A description of inappropriate hospital stays in selected in-patient services: a study of cases receiving social work services.

The number of discharges (63,303) from a university-affiliated medical center in Israel were reviewed. Eight percent of cases in three departments rcceivcd social work services. Patients experiencing inappropriate hospital stay (discharge delay) and who received social work services were characterized and compared with social work clients not experiencing delay. Discharge delay patients differed from other social work clients on key sociodemographic variables. Patients admitted because of "injury" were significantly more likely to experience delay than patients admitted because of "illness." "Waiting for community/institutional resources" was the most common reason for delay and discharge to an institutional setting increased the likelihood of delayed discharge. High risk factors were department-specific and should be studied in context. Results suggested the limited but positive impact of hospital-community collaborative strategies in reducing the incidence of delay over time.     

A comparative study of the characteristics and social backgrounds of frail and elderly persons at home, long-stay elderly hospital patients, and residents of welfare homes for the frail elderly]

Three studies were carried out in Mino City, Osaka Prefecture, on 188 frail and elderly persons living at home (the home group), 61 elderly patients who had been hospitalized more than six months (the inpatient group), and 72 residents of welfare homes for the frail elderly (the resident group). The characteristics and social backgrounds of the three groups were compared. About 30% of each group had suffered a stroke. As for ADL score, moderate disability was dominant in the home group, severe disability in the inpatient group, and slight disability in the resident group. The proportions of those who had been living alone and those who had no spouse were significantly higher in the inpatient group and in the resident group than in the home group. Significantly fewer subjects in the resident group had been living with their offspring than in the home group or in the inpatient group. The percentage of those who did not have their own home was the highest for the resident group. Multivariate analyses using Hayashi's quantification method II were conducted for a comparison between cases belonging to the home group and the inpatient group, and between the home group and the resident group. The analysis of the home group and the inpatient group revealed a relationship of the inpatient group to severe disability in ADL, and living alone. Differences between these two groups were related to such variables as ADL, sex, living or not living alone, living or not living with offspring, and having or not having a spouse.(ABSTRACT TRUNCATED AT 250 WORDS)     

Timing of social work intervention and medical patient's length of hospital stay

Findings report that hospital inpatients who receive social work intervention present difficult problems and have longer-than-average lengths of stay and that the earlier in the hospitalization that intervention occurs, the shorter the stay will be. A total of 243 patients referred for social services at a 440-bed teaching hospital were evaluated. Paired t-tests indicated a significant difference in the mean length of stay based on normative data. Timing of the intervention accounted for a significant amount of variance (13 percent) in length of hospital stay. The major clinical implications of the study are that social work intervention has the potential to decrease length of hospitalization, and that this methodology may be used reliably to evaluate changes in discharge planning protocol.     

Disease management in the frail and elderly population: integration of physicians in the intervention.

As financial, social, and quality-of-life challenges associated with chronic disease in the United States continue to proliferate, disease management (DM) has been identified as a viable and positive approach that serves all areas of impact. Using an "in-house" model, Physician Health Partners, LLC, designed, developed, and implemented a DM program for the frail and elderly population. Given the special needs of this population the typical DM intervention was modified to include elements of physician involvement. The Frail and Elderly Program, as the DM program is called, produced statistically significant improvements in functional, behavioral, and clinical status and health-related quality of life. This model can help result in program success with potential benefits for individuals, practices, communities, and all whose lives are touched, directly or indirectly, by chronic disease.     

Comorbidity and social factors predicted hospitalization in frail elderly patients

OBJECTIVE: Studies on factors predicting the hospital admission of geriatric patients have reported different findings. The present study was undertaken to examine the rate of hospitalization among a large sample of frail elderly people living in the community and to identify the most important clinical and patient-centered factors associated with the hospital admission. STUDY DESIGN AND SETTING: This is an observational cohort study. All patients (n = 1,291) in six Italian home health care agencies were assessed by a trained staff who collected data on the Minimum Data Set for Home Care (MDS-HC) form. We constructed a longitudinal database including MDS-HC data and information on hospital utilization by each patient. RESULTS: During the follow-up of 12 months, the rate of hospitalization was about 26% of the studied sample. Persons living alone were more likely to have a hospital admission than those living with an informal caregiver (odds ratio OR = 2.59, 95% confidence interval CI = 1.82-3.69). Similarly, persons with economic hardship were more frequently hospitalized than those without these problems(OR = 3.01, 95% CI = 1.75-5.18). Comorbidity and previous hospital admission were associated with a higher risk to be hospitalized, too. CONCLUSION: Our results support the hypothesis that a mix of social and health problems are independent predictors of hospitalization.Identification of those factors that best predict hospital admissions and readmissions gives direction for potential interventions and further research toward reducing unnecessary hospitalizations.     

