51
|
Fernando DT, Berecki-Gisolf J, Newstead S, Ansari Z. Effect of comorbidity on injury outcomes: a review of existing indices. Ann Epidemiol 2019; 36:5-14. [DOI: 10.1016/j.annepidem.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/08/2019] [Accepted: 06/16/2019] [Indexed: 01/13/2023]
|
52
|
Blanc AL, Fumeaux T, Stirnemann J, Dupuis Lozeron E, Ourhamoune A, Desmeules J, Chopard P, Perrier A, Schaad N, Bonnabry P. Development of a predictive score for potentially avoidable hospital readmissions for general internal medicine patients. PLoS One 2019; 14:e0219348. [PMID: 31306461 PMCID: PMC6629067 DOI: 10.1371/journal.pone.0219348] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 06/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Identifying patients at high risk of hospital preventable readmission is an essential step towards selecting those who might benefit from specific transitional interventions. OBJECTIVE Derive and validate a predictive risk score for potentially avoidable readmission (PAR) based on analysis of readmissions, with a focus on medication. DESIGN/SETTING/PARTICIPANTS Retrospective analysis of all hospital admissions to internal medicine wards between 2011 and 2014. Comparison between patients readmitted within 30 days and non-readmitted patients, as identified using a specially designed algorithm. Univariate and multivariate regression analyses of demographic data, clinical diagnoses, laboratory results, and the medication data of patients admitted during the first period (2011-2013), to identify factors associated with PAR. Using these, derive a predictive score with a regression coefficient-based scoring method. Subsequently, validate this score with a second cohort of patients admitted in 2013-2014. Variables were identified at hospital discharge. RESULTS The derivation cohort included 7,317 hospital stays. Multivariate logistic regressions found significant associations with PAR for: [adjusted OR (95% CI)] hospital length of stay > 4 days [1.3 (1.1-1.7)], admission in previous 6 months [2.3 (1.9-2.8)], heart failure [1.3 (1.0-1.7)], chronic ischemic heart disease [1.7 (1.2-2.3)], diabetes with organ damage [2.2 (1.3-3.8)], cancer [1.4 (1.0-1.9)], metastatic carcinoma [1.9 (1.3-3.0)], anemia [1.2 (1.0-1.5)], hypertension [1.3 (1.1-1.7)], arrhythmia [1.3 (1.0-1.6)], hyperkalemia [1.4 (1.0-1.7)], opioid drug prescription [1.3 (1.1-1.6)], and acute myocardial infarction [0.6 (0.4-0.9)]. The PAR-Risk Score, derived from these results, demonstrated fair discriminatory and calibration power (C-statistic = 0.699; Brier Score = 0.069). The results for the validation cohort's operating characteristics were similar (C-statistic = 0.687; Brier Score = 0.064). CONCLUSION This study identified routinely-available factors that were significantly associated with PAR. A predictive score was derived and internally validated.
Collapse
Affiliation(s)
- Anne-Laure Blanc
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland
- Pharmacie Interhospitalière de la Côte, Morges, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| | - Thierry Fumeaux
- Groupement hospitalier de l’ouest lémanique (GHOL), Nyon, Switzerland
| | - Jérôme Stirnemann
- Department of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Elise Dupuis Lozeron
- Division of Clinical Epidemiology, Geneva University Hospitals, Geneva, Switzerland
| | - Aimad Ourhamoune
- Department of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
- Division of Quality of Care, Medical and Quality Directorate, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Clinical Pharmacology and Toxicology, Geneva University Hospitals, Geneva, Switzerland
| | - Pierre Chopard
- Department of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
- Division of Quality of Care, Medical and Quality Directorate, Geneva University Hospitals, Geneva, Switzerland
| | - Arnaud Perrier
- Department of General Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Nicolas Schaad
- Pharmacie Interhospitalière de la Côte, Morges, Switzerland
| | - Pascal Bonnabry
- Pharmacy, Geneva University Hospitals, Geneva, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland
| |
Collapse
|
53
|
Chan B, Goldman LE, Sarkar U, Guzman D, Critchfield J, Saha S, Kushel M. High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population. BMC Health Serv Res 2019; 19:334. [PMID: 31126336 PMCID: PMC6534878 DOI: 10.1186/s12913-019-4162-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 05/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early readmission amongst older safety-net hospitalized adults is costly. Interventions to prevent early readmission have had mixed success. The role of perceived social support is unclear. We examined the association of perceived social support in 30-day readmission or death in older adults admitted to a safety-net hospital. METHODS This is an observational cohort study derived from the Support From Hospital to Home for Elders (SHHE) trial. Participants were community-dwelling English, Spanish and Chinese speaking older adults admitted to medicine wards at an urban safety-net hospital in San Francisco. We assessed perceived social support using the Multidimensional Scale of Perceived Social Support (MSPSS). We defined high social support as the highest quartile of MSPSS. We ascertained 30-day readmission and mortality based on a combination of participant self-report, hospital and death records. We used multiple/multivariable logistic regression to adjust for patient demographics, health status, and health behaviors. We tested for whether race/ethnicity modified the effect high social support had on 30-day readmission or death by including a race-social support interaction term. RESULTS Participants (n = 674) had mean age of 66.2 (SD 9.0), with 18.8% White, 24.8% Black, 31.9% Asian, and 19.3% Latino. The 30-day readmission or death rate was 15.0%. Those with high social support had half the odds of readmission or death than those with low social support (OR = 0.47, 95% CI 0.26-0.88). Interaction analyses revealed race modified this association; higher social support was protective against readmission or death among minorities (AOR = 0.35, 95% CI 0.16-0.76) but increased likelihood of readmission or death among Whites (AOR = 3.7, 95% CI 1.07-12.9). CONCLUSION In older safety-net patients nearing discharge, high perceived social support may protect against 30-day readmission or death among minorities. Assessing patients' social support may aid targeting of transitional care resources and intervention design. How perceived social support functions across racial/ethnic groups in health outcomes warrants further study. TRIAL REGISTRATION NIH trials registry number ClinicalTrials.gov: NCT01221532 .
Collapse
Affiliation(s)
- Brian Chan
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road L475, Portland, OR 97239-3098 USA
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
- Central City Concern, Portland, OR USA
| | - L. Elizabeth Goldman
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
| | - Urmimala Sarkar
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
| | - David Guzman
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
| | - Jeff Critchfield
- Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
| | - Somnath Saha
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road L475, Portland, OR 97239-3098 USA
- VA Portland Health Care System, Portland, OR USA
| | - Margot Kushel
- Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA USA
| |
Collapse
|
54
|
Abstract
BACKGROUND There are numerous definitions of multimorbidity (MM). None systematically examines specific comorbidity combinations accounting for multiple testing when exploring large datasets. OBJECTIVES Develop and validate a list of all single, double, and triple comorbidity combinations, with each individual qualifying comorbidity set (QCS) more than doubling the odds of mortality versus its reference population. Patients with at least 1 QCS were defined as having MM. RESEARCH DESIGN Cohort-based study with a matching validation study. SUBJECTS All fee-for-service Medicare patients between age 65 and 85 without dementia or metastatic solid tumors undergoing general surgery in 2009-2010, and an additional 2011-2013 dataset. MEASURES 30-day all-location mortality. RESULTS There were 576 QCSs (2 singles, 63 doubles, and 511 triples), each set more than doubling the odds of dying. In 2011, 36% of eligible patients had MM. As a group, multimorbid patients (mortality rate=7.0%) had a mortality Mantel-Haenszel odds ratio=1.90 (1.77-2.04) versus a reference that included both multimorbid and nonmultimorbid patients (mortality rate=3.3%), and Mantel-Haenszel odds ratio=3.72 (3.51-3.94) versus only nonmultimorbid patients (mortality rate=1.6%). When matching 3151 pairs of multimorbid patients from low-volume hospitals to similar patients in high-volume hospitals, the mortality rates were 6.7% versus 5.2%, respectively (P=0.006). CONCLUSIONS A list of QCSs identified a third of older patients undergoing general surgery that had greatly elevated mortality. These sets can be used to identify vulnerable patients and the specific combinations of comorbidities that make them susceptible to poor outcomes.
Collapse
|
55
|
Bouza C, Martínez-Alés G, López-Cuadrado T. The impact of dementia on hospital outcomes for elderly patients with sepsis: A population-based study. PLoS One 2019; 14:e0212196. [PMID: 30779777 PMCID: PMC6380589 DOI: 10.1371/journal.pone.0212196] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 01/29/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Prior studies have suggested that dementia adversely influences clinical outcomes and increases resource utilization in patients hospitalized for acute diseases. However, there is limited population-data information on the impact of dementia among elderly hospitalized patients with sepsis. METHODS From the 2009-2011 National Hospital Discharge Database we identified hospitalizations in adults aged ≥65 years. Using ICD9-CM codes, we selected sepsis cases, divided them into two cohorts (with and without dementia) and compared both groups with respect to organ dysfunction, in-hospital mortality and the use of hospital resources. We estimated the impact of dementia on these primary endpoints through multivariate regression models. RESULTS Of the 148 293 episodes of sepsis identified, 16 829 (11.3%) had diagnoses of dementia. Compared to their dementia-free counterparts, they were more predominantly female and older, had a lower burden of comorbidities and were more frequently admitted due to a principal diagnosis of sepsis. The dementia cohort showed a lower risk of organ dysfunction (adjusted OR: 0.84, 95% Confidence Interval [CI]: 0.81, 0.87) but higher in-hospital mortality (adjusted OR: 1.32, 95% [CI]: 1.27, 1.37). The impact of dementia on mortality was higher in the cases of younger age, without comorbidities and without organ dysfunction. The cases with dementia also had a lower length of stay (-3.87 days, 95% [CI]: -4.21, -3.54) and lower mean hospital costs (-3040€, 95% [CI]: -3279, -2800). CONCLUSIONS This nationwide population-based study shows that dementia is present in a substantial proportion of adults ≥65s hospitalized with sepsis, and while the condition does seem to come with a lower risk of organ dysfunction, it exerts a negative influence on in-hospital mortality and acts as an independent mortality predictor. Furthermore, it is significantly associated with shorter length of stay and lower hospital costs.
Collapse
Affiliation(s)
- Carmen Bouza
- Health Technology Assessment Agency, Carlos III Health Institute, Madrid, Spain
- * E-mail:
| | - Gonzalo Martínez-Alés
- Department of Psychiatry, La Paz University Hospital, Madrid, Spain
- School of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Teresa López-Cuadrado
- School of Medicine, Autonomous University of Madrid, Madrid, Spain
- National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain
| |
Collapse
|
56
|
Hajat C, Stein E. The global burden of multiple chronic conditions: A narrative review. Prev Med Rep 2018; 12:284-293. [PMID: 30406006 PMCID: PMC6214883 DOI: 10.1016/j.pmedr.2018.10.008] [Citation(s) in RCA: 390] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/21/2018] [Accepted: 10/14/2018] [Indexed: 01/19/2023] Open
Abstract
Globally, approximately one in three of all adults suffer from multiple chronic conditions (MCCs). This review provides a comprehensive overview of the resulting epidemiological, economic and patient burden. There is no agreed taxonomy for MCCs, with several terms used interchangeably and no agreed definition, resulting in up to three-fold variation in prevalence rates: from 16% to 58% in UK studies, 26% in US studies and 9.4% in Urban South Asians. Certain conditions cluster together more frequently than expected, with associations of up to three-fold, e.g. depression associated with stroke and with Alzheimer's disease, and communicable conditions such as TB and HIV/AIDS associated with diabetes and CVD, respectively. Clusters are important as they may be highly amenable to large improvements in health and cost outcomes through relatively simple shifts in healthcare delivery. Healthcare expenditures greatly increase, sometimes exponentially, with each additional chronic condition with greater specialist physician access, emergency department presentations and hospital admissions. The patient burden includes a deterioration of quality of life, out of pocket expenses, medication adherence, inability to work, symptom control and a high toll on carers. This high burden from MCCs is further projected to increase. Recommendations for interventions include reaching consensus on the taxonomy of MCC, greater emphasis on MCCs research, primary prevention to achieve compression of morbidity, a shift of health systems and policies towards a multiple-condition framework, changes in healthcare payment mechanisms to facilitate this change and shifts in health and epidemiological databases to include MCCs.
