BACKGROUND:The post-hospitalization period is a precarious time for patients. Post-discharge nurse telephone call programs aiming to prevent unnecessary readmissions have had mixed results. OBJECTIVE: Describe a primary-care based program to identify and address problems arising after hospital discharge. DESIGN: A quality improvement program embedding registered nurses in a primary care practice to call patients within 72 h of hospital discharge and route problems within the practice for real-time resolution. PARTICIPANTS: Adult patients with a primary care provider in the general internal medicine practice at the University of California San Francisco who were discharged home from the Medicine service. MAIN MEASURES: Patients reached directly by phone had a 'full-scripted encounter;' those reached only by voice-mail had a 'message-scripted encounter;' those not reached despite multiple attempts had a 'missed encounter.' Among patients with full-scripted encounters, we identified and cataloged problems arising after hospital discharge and measured the proportion of calls in which a problem was uncovered. For the different encounter types, we compared follow-up appointment attendance and 30-day readmission rates. KEY RESULTS: Of 790 eligible discharges, 486 had a full-scripted, 229 a message-scripted and 75 a missed encounter. Among the 486 full-scripted encounters, nurses uncovered at least one problem in 371 (76 %) discharges, 25 % of which (n=94) included new symptoms, and 47 % (n=173) included medication issues. Discharges with full-scripted and message-scripted encounters were associated with higher follow-up appointment attendance rates compared with those with missed encounters (60.1 %, 58.5 %, 38.5 % respectively p=0.004). There was no significant difference in 30-day readmission rates (12.8 %, 14.8 %, 14.7 %; p=0.72). CONCLUSIONS: Our results suggest that centering a post-discharge phone call program within the primary care practice improves post-hospital care by identifying clinical and care-coordination problems early. With the new Medicare transitional care payment, such programs could become an important, self-sustaining part of the patient-centered medical home.KEY WORDS: care management; care transitions; health care delivery; primary care; quality improvement.
Direct touch displays can improve the human-computer experience and productivity; however, the higher hand locations may increase shoulder fatigue. Palm rejection (PR) technology may reduce shoulder loads by allowing the palms to rest on the display and increase productivity by registering the touched content and fingertips through the palms rather than shoulders. The effects of PR were evaluated by having participants perform touch tasks while posture and reaction force on the display were measured. Enabling PR, during which the subjects could place the palms on the display (but were not required to), resulted in increased wrist extension, force applied to the display and productivity, and less discomfort, but had no effect on the self-selected positioning of the display. Participants did not deliberately place their palms on the display; therefore, there was no reduction in shoulder load and the increased productivity was not due to improved hand registration. The increased productivity may have been due to reduced interruptions from palm contacts or reduced motor control demands.
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