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Publications (160)
Older adults are often accompanied by their family caregivers during hospitalization and their attitudes could influence care processes and outcomes. However, little is known about the cultural differences of family-caregivers attitudes. We aim to explore cultural differences in family-caregivers’ attitudes toward in-hospital mobility of hospitaliz...
Improving mobility among hospitalized older adults remains a challenge. Qualitative research indicates that patients’ attitudes are one of the key factors associated with mobility levels. According to the Family Centered Approach, family members have an influence on both patients’ attitudes and actual mobility that are yet to be supported empirical...
Family support is important for older adults during hospitalization; however this stressful period can exacerbate or precipitate conflicts between patients and their caregivers. We aimed to identify predictors of conflicts between hospitalized older adults and family caregivers across individual, social, and cultural levels of ecological model, uti...
Cultural differences are significantly related to the management of illness and symptoms, particularly in hospitalized older adults where medications are often employed for health stabilization. This study aimed to examine cultural variations in medication burden, specifically focusing on sedative and anticholinergic medications, among older patien...
Cultural differences are significantly related to the management of illness and symptoms, particularly in hospitalized older adults where medications are often employed for health stabilization. This study aimed to examine cultural variations in medication burden, specifically focusing on sedative and anticholinergic medications, among older patien...
Psychiatric rehabilitation for people with severe mental illness (SMI) has many documented benefits, but less is known about cultural related aspects. To date, no comparison of psychiatric rehabilitation outcomes between Israeli Jews and Israeli Arabs has been carried out. Thus, the purpose of the present study was to compare the outcome measures o...
Background
The high rates of psychiatric re-hospitalizations (also termed “revolving door”) presents a “wicked problem” which requires a systematic and holistic approach to its resolution. Israel’s mental-health rehabilitation law provides a comprehensive set of services intended to support the ability of persons with severe mental illness to rely...
Introduction:
Studies of community-dwelling older adults find subjective age affects health and functional outcomes. This study explored whether younger subjective age serves as a protective factor against hospital-associated physical, cognitive, and emotional decline, well-known consequences of hospitalization among the elderly.
Methods:
The pa...
Most of hospitalized older adults receive instrumental care (such as help with dressing, bathing, eating) from hospital staff and family members. Current study explored effect of family and staff involvement in this kind of care on hospitalization outcomes. Study sample included 615 acute hospitalized older adults (Age 77.6± 6.7, females 44.3%). Da...
Background
The high rates of psychiatric re-hospitalizations (also termed “revolving door”) presents a “wicked problem” which requires a systematic and holistic approach to its resolution. Israel’s mental-health rehabilitation law provides a comprehensive set of services intended to support the ability of persons with Severe Mental Illness (SMI) to...
Background:
low mobility of hospitalised older adults is associated with adverse outcomes and imposes a significant burden on healthcare and welfare systems. Various interventions have been developed to reduce this problem; at present, however, their methodologies and outcomes vary and information is lacking about their long-term sustainability. T...
Background
Low in-hospital mobility is widely acknowledged as a major risk factor in acquiring hospital-associated disabilities. Various predictors of in-hospital low mobility have been suggested, among them older age, disabling admission diagnosis, poor cognitive and physical functioning, and pre-hospitalization mobility. However, the universalism...
Subjective age contributes to a range of health and functional outcomes in older adults. Most of the evidence comes from studies in community dwelling older adults. The current study explores whether younger subjective age serves as a protective factor against hospital associated physical, cognitive, and emotional decline. This paper is a secondary...
Objectives
The Necesidades Paliativas CCOMS-ICO© (NECPAL) screening tool was developed to identify patients in need of palliative care and has been used in Israel without formal translation, reliability testing, or validation. Because cultural norms significantly affect subscales such as social vulnerability and health-care delivery, research is ne...
Background
Nurse champions are front-line practitioners who implement innovation and reconstruct policy.
Purpose
To understand through a network theory lens the factors that facilitate nurse champions’ engagement with radical projects, representing their actions as street-level bureaucrats (SLBs).
Materials and methods
A personal-network survey w...
Objective: Low in-hospital mobility is widely acknowledged as a major risk factor in acquiring hospital-associated disabilities. Various predictors of in-hospital mobility limitations have been proposed across studies, however, it is unknown whether similar risk factors are associated with in-hospital mobility across countries, given different mobi...
