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Klunder JH, Bordonis V, Heymans MW, van der Roest HG, Declercq A, Smit JH, Garms-Homolova V, Jónsson PV, Finne-Soveri H, Onder G, Joling KJ, Maarsingh OR, van Hout HPJ. Predicting unplanned hospital visits in older home care recipients: a cross-country external validation study. BMC Geriatr 2021; 21:551. [PMID: 34649526 PMCID: PMC8515741 DOI: 10.1186/s12877-021-02521-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background Accurate identification of older persons at risk of unplanned hospital visits can facilitate preventive interventions. Several risk scores have been developed to identify older adults at risk of unplanned hospital visits. It is unclear whether risk scores developed in one country, perform as well in another. This study validates seven risk scores to predict unplanned hospital admissions and emergency department (ED) visits in older home care recipients from six countries. Methods We used the IBenC sample (n = 2446), a cohort of older home care recipients from six countries (Belgium, Finland, Germany, Iceland, Italy and The Netherlands) to validate four specific risk scores (DIVERT, CARS, EARLI and previous acute admissions) and three frailty indicators (CHESS, Fried Frailty Criteria and Frailty Index). Outcome measures were unplanned hospital admissions, ED visits or any unplanned hospital visits after 6 months. Missing data were handled by multiple imputation. Performance was determined by assessing calibration and discrimination (area under receiver operating characteristic curve (AUC)). Results Risk score performance varied across countries. In Iceland, for any unplanned hospital visits DIVERT and CARS reached a fair predictive value (AUC 0.74 [0.68–0.80] and AUC 0.74 [0.67–0.80]), respectively). In Finland, DIVERT had fair performance predicting ED visits (AUC 0.72 [0.67–0.77]) and any unplanned hospital visits (AUC 0.73 [0.67–0.77]). In other countries, AUCs did not exceed 0.70. Conclusions Geographical validation of risk scores predicting unplanned hospital visits in home care recipients showed substantial variations of poor to fair performance across countries. Unplanned hospital visits seem considerably dependent on healthcare context. Therefore, risk scores should be validated regionally before applied to practice. Future studies should focus on identification of more discriminative predictors in order to develop more accurate risk scores. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02521-2.
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Affiliation(s)
- Jet H Klunder
- Department of General Practice, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.
| | - Veronique Bordonis
- Department of General Practice, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Henriëtte G van der Roest
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, The Netherlands
| | - Anja Declercq
- Center for Care Research & Consultancy (LUCAS) & Center for Sociological Research (CESO), KU Leuven, Leuven, Belgium
| | - Jan H Smit
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Vjenka Garms-Homolova
- Department of Economics and Law, HTW Berlin University of Applied Sciences, Berlin, Germany
| | - Pálmi V Jónsson
- Department of Geriatrics, Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Harriet Finne-Soveri
- Department of Wellbeing, National Institute for Health and Wellbeing, Helsinki, Finland
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Hein P J van Hout
- Department of General Practice, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Medicine for Older People, Amsterdam University Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
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Caramello V, Marulli G, Reimondo G, Fanto' F, Boccuzzi A. Inpatient disposition in overcrowded hospitals: is it safe and effective to use reverse triage and readmission screening tools for appropriate discharge? An observational prospective study of an Italian II level hospital. Int J Clin Pract 2018; 73:e13281. [PMID: 30288861 DOI: 10.1111/ijcp.13281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/25/2018] [Accepted: 09/28/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Reverse triage (RT) identifies patients eligible for discharge and have been proposed to cope with daily surge. Nevertheless, early discharge could increase the rate of readmission. Our aim is to test the effectiveness and safety of RT alone and with readmission screening tools (Identification Senior At Risk [ISAR], HOSPITAL, and Groeningen Frailty Index [GFI] scores) to predict appropriate discharge. MATERIAL AND METHODS We prospectively assessed every 4 days (t0 ) inpatients of medical divisions (High Dependency Unit (HDU), Internal Medicine (IM), and Geriatrics (Ger)) of an Italian Hospital. RT score was calculated for each patient and an RT ≤3 identified those eligible for safe discharge. ISAR, HOSPITAL, and GFI were then applied. We assessed reinstituting of interventions and transferring to an increased level of care unit at 4 days as an ethical proxy of consequential medical events following hypothetical discharge. Date of effective discharge, death, and readmission were measured at 4, 7, 15, and 30 days after the first evaluation. RESULTS Twenty-five (9.6%) out of 260 patients in our sample had an RT ≤3. Twenty-four (96%) of them compared with 205 (87%) of the RT >3 group (P = NS) were discharged. Patients with RT ≤3 were discharged significantly earlier (3.5 vs 8 days after t0 [P = 0.0002]). In the RT ≤3 group, all but one patient were alive and healthy at 7, 15, and 30 days. The HOSPITAL score seemed to have the best concordance with RT (84%), in comparison with the ISAR (52%) and the GFI (48%) scores. RT showed a low sensitivity (22%) and high specificity (95%), which was even higher when using RT associated with readmission screening tools. CONCLUSIONS Reverse triage proved to be a safe and conservative tool, with high specificity alone and with readmission screening tools. RT correctly identifies patients that will be discharged earlier.
