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Nash T, MacRae N, Pitt D, Bennetts C, Scanlan A, Eley R. Retrospective observational study of aged care facility residents presenting to ED post fall: A case for person-centred shared decision making. Emerg Med Australas 2024; 36:512-519. [PMID: 38418226 DOI: 10.1111/1742-6723.14391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Identify the incidence of intracranial haemorrhage in people from residential aged care facilities following falls who had a CT head performed. The secondary objectives were to identify predictor variables for intracranial haemorrhage to inform person-centred shared decision making. METHODS Retrospective chart review of aged care residents who presented to ED with a triage of fall. Documented evidence of vomiting, headache, external signs of head injury, deviation from baseline neurology and the presence of anticoagulation or antiplatelet agents was reviewed. The rates of CT head, intracranial haemorrhage, emergent interventions, disposition and mortality were assessed. RESULTS Of the 2546 presentations, 1732 (68.0%) had a CT head and intracranial haemorrhage was found in 76 (4.4%) patients. External signs of head injury and deviation from neurological baseline have a strong association with intracranial haemorrhage in 26 (22.2%) patients, only 4 (0.61%) patients with intracranial haemorrhage had neither. There was a strong association between these clinical features and identification of intracranial haemorrhage on CT head. Anticoagulation and antiplatelet use had no association with intracranial haemorrhage. A 30-day mortality was increased in patients with deviation from neurological baseline. No neurosurgical intervention was performed, and there was inconsistent advice regarding anticoagulation or antiplatelet agents. CONCLUSIONS Deviation from neurological baseline or external signs of head injury may be predictors of intracranial haemorrhage. Vomiting, headache, anticoagulation or antiplatelets were not associated with intracranial haemorrhage. A person-centred decision-making approach, that is informed by treatment options could better guide clinicians on when to order a CT head after a fall.
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Affiliation(s)
- Terry Nash
- CAREPACT (Comprehensive Aged Resident Emergency Partners in Assessment Care and Treatment), Metro South Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Nicola MacRae
- CAREPACT (Comprehensive Aged Resident Emergency Partners in Assessment Care and Treatment), Metro South Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Daniel Pitt
- CAREPACT (Comprehensive Aged Resident Emergency Partners in Assessment Care and Treatment), Metro South Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Casey Bennetts
- CAREPACT (Comprehensive Aged Resident Emergency Partners in Assessment Care and Treatment), Metro South Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Alyce Scanlan
- CAREPACT (Comprehensive Aged Resident Emergency Partners in Assessment Care and Treatment), Metro South Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
| | - Robert Eley
- Princess Alexandra Hospital, Metro South Hospital and Health Service, Queensland Health, Brisbane, Queensland, Australia
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Miller J, Bee A, Pattison D, Walker M, Aldridge E, Hackett L, Owen PJ, Marangon-Elliott R, Buntine P. Managing falls onsite in residential aged care homes reduced hospitalisation: Mixed methods results from the Falls Outreach and Residential Mobile Assessment Team (FORMAT) pilot study. Australas J Ageing 2024. [PMID: 38932520 DOI: 10.1111/ajag.13336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 04/10/2024] [Accepted: 05/03/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Falls are the leading cause of hospital transfer from residential aged care homes (RACHs). However, many falls do not result in significant injury, and ageing patients are exposed to complications while hospitalised. Inreach services are designed to reduce hospital transfer by providing care, support and assessment to residents at the RACH. This study evaluated a pilot inreach program targeting ageing patients following a fall. METHODS We conducted a prospective, mixed methods evaluation of a 5-month (May-September 2022) pilot implementation across 108 government-funded RACHs within a single health-care network in Melbourne, Australia. RESULTS A total of 123 residents (median [interquartile range] age: 88 [82, 94] years, female: 49%) were included in the intervention. The majority (n = 116, 94%) of residents were managed onsite and required no further investigation (n = 80, 69%) or treatment (n = 63, 54%). Among the seven residents referred to the emergency department (ED), two received hospital admission and five were transferred back to residential care. In the 7 days following referral to the intervention, four additional residents were referred to the ED and one received hospital admission. Qualitative feedback (n = 40) included specific comments relating to themes of general satisfaction (n = 20, 50%), compliments for staff (n = 16, 40%) and acknowledgement of comprehensiveness (n = 9, 23%). CONCLUSIONS Implementation of a specialised fall assessment team to complement an existing geriatric-led RACH assessment service meant that a high rate of eligible residents were managed onsite, with very low need for subsequent hospitalisation. Residents, family members and caregivers expressed high rates of satisfaction with the service.
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Affiliation(s)
- Joseph Miller
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Residential Inreach Service, Eastern Health, Box Hill, Victoria, Australia
| | - Andrea Bee
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Donna Pattison
- Eastern Health Emergency Medicine Program, Melbourne, Victoria, Australia
| | - Megan Walker
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Emogene Aldridge
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Residential Inreach Service, Eastern Health, Box Hill, Victoria, Australia
| | - Liam Hackett
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Residential Inreach Service, Eastern Health, Box Hill, Victoria, Australia
| | - Patrick J Owen
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Residential Inreach Service, Eastern Health, Box Hill, Victoria, Australia
| | | | - Paul Buntine
- Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
- Eastern Residential Inreach Service, Eastern Health, Box Hill, Victoria, Australia
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Lemoyne S, Van Bastelaere J, Nackaerts S, Verdonck P, Monsieurs K, Schnaubelt S. Emergency physicians' and nurses' perception on the adequacy of emergency calls for nursing home residents: a non-interventional prospective study. Front Med (Lausanne) 2024; 11:1396858. [PMID: 38962739 PMCID: PMC11220277 DOI: 10.3389/fmed.2024.1396858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/07/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction A considerable percentage of daily emergency calls are for nursing home residents. With the ageing of the overall European population, an increase in emergency calls and interventions in nursing homes (NH) is to be expected. A proportion of these interventions and hospital transfers may be preventable and could be considered as inappropriate by prehospital emergency medical personnel. The study aimed to understand Belgian emergency physicians' and emergency nurses' perspectives on emergency calls and interventions in NHs and investigate factors contributing to their perception of inappropriateness. Methods An exploratory non-interventional prospective study was conducted in Belgium among emergency physicians and emergency nurses, currently working in prehospital emergency medicine. Electronic questionnaires were sent out in September, October and November 2023. Descriptive statistics were used to analyze the overall results, as well as to compare the answers between emergency physicians and emergency nurses about certain topics. Results A total of 114 emergency physicians and 78 nurses responded to the survey. The mean age was 38 years with a mean working experience of 10 years in prehospital healthcare. Nursing home staff were perceived as understaffed and lacking in competence, with an impact on patient care especially during nights and weekends. General practitioners were perceived as insufficiently involved in the patient's care, as well as often unavailable in times of need, leading to activation of Emergency Medical Services (EMS) and transfers of nursing home residents to the Emergency Department (ED). Advance directives were almost never available at EMS interventions and transfers were often not in accordance with the patient's wishes. Palliative care and pain treatment were perceived as insufficient. Emergency physicians and nurses felt mostly disappointed and frustrated. Additionally, differences in perception were noted between emergency physicians and nurses regarding certain topics. Emergency nurses were more convinced that the nursing home physician should be available 24/7 and that transfers could be avoided if nursing home staff had more authority regarding medical interventions. Emergency nurses were also more under the impression that pain management was inadequate, and emergency physicians were more afraid of the medical implications of doing too little during interventions than emergency nurses. Suggestions to reduce the number of EMS interventions were more general practitioner involvement (82%), better nursing home staff education/competences (77%), more nursing home staff (67%), mobile palliative care support teams (65%) and mobile geriatric nursing intervention teams (52%). Discussion and conclusion EMS interventions in nursing homes were almost never seen as necessary or indicated by emergency physicians and nurses, with the appropriate EMS level almost never being activated. The following key issues were found: shortages in numbers and competence of nursing home staff, insufficient primary care due to the unavailability of the general practitioner as well as a lack of involvement in patient care, and an absence of readily available advance directives. General practitioners should be more involved in the decision to call the Emergency Medical Services (EMS) and to transfer nursing home residents to the Emergency Department. Healthcare workers should strive for vigilance regarding the patients' wishes. The emotional burden of deciding on an avoidable hospital admission of nursing home residents, perhaps out of fear for medico-legal consequences if doing too little, leaves the emergency physicians and nurses frustrated and disappointed. Improvements in nursing home staffing, more acute and chronic general practitioner consultations, and mobile geriatric and palliative care support teams are potential solutions. Further research should focus on the structural improvement of the above-mentioned shortcomings.
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Affiliation(s)
- Sabine Lemoyne
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - Joanne Van Bastelaere
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Department of Public Health and Primary Care, Catholic University of Leuven, Leuven, Belgium
| | - Sofie Nackaerts
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - Philip Verdonck
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - Koenraad Monsieurs
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
| | - Sebastian Schnaubelt
- Department of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Antwerp, Belgium
- Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
- Emergency Medical Service Vienna, Vienna, Austria
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Bauer AK, Fassmer AM, Zuidema SU, Janus SIM, Hoffmann F. End-of-life care in German and Dutch nursing homes: a cross-sectional study on nursing home staff's perspective in 2022. Arch Public Health 2024; 82:85. [PMID: 38877598 PMCID: PMC11177492 DOI: 10.1186/s13690-024-01316-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 06/06/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND As society ages, the need for nursing home care is steadily increasing and end-of-life care of nursing home residents has become increasingly more important. End-of-life care differs between Germany and the neighbouring Netherlands. For example, a much higher proportion of German compared to Dutch nursing home residents is hospitalized at the end of life. Therefore, the aim of this study was to evaluate end-of-life care in German and Dutch nursing homes. METHODS In this cross-sectional study, a postal survey was sent to 600 randomly selected German and Dutch nursing homes each and addressed to the nursing staff management. Participants were asked to estimate the percentage of nursing home residents whose wishes for emergency situations (e.g. cardiopulmonary resuscitation) are known and to indicate whether facilities offer advanced care planning (ACP). They were also asked to estimate whether general practitioners (GPs)/elder care physicians (ECPs) and nursing home staff are usually well trained for end-of-life care. Finally, participants were asked to estimate the proportion of nursing home residents who die in hospital rather than in the nursing home and to rate overall end-of-life care provision. RESULTS A total of 301 questionnaires were included in the analysis; 199 from German and 102 from Dutch nursing homes (response 33.2% and 17.0%). German participants estimated that 20.5% of residents die in the hospital in contrast to the Dutch estimation of 5.9%. In German nursing homes, ACP is offered less often (39.2% in Germany, 75.0% in the Netherlands) and significantly fewer wishes for emergency situations of residents were known than in Dutch nursing homes. GPs were considered less well-trained for end-of-life care in Germany. The most important measures to improve end-of-life care were comparable in both countries. CONCLUSION Differences in (the delivery and knowledge of) end-of-life care between Germany and the Netherlands could be observed in this study. These could be due to structural differences (ECPs available 24/7 in the majority of Dutch nursing homes) and cultural differences (more discussion on quality of life versus life-sustaining treatments in the Netherlands). Due to these differences, a country-specific approach is necessary to improve end-of-life care.
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Affiliation(s)
- Ann-Kathrin Bauer
- Department of Health Service Research, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.
- Institute of Medical Genetics, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany.
| | | | - Sytse U Zuidema
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah I M Janus
- Department of Primary and Long-Term Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Falk Hoffmann
- Department of Health Service Research, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
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Charon C, Wuillemin PH, Havreng-Théry C, Belmin J. One Month Prediction of Pressure Ulcers in Nursing Home Residents with Bayesian Networks. J Am Med Dir Assoc 2024; 25:104945. [PMID: 38431264 DOI: 10.1016/j.jamda.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Pressure ulcers (PUs) are a common and avoidable condition among residents of nursing homes, and their consequences are severe. Reliable and simple identification of high-risk residents is a major challenge for prevention. Available tools like the Braden and Norton scale have imperfect predictive performance. The objective is to predict the occurrence of PUs in nursing home residents from electronic health record (EHR) data. DESIGN Longitudinal retrospective nested case-control study. SETTING AND PARTICIPANTS EHR database of French nursing homes from 2013 to 2022. METHODS Residents who suffered from PUs were cases and those who did not were controls. For cases, we analyzed the data available in their EHR 1 month before the occurrence of the first PU. For controls, we used available data 1 month before an index date adjusted on the delays of PU onset. We conducted a Bayesian network (BN) analysis, an explainable machine learning method, using 136 input variables of potential medical interest determined with experts. To validate the model, we used scores, features selection, and explainability tools such as Shapley values. RESULTS Among 58,368 residents analyzed, 29% suffered from PUs during their stay. The obtained BN model predicts the occurrence of a PU at a 1-month horizon with a sensitivity of 0.94 (±0.01), a precision of 0.32 (±0.01) and an area under the curve of 0.69 (±0.02). It selects 3 variables: length of stay, delay since last hospitalization, and dependence for transfer. This BN model is suitable and simpler than models provided by other machine learning methods. CONCLUSIONS AND IMPLICATIONS One-month prediction for incident PU is possible in nursing home residents from their EHR data. The study paves the way for the development of a predictive tool fueled by routinely collected data that do not require additional work from health care professionals, thereby opening a new preventive strategy for PUs.
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Affiliation(s)
- Clara Charon
- LIP6 (UMR 7606), Sorbonne Université, Paris, France; Teranga Software, Paris, France
| | | | | | - Joël Belmin
- LIMICS (UMR 1142), Sorbonne Université, Paris, France; AP-HP, Hôpital Charles-Foix, Ivry-sur-Seine, France.
