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Vasilevskis EE, Trumbo SP, Shah AS, Hollingsworth EK, Shotwell MS, Mixon AS, Simmons SF. Medication Discrepancies among Older Hospitalized Adults Discharged from Post-Acute Care Facilities to Home. J Am Med Dir Assoc 2024; 25:105017. [PMID: 38754476 PMCID: PMC11335011 DOI: 10.1016/j.jamda.2024.105017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES The epidemiology of medication discrepancies during transitions from post-acute care (PAC) to home is poorly described. We sought to describe the frequency and types of medication discrepancies among hospitalized older adults transitioning from PAC to home. DESIGN A nested cohort analysis. SETTING AND PARTICIPANTS Included participants enrolled in a patient-centered deprescribing trial, for patients (aged ≥50 years and taking at least 5 medications) transitioning from one of 22 PACs to home. METHODS We assessed demographic and medication measures at the initial hospitalization. The primary outcome measure was medication discrepancies, with the PAC discharge list serving as reference for comparison to the participant's self-reported medication list at 7 days following PAC discharge. Discrepancies were categorized as additions, omissions, and dose discrepancies and were organized by common medication classes and risk of harm (eg, 2015 Beers Criteria). Ordinal logistic regression assessed for patient risk factors for PAC discharge discrepancy count. RESULTS A total of 184 participants had 7-day PAC discharge medication data. Participants were predominately female (67%) and Caucasian (83%) with a median of 16 prehospital medications [interquartile range (IQR) 11, 20]. At the 7-day follow-up, 98% of participants had at least 1 medication discrepancy, with a median number of 7 medication discrepancies (IQR 4, 10) per person, 4 (IQR 2, 6) of which were potentially inappropriate medications as defined by the Beers Criteria. Higher medication discrepancies at index hospital admission and receipt of caregiver assistance with medications were 2 key predictors of medication discrepancies in the week after PAC discharge to home. CONCLUSIONS AND IMPLICATIONS Older patients transitioning home from a PAC facility are at high risk for medication discrepancies. This study underscores the need for interventions targeted at this overlooked transition period, especially as patients resume responsibility for managing their own medications after both a hospital and PAC stay.
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Affiliation(s)
- Eduard Eric Vasilevskis
- Division of Hospital Medicine, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA; Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA.
| | - Silas P Trumbo
- Department of Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Avantika Saraf Shah
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily Kay Hollingsworth
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Amanda S Mixon
- Section of Hospital Medicine, Division of General Internal Medicine & Public Health, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Sandra Faye Simmons
- Center for Quality Aging, Vanderbilt University Medical Center, Nashville, TN, USA; Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA; Geriatric Research Education and Clinical Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA; Division of Geriatrics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Fernandes S, Bula C, Krief H, Carron PN, Seematter-Bagnoud L. Unplanned transfer to acute care during inpatient geriatric rehabilitation: incidence, risk factors, and associated short-term outcomes. BMC Geriatr 2024; 24:456. [PMID: 38789942 PMCID: PMC11127364 DOI: 10.1186/s12877-024-05081-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Information is scarce on unplanned transfers from geriatric rehabilitation back to acute care despite their potential impact on patients' functional recovery. This study aimed 1) to determine the incidence rate and causes of unplanned transfers; 2) to compare the characteristics and outcomes of patients with and without unplanned transfer. METHODS Consecutive stays (n = 2375) in a tertiary geriatric rehabilitation unit were included. Unplanned transfers to acute care and their causes were analyzed from discharge summaries. Data on patients' socio-demographics, health, functional, and mental status; length of stay; discharge destination; and death, were extracted from the hospital database. Bi- and multi-variable analyses investigated the association between patients' characteristics and unplanned transfers. RESULTS One in six (16.7%) rehabilitation stays was interrupted by a transfer, most often secondary to infections (19.3%), cardiac (16.8%), abdominal (12.7%), trauma (12.2%), and neurological problems (9.4%). Older patients (AdjORage≥85: 0.70; 95%CI: 0. 53-0.94, P = .016), and those admitted for gait disorders (AdjOR: 0.73; 95%CI: 0.53-0.99, P = .046) had lower odds of transfer to acute care. In contrast, men (AdjOR: 1.71; 95%CI: 1.29-2.26, P < .001), patients with more severe disease (AdjORCIRS: 1.05; 95%CI: 1.02-1.07, P < .001), functional impairment before (AdjOR: 1.69; 95%CI: 1.05-2.70, P = .029) and at rehabilitation admission (AdjOR: 2.07; 95%CI: 1.56- 2.76, P < .001) had higher odds of transfer. Transferred patients were significantly more likely to die than those without transfer (AdjOR 13.78; 95%CI: 6.46-29.42, P < .001) during their stay, but those surviving had similar functional performance and rate of home discharge at the end of the stay. CONCLUSION A significant minority of patients experienced an unplanned transfer that potentially interfered with their rehabilitation and was associated with poorer outcomes. Men, patients with more severe disease and functional impairment appear at increased risk. Further studies should investigate whether interventions targeting these patients may prevent unplanned transfers and modify associated adverse outcomes.
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Affiliation(s)
- Sofia Fernandes
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, 1011, Switzerland
| | - Christophe Bula
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, 1011, Switzerland
| | - Hélène Krief
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, 1011, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, 1011, Switzerland
| | - Laurence Seematter-Bagnoud
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital and University of Lausanne (CHUV), Lausanne, 1011, Switzerland.
- Centre for Primary Care and Public Health (Unisanté), Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland.
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Wang J, Shen JY, Conwell Y, Podsiadly EJ, Caprio TV, Nathan K, Yu F, Ramsdale EE, Fick DM, Mixon AS, Simmons SF. Implementation considerations of deprescribing interventions: A scoping review. J Intern Med 2024; 295:436-507. [PMID: 36524602 DOI: 10.1111/joim.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Over half of older adults experience polypharmacy, including medications that may be inappropriate or unnecessary. Deprescribing, which is the process of discontinuing or reducing inappropriate and/or unnecessary medications, is an effective way to reduce polypharmacy. This review summarizes (1) the process of deprescribing and conceptual models and tools that have been developed to facilitate deprescribing, (2) barriers, enablers, and factors associated with deprescribing, and (3) characteristics of deprescribing interventions in completed trials, as well as (4) implementation considerations for deprescribing in routine practice. In conceptual models of deprescribing, multilevel factors of the patient, clinician, and health-care system are all related to the efficacy of deprescribing. Numerous tools have been developed for clinicians to facilitate deprescribing, yet most require substantial time and, thus, may be difficult to implement during routine health-care encounters. Multiple deprescribing interventions have been evaluated, which mostly include one or more of the following components: patient education, medication review, identification of deprescribing targets, and patient and/or provider communication about high-risk medications. Yet, there has been limited consideration of implementation factors in prior deprescribing interventions, especially with regard to the personnel and resources in existing health-care systems and the feasibility of incorporating components of deprescribing interventions into the routine care processes of clinicians. Future trials require a more balanced consideration of both effectiveness and implementation when designing deprescribing interventions.
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Affiliation(s)
- Jinjiao Wang
- Elaine, Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Jenny Y Shen
- Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA
| | - Eric J Podsiadly
- Harriet J. Kitzman Center for Research Support, School of Nursing, University of Rochester, Rochester, New York, USA
| | - Thomas V Caprio
- Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- UR Medicine Home Care, University of Rochester Medical Center, Rochester, New York, USA
- University of Rochester Medical Center, Finger Lakes Geriatric Education Center, Rochester, New York, USA
| | - Kobi Nathan
- Department of Medicine, Division of Geriatrics & Aging, University of Rochester Medical Center, Rochester, New York, USA
- St. John Fisher College, Wegmans School of Pharmacy, Rochester, New York, USA
| | - Fang Yu
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Erika E Ramsdale
- Department of Medicine, Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, New York, USA
| | - Donna M Fick
- Ross and Carol Nese College of Nursing, Penn State University, University Park, Pennsylvania, USA
| | - Amanda S Mixon
- Department of Medicine, Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Sandra F Simmons
- Department of Medicine, Center for Quality Aging, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research, Education and Clinical Center (GRECC), VA Tennessee Valley Healthcare System, Nashville, Tennessee, USA
- Department of Medicine, Division of Geriatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Saragosa M, Zagrodney KAP, Rabeenthira P, King EC, McKay SM. How Might We Have Known? Using Administrative Data to Predict 30-Day Hospital Readmission in Clients Receiving Home Care Services from 2018 to 2021. Health Serv Insights 2023; 16:11786329231211774. [PMID: 38028118 PMCID: PMC10644727 DOI: 10.1177/11786329231211774] [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: 08/01/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Reducing hospital readmissions can improve individual health outcomes and lower system-level costs. This study aimed to understand the characteristics of home care Personal Support clients who experienced a hospital admission (ie, hospital hold) and to identify factors that predict hospital readmission within 30 days of resuming home care Personal Support services. Methods We conducted a retrospective cohort study using client administrative data from a home healthcare provider organization (2018-2021). The sample included clients (⩾18 years) who received publicly funded Personal Support services and experienced a hospital hold. Descriptive statistics and a binary logistic regression model analyzed the relationship between demographics, hospital service utilization, home care service utilization, and contextual factors on the outcome of 30-day hospital readmission. Results Approximately 17% (n = 662) of all clients with a hospital hold (n = 3992) were readmitted to hospital within 30 days. Compared with non-readmitted clients, those with greater home care Personal Support service intensity after the index hospital hold were less likely to experience a hospital 30-day readmission. In contrast, those with greater acuity, higher assessed care needs, more hospital holds overall, more extended hospital stays (⩾2 weeks), and lower social support had a higher likelihood of 30-day hospital readmission. Conclusion The findings from this study provide a greater understanding of factors associated with home care clients' risk of hospital readmission within 30 days and can be used to inform targeted, evidence-based support to reduce home care clients' hospital readmissions.
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Affiliation(s)
- Marianne Saragosa
- VHA Home HealthCare, Toronto, ON, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
- Science of Care Insitute, Sinai Health, Toronto, ON, Canada
| | - Katherine AP Zagrodney
- VHA Home HealthCare, Toronto, ON, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
- Canadian Health Workforce Network, University of Ottawa, Ottawa, ON, Canada
| | - Prakathesh Rabeenthira
- VHA Home HealthCare, Toronto, ON, Canada
- Public Health Agency of Canada, Toronto, ON, Canada
| | - Emily C King
- VHA Home HealthCare, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sandra M McKay
- VHA Home HealthCare, Toronto, ON, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, ON, Canada
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Biru GD, Derebe MA, Workie DL. Joint modeling of longitudinal changes of pulse rate and body temperature with time to recovery of pneumonia patients under treatment: a prospective cohort study. BMC Infect Dis 2023; 23:682. [PMID: 37828463 PMCID: PMC10571452 DOI: 10.1186/s12879-023-08646-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Pneumonia is the leading infectious cause of mortality worldwide and one of the most common lower respiratory tract infections that is contributing significantly to the burden of antibiotic consumption. The study aims to identify the determinants of the progress of pulse rate, body temperature and time to recovery of pneumonia patients. METHOD A prospective cohort study design was used from Felege Hiwot referral hospital on 214 sampled pneumonia patients from March 01, 2022 up to May 31, 2022. The Kaplan-Meier survival estimate and Log-Rank test was used to compare the survival time. Joint model of bivariate longitudinal and time to event model was used to identify factors of longitudinal change of pulse rate and body temperature with time to recovery jointly. RESULT As the follow up time of pneumonia patient's increase by one hour the average longitudinal change of pulse rate and body temperature were decreased by 0.4236 bpm and 0.0119 [Formula: see text]. The average longitudinal change of pulse rate and body temperature of patients who lived in rural was 1.4602 bpm and 0.1550 [Formula: see text] times less as compared to urban residence. Patients who had dangerous signs are significantly increased the average longitudinal change of pulse rate and body temperature by 2.042 bpm and 0.6031 [Formula: see text] as compared to patients who had no dangerous signs. A patient from rural residence was 1.1336 times more likely to experience the event of recovery as compared to urban residence. The estimated values of the association parameter for pulse rate and body temperature were -0.4236 bpm and -0.0119 respectively, which means pulse rate and body temperature were negatively related with patients recovery time. CONCLUSION Pulse rate and body temperature significantly affect the time to the first recovery of pneumonia patients who are receiving treatment. Age, residence, danger sign, comorbidity, baseline symptom and visiting time were the joint determinant factors for the longitudinal change of pulse rate, body temperature and time to recovery of pneumonia patients. The joint model approach provides precise dynamic predictions, widespread information about the disease transitions, and better knowledge of disease etiology.