Objectives
Patients with haematological malignancies receiving immunosuppressive therapy are at highest risk of invasive pneumococcal disease. Our goal was to investigate whether vaccination of haematological patients with pneumococcal 13-valent conjugated vaccine (PCV13) prior to therapy initiation is associated with decreased hospital admissions...
Background
Evidence from various sources suggests that females with schizophrenia tend to report lower quality of life than males with schizophrenia despite having a less severe course of the disorder. However, studies have not examined this directly.
Aims
To examine gender differences in the association between quality of life and the risk of sub...
Low levels of in-hospital mobility and excessive bed rest are widely described across the globe as a major risk factor for hospital associated disabilities. Different predictors of in-hospital and post-discharge mobility limitations have been proposed across studies, including age, admission diagnosis, physical performance, cognitive impairment, pe...
Life-space mobility (LSM) is critical to aging successfully since it is essential to maintain independence, affecting the health and quality of life of older adults. During the COVID-19 pandemic older adults, who are at high-risk of serious illness and complications, are restricted by stay-at-home orders, limiting their outdoor activities. This stu...
Aim
This study explores the potential benefit of combining clinicians’ risk assessments and the automated 30-day readmission prediction model.
Background
Automated readmission prediction models based on electronic health records are increasingly applied as part of prevention efforts, but their accuracy is moderate.
Methods
This prospective multi-...
Many older adults need help with Activities of Daily Living (ADL) and emotional support during hospitalization. Hospital staff is officially responsible for care, but most older adults are accompanied by family members who provide at least some of the support. In this study, we asked physicians, nurses, nursing assistants, and relatives about hospi...
Mobile health (mHealth)—hand-held technologies to address health priorities—has significant potential to answer the growing need for patient chronic illness self-care interventions. Previous reviews examined mHealth effect on patient outcomes. None have a detailed examination and mapping of specific technology features to targeted health outcomes....
Background
Performance of function-preserving hospitalization processes related to patient mobility, use of continence aids and food intake is significantly associated with outcomes in older adults. Nurses are the front-line personnel responsible for promoting performance of such processes. The degree to which nurse staffing is related to this perf...
Background
Parents of children following traumatic medical events (TMEs) are known to be at high risk for developing severe post-traumatic stress symptoms (PTSS). Findings on the negative impact of TMEs on parents’ PTSS have been described in different cultures and societies. Parents from ethnic minority groups may be at particularly increased risk...
Background:
Oral anticancer therapy (OACT) poses adherence-related challenges to patients while generating a setting in which both primary care physicians (PCPs) and oncologists are involved in the active treatment of cancer. Continuity of care (COC) was shown to be associated with medication adherence. While maintaining COC is a central role of t...
Objectives
To assess whether the extent of deviation from chronic disease guideline recommendations is more prominent for specific diseases compared with combined-care across multiple conditions among multimorbid patients, and to examine reasons for this deviation.
Design
A cross-sectional cohort.
Setting
Multimorbidity care management programme...
Background: Parents of children following a traumatic medical event (TME) are known to be at high risk for developing severe post-traumatic stress symptoms (PTSS). Findings on the negative impact of TMEs on parents’ PTSS have been described in different cultures and societies worldwide. However, in some cases, a specific ethnic group may also be a...
Hospitalization processes related to patient mobility and food-intake significantly affect outcomes of older adults. Nurses are the front-line personnel responsible for promoting performance of these functioning-preserving processes. The degree to which nursing skill-mix is related to their performance is unclear. We investigated the association be...
Reasons why care does not conform to single-disease guideline recommendations for multimorbid patients have not been systematically measured in practice. Using a mixed methods approach, we identified and quantified types of reasons why care deviates from nine sets of disease guideline recommendations for multimorbid patients. Utilizing a focus grou...
Aims
To: (1) Assess patients’ interest and perceived capability of participating in hemodialysis; (2) Assess nurses’ perceptions of patients’ interest and perceived capability of participating in hemodialysis; (3) Examine associations between patient characteristics and interest and perceived capability of performing hemodialysis self‐care.
Design...
