The Integrated Comprehensive Care Program: A Novel Home Care Initiative After Major Thoracic Surgery

Shargall, Yaron; Hanna, Waël C.; Schneider, Laura; Schieman, Colin; Finley, Christian; Tran, Anna; Demay, Shantel; Gosse, Carolyn; Bowen, James M.; Blackhouse, Gord; Smith, Kevin

doi:10.1053/j.semtcvs.2015.12.003

Cited by 15 publications

(21 citation statements)

References 22 publications

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“…Though none of the results regarding the ICC program in either stream would indicate worse outcomes with the ICC program, added benefits provided by the ICC program seem to differ between streams. For example, within the COPD stream, benefits with the ICC program were generally observed within the index hospitalization ( Table 3 ), whereas benefits provided within the thoracic surgery stream tended to be in the postdischarge phase [ 9 ]. Continued assessment of the performance of the ICC program within these two streams is required to better comprehend if these results reflect true differences regarding the performance of the ICC program at SJHH (i.e., that ICC program provides benefits solely within the index hospitalization within the COPD stream and only within the postdischarge phase within the thoracic surgery stream) or if both studies lacked statistical power to detect a statistically significant result in both phases.…”

Section: Discussionmentioning

confidence: 99%

“…A previous evaluation of the ICC program within the thoracic surgery clinical stream at SJHH showed that, despite having minimal impact within the initial hospitalization, the ICC program was associated with lower proportions of emergency department visits and hospitalization in the postdischarge phase and with a tendency to reduce overall costs [ 9 ]. However, it is unknown if these results apply to different populations.…”

Section: Introductionmentioning

confidence: 99%

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Preliminary Results of the Adoption and Application of the Integrated Comprehensive Care Bundle Care Program When Treating Patients with Chronic Obstructive Pulmonary Disease

Guertin

Bowen

Gosse

et al. 2017

Canadian Respiratory Journal

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Background St. Joseph's Health System has implemented an integrated comprehensive care bundle care (ICC) program with the hopes that it would improve patients' care while reducing overall costs. The aim of this analysis was to evaluate the performance of the ICC program within patients admitted with chronic pulmonary obstructive disease (COPD). Methods We conducted a retrospective observational cohort study comparing ICC patients to non-ICC patients admitted to St. Joseph's Healthcare Hamilton for COPD being discharged with support services between June 2012 and March 2015, using administrative data. Confounding adjustment was achieved through the use of propensity score matching. Medical resource utilizations during the initial hospitalization and within the 60 days following discharge were compared using regression models. Results All 76 patients who entered the ICC program (100.0%) were matched 1 : 1 to 76 eligible non-ICC patients (28.4%). Length of stay (6.47 [7.29] versus 9.55 [10.21] days) and resource intensity weights (1.16 [0.80] versus 1.64 [1.69]) were lower in the ICC group within the initial hospitalization but, while favoring the ICC program, healthcare resource use tended not to differ statistically following discharge. Interpretation The ICC program was able to reduce initial medical resource utilization without increasing subsequent medical resource use.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preliminary Results of the Adoption and Application of the Integrated Comprehensive Care Bundle Care Program When Treating Patients with Chronic Obstructive Pulmonary Disease

Guertin

Bowen

Gosse

et al. 2017

Canadian Respiratory Journal

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“…In total, 54 studies, reported in 55 articles, met the inclusion criteria. 57,58,67,71,74,[81][82][83][84]86,91,96,97,100,[104][105][106]109,110,112,115,116,[119][120][121]123,125,131,133,134,145,146,151,159,162,166,179,183,184,186,210,211,215,[222][223][224]232,244,256,257,…”