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Affiliation(s)
- Getu Dessie Biru
- Department of Statistics, Dembi Dolo University, Debretabor University, Ethiopia
| | - Muluwerk Ayele Derebe
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Demeke Lakew Workie
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
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Bag Soytas R, Levinoff EJ, Smith L, Doventas A, Morais JA, Veronese N, Soysal P. Predictive Strategies to Reduce the Risk of Rehospitalization with a Focus on Frail Older Adults: A Narrative Review. EPIDEMIOLOGIA 2023; 4:382-407. [PMID: 37873884 PMCID: PMC10594531 DOI: 10.3390/epidemiologia4040035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/16/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023] Open
Abstract
Frailty is a geriatric syndrome that has physical, cognitive, psychological, social, and environmental components and is characterized by a decrease in physiological reserves. Frailty is associated with several adverse health outcomes such as an increase in rehospitalization rates, falls, delirium, incontinence, dependency on daily living activities, morbidity, and mortality. Older adults may become frailer with each hospitalization; thus, it is beneficial to develop and implement preventive strategies. The present review aims to highlight the epidemiological importance of frailty in rehospitalization and to compile predictive strategies and related interventions to prevent hospitalizations. Firstly, it is important to identify pre-frail and frail older adults using an instrument with high validity and reliability, which can be a practically applicable screening tool. Comprehensive geriatric assessment-based care is an important strategy known to reduce morbidity, mortality, and rehospitalization in older adults and aims to meet the needs of frail patients with a multidisciplinary approach and intervention that includes physiological, psychological, and social domains. Moreover, effective multimorbidity management, physical activity, nutritional support, preventing cognitive frailty, avoiding polypharmacy and anticholinergic drug burden, immunization, social support, and reducing the caregiver burden are other recommended predictive strategies to prevent post-discharge rehospitalization in frail older adults.
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Affiliation(s)
- Rabia Bag Soytas
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Elise J. Levinoff
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Lee Smith
- Center for Health Performance and Wellbeing, Anglia Ruskin University, East Road, Cambridge CB1 1PT, UK
| | - Alper Doventas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34320, Turkey;
| | - José A. Morais
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, 90133 Palermo, Italy;
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34320, Turkey;
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Trevisan C, Noale M, Zatti G, Vetrano DL, Maggi S, Sergi G. Hospital length of stay and 30-day readmissions in older people: their association in a 20-year cohort study in Italy. BMC Geriatr 2023; 23:154. [PMID: 36941535 PMCID: PMC10029164 DOI: 10.1186/s12877-023-03884-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/11/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND There are conflicting data on whether hospital length of stay (LOS) reduction affects readmission rates in older adults. We explored 20-year trends of hospital LOS and 30-day rehospitalizations in a cohort of Italian older people, and investigated their association. METHODS Participants in the Pro.V.A. project (n = 3099) were followed-up from 1996 to 2018. LOS and 30-day rehospitalizations, i.e. new hospitalizations within 30 days from a previous discharge, were obtained from personal interviews and regional registers. Rehospitalizations in the 6 months before death were also assessed. Linear regressions evaluated the associations between LOS and the frequency of 30-day rehospitalizations, adjusting for the mean age of the cohort within each year. RESULTS Over 20 years, 2320 (74.9%) participants were hospitalized. Mean LOS gradually decreased from 17.3 days in 1996 to 11.3 days in 2018, while 30-day rehospitalization rates increased from 6.6% in 1996 to 13.6% in 2018. LOS was inversely associated with 30-day rehospitalizations frequency over time (β = -2.33, p = 0.01), similarly in men and women. A total of 1506 individuals was hospitalized within 6 months before death. The frequency of 30-day readmissions at the end of life increased from 1.4% in 1997 to 8.3% in 2017 and was associated with mean LOS (β = -1.17, p = 0.03). CONCLUSIONS The gradual LOS reduction observed in the latter decades is associated with higher 30-day readmission rates in older patients in Italy. This suggests that a careful pre-discharge assessment is warranted in older people, and that community healthcare services should be improved to reduce the risk of readmission.
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Affiliation(s)
- Caterina Trevisan
- Geriatric Unit, Department of Medicine, University of Padova, Padua, Italy.
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro, 8, Ferrara, 44124, Italy.
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Marianna Noale
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Giancarlo Zatti
- Geriatric Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Stefania Maggi
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Giuseppe Sergi
- Geriatric Unit, Department of Medicine, University of Padova, Padua, Italy
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Kayhan Kocak FO, Sahin S, Taşkıran E, Simsek H, Daylan A, Arman P, Dikmeer A, Kılıc F, Balci C, Tosun Tasar P, Doventas A, Yavuz BB, Akcicek SF. Frequency and Risk Factors of Re-hospitalization in Geriatric Inpatient Wards: A Multicenter Retrospective Analysis. Exp Aging Res 2023; 49:70-82. [PMID: 35175909 DOI: 10.1080/0361073x.2022.2041323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE We aimed to evaluate frequency and risk factors of re-hospitalization which are not stated in comorbidity indexes in geriatric wards. METHODS A total of 585 patients who were admitted to tertiary care geriatric inpatient clinics at least once between 1 September 2017 and 1 September 2018 and who survived to discharge during initial hospitalization were included in this cross-sectional retrospective multicenter study. RESULTS Overall, 507(86.7%) patients were hospitalized once for treatment during the study period, while re-hospitalization occurred in 78(13.3%) patients. Rates of previous surgery (10.3 vs. 3.0%, p = .006), urinary incontinence (UI) (50.0 vs. 36.3%, p = .021), controlled hypertension (64.1 vs. 46.4%, p = .024), malnutrition (55.1 vs. 29.6%, p = .014) were significantly higher in re-hospitalized patients. Re-hospitalized patients were younger (mean ± SD 76.4 ± 8.3 vs. 79.6 ± 7.9 years, p = .002) than once-hospitalized patients. Multivariate logistic regression analysis revealed the younger patient age (OR, 0.942, 95% CI 0.910 to 0.976, p = .001), higher Modified Charlson Comorbidity Index (MCCI) score (OR, 1.368, 95% CI 1.170 to 1.600, p < .001) to significantly predict the increased risk of re-hospitalization. CONCLUSIONS Our findings showed that previous history of surgery and geriatric syndromes such as UI, malnutrition were determined to significantly predict the increased risk of re-hospitalization. We suggest that these risk factors be added to prognostic tools designed for elderly patients.
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Affiliation(s)
- Fatma Ozge Kayhan Kocak
- Department of Internal Medicine, Division of Geriatrics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Sevnaz Sahin
- Department of Internal Medicine, Division of Geriatrics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Emin Taşkıran
- Department of Internal Medicine, Division of Geriatrics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Hatice Simsek
- Department of Public Health, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ayse Daylan
- Department of Internal Medicine, Division of Geriatrics, Ege University Faculty of Medicine, Izmir, Turkey
| | - Pinar Arman
- Department of Internal Medicine, Division of Geriatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Ayse Dikmeer
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Furkan Kılıc
- Department of Internal Medicine, Division of Geriatrics, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Cafer Balci
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pınar Tosun Tasar
- Department of Internal Medicine, Division of Geriatrics, Ataturk University Faculty of Medicine, Erzurum, Turkey
| | - Alper Doventas
- Department of Internal Medicine, Division of Geriatrics, Istanbul University Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Burcu Balam Yavuz
- Department of Internal Medicine, Division of Geriatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selahattin Fehmi Akcicek
- Department of Internal Medicine, Division of Geriatrics, Ege University Faculty of Medicine, Izmir, Turkey
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Silcock J, Marques I, Olaniyan J, Raynor DK, Baxter H, Gray N, Zaidi STR, Peat G, Fylan B, Breen L, Benn J, Alldred DP. Co-designing an intervention to improve the process of deprescribing for older people living with frailty in the United Kingdom. Health Expect 2022; 26:399-408. [PMID: 36420768 PMCID: PMC9854320 DOI: 10.1111/hex.13669] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In older people living with frailty, polypharmacy can lead to preventable harm like adverse drug reactions and hospitalization. Deprescribing is a strategy to reduce problematic polypharmacy. All stakeholders should be actively involved in developing a person-centred deprescribing process that involves shared decision-making. OBJECTIVE To co-design an intervention, supported by a logic model, to increase the engagement of older people living with frailty in the process of deprescribing. DESIGN Experience-based co-design is an approach to service improvement, which uses service users and providers to identify problems and design solutions. This was used to create a person-centred intervention with the potential to improve the quality and outcomes of the deprescribing process. A 'trigger film' showing older people talking about their healthcare experiences was created and facilitated discussions about current problems in the deprescribing process. Problems were then prioritized and appropriate solutions were developed. The review located the solutions in the context of current processes and procedures. An ideal care pathway and a complex intervention to deliver better care were developed. SETTING AND PARTICIPANTS Older people living with frailty, their informal carers and professionals living and/or working in West Yorkshire, England, UK. Deprescribing was considered in the context of primary care. RESULTS The current deprescribing process differed from an ideal pathway. A complex intervention containing seven elements was required to move towards the ideal pathway. Three of these elements were prototyped and four still need development. The complex intervention responded to priorities about (a) clarity for older people about what was happening at all stages in the deprescribing process and (b) the quality of one-to-one consultations. CONCLUSIONS Priorities for improving the current deprescribing process were successfully identified. Solutions were developed and structured as a complex intervention. Further work is underway to (a) complete the prototyping of the intervention and (b) conduct feasibility testing. PATIENT OR PUBLIC CONTRIBUTION Older people living with frailty (and their informal carers) have made a central contribution, as collaborators, to ensure that a complex intervention has the greatest possible potential to enhance the experience of deprescribing medicines.
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Affiliation(s)
- Jonathan Silcock
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | - Iuri Marques
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK
| | - Janice Olaniyan
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | | | - Helen Baxter
- Alliance Manchester Business School, Faculty of HumanitiesUniversity of ManchesterManchesterUK
| | - Nicky Gray
- Department of Pharmacy, School of Applied SciencesUniversity of HuddersfieldHuddersfieldUK
| | | | - George Peat
- Department of Health SciencesUniversity of YorkYorkUK
| | - Beth Fylan
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | - Liz Breen
- School of Pharmacy and Medical Sciences, Faculty of Life SciencesUniversity of BradfordBradfordUK,NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK
| | - Jonathan Benn
- NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK,School of PsychologyUniversity of LeedsLeedsUK
| | - David P. Alldred
- NIHR Yorkshire and the Humber Patient Safety Translational Research Centre, Bradford Institute for Health ResearchBradfordUK,School of HealthcareUniversity of LeedsLeedsUK
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10
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Cowley A, Goldberg SE, Gordon AL, Logan PA. A non-randomised feasibility study of the Rehabilitation Potential Assessment Tool (RePAT) in frail older people in the acute healthcare setting. BMC Geriatr 2022; 22:785. [PMID: 36207681 PMCID: PMC9541000 DOI: 10.1186/s12877-022-03420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/24/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rehabilitation potential involves predicting who will benefit from rehabilitation. Decisions about rehabilitation potential must take into account personal, clinical and contextual factors, a process which is complicated in the presence of acute ill-health and frailty. This study aimed to evaluate the feasibility and acceptability of the Rehabilitation Potential Assessment Tool (RePAT) - a 15 item holistic, person-centred assessment tool and training package - in the acute hospital setting. METHODS A non-randomised feasibility study with nested semi-structured interviews explored whether RePAT was feasible and acceptable. Feasibility was tested by recruiting physiotherapy and occupational therapy participants delivering the RePAT intervention to patients alongside usual clinical care. Acceptability was tested by conducting semi-structured interviews with staff, patient and carer participants. Staff and patient characteristics were analysed using descriptive statistics. Interview data were analysed thematically. Fidelity of completed RePAT items was assessed against a priori criteria on how closely they matched tool guidance by two researchers. Mean values of the two scores were calculated. RePAT content was analysed and supported with verbatim quotes. RESULTS Six staff participants were recruited and trained. They assessed 26 patient participants using RePAT. Mean (SD) patient age was 86.16 (±6.39) years. 32% were vulnerable or mildly frail, 42% moderately frail and 26% severely or very severely frail using the Clinical Frailty Scale. Mean (SD) time to complete RePAT was 32.7 (±9.6) minutes. RePAT fidelity was good where 13 out of 15 items achieved a priori fidelity. RePAT was acceptable and tolerated by staff and patients. Staff participants reported RePAT enabled them to consider rehabilitation decisions in a more structured and consistent way. Patients and carer participants, although unable to comment directly on RePAT, reported being satisfied with their rehabilitation assessments which were found to embrace a person-centred approach. CONCLUSIONS RePAT was found to be acceptable and feasible by staff, carers and patients. It allowed clinicians to make explicit their reasoning behind rehabilitation assessments and encouraged them to become more cognisant of factors which affected their clinical decision-making. TRIAL REGISTRATION ID ISRCTN31938453 . Registered 05/10/2021.
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Affiliation(s)
- Alison Cowley
- Research and Innovation, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK.
