Progressive Patient Care Research Articles

A Few Words about Progressive Care

Progressive patient care means its maximum adaptation to the patient’s needs. Progressive care implies the classification of patients into groups, according to the degree of care required, the use of certain medical-technical and other equipment and the work of professional staff with appropriate training and work experience.

Innovative solutions for disease management

The increasing prevalence of chronic diseases is a driver for emerging big data technologies for healthcare including digital platforms for data collection, systems for active patient engagement and education, therapy specific predictive models, optimized patient pathway models. Powerful bioelectronic medicine tools for data collection, analysis and visualization allow for joint processing of large volumes of heterogeneous data, which in turn can produce new insights about patient outcomes and alternative interpretations of clinical patterns that can lead to implementation of optimized clinical decisions and clinical patient pathway by healthcare professionals.With this perspective, we identify innovative solutions for disease management and evaluate their impact on patients, payers and society, by analyzing their impact in terms of clinical outcomes (effectiveness, safety, and quality of life) and economic outcomes (cost-effectiveness, savings, and productivity).As a result, we propose a new approach based on the main pillars of innovation in the disease management area, i.e. progressive patient care models, patient-centric approaches, bioelectronics for precise medicine, and lean management that, combined with an increase in appropriate private-public-citizen-partnership, leads towards Patient-Centric Healthcare.

Intermediate care units in progressive patient care model: a systematic literature review


 Background: Progressive patient care (PPC) has been defined as a systematic classification and segregation of patients based on their medical and nursing needs. Aim of the present research was to perform a systematic literature review about existing medical intermediate care unit organizational models and their performance strengths and weaknesses with a specific focus on Italian implementation, respect to US model.
 Methods: Databases PubMed, Cinahl, Google and Google Scholar were searched until September 2017. The search was limited to Italian and English studies. All study design are included in the review.
 Results: Ten studies were included in the review. The American studies showed, after the PPC reorganization, an increase in level of satisfaction and nursing care, a reduction in average length of stay, costs and tensions between nurses and an improvement in nurse-physician communication. An Italian study reported the results of a project carried out in three case studies (Forlì, Foligno and Pontedera hospital), redesigning hospital patient flow logistics around the concept of intensity of care: in all three cases, after the reorganization, an increase in bed occupancy rate (before: 71%,81%,65%; after: 78%,84%,82%, respectively) and in hospital case-mix complexity (average DRG weight - before: 0.99,1.07,1.12; after: 1.19,1.09,1.61, respectively) and a reduction in turn-over ratio (before: 2.5,1.4,2.8; after: 1.5,1.2,1.7, respectively) was recorded. Considering Italian healthcare professionals’ point of view, majority of internists supported a hospital remodeling according to PPC model.
 Conclusions: The PPC model, theorized in US, has found several applications in Italian regional realities. Improvements in quality of care, appropriateness and productivity in healthcare facilities, that adopted the PPC program, were observed.

Oregon Health & Science University School of Medicine.

Oregon Health & Science University School of Medicine.

Reexamining the Academic Partnerships with Federal Pharmacy: 2018-19 Argus Commission Report

The Argus Commission examined the history and current status of progressive pharmacy patient care services across several federal branches of government, including the Veterans Administration, Department of Defense, and the U.S. Public Health Service where officers and civilian pharmacists practice in the Indian Health Service, Bureau of Prisons, Area Health Education Centers and other locations. The engagement of pharmacy faculty, students and residents in these practices was assessed. Colleges and schools of pharmacy advocate for the expansion of the capacity for placement of learners in these progressive practices. AACP is encouraged to establish on going collaborations with federal pharmacy leaders to create new opportunities for partnerships that advance patient care, especially for special populations served in these federal programs.

Application of Four in One model for diabetes management in hospital consortium

In 2017, the Diabetes Management Center was founded in Shandong Third Provincial Hospital. On the basis of the center, a network was established which integrated the tertiary hospital, district hospitals, community health service institutions and family of patients forming the Four in One model of diabetes management. This article introduces the background, application, and preliminary accomplishments in individualized and standardized diabetic management of this internet plus model. The challenges and suggestions for future development of theFour in One model are also discussed. Key words: Disease management; Diabetes; Computer communication networks; Progressive patient care; Hospital shared services

The application of a mobile-phone based telemedicine of hierarchical medical system in patients with ST segment elevation myocardial infarction