Section: Study Selectionmentioning

confidence: 99%

Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review

Nunns

Shaw

Briscoe

et al. 2019

Health Serv Deliv Res

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Background Elective older adult inpatient admissions are increasingly common. Older adults are at an elevated risk of adverse events in hospital, potentially increasing with lengthier hospital stay. Hospital-led organisational strategies may optimise hospital stay for elective older adult inpatients. Objectives To evaluate the effectiveness and cost-effectiveness of hospital-led multicomponent interventions to reduce hospital stay for older adults undergoing elective hospital admissions. Data sources Seven bibliographic databases (MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Health Management Information Consortium, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature and Allied and Complementary Medicine Database) were searched from inception to date of search (August 2017), alongside carrying out of web searches, citation searching, inspecting relevant reviews, consulting stakeholders and contacting authors. This search was duplicated, with an additional cost-filter, to identify cost-effectiveness evidence. Review methods Comparative studies were sought that evaluated the effectiveness or cost-effectiveness of relevant interventions in elective inpatients with a mean or median age of ≥ 60 years. Study selection, data extraction and quality assessment were completed independently by two reviewers. The main outcome was length of stay, but all outcomes were considered. Studies were sorted by procedure, intervention and outcome categories. Where possible, standardised mean differences or odds ratios were calculated. Meta-analysis was performed when multiple randomised controlled trials had the same intervention, treatment procedure, comparator and outcome. Findings were explored using narrative synthesis. Findings A total of 218 articles were included, with 80 articles from 73 effectiveness studies (n = 26,365 patients) prioritised for synthesis, including 34 randomised controlled trials conducted outside the UK and 39 studies from the UK, of which 12 were randomised controlled trials. Fifteen studies included cost-effectiveness data. The evidence was dominated by enhanced recovery protocols and prehabilitation, implemented to improve recovery from either colorectal surgery or lower limb arthroplasty. Six other surgical categories and four other intervention types were identified. Meta-analysis found that enhanced recovery protocols were associated with 1.5 days’ reduction in hospital stay among patients undergoing colorectal surgery (Cohen’s d = –0.51, 95% confidence interval –0.78 to –0.24; p < 0.001) and with 5 days’ reduction among those undergoing upper abdominal surgery (Cohen’s d = –1.04, 95% confidence interval –1.55 to –0.53; p < 0.001). Evidence from the UK was not pooled (owing to mixed study designs), but it echoed findings from the international literature. Length of stay usually was reduced with intervention or was no different. Other clinical outcomes also improved or were no worse with intervention. Patient-reported outcomes were not frequently reported. Cost and cost-effectiveness evidence came from 15 highly heterogeneous studies and was less conclusive. Limitations Studies were usually of moderate or weak quality. Some intervention or treatment types were under-reported or absent. The reporting of variance data often precluded secondary analysis. Conclusions Enhanced recovery and prehabilitation interventions were associated with reduced hospital stay without detriment to other clinical outcomes, particularly for patients undergoing colorectal surgery, lower limb arthroplasty or upper abdominal surgery. The impacts on patient-reported outcomes, health-care costs or additional service use are not well known. Future work Further studies evaluating of the effectiveness of new enhanced recovery pathways are not required in colorectal surgery or lower limb arthroplasty. However, the applicability of these pathways to other procedures is uncertain. Future studies should evaluate the implementation of interventions to reduce service variation, in-hospital patient-reported outcomes, impacts on health and social care service use, and longer-term patient-reported outcomes. Study registration This study is registered as PROSPERO CRD42017080637. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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“…Therefore, enhanced recovery protocols, as well as the growing emphases on readmission, must force the thoracic surgical community to reexamine the transition from inpatient to outpatient settings, and to actively pursue ways to address patients' postdischarge needs. Shargall and colleagues [30] have shown that an intensive home health care program after thoracic surgery significantly reduced costs and readmissions compared with a historical control. That is especially important in thoracic oncology, as readmission after pulmonary resection is associated with delayed time to adjuvant chemotherapy and a 14.4% risk of mortality at 90 days compared with 2.5% for patients who are not readmitted [29,31].…”

Section: Commentmentioning

confidence: 99%

Results of Postdischarge Nursing Telephone Assessments: Persistent Symptoms Common Among Pulmonary Resection Patients

Antonoff

Ragalie

Correa

et al. 2016

The Annals of Thoracic Surgery

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Patient complaints after pulmonary resection were frequent, with most problems resolved by telephone counseling. Despite highly prevalent concerns, predictors of need for counseling or care escalation were not identified, suggesting ongoing utility in the practice of telephoning all patients. Further, this study serves as a needs assessment, highlighting the importance of patient education and discharge planning.

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The Integrated Comprehensive Care Program: A Novel Home Care Initiative After Major Thoracic Surgery

Cited by 15 publications

References 22 publications

Preliminary Results of the Adoption and Application of the Integrated Comprehensive Care Bundle Care Program When Treating Patients with Chronic Obstructive Pulmonary Disease

Preliminary Results of the Adoption and Application of the Integrated Comprehensive Care Bundle Care Program When Treating Patients with Chronic Obstructive Pulmonary Disease

Multicomponent hospital-led interventions to reduce hospital stay for older adults following elective surgery: a systematic review

Results of Postdischarge Nursing Telephone Assessments: Persistent Symptoms Common Among Pulmonary Resection Patients

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