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Sarwari Z, Kristensen GS, Petersen SR, Mogensen CB. Analysis of traumatic event emergency department visits among care home residents aged 65 + years in Southern Jutland, Denmark: implications for comprehensive care and subsequent hospital admissions - a register-based cohort study. BMC Geriatr 2024; 24:465. [PMID: 38807046 PMCID: PMC11134667 DOI: 10.1186/s12877-024-05092-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Care home residents aged 65 + years frequently experience acute health issues, leading to emergency department visits. Falls and associated injuries are a common cause of these visits and falls in a geriatric population can be a symptom of an incipient acute illness such as infection. Conversely, the traumatic event can cause illnesses to arise due to consequences of the fall, e.g. delirium or constipation due to opioid use. We hypothesised that a traumatic event treat-and-release emergency department visit serves as an indicator for an upcoming acute hospital admission due to non-trauma-related conditions. METHODS We studied emergency department visits for traumatic events among all care home residents aged 65+ (n = 2601) living in Southern Jutland, Denmark, from 2018 to 2019. Data from highly valid national registers were used to evaluate diagnoses, mortality, and admissions. Cox Regression was used to analyse the hazard of acute hospital admission following an emergency department treat-and-release visit. RESULTS Most visits occurred on weekdays and during day shifts, and 72.0% were treated and released within 6 h. Contusions, open wounds, and femur fractures were the most common discharge diagnoses, accounting for 53.3% of all cases (n = 703). In-hospital mortality was 2.3%, and 30-day mortality was 10.4%. Among treat-and-release visits (n = 506), 25% resulted in a new hospital referral within 30 days, hereof 13% treat-and-release revisits (duration ≤ 6 h), and 12% hospital admissions (duration > 6 h). Over half (56%) of new hospital referrals were initiated within the first seven days of discharge. Almost three-fourths of subsequent admissions were caused by various diseases. The hazard ratio of acute hospital admissions was 2.20 (95% CI: 1.52-3.17) among residents with a recent traumatic event treat-and-release visit compared to residents with no recent traumatic event treat-and-release visit. CONCLUSION Traumatic event treat-and-release visits among care home residents serve as an indicator for subsequent hospitalisations, highlighting the need for a more comprehensive evaluation, even for minor injuries. These findings have implications for improving care, continuity, and resource utilisation. TRIAL REGISTRATION Not relevant.
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Affiliation(s)
- Zuhreh Sarwari
- Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Gitte Schultz Kristensen
- Emergency Department, Aabenraa Hospital, University Hospital of Southern Jutland, Aabenraa, Denmark.
- Department of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, Denmark.
| | - Sofie Ronja Petersen
- Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Christian Backer Mogensen
- Department of Clinical Research and Emergency Department, Aabenraa Hospital, University Hospital of Southern Denmark, Aabenraa, Denmark
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Klausen AD, Günther U, Schmiemann G, Hoffmann F, Seeger I. [Frequency and characteristics of interventions by community paramedics on people in need of care : Analysis of 2,410 deployment protocols for people aged 65+ years]. Med Klin Intensivmed Notfmed 2024; 119:316-322. [PMID: 38057556 PMCID: PMC11058764 DOI: 10.1007/s00063-023-01085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/25/2023] [Accepted: 10/29/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND The aim of this study was to obtain a differentiated view of interventions delivered by community paramedics (Gemeindenotfallsanitäter, G‑NFS) in older people in need of care living in nursing homes and at home. MATERIALS AND METHODS A retrospective analysis of G‑NFS documentation from 2021 with a focus on patients aged ≥65 years was performed. Data were grouped into callouts to nursing homes or private homes. Interventions, urgency, transport, and further recommendations were analyzed descriptively. RESULTS Of 5,900 G-NFS protocols, 43.0% (n = 2,410) were related to elderly people (mean age 80.8 years, 49.7% female). A total of 20.6% of these callouts involved nursing home residents, 38.4% (n = 926) were homecare patients, and 41% (n = 988) of callouts were to persons who did not rely on care. No specific interventions except advice were given to 48.4% of nursing home residents, and to even 82.1% of those in homecare and 83.7% of those without care needs. About 60% of the G‑NFS interventions were classified as non-urgent. Transport was waived for 63.1% of nursing home residents, for 58.1% in homecare, and for 60.6% of persons without care needs. A visit to the emergency department was recommended to 29.4% of nursing home residents, 37.6% of homecare patients, and 33.6% of persons without need of care. Measures related to urine catheters were documented much more often in nursing homes (38.5%) than in patients in homecare (15.1%) or without need of care (9.3%). CONCLUSION Community paramedics perform primary care tasks and can contribute to a reduction in unnecessary transport. It should be discussed whether the emergency medical service is responsible for such interventions and how older people in need of care can be cared for according to their needs in the future.
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Affiliation(s)
- Andrea Diana Klausen
- Fakultät VI Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland.
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland.
| | - Ulf Günther
- Fakultät VI Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
- Klinikum Oldenburg AöR, Universitätsklinik für Anästhesiologie | Intensivmedizin | Notfallmedizin | Schmerztherapie, Oldenburg, Deutschland
| | - Guido Schmiemann
- Abteilung Versorgungsforschung, Institut für Public Health und Pflegeforschung (IPP), Universität Bremen, Bremen, Deutschland
- Health Sciences Bremen, Universität Bremen, Bremen, Deutschland
| | - Falk Hoffmann
- Fakultät VI Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - Insa Seeger
- Fakultät VI Medizin und Gesundheitswissenschaften, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
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Gombault-Datzenko E, Costa N, Mounié M, Tavassoli N, Mathieu C, Roussel H, Lagarrigue JM, Berard E, Rolland Y, Molinier L. Cost of care pathways before and after appropriate and inappropriate transfers to the emergency department among nursing home residents: results from the FINE study. BMC Geriatr 2024; 24:353. [PMID: 38641801 PMCID: PMC11027376 DOI: 10.1186/s12877-024-04946-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 04/03/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Transfers of nursing home (NH) residents to the emergency department (ED) is frequent. Our main objective was to assess the cost of care pathways 6 months before and after the transfer to the emergency department among NH residents, according to the type of transfer (i.e. appropriate or inappropriate). METHODS This was a part of an observational, multicenter, case-control study: the Factors associated with INappropriate transfer to the Emergency department among nursing home residents (FINE) study. Sixteen public hospitals of the former Midi-Pyrénées region participated in recruitment, in 2016. During the inclusion period, all NH residents arriving at the ED were included. A pluri-disciplinary team categorized each transfer to the ED into 2 groups: appropriate or inappropriate. Direct medical and nonmedical costs were assessed from the French Health Insurance (FHI) perspective. Healthcare resources were retrospectively gathered from the FHI database and valued using the tariffs reimbursed by the FHI. Costs were recorded over a 6-month period before and after transfer to the ED. Other variables were used for analysis: sex, age, Charlson score, season, death and presence inside the NH of a coordinating physician or a geriatric nursing assistant. RESULTS Among the 1037 patients initially included in the FINE study, 616 who were listed in the FHI database were included in this economic study. Among them, 132 (21.4%) had an inappropriate transfer to the ED. In the 6 months before ED transfer, total direct costs on average amounted to 8,145€ vs. 6,493€ in the inappropriate and appropriate transfer groups, respectively. In the 6 months after ED transfer, they amounted on average to 9,050€ vs. 12,094€. CONCLUSIONS Total costs on average are higher after transfer to the ED, but there is no significant increase in healthcare expenditure with inappropriate ED transfer. Support for NH staff and better pathways of care could be necessary to reduce healthcare expenditures in NH residents. TRIAL REGISTRATION clinicaltrials.gov, NCT02677272.
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Affiliation(s)
- E Gombault-Datzenko
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France.
| | - N Costa
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
| | - M Mounié
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
| | - N Tavassoli
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - C Mathieu
- Gérontopôle, Toulouse University Hospital, Toulouse, France
- CREAI-ORS Occitanie, Toulouse, France
| | - H Roussel
- CNAM, DRSM Occitanie, 2 rue Georges Vivent, Toulouse, 31082, France
| | - J M Lagarrigue
- MSA Midi-Pyrénées Nord, 180 Avenue Marcel Unal, Montauban, 82000, France
| | - E Berard
- INSERM, UMR 1295, Toulouse, France
- Department of Epidemiology, University Hospital of Toulouse, 37 Allées Jules Guesde, Toulouse, 31000, France
| | - Y Rolland
- INSERM, UMR 1295, Toulouse, France
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - L Molinier
- Present address: Department of Medical Information (DIM), Toulouse University Hospital, 2 rue Viguerie, Toulouse Cedex 9, 31059, France
- INSERM, UMR 1295, Toulouse, France
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Bouzid W, Cantet C, Berard E, Mathieu C, Hermabessière S, Houles M, Krams T, Qassemi S, Cambon A, McCambridge C, Tavassoli N, Rolland Y. Exploring Predictive Factors for Potentially Avoidable Emergency Department Transfers: Findings From the FINE Study. J Am Med Dir Assoc 2024; 25:572-579.e1. [PMID: 38159914 DOI: 10.1016/j.jamda.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES To assess the prevalence of potentially avoidable transfers (PAT) and identify factors associated with these transfers to emergency departments (EDs) among nursing home (NH) residents. DESIGN This is a secondary outcome analysis of the FINE study, a multicenter observational study collecting data on NH residents, NH settings, and contextual factors of ED transfers. SETTINGS AND PARTICIPANTS NHs in the former Midi-Pyrénées region of the southwest of France (n = 312); a total of 1037 NH residents who experienced ED transfers (n = 1017) between January 2016 and December 2016. METHODS The analysis included resident baseline characteristics and NH and transfer decision-making characteristics. An expert group categorized the transfer status as either PAT or unavoidable. Multivariable analysis using a mixed logistic model, accounting for intra-NH correlation, was conducted to assess factors independently associated with PAT. RESULTS Among 1017 included transfers, 87.02% (n = 885) were identified as PAT and 12.98% (n = 132) unavoidable transfers. Multivariable analysis revealed that the following patient-related factors were associated with a likely high rate of PAT: usual behavior disturbances before transfer, including productive trouble (OR 2.04, 95% CI 1.25-3.33; P = .0044) and unusual symptom of falling during the week preceding the transfer (OR 4.55, 95% CI 1.76-11.82; P = .0019). On the other hand, distance between ED and NH (OR 0.98, 95% CI 0.97-0.998; P = .0231), NH staff trained in palliative care in the last 3 years (OR 0.52, 95% CI 0.29-0.95; P = .0324), the impossibility of direct hospitalization to an appropriate unit (OR 0.54, 95% CI 0.34-0.87; P = .0117), and the resident Charlson Comorbidity Index (OR 0.90, 95% CI 0.82-0.99; P = .0369) were associated with a lower probability of PAT. CONCLUSION AND IMPLICATIONS Transfers from NHs to hospital EDs were frequently potentially avoidable, meaning that there are still significant opportunities to reduce PAT. Our findings may help to specifically identify interventions that should be targeted at both NH and resident levels.
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Affiliation(s)
- Wafa Bouzid
- Gérontopôle, Toulouse University Hospital, Toulouse, France; Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France; Regional Health Agency of Occitanie, Toulouse, France.
| | | | - Emilie Berard
- Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France; UMR 1295 CERPOP, INSERM-Université de Toulouse III, Toulouse, France
| | - Celine Mathieu
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | - Mathieu Houles
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Thomas Krams
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Soraya Qassemi
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | | | | | - Neda Tavassoli
- Gérontopôle, Toulouse University Hospital, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Toulouse University Hospital, Toulouse, France; Centre Hospitalier Universitaire de Toulouse, Service d'Epidémiologie, Toulouse, France
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10
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Albanesi B, Conti A, Politano G, Dimonte V, Gianino MM, Campagna S. Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019. BMC Geriatr 2024; 24:295. [PMID: 38549053 PMCID: PMC10976813 DOI: 10.1186/s12877-024-04912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/21/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Visits to Emergency Departments (ED) can be traumatic for Nursing Home (NH) residents. In Italy, the rate of ED visits by NH residents was recently calculated as 3.3%. The reduction of inappropriate ED visits represents a priority for National Healthcare Systems worldwide. Nevertheless, research on factors associated with ED visits is still under-studied in the Italian setting. This study has two main aims: (i) to describe the baseline characteristics of NH residents visiting ED at regional level; (ii) to assess the characteristics, trends, and factors associated with these visits. METHODS A retrospective study of administrative data for five years was performed in the Piedmont Region. Data from 24,208 NH residents were analysed. Data were obtained by merging two ministerial databases of residential care and ED use. Sociodemographic and clinical characteristics of the residents, trends, and rates of ED visits were collected. A Generalized Linear Model (GLM) regression was used to evaluate the factors associated with ED visits. RESULTS In 5 years, 12,672 residents made 24,609 ED visits. Aspecific symptoms (45%), dyspnea (17%) and trauma (16%) were the most frequent problems reported at ED. 51% of these visits were coded as non-critical, and 58% were discharged to the NH. The regression analysis showed an increased risk of ED visits for men (OR = 1.61, 95% CI 1.51-1.70) and for residents with a stay in NH longer than 400 days (OR = 2.19, 95% CI 2.08-2.31). CONCLUSIONS Our study indicates that more than half of NH residents' ED visits could potentially be prevented by treating residents in NH. Investments in the creation of a structured and effective network within primary care services, promoting the use of health technology and palliative care approaches, could reduce ED visits and help clinicians manage residents on-site and remotely.
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Affiliation(s)
- Beatrice Albanesi
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Alessio Conti
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy.
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Turin, Italy
| | - Valerio Dimonte
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Maria Michela Gianino
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Sara Campagna
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
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11
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Brotherhood K, Searle B, Spiers GF, Caiado C, Hanratty B. Variations in older people's emergency care use by social care setting: a systematic review of international evidence. Br Med Bull 2024; 149:32-44. [PMID: 38112600 PMCID: PMC10938536 DOI: 10.1093/bmb/ldad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/16/2023] [Accepted: 11/28/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Older adults' use of social care and their healthcare utilization are closely related. Residents of care homes access emergency care more often than the wider older population; however, less is known about emergency care use across other social care settings. SOURCES OF DATA A systematic review was conducted, searching six electronic databases between January 2012 and February 2022. AREAS OF AGREEMENT Older people access emergency care from a variety of community settings. AREAS OF CONTROVERSY Differences in study design contributed to high variation observed between studies. GROWING POINTS Although data were limited, findings suggest that emergency hospital attendance is lowest from nursing homes and highest from assisted living facilities, whilst emergency admissions varied little by social care setting. AREAS TIMELY FOR DEVELOPING RESEARCH There is a paucity of published research on emergency hospital use from social care settings, particularly home care and assisted living facilities. More attention is needed on this area, with standardized definitions to enable comparisons between studies.
