Patient-Centered Care Transitions After Injury Hospitalization: A Comparative Effectiveness Trial

Autor:	Doyanne Darnell, Joan Russo, Erik van Eaton, Douglas F. Zatzick, Harry Teter, Jin Wang, Gregory J. Jurkovich, Lauren K. Whiteside, Peter Thomas, Leah Ingraham, Lea E. Parker, Kirsten Sandgren, Roxanne Guiney, Margot Kelly Hedrick
Rok vydání:	2018
Předmět:	Adult Male medicine.medical_specialty MEDLINE 01 natural sciences Stress Disorders Post-Traumatic 03 medical and health sciences Young Adult 0302 clinical medicine Intervention (counseling) Patient-Centered Care Medicine Humans 030212 general & internal medicine Survivors 0101 mathematics Young adult business.industry Depression 010102 general mathematics Follow up studies Patient-centered care Middle Aged Patient Acceptance of Health Care Hospitalization Psychiatry and Mental health Outcome and Process Assessment Health Care Usual care Stress disorders Physical therapy Wounds and Injuries Female business Emergency Service Hospital Follow-Up Studies
Zdroj:	Psychiatry. 81(2)
ISSN:	1943-281X
Popis:	The investigation aimed to compare two approaches to the delivery of care for hospitalized injury survivors, a patient-centered care transition intervention versus enhanced usual care.This pragmatic comparative effectiveness trial randomized 171 acutely injured trauma survivors with three or more early postinjury concerns and high levels of emotional distress to intervention (I; n = 85) and enhanced usual care control (C; n = 86) conditions. The care transition intervention components included care management that elicited and targeted improvement in patients' postinjury concerns, 24/7 study team cell phone accessibility, and stepped-up care. Posttraumatic concerns, symptomatic distress, functional status, and statewide emergency department (ED) service utilization were assessed at baseline and over the course of the 12 months after injury. Regression analyses assessed intervention and control group outcome differences over time.Over 80% patient follow-up was attained at each time point. Intervention patients demonstrated clinically and statistically significant reductions in the percentage of any severe postinjury concerns expressed when compared to controls longitudinally (Wald chi-square = 11.29, p = 0.01) and at the six-month study time point (C = 74%, I = 53%; Fisher's exact test, p = 0.02). Comparisons of ED utilization data yielded clinically significant cross-sectional differences (one or more three- to six-month ED visits; C = 30.2%, I = 16.5%, [relative risk (95% confidence interval] C versus I = 2.00 (1.09, 3.70), p = 0.03) that did not achieve longitudinal statistical significance (F (3, 507) = 2.24, p = 0.08). The intervention did not significantly impact symptomatic or functional outcomes.Orchestrated investigative and policy efforts should continue to evaluate patient-centered care transition interventions to inform American College of Surgeons' clinical guidelines for U.S. trauma care systems.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d77949943fbcc2f32802d503d321c3bd https://pubmed.ncbi.nlm.nih.gov/29533154 Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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