- Academic Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
| | - Sarah E Goldberg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Adam L Gordon
- Academic Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
| | - Pip A Logan
- Academic Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Applied Research Collaboration East Midlands (ARC-EM), Nottingham, UK
- Nottingham CityCare Partnership CIC, Nottingham, UK
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11
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Chen H, Hara Y, Horita N, Saigusa Y, Hirai Y, Kaneko T. Is rehabilitation effective in preventing decreased functional status after community-acquired pneumonia in elderly patients? Results from a multicentre, retrospective observational study. BMJ Open 2022; 12:e051307. [PMID: 36109034 PMCID: PMC9478837 DOI: 10.1136/bmjopen-2021-051307] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study was designed to evaluate the effect of rehabilitation in preventing decreased functional status (FS) after community-acquired pneumonia (CAP) in elderly patients. DESIGN This was a retrospective observational study. SETTING Multicentre study was conducted in two medical facilities from January 2016 to December 2018. PARTICIPANTS Hospitalised patients with CAP aged over 64 years were enrolled. FS was assessed by the Barthel Index (BI) (range, 0-100, in 5-point increments) at admission and before discharge and graded into three categories: independent, BI 80-100; semidependent, BI 30-75; and dependent, BI 0-25. Multivariable analysis of factors contributing to decreased FS was conducted with two groups: with a decrease of at least one category (decreased group) or without a decrease of category (maintained group). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was the effect of rehabilitation in preventing decreased FS. The secondary outcomes were factors associated with decreased FS. RESULTS The maintained and decreased groups included 400 and 138 patients, respectively. A high frequency of rehabilitation therapy was observed in the decreased group (189 (47.3%) vs 104 (75.4%); p<0.001). Multivariable analysis showed that the factors affecting FS were aspiration pneumonia, Pneumonia Severity Index (PSI) category V, length of stay and age (OR 2.66, 95% CI 1.58 to 4.49; OR 1.92, 95% CI 1.29 to 3.44; OR 1.05, 95% CI 1.04 to 1.07; and OR 1.05, 95% CI 1.02 to 1.09, respectively). After adjusting for factors contributing to decreased FS, rehabilitation showed a limited effect in preventing decreased FS in 166 matched pairs by McNemar's test (p=0.327). CONCLUSIONS Aspiration and PSI played important roles in reducing FS. The effect of rehabilitation remains unclear in CAP. TRIAL REGISTRATION NUMBER UMIN000046362.
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Affiliation(s)
- Hao Chen
- Department of Pulmonology, Yokohama City University Hospital, Yokohama, Japan
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Hospital, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Hospital, Yokohama, Japan
| | - Yusuke Saigusa
- Department of Biostatistics, Yokohama City University School of Medicine Graduate School of Medicine, Yokohama, Japan
| | - Yoshihiro Hirai
- Department of Pulmonology, Kanto Rosai Hospital, Yokohama, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Hospital, Yokohama, Japan
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12
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Eriksen AV, Thrane MD, Matzen L, Ryg J, Andersen-Ranberg K. Older patients acutely admitted and readmitted to the same geriatric department: a descriptive cohort study of primary diagnoses and health characteristics. Eur Geriatr Med 2022; 13:1109-1118. [PMID: 35900651 DOI: 10.1007/s41999-022-00670-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Advancing age is associated with increased risk for acute admissions and readmissions. The societal challenges of ageing populations have made the prevention of readmissions come into focus. Readmission may be perceived as the result of inadequate treatment during index admission but may also be caused by the onset of new disease following a generally impaired health of geriatric patients. We aimed at comparing the diagnoses at index and readmission to illuminate this issue. METHODS This is a descriptive, retrospective cohort study of patients acutely admitted and readmitted (within 30 days from discharge) to the same geriatric ward (November 1, 2017-April 30, 2018). Electronic medical records were scrutinised manually for discharge diagnoses and patient characteristics. RESULTS Readmission rate was 10.7% (98 of 918 unique admissions). Mean age was 85.6 (men 56%). About 75% were readmitted with a new acute disease unrelated to index admission, most commonly pneumonia (27%), other infections (22%), and dehydration (14%). The health characteristics were long index length-of-stay (median 7; IQR 5-11), high Charlson Comorbidity Index (CCI ≥ 3, n = 49 (50%), polypharmacy (≥ 5 prescriptions) (94%), and hospitalisations 12 months prior to index admission (57%). KEY CONCLUSIONS The majority of readmitted geriatric patients have contracted a new acute condition. Although being characterised by several adverse health characteristics, prospective studies comparing readmitted and non-readmitted geriatric patients are needed. Still, increasing the awareness of early recognition of acute disease onset in geriatric patients is warranted.
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Affiliation(s)
- Alexander Viktor Eriksen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløwsvej 4, Odense C, 5000, Odense, Denmark
| | - Mikkel Dreier Thrane
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløwsvej 4, Odense C, 5000, Odense, Denmark
| | - Lars Matzen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløwsvej 4, Odense C, 5000, Odense, Denmark
| | - Jesper Ryg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløwsvej 4, Odense C, 5000, Odense, Denmark
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløwsvej 4, Odense C, 5000, Odense, Denmark. .,Department of Public Health, Danish Aging Research Centre, University of Southern Denmark, Odense, Denmark.
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13
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Unplanned Readmissions Among Older Persons Result in Loss of Their Independence. Prof Case Manag 2022; 27:207-209. [PMID: 35617538 DOI: 10.1097/ncm.0000000000000579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Yin S, Paratz J, Cottrell M. Re-admission following discharge from a Geriatric Evaluation and Management Unit: identification of risk factors. AUST HEALTH REV 2022; 46:421-425. [PMID: 35710459 DOI: 10.1071/ah21357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/20/2022] [Indexed: 11/23/2022]
Abstract
ObjectiveTo establish independent factors that influence the likelihood of re-admission within 30 days of discharge from a Geriatric Evaluation and Management Unit.MethodsAn observational prospective cohort design using clinical data extracted from the medical charts of eligible patients discharged from a tertiary public hospital Geriatric Evaluation and Management Unit between July 2017 and April 2019. Binary logistic regression was undertaken to determine variables that increased the likelihood of hospital re-admission (dependent variable).ResultsA total of 367 patients were eligible for inclusion, with 69 patients re-admitted within 30 days of discharge. Univariate analysis demonstrated significant differences between groups (re-admission vs non-re-admission) with respect to Charlson Comorbidity Index (CCI) (7.4 [2.4] vs 6.3 [2.2], P = 0.001), Clinical Frailty Scale (CFS) (5.6 [1.1] vs 5.2 [1.34], P = 0.02), and documented malnourishment (36.2% vs 23.6%, P = 0.04). All three variables remained significant when entered into the regression model (X2 = 25.095, P < 0.001). A higher score for the CFS (OR 1.3; 95% CI 1.03-1.64; P = 0.03) and CCI (OR 1.2; 95% CI 1.06-1.33; P = 0.004), and documented malnourishment (OR 1.92; 95% CI 1.06-3.47; P = 0.03) were all independent factors that increased the likelihood of patient re-admission within 30 days of discharge.ConclusionsThis study supports the formal inclusion of the CCI and CFS into routine practice in Geriatric Evaluation and Management Units. The inclusion of the measures can help inform future discharge planning practices. Clinicians should use malnourishment status, CCI and CFS to identify at risk patients and target discharge planning interventions accordingly.
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Affiliation(s)
- Sally Yin
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Level 2 Ned Handlon Building, Herston, Brisbane, Qld 4029, Australia
| | - Jennifer Paratz
- Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland, Level 8, UQ Centre for Clinical Research (UQCCR), Royal Brisbane and Women's Hospital, Herston, Brisbane, Qld 4029, Australia
| | - Michelle Cottrell
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Level 2 Ned Handlon Building, Herston, Brisbane, Qld 4029, Australia
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15
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Sidoli C, Zambon A, Tassistro E, Rossi E, Mossello E, Inzitari M, Cherubini A, Marengoni A, Morandi A, Bellelli G, Tarasconi A, Sella M, Paternò G, Faggian G, Lucarelli C, De Grazia N, Alberto C, Porcella L, Nardiello I, Chimenti E, Zeni M, Romairone E, Minaglia C, Ceccotti C, Guerra G, Mantovani G, Monacelli F, Minaglia C, Candiani T, Santolini F, Minaglia C, Rosso M, Bono V, Sibilla S, Dal Santo P, Ceci M, Barone P, Schirinzi T, Formenti A, Nastasi G, Isaia G, Gonella D, Battuello A, Casson S, Calvani D, Boni F, Ciaccio A, Rosa R, Sanna G, Manfredini S, Cortese L, Rizzo M, Prestano R, Greco A, Lauriola M, Gelosa G, Piras V, Arena M, Cosenza D, Bellomo A, LaMontagna M, Gabbani L, Lambertucci L, Perego S, Parati G, Basile G, Gallina V, Pilone G, Giudice C, Pietrogrande L, Mosca M, Corazzin I, Rossi P, Nunziata V, D’Amico F, Grippa A, Giardini S, Barucci R, Cossu A, Fiorin L, Arena M, Distefano M, Lunardelli M, Brunori M, Ruffini I, Abraham E, Varutti A, Fabbro E, Catalano A, Martino G, Leotta D, Marchet A, Dell’Aquila G, Scrimieri A, Davoli M, Casella M, Cartei A, Polidori G, Basile G, Brischetto D, Motta S, Saponara R, Perrone P, Russo G, Del D, Car C, Pirina T, Franzoni S, Cotroneo A, Ghiggia F, Volpi G, Menichetti C, Bo M, Panico A, Calogero P, Corvalli G, Mauri M, Lupia E, Manfredini R, Fabbian F, March A, Pedrotti M, Veronesi M, Strocchi E, Borghi C, Bianchetti A, Crucitti A, DiFrancesco V, Fontana G, Geriatria A, Bonanni L, Barbone F, Serrati C, Ballardini G, Simoncelli M, Ceschia G, Scarpa C, Brugiolo R, Fusco S, Ciarambino T, Biagini C, Tonon E, Porta M, Venuti D, DelSette M, Poeta M, Barbagallo G, Trovato G, Delitala A, Arosio P, Reggiani F, Zuliani G, Ortolani B, Mussio E, Girardi A, Coin A, Ruotolo G, Castagna A, Masina M, Cimino R, Pinciaroli A, Tripodi G, Cassadonte F, Vatrano M, Scaglione L, Fogliacco P, Muzzuilini C, Romano F, Padovani A, Rozzini L, Cagnin A, Fragiacomo F, Desideri G, Liberatore E, Bruni A, Orsitto G, Franco M, Bonfrate L, Bonetto M, Pizio N, Magnani G, Cecchetti G, Longo A, Bubba V, Marinan L, Cotelli M, Turla M, Brunori M, Sessa M, Abruzzi L, Castoldi G, LoVetere D, Musacchio C, Novello M, Cavarape A, Bini A, Leonardi A, Seneci F, Grimaldi W, Seneci F, Fimognari F, Bambar V, Saitta A, Corica F, Braga M, Servi, Ettorre E, Camellini Bellelli CG, Annoni G, Marengoni A, Bruni A, Crescenzo A, Noro G, Turco R, Ponzetto M, Giuseppe L, Mazzei B, Maiuri G, Costaggiu D, Damato R, Fabbro E, Formilan M, Patrizia G, Santuar L, Gallucci M, Minaglia C, Paragona M, Bini P, Modica D, Abati C, Clerici M, Barbera I, NigroImperiale F, Manni A, Votino C, Castiglioni C, Di M, Degl’Innocenti M, Moscatelli G, Guerini S, Casini C, Dini D, DeNotariis S, Bonometti F, Paolillo C, Riccardi A, Tiozzo A, SamySalamaFahmy A, Riccardi A, Paolillo C, DiBari M, Vanni S, Scarpa A, Zara D, Ranieri P, Alessandro M, Calogero P, Corvalli G, Di F, Pezzoni D, Platto C, D’Ambrosio V, Ivaldi C, Milia P, DeSalvo F, Solaro C, Strazzacappa M, Bo M, Panico A, Cazzadori M, Bonetto M, Grasso M, Troisi E, Magnani G, Cecchetti G, Guerini V, Bernardini B, Corsini C, Boffelli S, Filippi A, Delpin K, Faraci B, Bertoletti E, Vannucci M, Crippa P, Malighetti A, Caltagirone C, DiSant S, Bettini D, Maltese F, Formilan M, Abruzzese G, Minaglia C, Cosimo D, Azzini M, Cazzadori M, Colombo M, Procino G, Fascendini S, Barocco F, Del P, D’Amico F, Grippa A, Mazzone A, Cottino M, Vezzadini G, Avanzi S, Brambilla C, Orini S, Sgrilli F, Mello A, Lombardi Muti LE, Dijk B, Fenu S, Pes C, Gareri P, Castagna A, Passamonte M, Rigo R, Locusta L, Caser L, Rosso G, Cesarini S, Cozzi R, Santini C, Carbone P, Cazzaniga I, Lovati R, Cantoni A, Ranzani P, Barra D, Pompilio G, Dimori S, Cernesi S, Riccò C, Piazzolla F, Capittini E, Rota C, Gottardi F, Merla L, Barelli A, Millul A, De G, Morrone G, Bigolari M, Minaglia C, Macchi M, Zambon F, D’Amico F, D’Amico F, Pizzorni C, DiCasaleto G, Menculini G, Marcacci M, Catanese G, Sprini D, DiCasalet T, Bocci M, Borga S, Caironi P, Cat C, Cingolani E, Avalli L, Greco G, Citerio G, Gandini L, Cornara G, Lerda R, Brazzi L, Simeone F, Caciorgna M, Alampi D, Francesconi S, Beck E, Antonini B, Vettoretto K, Meggiolaro M, Garofalo E, Bruni A, Notaro S, Varutti R, Bassi F, Mistraletti G, Marino A, Rona R, Rondelli E, Riva I, Cortegiani A, Pistidda L, D’Andrea R, Querci L, Gnesin P, Todeschini M, Lugano M, Castelli G, Ortolani M, Cotoia A, Maggiore S, DiTizio L, Graziani R, Testa I, Ferretti E, Castioni C, Lombardi F, Caserta R, Pasqua M, Simoncini S, Baccarini F, Rispoli M, Grossi F, Cancelliere L, Carnelli M, Puccini F, Biancofiore G, Siniscalchi A, Laici C, Mossello E, Torrini M, Pasetti G, Palmese S, Oggioni R, Mangani V, Pini S, Martelli M, Rigo E, Zuccalà F, Cherri A, Spina R, Calamai I, Petrucci N, Caicedo A, Ferri F, Gritti P, Brienza N, Fonnesu R, Dessena M, Fullin G, Saggioro D. Prevalence and features of delirium in older patients admitted to rehabilitation facilities: a multicenter study. Aging Clin Exp Res 2022; 34:1827-1835. [PMID: 35396698 DOI: 10.1007/s40520-022-02099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/16/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delirium is thought to be common across various settings of care; however, still little research has been conducted in rehabilitation. AIM We investigated the prevalence of delirium, its features and motor subtypes in older patients admitted to rehabilitation facilities during the three editions of the "Delirium Day project". METHODS We conducted a cross-sectional study in which 1237 older patients (age ≥ 65 years old) admitted to 50 Italian rehabilitation wards during the three editions of the "Delirium Day project" (2015 to 2017) were included. Delirium was evaluated through the 4AT and its motor subtype with the Delirium Motor Subtype Scale. RESULTS Delirium was detected in 226 patients (18%), and the most recurrent motor subtype was mixed (37%), followed by hypoactive (26%), hyperactive (21%) and non-motor one (16%). In a multivariate Poisson regression model with robust variance, factors associated with delirium were: disability in basic (PR 1.48, 95%CI: 1.17-1.9, p value 0.001) and instrumental activities of daily living (PR 1.58, 95%CI: 1.08-2.32, p value 0.018), dementia (PR 2.10, 95%CI: 1.62-2.73, p value < 0.0001), typical antipsychotics (PR 1.47, 95%CI: 1.10-1.95, p value 0.008), antidepressants other than selective serotonin reuptake inhibitors (PR 1.3, 95%CI: 1.02-1.66, p value 0.035), and physical restraints (PR 2.37, 95%CI: 1.68-3.36, p value < 0.0001). CONCLUSION This multicenter study reports that 2 out 10 patients admitted to rehabilitations had delirium on the index day. Mixed delirium was the most prevalent subtype. Delirium was associated with unmodifiable (dementia, disability) and modifiable (physical restraints, medications) factors. Identification of these factors should prompt specific interventions aimed to prevent or mitigate delirium.
