Continuous Care Model Research Articles

Influence of continuity care on how to deal with medical waste among domestic patients of insulin injections

Objective To explore the influence of continuity care model on how to deal with medical waste of insulin injections among domestic patients Methods Consecutive diabetes patients using the home insulin injections were recruited as the the members of our Diabetes Education Class from September 2014 to March 2015. The home medical waste disposal was brought into the content of diabetes education; problems were intervened through the continuity care model. Using the questionnaire survey to investigate the cognitive and disposal of patients on medical waste, to compare the difference of results of questionnaire before and after the intervention. Results The cognitive rate of medical waste after intervention was 97.70% (212/217), while the cognitive rate before intervention was 3.69% (8/217), the difference was significant (χ2 =383.63, P < 0.01). Disposal of diabetes patients using the home insulin injections had improved after the continuity care, the rate of dealing with medical waste according to specification after the intervention was 91.24% (198/217), while the rate before the intervention was 3.23% (7/217), the difference was significant (χ2=337.26, P < 0.01). Conclusions The continuity care model standardized the behavior of patients for disposal of medical waste, reduced the environment pollution of medical waste and decreased the spread of disease. Key words: Continuity care; Home insulin injection; Medical waste

Advances on continuing care in patients with ankylosing spondylitis

It reviewed the necessity and the present situation of ankylosing spondylitis continuity of care and countermeasure research progress, and explore suitable continuity care model for China's current system of medical treatment in patients with ankylosing spondylitis. In order to facilitate the development of targeted services, so as to improve the compliance of treatment of ankylosing spondylitis patients, and improve the patients' quality of life. Key words: Ankylosing spondylitis; Review; Continuing care

Influence of CCM on postoperative function training effect of anal sphincter in patients with anus preserving surgery for low rectal cancer

Objective To discuss influence of continuous collaboration care model (CCM) on postoperative function training effect of anal sphincter in patients with anus preserving surgery for low rectal cancer. Methods 86 cases with low rectal cancer treated by anus preserving surgery from July to December in 2013 were selected as control group, to whom routine nursing care was carried out. 88 patients with low rectal cancer treated by anus preserving surgery from July to December in 2014 were selected as observation group, to whom continuous CCM was implemented on the basis of routine nursing care in the control group. Defecation function and quality of life of patients in the two groups were compared 3 months and 6 months after the surgery. Results After 3 months of nursing intervention, 81.8% of patients in the observation group had fine anal function, higher than the number in the control group, 47.7%; after 6 months, the proportions of the two groups were 90.9% and 67.4% (χ2=8.632, 7.523; P<0.05). Physiological function, psychological function, social function, self-awareness of health and score of quality of life of patients in the observation group were all higher than those of the control group (t=5.264, 4.635, 4.265, 4.145, 3.958; P<0.01). Conclusions Implementation of continuous collaborative family care management can promote recovery of patients′ defecation function and improve their quality of life. Key words: Collaboration care model; Low rectal cancer; Anal sphincter; Function training

Effects of a Continuous Care Model on Patients' Knowledge and Health-Related Quality of Life in Systemic Lupus Erythematosus.

The purpose of this study was to evaluate the effects of applying the continuous care model (CCM) on the knowledge level and health-related quality of life (HRQoL) of systemic lupus erythematosus (SLE) patients and their perceptions of family awareness about the disease. The Continuous Care Model (CCM) was implemented for 3 months on 34 SLE patients, in a pretest-posttest quasiexperimental design. Two sets of questionnaires were designed for knowledge assessment. HRQoL was assessed by SF-36 questionnaires. Analysis was by paired t test and one-way ANOVA. The continuous care model significantly improved patients' knowledge level and their perceptions of their family members' awareness of their disease. HRQoL status in SLE patients was poorer than the general population in six of eight SF-36 scales (p < .05), except for Bodily Pain and Mental Health. Postintervention scores showed improvement in six SF-36 scales (p < .001), except for Bodily Pain and Social Functioning. Our results underlined the advantages of applying the CCM as a comprehensive method of self-care in SLE. Despite many improvements in SLE care, the patients' quality of life is still much affected by SLE. Implementation of the CCM could lead to improvement in the knowledge and HRQoL of SLE patients.

