A pilot study of the “Continuation of Care” model in “revolving-door” patients

Juven‐Wetzler, Alzbeta; Bar-Ziv, D.; Cwikel-Hamzany, Shlomit; Abudy, Anat; Peri, Neeraja; Zohar, Joseph

doi:10.1016/j.eurpsy.2011.05.003

Cited by 18 publications

(24 citation statements)

References 20 publications

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“…Follow-up in the ward, by the same staff, significantly reduced the number and length of hospitalizations as compared to the traditional system of follow-up in an outpatient clinic [80]. In one study continuity of treatment made no difference for affective disorders patients but it protected schizophrenic patients from rehospitalisation [59] while in another intervention study even if a reduction in total readmissions could not be proved to be significant, a decrease of involuntary readmissions was observed [81].…”

Section: Resultsmentioning

confidence: 99%

Overview of post-discharge predictors for psychiatric re-hospitalisations: a systematic review of the literature

et al. 2017

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Background: High levels of hospital readmission (rehospitalisation rates) is widely used as indicator of a poor quality of care. This is sometimes also referred to as recidivism or heavy utilization. Previous studies have examined a number of factors likely to influence readmission, although a systematic review of research on post-discharge factors and readmissions has not been conducted so far. The main objective of this review was to identify frequently reported post-discharge factors and their effects on readmission rates. Methods: Studies on the association between post-discharge variables and readmission after an index discharge with a main psychiatric diagnosis were searched in the bibliographic databases Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. Relevant articles published between January 1990 and June 2014 were included. A systematic approach was used to extract and organize in categories the information about post-discharge factors associated with readmission rates.

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Section: Resultsmentioning

confidence: 99%

Overview of post-discharge predictors for psychiatric re-hospitalisations: a systematic review of the literature

et al. 2017

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“…Numerous interventions instead encompassed a 'boundary spanning' element or agent, (i.e. a ward nurse in the community or a community nurse attending ward meetings) (18)(19)(20), which often had implications in terms of reducing readmissions (8,21). When studying stroke populations, researchers found that no single transition intervention can facilitate knowledge transfer and that a combined approach is often needed focused on three main elements: 1) information systems/technologies (an effective system that allows for the transfer of explicit knowledge), 2) roles (dedicated professional roles to support discharge planning), and 3) group activities (interprofessional or interorganizational group activities) (22).…”

Section: Introductionmentioning

confidence: 99%

Codesigning a Mental Health Discharge and Transitions of Care Intervention: A Modified Nominal Group Technique

et al. 2020

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Background: Discharge from acute mental health services has long been associated with mortality, risk, and related adverse outcomes for patients. Many of the interventions that currently aim to reduce adverse outcomes focus on a single group of healthcare professionals within a single healthcare setting. A recent systematic review highlights very few robust interventions that specifically aim to improve communication across services. However the importance of promoting interagency working and improving information flow between services is continually highlighted as a key priority.Methods: Using a novel codesign and experience based approach we worked with a multistakeholder group to develop possible solutions to reduce the adverse outcomes commonly associated with discharge from acute mental health services. This utilized a modified Nominal Group Technique and creative problem solving method to follow a fourstage process: Problem Identification, Solution Generation, Decision-Making, Prioritization and Implementation. Thirty-two healthcare professionals and an expert by lived experienced engaged with the process that took place over two stakeholder events.Results: Stakeholders at the first event identified and agreed upon 24 potential ideas to improve discharge from acute mental health services. These were refined at the second event to four elements of an interagency intervention: a multiagency 'Discharge Team' (with designated discharge coordinator), inclusive technology enabled team meetings, universal documentation and a patient generated discharge plan.Conclusion: This is the first study to codesign an interagency mental health discharge intervention based around a discharge team. We developed a model for working that places a greater focus on a patient generated discharge plan, interagency working, and Frontiers in Psychiatry | www.frontiersin.org

