Nutrition and Healthy Aging in the Community Workshop Summary (2012) / Chapter Skim
Currently Skimming:
3 Transitional Care and Beyond
3 Transitional Care and Beyond
Pages 49-62
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 49... ...
Nutrition services are an important element of transitional care and recovery to ensure that older adults in their homes are well nourished. ROLE OF NUTRITION IN HOSPITAL DISCHARGE PLANNING: CURRENT AND POTENTIAL CONTRIBUTION OF THE DIETITIAN Presenter: Charlene Compher Charlene Compher, associate professor of nutrition science at the University of Pennsylvania School of Nursing, drew on her experiences in a hospital setting at the Hospital of the University of Pennsylvania (HUP)
|
From page 50... ...
There is a growing body of research demonstrating that dietitians can help prevent hospital readmission by providing nutrition counseling that changes patients' behaviors and improves clinical outcomes. Studies have shown that RD counseling can result in weight loss (Raatz et al., 2008)
|
From page 51... ...
RDs provide instructions for people being discharged with home tube feeding and parenteral nutrition support, take part in discharge planning rounds, and communicate with RDs in outpatient care centers. Compher remarked that, while it would be ideal to provide nutrition assessment to all patients, the process is time consuming, hospitals have inadequate RD staff, hospital stays are too short, and hospitals' limited resources are used on patients for whom nutrition interventions will provide the best outcomes.
|
From page 52... ...
Ideally, RDs would be included on the discharge planning team to review hospital records for nutrition care plans that require home support, identify people whose nutrition status has changed and who require increased care, and communicate with staff at outside facilities that provide postdischarge care.
|
From page 53... ...
The ultimate goal for transitional care is "to create a match between the individual's care needs and his or her care setting." Achieving that goal can reduce frequent and costly readmission rates; the Medicare 30-day hospital readmission rate is nearly 20 percent (AHRQ, 2007) and hospitals with high readmission rates are financially penalized under the Affordable Care Act.
|
From page 54... ...
. editable vectors The Care Transitions InterventionTM The Care Transitions InterventionTM (CTI)
|
From page 55... ...
. Preliminary data from evidence-based care transition grants from the Administration on Aging and the Centers for Medicare & Medicaid Services show that 16 states are employing models to help older adults stay in their homes after discharge from hospitals, rehabilitation centers, or skilled nursing facilities, 11 of which are implementing CTI.
|
From page 56... ...
Services provided under the Older Americans Act (OAA) Elderly Nutrition Program aim to promote health, provide nutritious meals that meet current dietary guidelines and older adults' needs, reduce social isolation, and link adults to social rehabilitative services through other home- and community-based long-term care organizations.
|
From page 57... ...
Alabama has a statewide contract with Valley Food Service for preparation of all hot and frozen meals for the state. The benefit of a statewide contract is reduced meal costs; however, it also limits the variety of available foods and results in all state participants receiving the same meal.
|
From page 58... ...
She suggested that service programs and funding streams be brought together to ensure that older adults receive the information, referrals, and care they need. The long-term goal is for older adults to make informed choices for their long-term care, while reducing and controlling Medicaid spending, decreasing nursing home and institutional care, increasing availability of home- and community-based services, and reducing the number of people on waiting lists for nutrition services.
|
From page 59... ...
She also suggested that health care professions using various screening tools collaborate to ensure consistency, and nurses would be amenable to using whatever tool is recommended. Role of Physicians in Referral Process Jennifer Troyer referred to Compher's statement that two-thirds of referrals to RDs for nutrition assessment were from physicians and wondered if it was the same physicians repeatedly making the referrals.
|
From page 60... ...
2008. Crouse Hospital Care Transitions Program.
|
From page 61... ...
2006. A qualitative exploration of a patient centered coaching intervention to improve care transitions in chronically ill older adults.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.