The Effect of Continuous Care Model on the Sleep Quality of Hemodialysis Patients.

BackgroundOne of the most prevalent problems in hemodialysis patients is sleep disturbance. Poor sleep quality has unpleasant bio-psycho-social outcomes. The positive effects of implementing the continuous care model (CCM) were verified with different variables, including sleep quality. This study was done with different populations, using two groups.ObjectivesThis study aims to identify the sleep quality of hemodialysis patients in the city of Ilam and determine the effects of CCM on sleep quality.Patients and MethodsWe performed a quasi-experimental research study with 56 hemodialysis patients at the Shahid Mostafa Hospital in Ilam during 2014 and 2015. Pretests and posttests were conducted with the study groups and the control groups. Pretests were conducted over a one-month period, then repeated immediately before the study. Posttests were conducted immediately after the study and then repeated one month later. Participants were selected by census method and randomly divided into two groups. Ethical considerations were observed. Based on the continuous care model, interventions were performed through educational sessions over a three-week period. Consultations for continuous sleep monitoring, controls, and evaluations were conducted with the study group over the next nine weeks. Data were gathered from patient demographics questionnaires and PQSI, then introduced in SPSS 22 and analyzed with descriptive and analytic statistics (t-paired, ANOVA with repeated measures, follow-up tests such as S-N-K, Duncan, Sheffe and Tukey).ResultsOne month prior to the study, 94.6% of the participants suffered from poor sleep quality. Immediately before and after the study, 91% complained of poor sleep quality. And one month after intervention, the figure dropped to 82%. Applying the CCM positively affected the sleep quality of hemodialysis patients in Ilam, and was statistically meaningful one month after intervention (P = 0.001).ConclusionsHemodialysis patients need a consistent care plan to manage poor sleep quality. This research has proven the effectiveness of implementing CCM as an intervention for improving the sleep quality of hemodialysis patients. CCM provides a comprehensive model for caring for hemodialysis patients, and its executive stages are congruent with the many stages of the nursing process. Practitioners in different domains of nursing care, education, and management can derive great benefit from this valuable care model

Shifting Towards Autonomy: A Continuing Care Model for Canada

For many seniors, their greatest health concern is the ongoing care that many of them will need as their ability to cope with the routine tasks of daily life declines. Due to various chronic health problems or just old age, supportive services for seniors – often referred to as continuing care – encompass a wide range of needs, from help with daily meals in patients’ homes to institutional care for those with major cognitive or physical disabilities. On this score, many Canadians have expressed concerns about affordability and access to care in their desired location. The state of continuing care in Canada is troublesome on a number of fronts, including the rising stress on caregivers, long waits for nursing home beds, and unmet homecare needs. More than one in four Canadians provide care to family or friends, and among this group one in 10 provides more than 30 hours weekly, often with significant disruption to their paid work. It has been estimated that more than 15 percent of all acute-care hospital beds in Canada are filled every day with patients waiting for care in a location outside a hospital, costing provincial governments slightly under $3 billion per year. And although there has been an increase in subsidized care in people’s homes in recent years, the provinces appear to be well behind the international trend in this regard and will struggle to keep pace with rising demand. Canada’s provinces can learn important lessons from the debates and reforms in other developed countries. A number of them have faced the same challenges but have been much more proactive in establishing a framework for supporting greater independence among the elderly. In doing so, they have recognized that shifting more services to the home and community is a key goal. The experience abroad shows several countries, such as France, Germany and recently Australia, have implemented self-directed models of care delivery, boosting patient satisfaction by giving individuals and families a greater say in their care packages. Two of the biggest challenges for governments contemplating more cash-based, self-directed benefits for continuing-care services are impact on government budgets and quality assurance. All countries we studied have, however, managed to overcome these challenges, at least to some degree, through restrictions on the size of the subsidy to those with substantial means or available family help and by establishing oversight in the use of the cash subsidies. In the study, we sketch a provincial continuing care model that would draw on these countries’ experience. Establishing a new comprehensive self-directed model along the lines we propose will require: an assessment system; means testing; a funding mechanism that is based on need but controls government costs; an oversight system to ensure quality and enforce restrictions on use; and, establishing who will oversee, coordinate and be accountable for care. The time to adopt new systems of supportive services for the elderly is now – before many more retiring babyboomers start drawing heavily on them.