Collapse
Affiliation(s)
| | - Emma Stein
- Yale School of Public Health, United States of America
| |
Collapse
|
57
|
Ginoux M, Turquier S, Chebib N, Glerant JC, Traclet J, Philit F, Sénéchal A, Mornex JF, Cottin V. Impact of comorbidities and delay in diagnosis in elderly patients with pulmonary hypertension. ERJ Open Res 2018; 4:00100-2018. [PMID: 30510957 PMCID: PMC6258090 DOI: 10.1183/23120541.00100-2018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 09/12/2018] [Indexed: 11/05/2022] Open
Abstract
Patient age at diagnosis of pulmonary hypertension is steadily increasing. The present study sought to analyse clinical characteristics, time to diagnosis and prognosis of pulmonary hypertension in elderly and very elderly patients. A study was conducted in a French regional referral centre for pulmonary hypertension. All consecutive patients diagnosed with pre-capillary pulmonary hypertension were included and categorised according to age: <65 years (“young”), 65–74 years (“elderly”) and ≥75 years (“very elderly”). Over a 4-year period, 248 patients were included: 101 (40.7%) were young, 82 (33.1%) were elderly and 65 (26.2%) were very elderly. The median age at diagnosis among the total population was 68 years. Compared with young patients, elderly and very elderly patients had a longer time to diagnosis (7±48, 9±21 and 16±32 months, respectively; p<0.001). Patients ≥75 years also more often had group 4 pulmonary hypertension. The median overall survival was 46±1.4 months, but was only 37±4.9 months in elderly patients and 28±4.7 months in very elderly patients. Survival from the first symptoms and survival adjusted to comorbidity was similar across age groups. Patient age should be taken into account when diagnosing pulmonary hypertension as it is associated with a specific clinical profile and a worse prognosis. The difference in prognosis is likely to be related to a delay in diagnosis and a greater number of comorbidities. More than a quarter of patients diagnosed with pre-capillary pulmonary hypertension are older than 75 years; they have a poorer prognosis, likely related to a longer delay in diagnosis and a higher burden of comorbiditieshttp://ow.ly/87FQ30m0WM7
Collapse
Affiliation(s)
- Marylise Ginoux
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Ségolène Turquier
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Nader Chebib
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Jean-Charles Glerant
- Dept of Respiratory Physiology, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Julie Traclet
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - François Philit
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Agathe Sénéchal
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France
| | - Jean-François Mornex
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,Université Lyon I, INRA, UMR754, Lyon, France
| | - Vincent Cottin
- Competence Center for Severe Pulmonary Hypertension, Reference Center for Rare Pulmonary Diseases, Dept of Respiratory Medicine, Hospices Civils de Lyon, Louis Pradel Hospital, Lyon, France.,Université Lyon I, INRA, UMR754, Lyon, France
| |
Collapse
|
58
|
Pouplier S, Olsen MÅ, Willadsen TG, Sandholdt H, Siersma V, Andersen CL, Olivarius NDF. The development of multimorbidity during 16 years after diagnosis of type 2 diabetes. JOURNAL OF COMORBIDITY 2018; 8:2235042X18801658. [PMID: 30363325 PMCID: PMC6169975 DOI: 10.1177/2235042x18801658] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 08/14/2018] [Indexed: 12/21/2022]
Abstract
Objective: The aims of this study were to (1) quantify the development and composition
of multimorbidity (MM) during 16 years following the diagnosis of type 2
diabetes and (2) evaluate whether the effectiveness of structured personal
diabetes care differed between patients with and without MM. Research design and methods: One thousand three hundred eighty-one patients with newly diagnosed type 2
diabetes were randomized to receive either structured personal diabetes care
or routine diabetes care. Patients were followed up for 19 years in Danish
nationwide registries for the occurrence of outcomes. We analyzed the
prevalence and degree of MM based on 10 well-defined disease groups. The
effect of structured personal care in diabetes patients with and without MM
was analyzed with Cox regression models. Results: The proportion of patients with MM increased from 31.6% at diabetes diagnosis
to 80.4% after 16 years. The proportion of cardiovascular and
gastrointestinal diseases in surviving patients decreased, while, for
example, musculoskeletal, eye, and neurological diseases increased. The
effect of the intervention was not different between type 2 diabetes
patients with or without coexisting chronic disease. Conclusions: In general, the proportion of patients with MM increased after diabetes
diagnosis, but the composition of chronic disease changed during the 16
years. We found cardiovascular and musculoskeletal disease to be the most
prevalent disease groups during all 16 years of follow-up. The post hoc
analysis of the intervention showed that its effectiveness was not different
among patients who developed MM compared to those who continued to have
diabetes alone.
Collapse
Affiliation(s)
- Sandra Pouplier
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maria Åhlander Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tora Grauers Willadsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Håkon Sandholdt
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Niels de Fine Olivarius
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
59
|
Segaloff HE, Petrie JG, Malosh RE, Cheng CK, McSpadden EJ, Ferdinands JM, Lamerato L, Lauring AS, Monto AS, Martin ET. Severe morbidity among hospitalised adults with acute influenza and other respiratory infections: 2014-2015 and 2015-2016. Epidemiol Infect 2018; 146:1350-1358. [PMID: 29880077 PMCID: PMC6089216 DOI: 10.1017/s0950268818001486] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/19/2018] [Accepted: 05/09/2018] [Indexed: 11/07/2022] Open
Abstract
Our objective was to identify predictors of severe acute respiratory infection in hospitalised patients and understand the impact of vaccination and neuraminidase inhibitor administration on severe influenza. We analysed data from a study evaluating influenza vaccine effectiveness in two Michigan hospitals during the 2014-2015 and 2015-2016 influenza seasons. Adults admitted to the hospital with an acute respiratory infection were eligible. Through patient interview and medical record review, we evaluated potential risk factors for severe disease, defined as ICU admission, 30-day readmission, and hospital length of stay (LOS). Two hundred sixteen of 1119 participants had PCR-confirmed influenza. Frailty score, Charlson score and tertile of prior-year healthcare visits were associated with LOS. Charlson score >2 (OR 1.5 (1.0-2.3)) was associated with ICU admission. Highest tertile of prior-year visits (OR 0.3 (0.2-0.7)) was associated with decreased ICU admission. Increasing tertile of visits (OR 1.5 (1.2-1.8)) was associated with 30-day readmission. Frailty and prior-year healthcare visits were associated with 30-day readmission among influenza-positive participants. Neuraminidase inhibitors were associated with decreased LOS among vaccinated participants with influenza A (HR 1.6 (1.0-2.4)). Overall, frailty and lack of prior-year healthcare visits were predictors of disease severity. Neuraminidase inhibitors were associated with reduced severity among vaccine recipients.
Collapse
Affiliation(s)
- H. E. Segaloff
- University of Michigan School Of Public Health, Ann Arbor, Michigan 48109, USA
| | - J. G. Petrie
- University of Michigan School Of Public Health, Ann Arbor, Michigan 48109, USA
| | - R. E. Malosh
- University of Michigan School Of Public Health, Ann Arbor, Michigan 48109, USA
| | - C. K. Cheng
- University of Michigan School Of Public Health, Ann Arbor, Michigan 48109, USA
| | - E. J. McSpadden
- University of Michigan School Of Public Health, Ann Arbor, Michigan 48109, USA
| | - J. M. Ferdinands
- Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA
| | - L. Lamerato
- Henry Ford Health System, Detroit, Michigan 48202, USA
| | - A. S. Lauring
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan 48109, USA
| | - A. S. Monto
- University of Michigan School Of Public Health, Ann Arbor, Michigan 48109, USA
| | - E. T. Martin
- University of Michigan School Of Public Health, Ann Arbor, Michigan 48109, USA
| |
Collapse
|
60
|
Vasiliadis HM, Milan R, Gontijo Guerra S, Fleury MJ. Patient and health system factors associated with hospital readmission in older adults without cognitive impairment. Gen Hosp Psychiatry 2018; 53:44-51. [PMID: 29804009 DOI: 10.1016/j.genhosppsych.2018.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/28/2018] [Accepted: 05/03/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To study the factors associated with hospital readmission. METHODS Data used in this study came from a population-based survey of older adults without cognitive impairment. Cox regression was used to assess the factors associated with readmission within a 2-year follow-up period. According to Andersen's model of healthcare seeking behavior, study variables considered included predisposing, enabling and need factors at the individual and health system levels. RESULTS Of the 433 participants with an index hospitalization, 97% were discharged with a physical and 3% with a psychiatric disorder. During follow-up, 29% (128/433) were readmitted with a median time to readmission reaching 83 days. The risk of readmission was associated with the following: age, marital status, attraction index of the region of residence for psychiatric services, the presence of an anxio-depressive and other mental disorder, as well as a disorder of the musculoskeletal system. The presence of a physical and psychiatric comorbidity was also associated with readmission. CONCLUSIONS Post-discharge follow-up of vulnerable populations with a history of mental disorders and improved availability of psychiatric services in the community are associated with a reduced risk of readmission.
Collapse
Affiliation(s)
- Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke (QC), Canada and Charles-Le Moyne Hospital Research Center, Greenfield Park, (QC), Canada.
| | - Raymond Milan
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, (QC), Canada.
| | | | - Marie-Josée Fleury
- Department of Psychiatry, McGill University, Montreal, (QC), Canada and Douglas Mental Health University Institute Research Centre, Montreal, (QC), Canada.
| |
Collapse
|
61
|
Association between multimorbidity and undiagnosed obstructive sleep apnea severity and their impact on quality of life in men over 40 years old. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2018; 3:e10. [PMID: 30263134 PMCID: PMC6152492 DOI: 10.1017/gheg.2018.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 03/05/2018] [Accepted: 04/15/2018] [Indexed: 02/06/2023]
Abstract
Background. Multimorbidity is common but little is known about its relationship with obstructive sleep apnea (OSA). Methods. Men Androgen Inflammation Lifestyle Environment and Stress Study participants underwent polysomnography. Chronic diseases (CDs) were determined by biomedical measurement (diabetes, dyslipidaemia, hypertension, obesity), or self-report (depression, asthma, cardiovascular disease, arthritis). Associations between CD count, multimorbidity, apnea-hyponea index (AHI) and OSA severity and quality-of-life (QoL; mental & physical component scores), were determined using multinomial regression analyses, after adjustment for age. Results. Of the 743 men participating in the study, overall 58% had multimorbidity (2+ CDs), and 52% had OSA (11% severe). About 70% of those with multimorbidity had undiagnosed OSA. Multimorbidity was associated with AHI and undiagnosed OSA. Elevated CD count was associated with higher AHI value and increased OSA severity. Conclusion. We demonstrate an independent association between the presence of OSA and multimorbidity in this representative sample of community-based men. This effect was strongest in men with moderate to severe OSA and three or more CDs, and appeared to produce a greater reduction in QoL when both conditions were present together.
Collapse
|
62
|
Healthcare costs of ICU survivors are higher before and after ICU admission compared to a population based control group: A descriptive study combining healthcare insurance data and data from a Dutch national quality registry. J Crit Care 2018; 44:345-351. [DOI: 10.1016/j.jcrc.2017.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/24/2017] [Accepted: 12/10/2017] [Indexed: 11/24/2022]
|
63
|
Sarvepalli S, Garg SK, Sarvepalli SS, Parikh MP, Wadhwa V, Jang S, Thota PN, Sanaka MR. Inpatient burden of esophageal cancer and analysis of factors affecting in-hospital mortality and length of stay. Dis Esophagus 2018; 31:4956135. [PMID: 29617798 PMCID: PMC7055505 DOI: 10.1093/dote/doy022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/16/2018] [Indexed: 12/11/2022]
Abstract
Esophageal cancer (EC) continues to be a major source of morbidity and mortality in the United States. However, there has been a relative dearth of research into hospital utilization in patients with EC. This study examines temporal trends in hospital admissions, length of stay (LOS), mortality, and costs associated with EC. In addition, we also analyzed factors associated with inpatient mortality and LOS. We interrogated National Inpatient Sample (NIS), a large registry of inpatient data, to retrieve information about various demographic and factors associated with hospital stay in patients who were admitted for EC between the years 1998 and 2013 in the United States. After examining trends over time, multivariate analysis was performed to identify factors associated with LOS and mortality. During 1998-2013, 538,776 hospital stays with principal diagnosis of EC were reviewed. Number of hospital stays and inpatient charges increased by 397 per year (±67.8; P < 0.0001) and $3,033 per patient per year (±135; <0.0001) respectively. Mortality and LOS decreased by 0.23% per year (±0.03; P < 0.0001) and 0.07 days per year (±0.006; P < 0.0001) respectively. Multiple factors associated with LOS and mortality were outlined. Despite overall increase in hospital utilization with respect to number of admissions and inpatient charges, inpatient mortality and LOS associated with EC declined. Factors associated with inpatient mortality and LOS may help drive clinical decision-making and influence healthcare or hospital policy.
