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1 – 10 of over 3000
Article
Publication date: 2 November 2021

Yuan Ying Lee, Lay Hwa Tiew, Yee Kian Tay and John Chee Meng Wong

Transitional care is increasingly important in reducing readmission rates and length of stay (LOS). Singapore is focusing on transitional care to address the evolving care…

Abstract

Purpose

Transitional care is increasingly important in reducing readmission rates and length of stay (LOS). Singapore is focusing on transitional care to address the evolving care needs of a multi-morbid ageing population. This study aims to investigate the impact of transitional care programs (TCPs) on acute healthcare utilization.

Design/methodology/approach

A retrospective, longitudinal, interventional study was conducted. High-risk patients were enrolled into a transitional care program of local tertiary hospital. Patients received either telephone follow-up (TFU) or home-based intervention (HBI) with TFU. Readmission rates and LOS were assessed for both groups.

Findings

There was no statistically significant difference in readmissions or LOS between TFU and HBI. After excluding demised patients, TFU had statistically significant lower LOS than HBI. Both interventions demonstrated statistically significant reductions in readmissions and LOS in pre–post analyses.

Research limitations/implications

TFU may be more effective than HBI in patients with lower clinical severity, despite both interventions showing statistically significant reductions in acute healthcare utilization. Study findings may be used to inform transitional care practices. Future studies should continue to examine the comparative effectiveness of transitional care interventions and the patient populations most likely to benefit.

Originality/value

Previous studies demonstrated promising outcomes for TFU and HBIs, but few have evaluated their comparative effectiveness on acute healthcare utilization and specific patient populations most likely to benefit. This study evaluated interventional effectiveness of both, which might be useful for informing allocation of resources based on clinical complexity and care needs.

Details

Journal of Integrated Care, vol. 29 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 11 March 2019

Oguchi Nkwocha

Measures are important to healthcare outcomes. Outcome changes result from deliberate selective intervention introduction on a measure. If measures can be characterized…

Abstract

Purpose

Measures are important to healthcare outcomes. Outcome changes result from deliberate selective intervention introduction on a measure. If measures can be characterized and categorized, then the resulting schema may be generalized and utilized as a framework for uniquely identifying, packaging and comparing different interventions and probing target systems to facilitate selecting the most appropriate intervention for maximum desired outcomes. Measure characterization was accomplished with multi-axial statistical analysis and measure categorization by logical tabulation. The measure of interest is a key provider productivity index: “patient visits per hour,” while the specific intervention is “patient schedule manipulation by overbooking.” The paper aims to discuss these issues.

Design/methodology/approach

For statistical analysis, interrupted time series (ITS), robust-ITS and outlier detection models were applied to an 18-month data set that included patient visits per hour and intervention introduction time. A statistically significant change-point was determined, resulting in pre-intervention, transitional and post-effect segmentation. Linear regression modeling was used to analyze pre-intervention and post-effect mean change while a triangle was used to analyze the transitional state. For categorization, an “intervention moments” table was constructed from the analysis results with: time-to-effect, pre- and post-mean change magnitude and velocity; pre- and post-correlation and variance; and effect decay/doubling time. The table included transitional parameters such as transition velocity and transition footprint visualization represented as a triangle.

Findings

The intervention produced a significant change. The pre-intervention and post-effect means for patient visits per hour were statistically different (0.38, p=0.0001). The pre- and post-variance change (0.23, p=0.01) was statistically significant (variance was higher post-intervention, which was undesirable). Post-intervention correlation was higher (desirable). Decay time for the effect was calculated as 11 months post-effect. Time-to-effect was four months; mean change velocity was +0.094 visits per h/month. A transition triangular footprint was produced, yielding 0.35 visits per hr/month transition velocity. Using these results, the intervention was fully profiled and thereby categorized as an intervention moments table.

Research limitations/implications

One limitation is sample size for this time series, 18 monthly cycles’ analysis. However, interventions on measures in healthcare demand short time cycles (hence necessarily yielding fewer data points) for practicality, meaningfulness and usefulness. Despite this shortcoming, the statistical processes applied such as outliers detection, t-test for mean difference, F-test for variances and modeling, all consider the small sample sizes. Seasonality, which usually affects time series, was not detected and even if present, was also considered by modeling.