Objective To explore the effect of a mobile-phone based two-way referral system on the timing of myocardial reperfusion and on a prognosis of patients with ST segment elevation myocardial infarction(STEMI). Methods Patients with STEMI were divided into an intervention group whose first admission clinics were equipped with a telemedicine system at the first medical contact(FMC), and a control group without a telemedicine system at FMC.The rate of heart failure and cardiac death during hospitalization, every time point of transporting process, the value of left ventricular ejection fractions(LVEF)measured at 24 h, and length of hospital stay were collected and compared. Results In comparison of intervention versus control group, the timing of myocardial reperfusion at every time point was shorter(P<0.05), the value of LVEF within 24 h was significantly lower[(46.8±3.9)%]vs[(50.3±5.1)%](t=2.32, P<0.05), the cardiac mortality was lower(4% vs 7%), without statistical significance(χ2=0.19, P=0.66), and the length of hospital stay were lower[(6.35±3.68)d]vs[(8.64±5.19)d]without statistical significance(t=2.75, P=0.01). Conclusions A mobile-phone based telemedicine can significantly shorten the time delay of myocardial reperfusion in patients with STEMI, improve heart function in acute stage, and reduce the length of hospital stay. Key words: Telemedicine; Progressive patient care; Myocardial infarction, ST-segment elevation; Door-to-balloon time

Nursing experience of inter-hospital referral in hierarchical medical system: a qualitative research

Objective To explore the nursing experience of inter-hospital referral in hierarchical medical system, so as to provide references for further improvement in patient referral. Methods From March to April 2017, a total of 16 emergency nurses from a Class Ⅲ Grade A hospital were selected by purposive sampling method. Semi-structured interviews were conducted using the method of phenomenology in qualitative research, and Nvivo 8.0 qualitative analysis software was applied for data collation and analysis. Results In the current stage, the factors causing the poor access of patient referral could be summarized in the evaluation, communication and medical documents. There were 7 themes of it: lack of assessment, poor observation of patients' conditions, poor notification, poor communication between hospitals, lack of effective handover, incompleteness of the medical documents, and irregular of the medical documents. Conclusions It is necessary to strengthen the skills of evaluation and communication of medical staff in the hierarchical medical system. At the same time, standardizing medical documents and improving the efficiency of inter-hospital referral were to improve patients' referral and ensure patients safety. Key words: Progressive patient care; Patient transfer; Disease information transition; Qualitative research

Translating strategy into practice: A tool to understand organizational change in a Spanish university hospital. An in-depth analysis in Hospital Clinic

ABSTRACTPurpose: The progressive patient care (PPC) model, the patient-centered approach, and the lean philosophy are key ‘pillars of change’ in hospital settings. This work aims at providing a clear methodological guidance in evaluating a hospital’s positioning in reference to the main pillars of change, as well as on the effectiveness of how enablers of change are concretely enhanced.Methodology/approach: A mixture of qualitative methods such as semi-structured interviews, ethnographic observations, and informal conversations has been used. The most valuable source of data consists of six interviews to key figures within the hospital.Findings: The PPC organizational model is detected to be Non-strategic. Although highly innovative, the new organizational features do not respond to the typical PPC approach. Patient-centeredness assumes a Developed/Advanced position. ‘Units’ are the major response to the hospital’s strategy of introducing patient centeredness. Finally, the implementation of lean reaches a Starting/Developed positioning. The approach followed is responsive to staff’s engagement and commitment, but implementation is isolated and ‘one-shot’. Its positioning on the scales of three pillars of change seems extremely coherent with the hospital’s strategic priorities. The highest position is reached for patient-centered care, which is the prior objective of the hospital’s main pressures for change.Originality/value: The approach’s major potential is in comparing the hospitals’ current position with its strategy, as well as detecting differences with similar settings. This approach provides hospitals’ management with an effective support in ranking priorities through insights on which enabling tools should urgently be further developed.