Collapse
Affiliation(s)
- S Sarvepalli
- Department of Hospital Medicine, Medicine Institute,Address correspondence to: Shashank Sarvepalli, Department of Hospital Medicine, M75 9500 Euclid Ave, Cleveland, OH 44195, USA.
| | - S K Garg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - S S Sarvepalli
- College of Liberal Arts and Science, Wayne State University, Detroit, Michigan
| | - M P Parikh
- Department of Hospital Medicine, Medicine Institute
| | - V Wadhwa
- Department of Gastroenterology and Hepatology, Digestive Diseases and Surgery Institute, Cleveland Clinic, Weston, Florida, USA
| | - S Jang
- Department of Gastroenterology and Hepatology, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - P N Thota
- Department of Gastroenterology and Hepatology, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| | - M R Sanaka
- Department of Gastroenterology and Hepatology, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
64
|
Li X, Srasuebkul P, Reppermund S, Trollor J. Emergency department presentation and readmission after index psychiatric admission: a data linkage study. BMJ Open 2018; 8:e018613. [PMID: 29490956 PMCID: PMC5855390 DOI: 10.1136/bmjopen-2017-018613] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To use linked administrative datasets to assess factors associated with emergency department (ED) presentation and psychiatric readmission in three distinctive time intervals after the index psychiatric admission. DESIGN A retrospective data-linkage study. SETTING Cohort study using four linked government minimum datasets including acute hospital care from July 2005 to June 2012 in New South Wales, Australia. PARTICIPANTS People who were alive and aged ≥18 years on 1 July 2005 and who had their index admission to a psychiatric ward from 1 July 2007 to 30 June 2010. OUTCOME MEASURES ORs of factors associated with psychiatric admission and ED presentation were calculated for three intervals: 0-1 month, 2-5 months and 6-24 months after index separation. RESULTS Index admission was identified in 35 056 individuals (51% -males) with a median age of 42 years. A total of 12 826 (37%) individuals had at least one ED presentation in the 24 months after index admission. Of those, 3608 (28%) presented within 0-1 month, 6350 (50%) within 2-5 months and 10 294 (80%) within 6-24 months after index admission. A total of 14 153 (40%) individuals had at least one psychiatric readmission in the first 24 months. Of those, 6808 (48%) were admitted within 0-1 month, 6433 (45%) within 2-5 months and 7649 (54%) within 6-24 months after index admission. Principal diagnoses and length of stay at index admission, sociodemographic factors, Charlson Comorbidity Index score, drug and alcohol comorbidity, intellectual disability and other inpatient service use were significantly associated with ED presentations and psychiatric readmissions, and these relationships varied somewhat over the intervals studied. CONCLUSION Social determinants of service use, drug and alcohol intervention, addressing needs of individuals with intellectual disability and recovery-oriented whole-person approaches at index admission are key areas for investment to improve trajectories after index admission.
Collapse
Affiliation(s)
- Xue Li
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Simone Reppermund
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
65
|
Aslam F, Khan NA. Tools for the Assessment of Comorbidity Burden in Rheumatoid Arthritis. Front Med (Lausanne) 2018; 5:39. [PMID: 29503820 PMCID: PMC5820312 DOI: 10.3389/fmed.2018.00039] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/02/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction Comorbidities influence the prognosis, clinical outcomes, disease activity, and treatment response in rheumatoid arthritis (RA). RA patients have a high-comorbidity burden necessitating their study. Comorbidity indices are used to measure comorbidities and to study their impacts on different outcomes. A large number of such indices are used in clinical research. Some indices have been specifically developed in RA patients. Aim This review aims to provide an overview of generic and specific comorbidity indices commonly used in RA research. Methods We performed a critical literature review of comorbidity indices in RA using the PubMed database. Results/discussion This non-systematic literature review provides an overview of generic and specific comorbidity indices commonly used in RA studies. Some of the older but commonly used comorbidity indices like the Charlson comorbidity index and the Elixhauser comorbidity measure were primarily developed to estimate mortality risk from comorbid diseases. They were not specifically developed for RA patients but have been widely used in rheumatology comorbidity measurement. Of the many comorbidity indices available, only the rheumatic disease comorbidity index (RDCI) and the multimorbidity index have been specifically developed in RA patients. The functional comorbidity index was developed to look at functional disability and has been used in RA patients considering that morbidity is more important than mortality in such patients. While there is limited data comparing these indices, available evidence seems to favor the use of RDCI as it predicts mortality, hospitalization, disability, and healthcare utilization. The choice of the index, however, depends on several factors such as the population under study, outcome of interest, and sources of data. More research is needed to study the RA-specific comorbidity measures to make evidence-based recommendations for the choice of a comorbidity measure.
Collapse
Affiliation(s)
- Fawad Aslam
- Division of Rheumatology, Mayo Clinic, Scottsdale, AZ, United States
| | - Nasim Ahmed Khan
- Division of Rheumatology, University of Arkansas for Medical Sciences & Central Arkansas Veterans Health Care System, Little Rock, AR, United States
| |
Collapse
|
66
|
Yu J, Pincus K, Mattingly TJ. Service description and analysis for an interprofessional discharge clinic within a primary care practice. J Interprof Care 2017; 31:771-773. [PMID: 28956674 DOI: 10.1080/13561820.2017.1347611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
At care transitions, patients are susceptible to adverse events and medication errors that can lead to harm or hospital readmission. This study describes the services provided by an interprofessional discharge clinic (IDC) aimed to improve these transitions and the impact on 30-day readmission rate, medication errors, and interventions documented. Data were collected retrospectively using an electronic medical record and analysed using SAS data system. Among 167 discharged patients, 154 patients were seen by a physician only (PO) and 13 patients were seen in the IDC. Thirty-day readmission rates were 26.6% and 7.7% for patients in the PO and IDC groups, respectively (p = 0.19). Seventy patients (45.5%) in the PO group and 11 patients (84.6%) in the IDC group (p = 0.0082) were found to have at least one medication error. All patients seen at the IDC had an intervention made, while 68 (44.2%) seen by a PO received no intervention (p = 0.0009). While sample size was a major limitation, a statistically significant increase in identified medication errors and intervention documentation was found in the IDC group. It is critical that healthcare systems continue to develop new strategies, such as IDCs, to reduce hospital readmissions.
Collapse
Affiliation(s)
- Joyce Yu
- a University of Maryland , Baltimore School of Pharmacy , Baltimore , Maryland , USA
| | - Kathleen Pincus
- b University of Maryland , Baltimore School of Pharmacy, Department of Pharmacy Practice and Sciences , Baltimore , Maryland , USA
| | - T Joseph Mattingly
- b University of Maryland , Baltimore School of Pharmacy, Department of Pharmacy Practice and Sciences , Baltimore , Maryland , USA
| |
Collapse
|
67
|
Abstract
BACKGROUND Long waiting times from early symptoms to diagnosis and treatment may influence the staging and prognosis of patients with colorectal cancer. We analyzed the effect of colonoscopy timing on the outcome of these patients. OBJECTIVE This study aimed to compare the outcome (tumoral staging and long-term survival) of patients with suspected colorectal cancer according to diagnostic colonoscopy timing. DESIGN This study is an analysis of a prospectively maintained database. SETTINGS The study was conducted at the Open Access Endoscopy Service of the tertiary public healthcare center Hospital Universitario de Canarias, in the Spanish island of Tenerife. PATIENTS Consecutive patients diagnosed of colorectal cancer between February 2008 and October 2010, fulfilling 1 or more National Institute for Health and Clinical Excellence criteria, were assigned to early colonoscopy (<30 days from referral) or to standard-schedule colonoscopy at the discretion of the referring physician. Tumor staging (TNM classification) at diagnosis and long-term survival after treatment were compared in both strategies. MAIN OUTCOME MEASURES The primary outcomes measured were the stage at presentation and overall survival, as determined by prompt or standard referral. RESULTS Overall, 257 patients with colorectal cancer were diagnosed (101 at early colonoscopy and 156 at standard-schedule colonoscopy). TNM stages I and II were found in 52 (54.2%) and 60 (41.7%) patients in the early colonoscopy group and standard-schedule colonoscopy group. Stage IV was confirmed in 13 patients (13.5%) diagnosed in the early colonoscopy group and in 40 (28%) detected in the standard-schedule colonoscopy group. Survival rates at 12 and 60 months after treatment were significantly higher in the early colonoscopy group compared with the standard-schedule colonoscopy group (p < 0.001). LIMITATIONS Controlled randomization of early versus standard-referral colonoscopy, size and scope of analysis, the time interval from symptom onset to first physician assessment, and the different locations of colorectal cancer between groups were limitations of the study. CONCLUSIONS Colonoscopy within 30 days from referral improves outcome in patients with symptomatic colorectal cancer. See Video Abstract at http://journals.lww.com/dcrjournal/Pages/videogallery.aspx.
Collapse
|
68
|
Stenius-Ayoade A, Haaramo P, Erkkilä E, Marola N, Nousiainen K, Wahlbeck K, Eriksson JG. Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland. BMC Health Serv Res 2017. [PMID: 28637455 PMCID: PMC5480200 DOI: 10.1186/s12913-017-2372-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Homelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland. Methods The study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs. Results During the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9–20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5–9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4–10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3–31.2) and SUDs (11.5, 95% CI 5.7–23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes. Conclusions Dual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary health care level emergency rooms are strongly associated with both dual diagnosis and SUDs. Active treatment for SUDs could reduce the amount of emergency visits made by homeless shelter users.
Collapse
Affiliation(s)
- Agnes Stenius-Ayoade
- Folkhälsan Research Center, Helsinki, Finland. .,National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland. .,Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland.
| | - Peija Haaramo
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
| | - Elisabet Erkkilä
- Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland
| | - Niko Marola
- National Institute for Health and Welfare, Mental Health Unit, Helsinki, Finland
| | - Kirsi Nousiainen
- Department of Social Research, University of Helsinki, Helsinki, Finland
| | | | - Johan G Eriksson
- Folkhälsan Research Center, Helsinki, Finland.,National Institute for Health and Welfare, Department of Chronic Disease Prevention, Helsinki, Finland.,Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| |
Collapse
|
69
|
Aubert CE, Folly A, Mancinetti M, Hayoz D, Donzé JD. Performance-based functional impairment and readmission and death: a prospective study. BMJ Open 2017; 7:e016207. [PMID: 28600376 PMCID: PMC5726050 DOI: 10.1136/bmjopen-2017-016207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Readmission and death are frequent after a hospitalisation and difficult to predict. While many predictors have been identified, few studies have focused on functional status. We assessed whether performance-based functional impairment at discharge is associated with readmission and death after an acute medical hospitalisation. DESIGN, SETTING AND PARTICIPANTS We prospectively included patients aged ≥50 years admitted to the Department of General Internal Medicine of a large community hospital. Functional status was assessed shortly before discharge using the Timed Up and Go test performed twice in a standard way by trained physiotherapists and was defined as a test duration ≥15 s. Sensitivity analyses using a cut-off at >10 and >20 s were performed. PRIMARY AND SECONDARY OUTCOME MEASURES The primary and secondary outcome measures were unplanned readmission and death, respectively, within 6 months after discharge. RESULTS Within 6 months after discharge, 107/338 (31.7%) patients had an unplanned readmission and 31/338 (9.2%) died. Functional impairment was associated with higher risk of death (OR 2.44, 95% CI 1.15 to 5.18), but not with unplanned readmission (OR 1.34, 95% CI 0.84 to 2.15). No significant association was found between functional impairment and the total number of unplanned readmissions (adjusted OR 1.59, 95% CI 0.95 to 2.67). CONCLUSIONS Functional impairment at discharge of an acute medical hospitalisation was associated with higher risk of death, but not of unplanned readmission within 6 months after discharge. Simple performance-based assessment may represent a better prognostic measure for mortality than for readmission.
Collapse
Affiliation(s)
- Carole E Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of General Internal Medicine, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Antoine Folly
- Department of General Internal Medicine, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Marco Mancinetti
- Department of General Internal Medicine, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Daniel Hayoz
- Department of General Internal Medicine, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Jacques D Donzé
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
- Medicine, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
70
|
Pulignano G, Gulizia MM, Baldasseroni S, Bedogni F, Cioffi G, Indolfi C, Romeo F, Murrone A, Musumeci F, Parolari A, Patanè L, Pino PG, Mongiardo A, Spaccarotella C, Di Bartolomeo R, Musumeci G. ANMCO/SIC/SICI-GISE/SICCH Executive Summary of Consensus Document on Risk Stratification in elderly patients with aortic stenosis before surgery or transcatheter aortic valve replacement. Eur Heart J Suppl 2017; 19:D354-D369. [PMID: 28751850 PMCID: PMC5520760 DOI: 10.1093/eurheartj/sux012] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Aortic stenosis is one of the most frequent valvular diseases in developed countries, and its impact on public health resources and assistance is increasing. A substantial proportion of elderly people with severe aortic stenosis is not eligible to surgery because of the advanced age, frailty, and multiple co-morbidities. Transcatheter aortic valve implantation (TAVI) enables the treatment of very elderly patients at high or prohibitive surgical risk considered ineligible for surgery and with an acceptable life expectancy. However, a significant percentage of patients die or show no improvement in quality of life (QOL) in the follow-up. In the decision-making process, it is important to determine: (i) whether and how much frailty of the patient influences the risk of procedures; (ii) how the QOL and the individual patient's survival are influenced by aortic valve disease or from other associated conditions; and (iii) whether a geriatric specialist intervention to evaluate and correct frailty or other diseases with their potential or already manifest disabilities can improve the outcome of surgery or TAVI. Consequently, in addition to risk stratification with conventional tools, a number of factors including multi-morbidity, disability, frailty, and cognitive function should be considered, in order to assess the expected benefit of both surgery and TAVI. The pre-operative optimization through a multidisciplinary approach with a Heart Team can counteract the multiple damage (cardiac, neurological, muscular, respiratory, and kidney) that can potentially aggravate the reduced physiological reserves characteristic of frailty. The systematic application in clinical practice of multidimensional assessment instruments of frailty and cognitive function in the screening and the adoption of specific care pathways should facilitate this task.