The care network for drug users: what do professionals say about it?

This article aimed to understand, from the framework of community psychology, the care network for drug users from professionals’ experiences, and implications of a community level work. Six semi-structured focus groups were conducted with 42 professionals from care networks of four Brazilian cities in the state of Minas Gerais. Data was analyzed through thematic content analysis. Results indicate the need of enhancing network’s operational structure and, mainly, consolidating a comprehensive and continuous care model. Professionals’ critical views of the care network lift a series of contributions to improve it, with the necessity of embracing a community level work and a resources-focus approach to drug abuse. Related to this, there is the necessity to focus care on community and its needs, by understanding it as the main element of care networks for drug users.

Initial outcomes of a comprehensive care model for sickle cell disease among a tribal population in rural western India

Background: Sickle cell disease (SCD) is the most prevalent inherited blood disorder worldwide, and is increasingly recognized as a neglected chronic disease. Several cost-effective interventions have dramatically reduced morbidity and mortality from SCD in developed countries. However, access to care for SCD in India is limited in most rural tribal regions with the highest SCD prevalence . Methods: In 2014, we implemented a comprehensive care model in rural Gujarat, India, with the aim of providing high-quality screening and treatment to increase coverage of proven interventions for sickle cell disease. Components of the intervention include: new-born, antenatal and family screening; outpatient sickle cell clinic; inpatient protocols; chronic disease registry; and health education. We followed a cohort of patients enrolled between February 2014 and October 2014 and compared the severity of disease and coverage of proven interventions at baseline and after one year of follow-up. Results: Of 164 patients diagnosed with sickle cell disease who enrolled in the comprehensive care program, 72 patients (43.9%) had SCD pain crises, 59 (35.9%) were hospitalized, 43 (26.2%) received blood transfusions, and 3 (1.8%) died during follow-up. Compared to baseline, coverage of pneumococcal vaccine (0.6% to 78.5%, p<0.001) and hydroxyurea (4.5% to 50.0%, p=0.002) significantly improved. There was a reduction in the proportion of patients with ≥3 pain crises per year (35.4% to 9.8%, p<0.001) and the proportion of patients with ≥1 hospitalization per year (56.7 go 36.0%, p<0.001) with no significant change in patients with ≥1 blood transfusion in last year (32.9% to 26.2%, p=0.127) . Conclusions: This study demonstrates that implementing a continuity care model for sickle cell disease in rural India is feasible and can improve coverage of evidence-based interventions.

Knowledge gaps and acceptability of abbreviated alcohol screening in general practice: a cross-sectional survey of hazardous and non-hazardous drinkers.

BackgroundGeneral practice provides a unique setting where hazardous alcohol consumption can be screened for and behavioural interventions can be implemented in a continuous care model. Our aim was to assess in a general practice population, the prevalence of hazardous drinking, the knowledge and attitudes surrounding alcohol, and the acceptability of brief interventions in alcohol.MethodsA cross-sectional survey in a practice in South London, performed as part of a wider service evaluation. Questionnaires were offered to adult patients awaiting their appointments. Responses were stratified according to hazardous drinking, as per the abbreviated ‘Alcohol Use Disorders Identification Test’ (AUDIT-C).ResultsOf 179 respondents (30 % male), 34 % yielded an AUDIT-C ≥5 and 18 % reported that they never drink alcohol. Male and Caucasian patients were more likely to self-report hazardous drinking, who in turn were more likely to believe in the health benefits of moderate consumption. Little over half of patents thought that alcohol is a risk factor for cancer and were misinformed of its calorific content, suggesting two targets for future improvement. Patients’ knowledge about what is a single ‘unit’ of alcohol was below that expected by random chance 66 % agreed that alcohol screening should feature in all GP consultations.ConclusionsWhile awareness of alcohol related health risks is generally good, future efforts may benefit from focusing on the association with cancer and calories. Our findings question the utility of the ‘unit’ system, as well as dissemination of suggested ‘health benefits’ of moderate consumption. General practice initiatives in screening and brief advice for alcohol deserve further study.

