application). A variety of competing forces are currently shaping health care in the United States, including aging of the population and aggressive efforts to control health care costs. Declining inpatient stay has been a major contributor in attempts to control health care costs. A primary impetus has been the growth of managed care which has led to shortened hospital stays due to early discharge. Disadvantages of early discharge include concerns that patients may be discharged too sick for family members to manage, particularly if the patient or caregiver are elders. Few studies have investigated outcomes following early discharge and most only examined these outcomes for a short interval (30 days). The purpose of this study is to describe patient outcomes, resource utilization and caregiver burden following early discharge (5-7 days) to home after abdominal aortic aneurysm (AAA) repair. This patient group was chosen because this condition represents a unique opportunity to evaluate outcomes of early discharge in a vulnerable population of elderly patients who require major surgery.
Specific Aims are: (1) to describe patient outcomes (symptom, quality of life) at 1, 4 and 8 weeks after early discharge (5-7 days) to home following AAA repair; (2) to describe the caregiving experience from the perspective of the primary care partner at these same intervals; (3) to describe resource utilization (homemaker services, skilled care needs, types of health care contacts & complications) in 8 weeks after early discharge to home; and (4) to identify factors associated with decreased symptom, improved quality of life and decreased caregiver burden. The study will use a prospective, descriptive, longitudinal design. From patients, measures will be obtained 1, 4, and 8 weeks after discharge of symptom (Symptom Checklist) and quality of life (SF-36 Health Survey). From caregivers, measures will be obtained at the same intervals of the caregiving experience (Caregiver Questionnaire) and resource utilization (Resource Utilization List). To validate and amplify information gained through these instruments, the investigator will interview a subsample of 5 caregivers using qualitative methodology (Experience of Caregiving Interview Guide). Repeated measures ANOVA will be used to analyze change in symptoms, quality of life, caregiver burden and health resource use over time. Pearson's correlation coefficients will be used to analyze relationships between demographic characteristics and symptom, quality of life, caregiver burden and resource use. Qualitative data will be analyzed using content analysis. Recommendations will be developed from this analysis to direct future studies, design discharge teaching materials and follow-up programs which provide support services for the elderly patient and caregiver that then can be tested in future studies.
| Jones, Mildred A; Hoffman, Leslie A; Makaroun, Michel S et al. (2002) Early discharge following abdominal aortic aneurysm repair: Impact on patients and caregivers. Res Nurs Health 25:345-56 |
| Aquino, R V; Jones, M A; Zullo, T G et al. (2001) Quality of life assessment in patients undergoing endovascular or conventional AAA repair. J Endovasc Ther 8:521-8 |
| Jones, M A; Hoffman, L A; Makaroun, M S (2000) Endovascular grafting for repair of abdominal aortic aneurysm. Crit Care Nurse 20:38-48, 50-1; quiz 52-3 |