Collapse
Affiliation(s)
- Giovanni Pulignano
- Cardiology Department 1, Ospedale San Camillo-Forlanini, Via O. Regnoli, 8 00152 Rome, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi" Catania, Italy
| | | | - Francesco Bedogni
- CCU-Cardiology Unit, IRCCS Policlinico San Donato, San Donato Milanese (Milano), Italy
| | - Giovanni Cioffi
- Cardiology and Medicine Unit, Casa di Cura Villa Bianca, Trento, Italy
| | - Ciro Indolfi
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
| | - Francesco Romeo
- Cardiology and Interventional Cardiology Department, Policlinico "Tor Vergata", Rome, Italy
| | - Adriano Murrone
- Cardiology and Cardiovascular Pathophysiology Department, Azienda Ospedaliera di Perugia, Perugia, Italy
| | | | - Alessandro Parolari
- Heart Surgery Unit, Centro Cardiologico Monzino IRCCS, Università degli Studi, Milano, Italy
| | - Leonardo Patanè
- Cardiology Cardiac Surgery Department (Centro Cuore), Centro Clinico Diagnostico G.B. Morgagni, Pedara (Catania), Italy
| | | | - Annalisa Mongiardo
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
| | - Carmen Spaccarotella
- Cardiology Unit- Campus Universitario, Azienda Ospedaliera Universitaria Mater Domini, Catanzaro, Italy
| | | | | |
Collapse
|
71
|
Karapinar-Çarkıt F, van der Knaap R, Bouhannouch F, Borgsteede SD, Janssen MJA, Siegert CEH, Egberts TCG, van den Bemt PMLA, van Wier MF, Bosmans JE. Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital. PLoS One 2017; 12:e0174513. [PMID: 28445474 PMCID: PMC5406030 DOI: 10.1371/journal.pone.0174513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 03/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective. Methods A controlled clinical trial was performed at the Internal Medicine department of a general teaching hospital. All admitted patients using at least one prescription drug were included. The COACH program consisted of medication reconciliation, patient counselling at discharge, and communication to healthcare providers in primary care. The primary outcome was the proportion of patients with an unplanned rehospitalisation within three months after discharge. Also, the number of quality-adjusted life-years (QALYs) was assessed. Cost data were collected using cost diaries. Uncertainty surrounding cost differences and incremental cost-effectiveness ratios between the groups was estimated by bootstrapping. Results In the COACH program, 168 patients were included and in usual care 151 patients. There was no significant difference in the proportion of patients with unplanned rehospitalisations (mean difference 0.17%, 95% CI -8.85;8.51), and in QALYs (mean difference -0.0085, 95% CI -0.0170;0.0001). Total costs for the COACH program were non-significantly lower than usual care (-€1160, 95% CI -3168;847). Cost-effectiveness planes showed that the program was not cost-effective compared with usual care for unplanned rehospitalisations and QALYs gained. Conclusion The COACH program was not cost-effective in comparison with usual care. Future studies should focus on high risk patients and include other outcomes (e.g. adverse drug events) as this may increase the chances of a cost-effective intervention. Dutch trial register NTR1519
Collapse
Affiliation(s)
| | | | | | | | | | | | - Toine C. G. Egberts
- Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
- Division Pharmacoepidemiology & Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Marieke F. van Wier
- Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Judith E. Bosmans
- Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
72
|
Palmer D, El Miedany Y. Tackling comorbidity associated with rheumatic diseases in standard practice. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2017; 26:380-387. [PMID: 28410044 DOI: 10.12968/bjon.2017.26.7.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In spite of the dramatic improvement of the long-term prognosis of inflammatory arthritic conditions, patients living with arthritis remain more likely to have a shorter lifespan in contrast to the age-matched population without arthritis. This high incidence of morbidity-mortality has been attributed to an increased prevalence of comorbidities, particularly cardiovascular disease, infections, and the development of malignant space-occupying lesions. In spite of the published guidelines highlighting the importance of comorbidity assessment and management, implementing these recommendations in standard clinical practice remains a challenge for the treating rheumatologists and rheumatology nurse specialists. This article will review the challenge of comorbidity in inflammatory arthritic conditions and its dynamic nature, the impact on patient management, as well as recent trends in the screening and assessment of comorbidity risk in standard clinical practice.
Collapse
Affiliation(s)
- Deborah Palmer
- Advanced Nurse Practitioner, North Middlesex University Hospital, London
| | | |
Collapse
|
73
|
Lowe DB, Taylor MJ, Hill SJ. Associations between multimorbidity and additional burden for working-age adults with specific forms of musculoskeletal conditions: a cross-sectional study. BMC Musculoskelet Disord 2017; 18:135. [PMID: 28376838 PMCID: PMC5379740 DOI: 10.1186/s12891-017-1496-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 03/20/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Multiple health conditions are increasingly a problem for adults with musculoskeletal conditions. However, multimorbidity research has focused primarily on the elderly and those with a limited subset of musculoskeletal disorders. We sought to determine whether associations between multimorbidity and additional burden differ with specific forms of musculoskeletal conditions among working-age adults. METHODS Data were sourced from a nationally representative Australian survey. Specific musculoskeletal conditions examined were osteoarthritis; inflammatory arthritis; other forms of arthritis or arthropathies; musculoskeletal conditions not elsewhere specified; gout; back pain; soft tissue disorders; or osteoporosis. Multimorbidity was defined as the additional presence of one or more of the Australian National Health Priority Area conditions. Burden was assessed by self-reported measures of: (i) self-rated health (ii) musculoskeletal-related healthcare and medicines utilisation and, (iii) general healthcare utilisation. Associations between multimorbidity and additional health or healthcare utilisation burden among working-age adults (aged 18 - 64 years of age) with specific musculoskeletal conditions were estimated using logistic regression, adjusting for confounders. Interaction terms were fitted to identify whether there were specific musculoskeletal conditions where multimorbidity was more strongly associated with poorer health or greater healthcare utilisation than in the remaining musculoskeletal group. RESULTS Among working-age adults, for each of the specified musculoskeletal conditions, multimorbidity was associated with similar, increased likelihood of additional self-rated health burden and certain types of healthcare utilisation. While there were differences in the relationships between multimorbidity and burden for each of the specific musculoskeletal conditions, no one specific musculoskeletal condition appeared to be consistently associated with greater additional health burden in the presence of multimorbidity across the majority of self-rated health burden and healthcare use measures. CONCLUSIONS For working-age people with any musculoskeletal conditions examined here, multimorbidity increases self-reported health and healthcare utilisation burden. As no one musculoskeletal condition appears consistently worse off in the presence of multimorbidity, there is a need to better understand and identify strategies that acknowledge and address the additional burden of concomitant conditions for working-age adults with a range of musculoskeletal conditions.
Collapse
Affiliation(s)
- Dianne B. Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Michael J. Taylor
- School of Allied Health, Australian Catholic University, Fitzroy, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Sophie J. Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| |
Collapse
|
74
|
Lowe DB, Taylor MJ, Hill SJ. Cross-sectional examination of musculoskeletal conditions and multimorbidity: influence of different thresholds and definitions on prevalence and association estimates. BMC Res Notes 2017; 10:51. [PMID: 28100264 PMCID: PMC5242059 DOI: 10.1186/s13104-017-2376-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 01/04/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Multimorbidity and musculoskeletal conditions create substantial burden for people and health systems. Quantifying the extent of co-occurring conditions is hampered by conceptual heterogeneity, imprecision and/or indecision about how multimorbidity is defined. The purpose of this study is to examine the influence of different ways of operationalising multimorbidity on multimorbidity prevalence rates with a focus on working-age adults with musculoskeletal conditions. Weighted population prevalence rates of multimorbidity among working-age Australians were estimated using data from the National Health Survey. Two nominal thresholds (2+ or 3+ co-occurring conditions) and three operational definitions of multimorbidity (survey-, policy- and research-based) were examined. Using logistic regression, we estimated the association between the prevalence of multimorbidity among persons with musculoskeletal conditions compared to persons with non-musculoskeletal conditions for each definition and threshold combination. RESULTS As few as 7.9% of working-age Australians have 2+ conditions using the research-based definition (95% CI 7.4-8.5%), compared to estimates of 15.3% (95% CI 14.3-16.2%) and 61.5% (95% CI 60.3-62.7%). with the policy- and survey-based definitions, respectively. Depending on definition, with the 3+ threshold multimorbidity prevalence ranged from 2.1% (research) to 41.9% (survey). Among the sub-sample with musculoskeletal conditions, multimorbidity with the 2+ threshold ranged from 20.2 to 92.2%; and with 3+ threshold from 5.9 to 75.4%, again lowest with the research-definition and highest with the survey-definition. When compared to any other condition (i.e. non-musculoskeletal conditions), all musculoskeletal conditions were positively associated with multimorbidity, regardless of definition or threshold. CONCLUSIONS Depending on definition and threshold, multimorbidity is either rare or endemic in working-age Australians. Irrespective of definition, musculoskeletal conditions are a near-ubiquitous feature of multimorbidity.
Collapse
Affiliation(s)
- Dianne B. Lowe
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Michael J. Taylor
- School of Allied Health, Australian Catholic University, Fitzroy, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Sophie J. Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- Cochrane Consumers and Communication Review Group, School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| |
Collapse
|
75
|
Higher Charlson Comorbidity Index Scores Are Associated With Increased Hospital Length of Stay After Lower Extremity Orthopaedic Trauma. J Orthop Trauma 2017; 31:21-26. [PMID: 27611667 DOI: 10.1097/bot.0000000000000701] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of this study was to explore the relationship between preoperative Charlson Comorbidity Index (CCI) and postoperative length of stay (LOS) for lower extremity and hip/pelvis orthopaedic trauma patients. DESIGN Retrospective. SETTING Urban level 1 trauma center. PATIENTS/PARTICIPANTS A total of 1561 patients treated for isolated lower extremity and pelvis fractures between 2000 and 2012. INTERVENTIONS Surgical intervention for fractures MAIN OUTCOME MEASUREMENTS:: The main outcome metric was LOS. Negative binomial regression analysis was used to examine the association between CCI and LOS while controlling for significant confounders. RESULTS One thousand five hundred sixty-one patients met the inclusion criteria, 1302 (83.4%) of which had lower extremity injuries and 259 (16.6%) experienced hip/pelvis trauma. A total of 1001 (64.1%) patients presented with a CCI score of 1 and stayed an average of 7.9 days. Patients with a CCI of 3 experienced a mean LOS of 1.2 days longer than patients presenting with a CCI of 1, whereas patients presenting with a CCI score of 5 stayed an average of 4.6 days longer. After controlling for age, race, American Society of Anesthesiologists score, sex, anesthesia type, and anesthesia time, a higher preoperative CCI was found to be associated with longer LOS for patients with lower extremity fractures (Incidence Rate Ratio: 1.04, P = 0.01). No significant association was found between CCI and LOS for patients with hip/pelvic fractures. CONCLUSIONS This study demonstrated the potential utility of the CCI as a predictor of hospital LOS for lower extremity patients; however, the association may be small given the smaller Incidence Rate Ratio value. Further studies are needed to clarify the predictive value of the CCI for different types of orthopaedic injuries. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete.
Collapse
|
76
|
Simões D, Araújo FA, Severo M, Monjardino T, Cruz I, Carmona L, Lucas R. Patterns and Consequences of Multimorbidity in the General Population: There is No Chronic Disease Management Without Rheumatic Disease Management. Arthritis Care Res (Hoboken) 2016; 69:12-20. [PMID: 27482954 DOI: 10.1002/acr.22996] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 07/08/2016] [Accepted: 07/19/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To identify empirical model-based patterns of multimorbidity from chronic noncommunicable diseases in the general population, with a focus on the contribution of rheumatic and musculoskeletal diseases (RMDs), and to quantify their association with adverse health outcomes. METHODS Cross-sectional data from the Portuguese Fourth National Health Survey were analyzed (n = 23,754). Latent class analysis was used to identify patterns of coexistence of 11 chronic noncommunicable diseases (RMDs, diabetes mellitus, hypertension, chronic obstructive pulmonary disease, stroke, depression, myocardial infarction, cancer, osteoporosis, asthma, and renal failure). Based on the Outcome Measures in Rheumatology, filter 2.0, health outcomes included life impact, pathophysiologic manifestations, and resource use. We assessed the association between patterns and adverse health outcomes, through sex-, age-, and body mass index-adjusted prevalence ratios with 95% confidence intervals, obtained using Poisson regression. RESULTS Four patterns of chronic noncommunicable diseases co-occurrence were identified and labeled as low disease probability, cardiometabolic conditions, respiratory conditions, and RMDs and depression. RMDs were highly prevalent in patients with chronic diseases (from 38.6% in cardiometabolic conditions to 66.7% in RMDs and depression). While negative self-rated health, short-term disability, and chronic pain were more strongly associated with cardiometabolic conditions and respiratory conditions, all multimorbidity patterns were similarly associated with long-term disability, frequent health care utilization, and out-of-pocket health care expenses. CONCLUSION Our study emphasizes RMDs as a major presence in multimorbidity in the general population. All multimorbidity patterns were associated with a wide set of adverse health outcomes. Management strategies for the patient with chronic cardiometabolic, respiratory, or depressive conditions should also target RMDs.