An Investigation on the Effect of Continuous Care Model on Depression, Anxiety and Stress Among Renal Transplant Patients

An Investigation on the Effect of Continuous Care Model on Depression, Anxiety and Stress Among Renal Transplant Patients

Toward a model of continuous care: A necessity for caregiving partners.

Caregiving partners constitute a unique group, who provide both physical and emotional care for patients. There has been extensive research conducted on caregivers during either the caregiving or bereavement phase; however, these phases are often treated as separate entities rather than as part of a continuum. In this paper, utilizing relevant literature and clinical observations, we map the emotional journey and lived experience of caregivers moving from disease progression, to the end of life, to the dying process itself, and then through life after the death of a partner. Along this journey, we identify the links between pre-death caregiving and bereavement. Our illustration raises awareness regarding the unmet needs experienced by caregiving partners across the continuum and provides an alternative framework through which clinicians can view this course. of Results We bolster arguments for improved palliative care services and early interventions with distressed caregiving partners by emphasizing continuity of care both before and after a patient's death.

Primary Care Clinic Visit Efficiency

A study was done in 2013 regarding Veteran's Affairs primary care clinics in New Mexico. The primary care clinics provide care for a group of patients on regular basis. They also see additional patients as needed. The team consisting of the provider(s), nurse(s), technician(s), and schedulers providing continuous and coordinated care throughout patient's life-time is called Patient Aligned Care Team (PACT). The purpose of the PACT is to maximize patient care using this continuous and familiar care model for the patients. The performance of five out of ten primary care teams were provided using the traditional measures identified by their healthcare system in the Patient Aligned Care Teams Compass Data Definitions. The measurements that were specifically interesting were Ratio of PC Telephone Encounters to All PC Encounters, Ratio of Non-Traditional Encounters, Same Day Appts. w/PC Provider Ratio, Continuity PCP (ER Excluded), Team 2ndDay Post DC Contact Ratio. The data was collected in 2012 and the evaluations, interviews, and analysis was completed in 2013. The team scores was provided and access was obtained to only five out of ten teams which data was available for. The Veteran's Affairs provided data regarding the performance metrics of the PACT teams. The data was evaluated by using statistical correlations. The interview questions were designed to further dissect the performance of each team and their practices. Teams were interviewed and the responses were summarized and analyzed. Responses from each team were converted into team's scores and compared to their PACT performance metrics. The comparison between teams' scores and PACT performance metrics provided insight into each team's perception of its own performance and its PACT performance metrics. The purpose of this project is to identify the value adding and non-value adding activities of the each team. So the management can encourage the promotion of value adding activities, decreasing the variation in the performance of the teams and so maximizing the patient care.

The effects of diversified continuous care model on the post-discharge cardiac re-habilitation of the patient with coronary heart disease

Objective To explore the effect of hospitals , communities , families diversified factors implementing continuous nursing model on the post -discharge cardiac rehabilitation of patients with coronary heart disease （ CHD） .Methods A total of 151 patients with coronary heart disease were selected from January 2011 to January 2013 in our hospital and divided into observation group and control group . When they discharged from hospital and rehabilitation after 1 year, they were surveyed by the full -time doctors on quality of life , blood pressure, blood sugar, blood fat success rate, recurrence of cardiovascular vents.Results When two groups of patients discharged from hos-pital, there was no significant difference in the incidence rate of abnormal blood pressure , blood sugar, blood fat （P〉0.05） and 1 year after the rehabilitation , the observation group of patients with abnormal blood pressure , blood sugar , blood lipid rate were significantly lower than those in the control group （ P〈0.01 ） .There was no significant difference in discharge quality of life score significance （ P〉0.05 ） , and fol-lowed up for 1 years later, the quality of life score in observation group of patients was significantly higher than that of the control group （P〈0.05~0.01 ） .The difference of two groups of patients with readmission rate was statistically significant （ P〈0.05 ） .Conclusions Diver-sified continuous care model can improve the life quality of patients , promote the blood pressure , blood sugar , blood fat to reach standard , be a effective measures for the early cardiac rehabilitation , and it is wothing spreading in clinic . Key words: Diversified; Continuous care model; Coronary heart disease; Cardiac rehabilitation; Outside the hospital medical; Secondary prevention; Quality of life