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Affiliation(s)
- Valeria Caramello
- Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Giulia Marulli
- Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Giuseppe Reimondo
- Internal Medicine Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Fausto Fanto'
- Geriatric Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Adriana Boccuzzi
- Emergency Department, San Luigi Gonzaga University Hospital, Orbassano, Italy
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Frailty assessment in primary health care and its association with unplanned secondary care use: a rapid review. BJGP Open 2018; 2:bjgpopen18X101325. [PMID: 30564700 PMCID: PMC6181074 DOI: 10.3399/bjgpopen18x101325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background The growing frail, older population is increasing pressure on hospital services. This is directing the attention of clinical commissioning groups towards more comprehensive approaches to managing frailty in the primary healthcare environment. Aim To review the literature on whether assessment of frailty in primary health care leads to a reduction in unplanned secondary care use. Design & setting A rapid review involving a systematic search of Medline and Medline In-Process. Method Relevant data were extracted following the iterative screening of titles, abstracts, and full texts to identify studies in the primary or community healthcare setting which assessed the effect of frailty on unplanned secondary care use between January 2005–June 2016. Results The review included 11 primary studies: nine observational studies; one randomised controlled trial (RCT); and one non-randomised controlled trial (nRCT). Eight out of nine observational studies reported a positive association between frailty and secondary care utilisation. The RCT and nRCT reported conflicting findings. Conclusion Older people identified as frail in a primary healthcare setting were more likely to be admitted to hospital. Based on the limited and equivocal trial evidence, it is not possible to draw firm conclusions regarding appropriate tools for the identification and management of frail older people at risk of hospital admission.
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Screening tools to identify patients with complex health needs at risk of high use of health care services: A scoping review. PLoS One 2017; 12:e0188663. [PMID: 29190658 PMCID: PMC5708762 DOI: 10.1371/journal.pone.0188663] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/10/2017] [Indexed: 12/02/2022] Open
Abstract
Background Many people with chronic conditions have complex health needs often due to multiple chronic conditions, psychiatric comorbidities, psychosocial issues, or a combination of these factors. They are at high risk of frequent use of healthcare services. To offer these patients interventions adapted to their needs, it is crucial to be able to identify them early. Objective The aim of this study was to find all existing screening tools that identify patients with complex health needs at risk of frequent use of healthcare services, and to highlight their principal characteristics. Our purpose was to find a short, valid screening tool to identify adult patients of all ages. Methods A scoping review was performed on articles published between 1985 and July 2016, retrieved through a comprehensive search of the Scopus and CINAHL databases, following the methodological framework developed by Arksey and O’Malley (2005), and completed by Levac et al. (2010). Results Of the 3,818 articles identified, 30 were included, presenting 14 different screening tools. Seven tools were self-reported. Five targeted adult patients, and nine geriatric patients. Two tools were designed for specific populations. Four can be completed in 15 minutes or less. Most screening tools target elderly persons. The INTERMED self-assessment (IM-SA) targets adults of all ages and can be completed in less than 15 minutes. Conclusion Future research could evaluate its usefulness as a screening tool for identifying patients with complex needs at risk of becoming high users of healthcare services.
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Huckel Schneider C, Gillespie JA, Wilson A. Implementing system-wide risk stratification approaches: A review of critical success and failure factors. Health Serv Manage Res 2017; 30:72-84. [PMID: 28349705 DOI: 10.1177/0951484817695738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Risk stratification has become a widely used tool for linking people identified at risk of health deterioration to the most appropriate evidence-based care. This article systematically reviews recent literature to determine key factors that have been identified as critical enablers and/or barriers to successful implementation of risk stratification tools at a system level. A systematic search found 23 articles and four promising protocols for inclusion in the review, covering the use to 20 different risk stratification tools. These articles reported on only a small fraction of the risk stratification tools used in health systems; suggesting that while the development and statistical validation of risk stratification algorithms is widely reported, there has been little published evaluation of how they are implemented in real-world settings. Controlled studies provided some evidence that the use of risk stratification tools in combination with a care management plan offer patient benefits and that the use of a risk stratification tool to determine components of a care management plan may contribute to reductions in hospital readmissions, patient satisfaction and improved patient outcomes. Studies with the strongest focus on implementation used qualitative and case study methods. Among these, the literature converged on four key areas of implementation that were found to be critical for overcoming barriers to success: the engagement of clinicians and safeguarding equity, both of which address barriers of acceptance; the health system context to address administrative, political and system design barriers; and data management and integration to address logistical barriers.
