Transitional Care Partners: A hospital‐to‐home support for older adults and their caregivers. Issue 8 (26th November 2012)

• Record Type: Journal Article
• Authors: Hendrix, Cristina; Tepfer, Sara; Forest, Sabrina; Ziegler, Karen; Fox, Valerie; Stein, Jeannette; McConnell, Eleanor S.; Hastings, Susan Nicole; Schmader, Kenneth; Colon‐Emeric, Cathleen
• Is Part Of: Journal of the American Association of Nurse Practitioners. Volume 25:Issue 8(2013)
• Page Start: 407
• Page End: 414
• Publication Date: 2012-11-26
• Subjects: Nurse practitioners -- Periodicals; Nursing -- Periodicals; 610.730692
• DOI: 10.1111/j.1745-7599.2012.00803.x
• Languages: English
• ISSNs: 2327-6886

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="jaan803-sec-0010" sec-type="section"> <title>Purpose</title> <p>To describe the development, implementation, and preliminary results of the Transitional Care (TLC) Partners, a clinical demonstration program that supports the transition from hospital to home of older veterans.</p> </sec> <sec id="jaan803-sec-0020" sec-type="section"> <title>Data sources</title> <p>Hospital records of TLC patients to track their hospital and emergency department visits before and after the TLC Partners enrollment. Caregivers of patients completed Preparedness in Caregiving and the Short Form Zarit Burden Scale during the first week of the TLC Partners enrollment and on the week when the services ended.</p> </sec> <sec id="jaan803-sec-0030" sec-type="section"> <title>Conclusions</title> <p>The proportion of patients with one or more emergency department visits and rehospitalization is consistently lower among TLC patients compared to non‐TLC patients at 30 and 60 days of hospital discharge. The mean preparedness and burden scores before and after the program essentially remained the same.</p> </sec> <sec id="jaan803-sec-0040" sec-type="section"> <title>Implications for practice</title> <p>The description of the implementation of the TLC Partners offers an example of how nurse practitioner‐led interprofessional care models can be adapted to the needs of specific healthcare systems, and how they can be monitored to evaluate their reach, effectiveness, and fidelity to the core components of proved care models.</p> </sec> </abstract>