The effect of continuous care model on quality of life of patients after coronary angioplasty in Bou Ali Sina hospital

Background: Due to high prevalence of coronary artery disorders and increasing need for surgical interventions, especially angioplastic surgery, it is expected that the quality of life increases to an acceptable level with this surgery; although studies have shown an unremarkable development in this regard. Aim: To determine the effect of continuous care model on the post-angioplasty patient’s quality of life. Methods: This clinical trial study was performed in Bou Ali Sina hospital of Qazvin in 2012 on 93 candidates of angioplasty, which were divided into two groups entitled experiment and control with random allocations. Continuous care model was applied on the experiment group for period of two months. For data collection, demographic checklist and “MacNew quality of life” questionnaire in three stages were used .Data were analyzed with paired t-test, chi-square and repeated measure ANOVA. Results: In the experiment group, the average score of the quality of life before the intervention was 126 ± 3.1, while it was 132 ± 3.05 after one month, and 147 ± 2.6 after two months. The same scores for the control group were114 ±3.7, 104 ± 3.6 and 110 ± 3.8, respectively. The average score in physical, emotional and social domains of the quality of life showed significant difference in the experience group (p<0.001). Conclusion: The results confirmed the positive effect of applying continuous care model on the score of post-angioplasty patients’ quality of life.

The effectiveness of continuing care models in patients with chronic diseases: a systematic review

Population aging has caused significant rises in the prevalence of chronic diseases and the utilization of healthcare services in Taiwan. The current healthcare delivery system is fragmented. Integrating medical services may increase the quality of healthcare, enhance patient and patient family satisfaction with healthcare services, and better contain healthcare costs. This article introduces two continuing care models: discharge planning and case management. Further, the effectiveness and essential components of these two models are analyzed using a systematic review method. Articles included in this systematic review were all original articles on discharge-planning or case-management interventions published between February 1999 and March 2013 in any of 6 electronic databases (Medline, PubMed, Cinahl Plus with full Text, ProQuest, Cochrane Library, CEPS and Center for Chinese Studies electronic databases). Of the 70 articles retrieved, only 7 were randomized controlled trial studies. Three types of continuity-of-care models were identified: discharge planning, case management, and a hybrid of these two. All three models used logical and systematic processes to conduct assessment, planning, implementation, coordination, follow-up, and evaluation activities. Both the discharge planning model and the case management model were positively associated with improved self-care knowledge, reduced length of stay, decreased medical costs, and better quality of life. This study cross-referenced all reviewed articles in terms of target clients, content, intervention schedules, measurements, and outcome indicators. Study results may be referenced in future implementations of continuity-care models and may provide a reference for future research.

Introduction to the Special Series on Booster Sessions and Long-Term Maintenance of Treatment Gains