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Affiliation(s)
- Kelly Brotherhood
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
| | - Ben Searle
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
| | - Gemma Frances Spiers
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
| | - Camila Caiado
- Department of Mathematical Sciences, Mathematical Sciences & Computer Science Building, Durham University, Upper Mountjoy Campus, Stockton Road, Durham, DH1 3LE, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Biomedical Research Building (Second Floor), Newcastle upon Tyne NE1 7RU, UK
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12
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Seaman K, Huang G, Wabe N, Nguyen A, Pinto S, Westbrook J. Hospitalisations before and after entry into a residential aged care facility: An interrupted time series analysis. Australas J Ageing 2024; 43:61-70. [PMID: 37861132 DOI: 10.1111/ajag.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/05/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE Hospitalisations are an important indicator of safety and quality of care in residential aged care facilities (RACFs). This study aimed to investigate changes in hospital use 12 months before and 12 months after RACF entry using routinely collected data from 25 Australian RACFs. METHODS This was a retrospective longitudinal cohort study using linked aged care provider and hospital record data. The sample comprised 1029 residents living in an aged care facility between July 2014 and December 2019 who had stayed a minimum of 12 months in an RACF. The outcome measures were all-cause hospitalisations and fall-related hospitalisations. We applied an interrupted time series analysis using segmented regression to examine changes in both outcome measures over time. Stratified analyses were conducted by gender and dementia status. RESULTS The rate of all-cause hospitalisations increased dramatically over the 12 months before RACF entry, from 97 per 1000 residents per month 12 months prior to RACF admission to 303 per 1000 residents at the second month prior to RACF entry. All-cause hospitalisations then decreased considerably to 55 per 1000 residents upon RACF admission and stabilised across the next 12 months. Such trajectories were also observed in fall-related hospitalisations and were consistent for gender and dementia status. CONCLUSIONS In this study, hospitalisation rates decreased significantly after RACF entry, and such reductions were maintained for residents who stayed for 12 months in RACFs. Multiple hospital admissions are likely to precipitate entry into RACF. Additional investigation of how community-based services can be successful in reducing the escalating hospitalisations is needed.
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Affiliation(s)
- Karla Seaman
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Guogui Huang
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nasir Wabe
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Amy Nguyen
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Sonali Pinto
- Sydney Anglican Diocese, Sydney, New South Wales, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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13
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Mäki LJ, Kontunen PJ, Kaartinen JM, Castrén MK. Value-based care of older people-The impact of an acute outreach service unit on emergency medical service missions: A quasi-experimental study. Scand J Caring Sci 2024; 38:169-176. [PMID: 37807498 DOI: 10.1111/scs.13220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/31/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Transfers to the emergency department can be burdensome for the residents of long-term residential care facilities (LTRCFs) and often lead to adverse effects. Since March 2019, a nurse-led acute outreach service unit "Mobile hospital" (in Finnish, Liikkuva sairaala, LiiSa) has been providing on-site care to LTRCF residents to reduce transfers to the emergency department. METHODS This study compares the numbers and acuities of emergency medical service (EMS) missions carried out in the LTRCFs of Espoo and Kauniainen during two six-month periods: before the implementation of LiiSa and with LiiSa in use. In Finland, EMS missions are divided into four categories (A-D), with category A missions being the most urgent. These categories were used to investigate the impact on mission acuities. RESULTS Due to the implementation of LiiSa, the number of EMS missions decreased by 16.8% (95% confidence interval 10.6%-22.6%, p < 0.001), the number of category D missions by 19.8% (7.1%-30.8%, p = 0.003) and the number of category C missions by 30.3% (17.3%-41.3%, p < 0.001). Changes in the numbers of category A and B missions were not statistically significant. CONCLUSIONS LiiSa helped to avoid many transfers of frail LTRCF patients to the emergency department, and it did not hinder the care of patients with true emergencies by EMSs.
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Affiliation(s)
- Lauri J Mäki
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Perttu J Kontunen
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
- Päijät-Häme Social and Health Care, Lahti, Finland
| | - Johanna M Kaartinen
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Maaret K Castrén
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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14
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Harrison SL, Lang C, Eshetie TC, Crotty M, Whitehead C, Evans K, Corlis M, Wesselingh S, Caughey GE, Inacio MC. Hospitalisations and emergency department presentations by older individuals accessing long-term aged care in Australia. AUST HEALTH REV 2024; 48:182-190. [PMID: 38537302 DOI: 10.1071/ah24019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024]
Abstract
Objective The study examined emergency department (ED) presentations, unplanned hospitalisations and potentially preventable hospitalisations in older people receiving long-term care by type of care received (i.e. permanent residential aged care or home care packages in the community), in Australia in 2019. Methods A retrospective cohort study was conducted using the Registry of Senior Australians National Historical Cohort. Individuals were included if they resided in South Australia, Queensland, Victoria or New South Wales, received a home care package or permanent residential aged care in 2019 and were aged ≥65 years. The cumulative incidence of ED presentations, unplanned hospitalisations and potentially preventable hospitalisations in each of the long-term care service types were estimated during the year. Days in hospital per 1000 individuals were also calculated. Results The study included 203,278 individuals accessing permanent residential aged care (209,639 episodes) and 118,999 accessing home care packages in the community (127,893 episodes). A higher proportion of people accessing home care packages had an ED presentation (43.1% [95% confidence interval, 42.8-43.3], vs 37.8% [37.6-38.0]), unplanned hospitalisation (39.8% [39.6-40.1] vs 33.4% [33.2-33.6]) and potentially preventable hospitalisation (11.8% [11.6-12.0] vs 8.2% [8.1-8.4]) than people accessing permanent residential aged care. Individuals with home care packages had more days in hospital due to unplanned hospitalisations than those in residential care (7745 vs 3049 days/1000 individuals). Conclusions While a high proportion of older people in long-term care have ED presentations, unplanned hospitalisations and potentially preventable hospitalisations, people in the community with home care packages experience these events at a higher frequency.
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Affiliation(s)
- Stephanie L Harrison
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Catherine Lang
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Tesfahun C Eshetie
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; and UniSA Clinical & Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Maria Crotty
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Craig Whitehead
- Southern Adelaide Local Health Network, SA Health, Adelaide, SA, Australia; and College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Keith Evans
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia
| | - Megan Corlis
- Australian Nursing and Midwifery Federation SA Branch, Adelaide, SA, Australia
| | - Steve Wesselingh
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and National Health and Medical Research Council, ACT, Australia
| | - Gillian E Caughey
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, Australia; and Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
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15
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Dwyer R, Jachno K, Tran T, Owen A, Layton N, Collyer T, Kirkman M, Lowthian J, Hammarberg K, McNeil JJ, Woods RL, Berk M, Fisher J. Symptoms of depression and risk of emergency department visits among people aged 70 years and over. BMC Public Health 2024; 24:385. [PMID: 38317172 PMCID: PMC10845391 DOI: 10.1186/s12889-024-17794-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/17/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Older people experiencing depression and anxiety have higher rates of health service utilisation than others, but little is known about whether these influence their seeking of emergency care. The aim was to examine the associations between symptoms of depression and the use of emergency health care, in an Australian context, among a population of people aged 70 years and over initially free of cardiovascular disease, dementia or major physical disability. METHODS We undertook secondary analyses of data from a large cohort of community-dwelling Australians aged [Formula: see text]70 years. Multivariable logistic regression was used to compare the association of symptoms of depression (measured using the Center for Epidemiological Studies Depression Scale 10 question version, CESD at baseline) with subsequent episodes of emergency care, adjusting for physical and social factors of clinical interest. Marginal adjusted odds ratios were calculated from the logistic regression. RESULTS Data were available for 10,837 Australian participants aged at least 70 years. In a follow-up assessment three years after the baseline assessment, 17.6% of people self-reported an episode of emergency care (attended an ED of called an emergency ambulance) in the last 12 months. Use of emergency healthcare was similar for men and women (17.8% vs. 17.4% p = 0.61). A score above the cut-off on the CESD at baseline was associated with greater use of emergency health care (OR = 1.35, 95% CI 1.11,1.64). When modelled separately, there was a greater association between a score above the cut-off on the CESD and emergency healthcare for women compared with men. CONCLUSIONS This study is unique in demonstrating how depressive symptoms among healthy older persons are associated with subsequent increased use of emergency healthcare. Improved understanding and monitoring of mental health in primary care is essential to undertake effective healthcare planning including prevention of needing emergency care.
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Affiliation(s)
- Rosamond Dwyer
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- Emergency Department, Peninsula Health, Frankston, VIC, Australia.
- National Centre for Healthy Ageing, Melbourne, Australia.
| | - Kim Jachno
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Thach Tran
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Natasha Layton
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Taya Collyer
- Academic Unit, Peninsula Clinical School, Central Clinical School, Peninsula Health, Monash University, Melbourne, VIC, Australia
| | - Maggie Kirkman
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Judy Lowthian
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Bolton Clarke Research Institute, Forrest Hill, VIC, Australia
| | - Karin Hammarberg
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, IMPACT, Deakin University, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
- Orygen The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | - Jane Fisher
- School of Public Health and Preventive Medicine, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Global and Women's Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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16
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Marjanovic N, Jonchier M, Guenezan J, Delelis-Fanien H, Reuter PG, Mimoz O. Telemedicine in Nursing Home Residents Requiring a Call to an Emergency Medical Communication Center. J Am Med Dir Assoc 2024; 25:195-200.e1. [PMID: 38623779 DOI: 10.1016/j.jamda.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 04/17/2024]
Abstract
OBJECTIVES To compare the proportion of nursing home residents dispatched to an emergency department (ED) after a call to the emergency medical communication center (EMCC) according to the availability or nonavailability of telemedicine. DESIGN This prospective, observational trial was conducted in the EMCC and 74 nursing homes in a French county. SETTING AND PARTICIPANTS All nursing home residents who needed to contact the EMCC between June 2019 and April 2020 were included in the study. We excluded calls notifying the death of a resident, for completing data from a previous call, and for nursing home staff. METHODS The primary outcome was the proportion of residents dispatched to an ED after their first call to the EMCC. The secondary outcomes were the proportion of second calls, proportion of residents dispatched to an ED after a second call, and proportion of death within 30 days. RESULTS We included 3103 calls in the final analysis (355 from equipped nursing homes and 2748 from unequipped nursing homes). The proportion of patients dispatched to an ED after the first call was lower among telemedicine-equipped than among telemedicine-unequipped nursing homes (41% vs 50%; odds ratio, 0.71; 95% CI, 0.56-0.90). The proportion of a second call for the same purpose within 72 hours, proportion of dispatching to an ED at the second call, and proportion of deaths within 30 days were similar between the groups. CONCLUSION AND IMPLICATIONS The use of telemedicine by nursing home residents requiring a call to the EMCC is associated with a reduction in the number of dispatches to an ED without any increase in the number of 72-hour callbacks or 30-day mortality rates.
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Affiliation(s)
- Nicolas Marjanovic
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France.
| | - Maxime Jonchier
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France
| | - Jérémy Guenezan
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France
| | - Henri Delelis-Fanien
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France
| | - Paul-Georges Reuter
- Emergency Department and Prehospital Care, University Hospital of Rennes, Rennes, France
| | - Olivier Mimoz
- Emergency Department and Prehospital Care, University Hospital of Poitiers, Poitiers, France
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17
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Hirooka K, Fukahori H, Ninomiya A, Fukui S, Takahashi K, Anzai T, Ishibashi T. Impact of family involvement and an advance directive to not hospitalize on hospital transfers of residents in long-term care facilities. Arch Gerontol Geriatr 2024; 117:105183. [PMID: 37690255 DOI: 10.1016/j.archger.2023.105183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/04/2023] [Accepted: 09/04/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE With the rapidly aging population, the number of residents transferred to hospitals from long-term care facilities (LTCFs) is increasing globally. The objective of this study was to investigate the association between family involvement and an advance directive (AD) for not hospitalizing and hospital transfers among LTCF residents with dementia. METHOD Using the InterRAI assessment database from September 2014 to June 2019, we included 874 residents from 16 LTCFs in Japan. RESULTS Of the 874 participants, 19.0% had an AD for not hospitalizing, and 20.5% were transferred to hospitals. An AD for not hospitalizing decreased the likelihood of hospital transfers (p = 0.005). Multilevel logistic regression analysis showed that family involvement was not associated with hospital transfers (odds ratio [OR]: 1.18; 95% confidence interval [CI]: 0.77-1.80), while an AD for not hospitalizing was significantly associated with decreased hospital transfers (OR: 0.50; 95% CI: 0.28-0.89) among the LTCF residents. CONCLUSIONS Although ADs are not legally defined in Japan, we found that an AD for not hospitalizing decreased hospital transfers. Given that many older people tend to hesitate to express their wishes in clinical decision-making situations in Japan, regular discussions are necessary to help them express their care preferences while also documenting the discussions to ensure the residents receive high-quality care.