Introduction
Informal caregiving during hospitalization of older adults is significantly related to hospital processes and patient outcomes. Studies in home settings demonstrate that ethno-cultural background is related to various aspects of informal caregiving; however, this association in the hospital setting is insufficiently researched.
Object...
Aims:
To develop and test the relationship between nurse champions' personal social networks and innovation success in terms of spread.
Design:
A cross sectional.
Method(s):
Data were collected on 94 nurse champions at three medium-large tertiary medical centres from 2015-2016. Data from champions on their personal network were assessed via a...
Objective:
This study examined whether personal characteristics of consumers with serious mental illness (SMI), including being an immigrant, explained the lack of concordance in quality-of-life (QOL) ratings reported by consumers versus those reported by staff caring for consumers.
Method:
In a sample of consumers with SMI (n = 4,956), including...
Self‐management, or self‐care, by individuals and/or families is a critical element in chronic illness management as more care shifts to the home setting. Mobile device‐enhanced health care, or mHealth, is being touted as a means to support self‐care. Previous mHealth reviews examined the effect of mHealth on patient outcomes, however, none used a...
Introduction Informal caregiving during hospitalization of older adults is significantly related to hospital processes and patient outcomes. Studies in the home settings demonstrate that ethno-cultural background is related to various aspects of informal caregiving; however, this association in the hospital setting was insufficiently researched.
Ob...
Introduction Informal caregiving during hospitalization of older adults is significantly related to hospital processes and patient outcomes. Studies in home settings demonstrate that ethno-cultural background is related to various aspects of informal caregiving; however, this association in the hospital setting is insufficiently researched.
Objecti...
The COVID-19 is disproportionally affecting the poor, minorities and a broad range of vulnerable populations, due to its inequitable spread in areas of dense population and limited mitigation capacity due to high prevalence of chronic conditions or poor access to high quality public health and medical care. Moreover, the collateral effects of the p...
Objective:
Persons with serious mental illnesses are at increased risk for co-occurring physical comorbidities. Patient-reported outcome measures are increasingly used in routine assessments of persons with serious mental illnesses, yet the relation of patient-reported outcome measures to physical health outcomes has not been comprehensively inves...
Aim
To assess the relationship between continuity in nursing assignment in older adults' acute hospitalization and patient experience and functional decline.
Background
In‐hospital functional decline affects up to 40% of hospitalized older adults. Nurses are responsible for performing functioning preserving interventions. Whether continuity of nur...
Objective:
Vocational rehabilitation for people with severe mental illness (SMI) has many benefits. Among the existing models, supported employment has consistently shown to have better impact on vocational outcomes while the findings on non-vocational outcomes are inconsistent. One source of variation with regard to non-vocational outcomes could...
Background:
Disease-specific guidelines are not aligned with multimorbidity care complexity. Meeting all guideline-recommended care for multimorbid patients has been estimated but not demonstrated across multiple guidelines.
Objective:
Measure guideline-concordant care for patients with multimorbidity; assess in what types of care and by whom (c...
Background
Predictive models based on electronic health records (EHRs) are used to identify patients at high risk for 30-day hospital readmission. However, these models’ ability to accurately detect who could benefit from inclusion in prevention interventions, also termed “perceived impactibility”, has yet to be realized.Objective
We aimed to explo...
We study a large intervention intended to reduce hospital readmission rates in Israel. Since 2012, readmission risk was calculated for patients aged 65 and older, and high-risk patients were flagged to providers upon admission and after discharge. Analyzing 171,541 admissions during 2009–2016, we find that the intervention reduced 30-day readmissio...
In-hospital cognitive decline affects up to 40% of hospitalized older adults and is associated with post-hospitalization worsening of medical and functional status. Studies pointed to the substantial role of the interpersonal relationship between older adults with cognitive impairment and the nurses who care for them. We investigated the associatio...
Evaluation of in-hospital mobility programs is usually short-term. To examine the sustainability of Walk-FOR (Walk for Outcome and Recovery), an in-hospital mobility program in internal-medicine older (70+) patients, we conducted a quasi-experimental pre-post four-group comparative study. Walk-FOR incorporated policies encouraging patients to walk...
Purpose
To explore factors associated with necessity beliefs and concerns among patients receiving oral anticancer therapy (OACT) and, specifically, to examine the relationship between continuity of care (COC) and patients’ beliefs about OACT.