In 1998, Eyberg and colleagues conducted a review of the literature of booster sessions and other maintenance strategies for enhancing the long-term maintenance of treatment effects for parent training programs. This timely review concluded with a call for more studies examining: 1) the long-term maintenance of treatment effects, and 2) the need to test the incremental benefit of booster sessions using randomized control group designs. Ten years later, an updated review by Eyberg and colleagues (2008) of treatments for disruptive behavior reported that most of the interventions included in that review had shown maintenance of treatment gains for at least a year after treatment had ended, but that many of the follow-up studies included designs that were only modestly rigorous. They suggested the need to explore alternative designs that would permit careful evaluation of disruptive behavior over time to more rigorously document maintenance effects. This special series is a step towards providing a response to this call. All four papers in this special series address the first of these two recommendations (i.e. long-term maintenance of treatment effects) and three specifically test the utility of booster sessions using a randomized control group design. Dishion and colleagues (this issue) report on the long-term maintenance of benefits from yearly Family Check-Ups (FCUs) in a multiethnic sample of high-risk families. Eyberg and colleagues (this issue) examine a continuing care model of maintenance treatment following Parent-Child Interaction Therapy (PCIT) for families of young children. Young children diagnosed with oppositional defiant disorder (ODD) who completed the original treatment were then randomized to PCIT maintenance treatment (MT) or to an assessment-only follow-up condition (AO). Maintenance treatment consisted of monthly telephone contact to monitor progress and provide additional booster support. Lochman and colleagues (this issue) report on a child-oriented booster intervention with children who had previously received an abbreviated version of the Coping Power program in the 5th grade. The booster sessions consisted of non-manualized, brief monthly individual contact. Finally, Kolko and colleagues (this issue) examine the impact of a brief booster treatment that was delivered three years after an acute treatment for clinically referred boys and girls originally diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD). At the conclusion of the acute treatment and three-year follow-up period (i.e., study month 42), the sample was re-randomized into Booster treatment or Enhanced Usual Care and then assessed through two year follow-up. Although these studies vary widely on specific parameters, all share a randomized design and empirical effort to examine the long-term maintenance of treatment/prevention effects and/or the incremental benefit of booster sessions for children with disruptive behavior problems and their families. There are many parameters that are relevant to the evaluation of booster or sessions or maintenance treatment, many of which are represented in the studies described in this special issue. These include the timing of sessions (when to begin booster sessions), frequency of sessions, dose (both number and length of sessions), and modality (e.g. office visits versus phone check-ups). Another important consideration is whether booster sessions should be administered to all participants or a just a subgroup of participants (perhaps those who have failed to maintain their initial treatment gains). Other considerations include whether or not to introduce new treatment content and/or select new or revised treatment goals. For purposes of providing some background on these and other parameters, we have included a description of the key parameters of several early and more recent studies reporting on the effects of treatment maintenance or booster treatment effects in Table 1. These few studies may provide a context for understanding some of the strengths and limitations of the research conducted in this area, as well as for appreciating the four studies included in this series. Table 1 Summary of Studies Examining Treatment Maintenance or Booster Effects Finally, the series includes a commentary by Patrick Tolan (this issue), who has conducted one the few studies designed to evaluate the incremental benefits of a booster intervention for school students that was conducted in the context of a prevention trial with high risk youth (Tolan et al., 2009). He provides an informed perspective on the role of booster or maintenance that incorporates his review of the four papers included in this series and his understanding of the long-term course of disruptive behavior disorders and juvenile delinquency. We hope that this series provides the reader with a clear and comprehensive understanding of the description and evaluation of alternative applications of booster or maintenance interventions with children and adolescents. In addition, we hope that the series helps to frame some of the critical research and practice directions that should be addressed to enhance the careful study and successful incorporation of these conditions in routine clinical practice.

The continuing care model of substance use treatment: what works, and when is "enough," "enough?".

There is little disagreement in the substance use treatment literature regarding the conceptualization of substance dependence as a cyclic, chronic condition consisting of alternating episodes of treatment and subsequent relapse. Likewise, substance use treatment efforts are increasingly being contextualized within a similar disease management framework, much like that of other chronic medical conditions (diabetes, hypertension, etc.). As such, substance use treatment has generally been viewed as a process comprised of two phases. Theoretically, the incorporation of some form of lower intensity continuing care services delivered in the context of outpatient treatment after the primary treatment phase (e.g., residential) appears to be a likely requisite if all stakeholders aspire to successful long-term clinical outcomes. Thus, the overarching objective of any continuing care model should be to sustain treatment gains attained in the primary phase in an effort to ultimately prevent relapse. Given the extant treatment literature clearly supports the contention that treatment is superior to no treatment, and longer lengths of stay is associated with a variety of positive outcomes, the more prudent question appears to be not whether treatment works, but rather what are the specific programmatic elements (e.g., duration, intensity) that comprise an adequate continuing care model. Generally speaking, it appears that the duration of continuing care should extend for a minimum of 3 to 6 months. However, continuing care over a protracted period of up to 12 months appears to be essential if a reasonable expectation of robust recovery is desired. Limitations of prior work and implications for routine clinical practice are also discussed.