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Affiliation(s)
- Kayo Hirooka
- Department of Home Health and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan; The Dia Foundation for Research on Ageing Societies, Tokyo, Japan.
| | - Hiroki Fukahori
- Division of Gerontological Nursing, Faculty of Nursing and Medical Care, Keio University, Kanagawa, Japan
| | - Ayako Ninomiya
- The Dia Foundation for Research on Ageing Societies, Tokyo, Japan; Division of Fundamental Nursing, Josai International University, Chiba, Japan
| | - Sakiko Fukui
- Department of Home Health and Palliative Care Nursing, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan; The Dia Foundation for Research on Ageing Societies, Tokyo, Japan
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
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18
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Sunner C, Giles M, Ball J, Barker R, Hullick C, Oldmeadow C, Foureur M. Implementation and evaluation of a nurse-led intervention to augment an existing residential aged care facility outreach service with a visual telehealth consultation: stepped-wedge cluster randomised controlled trial. BMC Health Serv Res 2023; 23:1429. [PMID: 38110923 PMCID: PMC10726593 DOI: 10.1186/s12913-023-10384-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 11/27/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Up to 75% of residents from residential aged care facilities (RACF) are transferred to emergency departments (ED) annually to access assessment and care for unplanned or acute health events. Emergency department presentations of RACF residents can be both expensive and risky, and many are unnecessary and preventable. Processes or triage systems to assess residents with a health event, prior to transfer, may reduce unnecessary ED transfer. The Aged Care Emergency (ACE) service is a nurse-led ED outreach service that provides telephone support to RACF nurses regarding residents' health events. This service is available Monday to Friday, 8am to 4 pm (ED ACE hours). The primary objective of this study was to assess whether the augmentation of the phone-based ED ACE service with the addition of a visual telehealth consultation (VTC) would reduce RACF rate of ED presentations compared to usual care. The secondary objectives were to 1) monitor presentations to ED within 48 h post VTC to detect any adverse events and 2) measure RACF staff perceptions of VTC useability and acceptability. METHODS This implementation study used a stepped wedge cluster randomised controlled trial design. Study settings were four public hospital EDs and 16 RACFs in two Local Health Districts. Each ED was linked to 4 RACFs with approximately 350 RACF beds, totalling 1435 beds across 16 participating RACFs. Facilities were randomised into eight clusters with each cluster comprising one ED and two RACFs. RESULTS A negative binomial regression demonstrated a 29% post-implementation reduction in the rate of ED presentations (per 100 RACF beds), within ED ACE hours (IRR [95% CI]: 0.71 [0.46, 1. 09]; p = 0.122). A 29% reduction, whilst not statistically significant, is still clinically important and impactful for residents and EDs. A post-hoc logistic regression demonstrated a statistically significant 69% reduction in the probability that an episode of care resulted in an ED presentation within ED ACE hours post-implementation compared to pre-implementation (OR [95% CI]: 0.31 [0.11, 0.87]; p = 0.025). CONCLUSION Findings have shown the positive impact of augmenting ACE with a VTC. Any reduction of resident presentations to a busy ED is beneficial to healthcare overall, but more so to the individual older person who can recover safely and comfortably in their own RACF. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ID ACTR N12619001692123) (02/12/2019) https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378629andisReview=true.
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Affiliation(s)
- Carla Sunner
- Hunter New England Local Health District, Newcastle, 2300, Australia.
- University of Newcastle, Callaghan, 2308, Australia.
| | - Michelle Giles
- Hunter New England Local Health District, Newcastle, 2300, Australia
- University of Newcastle, Callaghan, 2308, Australia
| | - Jean Ball
- Hunter New England Local Health District, Newcastle, 2300, Australia
| | - Roslyn Barker
- Hunter New England Local Health District, Newcastle, 2300, Australia
| | - Carolyn Hullick
- Hunter New England Local Health District, Newcastle, 2300, Australia
- University of Newcastle, Callaghan, 2308, Australia
| | | | - Maralyn Foureur
- Hunter New England Local Health District, Newcastle, 2300, Australia
- University of Newcastle, Callaghan, 2308, Australia
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Allen MJ, Carter HE, Cyarto E, Meyer C, Dwyer T, Oprescu F, Aitken C, Farrington A, Shield C, Rowland J, Lee XJ, Graves N, Parkinson L, Harvey G. From pilot to a multi-site trial: refining the Early Detection of Deterioration in Elderly Residents (EDDIE +) intervention. BMC Geriatr 2023; 23:811. [PMID: 38057722 PMCID: PMC10698876 DOI: 10.1186/s12877-023-04491-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Early Detection of Deterioration in Elderly Residents (EDDIE +) is a multi-modal intervention focused on empowering nursing and personal care workers to identify and proactively manage deterioration of residents living in residential aged care (RAC) homes. Building on successful pilot trials conducted between 2014 and 2017, the intervention was refined for implementation in a stepped-wedge cluster randomised trial in 12 RAC homes from March 2021 to May 2022. We report the process used to transition from a small-scale pilot intervention to a multi-site intervention, detailing the intervention to enable future replication. METHODS The EDDIE + intervention used the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide the intervention development and refinement process. We conducted an environmental scan; multi-level context assessments; convened an intervention working group (IWG) to develop the program logic, conducted a sustainability assessment and deconstructed the intervention components into fixed and adaptable elements; and subsequently refined the intervention for trial. RESULTS The original EDDIE pilot intervention included four components: nurse and personal care worker education; decision support tools; diagnostic equipment; and facilitation and clinical support. Deconstructing the intervention into core components and what could be flexibly tailored to context was essential for refining the intervention and informing future implementation across multiple sites. Intervention elements considered unsustainable were updated and refined to enable their scalability. Refinements included: an enhanced educational component with a greater focus on personal care workers and interactive learning; decision support tools that were based on updated evidence; equipment that aligned with recipient needs and available organisational support; and updated facilitation model with local and external facilitation. CONCLUSION By using the i-PARIHS framework in the scale-up process, the EDDIE + intervention was tailored to fit the needs of intended recipients and contexts, enabling flexibility for local adaptation. The process of transitioning from a pilot to larger scale implementation in practice is vastly underreported yet vital for better development and implementation of multi-component interventions across multiple sites. We provide an example using an implementation framework and show it can be advantageous to researchers and health practitioners from pilot stage to refinement, through to larger scale implementation. TRIAL REGISTRATION The trial was prospectively registered with the Australia New Zealand Clinical Trial Registry (ACTRN12620000507987, registered 23/04/2020).
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Affiliation(s)
- Michelle J Allen
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia.
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Elizabeth Cyarto
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, Australia
| | - Trudy Dwyer
- Central Queensland University, Norman Gardens, Australia
| | - Florin Oprescu
- School of Health, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Christopher Aitken
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Alison Farrington
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Carla Shield
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Jeffrey Rowland
- Faculty of Medicine, University of Queensland, Herston, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Kelvin Grove, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Xing J Lee
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | | | - Lynne Parkinson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
| | - Gillian Harvey
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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20
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Nasu K, Miyashita M, Hirooka K, Endo T, Fukahori H. Ambulance use and emergency department visits among people with dementia: A cross-sectional survey. Nurs Health Sci 2023; 25:712-720. [PMID: 37987542 DOI: 10.1111/nhs.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023]
Abstract
This study aimed to explore factors associated with ambulance use and emergency department (ED) visits among people with dementia in the month before death. A web-based survey of bereaved family caregivers of people with dementia was conducted in March 2020. Multivariate logistic regression analyses were conducted with ambulance use and ED visits in the month before death as dependent variables. Age and gender of people with dementia and their family caregivers, home care use, decision-makers, comorbidities, degree of independence in daily living, and caregivers' preparedness for death were independent variables. Data were collected from 817 caregivers of people with dementia who had died at hospitals (52.4%), long-term care facilities (25.0%), or own homes (22.4%). Caregivers' lack of preparedness for death was significantly associated with ambulance use in the month before death. Comorbidites and males with dementia were significantly associated with ED visits in the month before death. Better death preparedness of family caregivers may reduce ambulance use for symptoms that can be more effectively addressed by palliative care than acute care for people with dementia.
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Affiliation(s)
- Katsumi Nasu
- Keio Research Institute at SFC, Fujisawa, Japan
- School of Nursing, Yasuda Women's University, Hiroshima, Japan
| | | | - Kayo Hirooka
- Graduate School of Health Care Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuro Endo
- International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Fujisawa, Japan
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21
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Affiliation(s)
- Morgan J Katz
- From the Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore
| | - Sara E Cosgrove
- From the Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore
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22
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Nabavi H, Mehdizadeh S, Shum LC, Flint AJ, Mansfield A, Taati B, Iaboni A. A pilot observational study of gait changes over time before and after an unplanned hospital visit in long-term care residents with dementia. BMC Geriatr 2023; 23:723. [PMID: 37940854 PMCID: PMC10634101 DOI: 10.1186/s12877-023-04385-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/05/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Older adults with dementia living in long-term care (LTC) have high rates of hospitalization. Two common causes of unplanned hospital visits for LTC residents are deterioration in health status and falls. Early detection of health deterioration or increasing falls risk may present an opportunity to intervene and prevent hospitalization. There is some evidence that impairments in older adults' gait, such as reduced gait speed, increased variability, and poor balance may be associated with hospitalization. However, it is not clear whether changes in gait are observable and measurable before an unplanned hospital visit and whether these changes persist after the acute medical issue has been resolved. The objective of this study was to examine gait changes before and after an unplanned acute care hospital visit in people with dementia. METHODS We performed a secondary analysis of quantitative gait measures extracted from videos of natural gait captured over time on a dementia care unit and collected information about unplanned hospitalization from health records. RESULTS Gait changes in study participants before hospital visits were characterized by decreasing stability and step length, and increasing step variability, although these changes were also observed in participants without hospital visits. In an age and sex-adjusted mixed effects model, gait speed and step length declined more quickly in those with a hospital visit compared to those without. CONCLUSIONS These results provide preliminary evidence that clinically meaningful longitudinal gait changes may be captured by repeated non-invasive gait monitoring, although a larger study is needed to identify changes specific to future medical events.
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Affiliation(s)
- Hoda Nabavi
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Sina Mehdizadeh
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Leia C Shum
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Alastair J Flint
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Avril Mansfield
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Evaluative Clinical Sciences, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Babak Taati
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
- Department of Computer Science, University of Toronto, Toronto, ON, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Vector Institute for Artificial Intelligence, Toronto, ON, Canada
| | - Andrea Iaboni
- KITE Research Institute - Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
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23
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Pechová K, Loučka M. Factors Influencing Decision Making in Terminal Hospitalization of Nursing Home Residents: A Qualitative Study of the Perspective of Nurses, Social Workers, and General Practitioners. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:942-959. [PMID: 37051657 DOI: 10.1080/01634372.2023.2199796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 06/19/2023]
Abstract
A significant percentage of nursing home residents die in hospitals. The objective of this study is to explore the factors that influence decision-making about hospitalizations of nursing home residents in the Czech Republic that become terminal. A total of 27 semi-structured interviews with nurses and social workers registered with nursing homes, as well as general practitioners cooperating with nursing homes, were conducted. Data were analyzed using thematic analysis. Six themes of the factors influencing decision-making about hospitalizations were made: the options of the nursing home, the accessibility of medical decision-making, inadequate care planning, the age of the resident, fear of legal action, and making the decision to hospitalize. Terminality of life seems to have no impact on the decision of nurses about hospitalization. Terminal hospitalization seems to be the result of the limited options that nurses have in different nursing homes in terms of how to organize end-of-life care.
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Affiliation(s)
- Karolína Pechová
- Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Martin Loučka
- Centre for Palliative Care, Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
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24
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Hoffmann F, Habbinga K. [Emergency department visits by nursing home residents: analysis of routine data from an urban hospital]. Med Klin Intensivmed Notfmed 2023; 118:549-555. [PMID: 36069998 PMCID: PMC10564807 DOI: 10.1007/s00063-022-00952-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/09/2022] [Accepted: 07/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND The number of emergency department (ED) visits in Germany continues to increase, especially by older people and persons receiving care. OBJECTIVES We aimed to characterize ED visits by nursing home residents (NHR) in Germany. MATERIALS AND METHODS We analyzed routine data of a hospital without trauma surgery (Pius-Hospital Oldenburg). All ED visits by NHR in the period 06/2014-05/2017 were selected from the hospital information system. RESULTS Of 47,270 ED visits, 1676 (3.6%) were NHR (mean age: 78.8 years; 62.9% women; 40.3% were referred). Of them, 20.1% were on weekends and 80.6% occurred between 8 am-8 pm. A total of 84.2% visits led to hospitalization; the length of stay was 1 day for 21.1% and 2-3 days for another 14.6%. With longer length of stay, the proportion of admissions by referring physicians increased. Of those admitted, 10.3% died during hospitalization (28.2% on the day of admission; 47.9% within the first 3 days). People who died were older, their visits were more frequently on weekends, and they were less often referred. CONCLUSION Our study reveals problems in several areas. Improved interprofessional cooperation with general practitioners and strengthened palliative structures should be implemented in nursing homes. Furthermore, there is a need for establishing processes in EDs to realize continued outpatient care for these patients.
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Affiliation(s)
- Falk Hoffmann
- Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Ammerländer Heerstr. 140, 26129, Oldenburg, Deutschland.
| | - Kirsten Habbinga
- Pius-Hospital, Medizinischer Campus der Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
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25
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Basso I, Gonella S, Bassi E, Caristia S, Campagna S, Dal Molin A. Quality improvement interventions to prevent the use of hospital services among nursing home residents: protocol for a systematic review and meta-analysis. BMJ Open 2023; 13:e074684. [PMID: 37758680 PMCID: PMC10537830 DOI: 10.1136/bmjopen-2023-074684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Quality improvement interventions are a promising strategy for reducing hospital services use among nursing home residents. However, evidence for their effectiveness is limited. It is unclear which characteristics of the quality improvement intervention and activities planned to facilitate implementation may promote fidelity to organisational and system changes. This systematic review and meta-analysis will assess the effectiveness of quality improvement interventions and implementation strategies aimed at reducing hospital services use among nursing home residents. METHODS AND ANALYSIS The MEDLINE, CINAHL, Cochrane Library, Embase and Web of Science databases will be comprehensively searched in September 2023. The eligible studies should focus on the implementation of a quality improvement intervention defined as the systematic, continuous approach that designs, tests and implements changes using real-time measurement to reduce hospitalisations or emergency department visits among long-stay nursing home residents. Quality improvement details and implementation strategies will be deductively categorised into effective practice and organisation of care taxonomy domains for delivery arrangements and implementation strategies. Quality and bias assessments will be completed using the Quality Improvement Minimum Quality Criteria Set and the Joanna Briggs Institute Critical Appraisal Tools.The results will be pooled in a meta-analysis, by combining the natural logarithms of the rate ratios across the studies or by calculating the rate ratio using the generic inverse-variance method. Heterogeneity will be assessed using the I2 or H2 statistics if the number of included studies will be less than 10. Raw data will be requested from the authors, as required. ETHICS AND DISSEMINATION Ethical approval is not required. The results will be published in a peer-review journal and presented at (inter)national conferences. PROSPERO REGISTRATION NUMBER CRD42022364195.