Collapse
Affiliation(s)
- Daniela Simões
- University of Porto, Porto, Portugal, and Cooperativa de Ensino Superior Politécnico e Universitário, Gandra, Paredes, Portugal
| | | | | | | | - Ivo Cruz
- University of Porto, and ACeS Grande Porto V, Porto Ocidental, Porto, Portugal
| | | | | |
Collapse
|
77
|
Bouza C, Lopez-Cuadrado T, Amate-Blanco JM. Use of explicit ICD9-CM codes to identify adult severe sepsis: impacts on epidemiological estimates. Crit Care 2016; 20:313. [PMID: 27716355 PMCID: PMC5047045 DOI: 10.1186/s13054-016-1497-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe sepsis is a challenge for healthcare systems, and epidemiological studies are essential to assess its burden and trends. However, there is no consensus on which coding strategy should be used to reliably identify severe sepsis. This study assesses the use of explicit codes to define severe sepsis and the impacts of this on the incidence and in-hospital mortality rates. METHODS We examined episodes of severe sepsis in adults aged ≥18 years registered in the 2006-2011 national hospital discharge database, identified in an exclusive manner by two ICD-9-CM coding strategies: (1) those assigned explicit ICD-9-CM codes (995.92, 785.52); and (2) those assigned combined ICD-9-CM infection and organ dysfunction codes according to modified Martin criteria. The coding strategies were compared in terms of the populations they defined and their relative implementation. Trends were assessed using Joinpoint regression models and expressed as annual percentage change (APC). RESULTS Of 222 846 episodes of severe sepsis identified, 138 517 (62.2 %) were assigned explicit codes and 84 329 (37.8 %) combination codes; incidence rates were 60.6 and 36.9 cases per 100 000 inhabitants, respectively. Despite similar demographic characteristics, cases identified by explicit codes involved fewer comorbidities, fewer registered pathogens, greater extent of organ dysfunction (two or more organs affected in 60 % versus 26 % of cases) and higher in-hospital mortality (54.5 % versus 29 %; risk ratio 1.86, 95 % CI 1.83, 1.88). Between 2006 and 2011, explicit codes were increasingly implemented. Standardised incidence rates in this cohort increased over time with an APC of 12.3 % (95 % CI 4.4, 20.8); in the combination code cohort, rates increased by 3.8 % (95 % CI 1.3, 6.3). A decreasing trend in mortality was observed in both cohorts though the APC was -8.1 % (95 % CI -10.4, -5.7) in the combination code cohort and -3.5 % (95 % CI -3.9, -3.2) in the explicit code cohort. CONCLUSIONS Our findings suggest greater and increasing use of explicit codes for adult severe sepsis in Spain. This trend will have substantial impacts on epidemiological estimates, because these codes capture cases featuring greater organ dysfunction and in-hospital mortality.
Collapse
Affiliation(s)
- C. Bouza
- Health-Care Technology Assessment Agency, Institute of Health Carlos III, Madrid, Spain
| | - T. Lopez-Cuadrado
- National Centre of Epidemiology, Institute of Health Carlos III, Madrid, Spain
| | - J. M. Amate-Blanco
- Health-Care Technology Assessment Agency, Institute of Health Carlos III, Madrid, Spain
| |
Collapse
|
78
|
Attitudes: Mediators of the Relation between Health and Driving in Older Adults. Can J Aging 2016; 35 Suppl 1:44-58. [PMID: 27256819 DOI: 10.1017/s0714980816000076] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RÉSUMÉNous avons examiné les relations entre la santé perçue (p. ex., l’état de santé auto-évaluation) et des pratiques d’autorégulation de la conduite (p. ex., la fréquence de la conduite, l’evitement des situations de conduite difficiles) comme médiée par les attitudes et les perceptions de conduite (à savoir, le confort de conduite, les attitudes positif et négatif envers la conduite) dans les données recueillies pour 928 conducteurs âgés de 70 ans et plus inscrits à l’étude Candrive II. Nous avons observé que les attitudes spécifiques à la conduite (p. ex., le confort de conduite, les attitudes négatives envers la conduite) assurent la médiation des relations entre les symptômes de santé et les comportements de conduite auto-reglementés au début et au fil du temps. Seuls les attitudes négatives à l’égard de conduite ont mediés entièrement les relations entre les changements dans les symptômes perçus de la santé et les changements dans le comportement de conduite. Les symptômes perçus pour la santé influencent apparemment la probabilité d’éviter des situations difficiles de conduite par le biais de deux attitudes négatives initiales pour la conduite, ainsi que des changements dans les attitudes négatives au fil du temps. Comprendre les influences sur le comportement de conduite d’auto-réglementation seront bénéfiques lors de la conception des interventions visant à améliorer la sécurité des conducteurs âgés.
Collapse
|
79
|
Sukumar DW, Harvey LA, Mitchell RJ, Close JC. The impact of geographical location on trends in hospitalisation rates and outcomes for fall-related injuries in older people. Aust N Z J Public Health 2016; 40:342-8. [DOI: 10.1111/1753-6405.12524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 10/01/2015] [Accepted: 12/01/2015] [Indexed: 12/22/2022] Open
Affiliation(s)
- Dharan W. Sukumar
- Falls and Injury Prevention Group; Neuroscience Research Australia; New South Wales
- Prince of Wales Clinical School; UNSW Australia; New South Wales
| | - Lara A. Harvey
- Falls and Injury Prevention Group; Neuroscience Research Australia; New South Wales
| | - Rebecca J. Mitchell
- Falls and Injury Prevention Group; Neuroscience Research Australia; New South Wales
- Australian Institute of Health Innovation; Macquarie University; New South Wales
| | - Jacqueline C.T. Close
- Falls and Injury Prevention Group; Neuroscience Research Australia; New South Wales
- Prince of Wales Clinical School; UNSW Australia; New South Wales
| |
Collapse
|
80
|
Han MK, Martinez CH, Au DH, Bourbeau J, Boyd CM, Branson R, Criner GJ, Kalhan R, Kallstrom TJ, King A, Krishnan JA, Lareau SC, Lee TA, Lindell K, Mannino DM, Martinez FJ, Meldrum C, Press VG, Thomashow B, Tycon L, Sullivan JL, Walsh J, Wilson KC, Wright J, Yawn B, Zueger PM, Bhatt SP, Dransfield MT. Meeting the challenge of COPD care delivery in the USA: a multiprovider perspective. THE LANCET RESPIRATORY MEDICINE 2016; 4:473-526. [PMID: 27185520 DOI: 10.1016/s2213-2600(16)00094-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/21/2022]
Abstract
The burden of chronic obstructive pulmonary disease (COPD) in the USA continues to grow. Although progress has been made in the the development of diagnostics, therapeutics, and care guidelines, whether patients' quality of life is improved will ultimately depend on the actual implementation of care and an individual patient's access to that care. In this Commission, we summarise expert opinion from key stakeholders-patients, caregivers, and medical professionals, as well as representatives from health systems, insurance companies, and industry-to understand barriers to care delivery and propose potential solutions. Health care in the USA is delivered through a patchwork of provider networks, with a wide variation in access to care depending on a patient's insurance, geographical location, and socioeconomic status. Furthermore, Medicare's complicated coverage and reimbursement structure pose unique challenges for patients with chronic respiratory disease who might need access to several types of services. Throughout this Commission, recurring themes include poor guideline implementation among health-care providers and poor patient access to key treatments such as affordable maintenance drugs and pulmonary rehabilitation. Although much attention has recently been focused on the reduction of hospital readmissions for COPD exacerbations, health systems in the USA struggle to meet these goals, and methods to reduce readmissions have not been proven. There are no easy solutions, but engaging patients and innovative thinkers in the development of solutions is crucial. Financial incentives might be important in raising engagement of providers and health systems. Lowering co-pays for maintenance drugs could result in improved adherence and, ultimately, decreased overall health-care spending. Given the substantial geographical diversity, health systems will need to find their own solutions to improve care coordination and integration, until better data for interventions that are universally effective become available.
Collapse
Affiliation(s)
- MeiLan K Han
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA.
| | - Carlos H Martinez
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - David H Au
- Center of Innovation for Veteran-Centered and Value-Driven Care, and VA Puget Sound Health Care System, US Department of Veteran Affairs, Seattle, WA, USA; Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA
| | - Jean Bourbeau
- McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Richard Branson
- Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Gerard J Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Ravi Kalhan
- Asthma and COPD Program, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Jerry A Krishnan
- University of Illinois Hospital & Health Sciences System, University of Illinois, Chicago, IL, USA
| | - Suzanne C Lareau
- University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois, Chicago, IL, USA
| | | | - David M Mannino
- Department of Preventive Medicine and Environmental Health, University of Kentucky, Lexington, KY, USA
| | - Fernando J Martinez
- Department of Internal Medicine, Weill Cornell School of Medicine, New York, NY, USA
| | - Catherine Meldrum
- Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI, USA
| | - Valerie G Press
- Section of Hospital Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Byron Thomashow
- Division of Pulmonary, Critical Care and Sleep Medicine, Columbia University Medical Center, New York, NY, USA
| | - Laura Tycon
- Palliative and Supportive Institute, Pittsburgh, PA, USA
| | | | | | - Kevin C Wilson
- Boston University School of Medicine, Boston, MA, USA; American Thoracic Society, New York, NY, USA
| | - Jean Wright
- Carolinas HealthCare System, Charlotte, NC, USA
| | - Barbara Yawn
- Family and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Patrick M Zueger
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois, Chicago, IL, USA
| | - Surya P Bhatt
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mark T Dransfield
- Division of Pulmonary, Allergy and Critical Care Medicine, and UAB Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA
| |
Collapse
|
81
|
Outcomes and Costs of Poisoned Patients Admitted to an Adult Emergency Department of a Spanish Tertiary Hospital: Evaluation through a Toxicovigilance Program. PLoS One 2016; 11:e0152876. [PMID: 27100460 PMCID: PMC4839757 DOI: 10.1371/journal.pone.0152876] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 03/21/2016] [Indexed: 01/21/2023] Open
Abstract
Abstract Toxicovigilance is the active process of identifying and evaluating the toxic risks existing in a community, and evaluating the measures taken to reduce or eliminate them. Objective Through a validated toxicovigilance program (SAT-HULP) we examined the characteristics of acute poisoning cases (APC) attended in the Emergency Department (ED) of La Paz Hospital (Madrid, Spain) and assessed their economic impact on the health system. Material and Methods The active poisoning surveillance system performs a daily search for cases in the hospital´s computerized case records. Found cases are entered into a database for recording of type of poisoning episode, reasons for exposure, causative agent, signs and symptoms and treatment. We carried out a cross-sectional epidemiological study with analytical projection, based on an impact study on cost per survivor. The data for the costs attributable to cases of APC observed at HULP (outpatients and inpatients) was obtained from the based on the information provided by the diagnosis-related groups (DRG) through the corresponding hospital discharge reports (available through SAT-HULP). Results During the first 30 month of SAT-HULP operation we found a total of 3,195 APC, a cumulative incidence rate of 1.75% of patients attended in the ED. The mean (SD) patient age was 40.9 (17.8) years and 51.2% were men. Drug abuse accounted for 47.5% of the cases. Suicide attempt was the second most frequent category (38.1%) and other causes accounted for 14.5% of APC. The total cost of hospital care for our hospital rose to €1,825,263.24 (approximately €730,105.30/year) resulting in a permanent occupation of 4 beds/year. Conclusions SAT-HULP constitutes a validated toxicovigilance tool, which continuously integrates available data in real-time and helps health services manage APC data flexibly, including the consumption of resources from the health system.
