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Background
Roughly one-third of all abortions in Canada are subsequent abortions. However, few published reports showcase women's voices or explore women's experiences on this topic. Our study aimed to understand better the ways that women who have had multiple abortions talk about and view those experiences.Methods
Between 2012 and 2016, we conducted in-depth interviews with 41 Canadian women who had a total of 87 abortions in the 5 years preceding the interviews. We audio-recorded and transcribed all English- and French-language interviews and analyzed our data for content and themes using a multiphased iterative approach and inductive and deductive techniques.Results
Women described their abortion experiences as unique life events, even in cases when the overarching circumstances surrounding the pregnancies were similar. Participants recalled multiple factors that influenced their decisions to terminate, including their relationship status; level of support from family and friends; financial situation; health status; previous reproductive health, pregnancy, and abortion experiences; and desire to parent. In general, a previous abortion demystified the abortion process but did not play a significant role in decision making. Women described intensified feelings of shame and both internalized and externalized stigma surrounding their decision to have more than one abortion. However, the overwhelming majority were confident in their decisions.Conclusions
The often-used phase “repeat abortion” fails to capture women's experiences and the complex decision making surrounding each pregnancy. Efforts to reframe the narrative of multiple abortions, including among health care providers, could help reduce the amplified stigma associated with having more than one lifetime abortion. 相似文献3.
Objective
To compare long-acting reversible contraceptive (LARC) uptake before and after the Affordable Care Act (ACA) contraceptive mandate among women undergoing a first trimester surgical abortion.Study Design
We conducted a retrospective chart review of 867 women undergoing a first trimester surgical abortion at an academic gynecology practice between December 2010 and December 2014 (excluding August to December 2012) to evaluate intrauterine device and contraceptive implant uptake before and after the ACA contraceptive mandate.Results
Before the ACA contraceptive mandate, 79% of privately insured women (213 of 271) had full LARC coverage (no out-of-pocket costs) compared with 92% (298 of 324) after the mandate (p < .001). We found no difference in postabortal LARC uptake before and after the ACA in women with private insurance, Medicaid, or overall. Among all women, 46% chose a postabortal LARC method before the mandate as compared with 48% after the mandate (p = .63). Among privately insured women, 45% used a postabortal LARC method before the mandate as compared with 50% after the mandate (p = .25). One-half of privately insured women (268 of 534) with full or partial LARC coverage used a postabortal LARC method compared with 32% of privately insured women (18 of 56) with no LARC coverage after implementation of the ACA contraceptive mandate (p = .01).Conclusions
Despite the significant increase in full coverage of LARC among privately insured women, there was no change in postabortal LARC use after the ACA. However, privately insured women with full or partial LARC coverage were more likely to use a postabortal LARC method compared with privately insured women with no LARC coverage after the implementation of the ACA contraceptive mandate. 相似文献4.
Julie Chor Sarah Garcia-Ricketts Danielle Young Luciana E. Hebert Lee A. Hasselbacher Melissa L. Gilliam 《Women's health issues》2018,28(5):387-392
Objectives
This study uses the abortion visit as an opportunity to identify women lacking well-woman care (WWC) and explores factors influencing their ability to obtain WWC after implementation of the Affordable Care Act.Methods
We conducted semistructured interviews with low-income women presenting for induced abortion who lacked a well-woman visit in more than 12 months or a regular health care provider. Dimensions explored included 1) pre-abortion experiences seeking WWC, 2) postabortion plans for obtaining WWC, and 3) perceived barriers and facilitators to obtaining WWC. Interviews were transcribed and analyzed using ATLAS.ti.Results
Thirty-four women completed interviews; three-quarters were insured. Women described interacting psychosocial, interpersonal, and structural barriers hindering WWC use. Psychosocial barriers included negative health care experiences, low self-efficacy, and not prioritizing personal health. Women's caregiver roles were the primary interpersonal barrier. Most prominently, structural challenges, including insurance insecurity, disruptions in patient–provider relationships, and logistical issues, were significant barriers. Perceived facilitators included online insurance procurement, care integration, and social support.Conclusions
Despite most being insured, participants encountered WWC barriers after implementation of the Affordable Care Act. Further work is needed to identify and engage women lacking preventive reproductive health care. 相似文献5.