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Readmission, healthcare consumption, and mortality in Clostridioides difficile infection hospitalizations: a nationwide cohort study. Int J Colorectal Dis 2021; 36:2629-2635. [PMID: 34363511 DOI: 10.1007/s00384-021-04001-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Despite being the most common healthcare-related infection in the US, nationwide data on readmission, healthcare consumption, and mortality in Clostridioides difficile infection (CDI) remain limited. We examined these outcomes in a US-based cohort of patients with CDI. METHODS We queried the 2017 Nationwide Readmission Database using ICD-10-CM codes to identify all adult patients admitted with a principal diagnosis of CDI. Primary outcomes were 30- and 90-day readmission rates. Secondary outcomes included mortality rates and healthcare consumption. RESULTS Of the 83,865 patients discharged from an index hospitalization for CDI, 22.37% were readmitted within 30 days, and an additional 15.01% were readmitted within 90 days. Recurrent CDI was responsible for more than 30% of readmissions at both 30 and 90 days. Compared to the index hospitalization, readmissions were characterized by higher mortality (1.41% index vs. 4.86% 30-day vs. 4.40% 90-day) and increased hospital length of stay and charges. Medicaid insurance (HR 1.16), cirrhosis (HR 1.31), Type 1 diabetes mellitus (HR 1.38), and end-stage renal disease (HR 1.36) were independently associated with 30-day readmission (all p < 0.01), with similar findings in 90-day readmissions. CONCLUSIONS In a large cohort of patients hospitalized for CDI, we found that approximately 1 in 5 were readmitted within 30-days, and more than 1 in 3 within 90-days. Readmission was characterized by increased mortality and greater healthcare consumption. Additionally, we found independent associations for readmission that may help identify patients at high-risk. Prospective investigation is needed to identify means to reduce the healthcare consumption and mortality in CDI.
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Lo YT, Liao JCH, Chen MH, Chang CM, Li CT. Predictive modeling for 14-day unplanned hospital readmission risk by using machine learning algorithms. BMC Med Inform Decis Mak 2021; 21:288. [PMID: 34670553 PMCID: PMC8527795 DOI: 10.1186/s12911-021-01639-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early unplanned hospital readmissions are associated with increased harm to patients, increased medical costs, and negative hospital reputation. With the identification of at-risk patients, a crucial step toward improving care, appropriate interventions can be adopted to prevent readmission. This study aimed to build machine learning models to predict 14-day unplanned readmissions. METHODS We conducted a retrospective cohort study on 37,091 consecutive hospitalized adult patients with 55,933 discharges between September 1, 2018, and August 31, 2019, in an 1193-bed university hospital. Patients who were aged < 20 years, were admitted for cancer-related treatment, participated in clinical trial, were discharged against medical advice, died during admission, or lived abroad were excluded. Predictors for analysis included 7 categories of variables extracted from hospital's medical record dataset. In total, four machine learning algorithms, namely logistic regression, random forest, extreme gradient boosting, and categorical boosting, were used to build classifiers for prediction. The performance of prediction models for 14-day unplanned readmission risk was evaluated using precision, recall, F1-score, area under the receiver operating characteristic curve (AUROC), and area under the precision-recall curve (AUPRC). RESULTS In total, 24,722 patients were included for the analysis. The mean age of the cohort was 57.34 ± 18.13 years. The 14-day unplanned readmission rate was 1.22%. Among the 4 machine learning algorithms selected, Catboost had the best average performance in fivefold cross-validation (precision: 0.9377, recall: 0.5333, F1-score: 0.6780, AUROC: 0.9903, and AUPRC: 0.7515). After incorporating 21 most influential features in the Catboost model, its performance improved (precision: 0.9470, recall: 0.5600, F1-score: 0.7010, AUROC: 0.9909, and AUPRC: 0.7711). CONCLUSIONS Our models reliably predicted 14-day unplanned readmissions and were explainable. They can be used to identify patients with a high risk of unplanned readmission based on influential features, particularly features related to diagnoses. The operation of the models with physiological indicators also corresponded to clinical experience and literature. Identifying patients at high risk with these models can enable early discharge planning and transitional care to prevent readmissions. Further studies should include additional features that may enable further sensitivity in identifying patients at a risk of early unplanned readmissions.
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Affiliation(s)
- Yu-Tai Lo
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan (R.O.C.)
| | - Jay Chie-Hen Liao
- Institute of Data Science, National Cheng Kung University, No. 1, University Road, Tainan City 701, Taiwan (R.O.C.)
| | - Mei-Hua Chen
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan (R.O.C.)
| | - Chia-Ming Chang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan (R.O.C.).,Department of Medicine and Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan (R.O.C.)
| | - Cheng-Te Li
- Institute of Data Science, National Cheng Kung University, No. 1, University Road, Tainan City 701, Taiwan (R.O.C.).
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Factors associated with early 14-day unplanned hospital readmission: a matched case-control study. BMC Health Serv Res 2021; 21:870. [PMID: 34433448 PMCID: PMC8390214 DOI: 10.1186/s12913-021-06902-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background/Purpose Early unplanned hospital readmissions are burdensome health care events and indicate low care quality. Identifying at-risk patients enables timely intervention. This study identified predictors for 14-day unplanned readmission. Methods We conducted a retrospective, matched, case–control study between September 1, 2018, and August 31, 2019, in an 1193-bed university hospital. Adult patients aged ≥ 20 years and readmitted for the same or related diagnosis within 14 days of discharge after initial admission (index admission) were included as cases. Cases were 1:1 matched for the disease-related group at index admission, age, and discharge date to controls. Variables were extracted from the hospital’s electronic health records. Results In total, 300 cases and 300 controls were analyzed. Six factors were independently associated with unplanned readmission within 14 days: previous admissions within 6 months (OR = 3.09; 95 % CI = 1.79–5.34, p < 0.001), number of diagnoses in the past year (OR = 1.07; 95 % CI = 1.01–1.13, p = 0.019), Malnutrition Universal Screening Tool score (OR = 1.46; 95 % CI = 1.04–2.05, p = 0.03), systolic blood pressure (OR = 0.98; 95 % CI = 0.97–0.99, p = 0.01) and ear temperature within 24 h before discharge (OR = 2.49; 95 % CI = 1.34–4.64, p = 0.004), and discharge with a nasogastric tube (OR = 0.13; 95 % CI = 0.03–0.60, p = 0.009). Conclusions Factors presented at admission (frequent prior hospitalizations, multimorbidity, and malnutrition) along with factors presented at discharge (clinical instability and the absence of a nasogastric tube) were associated with increased risk of early 14-day unplanned readmission.
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Ordak M, Nasierowski T, Muszynska E, Bujalska-Zadrozny M. Increasing the Effectiveness of Pharmacotherapy in Psychiatry by Using a Pharmacological Interaction Database. J Clin Med 2021; 10:jcm10102185. [PMID: 34070064 PMCID: PMC8158110 DOI: 10.3390/jcm10102185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 12/27/2022] Open
Abstract
Recent studies have shown that the knowledge of pharmacological interaction databases in global psychiatry is negligible. The frequency of hospitalizations in the case of patients taking new psychoactive substances along with other drugs continues to increase, very often resulting in the need for polypharmacotherapy. The aim of our research was to make members of the worldwide psychiatric community aware of the need to use a pharmacological interaction database in their daily work. The study involved 2146 psychiatrists from around the world. Participants were primarily contacted through the LinkedIn Recruiter website. The surveyed psychiatrists answered 5 questions concerning case reports of patients taking new psychoactive substances along with other drugs. The questions were answered twice, i.e., before and after using the Medscape drug interaction database. The mean percentage of correct answers given by the group of psychiatrists who were studied separately in six individual continents turned out to be statistically significantly higher after using the pharmacological interaction database (p < 0.001). This also applies to providing correct answers separately, i.e., to each of the five questions asked concerning individual case reports (p < 0.001). Before using the drug interaction database, only 14.1% of psychiatrists stated that they knew and used this type of database (p < 0.001). In the second stage of the study, a statistically significant majority of subjects stated that they were interested in using the pharmacological interaction database from that moment on (p < 0.001) and expressed the opinion that it could be effective in everyday work (p < 0.001). Using a pharmacological interaction database in psychiatry can contribute to the effectiveness of pharmacotherapy.
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Affiliation(s)
- Michal Ordak
- Department of Pharmacodynamics, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, 02-091 Warsaw, Poland;
- Correspondence:
| | - Tadeusz Nasierowski
- Department of Psychiatry, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Elzbieta Muszynska
- Department of Medical Biology, Medical University of Bialystok, 15-089 Bialystok, Poland;
| | - Magdalena Bujalska-Zadrozny
- Department of Pharmacodynamics, Centre for Preclinical Research and Technology (CePT), Medical University of Warsaw, 02-091 Warsaw, Poland;
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Tham HY, Lim WH, Jain SR, Mg CH, Lin SY, Xiao JL, Foo FJ, Wong KY, Chong CS. Is colonic lavage a suitable alternative for left-sided colonic emergencies? World J Gastrointest Surg 2021; 13:379-391. [PMID: 33968304 PMCID: PMC8069066 DOI: 10.4240/wjgs.v13.i4.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/16/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The use of intra-operative colonic lavage (IOCL) with primary anastomosis remains controversial in the emergency left-sided large bowel pathologies, with alternatives including Hartmann’s procedure, manual decompression and subtotal colectomy.
AIM To compare the peri-operative outcomes of IOCL to other procedures.
METHODS Electronic databases were searched for articles employing IOCL from inception till July 13, 2020. Odds ratio and weighted mean differences (WMD) were estimated for dichotomous and continuous outcomes respectively. Single-arm meta-analysis was conducted using DerSimonian and Laird random effects.
RESULTS Of 28 studies were included in this meta-analysis, involving 1142 undergoing IOCL, and 634 other interventions. IOCL leads to comparable rates of wound infection when compared to Hartmann’s procedure, and anastomotic leak and wound infection when compared to manual decompression. There was a decreased length of hospital stay (WMD = -7.750; 95%CI: -13.504 to -1.996; P = 0.008) compared to manual decompression and an increased operating time. Single-arm meta-analysis found that overall mortality rates with IOCL was 4% (CI: 0.03-0.05). Rates of anastomotic leak and wound infection were 3% (CI: 0.02-0.04) and 12% (CI: 0.09-0.16) respectively.