Collapse
|
82
|
Changing definitions altered multimorbidity prevalence, but not burden associations, in a musculoskeletal population. J Clin Epidemiol 2016; 78:116-126. [PMID: 27036547 DOI: 10.1016/j.jclinepi.2016.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/07/2016] [Accepted: 03/22/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES The inclusion of musculoskeletal conditions within multimorbidity research is inconsistent, and working-age populations are largely ignored. We aimed to: (1) estimate multimorbidity prevalence among working-age individuals with a range of musculoskeletal conditions; and (2) better understand the implications of decisions about the number and range of conditions constituting multimorbidity on the strength of associations between multimorbidity and burden (e.g., health status and health care utilization). STUDY DESIGN AND SETTING Using data from the Australian National Health Survey 2007-08, the associations between burden measures and three ways of operationalizing multimorbidity (survey, policy, and research based) within the working-age (18-64 years) musculoskeletal population were estimated using multiple logistic regression (age and gender adjusted). RESULTS Depending on definition, from 20.2% to 75.4% of working-age individuals with musculoskeletal conditions have multimorbidity. Irrespective of definition, multimorbidity was associated with increased likelihood of subjective health burden, pain or musculoskeletal medicines use, nonmusculoskeletal specialist and pharmacist (advice only) consultations, and reduced likelihood of not consulting health professionals. A group with intermediate health outcomes was considered multimorbid by some, but not all definitions. With the restrictive policy and research multimorbidity definitions, this intermediate group is included within the reference population (i.e., are considered nonmultimorbid). This worsens the reference group's apparent health status thereby leveling the comparative burden between those with and without multimorbidity. Consequently, dichotomous cut points lead to similar associations with burden measures despite the increasingly restrictive multimorbidity definitions used. CONCLUSIONS All multimorbidity definitions were associated with burden among the working-age musculoskeletal population. However, dichotomous cut points obscure the gradient of increased burden associated with restrictive definitions.
Collapse
|
83
|
Loeb DF, Bayliss EA, Candrian C, deGruy FV, Binswanger IA. Primary care providers' experiences caring for complex patients in primary care: a qualitative study. BMC FAMILY PRACTICE 2016; 17:34. [PMID: 27004838 PMCID: PMC4804627 DOI: 10.1186/s12875-016-0433-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 03/15/2016] [Indexed: 12/21/2022]
Abstract
Background Complex patients are increasingly common in primary care and often have poor clinical outcomes. Healthcare system barriers to effective care for complex patients have been previously described, but less is known about the potential impact and meaning of caring for complex patients on a daily basis for primary care providers (PCPs). Our objective was to describe PCPs’ experiences providing care for complex patients, including their experiences of health system barriers and facilitators and their strategies to enhance provision of effective care. Methods Using a general inductive approach, our qualitative research study was guided by an interpretive epistemology, or way of knowing. Our method for understanding included semi-structured in-depth interviews with internal medicine PCPs from two university-based and three community health clinics. We developed an interview guide, which included questions on PCPs’ experiences, perceived system barriers and facilitators, and strategies to improve their ability to effectively treat complex patients. To focus interviews on real cases, providers were asked to bring de-identified clinical notes from patients they considered complex to the interview. Interview transcripts were coded and analyzed to develop categories from the raw data, which were then conceptualized into broad themes after team-based discussion. Results PCPs (N = 15) described complex patients with multidimensional needs, such as socio-economic, medical, and mental health. A vision of optimal care emerged from the data, which included coordinating care, preventing hospitalizations, and developing patient trust. PCPs relied on professional values and individual care strategies to overcome local and system barriers. Team based approaches were endorsed to improve the management of complex patients. Conclusions Given the barriers to effective care described by PCPs, individual PCP efforts alone are unlikely to meet the needs of complex patients. To fulfill PCP’s expressed concepts of optimal care, implementation of effective systemic approaches should be considered. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0433-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Danielle F Loeb
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
| | - Elizabeth A Bayliss
- Kaiser Colorado, Kaiser Permanente Institute for Health Research, Denver, USA.,Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Carey Candrian
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Frank V deGruy
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ingrid A Binswanger
- Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, 80045, USA.,Kaiser Colorado, Kaiser Permanente Institute for Health Research, Denver, USA
| |
Collapse
|
84
|
Zenga M, Marshall AH, Crippa F, Mitchell H. The coxian phase-type distribution as a contribution to the multilevel model of in-hospital mortality. COMMUN STAT-THEOR M 2016. [DOI: 10.1080/03610926.2015.1038394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
85
|
Smith SM, Wallace E, O'Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev 2016; 3:CD006560. [PMID: 26976529 PMCID: PMC6703144 DOI: 10.1002/14651858.cd006560.pub3] [Citation(s) in RCA: 287] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions to improve outcomes for people with multimorbidity. OBJECTIVES To determine the effectiveness of health-service or patient-oriented interventions designed to improve outcomes in people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. SEARCH METHODS We searched MEDLINE, EMBASE, CINAHL and seven other databases to 28 September 2015. We also searched grey literature and consulted experts in the field for completed or ongoing studies. SELECTION CRITERIA Two review authors independently screened and selected studies for inclusion. We considered randomised controlled trials (RCTs), non-randomised clinical trials (NRCTs), controlled before-after studies (CBAs), and interrupted time series analyses (ITS) evaluating interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. This includes studies where participants can have combinations of any condition or have combinations of pre-specified common conditions (comorbidity), for example, hypertension and cardiovascular disease. The comparison was usual care as delivered in that setting. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the included studies, evaluated study quality, and judged the certainty of the evidence using the GRADE approach. We conducted a meta-analysis of the results where possible and carried out a narrative synthesis for the remainder of the results. We present the results in a 'Summary of findings' table and tabular format to show effect sizes across all outcome types. MAIN RESULTS We identified 18 RCTs examining a range of complex interventions for people with multimorbidity. Nine studies focused on defined comorbid conditions with an emphasis on depression, diabetes and cardiovascular disease. The remaining studies focused on multimorbidity, generally in older people. In 12 studies, the predominant intervention element was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In six studies, the interventions were predominantly patient-oriented, for example, educational or self-management support-type interventions delivered directly to participants. Overall our confidence in the results regarding the effectiveness of interventions ranged from low to high certainty. There was little or no difference in clinical outcomes (based on moderate certainty evidence). Mental health outcomes improved (based on high certainty evidence) and there were modest reductions in mean depression scores for the comorbidity studies that targeted participants with depression (standardized mean difference (SMD) -2.23, 95% confidence interval (CI) -2.52 to -1.95). There was probably a small improvement in patient-reported outcomes (moderate certainty evidence) although two studies that specifically targeted functional difficulties in participants had positive effects on functional outcomes with one of these studies also reporting a reduction in mortality at four year follow-up (Int 6%, Con 13%, absolute difference 7%). The intervention may make little or no difference to health service use (low certainty evidence), may slightly improve medication adherence (low certainty evidence), probably slightly improves patient-related health behaviours (moderate certainty evidence), and probably improves provider behaviour in terms of prescribing behaviour and quality of care (moderate certainty evidence). Cost data were limited. AUTHORS' CONCLUSIONS This review identifies the emerging evidence to support policy for the management of people with multimorbidity and common comorbidities in primary care and community settings. There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity in general due to the relatively small number of RCTs conducted in this area to date, with mixed findings overall. It is possible that the findings may change with the inclusion of large ongoing well-organised trials in future updates. The results suggest an improvement in health outcomes if interventions can be targeted at risk factors such as depression, or specific functional difficulties in people with multimorbidity.
Collapse
Affiliation(s)
- Susan M Smith
- RCSI Medical SchoolHRB Centre for Primary Care Research, Department of General Practice123 St Stephens GreenDublin 2Ireland
| | - Emma Wallace
- RCSI Medical SchoolHRB Centre for Primary Care Research, Department of General Practice123 St Stephens GreenDublin 2Ireland
| | - Tom O'Dowd
- Trinity College Centre for Health SciencesDepartment of Public Health and Primary CareAdelaide and Meath Hosptials, Incorporating the National Children's HospitalTallaghtDublinIreland24
| | - Martin Fortin
- University of SherbrookeDepartment of Family MedicineUnite de Medicine de famille de Chicoutimi305, St‐Vallier ChicoutimiQuebecCanadaG7H 5H6
| |
Collapse
|
86
|
Do NSAIDs and ASA Cause More Upper Gastrointestinal Bleeding in Elderly than Adults? Gastroenterol Res Pract 2016; 2016:8419304. [PMID: 26880898 PMCID: PMC4736379 DOI: 10.1155/2016/8419304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 12/09/2015] [Indexed: 01/26/2023] Open
Abstract
Purpose. NSAIDs and ASA may cause upper gastrointestinal bleeding (UGIB) both in adults and in elderly. There is no study that compares this increased bleeding risk between adult and elderly subjects. Methods. A total of 524 patients with UGIB were included in this study. The data of patients were, respectively, analyzed. Results. NSAIDs and ASA-associated UGIB rates were similar between <65 years (345 patients) (group 1) and ≥65 years (179 patients) (group 2) (28.4% versus 23.5%, p = 0.225 and 13% versus 19%, p = 0.071, resp.). Warfarin-associated UGIB was found significantly higher in group 2 than group 1. Elderly patients with NSAID-associated UGIB had significantly higher length of stay (LoS) and CoH than adult patients with NSAID-associated UGIB (p = 0.002 and 0.001, resp.). Elderly patients with ASA-associated UGIB had significantly higher CoH than adult patients with NSAID-associated UGIB. Conclusions. Using NSAIDs without gastroprotective drugs or using ASA with gastroprotective drugs in elderly patients is as safe as in adult patients. Not only should adding gastroprotective drugs to ASA or NSAID be based on their risk of UGIB, but the cost of hospitalization of ASA or NSAID-associated UGIB should be considered.
Collapse
|
87
|
Bouza C, López-Cuadrado T, Amate-Blanco JM. Characteristics, incidence and temporal trends of sepsis in elderly patients undergoing surgery. Br J Surg 2015; 103:e73-82. [PMID: 26670423 DOI: 10.1002/bjs.10065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 10/02/2015] [Accepted: 10/27/2015] [Indexed: 01/15/2023]
Abstract
BACKGROUND Despite increasing rates of surgery in the elderly, there is limited population-based information on sepsis in this age group. This study aimed to characterize the epidemiology and national trends of sepsis among elderly patients undergoing surgery in Spain. METHODS This population-based longitudinal study of patients aged 65 years or older, undergoing surgery between 2006 and 2011, used data from the national hospital discharge database. Patients were identified by ICD coding. Primary endpoints were incidence and case-fatality rates of sepsis. Predefined age groups were examined. In-hospital mortality-related factors were assessed by means of exploratory logistic regression. Trends were assessed for annual percentage change in rates using Joinpoint regression analysis. RESULTS A total of 44 342 episodes of sepsis were identified, representing 1·5 per cent of all 2 871 199 surgical hospital admissions of patients aged 65 years or older. The rates varied with age and sex. The in-hospital case-fatality rate was 43·9 per cent (19 482 patients), and associated with age, co-morbidity and organ dysfunction. Standardized rates of sepsis increased over time, with an annual change of 4·7 (95 per cent c.i. 1·4 to 8·5) per cent, whereas the case-fatality rate declined, with an overall annual change of -3·6 (-4·3 to -2·8) per cent. The decrease in mortality was more limited in patients with organ dysfunction and in the oldest age group. CONCLUSION Rates of sepsis are increasing among elderly patients undergoing surgery, whereas in-hospital case fatality, although common, is showing a decreasing trend.
Collapse
Affiliation(s)
- C Bouza
- Health Care Technology Assessment Agency, National Centre of Epidemiology, Instituto de Salud Carlos III, Avenida Monforte de Lemos 5, 28029 Madrid, Spain
| | - T López-Cuadrado
- Health Care Technology Assessment Agency, National Centre of Epidemiology, Instituto de Salud Carlos III, Avenida Monforte de Lemos 5, 28029 Madrid, Spain
| | - J M Amate-Blanco
- Health Care Technology Assessment Agency, National Centre of Epidemiology, Instituto de Salud Carlos III, Avenida Monforte de Lemos 5, 28029 Madrid, Spain
| |
Collapse
|
88
|
Lizaur-Utrilla A, Serna-Berna R, Lopez-Prats FA, Gil-Guillen V. Early rehospitalization after hip fracture in elderly patients: risk factors and prognosis. Arch Orthop Trauma Surg 2015; 135:1663-7. [PMID: 26377732 DOI: 10.1007/s00402-015-2328-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Hip fracture usually occurs in older patients. These patients remain at risk for developing new medical complications even after discharge from the hospital. The objective of this study was to identify risk factors for hospital readmission 30 days after hip fracture and the prognosis of the readmitted patients. MATERIALS METHODS A prospective, observational cohort study of 732 consecutive patients over 65 years surgically treated for hip fracture and discharged alive in 2010-2014 was conducted. The measurements were patient demographic characteristics, residential and discharge status, Katz Index, Merle D'aubigné Hip Score, Mini-Mental Test, comorbid conditions, Charlson Index, ASA group, type of fracture and repair, and postoperative complications. Patient characteristics were tested by bivariate and multivariate analyses. RESULTS 8.3 % of patients were readmitted within 30 days (56.0 % of these within 2 weeks). Medical reasons were 13 times more frequent than surgical reasons. Diagnoses more prevalent for readmission were pulmonary disease, deep vein thrombosis, heart failure, and renal failure. Predictors of readmission were female gender (HR 1.9, 95 % CI 1.1-3.4), grade III-IV ASA (HR 2.1, 95 % CI 1.1-4.2), and pre-existing pulmonary disease (HR 5.3, 95 % CI 3.4-9.6). In-hospital mortality among readmitted patients was 22.9 %. In bivariate analyses, male gender, ASA III-IV, cognitive impairment, and more than two comorbidities were potential predictive factors for readmission, and in multivariate analysis only male gender and ASA III-IV. Mortality risk among readmitted patients was significantly higher compared to the in-hospital mortality in the overall cohort (OR 1.8, 95 % CI 1.5-2.3). CONCLUSIONS Hospital readmissions after hip fracture were mainly due to medical complications and a fraction of these may be preventable. Readmission was associated with increased morbidity and mortality.
