RESUMEN
Care transitions (CT) are critical junctures in the healthcare delivery process. Effective transitions reduce the need for subsequent transfers between healthcare settings, including nursing homes. Understanding social services (SS) involvement in these processes in nursing homes is important from a quality and holistic care perspective. Using logistic regression, this study examines structural and relational factors identified with higher involvement of SS in care transitions and admissions. SS directors from 924 nursing homes were evaluated in relation to SS involvement in care transitions and admissions processes. Results suggest the level of SS involvement in care transitions and admissions are associated with structural factors such as size of facility, geographical location, ratio of FTE's to beds, ownership status, and standalone SS departments, as well as relational factors, including perceptions and utilization of SS staff by facility leadership, coworkers, and family. Additionally, SS staff with higher levels of expertise and with social work degrees are less involved in admissions tasks.
Asunto(s)
Casas de Salud , Transferencia de Pacientes , Hospitalización , Humanos , Propiedad , Servicio SocialRESUMEN
BACKGROUND: There is considerable evidence that exposure to fine particulate matter (PM2.5) air pollution is associated with a variety of adverse health outcomes. However, true exposure-outcome associations are hampered by measurement issues, including compliance and exposure misclassification. OBJECTIVE: This paper describes the use of the design-feedback iterative cycle to improve the design and usability of a new portable PM2.5 monitor for use in an epidemiologic study of personal air pollution measures. METHODS: In total, 10 adults carried on their person a prefabricated PM2.5 monitor for 1 week over 3 waves of the iterative cycle. At the end of each wave, they participated in a 30-minute moderated focus group and completed 2 validated questionnaires on usability and views on research. The topics addressed included positives and negatives of the monitor, charging and battery life, desired features, and changes to the monitor from each previous wave. They also completed a log to record device wear time each day. The log also provided space to record any issues that may have arisen with the device or for general comments during the week of collection. RESULTS: The major focus group topics included device size, noise, battery and charge time, and method for carrying the device. These topics formed the basis of iterative design changes; by the final cycle, the device was reasonably smaller, quieter, held a longer charge, and was more convenient to carry. System usability scores improved systematically across each wave (median scores of 50-66 on a 100-point scale), as did median daily wear time (approximately 749-789 minutes). CONCLUSIONS: Both qualitative and quantitative measures showed an improvement in device usability over the 3 waves. This study demonstrates how the design-feedback iterative cycle can be used to improve the usability of devices manufactured for use in large epidemiologic studies on personal air pollution exposures.