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Affiliation(s)
- Ines Basso
- Department of Medicina Traslazionale, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Vercelli, Italy
| | - Silvia Gonella
- Direction of Health Professions, Azienda Ospedaliero Universitaria Citta della Salute e della Scienza di Torino, Torino, Italy
| | - Erika Bassi
- Department of Medicina Traslazionale, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Vercelli, Italy
| | - Silvia Caristia
- Department of Medicina Traslazionale, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Vercelli, Italy
| | - Sara Campagna
- Department of Public Health and Pediatrics, Università degli Studi di Torino, Torino, Italy
| | - Alberto Dal Molin
- Department of Medicina Traslazionale, Università degli Studi del Piemonte Orientale Amedeo Avogadro, Vercelli, Italy
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26
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Hamasaki Y, Sakata N, Jin X, Sugiyama T, Morita K, Uda K, Matsuda S, Tamiya N. Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: a retrospective cohort study. BMC Geriatr 2023; 23:566. [PMID: 37715180 PMCID: PMC10504825 DOI: 10.1186/s12877-023-04278-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Wide variations in facility staffing may lead to differences in care, and consequently, adverse outcomes such as hospitalizations. However, few studies focused on types of occupations. Therefore, we aimed to examine the association between a wide variety of facility staffing and potentially avoidable hospitalizations of nursing home residents in Japan. METHODS In this retrospective cohort study using long-term care and medical insurance claims data in Ibaraki Prefecture from April 2018 to March 2019, we identified individuals aged 65 years and above who were newly admitted to nursing homes. In addition, facility characteristic data were obtained from the long-term care insurance service disclosure system. Subsequently, we conducted a multivariable Cox regression analysis and evaluated the association between facility staffing and potentially avoidable hospitalizations. RESULTS A total of 2909 residents from 235 nursing homes were included. The cumulative incidence of potentially avoidable hospitalizations at 180 days was 14.2% (95% confidence interval [CI] 12.7-15.8). Facilities with full-time physicians (adjusted hazard ratio [HR]: 0.59, 95% CI: 0.37-0.94) and a higher number of dietitians (HR: 0.72, 95% CI: 0.54-0.97) were significantly associated with a lower likelihood of potentially avoidable hospitalizations. In contrast, having nurses or trained caregivers during the night shift (HR: 1.72, 95% CI: 1.25-2.36) and a higher number of care managers (HR: 1.37, 95% CI: 1.03-1.83) were significantly associated with a high probability of potentially avoidable hospitalizations. CONCLUSIONS We revealed that variations in facility staffing were associated with potentially avoidable hospitalizations. The results suggest that optimal allocation of human resources, such as dietitians and physicians, may be essential to reduce potentially avoidable hospitalizations. To provide appropriate care to nursing home residents, it is necessary to establish a system to effectively allocate limited resources. Further research is warranted on the causal relationship between staff allocation and unnecessary hospitalizations, considering the confounding factors.
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Affiliation(s)
- Yoko Hamasaki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nobuo Sakata
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan.
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8575, Japan.
- Heisei Medical Welfare Research Institute, Shibuya-ku, Tokyo, Japan.
| | - Xueying Jin
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Social Science, Research Institute, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Takehiro Sugiyama
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8575, Japan
- Diabetes and Metabolism Information Center, Research Institute, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Kojiro Morita
- Global Nursing Research Center, Graduate School of Medicine, University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kazuaki Uda
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinya Matsuda
- Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Nanako Tamiya
- Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Department of Health Services Research, Institute of Medicine, University of Tsukuba, 1-1-1 Tenno-Dai, Tsukuba, Ibaraki, 305-8575, Japan
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Brühmann BA, von der Warth R, Kaier K, Sehlbrede M, Ott M, Farin-Glattacker E. [Impact of CoCare, a Complex Model Intervention, on medical care in long-term care nursing homes in Germany: An overview of the outcome and process evaluation]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 181:42-54. [PMID: 37357109 DOI: 10.1016/j.zefq.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 03/30/2023] [Accepted: 04/03/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION More and more people are being cared for in nursing homes these days. Multimorbidity results in frequent but sometimes unnecessary patient transports and hospitalisations. The CoCare intervention was developed as a nursing home-based intervention to improve coordination of medical care and GP and specialist care in long-term care homes. The project aimed to reduce avoidable hospital admissions and ambulance transportation, minimise costs through the resulting better collaboration and improving the quality of life of nursing home residents. This article presents the results of the process and outcome evaluation of the intervention in an integrated way and assesses them against the background of the project objectives. METHODS Intervention and data collection started in January 2018 and ended in September 2020. A mixed-methods design was chosen for the evaluation. The (cost) effectiveness of the intervention was tested by a controlled observational study, comparing intervention (IG) and control group (CG). As part of the evaluation of the results, claims data from health insurance funds and a questionnaire-based survey among nursing staff, physicians and nursing home residents were analysed. As part of the process evaluation, subjectively perceived changes in care and implementation difficulties were recorded with the help of focus groups and telephone interviews conducted quarterly. RESULTS From the point of view of the health economic evaluation, with a decrease in total costs of € 468.56 (p<.001) per nursing home resident and quarter, an advantageous cost-benefit ratio can be assumed. Thus, the significant increase in outpatient care for nursing home residents goes along with a reduction of ambulance transportation by 0.19 (p=.049) and hospitalization rates by 0.08 (p=.001). In the nursing staff sample, a significant positive difference between IG (T1) and CG was observed with regard to communication and cooperation. In addition, pre-post comparison showed a significant improvement in the nursing staff's assessment of interprofessional cooperation in IG at T1 compared to T0. Both nursing staff and physicians perceived positive changes in care and positively assessed the benefit of the intervention. While practitioners experienced an intensification and improvement of communication and cooperation through the implementation of the CoCare measures, these changes were not perceived by residents. DISCUSSION The CoCare intervention lowered the barriers for nursing homes to contact general practitioners, specifically in unclear situations and can thus be seen as an effective tool to reduce potentially avoidable hospital admissions and costs. It is conceivable that results can be transferred to other regions in Germany and to similar care scenarios. It should be examined to what extent approaches of this new form of care can be transferred to standard care and whether adjustments to facilitate the implementation of coordinated care approaches across occupational groups in inpatient care facilities can be proposed within the framework of legislative procedures.
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Affiliation(s)
- Boris A Brühmann
- Institut für Medizinische Biometrie und Statistik, Sektion Versorgungsforschung und Rehabilitationsforschung (SEVERA), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland.
| | - Rieka von der Warth
- Institut für Medizinische Biometrie und Statistik, Sektion Versorgungsforschung und Rehabilitationsforschung (SEVERA), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Klaus Kaier
- Institut für Medizinische Biometrie und Statistik, Abteilung Methoden der klinischen Epidemiologie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Matthias Sehlbrede
- Institut für Medizinische Biometrie und Statistik, Sektion Versorgungsforschung und Rehabilitationsforschung (SEVERA), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Margrit Ott
- Zentrum für Geriatrie und Gerontologie Freiburg (ZGGF), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
| | - Erik Farin-Glattacker
- Institut für Medizinische Biometrie und Statistik, Sektion Versorgungsforschung und Rehabilitationsforschung (SEVERA), Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg, Deutschland
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Wang JY, Yang YW, Liu CH, Chang KC, Lin YT, Liu CC. Emergency department visits and associated factors among people with dementia residing in nursing homes in Taiwan: a one-year cohort study. BMC Geriatr 2023; 23:503. [PMID: 37605133 PMCID: PMC10441757 DOI: 10.1186/s12877-023-04221-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Residing in a nursing home (NH) may increase emergency department (ED) utilization in patients with dementia; however, evidence regarding the status of and predictors for ED utilization of NH residents with dementia remains unclear, especially in Asia. This study aimed to assess the incidence density of ED visits and associated factors for the risk of ED utilization among NH residents with dementia. METHODS This one-year cohort study followed 6595 NH residents with dementia aged ≧ 40 years from Taiwan's National Health Insurance Research Database between 2012 and 2014. The Andersen-Gill extension of Cox regression analysis with death as a competing risk was applied to investigate the association of the risk of all causes and the most common causes of ED utilization with the predisposing, enabling, and need factors as defined by the Andersen model. RESULTS All participants encountered 9254 emergency visits in the 5371.49 person-years observed, representing incidence densities of ED visits of 1722.80 per 1000 person-years. Among them, respiratory disease was the most common cause of ED visits. The significant predictors for the risk of all-cause and respiratory-cause ED visits included: (1) predisposing factors (i.e., age and gender); (2) enabling factors (i.e., regional variables); and (3) need factors (i.e., prolonged ventilator dependence and comorbidity status). CONCLUSIONS Predisposing, enabling, and need factors could influence ED visits among studies patients. NH providers should consider these factors to develop strategies for reducing ED utilization.
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Affiliation(s)
- Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Yu-Wan Yang
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Hui Liu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Division of Emergency Medical Service, New Taipei City Fire Department, New Taipei, Taiwan
| | - Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ting Lin
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan
| | - Chih-Ching Liu
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd, Wufeng, Taichung, 41354, Taiwan.
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Keddem S, Ayele R, Ersek M, Murray A, Griffith M, Morawej S, Kutney-Lee A. Barriers and facilitators to goals of care conversations with Veteran residents of community nursing homes. J Am Geriatr Soc 2023; 71:2539-2548. [PMID: 37036028 DOI: 10.1111/jgs.18365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 03/01/2023] [Accepted: 03/19/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Despite evidence that structured goals of care conversations (GoCCs) and documentation of life-sustaining treatment (LST) preferences improve the delivery of goal-concordant care for seriously ill patients, rates of completion remain low among nursing home residents. The Preferences Elicited and Respected for Seriously Ill Veterans through Enhanced Decision-Making (PERSIVED) program aims to improve the consistent documentation of LST preferences among Veterans receiving care in veterans affairs (VA)-paid community nursing homes (CNH); however, the barriers and facilitators of completing and documenting GoCCs in this unique context of care have not been described. METHODS We conducted semi-structured, qualitative interviews with key stakeholders of the VA CNH programs located at six VA Medical Centers between July 2021 and July 2022. With a rapid approach to analysis, interview transcripts were reduced into memo templates using the Tailored Implementation for Chronic Disease Checklist and coded and analyzed using qualitative data analysis software. RESULTS The 40 participants consisted of nurses (n = 13), social workers (n = 25), and VA physicians (n = 2). Most participants felt confident about conducting GoCC; however, several barriers were identified. At the staff level, our results indicated inconsistent completion of GoCC and documentation due to a lack of training, confusion about roles and responsibilities, and challenging communication within the VA as well as with CNH. At the organizational level, there was a lack of standardization across sites for how LST preferences were documented. At the patient level, we found key barriers related to patient and family readiness and issues finding surrogate decision makers. While COVID-19 brought end-of-life issues to the forefront, lockdowns hindered communication about the goals of care. CONCLUSION Findings from this pre-implementation evaluation revealed multi-level barriers in conducting and documenting GoCCs with Veterans receiving VA-paid CNH care, as well as several facilitators that can be used to inform strategies for improvement.
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Affiliation(s)
- Shimrit Keddem
- Center for Health Equity, Research & Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Department of Family Medicine & Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Roman Ayele
- Center of Innovation for Veteran-Centered and Value-Driven Care, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
- University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Mary Ersek
- Center for Health Equity, Research & Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Andrew Murray
- Center for Health Equity, Research & Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - Matthew Griffith
- University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
- Pulmonary and Critical Care Medicine Section, VA Eastern Colorado Health Care System, Aurora, Colorado, USA
| | - Sabrina Morawej
- Center for Health Equity, Research & Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Ann Kutney-Lee
- Center for Health Equity, Research & Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Veteran Experience Center, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA
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Glober N, LaShell A, Montelauro N, Troyer L, Supples M, Unroe K, Tainter C, Faris G, Fuchita M, Boustani M. Impact of interhospital transfer on patients with Alzheimer's disease and other related dementias. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12469. [PMID: 37693225 PMCID: PMC10485388 DOI: 10.1002/dad2.12469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
Older adults are often transferred from one emergency department (ED) to another hospital for speciality care, but little is known about whether those transfers positively impact patients, particularly those with Alzheimer's disease and other related dementias (ADRD). In this study we aimed to describe the impact of interhospital transfer on older adults with and without ADRD. In a retrospective review of electronic medical records, we collected data on demographics, insurance type, initial code status, intensive care, length of stay, specialist consult, procedure within 48 hours, and discharge disposition for older adults (≥ 65 years). We included older adults with at least one ED visit, who were transferred to a tertiary care hospital. With logistic regression, we estimated odds of death, intensive care stay, or procedure within 48 hours by ADRD diagnosis. Patients with ADRD more often received a geriatrics (p < 0.001) or palliative care consult (p = 0.038). They were less likely to be full code at admission (p < 0.001) or to be discharged home (p < 0.001). Patients living with ADRD less often received intensive care or a procedure within 48 hours of transfer (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.22-2.88). Patients with ADRD were less likely to receive intensive care unit admission or specialist procedures after transfer. Further study is indicated to comprehensively understand patient-centered outcomes.