Practical implications

Obtaining an intervention profile, made possible by multidimensional analysis, allows interventions to be uniquely classified and categorized, enabling informed, comparative and appropriate selective deployment against health measures, thus potentially contributing to outcomes optimization.

Social implications

The inevitable direction for healthcare is heavy investment in measures outcomes optimization to improve: patient experience; population health; and reduce costs. Interventions are the tools that change outcomes. Creative modeling and applying novel methods for intervention analysis are necessary if healthcare is to achieve this goal. Analytical methods should categorize and rank interventions; probe the measures to improve future selection and adoption; reveal the organic systems’ strengths and shortcomings implementing the interventions for fine-tuning for better performance.

Originality/value

An “intervention moments table” is proposed, created from a multi-axial statistical intervention analysis for organizing, classifying and categorizing interventions. The analysis-set was expanded with additional parameters such as time-to-effect, mean change velocity and effect decay time/doubling time, including transition zone analysis, which produced a unique transitional footprint; and transition velocity. The “intervention moments” should facilitate intervention cross-comparisons, intervention selection and optimal intervention deployment for best outcomes optimization.

Details

International Journal of Health Care Quality Assurance, vol. 32 no. 2
Type: Research Article
ISSN: 0952-6862

Keywords

Abstract

Purpose

To identify transitional palliative care (TPC) interventions for older adults with non-malignant chronic diseases and complex conditions.

Design/methodology/approach

A systematic review of the literature was conducted. CINAHL, Cochrane Library, Embase and Pubmed databases were searched for studies reporting TPC interventions for older adults, published between 2002 and 2019. The Crowe Critical Appraisal Tool was used for quality appraisal.

Findings

A total of six studies were included. Outcomes related to TPC interventions were grouped into three categories: healthcare system-related outcomes (rehospitalisation, length of stay [LOS] and emergency department [ED] visits), patient-related outcomes and family/carer important outcomes. Overall, TPC interventions were associated with lower readmission rates and LOS, improved quality of life and better decision-making concerning hospice care among families. Outcomes for ED visits were unclear.

Research limitations/implications

Positive outcomes related to healthcare services (including readmissions and LOS), patients (quality of life) and families (decision-making) were reported. However, the number of studies supporting the evidence were limited.

Originality/value

Studies examining the effectiveness of existing care models to support transitions for those in need of palliative care are limited. This systematic literature review identified and appraised interventions aimed at improving transitions to palliative care in older adults with advanced non-malignant diseases or frailty.

Details

Journal of Integrated Care, vol. 28 no. 4
Type: Research Article
ISSN: 1476-9018

Keywords

Article
Publication date: 9 March 2015

Christopher Alan Griffiths, Samira Heinkel and Bohdana Dock

The purpose of this paper is to evaluate the impact on recovery and personal goal attainment of a transition intervention service for return to the community following…

Abstract

Purpose

The purpose of this paper is to evaluate the impact on recovery and personal goal attainment of a transition intervention service for return to the community following exit from an alternative to psychiatric inpatient admission – a residential recovery house. The services seek to facilitate community reintegration, promote recovery and prevent future mental health crisis. The service was funded by the Stone Family Foundation.

Design/methodology/approach

This evaluation employed a within groups design: a single case evaluation follow-up. Analysis of Recovery Star and personal goal achievement data collected at service entry and exit points during routine practice (n=181), at four sites in England. The adults had mental illness diagnoses including depression, schizophrenia, bipolar disorder, personality disorder, and anxiety disorder.

Findings

There was a significant increase in overall Recovery Star scores with a large effect size, and significant increases in eight of the ten Recovery Star life domains. There were significant increases in the goal scores linked to “Managing mental health”, “Self-care” and “Living skills”.

Practical implications

A transitional intervention service provided by the third sector for return to community following mental health crisis may contribute to recovery and personal goal achievement. A randomised control trial of this transition intervention service is recommended.

Originality/value

This is first outcome evaluation of an alternative to psychiatric inpatient admission transition intervention service and findings indicate the potential positive effect of having this service incorporated into the design of alternative to admission provision.

Details

The Journal of Mental Health Training, Education and Practice, vol. 10 no. 1
Type: Research Article
ISSN: 1755-6228

Keywords

Article
Publication date: 31 October 2018

Radames Carlo Jr and Rocky J. Dwyer

The purpose of this paper is to examine the difference in attaining and maintaining employment between transition age youth (ages 19–22) with emotional and behavioral…

Abstract

Purpose

The purpose of this paper is to examine the difference in attaining and maintaining employment between transition age youth (ages 19–22) with emotional and behavioral disorders (EBDs) completing and not completing vocational training.

