Home visit by case manager reduces readmission. Roslin, N. B., Tun, M. H., Ng, F. L., Neo, L. P., Oh, J. S. Y., & Ng, A. Annals of the Academy of Medicine Singapore, 39(11 SUPPL. 1):S288, 2010.
Home visit by case manager reduces readmission [link]Paper  abstract   bibtex   
Background/Hypothesis: Chronic Obstructive Pulmonary Disease (COPD) is a common disease afflicting millions of people worldwide and has resulted into heavily burdened global disease. In Singapore, it is the eighth leading cause of death and the top six conditions for hospitalisation. Currently, case managers have been providing patients with knowledge of the disease process and progression, reinforcing on compliance to medication and follow-up adherence. Coping strategies and energy conservation techniques were also shared. Other initiatives include encouraging patient to take flu or pneumoccocal vaccination, attend pulmonary rehabilitation and providing smoking cessation counselling. Home care programs aim to improve disease management, quality of life and prevent disease exacerbation, thereby reducing hospital admissions. Method(s): Twenty patients have been identified and visited since November 2008. 20% (n = 4) of them are in Stage 2, 60% (n = 12) in Stage 3 and 20 % (n = 4) are in stage 4. Over 12 months, their readmission rates within 30 days before home visit are tracked. Readmission within 30 days post home visit will be monitored. Result(s): Before initiation of home visitations, 40% (n = 8) of patients were reported having readmission within 30 days. A total of 34 episodes of readmission were reported among them. For post home visit, 55% (n = 11) were readmitted within 30 days. Their average length of stay per readmission is 4 days. Discussion & Conclusion(s): Our results suggested an increase in readmission after post home visit. Case managers learnt the need to identify other services gaps such as linking social support for patient and their caregivers. With these initiatives, we aim improve the patient quality of life and reducing hospital readmission within 30 days.
@article{roslin_home_2010,
	title = {Home visit by case manager reduces readmission},
	volume = {39},
	issn = {0304-4602},
	url = {http://www.annals.edu.sg/pdf/39VolNo11SupplNov2010/V39N11(Suppl).pdf http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed11&NEWS=N&AN=71796148},
	abstract = {Background/Hypothesis: Chronic Obstructive Pulmonary Disease (COPD) is a common disease afflicting millions of people worldwide and has resulted into heavily burdened global disease. In Singapore, it is the eighth leading cause of death and the top six conditions for hospitalisation. Currently, case managers have been providing patients with knowledge of the disease process and progression, reinforcing on compliance to medication and follow-up adherence. Coping strategies and energy conservation techniques were also shared. Other initiatives include encouraging patient to take flu or pneumoccocal vaccination, attend pulmonary rehabilitation and providing smoking cessation counselling. Home care programs aim to improve disease management, quality of life and prevent disease exacerbation, thereby reducing hospital admissions. Method(s): Twenty patients have been identified and visited since November 2008. 20\% (n = 4) of them are in Stage 2, 60\% (n = 12) in Stage 3 and 20 \% (n = 4) are in stage 4. Over 12 months, their readmission rates within 30 days before home visit are tracked. Readmission within 30 days post home visit will be monitored. Result(s): Before initiation of home visitations, 40\% (n = 8) of patients were reported having readmission within 30 days. A total of 34 episodes of readmission were reported among them. For post home visit, 55\% (n = 11) were readmitted within 30 days. Their average length of stay per readmission is 4 days. Discussion \& Conclusion(s): Our results suggested an increase in readmission after post home visit. Case managers learnt the need to identify other services gaps such as linking social support for patient and their caregivers. With these initiatives, we aim improve the patient quality of life and reducing hospital readmission within 30 days.},
	language = {English},
	number = {11 SUPPL. 1},
	journal = {Annals of the Academy of Medicine Singapore},
	author = {Roslin, N. B. and Tun, M. H. and Ng, F. L. and Neo, L. P. and Oh, J. S. Y. and Ng, A.},
	year = {2010},
	keywords = {*Singapore, *case manager, *health, *hospital readmission, *human, *professional practice, caregiver, cause of death, chronic obstructive lung disease, coping behavior, counseling, disease exacerbation, disease management, drug therapy, energy conservation, follow up, home care, hospital admission, influenza, length of stay, patient, pulmonary rehabilitation, quality of life, smoking cessation, social support, vaccination},
	pages = {S288}
}

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