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Affiliation(s)
- Nancy Glober
- Indiana University School of MedicineIndianapolisIndianaUSA
| | | | | | - Lindsay Troyer
- Indiana University School of MedicineIndianapolisIndianaUSA
| | - Michael Supples
- Department of Emergency MedicineWake Forest School of MedicineWinston‐SalemNorth CarolinaUSA
| | - Kathleen Unroe
- Indiana University School of MedicineIndianapolisIndianaUSA
| | | | - Greg Faris
- Indiana University School of MedicineIndianapolisIndianaUSA
| | | | - Malaz Boustani
- Indiana University School of MedicineIndianapolisIndianaUSA
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Wang X(J, Teno JM, Rosendaal N, Smith L, Thomas KS, Dosa D, Gozalo PL, Carder P, Belanger E. State Regulations and Assisted Living Residents' Potentially Burdensome Transitions at the End of Life. J Palliat Med 2023; 26:757-767. [PMID: 36580545 PMCID: PMC10278021 DOI: 10.1089/jpm.2022.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2022] [Indexed: 12/31/2022] Open
Abstract
Background: Potentially burdensome transitions at the end of life (e.g., repeated hospitalizations toward the end of life and/or health care transitions in the last three days of life) are common among residential care/assisted living (RC/AL) residents, and are associated with lower quality of end-of-life care reported by bereaved family members. We examined the association between state RC/AL regulations relevant to end-of-life care delivery and the likelihood of residents experiencing potentially burdensome transitions. Methods: Retrospective cohort study combining RC/AL registries of states' regulations with Medicare claims data for residents in large RC/ALs (i.e., 25+ beds) in the United States on the 120th day before death (N = 129,153), 2017-2019. Independent variables were state RC/AL regulations relevant to end-of-life care, including third-party services, staffing, and medication management. Analyses included: (1) separate logistic regression models for each RC/AL regulation, adjusting for sociodemographic covariates; (2) separate logistic regression models with a Medicare fee-for-service (FFS) subgroup to control for comorbidities, and (3) multivariable regression analysis, including all regulations in both the overall sample and the Medicare FFS subgroup. Results: We found a lack of associations between potentially burdensome transitions and regulations regarding third-party services and staffing. There were small associations found between regulations related to medication management (i.e., requiring regular medication reviews, permitting direct care workers for injections, requiring/not requiring licensed nursing staff for injections) and potentially burdensome transitions. Conclusions: In this cross-sectional study, the associations of RC/AL regulations with potentially burdensome transitions were either small or not statistically significant, calling for more studies to explain the wide variation observed in end-of-life outcomes among RC/AL residents.
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Affiliation(s)
- Xiao (Joyce) Wang
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Joan M. Teno
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Nicole Rosendaal
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Lindsey Smith
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Kali S. Thomas
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - David Dosa
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Pedro L. Gozalo
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- U.S. Department of Veterans Affairs Medical Center, Providence, Rhode Island, USA
| | - Paula Carder
- Institute on Aging, Portland State University, Portland, Oregon, USA
- School of Public Health, Oregon Health and Science University - Portland State University, Portland, Oregon, USA
| | - Emmanuelle Belanger
- Center for Gerontology and Healthcare Research, Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
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Peguero-Rodriguez G, Polomeno V, Backman C, Chartrand J, Lalonde M. The Experience of Families Accompanying a Senior to the Emergency Department: A Scoping Review. J Emerg Nurs 2023:S0099-1767(23)00062-4. [PMID: 37178091 DOI: 10.1016/j.jen.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Seniors are often accompanied by a family member to the emergency department. Families advocate for their needs and contribute to the continuity of care. However, they often feel excluded from care. To improve the quality and safety of care for seniors, it is necessary to consider the experience of families in the emergency department. The aim was to identify and synthesize the available scientific literature dealing with the experience of families accompanying a senior to the emergency department. To identify and synthesize the available scientific literature dealing with the experience of families accompanying a senior to the emergency department. METHODS A scoping review was conducted using the Arksey and O'Malley framework. Six databases were targeted. A description of the identified scientific literature and an inductive content analysis were performed. RESULTS Of the 3082 articles retrieved, 19 met the inclusion criteria. Most articles (89%) were published since 2010, were from nursing (63%), and used a qualitative research design (79%). The content analysis identified 4 main categories related to the experience of families accompanying a senior to the emergency department: (1) process leading to the emergency department, families feel uncertainty and ambiguity with the decision to go to the emergency department; (2) staying in the emergency department, families' experiences are influenced by the triage, the ED environment, and the interactions with ED personnel; (3) discharge from the emergency department, families consider that they should be part of the discharge planning; and (4) recommendations and possible solutions, there is a paucity of recommendations specifically focused on families. DISCUSSION The experience of families of seniors in the emergency department is multifactorial and part of a trajectory of care and health services.
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Tappen RM, Sopcheck J, Southard K, Hain D, Suriaga A. Regional Workshops to Disseminate Decision Guide to Reduce Potentially Preventable Hospital Transfers: Application of the Diffusion of Innovation Model. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:97-104. [PMID: 37141534 DOI: 10.1097/ceh.0000000000000510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
INTRODUCTION Medically unnecessary, potentially preventable transfers of nursing home (NH) residents to acute care poses multiple risks for residents. Family and resident insistence on these preventable transfers has not been thoroughly addressed in transfer reduction programs. METHODS The Diffusion of Innovation model guided dissemination of an evidence-based patient decision guide that addressed resident and family insistence on hospital transfer. Twenty workshops were held across eight states of Centers for Medicare and Medicaid Services Region IV. All Medicare-certified NHs in Region IV received emailed invitations to the workshops in their states. Quantitative and qualitative data were collected on workshop attendees, the facilities they represented, and response to the workshop including adoption of the Guide and its effect on hospital readmissions. RESULTS Altogether, 1124 facility representatives and affiliated professionals attended the workshops. NH administrators rated the program 4.4 out of 5. Of those who responded, 71% said that they were using the Guide as a result of the workshop; 89% of these said that it was helpful, especially to initiate difficult conversations about end-of-life care and to discuss the care a contemporary NH can provide. Readmission rates dropped 30% in the NHs that reported their results. DISCUSSION The use of the Diffusion of Innovation model was effective in delivering information to a large number of facilities in sufficient detail to implement the Decision Guide. However, the workshop format provided little opportunity to respond to concerns that arose after the workshops, to diffuse the innovation further, or to build sustainability.
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Affiliation(s)
- Ruth M Tappen
- Dr. Tappen: Christine E. Lynn Eminent Scholar and Professor, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL. Dr. Sopcheck: Research Associate, College of Nursing, Florida Atlantic University, Boca Raton, FL. Dr. Southard: Program Director (SC), The Carolinas Center for Medical Excellence, Cary, NC. Dr. Hain: Graduate Coordinator AGNP Concentration, Ronald and Elizabeth Blake Distinguished Professor, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL. Dr. Suriaga: Assistant Professor, Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, FL
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Mary de Farcy P, Kebouchi S, Pardineille C, Muller De Schongor F, Li Peng C, Sanapo F, Lechowski L. [Emergency room transfers for residents of the 16th arrondissement of Paris]. SOINS. GERONTOLOGIE 2023; 28:31-35. [PMID: 37328205 DOI: 10.1016/j.sger.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Access to care for the population residing in residential facilities for dependent elderly people (Ehpad), i.e. 600,000 people in France in 2019, is a major public health issue. Description of the characteristics and pathways of the residents of Ehpad transferred to the emergency department (SAU) in the Paris 16th district.
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Affiliation(s)
- Pauline Mary de Farcy
- Service de Médecine des Aînés, AP-HP, Université Paris-Saclay site Sainte-Périne, 11 rue Chardon-Lagache, 75016 Paris, France
| | - Samia Kebouchi
- Service de Médecine des Aînés, AP-HP, Université Paris-Saclay site Sainte-Périne, 11 rue Chardon-Lagache, 75016 Paris, France
| | - Clio Pardineille
- Service de Médecine des Aînés, AP-HP, Université Paris-Saclay site Sainte-Périne, 11 rue Chardon-Lagache, 75016 Paris, France.
| | - Florence Muller De Schongor
- Service de Médecine des Aînés, AP-HP, Université Paris-Saclay site Sainte-Périne, 11 rue Chardon-Lagache, 75016 Paris, France
| | - Chang Li Peng
- Service de Médecine des Aînés, AP-HP, Université Paris-Saclay site Sainte-Périne, 11 rue Chardon-Lagache, 75016 Paris, France
| | - Federica Sanapo
- Service de Médecine des Aînés, AP-HP, Université Paris-Saclay site Sainte-Périne, 11 rue Chardon-Lagache, 75016 Paris, France
| | - Laurent Lechowski
- Service de Médecine des Aînés, AP-HP, Université Paris-Saclay site Sainte-Périne, 11 rue Chardon-Lagache, 75016 Paris, France
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Kristensen GS, Kjeldgaard AH, Søndergaard J, Andersen-Ranberg K, Pedersen AK, Mogensen CB. Associations between care home residents' characteristics and acute hospital admissions - a retrospective, register-based cross-sectional study. BMC Geriatr 2023; 23:234. [PMID: 37072701 PMCID: PMC10114422 DOI: 10.1186/s12877-023-03895-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/15/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Care home residents are frail, multi-morbid, and have an increased risk of experiencing acute hospitalisations and adverse events. This study contributes to the discussion on preventing acute admissions from care homes. We aim to describe the residents' health characteristics, survival after care home admission, contacts with the secondary health care system, patterns of admissions, and factors associated with acute hospital admissions. METHOD Data on all care home residents aged 65 + years living in Southern Jutland in 2018-2019 (n = 2601) was enriched with data from highly valid Danish national health registries to obtain information on characteristics and hospitalisations. Characteristics of care home residents were assessed by sex and age group. Factors associated with acute admissions were analysed using Cox Regression. RESULTS Most care home residents were women (65.6%). Male residents were younger at the time of care home admission (mean 80.6 vs. 83.7 years), had a higher prevalence of morbidities, and shorter survival after care home admission. The 1-year survival was 60.8% and 72.3% for males and females, respectively. Median survival was 17.9 months and 25.9 months for males and females, respectively. The mean rate of acute hospitalisations was 0.56 per resident-year. One in four (24.4%) care home residents were discharged from the hospital within 24 h. The same proportion was readmitted within 30 days of discharge (24.6%). Admission-related mortality was 10.9% in-hospital and 13.0% 30 days post-discharge. Male sex was associated with acute hospital admissions, as was a medical history of various cardiovascular diseases, cancer, chronic obstructive pulmonary disease, and osteoporosis. In contrast, a medical history of dementia was associated with fewer acute admissions. CONCLUSION This study highlights some of the major characteristics of care home residents and their acute hospitalisations and contributes to the ongoing discussion on improving or preventing acute admissions from care homes. TRIAL REGISTRATION Not relevant.
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Affiliation(s)
- Gitte Schultz Kristensen
- Emergency Department, Aabenraa Hospital, Department of Regional Health Research, Faculty of Health Science, University Hospital of Southern Jutland, University of Southern Denmark, Odense, Denmark.
| | | | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, Department of Public Health, Department of Regional Health Research, Faculty of Health Science, Clinical research Department, Aabenraa Hospital, University of Southern Denmark University Hospital of Southern Denmark, Odense, Denmark
| | - Andreas Kristian Pedersen
- Department of Regional Health Research, Faculty of Health Science, Emergency Department, Aabenraa Hospital, The University of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
| | - Christian Backer Mogensen
- Department of Regional Health Research, Faculty of Health Science, Emergency Department, Aabenraa Hospital, The University of Southern Denmark, University Hospital of Southern Denmark, Odense, Denmark
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Muntendorf LK, Balzer K, Friede T, Hummers E, König HH, Müller C, Scherer M, Steyer L, Tetzlaff B, Pfeiffer S, Konnopka A. Cost-Effectiveness of Inter-Professional Collaboration to Reduce Hospitalisations in Nursing Home Residents: Results from the German Interprof ACT Trial. Int J Integr Care 2023; 23:8. [PMID: 37091495 PMCID: PMC10120601 DOI: 10.5334/ijic.7001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
Background The German multi-centre cluster-randomised controlled trial interprof ACT investigated interventions to increase inter-professional collaboration between nursing home (NH) staff and local general practitioners to reduce hospitalisations and improve nursing homes residents' (NHRs) quality of life. The trial was funded by the German Health Care Innovation Fund. Methods Cost-effectiveness of interprof ACT interventions was evaluated and compared to current standard of care (SOC) over 12 months, including 622 NHRs in 34 NHs in Germany. Multiplying resource use of healthcare services with German-specific unit costs generated costs. Health outcome was measured in quality-adjusted life-years QALYs), utility by multiplying EQ-5D-5L values with German-specific utility weights. Incremental cost-effectiveness analysis used an intention-to-treat approach and scenario analyses (SAs). Net-benefit-regression and cost-effectiveness acceptability curves addressed uncertainty. A German healthcare insurance perspective was assumed. Results Base case results showed non-significant cost savings of 851.88€ and non-significant QALY loss of -0,056. Discussion Dependency levels at baseline were non-significantly higher in IG compared to control group (CG). Lack of baseline costing data eliminated possibility to evaluate changes in costs due to the interprof ACT measures for both groups. Conclusion Interprof ACT interventions are not cost-effective compared to current SOC.
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Affiliation(s)
- Louisa-Kristin Muntendorf
- University Medical Center Hamburg-Eppendorf, Institute of Health Services Research and Health Economics, Martinistraße 52, D-20246 Hamburg, Germany
| | - Katrin Balzer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Ratzeburger Allee 160, Haus 50, D-23538 Lübeck, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, D-37073 Göttingen, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, D-37073 Göttingen, Germany
| | - Hans-Helmut König
- University Medical Center Hamburg-Eppendorf, Institute of Health Services Research and Health Economics, Martinistraße 52, D-20246 Hamburg, Germany
| | - Christiane Müller
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, D-37073 Göttingen, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany
| | - Linda Steyer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Ratzeburger Allee 160, Haus 50, D-23538 Lübeck, Germany
| | - Britta Tetzlaff
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, D-20246 Hamburg, Germany
| | - Sebastian Pfeiffer
- Department of Medical Statistics, University Medical Center Göttingen, Humboldtallee 32, D-37073 Göttingen, Germany
| | - Alexander Konnopka
- University Medical Center Hamburg-Eppendorf, Institute of Health Services Research and Health Economics, Martinistraße 52, D-20246 Hamburg, Germany
- Department Psychology, MSH Medical School Hamburg, Am Kaiserkai 1, D-20457 Hamburg, Germany
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Fassmer AM, Allers K, Helbach J, Zuidema S, Freitag M, Zieschang T, Hoffmann F. Hospitalization of German and Dutch Nursing Home Residents Depend on Different Long-Term Care Structures: A Systematic Review on Periods of Increased Vulnerability. J Am Med Dir Assoc 2023; 24:609-618.e6. [PMID: 36898411 DOI: 10.1016/j.jamda.2023.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To investigate proportions of hospitalized nursing home residents during periods of increased vulnerability, ie, the first 6 months after institutionalization and the last 6 months before death, and comparing the figures between Germany and the Netherlands. DESIGN Systematic review, registered in PROSPERO (CRD42022312506). SETTING AND PARTICIPANTS Newly admitted or deceased residents. METHODS We searched MEDLINE via PubMed, EMBASE, and CINAHL from inception through May 3, 2022. We included all observational studies that reported the proportions of all-cause hospitalizations among German or Dutch nursing home residents during these defined vulnerable periods. Study quality was assessed using the Joanna Briggs Institute's tool. We assessed study and resident characteristics and outcome information and descriptively reported them separately for both countries. RESULTS We screened 1856 records for eligibility and included 9 studies published in 14 articles (Germany: 8; Netherlands: 6). One study for each country investigated the first 6 months after institutionalization. A total of 10.2% of the Dutch and 42.0% of the German nursing home residents were hospitalized during this time. Overall, 7 studies reported on in-hospital deaths, with proportions ranging from 28.9% to 29.5% for Germany and from 1.0% to 16.3% for the Netherlands. Proportions for hospitalization in the last 30 days of life ranged from 8.0% to 15.7% (Netherlands: n = 2) and from 48.6% to 58.0% (Germany: n = 3). Only German studies assessed the differences by age and sex. Although hospitalizations were less common at older ages, they were more frequent in male residents. CONCLUSIONS AND IMPLICATIONS During the observed periods, the proportion of nursing homes residents being hospitalized differed greatly between Germany and the Netherlands. The higher figures for Germany can probably be explained by differences in the long-term care systems. There is a lack of research, especially for the first months after institutionalization, and future studies should examine the care processes of nursing home residents following acute events in more detail.