Impact of a clinical self-evaluation intervention on the appropriateness of hospital stays

AIM: To assess the impact of an intervention on inappropriate hospital stays (IHS) in acute-care hospitals in Catalonia (Spain) with the aim of testing the hypothesis that a simple intervention (adeQhos) reduces the proportion of IHS. METHODS: A pre-test/post-test study was performed through the questionnaire. Two intervention groups (internal medicine and general surgery) and 2 control groups (other medical specialities, orthopedics) were compared in 10 acute-care hospitals in Catalonia. The same evaluators assessed appropriateness of hospital stays before and after the intervention, using the Appropriateness Evaluation Protocol. RESULTS: A total of 1,594 pre-test stays and 1,495 post-test stays were reviewed. Of all the stays reviewed (day before discharge), 41.1% were inappropriate. The intervention was applied to 4,613 stays. There was a significant increase of IHS in the medicine control group (from 39.7 to 48.6%), and no decrease in the intervention groups (internal medicine [from 46.7 to 50.6%] or general surgery [from 27.2 to 31.2%]). The correlation between the intensity of the intervention and the difference in IHS before and after the intervention was r = -0.373 (p = 0.106). The intensity of intervention differed among the hospitals. In hospitals with an intensity of intervention > 60%, the proportion of IHS decreased by 10.7 points in internal medicine and by 4.8 points in general surgery, while the proportion of IHS increased in the control groups. CONCLUSIONS: The prevalanece of IHS the day before discharge in the hospitals studied was high (41.1%). No significant decrease in IHS was observed after a low-intensity intervention.     

Major determinants of social networks in frail elderly community residents

Although social networks has been extensively studied as independent, intervening, and moderating variables affecting health, little attention has been paid to social networks as dependent variables. The present research is a longitudinal study which focuses on social networks as the dependent variable. A sample of 3,559 poor, frail, elderly from California Multipurpose Senior Services Project (MSSP) were evaluated in six month intervals over an eighteen month period. The results indicate that life events, sex, ailments, mental functioning, and health habits are significant predictors of the elderly's social networks after six months, and that life events, sex, age, and health habits are significant predictors of the elderly's social networks after twelve months, as well as after eighteen months. Implications for intervention and for further research are discussed.     

How satisfaction with hospital field work affects social work students' willingness to accept employment in hospital settings.

This study of 238 social work students in 27 hospital field work programs examined how student satisfaction with field work affects their willingness to accept employment in host hospitals. Job willingness was positively correlated with five measures of student satisfaction. Factors predictive of each measure were identified. Findings suggest strategies that can be used by hospital social work managers and field work supervisors to enhance student satisfaction with the field work experience, in order to maximize the benefit of providing field work education as a way of recruiting graduating students for employment in hospital settings.     

Making a rehabilitation hospital for the elderly work.

We report our efforts to make a rehabilitation hospital work. The simple intervention of introducing a patient record system, in which problems, management, achievements and discharge plans were clearly documented, doubled the number of patients who returned home over an eight-month period. This resulted in greater availability of acute geriatric beds at the District General Hospital (DGH), where two thirds of the elderly medical inpatients occupy beds on other units, and in an improvement in morale of patients and staff. Greater co-operation between geriatric and medical teams in selecting those patients who would benefit from continuing rehabilitation is required. The advantages of accommodating such patients separately from patients with a poor prognosis and those requiring long-term care are discussed.     

