BACKGROUND: After hospitalization for cardiac disease, older patients are at high risk of readmission and death. Although geriatric conditions increase this risk, treatment of older cardiac patients is limited to the management of cardiac diseases. The aim of this study is to investigate if unplanned hospital readmission and mortality can be reduced by the Cardiac Care Bridge transitional care program (CCB program) that integrates case management, disease management and home-based cardiac rehabilitation.METHODS: In a randomized trial on patient level, 500 eligible patients ≥ 70 years and at high risk of readmission and mortality will be enrolled in six hospitals in the Netherlands. Included patients will receive a Comprehensive Geriatric Assessment (CGA) at admission. Randomization with stratified blocks will be used with pre-stratification by study site and cognitive status based on the Mini-Mental State Examination (15-23 vs ≥ 24). Patients enrolled in the intervention group will receive a CGA-based integrated care plan, a face-to-face handover with the community care registered nurse (CCRN) before discharge and four home visits post-discharge. The CCRNs collaborate with physical therapists, who will perform home-based cardiac rehabilitation and with a pharmacist who advices the CCRNs in medication management The control group will receive care as usual. The primary outcome is the incidence of first all-cause unplanned readmission or mortality within 6 months post-randomization. Secondary outcomes at three, six and 12 months after randomization are physical functioning, functional capacity, depression, anxiety, medication adherence, health-related quality of life, healthcare utilization and care giver burden.DISCUSSION: This study will provide new knowledge on the effectiveness of the integration of geriatric and cardiac care.TRIAL REGISTRATION: NTR6316 . Date of registration: April 6, 2017.
A keynote address, introducing the pdca quality systeem into education in prosthetics and orthotcs.
from the article: Abstract Based on a review of recent literature, this paper addresses the question of how urban planners can steer urban environmental quality, given the fact that it is multidimensional in character, is assessed largely in subjective terms and varies across time. The paper explores three questions that are at the core of planning and designing cities: ‘quality of what?’, ‘quality for whom?’ and ‘quality at what time?’ and illustrates the dilemmas that urban planners face in answering these questions. The three questions provide a novel framework that offers urban planners perspectives for action in finding their way out of the dilemmas identified. Rather than further detailing the exact nature of urban quality, these perspectives call for an approach to urban planning that is integrated, participative and adaptive. ; ; sustainable urban development; trade-offs; quality dimensions
