Framed messages effects on readmissions

Abstract

Objective: As the eighth leading cause of death in the US, pneumonia (PN) is relevant to the health of the elderly and young. Accountability for readmission is part of the Affordable Care Act's Hospital Readmissions Reduction Program (RRP), which levies penalties for readmissions. We examined communication using framing effects which can motivate patients' decisions collaboratively with providers for post discharge care and readmissions prevention. Communication strategies (CS) can facilitate decision-making (DM) about health care choices. The project's aims were to (1) compare CS of framing effects (positive or negative messages) on the readmission outcome 30 days post discharge; (2) assess PN readmissions decrease 30 days post discharge when CS include the patient/family in decisions about transitions; (3) determine the impact of between patients and HCPs agreement for post hospital care, and (4) examine confounding effects between framing effects and readmission rates of age, PN severity index (PSI), and the number of diagnoses. Methods: A double-blind randomized control trial (RCT) used parallel assignment of 153 PN patients to one of three arms to test the communication framing effects using power analysis, odds ratio, Fischer's exact and ANOVA. Arm A was the Intervention positive framing group (n = 44), arm B was the Intervention Negative framing group (n = 65), and arm C was the control group (n = 44). Conclusions: Findings suggest that framed messages aid in the reduction of PN readmission rates in hospitals. DM strategies incorporates education and understanding of risk by the patient, so the healthcare teams can encourage and improve readmission outcomes.

Why Mental Status Standards are Recommended on Medical Surgical Units in Hospitals?

“…In the study, 766 patients were screened, with 156 eligible and enrolled, resulting in allocation N =156 [2]. Our study's admitting diagnoses were: types of pneumonia, rule out (r/o) pneumonia, or sepsis with pneumonia N =156 or 20.21% of 766 patients screened were enrolled.…”

“…Patients diagnosed with pneumonia are at higher risk for temporary cognitive changes due to the severity of the disease [6]. Following strict criteria, subjects whom were unable to consent to participate in the study and/or if they had altered mental status secondary to dementia or found to have cognitive changes affecting their judgment as reflected in the medical record were excluded [2].…”

“…MMSE was developed in 1975 and is a tool often used to screen study subjects for dementia [2,12]. The MMSE tool had 5 questions and 11 criteria to calculate mental challenges with a potential highest score of 30.…”

“…The MMSE tool had 5 questions and 11 criteria to calculate mental challenges with a potential highest score of 30. A score of 30-29 indicates the person is cognitively normal, 28-26 indicates the person has borderline cognition and a score of 25 or lower indicates there is a memory issue [2], The MMSE according to Naylor and Bowles, 2005 [11], measures executive functions, memory, conceptual thinking, and language. Transition research made it a good tool and was recommended as an option in daily practice [11,13].…”

“…Identification by questions found from research findings and nurse's experience can contribute and suggest new standards with an aim to promote best practice performance [1]. A recent double blinded randomized control research study demonstrated that altered mental status (AMS) is inconsistently measured by hospital registered nurses (RNs) [2]. This discovery demonstrated that nurses caring for patients on medical surgical units had misconceived the patient's cognitive function, by asserting patients were cognitively eligible for decision making.…”