Katy B. Kozhimannil Ifeoma Muoto Blair G. Darney Aaron B. Caughey Jonathan M. Snowden 《Women's health issues》2018,28(3):224-231
Background
In 2011, Oregon implemented a policy that reduced the state's rate of early (before 39 weeks' gestation) elective (without medical need) births.Objective
This analysis measured differential policy effects by race, examining whether Oregon's policy was associated with changes in non-Hispanic Black–White disparities in early elective cesarean and labor induction.Methods
We used Oregon birth certificate data, defining prepolicy (2008–2010) and postpolicy (2012–2014) periods, including non-Hispanic Black and White women who gave birth during these periods (n = 121,272). We used longitudinal spline models to assess policy impacts by race and probability models to measure policy-associated changes in Black–White disparities.Results
We found that the prepolicy Black–White differences in early elective cesarean (6.1% vs. 4.3%) were eliminated after policy implementation (2.8% vs. 2.5%); adjusted models show decreases in the odds of elective early cesarean among Black women after the policy change (adjusted odds ratio, 0.47; 95% confidence interval, 0.22–1.00; p = .050) and among White women (adjusted odds ratio, 0.79; 95% confidence interval, 0.67–0.93; p = .006). Adjusted probability models indicated that policy implementation resulted in a 1.75-percentage point narrowing (p = .011) in the Black–White disparity in early elective cesarean. Early elective induction also decreased, from 4.9% and 4.7% for non-Hispanic Black and non-Hispanic White women to 3.8% and 2.5%, respectively; the policy was not associated with a statistically significant change in disparities.Conclusions
A statewide policy reduced racial disparities in early elective cesarean, but not early elective induction. Attention to differential policy effects by race may reveal changes in disparities, even when that is not the intended focus of the policy. 相似文献6.
Background
Breast cancer is a leading cause of death in the United States. Continuing medical education programs such as the American Board of Internal Medicine's Maintenance of Certification (MOC) program can increase early detection of cancers by educating physicians about the benefits of screening. Did the imposition of American Board of Internal Medicine's MOC requirement affect guideline-compliant mammography screening?Method
To address this question, we took advantage of a natural experiment that occurred when one group of general internists was required to complete MOC by 2001 because they initially certified in 1991 (MOC required) and another group was grandfathered out of this requirement because they initially certified in 1989 (MOC grandfathers). To measure associations with the MOC requirement, we compared mammography screening in the 2 years before and the 3 years after the 2001 MOC requirement among beneficiaries treated by the MOC-required physicians and compared this difference with the same difference in mammography screening among a control group of beneficiaries treated by the MOC-grandfathered physicians.Results
We found that the MOC requirement was associated with a regression adjusted 2.8% increase (p < .001) in annual screening and 1.7% increase (p < .001) in biennial screening. When we limited the sample to beneficiaries with no screening at baseline (1999 and 2000), these figures increased to 8.5% (p = .02) and 6.4% (p = .01), respectively.Conclusions
The MOC requirement was associated with an improvement in guideline-compliant mammography screening with the most pronounced improvements among women who were the least adherent at baseline and therefore might have benefited the most from screening. 相似文献7.
Bradley M. Appelhans Molly A. Martin Marieli Guzman Tamara Olinger Andrew Pleasant Jennifer Cabe Lynda H. Powell 《Journal of nutrition education and behavior》2018,50(1):51-55.e1
Objective
This report describes the development and validation of a technology-based system that integrates data on food choice, nutrition, and plate waste to generate feedback reports summarizing students' dietary intake at school meals.Methods
Cafeteria staff used the system to document the school lunch choices of seventh-graders (n = 37) in an urban charter school for 5 months. Plate waste was assessed by research staff using a visual estimation method that was validated against directly weighed plate waste.Results
Most food choices (97.1%) were correctly recorded through the system. Visual estimates of plate waste had excellent interrater reliability (r's ≥ .94) and agreement with direct measurements (ρ's ≥ .75). Plate waste assessment required approximately 10 s/tray. Fifty-four percent of parents received feedback reports consistently.Conclusions and Implications
The technology-based system enabled staff to monitor dietary intake accurately at school meals. The system could potentially inform lunch menu modifications aimed at reducing plate waste. 相似文献8.