Collapse
Affiliation(s)
- A Lizaur-Utrilla
- Department Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain.
| | - R Serna-Berna
- Department Orthopaedic Surgery, Elda University Hospital, Ctra Elda-Sax s/n, 03600, Elda, Alicante, Spain
| | - F A Lopez-Prats
- Department of Orthopaedia and Traumatology, Faculty of Medicine, Miguel Hernandez University, Elche, Alicante, Spain
| | - V Gil-Guillen
- Unit of Clinical Research, Elda University Hospital, Elda, Alicante, Spain
| |
Collapse
|
89
|
Tamayo-Fonseca N, Nolasco A, Quesada JA, Pereyra-Zamora P, Melchor I, Moncho J, Calabuig J, Barona C. Self-rated health and hospital services use in the Spanish National Health System: a longitudinal study. BMC Health Serv Res 2015; 15:492. [PMID: 26537822 PMCID: PMC4634188 DOI: 10.1186/s12913-015-1158-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 10/30/2015] [Indexed: 11/20/2022] Open
Abstract
Background Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. Methods Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. Results By the end of a 4-year follow-up period, 1,184 participants (22.4 %) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. Conclusions Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.
Collapse
Affiliation(s)
- Nayara Tamayo-Fonseca
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain.
| | - Andreu Nolasco
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain.
| | - Jose A Quesada
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain.
| | - Pamela Pereyra-Zamora
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain.
| | - Inmaculada Melchor
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain. .,Registro de Mortalidad de la Comunidad Valenciana, Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias. Subdirección General de Epidemiología y Vigilancia de la Salud. Conselleria de Sanitat, Plaza de España 6, 03010, Alicante, Spain.
| | - Joaquin Moncho
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain.
| | - Julia Calabuig
- Servicio de Análisis de Sistemas de Información Sanitaria, Conselleria de Sanitat, Generalitat Valenciana. C/Micer Mascó, 31-33, 46010, Valencia, Spain.
| | - Carmen Barona
- Servicio del Plan de Salud, Dirección General de Salud Pública. Conselleria de Sanitat, Generalitat Valenciana. Avda. Cataluña, 21, 46020, Valencia, Spain.
| |
Collapse
|
90
|
Olson CH, Dey S, Kumar V, Monsen KA, Westra BL. Clustering of elderly patient subgroups to identify medication-related readmission risks. Int J Med Inform 2015; 85:43-52. [PMID: 26526277 DOI: 10.1016/j.ijmedinf.2015.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 09/03/2015] [Accepted: 10/15/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION High Risk Medication Regimen (HRMR) scores are weakly predictive of hospital readmissions for elderly home health care patients. HRMR is composed of three elements related to drug risks: polypharmacy (number of medications); Potentially Inappropriate Medications (PIM) known to be harmful to the elderly; and the Medication Regimen Complexity Index (MRCI) that weighs drugs by the complexity of their dosing and instructions. In this paper, we hypothesized that HRMR scores are more predictive for demographic subgroups of elderly patients. The study used Outcome and Assessment Information Set (OASIS) variables to identify subgroups of patients for whom the HRMR measures appeared more predictive for hospital readmissions. METHODS OASIS and medication data were reused from a study of 911 patients (355 males, 556 females; mean age 78.9) from 15 Medicare-certified home health care agencies that established the relationship between HRMR and hospital readmissions. Hierarchical agglomerative clustering using the Jaccard distance measure and average-link method identified patient subgroups based on the OASIS data. Receiver operating curve (ROC) analyses evaluated the predictive strength of the HRMR variables for each subgroup. Additional False Discovery Rate (FDR) analyses assessed whether the clustered relationships were chance. RESULTS Clustering of OASIS data for 911 patients identified six subgroups: patients with Good Functional Status (n=382); Females with Moderate to Severe Pain (n=354); patients with poor prognosis needing functional status assistance (n=419); patients with Poor Functional Status (n=287); Males with Adult Children as Caregiver (n=198); adults living alone with spouses as primary caregiver (n=127). ROC results relating these subgroups to HRMR risks were strongest for Males with Adult Children as Caregivers (AUC: polypharmacy, 0.73; PIM, 0.64; MRCI, 0.77). The findings for this subgroup also met the FDR analysis threshold (<=0.20). CONCLUSIONS A risk of medication-related readmissions in elderly men with adult children as caregivers is consistent with research showing problems in medication adherence when seniors are supported by informal caregivers. The results from clustering analysis present a hypothesis for research on HRMR and on the relationship between adult caregivers and their fathers.
Collapse
Affiliation(s)
- Catherine H Olson
- Health Informatics, University of Minnesota, 330 Diehl Hall, 505 Essex Street SE Minneapolis, MN 55455, United States.
| | - Sanjoy Dey
- Research Assistant, Computer Science and Engineering University of Minnesota Minneapolis, MN, United States.
| | - Vipin Kumar
- Department Head, Computer Science and Engineering University of Minnesota Minneapolis, MN, United States.
| | - Karen A Monsen
- School of Nursing University of Minnesota Minneapolis, MN, United States.
| | - Bonnie L Westra
- School of Nursing University of Minnesota Minneapolis, MN, United States.
| |
Collapse
|
91
|
Kim M, Kim H, Hwang SH. Developing a Hospital-Wide All-Cause Risk-Standardized Readmission Measure Using Administrative Claims Data in Korea: Methodological Explorations and Implications. HEALTH POLICY AND MANAGEMENT 2015. [DOI: 10.4332/kjhpa.2015.25.3.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
92
|
Gümüş M, Satıcı Ö, Ülger BV, Oğuz A, Taşkesen F, Girgin S. Factors Affecting the Postsurgical Length of Hospital Stay in Patients with Breast Cancer. THE JOURNAL OF BREAST HEALTH 2015; 11:128-131. [PMID: 28331707 DOI: 10.5152/tjbh.2015.2546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 05/22/2015] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Breast cancer is the most common malignancy and the most common cause of mortality in women worldwide. In addition to the increasing incidence of breast cancer, the length of hospital stay (LOS) after breast cancer surgery has been decreasing. Because LOS is key in determining hospital usage, the decrease in the use of hospital facilities may have implications on healthcare planning. The purpose of this study was to evaluate the factors affecting postoperative LOS in patients with breast cancer. MATERIALS AND METHODS Seventy-six in patients with breast cancer, who had been treated between July 2013 and December 2014 in the General Surgery Clinic of Dicle University, were included in the study. The demographic characteristics of the patients, treatment methods, histopathological features of the tumor, concomitant diseases, whether they underwent neoadjuvant chemotherapy or not, and the length of drain remaining time were retrospectively recorded. RESULTS There was a correlation between drain remaining time, totally removed lymph node, the number of metastatic lymph node, and LOS. LOS of patients treated with neoadjuvant chemotherapy was longer. The patients who underwent breast-conserving surgery had a shorter LOS. Linear regression analysis revealed that the drain remaining time and the number of metastatic lymph nodes were independent risk factors for LOS. CONCLUSION Consideration should be given to cancer screening to diagnose the patients before lymph node metastasis occurs. In addition, drains should be avoided unless required and, if used, they should be removed as early as possible for shortening LOS.
Collapse
Affiliation(s)
- Metehan Gümüş
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Ömer Satıcı
- Department of Biotatistic, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Burak Veli Ülger
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Abdullah Oğuz
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Fatih Taşkesen
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Sadullah Girgin
- Department of General Surgery, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| |
Collapse
|
93
|
Bähler C, Huber CA, Brüngger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Serv Res 2015; 15:23. [PMID: 25609174 PMCID: PMC4307623 DOI: 10.1186/s12913-015-0698-2] [Citation(s) in RCA: 286] [Impact Index Per Article: 31.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 01/12/2015] [Indexed: 12/13/2022] Open
Abstract
Background Chronic conditions and multimorbidity have become one of the main challenges in health care worldwide. However, data on the burden of multimorbidity are still scarce. The purpose of this study is to examine the association between multimorbidity and the health care utilization and costs in the Swiss community-dwelling population, taking into account several sociodemographic factors. Methods The study population consists of 229'493 individuals aged 65 or older who were insured in 2013 by the Helsana Group, the leading health insurer in Switzerland, covering all 26 Swiss cantons. Multimorbidity was defined as the presence of two or more chronic conditions of a list of 22 conditions that were identified using an updated measure of the Pharmacy-based Cost Group model. The number of consultations (total and divided by primary care physicians and specialists), the number of different physicians contacted, the type of physician contact (face-to-face, phone, and home visits), the number of hospitalisations and the length of stay were assessed separately for the multimorbid and non-multimorbid sample. The costs (total and divided by inpatient and outpatient costs) covered by the compulsory health insurance were calculated for both samples. Multiple linear regression modelling was conducted to adjust for influencing factors: age, sex, linguistic region, purchasing power, insurance plan, and nursing dependency. Results Prevalence of multimorbidity was 76.6%. The mean number of consultations per year was 15.7 in the multimorbid compared to 4.4 in the non-multimorbid sample. Total costs were 5.5 times higher in multimorbid patients. Each additional chronic condition was associated with an increase of 3.2 consultations and increased costs of 33%. Strong positive associations with utilization and costs were also found for nursing dependency. Multimorbid patients were 5.6 times more likely to be hospitalised. Furthermore, results revealed a significant age-gender interaction and a socioeconomic gradient. Conclusions Multimorbidity is associated with substantial higher health care utilization and costs in Switzerland. Quantified data on the current burden of multimorbidity are fundamental for the management of patients in health service delivery systems and for health care policy debates about resource allocation. Strategies for a better coordination of multimorbid patients are urgently needed. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0698-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Caroline Bähler
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081, Zürich, Switzerland.
| | - Carola A Huber
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081, Zürich, Switzerland.
| | - Beat Brüngger
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081, Zürich, Switzerland.
| | - Oliver Reich
- Department of Health Sciences, Helsana Insurance Group, P.O. Box, 8081, Zürich, Switzerland.
| |
Collapse
|
94
|
Abstract
BACKGROUND The current treatment rate for chronic hepatitis C virus (HCV) infection is suboptimal despite the availability of efficacious antiviral therapy. OBJECTIVE To determine the rate, delay and predictors of treatment in patients with chronic HCV infection. METHODS A retrospective chart review of chronic HCV patients who were being evaluated at a tertiary hepatology centre in Vancouver, British Columbia, was performed. RESULTS One hundred sixty-four patients with chronic HCV infection who were assessed for treatment between February 2008 and January 2013 were reviewed. Treatment was initiated in 25.6% (42 of 164). In multivariate analyses, male sex (OR 7.90 [95% CI 1.35 to 46.15]) and elevated alanine aminotransferase (ALT) level (>1.5 times the upper limit of normal) (OR 3.10 [95% CI 1.32 to 7.27]) were positive predictors of treatment, whereas active smoking (OR 0.09 [95% CI 0.02 to 0.53]) and Charlson comorbidity index (per point increase) (OR 0.47 [95% CI 0.27 to 0.83]) were negative predictors of treatment. The most common reasons for treatment deferral were no or minimal liver fibrosis in 57.7% (n=30), persistently normal ALT levels in 57.7% (n=30) and patient unreadiness in 28.8% (n=15). The most common reasons for treatment noninitiation were patient refusal in 59.1% (n=26), medical comorbidities in 36.4% (n=16), psychiatric comorbidities in 9.1% (n=4) and decompensated cirrhosis in 9.1% (n=4). There was a statistically significant difference in the median time delay from HCV diagnosis to general practitioner referral between the treated and untreated patients (66.3 versus 119.5 months, respectively [P=0.033]). The median wait time from general practitioner referral to hepatologist consult was similar between the treated and untreated patients (1.7 months versus 1.5 months, respectively [P=0.768]). Among the treated patients, the median time delay was 6.8 months from hepatologist consult to treatment initiation. CONCLUSIONS The current treatment rate for chronic HCV infection remains suboptimal. Medical and psychiatric comorbidities represent a major obstacle to HCV treatment. Minimal hepatic fibrosis may no longer be a major reason for treatment deferral as more efficacious and tolerable antiviral therapies become available in the future. Greater educational initiatives for primary care physicians would promote early referral of patients. More nursing support would alleviate the backlog of patients awaiting treatment.