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Affiliation(s)
- Alexander M Fassmer
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany.
| | - Katharina Allers
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Jasmin Helbach
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Sytse Zuidema
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michael Freitag
- Division of General Practice, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Tania Zieschang
- Division of Geriatrics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
| | - Falk Hoffmann
- Division of Outpatient Care and Pharmacoepidemiology, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Lower Saxony, Germany
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Gual N, Nicolas CN, Inzitari M. Delirium in geriatric rehabilitation: the continued case of B.M. JOURNAL OF GERONTOLOGY AND GERIATRICS 2023. [DOI: 10.36150/2499-6564-n601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
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Guion V, Sabra A, Martin C, Blanc E, De Souto Barreto P, Rolland Y. Pneumonia-associated Emergency Transfers, Functional Decline, and Mortality in Nursing Home Residents. J Am Med Dir Assoc 2023; 24:747-752. [PMID: 36996877 DOI: 10.1016/j.jamda.2023.02.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 02/17/2023] [Accepted: 02/23/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE To describe nursing home residents (NHRs) transferred to the emergency department (ED) with pneumonia, and investigate the association of pneumonia with functional ability and mortality. DESIGN Case-control observational multicenter study. SETTING AND PARTICIPANTS Participants of the FINE study, including 1037 NHRs presenting to 17 EDs in France over 4 nonconsecutive weeks (1 per season) in 2016, mean age 87.2 years ± 7.1, 68.4% women. METHODS Activities of daily living (ADL) performance evolution between (1) 15 days before transfer and (2) within 7 days after discharge back to the nursing home was compared in NHRs with or without pneumonia. The association of pneumonia with functional evolution was investigated by a mixed-effect linear regression of ADL and mortality was compared by a χ2 test. RESULTS NHRs with pneumonia (n = 232; 22.4%) were more likely to have a lower ADL performance than NHRs without pneumonia (n = 805, 77.6%). They presented with a more severe clinical condition, were more likely to be hospitalized after ED and to stay longer in ED and in hospital. They showed a 0.5 decline in median ADL performance after transfer and a significantly higher mortality than NHRs without pneumonia (24.1% and 8.7%, respectively). Post-ED functional evolution did not differ significantly between NHRs with or without pneumonia. CONCLUSIONS AND IMPLICATIONS Pneumonia-associated ED transfers resulted in longer care pathways and higher mortality, but no significant difference in functional decline. This study identified a suggestive course of symptoms that could facilitate early identification of NHRs developing pneumonia and early management to prevent ED transfer.
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Affiliation(s)
- Vincent Guion
- Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France; Service de soins palliatifs, CHU de Besançon, Besançon, France.
| | - Ayman Sabra
- Direction Médicale Vaccins, Pfizer France, Paris, France
| | - Catherine Martin
- Medical Development and Scientific/Clinical Affairs, Pfizer Vaccines, Collegeville, PA, USA
| | | | - Philipe De Souto Barreto
- Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France; CERPOP Centre d'Epidémiologie et de Recherche en santé des POPulations UPS/INSERM UMR 1295, Toulouse, France
| | - Yves Rolland
- Gerontopole of Toulouse, Institute on Aging, Toulouse University Hospital (CHU Toulouse), Toulouse, France; CERPOP Centre d'Epidémiologie et de Recherche en santé des POPulations UPS/INSERM UMR 1295, Toulouse, France
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Cetin-Sahin D, Cummings GG, Gore G, Vedel I, Karanofsky M, Voyer P, Gore B, Lungu O, Wilchesky M. Taxonomy of Interventions to Reduce Acute Care Transfers From Long-term Care Homes: A Systematic Scoping Review. J Am Med Dir Assoc 2023; 24:343-355. [PMID: 36758622 DOI: 10.1016/j.jamda.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/22/2022] [Accepted: 12/31/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop a taxonomy of interventions aimed at reducing emergency department (ED) transfers and/or hospitalizations from long-term care (LTC) homes. DESIGN A systematic scoping review. SETTING AND PARTICIPANTS Permanent LTC home residents. METHODS Experimental and comparative observational studies were searched in MEDLINE, CINAHL, Embase Classic + Embase, the Cochrane Library, PsycINFO, Social Work Abstracts, AMED, Global Health, Health and Psychosocial Instruments, Joanna Briggs Institute EBP Database, Ovid Healthstar, and Web of Science Core Collection from inception until March 2020. Forward/backward citation tracking and gray literature searches strengthened comprehensiveness. The Mixed Methods Appraisal Tool was used to assess study quality. Intervention categories and components were identified using an inductive-deductive thematic analysis. Categories were informed by 3 intervention dimensions: (1) "when/at what point(s)" on the continuum of care they occur, (2) "for whom" (ie, intervention target resident populations), and (3) "how" these interventions effect change. Components were informed by the logistical elements of the interventions having the potential to influence outcomes. All interventions were mapped to the developed taxonomy based on their categories, components, and outcomes. Distributions of components by category and study year were graphically presented. RESULTS Ninety studies (25 randomized, 23 high quality) were included. Six intervention categories were identified: advance care planning; palliative and end-of-life care; onsite care for acute, subacute, or uncontrolled chronic conditions; transitional care; enhanced usual care (most prevalent, 31% of 90 interventions); and comprehensive care. Four components were identified: increasing human resource capacity (most prevalent, 93%), training or reorganization of existing staff, technology, and standardized tools. The use of technology increased over time. Potentially avoidable ED transfers and/or hospitalizations were measured infrequently as primary outcomes. CONCLUSIONS AND IMPLICATIONS This proposed taxonomy can guide future intervention designs. It can also facilitate systematic reviews and precise effect size estimations for homogenous interventions when outcomes are comparable.
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Affiliation(s)
- Deniz Cetin-Sahin
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada; Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada
| | - Greta G Cummings
- College of Health Sciences, University of Alberta, Edmonton, Canada
| | - Genevieve Gore
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Mark Karanofsky
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada; Herzl Family Practice Centre, Jewish General Hospital CIUSSS Centre Ouest de l'ile de Montreal, Montreal, Quebec, Canada
| | - Phillippe Voyer
- Faculty of Nursing, Université Laval, Quebec City, Quebec, Canada
| | - Brian Gore
- Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada
| | - Ovidiu Lungu
- Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Machelle Wilchesky
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada; Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada.
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O’Caoimh R. Validation of the Risk Instrument for Screening in the Community ( RISC) among Older Adults in the Emergency Department. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3734. [PMID: 36834429 PMCID: PMC9966437 DOI: 10.3390/ijerph20043734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Although several short-risk-prediction instruments are used in the emergency department (ED), there remains insufficient evidence to guide healthcare professionals on their use. The Risk Instrument for Screening in the Community (RISC) is an established screen comprising three Likert scales examining the risk of three adverse outcomes among community-dwelling older adults at one-year: institutionalisation, hospitalisation, and death, which are scored from one (rare/minimal) to five (certain/extreme) and combined into an Overall RISC score. In the present study, the RISC was externally validated by comparing it with different frailty screens to predict risk of hospitalisation (30-day readmission), prolonged length of stay (LOS), one-year mortality, and institutionalisation among 193 consecutive patients aged ≥70 attending a large university hospital ED in Western Ireland, assessed for frailty, determined by comprehensive geriatric assessment. The median LOS was 8 ± 9 days; 20% were re-admitted <30 days; 13.5% were institutionalised; 17% had died; and 60% (116/193) were frail. Based on the area under the ROC curve scores (AUC), the Overall RISC score had the greatest diagnostic accuracy for predicting one-year mortality and institutionalisation: AUC 0.77 (95% CI: 0.68-0.87) and 0.73 (95% CI: 0.64-0.82), respectively. None of the instruments were accurate in predicting 30-day readmission (AUC all <0.70). The Overall RISC score had good accuracy for identifying frailty (AUC 0.84). These results indicate that the RISC is an accurate risk-prediction instrument and frailty measure in the ED.
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Affiliation(s)
- Rónán O’Caoimh
- Department of Geriatric Medicine, Mercy University Hospital, Grenville Place, T12 WE28 Cork, Ireland; ; Tel.: +353-21-420-5976
- Clinical Research Facility Cork, Mercy University Hospital, University College Cork, T12 WE28 Cork, Ireland
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Bracci E, Allen M, Carter HE, Cyarto L, Dwyer T, Graves N, Lee XJ, Meyer C, Oprescu F, Harvey G. Protocol for a process evaluation of a stepped wedge randomised controlled trial to reduce unnecessary hospitalisations of older people from residential aged care: the EDDIE+ study. BMJ Open 2023; 13:e066857. [PMID: 36797014 PMCID: PMC9936275 DOI: 10.1136/bmjopen-2022-066857] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION The Early Detection of Deterioration in Elderly residents (EDDIE+) programme is a theory-informed, multi-component intervention aimed at upskilling and empowering nursing and personal care staff to identify and manage early signs of deterioration in residents of aged care facilities. The intervention aims to reduce unnecessary hospital admissions from residential aged care (RAC) homes. Alongside a stepped wedge randomised controlled trial, an embedded process evaluation will be conducted to assess the fidelity, acceptability, mechanisms of action and contextual barriers and enablers of the EDDIE+ intervention. METHODS AND ANALYSIS Twelve RAC homes in Queensland, Australia are participating in the study. A comprehensive mixed-methods process evaluation, informed by the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, will assess intervention fidelity, contextual barriers and enablers, mechanisms of action, and the acceptability of the programme from various stakeholder perspectives. Quantitative data will be collected prospectively from project documentation, including baseline context mapping of participating sites, activity tracking and regular check-in communication sheets. Qualitative data will be collected postintervention via semi-structured interviews with a range of stakeholder groups. The i-PARIHS constructs of innovation, recipients, context and facilitation will be applied to frame the analysis of quantitative and qualitative data. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the Bolton Clarke Human Research Ethics Committee (approval number: 170031) with administrative ethical approval granted by the Queensland University of Technology University Human Research Ethics Committee (2000000618). Full ethical approval includes a waiver of consent for access to residents' demographic, clinical and health services de-identified data. A separate health services data linkage based on RAC home addresses will be sought through a Public Health Act application. Study findings will be disseminated through multiple channels, including journal publications, conference presentations and interactive webinars with a stakeholder network. TRIAL REGISTRATION NUMBER Australia New Zealand Clinical Trial Registry (ACTRN12620000507987).
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Affiliation(s)
- Ella Bracci
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Michelle Allen
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Liz Cyarto
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Trudy Dwyer
- Appleton Institute, Central Queensland University, Rockhampton, Queensland, Australia
| | - Nicholas Graves
- Duke-NUS Postgraduate Medical School, National University of Singapore, Singapore
| | - Xing Ju Lee
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Forest Hill, Victoria, Australia
| | - Florin Oprescu
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, Queensland, Australia
| | - Gillian Harvey
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Searle B, Barker RO, Stow D, Spiers GF, Pearson F, Hanratty B. Which interventions are effective at decreasing or increasing emergency department attendances or hospital admissions from long-term care facilities? A systematic review. BMJ Open 2023; 13:e064914. [PMID: 36731926 PMCID: PMC9896242 DOI: 10.1136/bmjopen-2022-064914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE UK long-term care facility residents account for 185 000 emergency hospital admissions each year. Avoidance of unnecessary hospital transfers benefits residents, reduces demand on the healthcare systems but is difficult to implement. We synthesised evidence on interventions that influence unplanned hospital admissions or attendances by long-term care facility residents. METHODS This is a systematic review of randomised controlled trials. PubMed, MEDLINE, EMBASE, ISI Web of Science, CINAHL and the Cochrane Library were searched from 2012 to 2022, building on a review published in 2013. We included randomised controlled trials that evaluated interventions that influence (decrease or increase) acute hospital admissions or attendances of long-term care facility residents. Risk of bias and evidence quality were assessed using Cochrane Risk Of Bias-2 and Grading of Recommendations Assessment, Development and Evaluation. RESULTS Forty-three randomised studies were included in this review. A narrative synthesis was conducted and the weight of evidence described with vote counting. Advance care planning and goals of care setting appear to be effective at reducing hospitalisations from long-term care facilities. Other effective interventions, in order of increasing risk of bias, were: nurse practitioner/specialist input, palliative care intervention, influenza vaccination and enhancing access to intravenous therapies in long-term care facilities. CONCLUSIONS Factors that affect hospitalisation and emergency department attendances of long-term care facility residents are complex. This review supports the already established use of advance care planning and influenza vaccination to reduce unscheduled hospital attendances. It is likely that more than one intervention will be needed to impact on healthcare usage across the long-term care facility population. The findings of this review are useful to identify effective interventions that can be combined, as well as highlighting interventions that either need evaluation or are not effective at decreasing healthcare usage. PROSPERO REGISTRATION NUMBER CRD42020169604.
