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Hospital Readmissions: the Need for a Coordinated Transitional Care Model: Analysis and Synthesis of Research on Medicare Policy and Interventions for the Elderly

Description: The transition from hospital to home or alternate care setting is a time of vulnerability for all patients and particularly for our elders. If not handled appropriately there is a risk to our elders for readmission to the hospital environment that may decrease their overall quality of life and further compromise their health status. in addition to the individual risks associated with patient readmissions, there are societal impacts that reach far beyond our current generation of elders 65 and older. This impact may have dire implications for the future fiscal health of the next generation. a review of the current and past literature shows that there are a limited number of resources available for hospitals to use in order to comply with the new Value Based Purchasing initiatives that are being implemented by CMS regarding the reduction in readmission rates. the problem of hospital readmissions is confounded by the many processes that are available for study, from pre-hospitalization conditions and care through hospitalization, discharge, and finally to post discharge processes. While most research and literature reviews have focused on individual disease causes, there is a need to provide hospitals with a resource that outlines the available options and interventions that have been shown to be effective in reducing hospital readmissions. the purpose of this study is to review relevant literature related to the problem of hospital readmissions for our elder population. This study is designed to look at interventions, both disease based and non-disease based, that have been previously implemented and have shown effective reductions in readmission rates. This analysis and synthesis can provide an important contribution to our understanding of the factors and variables that influence the readmission rates of our elder population. This review has the potential to assist and direct hospital administrators and to discharge planners, social ...
Date: May 2012
Creator: Wolfe, Laura M.

Reform and change in police education: Examining the variations in the top-down and bottom-up structures in the process of implementation.

Description: This study examines the variations in the practice of implementation in different implementation structures using the case of police education reforms that were undertaken by the Turkish National Police (TNP) in 2001 and 2003. Differentiations and similarities in the top-down and bottom-up structures while practicing the process of implementation were investigated in this study. First, the study provides a comprehensive understanding of the process of implementation and structure of implementation. Second, the study introduces TNP education reforms and explains the reasons for the reform. Third, a quantitative approach is used to measure the success of the TNP educational reforms. Specifically, multiple regression analysis, one-way analysis of variance (ANOVA), and post hoc tests are used to clarify if police performance in the TNP has improved since the reforms. Fourth, the study uses a qualitative approach to find out how features associated with top-down or bottom up approaches were involved in the process of implementation of the educational reforms. Finally, based upon the views of the participants in the qualitative analysis, the study examines the variations in the practice of implementation between decision makers and the street level bureaucrats.
Date: August 2009
Creator: Kapti, Alican

A Survey of Collaborative Efforts Between Public Health and Aging Services Networks in Community Health Centers in Texas

Description: Federally qualified health centers (FQHCs) that harness the reinforcing nature of collaborative efforts with aging services can better prepare for the future of older adult populations. The purpose of this research was to identify collaborative efforts between FQHCs and aging services and distinguish perceptions and knowledge regarding older adult populations. Executive directors, medical directors and social service directors (N=44) at 31 FQHCs across the state of Texas completed surveys measuring structural, procedural and environmental components of the health center setting. The 2007 Uniform Data System and 2000 US Census provided additional data on health centers use and services. Descriptive statistics analyzed independent variables of health center characteristics. Bivariate analysis determined significance of association between independent variables and levels of collaboration with aging services. Results found that all health centers collaborated with at least one aging service, with more informal than formal partnerships. Respondents indicated major barriers to providing services to older adults, including inadequate transportation, inadequate insurance, and limited funding. Respondents also indicated overloaded staff as a major barrier to collaborating with aging services. Aging topics for staff development and perceptions about older adults were also identified. Health center tenure (p=0.005, lambda=1.000), professional tenure (p=0.011, lambda=1.000), leadership in aging services (p=0.002, lambda=1.000), recent gerontological training (p=0.002, lambda=0.500), formal gerontological training p=0.002, lambda=1.000), strategic planning (p=0.002, lambda=1.000), and having older adults on governing boards (p=0.002, lambda= 1.000) were significantly associated with informal collaboration with aging services. Health center tenure (p=0.006, lambda=0.500), leadership in aging services (p=0.004, lambda=0.500), recent training (p=0.010, lambda=0.500), formal training (p=0.005, lambda=0.500), the designation of health center staff older adult services (p=0.025, lambda=0.250), strategic planning (p=0.011, Iambda=0.500), and older adults on governing board (p=0.009, lambda=0.500) were significantly associated with formal collaboration with aging services. In conclusion, FQHCs' efforts at partnering with aging services should include an investment in ...
Date: May 2009
Creator: Severance, Jennifer Jurado

The Willingness of Older Adults to Evacuate in the Event of a Disaster

Description: The issue of rising number of disasters, the overwhelming increase in number of older adults, and historically flawed evacuations presents real challenges. Disasters can strike anywhere, any time, and have devastating consequences. Since 1900, the number of Americans 65 and older has increased 12 times (from 3.1 million to 36.3 million). During the next two decades, the number of American baby boomers, now aged 45-64, who turn 65, will increase by 40%. As evidenced by recent disasters, the imperfections and vulnerabilities of flawed evacuations for older adults are still present. This study examined the level of willingness to evacuate among older adults in the event of a disaster. Despite the extensive literature on disasters and evacuation, some significant questions regarding evacuation and older adults have not been addressed. This study addressed the following concerns: (1) What is the willingness among older adults to evacuate when asked to do so by emergency management officials? (2) Does the call to evacuate being mandatory versus voluntary influence the willingness of seniors to evacuate? (3) Do preconditions (Gender, Marital Status, Age, Ethnic Origin, and Education Levels) influence the willingness to evacuate among older adults? The sample population consisted of 765 voluntary participants aged 60 years and older from thirty senior/community centers within seven counties in the State of Oklahoma. A group administered survey (The Disaster Evacuation Survey) included a total of 15 questions. This study revealed the following findings: older adults are more likely to comply with a mandatory evacuation order. Individuals with college degrees are more likely to comply with mandatory evacuations. African Americans are more likely to comply with a voluntary request. American Indian/Alaskan Native are more likely to comply with mandatory evacuation orders from emergency officials. Important practical implications for emergency officials responding to vulnerable older adults in disaster situations are ...
Date: May 2009
Creator: Gray-Graves, Amy Michael