluster sampling. Results showed that the estimated lifetime prevalence of suicide ideation, plan, and attempt among Chinese migrant workers was 12.8%, 8.1%, and 4.6%, respectively. Structural equation modeling analyses revealed a significant positive association between childhood abuse and suicidal behaviors; this association was partially mediated by social support. A significant path from childhood abuse through alexithymia and social support to suicidal behaviors was also established. Findings of this study emphasize the importance of social support and alexithymia in understanding the possible mechanisms underlying the relationship between childhood abuse and suicidal behaviors and suggest possible avenues for suicide interventions.

Migration trends and dietary patterns in Sub-Saharan African adult immigrants: A comparative analysis of populations in France, the UK, and the USA

Abstract:

Sub-Saharan African (SSA) communities are part of a diverse and evolving African diaspora dispersed all over the world. Few studies have examined changes in eating habits of SSA communities who migrated in Western regions of the world. A critical review was conducted on the migration trends, dietary patterns, and dietary acculturation of SSA immigrants residing in the USA, the UK, and France. A comparative analysis revealed historical and contemporary influences of migration trends, the salience and significance of preserving traditional African diet post-migration, and the leading factors to and consequences of dietary acculturation. Limitations and recommendations for research and practice are described.