Methods
A cross-sectional study was conducted among patients from four oncology centers receiving OACT (e...
Introduction: Care transitions from hospital to outpatient care are a particularly vulnerable period in the care trajectory especially among minority patients, due to cultural and linguistic barriers that affect the comprehension of medical instructions and the ability to navigate among the various settings. Objectives: The study examines whether q...
Introduction: healthcare systems worldwide are constantly shifting from an acute, disease focused, and episodic orientation to an approach that acknowledges the increasing prevalence of chronic illness. Patients with chronic conditions and their families must cope with multifaceted challenges – managing symptoms, disability, emotional impacts, comp...
Introduction: Patient centred care is often at odds with disease-focused evidence-based clinical practice, particularly for patients with multiple chronic conditions (CCs). To assess the extent to which care for patients with multimorbidity was not guideline-concordant and the reasons why not, examining reasons stratified by disease. Methods: Retro...
Introduction: Most of readmission prediction models are implemented at the time of patient discharge. [1] However, interventions which include an early in-hospital component are critical for reducing readmissions and improving patient outcomes. [2] Thus, at-discharge high-risk identification may be too late for effective intervention. Nonetheless,...
Aim:
Poor food intake is a major concern among hospitalized older adults. This study investigated the frequency and optimal timing of in-hospital food intake assessment in terms of its ability to predict hospitalization functional outcomes.
Methods:
Secondary analysis of a cohort study of 699 older adults (age ≥70 years) admitted to internal med...
Background:
Most of readmission prediction models are implemented at the time of patient discharge. However, interventions which include an early in-hospital component are critical in reducing readmissions and improving patient outcomes. Thus, at-discharge high-risk identification may be too late for effective intervention. Nonetheless, the tradeo...
The two components of hope (i.e., hope‐agency defined as the ability to envision and believe in one's ability to achieve goals; hope‐pathway defined as belief in one's ability to devise strategies to achieve one's goals) propel adolescents toward well‐being, academic achievement and personal fulfillment. This study compares levels of hope and its c...
Objectives
The study examines whether hospital discharge practices and care-transition preparedness mediate the association between patients’ cultural factors and readmissions.
Methods
A prospective study of internal medicine patients (n=599) examining a culturally diverse cohort, at a tertiary medical centre in Israel. The in-hospital baseline qu...
Objective:
The objective of this study was to evaluate the incremental predictive power of electronic medical record (EMR) data, relative to the information available in more easily accessible and standardized insurance claims data.
Data and methods:
Using both EMR and Claims data, we predicted outcomes for 118,510 patients with 144,966 hospital...
Objective:
We examined whether patients' ratings of their in-hospital discharge briefing and their post-discharge Primary Care Physicians' (PCP) review of the discharge summary are associated with 30-day readmissions.
Methods:
A prospective study of 594 internal-medicine patients at a tertiary medical-center in Israel. The in-hospital baseline q...
Background:
Frontline nurse champions are key innovation-implementation agents. Despite the growing interest in nurse champions' innovation, whether project novelty is a product of championship behavior (e.g., expressing confidence in the innovation's success and network building), the project's contextual characteristics (project type and initiat...
The complex nature of studying health and healthcare disparities in general, and in the context of the Israeli healthcare system in particular, is depicted in two recent IJHPR articles. The first examines Emergency Department (ED) waiting times in a tertiary children’s hospital and the second examines disparities in the health care for people with...
Processes related to daily care of older adults during hospitalization, such as mobility and nutrition, have long-term consequences for their health and functioning. Although instrumental support provided by family members during hospitalization is highly prevalent, its relationship to older adults’ actual walking and eating is unknown.
Data on wal...
Documentation of primary care teams’ involvement in disparity reduction efforts exists, yet little is known about how teams interact or perceive their effectiveness. We investigated how the social network and structural ties among primary-care-clinic team members relate to their perceived team effectiveness (TE), in a large-scale disparity reductio...
Poor food-intake is a major concern among older adults. Large-scale surveys described patterns of food-intake among hospitalized older adults, yet, they are limited to episodic assessment. We performed a consecutive 3-day assessment of the amount actually consumed of the three main meals during internal-medicine hospitalizations of older adults. A...