Kriti M. Jain Melissa Davey-Rothwell Norah L. Crossnohere Carl A. Latkin 《Women's health issues》2018,28(3):273-280
Background
Post-traumatic stress disorder (PTSD) prevalence is high, but not well-understood, among women living in urban, impoverished areas. Although previous studies have established social support as an important factor in PTSD development and maintenance, little is known about how perceptions of neighborhood are linked to PTSD. This study examined the relationship between PTSD and social network and neighborhood factors among women with a low socioeconomic status.Methods
We analyzed cross-sectional data collected from a human immunodeficiency virus/sexually transmitted infection peer network study in Baltimore, Maryland (n = 438). We used bivariate analyses to examine the associations between PTSD and social network characteristics and time in neighborhood and satisfaction. We then constructed multivariable regression models that controlled for the following with PTSD: homelessness, cocaine/heroin use, and unemployment.Main Findings
Overall, 30% of women had PTSD symptom severity consistent with a clinical diagnosis. In the multivariable model, dissatisfaction with neighborhood block (odds ratio [OR], 1.80; p = .03) and living in one's neighborhood for more than 5 years (OR, 1.69; p = .03) were associated with PTSD. Social network factors that were significantly associated with PTSD included a higher number of network members in conflict with the participant (OR, 1.28; p = .02), presence of a network member who would let the participant stay with them (OR, 0.4; p = .004), and the number of network members with whom the participant socialized (OR, 0.6; p = .04).Conclusions
In this sample of impoverished urban women with a high prevalence of PTSD, duration of residency, satisfaction with neighborhood, and network characteristics were found to be strongly associated with PTSD symptom severity. 相似文献9.
Barrot H. Lambdin Megan Comfort Alex H. Kral Jennifer Lorvick 《Women's health issues》2018,28(5):470-475
Background
Jail is frequently described as a “revolving door,” which can be profoundly destabilizing to people moving in and out of the system. However, there is a dearth of research attempting to understand the impacts of the accumulation of incarceration events on women who use drugs. We examined the association of the frequency of jail incarceration with hardship, perceived health status, and unmet health care need among women who use drugs.Methods
Our community-based sample included women who use heroin, methamphetamine, crack cocaine, and/or powder cocaine (N = 624) in Oakland, California, from 2012 to 2014. Poisson regression models with robust variances were built to estimate adjusted prevalence ratios between the frequency of jail incarcerations and measures of hardship, perceived health, and unmet health care need, adjusting for a set of a priori specified covariates.Results
We observed associations between high levels of jail frequency and higher levels of homelessness (p = .024), feeling unsafe in their living situation (p = .011), stress (p = .047), fair to poor mental health (p = .034), unmet mental health care need (p = .037), and unmet physical health care need (p = .041). We did not observe an association between jail frequency and unmet subsistence needs score or fair to poor physical health.Conclusions
We observed associations between higher levels of jail frequency and a higher prevalence of hardship, poor mental health, and unmet health care need. Our findings suggest areas for additional research to untangle the impacts of frequent incarceration on women's health and well-being. 相似文献10.
Background
There is evidence that the combination of assistive technology and education increases ability to live and work independently, which in turn increases the quality of life (QOL) levels of adults with disabilities. No previously published treatment-comparison group intervention studies were found with adult farmers and ranchers with disabilities. Knowing how effective USDA's AgrAbility Project is at increasing this population's QOL and independent living and working (ILW) levels will reinforce and inform change in AgrAbility and will provide outcomes for stakeholders and public decision makers to better address agricultural communities' needs.Objectives
To assess whether or not AgrAbility is effective for enhancing QOL and ILW levels of agricultural producers with functional limitations and to assess intervention-comparison group differences.Methods
Intervention group participants (N = 225) included ranchers and farmers from 12 states with various disabilities who participated in AgrAbility. Comparison group participants (N = 100) from 17 states also included farmers and ranchers with various disabilities; they received no on-site visits or other AgrAbility services.Results
In this 10-year, 27-state study, AgrAbility participants reported statistically significant presurvey-postsurvey improvements in QOL levels (mean presurvey = 5.56; mean postsurvey = 7.13) while comparison group participants reported no change in QOL (mean presurvey = 5.10; mean postsurvey = 4.91). AgrAbility group mean ILW scores rose from 2.86 to 3.71 while comparison group mean ILW scores rose slightly from 3.24 to 3.50.Conclusions
These results suggest that AgrAbility was effective as compared with a no-treatment comparison group on improving QOL and ILW levels. 相似文献11.