Exploring \u201cpatient-centered\u201d hospitals: a systematic review to understand change

BackgroundThe healthcare scenario in developed countries is changing deeply: patients, who are frequently affected by multi-pathological chronic conditions, have risen their expectations. Simultaneously, there exist dramatic financial pressures which require healthcare organizations to provide more and better services with equal (or decreasing) resources. In response to these challenges, hospitals are facing radical transformations by bridging, redesigning and engaging their organization and staff.MethodsThis study has the ambitious aim to shed light and clearly label the trends of change hospitals are enhancing in developed economies, in order to fully understand the presence of common trends and which organizational models and features are inspiring the most innovative organizations. The purpose is to make stock of what is known in the field of hospital organization about how hospitals are changing, as well as of how such change may be implemented effectively through managerial tools. To do so the methodology adopted integrates a systematic literature review to a wider engaged research approach.ResultsEvidence suggests that the three main pillars of change of the system are given by the progressive patient care model, the patient-centered approach and the lean approach. However, there emerge a number of gaps in what is known about how to exploit drivers of change and their effects.ConclusionsThis study confirms that efforts in literature are concentrated in analyzing circumscribed experiences in the implementation of new models and approaches, failing therefore to extend the analysis at the organizational and inter-organizational level in order to legitimately draw consequences to be generalized. There seem to be a number of “gaps” in what is known about how to exploit drivers of change and their effects, suggesting that the research approach privileged till now fails in providing a clear guidance to policy makers and to organizations’ management on how to concretely and effectively implement new organizational models.

CE: Nursing's Evolving Role in Patient Safety.

Our aim in conducting this content analysis of AJN articles was to explore the nurse's historical and contemporary role in promoting patient safety. We chose to focus on AJN because, as the oldest continuously published nursing journal, it provided a unique opportunity for us to view trends in nursing practice over more than 100 years. We reviewed all AJN tables of contents from 1900 through 2015, identifying for inclusion articles with titles that suggested a focus on nursing care, patient safety, or clinical content. We then read and analyzed each of the final 1,086 articles over a period of nine months. Our content analysis indicates that the early articles (from 1900 through 1920) focused on such safety measures as asepsis and the newly understood germ theory. In the 1930s, articles proposed methods for preventing medication errors and encouraged the development of written procedures to standardize care. During World War II, nurse authors identified improved patient survival rates with the use of "shock wards" and recovery rooms. The 1950s saw the emergence of progressive patient care initiatives, through which patients were assigned to various levels of care (intensive, intermediate, self, long-term, or home care) based on patient acuity. The 1960s brought increasingly complex equipment and medication regimens, which created safety problems. Hospital-acquired infections were recognized. Unit-dose medication was instituted in the 1970s. In the next two decades, medication and nursing-procedure safety were emphasized. From 2000 to 2015, articles looked beyond human performance as causes of health care errors to systemic factors, such as poor communication, patient-nurse ratios, provider skill mix, disruptive or inappropriate provider behavior, shift work, and long working hours. Emphasis on patient safety increased as patient care became more complex. As nurses developed a professional identity, they often put a spotlight on safety concerns and solutions. The IOM report, which encouraged research focused on systemic solutions to errors, was instrumental in furthering the very culture of safety that the nursing profession had championed.

The Health Care System and Training Specialist in Intensive Care Medicine and Emergency in Cuba

Introduction: The contemporary social development requires the presence of specialists to ensure the quality of health services. Objective: To characterize the system of care and specialty medical training in intensive care medicine and emergency in Cuba. Methods: A historical research was conducted; the analytic-synthetic, historical and logical, and system approach modeling methods were used. Opinions of key informants and previous research concentrated. It was held a socio-demographic and influence of the specialty in the Cuban national health system study. Results: Cuba has a health behavior of developed countries. There are 17 mobile medical emergency centers, 120 municipal intensive areas and 109 hospital intensive care rooms with 1906 beds. There are 3286 specialists and residents working on stage specialty, which have increased in the last decade. There have been two ways of training specialists, with two output profiles: adult and pediatric, incorporating emergency profile is necessary. The role played by the Cuban Society of Intensive Care and Emergency Medicine, and the system of care specialty in Cuba is expressed. Conclusion: A continuous and progressive patient care with emergencies or emergencies, severe or critical, passing through the healthcare network and where there is always a specialist who combines the knowledge and skills of intensive medicine emergency medicine and emergencies is provided. It is necessary to update the curriculum by increasing the occupational profile and work scenarios.