Design/methodology/approach

A quantitative causal-comparative research design using existing data extracted from the National Longitudinal Transitional Study-2 (NLTS-2) via a restricted data use license issued by the National Center Special Education Research, Institution of Education Sciences, US Department of Education. One-way ANCOVA and multiple regression analysis with one independent variable and six control variables were used for the study.

Findings

The results showed there is a significant difference in employment status between transition age youth with EBDs completing vocational training as compared to non-completion of vocational training, controlling for gender, race, age, mental health services, academic achievement and prior work experience. Individuals who completed vocational training are more likely employed after two years, than those who had not completed vocational training.

Originality/value

The outcomes of the study showed that vocational training during the transitional period had a positive impact on outcomes such as employment status, participation in job skills programs and perceived preparedness for employment. These findings support the idea that vocational training during the secondary school period is an effective way to scaffold support for the transitional period. As a result, these findings justify the use of vocational training as part of the transitional preparation for students with emotional and behavioral disorders.

Details

The Journal of Mental Health Training, Education and Practice, vol. 13 no. 6
Type: Research Article
ISSN: 1755-6228

Keywords

Article
Publication date: 1 January 2004

Tsang‐Sing Chan, Geng Cui and Geng Cui

Burgeoning consumerism in transitional economies has significant implications for both multinational corporations and local companies. Based on a survey of four cities in…

5444

Abstract

Burgeoning consumerism in transitional economies has significant implications for both multinational corporations and local companies. Based on a survey of four cities in mainland China, this research examines consumer attitudes toward marketing, and compares the findings with those of previous studies of other economies. The results suggest that consumers in mainland China are less critical of marketing than their counterparts in advanced economies. Furthermore, consumer attitudes toward marketing, beliefs about business, and their interactions have significant effects on consumer satisfaction. The implications for marketing operations in transitional economies and avenues for future research are explored.

Details

Journal of Consumer Marketing, vol. 21 no. 1
Type: Research Article
ISSN: 0736-3761

Keywords

Article
Publication date: 9 September 2011

Yu Honghai, Xu Longbing and Chen Baizhu

The purpose of this paper is to study the capital structure of firms when controlling shareholders decide on the level of debt financing in an environment with poor legal…

1915

Abstract

Purpose

The purpose of this paper is to study the capital structure of firms when controlling shareholders decide on the level of debt financing in an environment with poor legal protection.

Design/methodology/approach

Theoretically this paper uses a dynamic model to analyze how the controlling shareholder expropriates the firm's benefit through debt financing. Empirically this paper uses a sample of Chinese publicly listed firms from 2004 to 2007, through the method of OLS and panel data, to verify the theoretical predictions.

Findings

Theoretically this paper finds that firms with controlling shareholders will take excess debt financing in an environment of controlled interest rate and poor legal protection to minority shareholders. Government intervention exacerbates while controlling shareholder's cash flow rights constrains excess debt financing. The empirical results conclude that the improvement of the legal environment, limiting government intervention, and raising controlling shareholder's cash flow rights will effectively reduce excess debt level, as well as long‐term debt ratio.

Originality/value

First, this paper provides a theoretical model to explain the mechanism of how the ownership structure, legal environment and government intervention interact to impact debt financing. This result also provides a theory to explain the “paradox” in a transitional economy that better legal protection lowers debt level and long‐term debt ratio. Second, this paper provides further evidence on controlling shareholder's expropriation to minority shareholder through debt financing.