Eliza Hartley Briony Hill Cate Bailey Matthew Fuller-Tyszkiewicz Helen Skouteris 《Women's health issues》2018,28(6):530-538
Background
Postpartum depression and anxiety are prevalent in the first year after giving birth and can have problematic health outcomes for the mother and infant, although further research is required about the factors that contribute to their development. This study explored the trajectory of depressive and anxiety symptoms across the first postpartum year and their associations with body attitudes, body mass index, and weight retention.Methods
Participants were 467 women recruited during pregnancy via online forums, in parenting magazines, and at baby and children's markets, or from a large tertiary Australian hospital. Participants reported retrospectively on the prepregnancy period and provided data in early pregnancy (Baseline; M = 17.1 weeks pregnant), at 3 months postpartum (T1; M = 13.1 weeks after birth), 6 months postpartum (T2; M = 26.6 weeks after birth), and 12 months postpartum (T3; M = 52.8 weeks after birth).Results
Latent growth curve modelling revealed that, from T1 to T3, depressive symptoms significantly decreased, whereas anxiety symptoms did not change significantly. Demographic factors, weight retention, body mass index, and body attitudes at T1 did not significantly predict the course of depression and anxiety over time; however, greater postpartum weight retention and negative body attitudes at T1 predicted a more severe experience of both depression and anxiety at T3.Conclusions
These findings emphasize the need to assess and monitor the risk factors that can have an adverse impact on postpartum women's psychological health. This finding is particularly important for women deemed to be at risk of problematic body image or weight issues so that health professionals can intervene, and better ensure the health of new mothers in the longer term. 相似文献12.
Hae-Young Kim Ashley Grosso Odette Ky-Zerbo Marcel Lougue Shauna Stahlman Cesaire Samadoulougou Gautier Ouedraogo Seni Kouanda Benjamin Liestman Stefan Baral 《Annals of epidemiology》2018,28(1):13-19
Purpose
The aim of this study is to examine the prevalence and correlates of perceived health care stigma among female sex workers (FSWs) and men who have sex with men (MSM), including other stigma types, suicidal ideation, and participation in social activities.Methods
FSWs (N = 350) and MSM (N = 330) aged ≥18 were recruited in Bobo-Dioulasso, Burkina Faso. Perceived health care stigma was defined as either ever being afraid of or avoiding health care services because someone might find out the participant has sex with men (for MSM) or sells sex (for FSW). Correlates of perceived health care stigma were examined using multivariable logistic regression.Results
The prevalence of perceived health care stigma was 14.9% (52/350) and 24.5% (81/330) in FSWs and MSM, respectively. Among FSWs, experienced or social stigma, including verbal harassment (adjusted odds ratio [aOR] = 3.59, 95% confidence interval [CI] 1.48–8.71), feeling rejected by friends (aOR = 2.30, 95% CI 1.14–4.64), and feeling police refused to protect them (aOR = 2.58, 95% CI 1.27–5.25), was associated with perceived health care stigma. Among MSM, experiencing verbal harassment (aOR = 1.95, 95% CI 1.09–3.50) and feeling scared to walk in public (aOR = 2.93, 95% CI 1.47–5.86) were associated with perceived health care stigma.Conclusions
In these key populations, perceived health care stigma was prevalent and associated with experienced and social stigmas. To increase coverage of effective HIV services, interventions should incorporate approaches to comprehensively mitigate stigma. 相似文献13.
Jill Theresa Messing Michelle Patch Janet Sullivan Wilson Gabor D. Kelen Jacquelyn Campbell 《Women's health issues》2018,28(1):104-111
Purpose
Because identification of intimate partner violence (IPV) in health care settings is low and strangulation increases lethality risk among women experiencing IPV, we examined the prevalence and correlates of nonfatal strangulation among 1,008 women survivors of IPV.Methods
Trained researchers conducted semistructured interviews with women survivors of IPV referred by police. Multinomial logistic regression examined differential correlates of attempted, completed, and multiple strangulation.Results
Interviews were conducted with 71.14% of eligible women contacted by researchers. A high proportion (79.66%) of the women interviewed experienced attempted (11.70%), completed (30.16%), or multiple (37.80%) strangulation. Each form of strangulation was independently significantly associated with sexual violence when compared with no strangulation. African American women were at increased risk of attempted (adjusted relative risk ratio [ARR], 2.02; p < .05), completed (ARR, 1.79; p < .05), and multiple strangulation (ARR, 2.62; p < .001). Compared with no strangulation, multiple strangulation was associated with more IPV injury and risk factors for homicide, including loss of consciousness (ARR, 2.95; p < .05) and miscarriage (ARR, 5.08; p < .05). Women who had lost consciousness owing to strangulation were more likely to seek medical care than those who had been strangled but had not lost consciousness (p < .01).Conclusions
Strangulation is a prevalent form of IPV that presents significant health risks to women. Women's health practitioners are optimally positioned to identify subtle signs and symptoms of strangulation, help women to understand the delayed sequelae and potential future fatality associated with strangulation, and connect them with appropriate resources to reduce the risk of morbidity and mortality. 相似文献14.