Perioperative nursing of patients undergoing hybrid coronary revascularization

Objective This study described our experience on perioperative nursing care for hybrid revascularization by endoscopic robotic coronary artery bypass on the beating heart with percutaneous coronary intervention （ PCI） in a staged approach .Methods Patients undergoing hybrid coronary revascularization from January 2007 to September 2013 were included in the study .The progressive patient care was different compared with conventional coronary artery bypass graft surgery （ CABG ） , so the health education and specific nursing were of great importance in different phases .The preoperative angina pectoris attacks therapy and pulmonary function training were necessary , and the hemodynamic monitoring , hemorrhage volume record , lung caring, pain therapy and anticoagulation after robotic assisted CABG were also important .At the same time, the intensive anticoagulation before PCI and renal injury , arterial hemorrhage prevention after PCI needed much attention.Results There was no death patients during the study phase . After the hybrid coronary revascularization, patients were stable and no severe complication was occurred .After 2 days of surgery, patients could take a walk at bedside .The mean time of ICU stay was （37.8 ±5.6） hours.After PCI, no bypass vascular stenosis occurred .Conclusions The comprehensive perioperative nursing care is necessary for patients received hybrid coronary revascularization surgery . Key words: Coronary artery bypass graft,extracorporeal circulation; Robot; Support; Hybrid; Perioperative nursing

Progressive Patient Care Model and its application into hospital organization: a narrative review

Aim of this article is to review the literature about the Progressive Patient Care Model, in particular its conceptual and practical characteristics, its implementation and effects on the current health care organization. Was conducted by an integrative-narrative literature review. The Progressive Patient Care is a model which aims at group patients according to their complexity in order to place patients in the most appropriate care setting. The original model consists on five care levels: intensive care, intermediate care, self-care, long term care, home care.In Italy the above mentioned model can be considered as a contextualization of Progressive Patient Care in the light of similarities both in terms of model purposes and care levels classification. The organization for intensive care levels is an opportunity for Italian healthcare facilities to reach continuity of care. This model emphazises care processes looking to patients' needs rather than a division according to criteria of specialties.

Standardized early medical care of Lushan earthquake victims in army hospitals

Objective To summarize the experiences with early treatment of the wounded associated with 4 · 20 Lushan earthquake in army hospitals.Methods Emergency response programs were started and tent hospitals were set up.According to the basic principle of wartime wound treatment regulation,emergency triage,emergency medical care,transferring,specialized treatment and evacuation were performed for the wounded in this earthquake.Results After the earthquake,the emergency rescue programs were started in the hospital.Twenty minutes later,emergence medical team with full equipment were set out for the epicenter and the tent hospitals were set up.A total of 181 earthquake cases were admitted within two weeks,of which 68 (37.6％) were transferred from the scene of earthquake and 113 (62.4％) were transferred after the primary treatment (including cases evacuating from other hospitals).Forty-nine surgeries had been done,including 30 emergence ones.Thirty-four cases (including 14 severe wounded) were evacuated to superior hospitals as their vital signs turned stable.There was no death or surgical wound infection.Conclusions Peacetime complete emergence programs and materials reserves,unified and well-organized command as well as normative grading treatment system in army hospitals assure the standardized medical care with high efficiency and high quality for earthquake victims.However,more researches are needed over diagnosis methods and standards for wound severity,equipment improvement and standards for casualty evacuation. Key words: Wounds and injuries; First aid; Progressive patient care; Earthquakes

Role of internal medicine in a new model of hospital: a proposal of Tuscany’s FADOI

BACKGROUND The Tuscany’s FADOI society proposes the role of internal medicine in a new model of hospital care. The cornerstones of this new model are the “care intensity” and the “department”. We propose that hospital care should be organized so that the patient and his needs represent the core of this care system, in accordance with the idea of the progressive patient care. This aim can be obtained by dividing the hospital’s areas for intensity of care and, therefore, going beyond the present model of hospital care, where the patients are treated in specialty divisions. This new model of care may find its own execution within the department. For medical area, the department of medicine undoubtedly offers a strong multidisciplinary integration and favours the organization for intensity of care. The management of a large amount of patients should be left to the internist. In fact, because of his olistic formation, this clinician seems more appropriate than the other specialists to play this role. The specialists will take care of those patients who suffer from disturbances with a strong specialistic characterization, and in other cases acting as consultants. CONCLUSIONS In Tuscany we can now view various experiences which are trying to experiment this model. Results are encouraging. Starting from these results and greatly believing in them, we offer this contribute to the internists who work in hospital, persuaded to draw from them useful matters for discussion.