Development of a Trauma-based Continuing Care Model for Enhancing Care Outcomes in Social Unrest Area: A Case Study

Background: Improving care outcomes in trauma patients is regarded as important and linked to an appropriate model of care particularly in social unrest area where there are limited resources and accessibility after discharge. To facilitate prompt management to improve patient recovery or quality of life and decrease some complications, a specific model of continuing care for those trauma survivors is required. Objective: This participatory action research (PAR) aimed to develop the trauma-based continuing care model (TCCM) for enhancing care outcomes in trauma patients affected from Social Unrest area. Method: A three-phase of PAR design was implemented with stakeholders in both hospital and community services related to care for trauma survivors and their families. In the first phase, 11 trauma survivors were interviewed and 3 focus group discussions with nurses and related health care staff were conducted to identify existing systems and problems encountered. The second phase consisted of two workshops, involving 20 key informants and allied health staff for the purpose of developing the model. The final phase evaluated the initial effects of the model after implementing with 20 patients by measuring the care process and outcomes such as nurses’satisfaction, patients’quality of life, patients’self care ability, caregivers’ ability to care. Data were analyzed using descriptive statistics for care outcomes and content analysis for the care process. Result: The model consisted of a) trauma-care process through a trauma nurse-initiated discharge planning program b) patient-family follow up. With the PAR process, the following steps included 1) preparing the multidisciplinary health care team including patient and family caregivers, 2) organizing the system, identifying individual role and function for continuing care, and 3) collaborating with community support network for patient and family management. The main strategies to drive all process were teamwork involvement, care coordination, and staff education. The model could enhance both health care staff and family caregivers in providing better care. In this study, most patients were able to manage themselves. Twenty patients and 10 family caregivers were satisfied with the care process and obtained better outcomes regarding health status and quality of life. In addition, the developed trauma nurse-initiated discharge planning program was also discussed for further implication. Conclusion: The key success was derived from trauma nurse-initiated discharge planning process and collaborating with community support network. To enhance the sustainability of the model, care managed by enhancing networking of community nurse, patient and family after discharge needs to be further explored.

Promoting recovery in an evolving policy context: What do we know and what do we need to know about recovery support services?

As both a concept and a movement, “recovery” is increasingly guiding substance use disorder (SUD) services and policy. One sign of this change is the emergence of recovery support services that attempt to help addicted individuals using a comprehensive continuing care model. This paper reviews the policy environment surrounding recovery support services, the needs to which they should respond, and the status of current recovery support models. We conclude that recovery support services (RSS) should be further assessed for effectiveness and cost-effectiveness, that greater efforts must be made to develop the RSS delivery workforce, and that RSS should capitalize on ongoing efforts to create a comprehensive, integrated and patient-centered health care system. As the SUD treatment system undergoes its most important transformation in at least 40years, recovery research and the lived experience of recovery from addiction should be central to reform.

Relationship between prenatal care and maternal complications in women with preeclampsia: Implications for continuity and discontinuity of prenatal care

ObjectivePrenatal care is associated with better pregnancy outcome and may be a patient safety issue. However, no studies have investigated the types and quality of prenatal care provided in northern Taiwan. This retrospective study assessed whether the hospital-based continuous prenatal care model at tertiary hospitals reduced the risk of perinatal morbidity and maternal complications in pre-eclampsia patients. Materials and MethodsOf 385 pre-eclampsia patients recruited from among 23,665 deliveries, 198 were classified as patients with little or no prenatal care who received traditional, individualized, and physician-based discontinuous prenatal care (community-based model), and 187 were classified as control patients who received tertiary hospital-based continuous prenatal care. ResultsThe effects on perinatal outcome were significantly different between the two groups. The cases in the hospital-based care group were less likely to be associated with preterm delivery, low birth weight, very low birth weight, and intrauterine growth restriction. After adjustment of confounding factors, the factors associated with pregnant women who received little or no prenatal care by individualized physician groups were diastolic blood pressure ≥105 mmHg, serum aspartate transaminase level ≥150 IU/L, and low-birth-weight deliveries. This study also demonstrated the dose–response effect of inadequate, intermediate, adequate, and intensive prenatal care status on fetal birth weight and gestational periods (weeks to delivery). ConclusionThe types of prenatal care may be associated with different pregnancy outcomes and neonatal morbidity. Factors associated with inadequate prenatal care may be predictors of pregnancy outcome in pregnant women with pre-eclampsia.