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Affiliation(s)
- Ben Searle
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Robert O Barker
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Stow
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Gemma F Spiers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Pearson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Sopcheck J, Tappen RM. Nursing Home Resident, Family, and Staff Perspectives on Hospital Transfers for End-of-Life Care. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:1046-1068. [PMID: 33632028 DOI: 10.1177/0030222821997708] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Residents who are terminally ill often experience transfers to the emergency department resulting in hospitalizations, which may be potentially avoidable with treatment in the nursing home. This qualitative study explored the perspectives of 15 residents, 10 family members, and 20 nursing home staff regarding end-of-life care and the circumstances prompting resident transfers. Data analysis of participant interviews conducted January to May 2019 in a South Florida nursing home identified four themes related to transfer to the hospital: time left to live, when aggressive treatments would be unavailing, not knowing what the nursing home can do, and transfer decisions are situation-dependent. Study findings underscore the importance of increasing resident and family awareness of treatments available in the nursing home and person-centered advance care planning discussions. Further research should explore the reasons for residents' and family members' choice of aggressive therapies and their goals for care at the end of life.
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Affiliation(s)
- Janet Sopcheck
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, United States
| | - Ruth M Tappen
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, United States
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Tulchinsky I, Buckley R, Meek R, Lim JJY. Potentially avoidable emergency department transfers from residential aged care facilities for possible post-fall intracranial injury. Emerg Med Australas 2023; 35:41-47. [PMID: 35879249 PMCID: PMC10087771 DOI: 10.1111/1742-6723.14051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/27/2022] [Accepted: 07/03/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To determine the percentage of potentially preventable residential aged care facility (RACF) to ED transfers for potential intracranial injury post-fall. To describe rates of CT brain (CTB) performance, intracranial trauma-related findings, neurosurgical intervention, and patient outcome. METHODS Patient lists were obtained from the hospital electronic medical record, screened for eligibility and data abstracted. Potentially preventable was defined as: (1) RACF return from ED within 24 h, regardless of CTB performance or finding; (2) ED management could reasonably have been provided at the RACF. Comparisons between those with CTB performed or not, including external signs of craniofacial trauma, anticoagulant medication use, baseline cognitive impairment and presence of an advanced care directive (ACD) were made. RESULTS Of 784 patients, 415 (53%) were classified as potentially avoidable. Of these, 314 (76%) had a CTB. Of all 784 patients, 538 (69%) had a CTB performed. CTB was more likely with presence of external signs of craniofacial trauma (26% [95% CI 23-30] vs 20% [95% CI 15-25], P < 0.001) and anticoagulant use (59% [95% CI 55-63] vs 42% [95% CI 37-49], P < 0.001) but not for presence of cognitive impairment or ACD. From the 538 CTBs, 31 (6%) patients had acute intracranial trauma-related findings with all having conservative management. None of the 11 (1%) deaths were in the potentially preventable subgroup. CONCLUSION Just over half of the RACF to ED transfers were classified as 'potentially avoidable'.
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Affiliation(s)
- Igor Tulchinsky
- Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Richard Buckley
- Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia
| | - Robert Meek
- Department of Emergency Medicine, Monash Health, Melbourne, Victoria, Australia.,School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Joel Jun Yi Lim
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
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Lemoyne SEE, Van Bogaert P, Calle P, Wouters K, Deblick D, Herbots H, Monsieurs K. Transferring nursing home residents to emergency departments by emergency physician-staffed emergency medical services: missed opportunities to avoid inappropriate care? Acta Clin Belg 2023; 78:3-10. [PMID: 35234573 DOI: 10.1080/17843286.2022.2042644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND The decision to transfer a nursing home (NH) resident to an emergency department (ED) is multifactorial and challenging but many of the emergency physician-staffed emergency medical service (EP-EMS) interventions and ED transfers are probably inappropriate. METHODS We conducted a retrospective, cross-sectional study in three EP-EMSs in Belgium over a period of three years. We registered indicators that are potentially associated with inappropriate transfers: patient characteristics, availability of written do not resuscitate (DNR) orders or treatment restrictions, involvement of a general practitioner (GP) and availability of transfer notes. We also explored the association between age, the Charlson Comordity Index (CCI), polypharmacy, dementia, and the availability of DNR documents. RESULTS We registered 308 EP-EMS interventions in NH residents. In 98% the caller was a health-care professional. In 75% there was no GP present and 40% had no transfer note. Thirty-two percentage of the patients had dementia, 45% had more than two comorbidities and 68% took five medications or more. In 6% cardiopulmonary resuscitation was performed. DNR orders were available in 25%. Eighty-eight percentage of the NH residents were transferred to the ED. Forty-four percent had a CCI >5. In patients of ≥90 years, with a CCI >5, with dementia and with polypharmacy, DNR orders were not available in 81%, 67%%,and 69%, respectively. CONCLUSIONS Improved EMS dispatch centre-NH caller interaction, more involvement of GP's, higher availability of DNR orders and better communication between GPs/NHs and EP-EMS could prevent inappropriate interventions, futile prehospital aactions,and ED transfers.
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Affiliation(s)
- Sabine E E Lemoyne
- Emergency Department, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Peter Van Bogaert
- Centre for Research and Innovation in Care, University of Antwerp, Edegem, Belgium
| | - Paul Calle
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Kristien Wouters
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Clinical Trial Center (CTC), CRC Antwerp, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Dennis Deblick
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Hanne Herbots
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Kg Monsieurs
- Emergency Department, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Kay S, Unroe KT, Lieb KM, Kaehr EW, Blackburn J, Stump TE, Evans R, Klepfer S, Carnahan JL. Improving Communication in Nursing Homes Using Plan-Do-Study-Act Cycles of an SBAR Training Program. J Appl Gerontol 2023; 42:194-204. [PMID: 36205006 PMCID: PMC9981342 DOI: 10.1177/07334648221131469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Incomplete communication between staff and providers may cause adverse outcomes for nursing home residents. The Situation-Background-Assessment-Recommendation (SBAR) tool is designed to improve communication around changes in condition (CIC). An adapted SBAR was developed for the Centers for Medicare and Medicaid Services demonstration project, OPTIMISTIC, to increase its use during a resident CIC and to improve documentation. METHODS Four Plan-Do-Study-Act (PDSA) cycles to develop and refine successive protocol implementation of the OPTIMISTIC SBAR were deployed in four Indiana nursing homes. Use of SBAR, documentation quality, and participant surveys were assessed pre- and post-intervention implementation. RESULTS OPTIMISTIC SBAR use and documentation quality improved in three of the four buildings. Participants reported improved collaboration between nurses and providers after SBAR intervention. CONCLUSION Successive PDSA cycles implementing changes in an OPTIMISTIC SBAR protocol for resident CIC led to an increase in SBAR use, improved documentation, and better collaboration between nursing staff and providers.
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Affiliation(s)
- Samantha Kay
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kathleen T. Unroe
- Indiana University School of Medicine, Indianapolis, IN, USA,Regenstrief Institute, Indiana University Center for Aging Research, Indianapolis, IN, USA
| | - Kristi M. Lieb
- Indiana University School of Medicine, Indianapolis, IN, USA,Roudebush VA Medical Center, Indianapolis, IN, USA
| | - Ellen W. Kaehr
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Justin Blackburn
- Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Timothy E. Stump
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | - Jennifer L. Carnahan
- Indiana University School of Medicine, Indianapolis, IN, USA,Regenstrief Institute, Indiana University Center for Aging Research, Indianapolis, IN, USA,Roudebush VA Medical Center, Indianapolis, IN, USA
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Kontunen PJ, Holstein RM, Torkki PM, Lang ES, Castrén MK. Acute outreach service to nursing homes: A systematic review with GRADE and triple aim approach. Scand J Caring Sci 2023; 37:582-594. [PMID: 36718539 DOI: 10.1111/scs.13148] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/23/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND People living in nursing homes face the risk of visiting the emergency department (ED). Outreach services are developing to prevent unnecessary transfers to ED. AIMS We aim to assess the performance of acute care services provided to people living in nursing homes or long-term homecare, focusing on ED transfer prevention, safety, cost-effectiveness and experiences. MATERIALS & METHODS This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies were eligible for inclusion if they were peer-reviewed and examined acute outreach services dedicated to delivering care to people in nursing homes or long-term homecare. The service models could also have preventive components. The databases searched were Scopus and CINAHL. In addition, Robins-I and SIGN checklists were used. The primary outcomes of prevented ED transfers or hospitalisations and the composite outcome of adverse events (mortality/Emergency Medical Service or ED visit after outreach service contact related to the same clinical condition) were graded with GRADE. RESULTS Fifteen relevant original studies were found-all were observational and focused on nursing homes. The certainty of evidence for acute outreach services with preventive components to prevent ED transfers or hospitalisations was low. Stakeholders were satisfied with these services. The certainty of evidence for solely acute outreach services to prevent ED transfers or hospitalisations was very low and inconclusive. Reporting of adverse events was inconsistent, certainty of evidence for adverse events was low. CONCLUSION Published data might support adopting acute outreach services with preventive components for people living in nursing homes to reduce ED transfers, hospitalisations and possibly costs. If an outreach service is started, it is recommended that a cluster-randomised or quasi-experimental research design be incorporated to assess the effectiveness and safety of the service. More evidence is also needed on cost-effectiveness and stakeholders' satisfaction. Systematic review registration number: PROSPERO CRD42020211048, date of registration: 25.09.2020.
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Affiliation(s)
- Perttu J Kontunen
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ria M Holstein
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
| | - Paulus M Torkki
- Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Industrial Engineering and Management, Aalto University, Espoo, Finland
| | - Eddy S Lang
- Department of Emergency Medicine, Cumming School of Medicin, University of Calgary, Calgary, Canada.,Alberta Health Service, Edmonton, Canada
| | - Maaret K Castrén
- Department of Emergency Medicine and Services, Helsinki University and Helsinki University Hospital, Helsinki, Finland
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Kim S, Ko SK, Lee TY, Lee JH. Potentially avoidable hospitalizations for older patients transferred from long-term care hospitals: a nationwide cross-sectional analysis of potential healthcare consequences. Intern Emerg Med 2023; 18:169-176. [PMID: 36331669 DOI: 10.1007/s11739-022-03146-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Multiple chronic disorders and disabilities among older patients in long term care hospitals (LTCH) tends to increase the healthcare burden by causing overcrowding, particularly in emergency departments. Therefore, access to timely and adequate healthcare for LTCH patients is an increasingly important issue, and potentially avoidable hospitalizations (PAHs) and hospitalizations during non-office hours can result as indicators of emergency department overcrowding. The study aimed to evaluate PAHs and hospitalizations during non-office hours in emergency departments for older patients transferred from LTCH compared to patients living at home. We performed a cross-sectional study using the National Emergency Department Information System database from January 2018 to December 2019, in South Korea, with older patients (≥ 65 years) who visited nationwide emergency departments. Adjusted odds ratio (aOR) and 95% confidence interval (CI) for indicators of overcrowding as PAHs and hospitalizations during non-office hours were calculated by logistic regression. Among the 2,177,663 older patients who visited the emergency departments, 98,434 patients were living in LTCH and 2,079,229 patients were living at home. The older patients living in LTCH was associated with PAHs (aOR: 1.90, 95% CI 1.87-1.94) and hospitalizations during non-office hours (aOR: 1.76, 95% CI 1.73-1.78). LTCH patients showed more hospital visits, extended stay in the emergency department, greater prevalence of chronic diseases, greater rates of transfer as well as higher admission rates and mortality as compared to the patients living at home. The LTCH older patients were associated with the indicators of emergency department overcrowding, which impacts health care quality in hospitals. Introduction of policy and training programs for LTCH staff are recommended to manage vulnerable groups in advance.
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Affiliation(s)
- Seonji Kim
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Sung-Keun Ko
- National Emergency Medical Center, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, South Korea
| | - Tae Young Lee
- National Emergency Medical Center, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, South Korea
| | - Jin-Hee Lee
- National Emergency Medical Center, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, 04564, South Korea.
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O'Neill BJ, Dwyer T, Parkinson L, Reid-Searl K, Jeffrey D. Identifying the core components of a nursing home hospital avoidance programme. Int J Older People Nurs 2023; 18:e12493. [PMID: 35943901 PMCID: PMC10078518 DOI: 10.1111/opn.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 05/23/2022] [Accepted: 06/27/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Nursing home hospital avoidance programmes have contributed to a reduction in unnecessary emergency transfers but a description of the core components of the programmes has not been forthcoming. A well-operationalised health-care programme requires clarity around core components to evaluate and replicate the programme. Core components are the essential functions and principles that must be implemented to produce expected outcomes. OBJECTIVES To identify the core components of a nursing home hospital avoidance programme by assessing how the core components identified at one nursing home (Site One) translated to a second nursing home (Site Two). METHODS Data collected during the programme's implementation at Site Two were reviewed for evidence of how the core components named at Site One were implemented at Site Two and to determine if any additional core components were evident. The preliminary updated core components were then shared with seven evaluators familiar with the hospital avoidance programme for consensus. RESULTS The updated core components were agreed to include the following: Decision Support Tools, Advanced Clinical Skills Training, Specialist Clinical Support and Collaboration, Facility Policy and Procedures, Family and Care Recipient Education and Engagement, Culture of Staff Readiness, Supportive Executive and Facility Management. CONCLUSION This study launches a discussion on the need to identify hospital avoidance programme core components, while providing valuable insight into how Site One core programme components, such as resources, education and training, clinical and facility support, translated to Site Two, and why modifications and additions, such as incorporating the programme into facility policy, family education and executive support were necessary, and the ramifications of those changes. The next step is to take the eight core component categories and undertake a rigorous fidelity assessment as part of formal process evaluation where the components can be critiqued and measured across multiple nursing home sites. The core components can then be used as evidence-based building blocks for developing, implementing and evaluating nursing home hospital avoidance programmes.
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Affiliation(s)
- Barbara J O'Neill
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia.,School of Nursing, University of Connecticut, Storrs, Connecticut, USA
| | - Trudy Dwyer
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Lynne Parkinson
- School of Medicine and Public Health, University of New Castle, Callaghan, New South Wales, Australia
| | - Kerry Reid-Searl
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, Queensland, Australia
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