CONCLUSION IOCL leads to similar rates of post-operative complications compared to other procedures. More extensive studies are needed to assess the outcomes of IOCL for emergency left-sided colonic surgeries.
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Affiliation(s)
- Hui Yu Tham
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore 11759, Singapore
| | - Wen Hui Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 11759, Singapore
| | - Sneha Rajiv Jain
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 11759, Singapore
| | - Cheng Han Mg
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 11759, Singapore
| | - Snow Yunni Lin
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 11759, Singapore
| | - Jie Ling Xiao
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 11759, Singapore
| | - Fung Joon Foo
- Department of Colorectal Surgery, Singapore General Hospital, Singapore 169608, Singapore
- Department of General Surgery, Sengkang Health, Singapore 544886, Singapore
| | - Kar Yong Wong
- Colorectal Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Choon Seng Chong
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore 119228, Singapore
- Department of General Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore
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Stenholt POO, Abdullah SMOB, Sørensen RH, Nielsen FE. Independent predictors for 90-day readmission of emergency department patients admitted with sepsis: a prospective cohort study. BMC Infect Dis 2021; 21:315. [PMID: 33794801 PMCID: PMC8017866 DOI: 10.1186/s12879-021-06007-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 03/22/2021] [Indexed: 12/28/2022] Open
Abstract
Background The primary objective of our study was to examine predictors for readmission in a prospective cohort of sepsis patients admitted to an emergency department (ED) and identified by the new Sepsis-3 criteria. Method A single-center observational population-based cohort study among all adult (≥18 years) patients with sepsis admitted to the emergency department of Slagelse Hospital during 1.10.2017–31.03.2018. Sepsis was defined as an increase in the sequential organ failure assessment (SOFA) score of ≥2. The primary outcome was 90-day readmission. We followed patients from the date of discharge from the index admission until the end of the follow-up period or until the time of readmission to hospital, emigration or death, whichever came first. We used competing-risks regression to estimate adjusted subhazard ratios (aSHRs) with 95% confidence intervals (CI) for covariates in the regression models. Results A total of 2110 patients were admitted with infections, whereas 714 (33.8%) suffered sepsis. A total of 52 patients had died during admission and were excluded leaving 662 patients (44.1% female) with a median age of 74.8 (interquartile range: 66.0–84.2) years for further analysis. A total of 237 (35,8%; 95% CI 32.1–39.6) patients were readmitted within 90 days, and 54(8.2%) had died after discharge without being readmitted. We found that a history of malignant disease (aSHR 1,61; 1.16–2.23), if previously admitted with sepsis within 1 year before the index admission (aSHR; 1.41; 1.08–1.84), and treatment with diuretics (aSHR 1.51; 1.17–1.94) were independent predictors for readmission. aSHR (1.49, 1.13–1.96) for diuretic treatment was almost unchanged after exclusion of patients with heart failure, while aSHR (1.47, 0.96–2.25) for malignant disease was slightly attenuated after exclusion of patients with metastatic tumors. Conclusions More than one third of patients admitted with sepsis, and discharged alive, were readmitted within 90 days. A history of malignant disease, if previously admitted with sepsis, and diuretic treatment were independent predictors for 90-day readmission.
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Affiliation(s)
- Peer Oscar Overgaard Stenholt
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Ebba Lunds Vej 40A, Entrance 67, 2400 NV, Copenhagen, Denmark.
| | | | - Rune Husås Sørensen
- Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark.,Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Finn Erland Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Ebba Lunds Vej 40A, Entrance 67, 2400 NV, Copenhagen, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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22
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Settanni F, Ponzetto F, Veronesi A, Nonnato A, Martinelli F, Rumbolo F, Fimognari M, Martinasso G, Mengozzi G. Total Value of Ownership and Overall Equipment Effectiveness analysis to evaluate the impact of automation on time and costs of therapeutic drug monitoring. Anal Chim Acta 2021; 1160:338455. [PMID: 33894968 DOI: 10.1016/j.aca.2021.338455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Total Value of Ownership (TVO) and Overall Equipment Effectiveness (OEE) analysis are novel tools capable of monitoring and analyzing industrial processes by assessing the efficiency of the entire instrumental equipment and calculating instrument capacity utilization. Such integrated analysis, measuring quality indicators of the testing process, could also provide new perspectives and methodologies for the workflow organization of clinical laboratories. In this study, TVO and OEE were employed for the evaluation of two different configurations of a therapeutic drug monitoring sector, comparing the results obtained for immunosuppressant (ISD) and anti-epileptic drugs (AED) analysis as well as checking their quantitative performance in terms of limit of quantification, accuracy and precision. TVO analysis was performed for ISDs, including the Total Direct Labor Time, Total Cycle Time and Turnaround Time as well as cost of testing. Instruments' performance and workload were assessed using OEE indicator, studying Availability, Performance and Quality factors. Total Cycle Time for a batch was 3.55 h, decreasing of 1.5 h in the new setting where personnel are engaged for 0.98 h, 25% of total testing time. The calculated cost per sample was 6.60 euro. Availability values were significantly higher for automated sample-handling system and ISDs analysis by LC-MS. Higher Performance values were obtained for LC-MS system for AED and other TDM. Quality values were >0.94 for all instruments. TVO and OEE proved to be applicable to clinical laboratory environment, quantifying benefits and costs of newly developed semi-automated therapeutic drug monitoring sector. This novel approach based on an integrated analysis may help activity planning and quality improvement and could be used in the future for benchmarking progress as a product/process comparison tool in other laboratory fields.
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Affiliation(s)
- Fabio Settanni
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - Federico Ponzetto
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy.
| | - Agnese Veronesi
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - Antonello Nonnato
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - Francesco Martinelli
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - Francesca Rumbolo
- Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, City of Health and Science University Hospital, University of Turin, Turin, Italy
| | - Maurizio Fimognari
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - Giovanna Martinasso
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
| | - Giulio Mengozzi
- Clinical Biochemistry Laboratory, City of Health and Science University Hospital, Turin, Italy
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Wan CS, Reijnierse EM, Maier AB. Risk Factors of Readmissions in Geriatric Rehabilitation Patients: RESORT. Arch Phys Med Rehabil 2021; 102:1524-1532. [PMID: 33607077 DOI: 10.1016/j.apmr.2021.01.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the risk factors associated with 30- and 90-day hospital readmissions in geriatric rehabilitation inpatients. DESIGN Observational, prospective longitudinal inception cohort. SETTING Tertiary hospital in Victoria, Australia. PARTICIPANTS Geriatric rehabilitation inpatients of the REStORing Health of Acutely Unwell AdulTs (RESORT) cohort evalutated by a comprehensive geriatric assessment including potential readmission risk factors (ie, demographic, social support, lifestyle, functional performance, quality of life, morbidity, length of stay in an acute ward). Of 693 inpatients, 11 died during geriatric rehabilitation. The mean age of the remaining 682 inpatients was 82.2±7.8 years, and 56.7% were women. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Thirty- and 90-day readmissions after discharge from geriatric inpatient rehabilitation. RESULTS The 30- and 90-day unplanned all-cause readmission rates were 11.6% and 25.2%, respectively. Risk factors for 30- and 90-day readmissions were as follows: did not receive tertiary education, lower quality of life, higher Charlson Comorbidity Index and Cumulative Illness Rating Scale (CIRS) scores, and a higher number of medications used in the univariable models. Formal care was associated with increased risk for 90-day readmissions. In multivariable models, CIRS score was a significant risk factor for 30-day readmissions, whereas high fear of falling and CIRS score were significant risk factors for 90-day readmissions. CONCLUSIONS High fear of falling and CIRS score were independent risk factors for readmission in geriatric rehabilitation inpatients. These variables should be included in hospital readmission risk prediction model developments for geriatric rehabilitation inpatients.
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Affiliation(s)
- Ching S Wan
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Esmee M Reijnierse
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia; Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands; Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Centre for Healthy Longevity, @AgeSingapore, National University Health System, Singapore.
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24
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Lopez Pineda A, Pourshafeie A, Ioannidis A, Leibold CM, Chan AL, Bustamante CD, Frankovich J, Wojcik GL. Discovering prescription patterns in pediatric acute-onset neuropsychiatric syndrome patients. J Biomed Inform 2020; 113:103664. [PMID: 33359113 DOI: 10.1016/j.jbi.2020.103664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/28/2020] [Accepted: 12/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Pediatric acute-onset neuropsychiatric syndrome (PANS) is a complex neuropsychiatric syndrome characterized by an abrupt onset of obsessive-compulsive symptoms and/or severe eating restrictions, along with at least two concomitant debilitating cognitive, behavioral, or neurological symptoms. A wide range of pharmacological interventions along with behavioral and environmental modifications, and psychotherapies have been adopted to treat symptoms and underlying etiologies. Our goal was to develop a data-driven approach to identify treatment patterns in this cohort. MATERIALS AND METHODS In this cohort study, we extracted medical prescription histories from electronic health records. We developed a modified dynamic programming approach to perform global alignment of those medication histories. Our approach is unique since it considers time gaps in prescription patterns as part of the similarity strategy. RESULTS This study included 43 consecutive new-onset pre-pubertal patients who had at least 3 clinic visits. Our algorithm identified six clusters with distinct medication usage history which may represent clinician's practice of treating PANS of different severities and etiologies i.e., two most severe groups requiring high dose intravenous steroids; two arthritic or inflammatory groups requiring prolonged nonsteroidal anti-inflammatory drug (NSAID); and two mild relapsing/remitting group treated with a short course of NSAID. The psychometric scores as outcomes in each cluster generally improved within the first two years. DISCUSSION AND CONCLUSION Our algorithm shows potential to improve our knowledge of treatment patterns in the PANS cohort, while helping clinicians understand how patients respond to a combination of drugs.
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Affiliation(s)
- Arturo Lopez Pineda
- Department of Biomedical Data Science, Stanford University, CA, USA; Department of Data Science, Amphora Health, Morelia, Mexico
| | - Armin Pourshafeie
- Department of Biomedical Data Science, Stanford University, CA, USA; Department of Physics, Stanford University, CA, USA
| | | | - Collin McCloskey Leibold
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University, CA, USA; Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Avis L Chan
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University, CA, USA
| | - Carlos D Bustamante
- Department of Biomedical Data Science, Stanford University, CA, USA; Department of Genetics, Stanford University, CA, USA; Chan Zuckerberg Biohub, San Francisco, CA, USA.
| | - Jennifer Frankovich
- Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Stanford University, CA, USA.
| | - Genevieve L Wojcik
- Department of Biomedical Data Science, Stanford University, CA, USA; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
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Eyigor S, Kutsal YG, Toraman F, Durmus B, Gokkaya KO, Aydeniz A, Paker N, Borman P. Polypharmacy, Physical and Nutritional Status, and Depression in the Elderly: Do Polypharmacy Deserve Some Credits in These Problems? Exp Aging Res 2020; 47:79-91. [PMID: 33183169 DOI: 10.1080/0361073x.2020.1846949] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: To investigate the association of polypharmacy with physical function, nutritional status, and depression in the elderly. Method: The study included 675 people aged over 65 years from 8 centers in various geographical regions. The polypharmacy status was categorized as non-polypharmacy (0-4 drugs), polypharmacy (≥5 drugs). The subjects' physical function was assessed based on their "physical activity levels, Holden ambulation scores, gait speeds, and hand grip strengths"; their nutritional status based on the "Mini Nutritional Assessment (MNA)"; and their psychological status based on the "Center for Epidemiologic Studies Depression Scale -CES-D". Results: The presence of polypharmacy in this population was found to be 30% (n = 203). A statistically significant difference was found between the groups on the level of physical activity, Holden ambulation score, and nutrition status (p < .05). There was a statistically significant difference between the groups also on hand grip strength, MNA score, Charlson score (p < .05). Conclusion: Polypharmacy was observed to have a significant association with physical function, nutrition, and depression in the elderly aged ≥ 65 years.