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“…There were some interventions included in the review that did not fit within the aforementioned primary categories, these groups had 3 or fewer studies, see table 2. These were categorised as pharmacy interventions [11,12] (medications focused interventions led by pharmacists), needsorientated discharge planning [44,49] (discharge planning interventions led by the needs of individuals), intervention to prevent homelessness (an intervention developed by Forchuk et al [10,50] focused only on homeless individuals), transitional care model (a nurse-based in home initiative) [51,52], whole care pathway initiatives [53,54] (that consider multiple agencies in the care pathway) and multi-component models [55][56][57] (using multiple interventions simultaneously). Despite studies reporting on these interventions they tended to be single instances and do not provide sufficient evidence for narrative synthesis on a categorical level.…”

Section: Other Interventionsmentioning

confidence: 99%

“…The most common challenge that the interventions aimed to solve was readmission to an acute ward within a given short-term period, sometimes indicative of shortcomings in service provision [6,18,53,54,[58][59][60][61][62]25,26,28,33,36,38,40,41]. Whilst some studies found evidence for a reduction in readmission due to the interventions [26,28,40], many failed to evidence this effect [6,33,36].…”

Section: Reducing Readmissionmentioning

confidence: 99%

“…The studies that had an effect on readmission tended to focus on either education, therapeutic relationships or increased continuity of care [28,63,64]. Many of the successful interventions bridged the boundaries between ward and community by providing care from ward based professionals in the community [28,54] or having community teams leading discharge planning on the wards [40].…”

Section: Reducing Readmissionmentioning

confidence: 99%

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Interventions to Improve Discharge from Acute Adult Mental Health Inpatient Care to the Community: Systematic Review and Narrative Synthesis

Wright

Waring

2019

Preprint

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Background: The transition from acute mental health inpatient care to community care is often a vulnerable period in the pathway, where people can experience additional risks and anxiety. Researchers globally have developed and tested a number of interventions that aim to improve continuity of care and safety in the transitions. However, there has been little attempt to compare and contrast the interventions and specify the variety of safety threats they attempt to resolve. Methods: The study aimed to identify the evidence base for interventions to support continuity of care and safety in the transition from acute mental health inpatient service to community care services at the point of discharge. Electronic Databases including PsycINFO, MEDLINE, Embase, HMIC, CINAHL, IBSS, Cochrane Library Trials, ASSIA, Web of Science and Scopus, were searched between 2000 and May 2018. Peer reviewed papers were eligible for inclusion if they addressed adults admitted to an acute inpatient mental health ward and reported on health interventions surrounding discharge from the acute ward to the community. The results were analysed using a narrative synthesis technique. Results: The total number of papers from which data was extracted was 45. The review found various interventions implemented across continents, addressing problems related to different aspects of discharge. Some interventions followed a distinct named approach (i.e. Critical Time Intervention, Transitional Discharge Model) others were grouped based on key components (i.e. peer support, pharmacist involvement). The primary problems interventions looked to address were reducing readmission, improving wellbeing, reducing homelessness, improving treatment adherence, accelerating discharge, reducing suicide. The 69 outcomes reported across studies were heterogeneous, meaning it was difficult to conduct comparative quantitative meta-analysis or synthesis. Conclusions: The interventions reviewed are spread across a spectrum ranging from addressing a single problem within a single agency with a single solution, to multiple solutions addressing multi-agency problems. We recommend that future research attempts to improve homogeneity in outcome reporting.

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A pilot study of the “Continuation of Care” model in “revolving-door” patients

Abstract: COC via inpatient follow-up significantly reduces the number and length of hospitalizations in "revolving door" psychiatric patients as compared to the traditional system of follow-up in an outpatient clinic.

Cited by 18 publications

References 20 publications

Overview of post-discharge predictors for psychiatric re-hospitalisations: a systematic review of the literature

Overview of post-discharge predictors for psychiatric re-hospitalisations: a systematic review of the literature

Codesigning a Mental Health Discharge and Transitions of Care Intervention: A Modified Nominal Group Technique

Interventions to Improve Discharge from Acute Adult Mental Health Inpatient Care to the Community: Systematic Review and Narrative Synthesis

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