1 / 28

Comorbidities in the Context of Care Transitions

NEWCOURTLAND CENTER FOR TRANSITIONS AND HEALTH University of Pennsylvania School of Nursing. Comorbidities in the Context of Care Transitions. Janet H. Van Cleave, PhD, MBA, MSN, ACNP-BC Harleah G Buck, PhD, RN, CHPN Susan Lysaght, MA, MS, GNP-BC Melissa O’Connor, PhD, MBA, RN, COS-C

selma
Download Presentation

Comorbidities in the Context of Care Transitions

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NEWCOURTLAND CENTER FOR TRANSITIONS AND HEALTH University of Pennsylvania School of Nursing Comorbidities in the Context of Care Transitions • Janet H. Van Cleave, PhD, MBA, MSN, ACNP-BC • Harleah G Buck, PhD, RN, CHPN • Susan Lysaght, MA, MS, GNP-BC • Melissa O’Connor, PhD, MBA, RN, COS-C • Mary D. Naylor, PhD, RN, FAAN

  2. Support • University of Pennsylvania School of Nursing NewCourtlandCenter for Transitions and Health • University of Pennsylvania Pre and Post-Doctoral Fellowships, National Institutes of Health, T32NR009356, Individualized Care for At-Risk Older Adults • John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Program

  3. NewCourtland Center Comorbidity Research Teams Evolutionary Dimensional Analysis Rebecca Trotta (Chair) Janet Van Cleave (Co-Chair) Susan Lysaught Melinda Steis Becky Lorenz Sarah Kagan-Expert Consultant • Salimah Meghani (Chair) • Leah Buck • EeeseungByun • Joan Davitt • Michael Fachko • Melissa O’Connor • Janet Prvu Bettger • Minkyoung Song • Christine Tocchi

  4. Comorbidity is a Significant Health Problem • Individuals with comorbidities • 28% of Americans • 3 out of 4 individuals over the age 65 • Increasing number of persons living with comorbidities • 1987: 31% Medicare beneficiaries with 5 or more comorbidities • 2002: ~50% of all Medicare beneficiaries with 5 or more comorbidities (Anderson, 2010; MedPAC, 2010; U.S. Dept Health & Human Services, 2010)

  5. Comorbidities Financially Challenge the Health Care System • Driving force of the United States health care spending • Individuals with comorbidities account for: • 98% of Medicare costs • Over 60% of total health care expenditures • Expenditures increase with each additional comorbidity (Anderson, 2010; U. S. Dept of Health & Human Services, 2010)

  6. Comorbidities Medically Challenge the Health Care System • Increase mortality and limit function • Inappropriate care unaligned with patient’s goals and preferences • Fractured care in multiple health care sites (NQF, 2012; Dept of Health & Human Services, 2010)

  7. Need for Research • U.S. Department of Health and Human Services. Multiple Chronic Conditions—A Strategic Framework: Optimum Health and Quality of Life for Individuals with Multiple Chronic Conditions. Washington, DC. December 2010. • Goal 4: Need for research to benefit individuals with comorbidities • Advance knowledge • Develop interventions • Develop systems

  8. What is Comorbidity? • Multiple terms used in health care to describe comorbidity(ies) • Multiple outcomes • Temporal components (Feinstein, 1970; Yancik et al., 2007; Vogeli et al., 2007; Wolff, Starfield, & Anderson, 2002; Karlamangla et al., 2007; Weiss, 2007)

  9. Research Question • What is the definition of comorbidity(ies) • Chronically ill adults • Transitioning through acute episodes of illness

  10. Today’s Symposium • The Science of Comorbidities: Current Quandaries and Future Recommendations • Concept Analyses • Empirical Article Selection for Concept Analysis • Dimensional Analysis: Comorbidities in the Face of Transitions • Evolutionary Analysis: Comorbidity in Patients Undergoing Transitions • Closing Remarks

  11. Empirical Article Selection for Concept Analysis of Patients with Comorbidities Undergoing Care Transitions Janet H. Van Cleave1 Harleah G. Buck2 Salimah Meghani3 Janet Prvu-Bettger4 Mary D. Naylor3 1New York University, 2Pennsylvania State University, 3University of Pennsylvania, 4Duke University

  12. Purpose • Decisions regarding search strategies and article selection influence concept analysis findings and impact knowledge development • Careful planning and explicit criteria decrease the potential to introduce study bias • The purpose of this presentation is to describe our methods to capture a heterogeneous, representative body of empirical literature for two concept analyses

  13. Literature Search • Goal: Transparent literature search • Preliminary literature searches • Developed and finalized literature search syntax Buck, H.G., Meghani, S., Bettger, J.P. et al., 2012. The use of comorbidities among adults experiencing care transitions: a systematic review and evolutionary analysis of empirical literature. Chronic Illness.

  14. Initial Inclusion Criteria • Years of publication: 1965-present • Age: Adults 19+ • Human • English language • Research Articles • Transition: There should be an acute event with at least one transition from high to low or low to high acuity care. • United States  (both VA and non-VA)

  15. Literature Search • Four databases • Medline • Cinahl • PsycINFO • Web of Science - Social Science • Uploaded into Refworks • 5,917 references

  16. Representative Heterogeneous Database • Random selection of 650 articles (50 articles per working group member) • Review articles according to inclusion criteria

  17. Initial Review • Selected 98 articles • Refinement of definition of transition

  18. Refinement of Parameters of Transitions • An acute episode of chronic illness with at least one transition • Transitional settings (i.e., in the context of low to high acuity or high to low acuity care) • Related variables directly or indirectly accounted for in the analysis of transitional outcomes (cost, re-hospitalization, functional status, and QOL)

  19. Continued Review of Articles • Final review for uniformity and fidelity to inclusion criteria • Final database: 60 articles

  20. Selection of Empirical Articles

  21. Empirical Articles • Published between 1990 and 2009

  22. Description of Empirical Articles

  23. Empirical Articles • 33 (55%) addressed higher to lower acuity transitions • 27 (45%) featured lower to higher acuity transitions

  24. Summary: Comorbidities in the Context of Care Transitions

  25. New Approaches • Patient focused • Loss of the voice of the individual • Individual experience • Measuring risk for individuals • Predict or explain outcomes on individual, disease, and system levels • Risk over time • Co-existing vs. co-occurring

  26. New Approaches • Relationships • Among comorbidities • Among individuals, comorbidities, and consequences • Complexity • Synergism vs. relative importance vs. patterns • Number, nature, and extent

  27. New Approaches • Importance of terminology • Nosology • Principality • Dynamicity

  28. Questions Thank you NEWCOURTLAND CENTER FOR TRANSITIONS AND HEALTH University of Pennsylvania School of Nursing

More Related