Mobility and nutrition during acute hospitalization have long-term consequences on older adults’ functioning, yet their performance remains poor. Instrumental support provided by family members or friends during hospitalization is highly prevalent, as up to 77–96% of older adults are accompanied by informal caregiver. The effect of this support on...
Aims
To identify the sociodemographic attributes, project characteristics, and champion strategies that differentiate formal from informal nursing champions, and to test their success in terms of project spread and novelty.
Background
Champions spread innovation in healthcare organizations. Empirical research has not explored the differences betwe...
Objectives
To assess the validity and reliability of the Nijmegen Continuity Questionnaire in Hebrew (NCQ‐H) for measuring patients' perceived continuity of care in the multiprovider setting of oral anticancer therapy (OACT).
Methods
Following forward–backward translation of the original instrument into Hebrew, the NCQ‐H was administered to adult...
Background:
Medication-related problems are common in older adults with multiple chronic conditions. We evaluated the impact of a nurse-based primary care intervention, based on the Guided Care model of care, on patient-centered aspects of medication use.
Methods:
Controlled clinical trial of the Comprehensive Care for Multimorbid Adults Project...
Introduction
Patients with low health literacy (HL) and minority patients encounter many challenges during hospital to community transitions. We assessed care transitions of minority patients with various HL levels and tested whether presence of caregivers and provision of language-concordant care are associated with better care transitions.
Metho...
Aim:
To investigate the characteristics of participants in the Diabetes Conversation Map™ (Map™) program who had higher vs. lower compliance to the program, to determine if program tailoring and monitoring is needed among these groups.
Methods:
This was a retrospective cohort study of 8,990 patients enrolled in the Map™ program (low compliance [...
Background: Diabetes Conversation Map™ (Map™) is a global education program that engages patients with type 2 diabetes Mellitus (T2DM) in group-based discussions on diabetes-related topics. This study compares outcomes annually between participants and matched controls over a 4-year period.
Methods: This was a retrospective cohort study of 11,053 C...
Background: The Diabetes Conversation Mapࡊ Program serves Clalit Health Services members with type 2 diabetes Mellitus (T2DM) for over 7 years, administered by over400 trained certified nurses. A formal evaluation of the programmatic factors of Mapࡊ has not yet been performed.
Methods: This was a retrospective cohort study of 5,597 participants wit...
Background
Disparity-reduction programs have been shown to vary in the degree to which they achieve their goal; yet the causes of these variations is rarely studied. We investigated a broad-scale program in Israel’s largest health plan, aimed at reducing disparities in socially disadvantaged groups using a composite measure of seven health and heal...
Questionnaire adapted from Shortell et al.docx.
(PDF)
Conclusion:
Findings suggest a social gradient in which positive healthcare experiences were more common among adolescence with higher socioeconomic status for some immigrants (Russian adolescents) but not for others. The two leading health indicators were related to healthcare experiences, but as adolescent smokers were less likely to have positi...
Background:
Disparities between mental health patients and their professional caregivers in quality of life appraisals have been identified, however, the structure that such disparities assume is unknown.
Aims:
To examine the network structure of quality of life appraisals and disparities using network analysis.
Methods:
Participants were 1639...
Introduction:
Hospital-associated functional decline (HAFD) is recognized as a leading cause of adverse hospitalization outcomes, such as prolonged hospitalization, falls, readmission, and mortality. Since most patients hospitalized in internal medicine wards are older-adults, HAFD presents a major challenge to internal medicine.
Objectives:
Des...
Since our launch in 2002, the International Journal for Equity in Health (IJEqH) has furthered our collective understanding of equity in health and health services by providing a platform on which academics and practitioners can share their work. Today, we celebrate our fifteenth anniversary with an article collection that presents a call for new a...
Objective:
This study tested concordance between consumers' and providers' reports of personal goal setting and its relationship to self-reported goal attainment.
Methods:
Data are from the Israeli Psychiatric Rehabilitation Patient Reported Outcome Measurement project. Consumers (N=2,885) and the providers who were most knowledgeable about thei...
Many of the successful outcomes of this system may likely be attributed to functional integration by design, mainly since the transformation brought about with the enactment of the National Health Insurance Law (NHIL) in 1995. Universal coverage is provided by four non-profit health funds that serve as insurers and as care providers. This structura...