Structural characteristics of social networks and their relationship with social support in the elderly: who provides support

The analyses presented here examine relationships between structural characteristics of social networks and two types of support (instrumental and emotional support) in a sample of community-dwelling individuals aged 65 and older. For each type of support, two dimensions are examined (1) the availability of such support and (2) the perceived adequacy of that support. Regression models, adjusting for age, sex, race and income show that structural characteristics such as total network size, number of face-to-face contacts and number of proximal ties are associated with greater availability of both instrumental and emotional support. The perceived adequacy of both types of support is most strongly related to the number of monthly face-to-face contacts. Comparisons of specific types of ties show that neither ones' spouse nor ones' children are primary sources of support. Rather the presence of a confidant is strongly associated with both dimensions of instrumental and emotional support; the presence of a spouse is not. And, while ties with children are most strongly related to aspects of instrumental support, ties with close friends and relatives are more strongly related to aspects of emotional support. Analyses of possible interactions show that for those without a spouse, confidants assume greater importance in providing emotional support. For those without children, ties with close friends and relatives assume a larger role relative to the perceived adequacy of both emotional and instrumental support.     

有效缩短平均住院日与提高医院效益的关系

通过实行住院床位统一调控、提高住院流程各环节的效率、减少相对低效的诊疗服务时间、控制院内感染等一系列措施．在确保医疗服务质量的前提下．有效缩短了平均住院日．提高了医院病床的效益和效率．实现了病人和医院利益双赢。     

Myocardial infarction patients in the acute care hospital: a conceptual framework for social work intervention

This paper describes a conceptual framework for identifying myocardial infarction patients in the acute care hospital who are at risk for medical and psychosocial complications that may impede recovery. Because of their precarious medical status, these patients present special issues for social work practice. Psychosocial factors affecting outcomes are reviewed and interventive strategies are outlined. The crucial role of adaptive denial in recovery is highlighted.     

Sixty years ago: hospital social work in 1918.

The year 1918 marked a juncture in the development of social work in health sare. During that year, the fledgling group of hospital social workers responded to needs created by World War I, the influenza pandemic, and epidemics of tuberculosis and venereal disease. At the same time, in order to meet these needs and to professionalize their services, they formed a professional organization, published two new journals, and expanded opportunities for professional education. Examination of these matters helps to explain the place and direction of hospital social work exactly 60 years ago.     

社会工作介入临终关怀的研究

随着人类社会的发展，人们越来越注重生活的质量，对于临终前的生命质量也提出了高的要求，这便产生了临终关怀。我国目前实施的临终关怀的形式主要有家庭型、综合医院型和专门临终机构型，而这3种形式又在不同方面存在着自己的缺陷。这就需要社会工作介入临终关怀之中。从介入理念、介入途径和方法上都可看出它的可行性和必要性。对于社会工作者在临终关怀中所担当的角色也进行了分析研究。     

Crisis intervention and social work practice in hospitals

Crisis intervention, with its emphasis on focused treatment in a limited time frame, is adaptable to social work practice in hospitals. The author discusses the crisis intervention model in relation to the hospitalized patient and his or her family and examines three kinds of crises: those caused by illness or injuries, by hospitalization itself, and by treatment procedures.     

Post-hospital support program for the frail elderly and their caregivers: a quasi-experimental evaluation.

This paper evaluates the Post-Hospital Support Program for the frail elderly and their caregivers using a quasi-experimental design. The program goals were to reduce stress in the caregivers, improve functioning and reduce mortality in patients, and reduce health service utilization in patients. Subjects were patients at the Johns Hopkins Hospital in Baltimore, Maryland, age 65 or over, who were returning home to the care of a non-paid caregiver and who had extensive post-hospital care needs which were expected to continue for at least one year. The 93 comparison group patient/caregiver pairs were discharged between May 15, 1983 and May 14, 1984. The 98 treatment group pairs were discharged between May 15, 1984 and May 14, 1985. Interviews were conducted with patients and caregivers at 1, 3, 6, 9, and 12 months after discharge. Results showed a slight reduction in caregiver stress and a substantial reduction in hospital days used by the treatment group. When confounding and history effects are taken into consideration, an average difference of 6.5 days per patients remains. The data also suggest that the treatment program may have postponed some deaths and nursing home placements. The results suggest that support services for the frail elderly and their caregivers can be cost efficient by reducing hospital length-of-stay. Savings were estimated at $4,585 per patient per year in this study. However, further work is needed to design programs which more effectively reduce caregiver stress.