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Affiliation(s)
- Carmen Huckel Schneider
- University of Sydney Level 6, The Hub Charles Perkins Centre Sydney, New South Wales, Australia
| | - James A Gillespie
- University of Sydney Level 6, The Hub Charles Perkins Centre Sydney, New South Wales, Australia
| | - Andrew Wilson
- University of Sydney Level 6, The Hub Charles Perkins Centre Sydney, New South Wales, Australia
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Doñate-Martínez A, Ródenas F, Garcés J. Impact of a primary-based telemonitoring programme in HRQOL, satisfaction and usefulness in a sample of older adults with chronic diseases in Valencia (Spain). Arch Gerontol Geriatr 2015; 62:169-75. [PMID: 26446784 DOI: 10.1016/j.archger.2015.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 09/21/2015] [Accepted: 09/23/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic patients are frequent users of healthcare services and are prone to hospital admissions. In Valencia (Spain) the Valcronic programme aims to manage chronic patients through different levels of telemonitoring and telecare. This paper examines the impact of the Valcronic programme on self-perceived HRQOL in a one-year period and on perceptions of satisfaction and usefulness in a sample of older adults with chronic diseases. METHODS The sample (n=74) was randomly selected from Valcronic users and was stratified considering different variables. HRQOL was assessed using the EQ-5D questionnaire at two points in time: before the beginning of the Valcronic programme and after a one-year follow-up. Satisfaction and usefulness were evaluated one year after users' inclusion. RESULTS The whole sample experienced improvement, although not significant, of its HRQOL; patients over 75 showed impairment. Patients with at least one problem in the EQ-5D dimensions decreased after one year (82.43% vs. 74.32%). Users' perceptions of satisfaction and usefulness were highly positive. CONCLUSIONS Our sample benefited from the Valcronic programme, experiencing an improvement in their HRQOL, a decreased use of health resources or high satisfaction levels. IMPLICATIONS Further adjustments are needed to address a comprehensive response to the needs of the global population of reference.
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Affiliation(s)
| | | | - Jorge Garcés
- Polibienestar Research Institute, University of Valencia, Spain
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O'Caoimh R, Cornally N, Weathers E, O'Sullivan R, Fitzgerald C, Orfila F, Clarnette R, Paúl C, Molloy DW. Risk prediction in the community: A systematic review of case-finding instruments that predict adverse healthcare outcomes in community-dwelling older adults. Maturitas 2015; 82:3-21. [PMID: 25866212 DOI: 10.1016/j.maturitas.2015.03.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 12/18/2022]
Abstract
Few case-finding instruments are available to community healthcare professionals. This review aims to identify short, valid instruments that detect older community-dwellers risk of four adverse outcomes: hospitalisation, functional-decline, institutionalisation and death. Data sources included PubMed and the Cochrane library. Data on outcome measures, patient and instrument characteristics, and trial quality (using the Quality In Prognosis Studies [QUIPS] tool), were double-extracted for derivation-validation studies in community-dwelling older adults (>50 years). Forty-six publications, representing 23 unique instruments, were included. Only five were externally validated. Mean patient age range was 64.2-84.6 years. Most instruments n=18, (78%) were derived in North America from secondary analysis of survey data. The majority n=12, (52%), measured more than one outcome with hospitalisation and the Probability of Repeated Admission score the most studied outcome and instrument respectively. All instruments incorporated multiple predictors. Activities of daily living n=16, (70%), was included most often. Accuracy varied according to instruments and outcomes; area under the curve of 0.60-0.73 for hospitalisation, 0.63-0.78 for functional decline, 0.70-0.74 for institutionalisation and 0.56-0.82 for death. The QUIPS tool showed that 5/23 instruments had low potential for bias across all domains. This review highlights the present need to develop short, reliable, valid instruments to case-find older adults at risk in the community.
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Affiliation(s)
- Rónán O'Caoimh
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland.
| | - Nicola Cornally
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; School of Nursing and Midwifery, University College Cork, Ireland
| | - Elizabeth Weathers
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; School of Nursing and Midwifery, University College Cork, Ireland
| | - Ronan O'Sullivan
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland
| | - Carol Fitzgerald
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland
| | - Francesc Orfila
- Institute for Research Primary Healthcare, Jordi Gol University, Barcelona, Spain
| | - Roger Clarnette
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia
| | - Constança Paúl
- Institute of Biomedical Sciences Abel Salazar - University of Porto, Porto, Portugal
| | - D William Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Douglas Road, Cork City, Ireland; COLLAGE (COLLaboration on AGEing), University College Cork, Cork City and Louth Age Friendly County Initiative, Co Louth, Ireland
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