Browsing by Author "Hernandez, Laura"

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    Co-development of a transitions in care bundle for patient transitions from the intensive care unit: a mixed-methods analysis of a stakeholder consensus meeting
    (2022-01-02) Rosgen, Brianna K.; Plotnikoff, Kara M.; Krewulak, Karla D.; Shahid, Anmol; Hernandez, Laura; Sept, Bonnie G.; Morrissey, Jeanna; Robertson, Kristin; Fraser, Nancy; Niven, Daniel J.; Straus, Sharon E.; Leigh, Jeanna P.; Stelfox, Henry T.; Fiest, Kirsten M.
    Abstract Background Intensive care unit (ICU) patients undergoing transitions in care are at increased risk of adverse events and gaps in medical care. We evaluated existing patient- and family-centered transitions in care tools and identified facilitators, barriers, and implementation considerations for the application of a transitions in care bundle in critically ill adults (i.e., a collection of evidence-based patient- and family-centred tools to improve outcomes during and after transitions from the intensive care unit [ICU] to hospital ward or community). Methods We conducted a concurrent mixed methods (quan + QUAL) study, including stakeholders with experience in ICU transitions in care (i.e., patient/family partners, researchers, decision-makers, providers, and other knowledge-users). First, participants scored existing transitions in care tools using the modified Appraisal of Guidelines, Research and Evaluation (AGREE-II) framework. Transitions in care tools were discussed by stakeholders and either accepted, accepted with modifications, or rejected if consensus was achieved (≥70% agreement). We summarized quantitative results using frequencies and medians. Second, we conducted a qualitative analysis of participant discussions using grounded theory principles to elicit factors influencing AGREE-II scores, and to identify barriers, facilitators, and implementation considerations for the application of a transitions in care bundle. Results Twenty-nine stakeholders attended. Of 18 transitions in care tools evaluated, seven (39%) tools were accepted with modifications, one (6%) tool was rejected, and consensus was not reached for ten (55%) tools. Qualitative analysis found that participants’ AGREE-II rankings were influenced by: 1) language (e.g., inclusive, balance of jargon and lay language); 2) if the tool was comprehensive (i.e., could stand alone); 3) if the tool could be individualized for each patient; 4) impact to clinical workflow; and 5) how the tool was presented (e.g., brochure, video). Participants discussed implementation considerations for a patient- and family-centered transitions in care bundle: 1) delivery (e.g., tool format and timing); 2) continuity (e.g., follow-up after ICU discharge); and 3) continuous evaluation and improvement (e.g., frequency of tool use). Participants discussed existing facilitators (e.g., collaboration and co-design) and barriers (e.g., health system capacity) that would impact application of a transitions in care bundle. Conclusions Findings will inform future research to develop a transitions in care bundle for transitions from the ICU, co-designed with patients, families, providers, researchers, decision-makers, and knowledge-users.
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    Predictors and Outcomes Associated with Improvements in Anxiety and Depressed Mood Among Patients Who Complete Cardiac Rehabilitation
    (2024-08-06) Hernandez, Laura; Campbell, Tavis; Rouleau, Codie; King-Shier, Kathryn; Carlson, Linda
    Background: Cardiac rehabilitation (CR) is an established treatment for coronary artery disease (CAD) that may also improve psychological functioning. However, the extent to which reductions in depressive and anxious symptoms are clinically meaningful remains unclear. This study examined the proportion of patients achieving a minimal clinically important difference (MCID) on the Hospital Anxiety and Depression Scale (HADS) following CR completion and whether these differences are associated with patient characteristics and subsequent mortality. Methods: Retrospective analyses were performed on data from an observational cohort study of CAD patients following coronary catheterization who completed a 12-week CR program during 2009-2019 (TotalCardiologyTM Rehabilitation, Calgary). Patient characteristics and depressive and anxious symptom severity were measured at baseline and post-CR. Mortality data were extracted from Alberta Vital Statistics. A MCID in depressive and anxious symptoms was indicated by an established cut-off (>1.7 decrease in HADS-Anxiety or HADS-Depression scores). Results: Among 6,208 patients (60.5 ± 10.8 years, 20.8% female), 13.0% and 15.9% achieved clinically significant reductions in HADS-Depression and HADS-Anxiety scores, respectively. In patients with baseline HADS-Depression >8 (n = 657), 31.2% reported improved severity of depressive symptoms. In patients with baseline HADS-Anxiety >8 (n = 1,509), 32.0% reported improved severity of anxious symptoms. Higher baseline anxious symptoms, depressive symptoms, and younger age were associated with a greater likelihood of improvements in depressive symptoms (OR = 0.98, 95% CI [0.97–0.99]) and anxiety (OR = 0.99 [0.98, 0.99]). Higher baseline cardiorespiratory fitness (OR = 1.03 [1.00, 1.06]) and higher baseline hemoglobin A1C (OR = 1.00 [1.00, 1.00]) were associated with improvements in anxiety. A reduction in anxiety during CR was associated with lower all-cause mortality at 3-year follow-up (HR = 0.12, [0.02, 0.88]) in patients with elevated baseline anxiety symptoms. Conclusion: CR completion is associated with improved depressive and anxious symptoms in one-third of patients, which could translate to improved health outcomes. A considerable subset of program completers remained symptomatic and may require targeted psychological intervention. Age, cardiorespiratory fitness, blood sugar control, and baseline mood/anxiety symptoms might contribute to differential treatment response.