Physician Gender Is Associated with Press Ganey Patient Satisfaction Scores in Outpatient Gynecology
Lisa J. Rogo-Gupta Carolyn Haunschild Jonathan Altamirano Yvonne A. Maldonado Magali Fassiotto 《Women's health issues》2018,28(3):281-285
Background
Patient satisfaction is gaining increasing attention as a quality measure in health care, but the methods used to assess it may negatively impact women physicians.Objective
Our objective was to examine the relationship between physician gender and patient satisfaction with outpatient gynecology care as measured by the Press Ganey patient satisfaction survey.Study Design
This cross-sectional study analyzed 909 Press Ganey patient satisfaction surveys linked to outpatient gynecology visits at a single academic institution (March 2013–August 2014), including self-reported demographics and satisfaction. Surveys are delivered in a standardized fashion electronically and by mail. Surveys were completed by 821 unique patients and 13,780 gynecology visits occurred during the study period. The primary outcome variable was likelihood to recommend (LTR) a physician. We used χ2 tests of independence to assess the effect of demographic concordance on LTR and two generalized estimating equations models were run clustered by physician, with topbox physician LTR as the outcome variable. Analysis was performed in SAS Enterprise Guide 7.1 (SAS, Inc., Cary, NC).Results
Nine hundred nine surveys with complete demographic data were completed by women during the study period (mean age, 49.3 years). Age- and race-concordant patient–physician pairs received significantly higher proportions of top LTR score than discordant pairs (p = .014 and p < .0001, respectively). In contrast, gender-concordant pairs received a significantly lower proportion of top scores than discordant pairs (p = .027). In the generalized estimating equations model adjusting for health care environment, only gender remained statistically significant. Women physicians had significantly lower odds (47%) of receiving a top score (odds ratio, 0.53; 95% CI, 0.37–0.78; p = .001).Conclusions
Women gynecologists are 47% less likely to receive top patient satisfaction scores compared with their male counterparts owing to their gender alone, suggesting that gender bias may impact the results of patient satisfaction questionnaires. Therefore, the results of this and similar questionnaires should be interpreted with great caution until the impact on women physicians is better understood. 相似文献15.
Robert J. Fetsch Danielle M. Jackman Christina L. Collins 《Disability and health journal》2018,11(2):230-236
Background
While emerging research has focused on quality of life (QOL) levels among farmers and ranchers with disabilities, much work is still needed on this largely understudied population. The AgrAbility Project, a USDA initiative, offers pragmatic solutions to increase farmers and ranchers with disabilities' QOL and ability to work and live independently (ILW).Objectives
To assess pretest-posttest changes in farmers and ranchers with disabilities' ILW and QOL levels after participating in AgrAbility, to identify demographic predictors of ILW and QOL (e.g. with whom AgrAbility works best), and to determine how much variance in QOL is accounted for by change in ILW levels.Methods
Participants (N = 191) included farmers and ranchers from 10 states with various disabilities who participated in AgrAbility. They completed ILW and McGill QOL measures before and after AgrAbility.Results
Paired samples t-tests highlighted that participants' ILW and QOL levels improved (p < 0.001) with large or larger than typical effect sizes. Repeated measures ANOVA indicated that change in ILW over time was qualified by age and origin of disability. Regression results revealed that change in ILW predicted 13% of the variance in QOL change.Conclusions
These results suggest that participation in the AgrAbility Project was positively associated with increased ILW and QOL levels. AgrAbility participants reported increases in their QOL levels and their ability to continue their work and live in their homes. Further research is needed to compare results with a no-treatment comparison group of similar ranchers and farmers with disabilities. 相似文献16.