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Affiliation(s)
- Sibel Eyigor
- Dept of Physical Medicine and Rehabilitation, Ege University Faculty of Medicine , Izmir, Turkey
| | - Yeşim Gökçe Kutsal
- Dept. of Physical Medicine and Rehabilitation, Hacettepe University Faculty of Medicine , Ankara, Turkey
| | - Fusun Toraman
- Dept of Physical Medicine and Rehabilitation, University of Health Sciences Antalya Education and Research Hospital , Antalya, Turkey
| | - Bekir Durmus
- Dept of Physical Therapy and Rehabilitation, Erenköy Education and Research Hospital Physical Therapy and Rehabilitation Clinic , Istanbul, Turkey
| | - Kutay Ordu Gokkaya
- Dept of Physical Therapy and Rehabilitation, Gaziler Physical Therapy and Rehabilitation Training and Research Hospital , Ankara, Turkey
| | - Ali Aydeniz
- Dept of Physical Medicine and Rehabilitation, Gaziantep University Faculty of Medicine , Gaziantep, Turkey
| | - Nurdan Paker
- Dept of Physical Therapy and Rehabilitation, Istanbul Physical Therapy and Rehabilitation Training and Research Hospital , İstanbul, Turkey
| | - Pinar Borman
- Dept. of Physical Medicine and Rehabilitation, Hacettepe University Faculty of Medicine , Ankara, Turkey
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Dipanda M, Barben J, Nuémi G, Vadot L, Nuss V, Vovelle J, Putot A, Manckoundia P. Changes in Treatment of Very Elderly Patients Six Weeks after Discharge from Geriatrics Department. Geriatrics (Basel) 2020; 5:geriatrics5030044. [PMID: 32751095 PMCID: PMC7555628 DOI: 10.3390/geriatrics5030044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022] Open
Abstract
We assessed the prescriptions of patients hospitalized in a geriatric unit and subsequently discharged. This prospective and observational study was conducted over a two-month period in the geriatrics department (acute and rehabilitation units) of a university hospital. Patients discharged from this department were included over a two-month period. Prescriptions were analyzed at admission and discharge from the geriatrics department (DGD), and six weeks after DGD. We included 209 patients, 63% female, aged 86.8 years. The mean number of medications prescribed was significantly higher at DGD than at admission (7.8 vs. 7.1, p = 0.003). During hospitalization, 1217 prescriptions were changed (average 5.8 medications/patient): 52.8% were initiations, 39.3% were discontinuations, and 7.9% were dose adjustments. A total of 156 of the 209 patients initially enrolled completed the study. Among these patients, 81 (51.9%) had the same prescriptions six weeks after DGD. In univariate analysis, medications were changed more frequently in patients with cognitive impairment (p = 0.04) and in patients for whom the hospital report did not indicate in-hospital modifications (p = 0.007). Multivariate analysis found that six weeks after DGD, there were significantly more drug changes for patients for whom there were changes in prescription during hospitalization (p < 0.001). A total of 169 medications were changed (mean number of medications changed per patient: 1.1): 52.7% discontinuations, 34.3% initiations, and 13% dosage modifications. The drug regimens were often changed during hospitalization in the geriatrics department, and a majority of these changes were maintained six weeks after DGD. Improvements in patient adherence and hospital-general practitioner communication are necessary to promote continuity of care and to optimize patient supervision after hospital discharge.
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Affiliation(s)
- Mélanie Dipanda
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
| | - Jérémy Barben
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
| | - Gilles Nuémi
- Department of Biostatistics and Bioinformatics, Dijon Bourgogne University Hospital, 21079 Dijon, France;
| | - Lucie Vadot
- Department of Pharmacy, Research and Vigilance, Dijon Bourgogne University Hospital, 21079 Dijon, France;
| | - Valentine Nuss
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
| | - Jérémie Vovelle
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
| | - Alain Putot
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
| | - Patrick Manckoundia
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
- INSERM U-1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy Franche-Comté, 21079 Dijon, France
- Correspondence: ; Tel.: +33-333-8029-3970; Fax: +33-333-8029-3621
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27
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Keim SK, Ratcliffe SJ, Naylor MD, Bowles KH. Patient Factors Linked with Return Acute Healthcare Use in Older Adults by Discharge Disposition. J Am Geriatr Soc 2020; 68:2279-2287. [PMID: 33267559 DOI: 10.1111/jgs.16645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 04/24/2020] [Accepted: 05/12/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Compare patient characteristics by hospital discharge disposition (home without services, home with home healthcare (HHC) services, or post-acute care (PAC) facilities). Examine timing and rates of 30-day healthcare utilization (rehospitalization, emergency department (ED) visit, or observation (OBS) visit) and patient characteristics associated with rehospitalization by discharge location. DESIGN Retrospective analysis of hospital administrative and clinical data. SETTING AND PARTICIPANTS A total of 3,294 older adult inpatients discharged home with or without HHC services or to a PAC facility. MEASUREMENTS Patient-level sociodemographic and clinical characteristics. Number of and time to occurrences of rehospitalization or ED/OBS visit within 30 days of hospital discharge. RESULTS Most rehospitalizations and ED/OBS visits occurred within 14 days from hospital discharge. Patients who returned within 24 hours came mostly from inpatient rehabilitation facilities (IRFs). More intense levels of PAC services were linked with higher rehospitalization risk. However, specific predictors differed by discharge location. Being unemployed, being single, and having more comorbidities were most associated with rehospitalization in those who went home with or without services, whereas patients rehospitalized from IRFs were younger, with less chronic illness burden, but greater and recent functional decline. Those discharged with HHC services had more return ED/OBS visits. CONCLUSIONS Although sicker patients were referred for more intense levels of PAC services, patients with greater chronic illness burden were still most often rehospitalized. In addition to unique patient differences, rehospitalizations from IRF within 24 hours suggest systems factors are contributory. Most return acute healthcare utilization occurred within 14 days; therefore, interventions should focus on smoothing transitions to all discharge locations. Because predictors of rehospitalization risk differed by discharge disposition, future research is necessary to study approaches aimed at matching patients' care needs with the most suitable PAC services at the right time. J Am Geriatr Soc 68:2279-2287, 2020.
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Affiliation(s)
- Susan K Keim
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah J Ratcliffe
- Division of Biostatistics, University of Virginia, Charlottesville, Virginia, USA
| | - Mary D Naylor
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathryn H Bowles
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Visiting Nurse Service of New York, New York, New York, USA
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Klinge M, Aasbrenn M, Öztürk B, Christiansen CF, Suetta C, Pressel E, Nielsen FE. Readmission of older acutely admitted medical patients after short-term admissions in Denmark: a nationwide cohort study. BMC Geriatr 2020; 20:203. [PMID: 32527311 PMCID: PMC7291666 DOI: 10.1186/s12877-020-01599-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background Knowledge of unplanned readmission rates and prognostic factors for readmission among older people after early discharge from emergency departments is sparse. The aims of this study were to examine the unplanned readmission rate among older patients after short-term admission, and to examine risk factors for readmission including demographic factors, comorbidity and admission diagnoses. Methods This cohort study included all medical patients aged ≥65 years acutely admitted to Danish hospitals between 1 January 2013 and 30 June 2014 and surviving a hospital stay of ≤24 h. Data on readmission within 30 days, comorbidity, demographic factors, discharge diagnoses and mortality were obtained from the Danish National Registry of Patients and the Danish Civil Registration System. We examined risk factors for readmission using a multivariable Cox regression to estimate adjusted hazard ratios (aHR) with 95% confidence intervals (CI) for readmission. Results A total of 93,306 patients with a median age of 75 years were acutely admitted and discharged within 24 h, and 18,958 (20.3%; 95% CI 20.1 - 20.6%) were readmitted with a median time to readmission of 8 days (IQR 3 - 16 days). The majority were readmitted with a new diagnosis. Male sex (aHR 1.15; 1.11 - 1.18) and a Charlson Comorbidity Index ≥3 (aHR 2.28; 2.20 - 2.37) were associated with an increased risk of readmission. Discharge diagnoses associated with increased risk of readmission were heart failure (aHR 1.26; 1.12 - 1.41), chronic obstructive pulmonary disease (aHR 1.33; 1.25 - 1.43), dehydration (aHR 1.28; 1.17 - 1.39), constipation (aHR 1.26; 1.14 - 1.39), anemia (aHR 1.45; 1.38 - 1.54), pneumonia (aHR 1.15; 1.06 - 1.25), urinary tract infection (aHR 1.15; 1.07 - 1.24), suspicion of malignancy (aHR 1.51; 1.37 - 1.66), fever (aHR 1.52; 1.33 - 1.73) and abdominal pain (aHR 1.12; 1.05 - 1.19). Conclusions One fifth of acutely admitted medical patients aged ≥65 were readmitted within 30 days after early discharge. Male gender, the burden of comorbidity and several primary discharge diagnoses were risk factors for readmission.
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Affiliation(s)
- M Klinge
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - M Aasbrenn
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - B Öztürk
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - C F Christiansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - C Suetta
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.,Geriatric Research Unit, Department of Medicine, Herlev-Gentofte Hospitals, Copenhagen, Denmark.,CopenAge - Copenhagen Center for Clinical Age Research, University of Copenhagen, Copenhagen, Denmark
| | - E Pressel
- Geriatric Research Unit, Department of Geriatrics, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - F E Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark. .,Department of Emergency Medicine, Slagelse Hospital, Bispebjerg and Frederiksberge, Denmark. .,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark.
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Shaw JA, Ali A, Qaiser R, Layman E, Fagan C, Schwartz O, Sima A, Hazelrigg M. Readmissions on Teaching Versus Non-Teaching Services: Are They Any Different? Cureus 2020; 12:e8529. [PMID: 32665876 PMCID: PMC7352802 DOI: 10.7759/cureus.8529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction There is a paucity of comparative data on readmissions between teaching services (TS) and nonteaching services (NTS). Therefore, we designed this study to determine if there are any differences in readmissions between the two services. Materials and methods A unique cohort of 384 readmissions during one year was retrospectively examined at Hunter Holmes McGuire Veterans Medical Center. The data on patient demographics, baseline characteristics, comorbid illnesses, length of stay (LOS), and reasons for readmission within 30 days were extracted. Results There were no differences in readmission rates (8.2% vs. 10.2%; P = .135), LOS during index admission (4.2 ± 4.8 vs. 4.1 ± 3.5; P = .712), and age-adjusted Charlson Comorbid Index Score (6.1 ± 3.0 vs. 6.8 ± 2.8; P = .037) between the TS and NTS groups. However, the reasons for readmissions between the two groups were statistically significantly different (P < .01). Specifically, these differences were found between system issues and new diagnoses. The NTS showed higher rates of readmissions secondary to new diagnoses and systems issues, whereas the TS showed higher rates of secondary to clinician issues and disease progression. Conclusions We have a new understanding of the difference in reasons for readmissions between TS and NTS; it possibly results from the different structures of the two teams, which may help us address readmissions in a different light to improve overall readmission rate.
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Affiliation(s)
- Jawaid A Shaw
- Internal Medicine, Virginia Commonwealth University, Richmond, USA
| | - Asghar Ali
- Internal Medicine/Hospital Medicine, Hunter Holmes McGuire VA Medical Center/Virginia Commonwealth University, Richmond, USA
| | - Rabia Qaiser
- Internal Medicine/Hospital Medicine, Hunter Holmes McGuire VA Medical Center/Virginia Commonwealth University, Richmond, USA
| | - Erynn Layman
- Internal Medicine/Hospital Medicine, Hunter Holmes McGuire VA Medical Center/Virginia Commonwealth University, Richmond, USA
| | - Cynthia Fagan
- Internal Medicine, Hunter Holmes McGuire VA Medical Center, Richmond, USA
| | - Owen Schwartz
- Internal Medicine/Hospital Medicine, MedStar Washington Hospital Center, Washington, DC, USA
| | - Adam Sima
- Biostatistics, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Monica Hazelrigg
- Internal Medicine/Hospital Medicine, Hunter Holmes McGuire VA Medical Center/Virginia Commonwealth University, Richmond, USA
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Koch D, Kutz A, Haubitz S, Baechli C, Gregoriano C, Conca A, Volken T, Schuetz P, Mueller B. Association of functional status and hospital-acquired functional decline with 30-day outcomes in medical inpatients: A prospective cohort study. Appl Nurs Res 2020; 54:151274. [PMID: 32650896 DOI: 10.1016/j.apnr.2020.151274] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/20/2020] [Accepted: 04/29/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND There is growing evidence that patients with functional decline are at increased risk of readmission, mortality and institutionalization. Instruments to measure the status of self-care could provide important information for efficient care planning. The widely used Self Care Index serves as an indicator for the severity of nursing dependency. To date, no evidence is available on the association of the instrument with rehospitalization, mortality and institutionalization. OBJECTIVES To examine the association of functional status measures (Self Care Index on admission, at discharge and functional decline) with 30-day mortality, readmission and institutionalization in hospitalized non-surgical patients. DESIGN Prospective cohort study. PARTICIPANTS We included 4540 emergency medical patients at a single hospital in Switzerland. METHODS Primary outcome was 30-day mortality rate; secondary outcomes were 30-day readmission and institutionalization. We analyzed the association of the functional status with the binary endpoints using logistic regression models and C-statistics for discrimination. RESULTS All of the examined measures were significant predictors of overall 30-day mortality; Self Care Index on admission: adj. OR: 0.90 (95% CI: 0.87-0.92); Self Care Index at discharge: adj. OR: 0.86 (95% CI: 0.83-0.88); functional decline: adj. OR: 1.22 (95% CI: 1.14-1.31) and all Self Care Index single items. A combined model (functional status on admission and functional decline during hospitalization) showed a good accuracy with regard to the AUC: adj. AUC: 0.80 (95% CI: 0.74-0.86). CONCLUSIONS Several functional measures were associated with 30-day mortality. Self Care Index total score, five single items and a combined model showed the best performance.