Feasibility study on nursing standards of nursing home for the elders

We investigated health condition and evaluate the viability of Barthel's measuring scale for 1297 elder patients at 17 nursing homes.We nursed all patients by standards and performed a comparison study.The nursing percentages of highest and lowest levels were higher than the previous ones ( P ＜ 0.01 ),while the nursing percentage of normal level was lower than the previous one ( P ＜ 0.01 ).The cooperation between doctors and nurses became optimized through progressive patient care.Ideal nursing standard should be based upon the doctors' judgment and nurses' evaluation.The new standard will be more suitable for patients and easier to control for nurses. Key words: Geriatric nursing; Progressive patient care

The history of geriatric medicine. The present: Problems and opportunities

Geriatric medicine has contributed to the advance of medicine by bringing into several basic principles, most of them consolidated nowadays as standard care. Some of these principles have been “exported” to other specialities. Among these principles are: fighting against immobility, multidisciplinary teams, orthogeriatic care, day hospitals, progressive patient care, home care, memory clinics and stroke units, the importance of environment, the value of quality of life, the fight against ageism, the description of geriatrics’ syndromes, and the introduction of Comprehensive Geriatric Assessment as a working tool. At present we must find valid answers to questions like: who are we today? Who are our target patients? Or where is geriatric medicine nowadays? Among the main challenges of geriatric medicine are: to reach a universal presence of geriatric medicine in the public health care system of every country, to incorporate teaching of geriatric medicine to every School of Medicine, to contribute to establish good public health educational programmes for older people, to reach comprehensive, inclusive and successful coordination of medical and social services for older individuals, and to fight against all forms of ageism. We must, also, to take into account as priorities clinical research and prevention. Finally, it is necessary to avoid some risks. The main of them are the temptation of the so-called “antiaging” ideas, or to fall in rivalry or competence with other specialities.

Do Hospital-to-Home Transitional Care Programs for Older Adults Address Palliative Care Domains? A Systematic Review (703)

1.To understand and appreciate the complexities challenging patients, caregivers, and health care providers alike in preparing frail hospitalized older adults to transition home from an acute hospitalization.2.To gain an appreciation of the paucity of palliative care domains addressed in existing hospital-to-home care transitions literature.3.To challenge all providers invested in the care of hospitalized elderly adults to better incorporate palliative care domains, especially those regarding care of the imminently dying and ethical / legal aspects of care, when designing future hospital-to-home transitional care programs. Transitional care programs focus on providing patients/families with resources/support to regain function post-hospitalization and reduce readmissions. Hospital palliative care teams are often consulted for patients imminently dying. These separate approaches overlook patients going home who aren't imminently dying, but have life-limiting chronic conditions with unmet palliative needs. Review literature on hospital-to-home transitional care programs for elderly to determine extent to which domains of palliative care are addressed. Design: Structured content analysis of studies published 1985-2008 using search terms: progressive patient care, after-care, transitional programs, and related terms. Databases: CINAHL, EMBASE, MEDLINE, EBM Reviews (CCRCT/CDRS/DARE). Inclusion criteria: English, >50% subjects >age 60, studies of hospital-to-home transitions. Strategy: Developed structured scoring tool based on National Consensus Project for Quality Palliative Care “Clinical Practice Guidelines” assessing 8 domains: Structure/Processes; Physical; Psychological/Psychiatric; Social; Spiritual, Religious & Existential; Cultural; Care of Imminently Dying; and Ethical/Legal. Domains scored: 0-content absent; 1-content minimally helpful; 2-content very helpful. Total score: 0-16. Descriptive statistics reported. We identified 1182 titles; 903 were eliminated (not meeting inclusion criteria) after inspection of titles/abstracts. 279 publications were selected for independent review by authors EB/GS. Ultimately 83 articles met inclusion criteria, were analyzed and scored. Domains were identified 340 out of a possible 664 times (51.2%). Physical aspects was identified in all 83 articles and Social aspects in 82 (98.8%). Ethical/Legal aspects was identified in only 9 (10.8%) of all articles reviewed, and Care of Imminently Dying merely 6 (7.2%) times. Physical and Social aspects were scored with mean of 1.771 (SD 0.422) and 1.831 (SD 0.408), respectively.

Oregon Health &amp; Science University School of Medicine

Number of Activities: 145 Number of Hours of Instruction: 1,964 Number of Physician Participants: 29,136 Number of Other Learners: 17,094 Received Commercial Support: Yes Received Income from Advertising or Exhibits: Yes Participated in Joint Providership: Yes Offered Courses: Yes Offered Enduring Materials: Yes Offered Internet Enduring Materials: Yes Offered Performance Improvement: Yes Offered RSS: Yes Offered Test Item Writing: Yes