Collapse
|
95
|
Yurkovich M, Avina-Zubieta JA, Thomas J, Gorenchtein M, Lacaille D. A systematic review identifies valid comorbidity indices derived from administrative health data. J Clin Epidemiol 2015; 68:3-14. [DOI: 10.1016/j.jclinepi.2014.09.010] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 07/19/2014] [Accepted: 09/03/2014] [Indexed: 01/08/2023]
|
96
|
Bouza C, López-Cuadrado T, Saz-Parkinson Z, Amate-Blanco JM. Epidemiology and recent trends of severe sepsis in Spain: a nationwide population-based analysis (2006-2011). BMC Infect Dis 2014; 14:3863. [PMID: 25528662 PMCID: PMC4327809 DOI: 10.1186/s12879-014-0717-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/15/2014] [Indexed: 11/30/2022] Open
Abstract
Background Although severe sepsis constitutes an important burden for healthcare systems, there is limited nationwide data on its epidemiology in European countries. Our objective was to examine the most recent epidemiological characteristics and trends of severe sepsis in Spain, from a population perspective. Methods Analysis of the 2006-2011 National Hospital Discharge Registry. Cases were identified by combining specific ICD-9CM codes. We estimated demographics, clinical characteristics and outcomes and calculated age- and sex- adjusted estimations of incidence and mortality rates. Trends were assessed in terms of annual percent change (APC) in rates using joinpoint regression analysis. Results Over the 6-year period we identified 240939 cases of severe sepsis nationwide representing 1.1% of all hospitalisations and 54% of hospitalisations with sepsis. Incidence was 87 cases per 100,000 population. Overall 58% of cases were men, 66% were over the age of 65 and about 67% had associated comorbidities. Bacteremia was coded in 16% of records. Almost 54% of cases had one organ dysfunction, 26% two and around 20% three or more dysfunctions. In-hospital case-fatality was 43% and associated with age, gender, comorbidities and organ dysfunctions, among others. We found significant demographic and clinical changes over time with an increase in the mean age of cases, comorbidities, number of organ dysfunctions and in the number of cases with gram-negative pathogens. Furthermore, even with gender disparities, standardised incidence and mortality rates increased with an overall APC of 8.6% (95% CI 5.1, 12.1) and 6% (95% CI 1.9, 10.3), respectively. Conversely, we detect a significant decrease in case-fatality rates with an overall APC of -3.24% (95% CI: -4.2, -2.2). Conclusions This nationwide population-based study shows that hospitalizations with severe sepsis are frequent and associated with substantial in-hospital mortality in Spain. Furthermore it indicates that the incidence and mortality rates of severe sepsis have notably increased in recent years, showing also a significant increase in the age and severity of the affected population. Despite this, there has been a significant decreasing trend in case-fatality rates over time. This information has significant implications for health-care system planning and may prove useful to estimate future care requirements. Electronic supplementary material The online version of this article (doi:10.1186/s12879-014-0717-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Carmen Bouza
- Health-Care Technology Assessment Agency, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
| | - Teresa López-Cuadrado
- Health-Care Technology Assessment Agency, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
| | - Zuleika Saz-Parkinson
- Health-Care Technology Assessment Agency, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
| | - José María Amate-Blanco
- Health-Care Technology Assessment Agency, National Center of Epidemiology, Instituto de Salud Carlos III, Madrid, Spain.
| |
Collapse
|
97
|
Ruiz-Laiglesia FJ, Sánchez-Marteles M, Pérez-Calvo JI, Formiga F, Bartolomé-Satué JA, Armengou-Arxé A, López-Quirós R, Pérez-Silvestre J, Serrado-Iglesias A, Montero-Pérez-Barquero M. Comorbidity in heart failure. Results of the Spanish RICA Registry. QJM 2014; 107:989-94. [PMID: 24947341 DOI: 10.1093/qjmed/hcu127] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND We sought to identify the comorbidities associated with heart failure (HF) in a non-selected cohort of patients, and its influence on mortality and rehospitalization. DESIGN AND METHODS Data were obtained from the 'Registro de Insuficiencia Cardiaca' (RICA) of the Spanish Society of Internal Medicine. The registry includes patients prospectively admitted in Internal Medicine units for acute HF. Variables included in Charlson Index (ChI) were collected and analysed according to age, gender, left ventricular ejection fraction (LVEF) and Barthel Index. The primary end point of study was the likelihood of rehospitalization and death for any cause during the year after discharge. RESULTS We included 2051 patients, mean age 78 and 53% females. LVEF was ⩾ 50% in 59.1% of the cohort. There was a high degree of dependency as measured by Barthel Index (14.8 % had an index ≤ 60). Mean ChI was 2.91 (SD ± 2.4). The most frequent comorbidities included in ChI were diabetes mellitus (44.3%), chronic renal impairment (30.8%) and chronic obstructive pulmonary disease (COPD) (27.4%). Age, myocardial infarction, peripheral artery disease, dementia, COPD, chronic renal impairment and diabetes with target-organ damage were all identified as independent prognostic factors for the combined end point of rehospitalization and death at 1 year. However, if multivariate analysis was done including ChI, only this remained as an independent prognostic factor for the combined end point (P < 0.001). CONCLUSIONS HF is a comorbid condition. ChI is a simple and feasible tool for estimating the burden of comorbidities in such population. We believe that a holistic approach to HF would improve prognosis and the relief the pressure exerted on public health services.
Collapse
Affiliation(s)
- F-J Ruiz-Laiglesia
- From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain
| | - M Sánchez-Marteles
- From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J-I Pérez-Calvo
- From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain
| | - F Formiga
- From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J A Bartolomé-Satué
- From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain
| | - A Armengou-Arxé
- From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain
| | - R López-Quirós
- From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain
| | - J Pérez-Silvestre
- From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain
| | - A Serrado-Iglesias
- From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain
| | - M Montero-Pérez-Barquero
- From the Department of Internal Medicine, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Department of Internal Medicine, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Department of Internal Medicine, Hospital de Fuenlabrada, Fuenlabrada, Madrid, Department of Internal Medicine, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Department of Internal Medicine, Hospital Costa del Sol, Marbella Málaga, Department of Internal Medicine, Consorcio Hospital General Universitario de Valencia, Valencia, Department of Internal Medicine, Hospital Municipal de Badalona, Badalona, Barcelona and Department of Internal Medicine, IMIBIC/Hospital Universitario Reina Sofía, Córdoba, Spain
| |
Collapse
|
98
|
Mavaddat N, Valderas JM, van der Linde R, Khaw KT, Kinmonth AL. Association of self-rated health with multimorbidity, chronic disease and psychosocial factors in a large middle-aged and older cohort from general practice: a cross-sectional study. BMC FAMILY PRACTICE 2014; 15:185. [PMID: 25421440 PMCID: PMC4245775 DOI: 10.1186/s12875-014-0185-6] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 10/28/2014] [Indexed: 01/10/2023]
Abstract
BACKGROUND The prevalence of coexisting chronic conditions (multimorbidity) is rising. Disease labels, however, give little information about impact on subjective health and personal illness experience. We aim to examine the strength of association of single and multimorbid physical chronic diseases with self-rated health in a middle-aged and older population in England, and to determine whether any association is mediated by depression and other psychosocial factors. METHODS 25 268 individuals aged 39 to 79 years recruited from general practice registers in the European Prospective Investigation of Cancer (EPIC-Norfolk) study, completed a survey including self-rated health, psychosocial function and presence of common physical chronic conditions (cancer, stroke, heart attack, diabetes, asthma/bronchitis and arthritis). Logistic regression models determined odds of "moderate/poor" compared to "good/excellent" health by condition and number of conditions adjusting for psychosocial measures. RESULTS One-third (8252) reported one, around 7.5% (1899) two, and around 1% (194) three or more conditions. Odds of "moderate/poor" self-rated health worsened with increasing number of conditions (one (OR = 1.3(1.2-1.4)) versus three or more (OR = 3.4(2.3-5.1)), and were highest where there was comorbidity with stroke (OR = 8.7(4.6-16.7)) or heart attack (OR = 8.5(5.3-13.6)). Psychosocial measures did not explain the association between chronic diseases and multimorbidity with self-rated health.The relationship of multimorbidity with self-rated health was particularly strong in men compared to women (three or more conditions: men (OR = 5.2(3.0-8.9)), women OR = 2.1(1.1-3.9)). CONCLUSIONS Self-rated health provides a simple, integrative patient-centred assessment for evaluation of illness in the context of multiple chronic disease diagnoses. Those registering in general practice in particular men with three or more diseases or those with cardiovascular comorbidities and with poorer self-rated health may warrant further assessment and intervention to improve their physical and subjective health.
Collapse
Affiliation(s)
- Nahal Mavaddat
- Primary Care Unit, Department of Public Health and Primary Care, Strangeways Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK.
| | | | | | | | | |
Collapse
|
99
|
Carrera-Lasfuentes P, Abad JM, Aguilar-Palacio I, Rabanaque MJ. [Comorbidity as a predictor of health services utilization and mortality in patients with diabetes]. GACETA SANITARIA 2014; 29:10-4. [PMID: 25200482 DOI: 10.1016/j.gaceta.2014.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/03/2014] [Accepted: 07/15/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Chronic diseases are the main cause of mortality worldwide. Study of the most prevalent diseases is essential, as well as the development of indicators of health services' utilization and mortality in these patients. The objective of this study was to identify which comorbidity measure best predicts health services' utilization and mortality in patients with diabetes mellitus in our environment. METHODS A longitudinal study was carried out in a cohort of diabetes mellitus patients diagnosed in 2006 in Zaragoza and followed up to 2010. Logistic regression predictive models were developed. The number of diagnosis, the number of ambulatory diagnostic groups (ADG), and the number of major ambulatory diagnostic groups (MADG) from the Ambulatory Care Groups system were used as comorbidity measures. The validity measure consisted of the improvement in the model's explanatory capacity (c-statistic). RESULTS The prevalence of diabetes mellitus was 8.8%. Both the number of diagnoses and comorbidity were associated with health services' utilization and mortality. For mortality, the best indicator of comorbidity was the number of MADGs (c=0.763). The model adjusted by sex, age, number of MADGs, and number of hospitalizations had the highest explanatory capacity (c=0.818). CONCLUSIONS The ACG system allows resource consumption and mortality to be predicted in people with diabetes mellitus in our environment. This study confirms the substantial healthcare burden generated by patients with diabetes mellitus and the need to tackle this situation.
Collapse
Affiliation(s)
- Patricia Carrera-Lasfuentes
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España
| | - José María Abad
- Dirección General de Planificación y Aseguramiento, Zaragoza, España; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Zaragoza, España
| | - Isabel Aguilar-Palacio
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Zaragoza, España.
| | - M José Rabanaque
- Departamento de Microbiología, Medicina Preventiva y Salud Pública, Universidad de Zaragoza, Zaragoza, España; Grupo de Investigación en Servicios Sanitarios de Aragón (GRISSA), Zaragoza, España
| |
Collapse
|
100
|
Pham C, Gibb C, Field J, Gray J, Fitridge R, Marshall V, Karnon J. Managing high-risk surgical patients: modifiable co-morbidities matter. ANZ J Surg 2014; 84:925-31. [PMID: 24945077 DOI: 10.1111/ans.12726] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND There are a subset of potentially modifiable co-morbidities that may be targeted in the preoperative phase with a view to optimizing control and improving post-operative outcomes. This study aims to estimate the effect of potentially modifiable co-morbidities on post-operative outcomes and to identify potential targets for preoperative management. METHODS Retrospective data on hospital separations in South Australia were analyzed using multiple regression to estimate the association between nine potentially modifiable co-morbidities and length of stay, post-operative complications and in-hospital mortality. RESULTS After adjusting for primary diagnosis, age, gender and other potential confounders, significant increases in length of stay and complications were recorded for eight and six of the nine modifiable co-morbidities, respectively. As examples, previous heart failure was associated with a 54% increase in length of stay and an odds ratio of 1.75 for complications. Asthma and chronic obstructive pulmonary disease was associated with a 38% increase in length of stay and an odds ratio of 1.64 for complications. CONCLUSIONS A set of potentially modifiable co-morbidities is associated with a range of poorer post-operative outcomes, relative to patients without those co-morbidities. There is a clinical rationale that outcomes will be worse in the subset of patients for whom such co-morbidities are poorly controlled, and that timely intervention to improve control in the period prior to surgery will improve post-operative outcomes. Further research is required on post-operative outcomes for patients with and without controlled co-morbidities and on the effects of timely intervention to improve control prior to surgery.
Collapse
Affiliation(s)
- Clarabelle Pham
- Discipline of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | | | | | | | | | | | | |
Collapse
|