Details

China Finance Review International, vol. 1 no. 4
Type: Research Article
ISSN: 2044-1398

Keywords

Book part
Publication date: 18 January 2022

Nadia Bhuiyan, Margaret Young and Daniel J. Svyantek

Over one million individuals diagnosed with autism spectrum disorder (ASD) will be entering adulthood and attempting to cultivate fulfilling, meaningful life experiences…

Abstract

Over one million individuals diagnosed with autism spectrum disorder (ASD) will be entering adulthood and attempting to cultivate fulfilling, meaningful life experiences. These young adults with ASD represent Generation A. The workplace will be a major element in cultivating fulfilling lives for Generation A. Social interaction is an integral component for functioning within most postsecondary and occupational settings. It is necessary to understand the interaction between autistic adults and organizations to understand potential social and behavioral deficits. The workplace is inherently a social place. Understanding both formal and informal social information in the workplace may be critical to successful job performance. Fit, particularly person–organization fit, is used to address this social nature of the workplace. Understanding this interaction helps provide a means for crafting both individual and organizational interventions which support autistic adults in the workplace. This chapter provides an analysis of interventions that support those with ASD in the workplace. It is proposed that these interventions will help create a more supportive work environment for those with ASD. As important, it is proposed that the accommodations for those with ASD are reasonable for any organization seeking to improve both satisfaction and performance for all its employees. By addressing these issues, organizations have the potential to create a more satisfying workplace for all workers, not just those in Generation A.

Article
Publication date: 15 February 2016

Hattie Catherine Ann Moyes, Joshua James Heath and Lucy Victoria Dean

The purpose of this paper is to review the literature on offenders with a dual diagnosis and discuss how prison-based services can improve to better meet the needs of…

Abstract

Purpose

The purpose of this paper is to review the literature on offenders with a dual diagnosis and discuss how prison-based services can improve to better meet the needs of prisoners with co-occurring substance misuse and mental health disorders.

Design/methodology/approach

A comprehensive literature search of PsycINFO, JSTOR, PubMed and Google Scholar, reviewing international studies on dual diagnosis amongst offender and community samples spanning the last three decades, supplemented by international policy, guidance papers and reports was conducted to explore how services can be improved.

Findings

It was found that research into dual diagnosis amongst prisoners internationally was scarce. However, from the evidence available, several consistent factors emerged that led to the following recommendations: integrated treatment needs to be coordinated and holistic, staged and gender-responsive; increased availability of “low level”, flexible interventions; transitional support and continuity of care upon release with the utilisation of peer mentors; comprehensive assessments in conducive settings; mandatory dual diagnosis training for staff; and increased funding for female/gender-responsive services.

Practical implications

The recommendations can inform commissioners, funders and service providers of areas where support must be improved to address the needs of prisoners with a dual diagnosis.

Social implications

Improved outcomes for prisoners with a dual diagnosis would likely have a positive effect on society, with improvements in mental health and substance misuse treatment impacting on rates of reoffending.

Originality/value

This paper brings originality and value to the sector because it reviews relevant research on dual diagnosis and translates it into practical implications for policy makers.

Details

Advances in Dual Diagnosis, vol. 9 no. 1
Type: Research Article
ISSN: 1757-0972

Keywords

Article
Publication date: 21 September 2015

Lynn Stewart and Renée Gobeil

A Rapid Evidence Assessment (REA) determined the effectiveness of correctional programmes for women offenders and examined features of programmes providing the strongest…

Abstract

Purpose

A Rapid Evidence Assessment (REA) determined the effectiveness of correctional programmes for women offenders and examined features of programmes providing the strongest outcomes. The paper aims to discuss these issues.

Design/methodology/approach

Electronic databases and web sites were reviewed to identify literature focused on interventions with female offenders published since 2006, the end point of the last REA conducted in the area. The following retention criteria were applied: participants were over age 18; sample included women and results are reported separately for women; study included an appropriate comparison group; study included recidivism as an outcome measure. Studies’ methodological design quality was assessed using the Maryland Scientific Methods Scale.

Findings

In total, one meta-analysis and 22 studies reflecting 17 unique samples, published from 2006 to December 2014, were identified. Overall, the best evidence suggests that the following programmes and approaches have an evidence base: first, substance abuse treatment, in particular in-custody or hierarchical therapeutic community programmes; second, gender-responsive programmes that emphasize existing strengths and competencies, as well as skills acquisition; and third, following in-custody programme treatment with participation in community follow-up sessions. There is also promising evidence for the use of community opioid maintenance among heroin addicted women.

Originality/value

This review demonstrated that since 2006 the number of high-quality research studies assessing women’s correctional outcomes has grown considerably. The results provide guidance to programme designers and administrators on programmes for women offenders likely to be effective in promoting public safety goals and offender reintegration.

Details

Journal of Criminological Research, Policy and Practice, vol. 1 no. 3
Type: Research Article
ISSN: 2056-3841

Keywords

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