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Affiliation(s)
- Daniel Koch
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland.
| | - Alexander Kutz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland; Department of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland
| | - Ciril Baechli
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Claudia Gregoriano
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Antoinette Conca
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Thomas Volken
- School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Philipp Schuetz
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Beat Mueller
- Division of General Internal and Emergency Medicine, University Department of Medicine, Kantonsspital Aarau, Aarau, Switzerland
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Rasu RS, Agbor-Bawa W, Rianon NJ. Greater Changes in Drug Burden Index (DBI) during Hospitalization and Increased 30-Day Readmission Rates among Older In-Hospital Fallers. Hosp Top 2020; 98:59-67. [PMID: 32543345 DOI: 10.1080/00185868.2020.1777916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A higher drug burden index (DBI) is known to be associated with pre-admission falls leading to hospitalization. We investigated whether a mean difference in DBI (ΔDBI) between the events of in-hospital falls and hospital admission was associated with 30-day readmission in 113 patients ≥50 years who fell during their hospital stays between 2007 and 2014. A greater ΔDBI (≥0.09) was positively associated with higher 30-day readmission rates (incident rate ratio: 2.02; 95% confidence interval: 1.49-2.74). An effort to keep DBI low may thus decrease 30-day readmissions for older in-hospital fallers.
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Affiliation(s)
- Rafia S Rasu
- aDepartment of Pharmacotherapy, System College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA
| | - Walter Agbor-Bawa
- aDepartment of Pharmacotherapy, System College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA
| | - Nahid J Rianon
- bDivision of Geriatric and Palliative Medicin, Department of Internal Medicine, UTHealth McGovern Medical School, Houston, TX, USA
- Department of Family Medicine, UT Health McGovern Medical School, Houston, TX, USA
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Predictors of hospital readmission among older adults with cancer. J Geriatr Oncol 2020; 11:1108-1114. [PMID: 32222347 DOI: 10.1016/j.jgo.2020.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/01/2020] [Accepted: 03/19/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Older adults with cancer are at higher risk for costly and potentially dangerous hospital readmissions. Identifying risk factors for readmission in this population is important for future prevention of readmission. MATERIALS AND METHODS Hospital discharges among patients ≥ 65 years with solid tumors on non-surgical services from 2006-2011 were reviewed in this matched case-control study. We abstracted patient/cancer characteristics; functional status; fall risk; chemotherapy line; comorbidities; laboratory values; discharge parameters; and miscellaneous information (Do Not Resuscitate Order, pain scores) from medical records. Conditional logistic regression was used for univariate and multivariable analysis. RESULTS This analysis included 184 case-patients readmitted within 30 days after discharge from the index admission and 184 sex- and age-matched control-patients discharged from index admission within three months of the cases with no readmission. Cases and controls had no differences in terms of primary cancer type, treatment, and index admission reason. Cases were more likely to have abnormal hemoglobin, albumin, sodium, and SGOT on discharge. Compared to those with ≤1 abnormal laboratory test, patients with 2 or more abnormal test results were 3 times more likely to be readmitted within 30 days. CONCLUSION This study demonstrated that older adults with cancer who had at least 2 abnormal laboratory results (hemoglobin, albumin, sodium, and SGOT) at discharge were 3 times more likely to be readmitted within 30 days compared to those with ≤1 abnormal results. These laboratory values may be predictive of the risk of readmission, and should be monitored before discharge to potentially prevent readmission.
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Street M, Dunning T, Bucknall T, Hutchinson AM, Rawson H, Hutchinson AF, Botti M, Duke MM, Mohebbi M, Considine J. Resuscitation status and characteristics and outcomes of patients transferred from subacute care to acute care hospitals: A multi-site prospective cohort study. J Clin Nurs 2020; 29:1302-1311. [PMID: 31793121 DOI: 10.1111/jocn.15125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To examine the relationship between resuscitation status and (i) patient characteristics; (ii) transfer characteristics; and (iii) patient outcomes following an emergency inter-hospital transfer from a subacute to an acute care hospital. BACKGROUND Patients who experience emergency inter-hospital transfers from subacute to acute care hospitals have high rates of acute care readmission (81%) and in-hospital mortality (15%). DESIGN This prospective, exploratory cohort study was a subanalysis of data from a larger case-time-control study in five Health Services in Victoria, Australia. There were 603 transfers in 557 patients between August 2015 and October 2016. The study was conducted in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guidelines. METHODS Data were extracted by medical record audit. Three resuscitation categories (full resuscitation; limitation of medical treatment (LOMT) orders; or not-for-cardiopulmonary resuscitation (CPR) orders) were compared using chi-square or Kruskal-Wallis tests. Stratified multivariable proportional hazard Cox regression models were used to account for health service clustering effect. FINDINGS Resuscitation status was 63.5% full resuscitation; 23.1% LOMT order; and 13.4% not-for-CPR. Compared to patients for full resuscitation, patients with not-for-CPR or LOMT orders were more likely to have rapid response team calls during acute care readmission or to die during hospitalisation. Patients who were not-for-CPR were less likely to be readmitted to acute care and more likely to return to subacute care. CONCLUSIONS Two-thirds of patients in subacute care who experienced an emergency inter-hospital transfer were for full resuscitation. Although the proportion of patients with LOMT and not-for-CPR orders increased after transfer, there were deficiencies in the documentation of resuscitation status and planning for clinical deterioration for subacute care patients. RELEVANCE TO CLINICAL PRACTICE As many subacute care patients experience clinical deterioration, patient preferences for care need to be discussed and documented early in the subacute care admission.
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Affiliation(s)
- Maryann Street
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Eastern Health Partnership, Deakin University, Geelong, Australia
| | - Trisha Dunning
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Barwon Health Partnership, Deakin University, Geelong, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Alfred Health Partnership, Deakin University, Geelong, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Monash Health Partnership, Deakin University, Geelong, Australia
| | - Helen Rawson
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Monash Health Partnership, Deakin University, Geelong, Australia
| | - Anastasia F Hutchinson
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Deakin University, Geelong, Australia
| | - Mari Botti
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Deakin University, Geelong, Australia
| | - Maxine M Duke
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research, Deakin University, Geelong, Australia
| | | | - Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research - Eastern Health Partnership, Deakin University, Geelong, Australia
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Soejono CH, Sutanto H. The functional status, rehospitalization, and hospital cost reduction in geriatric patients after the implementation of the universal health coverage program in the national referral hospital Indonesia. MEDICAL JOURNAL OF INDONESIA 2019. [DOI: 10.13181/mji.v28i4.3214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Universal health coverage program (UHCP) might implicate negatively toward geriatric care with its impact on higher cost. The evaluation had to be made, especially in functional status, rehospitalization, and cost-effectiveness.
METHODS Retrospective cohort study with historical control was done. Seventy two geriatric inpatients in the pre-UHCP group and 86 in the UHCP group were recruited from Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Subjects with geriatric syndromes admitted from July to December 2013 (pre-UHCP era) and January to June 2014 (UHCP era). Functional status changes, rehospitalization, and process indicators were observed. Cost reduction was calculated using the incremental cost-effectiveness ratio (ICER), whereby costs, functional status changes, and rehospitalization of both groups were used to identify the differences.
RESULTS Proportions of functional status increase were 35.3% and 34.8% in the pre- UHCP and UHCP groups, respectively (p = 1.00) and the decrease were 5.9% and 4.5% in the pre-UHCP and UHCP group, respectively (p = 1.00). Rehospitalization rates were 21.7% and 18.1% (p = 0.603) in the pre-UHCP and UHCP groups, respectively. Mean hospital expenses were between 17.1 million IDR (1,221 USD; 1 USD = 14,000 IDR) for the pre-UHCP group and 20.8 million IDR (1,486 USD) for the UHCP group. ICER showed that hospitalization cost was 3.7 million IDR (264 USD) higher to increase 1 activity of daily living score in the UHCP era. As for rehospitalization, the cost was 600,000 IDR (43 USD) less, with 3.6% smaller in readmission.
CONCLUSIONS There was no changes in patients’ functional status after the UHCP implementation. There was a reduction in rehospitalization with lower cost in the UHCP era.
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Komagamine J, Yabuki T, Kobayashi M. Association between potentially inappropriate medications at discharge and unplanned readmissions among hospitalised elderly patients at a single centre in Japan: a prospective observational study. BMJ Open 2019; 9:e032574. [PMID: 31699748 PMCID: PMC6858212 DOI: 10.1136/bmjopen-2019-032574] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To determine the prevalence of potentially inappropriate medication (PIM) use at admission and discharge among hospitalised elderly patients and evaluate the association between PIMs at discharge and unplanned readmission in Japan. DESIGN A prospective observational study conducted by using electronic medical records. PARTICIPANTS All consecutive patients aged 65 years or older who were admitted to the internal medicine ward were included. Patients who were electively admitted for diagnostic procedures were excluded. MAIN OUTCOME MEASURES The primary outcome was 30-day unplanned readmissions. The secondary outcome was the prevalence of any PIM use at admission and discharge. PIMs were defined based on the Beers Criteria. The association between any PIM use at discharge and the primary outcome was evaluated by using logistic regression. RESULTS Seven hundred thirty-nine eligible patients were included in this study. The median patient age was 82 years (IQR 74-88); 389 (52.6%) were women, and the median Charlson Comorbidity Index was 2 (IQR 0-3). The proportions of patients taking any PIMs at admission and discharge were 47.2% and 32.2%, respectively. Of all the patients, 39 (5.3%) were readmitted within 30 days after discharge for the index hospitalisation. The use of PIMs at discharge was not associated with an increased risk of 30-day readmission (OR 0.93; 95% CI 0.46 to 1.87). This result did not change after adjusting for patient age, sex, number of medications, duration of hospital stay and comorbidities (OR 0.78; 95% CI 0.36 to 1.66). CONCLUSION The prevalence of any PIM use at discharge was high among hospitalised elderly patients in a Japanese hospital. Although the use of PIMs at discharge was not associated with an increased risk of unplanned readmission, given a lack of power of this study due to a low event rate, further studies investigating this association are needed. TRIAL REGISTRATION NUMBER UMIN000027189.
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Affiliation(s)
- Junpei Komagamine
- Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
| | - Taku Yabuki
- Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
| | - Masaki Kobayashi
- Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Japan
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Functional Capacity but Not Early Uptake of Cardiac Rehabilitation Predicts Readmission in Patients With Metabolic Syndrome. J Cardiovasc Nurs 2019; 33:306-312. [PMID: 29303869 DOI: 10.1097/jcn.0000000000000454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Phase II cardiac rehabilitation reduces hospital readmissions and cardiovascular disease risk factors and improves functional capacity. Cardiovascular disease risk factors double with patients with metabolic syndrome, a population less likely to adhere to cardiac rehabilitation. PURPOSE The aim of this study was to determine relationships between cardiac rehabilitation uptake timing, demographic variables and functional capacity, and readmission in patients with metabolic syndrome. METHODS This retrospective, medical records study involved 353 patients with metabolic syndrome who subsequently received cardiac rehabilitation. Logistic regression was used to examine relationships between time from discharge to cardiac rehabilitation uptake and readmission. Unordered categorical factors were compared between readmission groups using Pearson χ tests. Multivariable logistic regression was used to identify predictors of readmission. RESULTS Patients readmitted within 30 and 90 days of hospitalization were more often women (P ≤ .018) and nonwhite (P ≤ .002) and had lower functional capacity (P < .001). In multivariable analysis, white race (odds ratio [OR], 0.50 [95% confidence interval (CI), 0.25-0.99]; P = .045) and higher functional capacity (OR, 0.80 [95% CI, 0.68-0.93]; P = .005) were protective against hospital readmission within the first 90 days. Race, sex, and functional capacity remained significant predictors of readmission at 1 year. In multivariable analysis, only race (OR, 0.41 [95% CI, 0.22-0.79]; P = .007) and functional capacity (OR, 0.83 [95% CI, 0.73-0.95]; P = .007) were significant. Early cardiac rehabilitation was not associated with readmission at any time point (P > .05). CONCLUSIONS Sex, race, and functional capacity were important predictors of readmission for metabolic syndrome, even when cardiac rehabilitation intake was delayed. Results raise questions about the unique traits of patients with metabolic syndrome and need for novel approaches to improve cardiac rehabilitation utilization and functional capacity in metabolic syndrome.
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Robinson R, Bhattarai M, Hudali T, Vogler C. Predictors of 30-day hospital readmission: The direct comparison of number of discharge medications to the HOSPITAL score and LACE index. Future Healthc J 2019; 6:209-214. [PMID: 31660528 DOI: 10.7861/fhj.2018-0039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Effective hospital readmission risk prediction tools exist, but do not identify actionable items that could be modified to reduce the risk of readmission. Polypharmacy has attracted attention as a potentially modifiable risk factor for readmission, showing promise in a retrospective study. Polypharmacy is a very complex issue, reflecting comorbidities and healthcare resource utilisation patterns. This investigation compares the predictive ability of polypharmacy alone to the validated HOSPITAL score and LACE index readmission risk assessment tools for all adult admissions to an academic hospitalist service at a moderate sized university-affiliated hospital in the American Midwest over a 2-year period. These results indicate that the number of discharge medications alone is not a useful tool in identifying patients at high risk of hospital readmission within 30 days of discharge. Further research is needed to explore the impact of polypharmacy as a risk predictor for hospital readmission.