Anu Manchikanti Gomez Stephanie Arteaga Natalie Ingraham Jennet Arcara Elodia Villaseñor 《Women's health issues》2018,28(5):408-414
Background
It is well-established that current measures of pregnancy intentions fail to capture the complexity of couples' lived experiences and decisions regarding reproductive decision making. Despite limitations, these measures guide programs, policy, and clinical practice. Herein, we explore prospective pregnancy acceptability, which captures whether individuals anticipate considering an unexpected pregnancy welcomed, manageable, or okay.Methods
Individual qualitative interviews were conducted with 50 young (ages 18–24 years) women and their male partners (N = 100) to elucidate prospective pregnancy desires and perspectives on pregnancy planning. Using a thematic approach, we analyzed data from a subsample (n = 88) of participants who did not currently desire a pregnancy.Results
Despite lack of pregnancy desire, 37 participants indicated that a pregnancy would be acceptable. Several themes emerged as reasons for pregnancy acceptability, including feeling prepared for children, relational stability, having knowledge of what it takes to parent, and taking a “whatever happens” approach toward pregnancy planning. Notably, a number of reasons for pregnancy acceptability were also described as reasons for lack of acceptability. For example, although many parents in the sample found pregnancy acceptable owing to their knowledge of the time and resources that raising children required, other parents found pregnancy unacceptable for this same reason.Conclusions
Acceptability captures nuances of prospective views on pregnancy and what it means for young people's lives that current intentions language and framing often neglects. Additionally, acceptability may be a construct that resonates with the perspectives and lives of young people for whom the notion of active pregnancy planning is not salient. 相似文献17.
Sarah F. Gallups Mary C. Connolly Catherine M. Bender Margaret Q. Rosenzweig 《Women's health issues》2018,28(6):553-558
Background
Recognition of potential explanations for nonadherence or treatment delays is crucial to improving survival, particularly among African American women, for whom there is limited research assessing patient factors that influence adherence to breast cancer chemotherapy.Objective
This study sought to examine the association of patient factors such as age, income, employment, and partner status with adherence (full dose/on time) to prescribed breast cancer adjuvant chemotherapy and delays in treatment among African American women.Methods
This observational, prospective study used baseline data from the Adherence, Communication, Treatment, and Support Intervention Study that included African American women with early stage breast cancer who were recommended to receive chemotherapy. Eleven baseline demographic variables measured by a sociodemographic questionnaire were analyzed against the outcome variables of 85% adherence to chemotherapy, dichotomized as yes or no, and chemotherapy treatment delays measured as number of days.Results
For the 121 African American women included in this study, only employment status and number of comorbidities were significant predictors for total treatment delays (incidence rate ratio [IRR] = 2.175 [p = .000]; IRR = 1.234 [p = .003]) in the adjusted models.Implications
Employment status and number of comorbidities are predictors of the ability to receive timely breast cancer chemotherapy among African American women. This knowledge allows identification of patients in need of tailored supportive care to encourage adherence and prevent treatment delays. 相似文献18.
19.
Nicholas J. Cordato Mary Kearns Peter Smerdely Katrin M. Seeher Matthew D. Gardiner Henry Brodaty 《Journal of the American Medical Directors Association》2018,19(3):276.e11-276.e19
Objectives
Rehospitalization of nursing home (NH) residents is frequent, costly, potentially avoidable and associated with diminished quality of life and poor survival. This study aims to evaluate the impact and cost-effectiveness of the Regular Early Assessment Post-Discharge (REAP) protocol of coordinated specialist geriatrician and nurse practitioner visits on rates of rehospitalization, hospital length of stay, and emergency department presentations for NH residents recently discharged from hospital.Design
Prospective randomized controlled study of recently hospitalized NH residents.Setting
Twenty-one of 24 eligible NHs within the geographical catchment area of St George Hospital, a 650-bed university hospital in Sydney, Australia.Participants
NH residents from eligible facilities admitted to St George Hospital's geriatric service were enrolled prior to hospital discharge.Intervention
REAP intervention of monthly coordinated specialist geriatrician and nurse practitioner assessments within participants' NHs for 6 months following hospital discharge.Measurements
Impact of the REAP intervention on hospital readmissions, hospital inpatient days, emergency department utilization, general practitioner visits, investigations and associated costs during the study intervention period.Results
Forty-three NH residents were randomly allocated to REAP intervention (n = 22) or control (n = 21) groups. The REAP intervention group had almost two-thirds fewer hospital readmissions (P = .03; Cohen's d = 0.73) and half as many emergency department visits than controls. Total costs were 50% lower in the REAP intervention group, with lower total hospital inpatient (P = .04; Cohen's d = 0.63) and total emergency department (P = .04; Cohen's d = 0.65) costs.Conclusion
Cost-effective reductions in the utilization of hospital-related services were demonstrated following implementation of the REAP intervention for NH residents recently discharged from hospital. 相似文献20.
Deana A. Hildebrand Priscilla Blevins Lillian Carl Barbara Brown Nancy M. Betts Tiffany Poe 《Journal of nutrition education and behavior》2018,50(2):118-124.e1