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Affiliation(s)
- Robert Robinson
- Southern Illinois University School of Medicine, Springfield, USA
| | - Mukul Bhattarai
- Southern Illinois University School of Medicine, Springfield, USA
| | - Tamer Hudali
- University of Alabama at Birmingham, Birmingham, USA
| | - Carrie Vogler
- Southern Illinois University Edwardsville School of Pharmacy, Edwardsville, USA and adjunct clinical assistant professor, Southern Illinois University School of Medicine, Springfield, USA
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Bao GC, Dillon J, Jannat-Khah D, Besada M, Marianova A, Mathewos A, Dargar S, Gerber LM, Tung J, Lee JI. Tai chi for enhanced inpatient mobilization: A feasibility study. Complement Ther Med 2019; 46:109-115. [PMID: 31519266 DOI: 10.1016/j.ctim.2019.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/13/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To determine whether utilizing beginner, video-guided tai chi and qigong classes as an adjunct to physical therapy to enhance mobilization among hospitalized patients is feasible and acceptable. DESIGN Single-arm feasibility study over a 15½-week period. SETTING Three medical-surgical units at one hospital. INTERVENTIONS Small-group video-guided beginner-level tai chi and qigong classes supervised by physical therapists occurred three times a week. MAIN OUTCOME MEASURES The primary outcome was weekly class attendance. Secondary outcomes included patient and staff satisfaction, collected by surveys and semi-structured interviews. Process measures included class duration. Balancing measures included falls. RESULTS One-hundred and fifty-seven patients were referred for recruitment, 45 gave informed consent, and 38 patients attended at least one class. The number of weekly class attendees increased during the study period. Based on first-class experience, 68% (26/38) of patients reported enjoying the class "quite a bit" or "extremely," 66% (25/38) of patients reported feeling "more mobile" afterward, and 76% (29/38) of patients agreed that the class made them more comfortable going home. Average class duration was 29 minutes. Zero falls occurred during or immediately following class. CONCLUSIONS Video-guided tai chi and qigong classes are feasible and well-received at our hospital. Future studies of the impact on preserving mobility and function or reducing length of stay are of interest.
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Affiliation(s)
| | | | | | - Melissa Besada
- NewYork-Presbyterian/Lower Manhattan Hospital, New York, NY, USA
| | | | - Ama Mathewos
- NewYork-Presbyterian/Lower Manhattan Hospital, New York, NY, USA
| | | | | | - Judy Tung
- Weill Cornell Medicine, New York, NY, USA
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Guedes RDC, Dias RC, Neri AL, Ferriolli E, Lourenço RA, Lustosa LP. Declínio da velocidade da marcha e desfechos de saúde em idosos: dados da Rede Fibra. FISIOTERAPIA E PESQUISA 2019. [DOI: 10.1590/1809-2950/18036026032019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO A velocidade da marcha (VM) tem sido considerada um marcador de saúde em idosos capaz de predizer desfechos adversos de saúde, mas a compreensão de fatores associados a ela ainda é limitada e controversa. O objetivo deste trabalho é identificar desfechos adversos de saúde relacionados ao declínio da velocidade de marcha em idosos comunitários. Trata-se de estudo transversal e multicêntrico, que avaliou o autorrelato de doenças crônicas e de hospitalização no último ano, polifarmácia e velocidade de marcha. Utilizou-se análise de regressão logística para estimar os efeitos de cada variável independente na chance de os idosos apresentarem declínio na velocidade de marcha inferior (VM<0,8m/s) (α=0,05). Participaram da pesquisa 5.501 idosos. A menor velocidade da marcha mostrou-se associada a portadores de doenças cardíacas (OR=2,06; IC: 1,67-2,54), respiratórias (OR=3,25; IC: 2,02-5,29), reumáticas (OR=2,16; IC: 1,79-2,52) e/ou depressão (OR=2,51; IC: 2,10-3,14), hospitalizados no último ano (OR=1,51; IC: 1,21-1,85) e polifarmácia (OR=2,14; IC: 1,80-2,54). Assim, os resultados indicaram que idosos com velocidade de marcha menor que 0,8m/s apresentam maior risco de eventos adversos de saúde. Dessa forma, sugere-se que a velocidade de marcha não seja negligenciada na avaliação de idosos comunitários, inclusive na atenção básica.
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Smith H, Miller K, Barnett N, Oboh L, Jones E, Darcy C, McKee H, Agnew J, Crawford P. Person-Centred Care Including Deprescribing for Older People. PHARMACY 2019; 7:E101. [PMID: 31349584 PMCID: PMC6789714 DOI: 10.3390/pharmacy7030101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 12/21/2022] Open
Abstract
There is concern internationally that many older people are using an inappropriate number of medicines, and that complex combinations of medicines may cause more harm than good. This article discusses how person-centred medicines optimisation for older people can be conducted in clinical practice, including the process of deprescribing. The evidence supports that if clinicians actively include people in decision making, it leads to better outcomes. We share techniques, frameworks, and tools that can be used to deprescribe safely whilst placing the person's views, values, and beliefs about their medicines at the heart of any deprescribing discussions. This includes the person-centred approach to deprescribing (seven steps), which incorporates the identification of the person's priorities and the clinician's priorities in relation to treatment with medication and promotes shared decision making, agreed goals, good communication, and follow up. The authors believe that delivering deprescribing consultations in this manner is effective, as the person is integral to the deprescribing decision-making process, and we illustrate how this approach can be applied in real-life case studies.
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Affiliation(s)
- Heather Smith
- Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK.
| | - Karen Miller
- South Eastern Health and Social Care Trust, Belfast BT16 1RH, UK
| | - Nina Barnett
- London North West University Healthcare NHS Trust, London, HA1 3UJ, UK
- Medicines Use and Safety Division, NHS Specialist Pharmacy Service, London, HA1 3UJ, UK
| | - Lelly Oboh
- Guys and St Thomas NHS Trust (Community Health Services), London SE1 7EH, UK
| | - Emyr Jones
- Cardiff and Vale University Health Board, Cardiff CF14 4XW, UK
| | - Carmel Darcy
- Western Health and Social Care Trust, Londonderry BT47 6SB, UK
| | - Hilary McKee
- Northern Health and Social Care Trust, Antrim BT41 2RL, UK
| | - Jayne Agnew
- Southern Health and Social Care Trust, Portadown BT63 5QQ, UK
| | - Paula Crawford
- Belfast Health and Social Care Trust, Belfast BT9 7AB, UK
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Considine J, Street M, Bucknall T, Rawson H, Hutchison AF, Dunning T, Botti M, Duke MM, Mohebbi M, Hutchinson AM. Characteristics and outcomes of emergency interhospital transfers from subacute to acute care for clinical deterioration. Int J Qual Health Care 2019; 31:117-124. [PMID: 29931281 DOI: 10.1093/intqhc/mzy135] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 05/03/2018] [Accepted: 05/24/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To describe characteristics and outcomes of emergency interhospital transfers from subacute to acute hospital care and develop an internally validated predictive model to identify features associated with high risk of emergency interhospital transfer. DESIGN Prospective case-time-control study. SETTING Acute and subacute healthcare facilities from five health services in Victoria, Australia. PARTICIPANTS Cases were patients with an emergency interhospital transfer from subacute to acute hospital care. For every case, two inpatients from the same subacute care ward on the same day of emergency transfer were randomly selected as controls. Admission episode was the unit of measurement and data were collected prospectively. MAIN OUTCOME MEASURES Patient and admission characteristics, transfer characteristics and outcomes (cases), serious adverse events and mortality. RESULTS Data were collected for 603 transfers in 557 patients and 1160 control patients. Cases were significantly more likely to be male, born in a non-English speaking country, have lower functional independence, more frequent vital sign assessments and experience a serious adverse event during first acute care or subacute care admissions. When adjusted for health service, cases had significantly higher inpatient mortality, were more likely to have unplanned intensive care unit admissions and rapid response team calls during their entire hospital admission. CONCLUSIONS Patients who require an emergency interhospital transfer from subacute to acute hospital care have hospital admission rates and in-hospital mortality. Clinical instability during the first acute care admission (serious adverse events or increased surveillance) may prompt reassessment of patient suitability for movement to a separate subacute care hospital.
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Affiliation(s)
- Julie Considine
- Deakin University, School of Nursing and Midwifery, Gheringhap St, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Arnold St, Box Hill, VIC, Australia
| | - Maryann Street
- Deakin University, School of Nursing and Midwifery, Gheringhap St, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Arnold St, Box Hill, VIC, Australia
| | - Tracey Bucknall
- Deakin University, School of Nursing and Midwifery, Gheringhap St, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research - Alfred Health Partnership, Commercial Rd, Melbourne, VIC, Australia
| | - Helen Rawson
- Deakin University, School of Nursing and Midwifery, Gheringhap St, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research - Monash Health Partnership, Clayton Rd, Clayton, VIC, Australia
| | - Anastasia F Hutchison
- Deakin University, School of Nursing and Midwifery, Gheringhap St, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Bridge Rd, Richmond, VIC, Australia
| | - Trisha Dunning
- Deakin University, School of Nursing and Midwifery, Gheringhap St, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research - Barwon Health Partnership, Bellerine St, Geelong, VIC, Australia
| | - Mari Botti
- Deakin University, School of Nursing and Midwifery, Gheringhap St, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Bridge Rd, Richmond, VIC, Australia
| | - Maxine M Duke
- Deakin University, School of Nursing and Midwifery, Gheringhap St, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research, Gheringhap St, Geelong, VIC, Australia
| | - Mohammadreza Mohebbi
- Faculty of Health Biostatistics Unit, Deakin University, Pigdons Rd, Geelong, VIC, Australia
| | - Alison M Hutchinson
- Deakin University, School of Nursing and Midwifery, Gheringhap St, Geelong, VIC, Australia.,Centre for Quality and Patient Safety Research - Monash Health Partnership, Clayton Rd, Clayton, VIC, Australia
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Vasilevskis EE, Shah AS, Hollingsworth EK, Shotwell MS, Mixon AS, Bell SP, Kripalani S, Schnelle JF, Simmons SF. A patient-centered deprescribing intervention for hospitalized older patients with polypharmacy: rationale and design of the Shed-MEDS randomized controlled trial. BMC Health Serv Res 2019; 19:165. [PMID: 30871561 PMCID: PMC6416929 DOI: 10.1186/s12913-019-3995-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 03/06/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Polypharmacy is prevalent among hospitalized older adults, particularly those being discharged to a post-care care facility (PAC). The aim of this randomized controlled trial is to determine if a patient-centered deprescribing intervention initiated in the hospital and continued in the PAC setting reduces the total number of medications among older patients. METHODS The Shed-MEDS study is a 5-year, randomized controlled clinical intervention trial comparing a patient-centered describing intervention with usual care among older (≥50 years) hospitalized patients discharged to PAC, either a skilled nursing facility (SNF) or an inpatient rehabilitation facility (IPR). Patient measurements occur at hospital enrollment, hospital discharge, within 7 days of PAC discharge, and at 60 and 90 days following PAC discharge. Patients are randomized in a permuted block fashion, with block sizes of two to four. The overall effectiveness of the intervention will be evaluated using total medication count as the primary outcome measure. We estimate that 576 patients will enroll in the study. Following attrition due to death or loss to follow-up, 420 patients will contribute measurements at 90 days, which provides 90% power to detect a 30% versus 25% reduction in total medications with an alpha error of 0.05. Secondary outcomes include the number of medications associated with geriatric syndromes, drug burden index, medication adherence, the prevalence and severity of geriatric syndromes and functional health status. DISCUSSION The Shed-MEDS trial aims to test the hypothesis that a patient-centered deprescribing intervention initiated in the hospital and continuing through the PAC stay will reduce the total number of medications 90 days following PAC discharge and result in improvements in geriatric syndromes and functional health status. The results of this trial will quantify the health outcomes associated with reducing medications for hospitalized older adults with polypharmacy who are discharged to post-acute care facilities. TRIAL REGISTRATION This trial was prospectively registered at clinicaltrials.gov ( NCT02979353 ). The trial was first registered on 12/1/2016, with an update on 09/28/17 and 10/12/2018.
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Affiliation(s)
- Eduard E. Vasilevskis
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN USA
- Vanderbilt University Medical Center, Section of Hospital Medicine, Nashville, TN USA
- Vanderbilt University Medical Center, Center for Clinical Quality and Implementation Research, Nashville, TN USA
| | - Avantika S. Shah
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
| | | | | | - Amanda S. Mixon
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN USA
- Vanderbilt University Medical Center, Section of Hospital Medicine, Nashville, TN USA
- Vanderbilt University Medical Center, Center for Clinical Quality and Implementation Research, Nashville, TN USA
| | - Susan P. Bell
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
- Division of Geriatrics, Vanderbilt University Medical Center, Nashville, TN USA
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN USA
| | - Sunil Kripalani
- Vanderbilt University Medical Center, Section of Hospital Medicine, Nashville, TN USA
- Vanderbilt University Medical Center, Center for Clinical Quality and Implementation Research, Nashville, TN USA
| | - John F. Schnelle
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
- Division of Geriatrics, Vanderbilt University Medical Center, Nashville, TN USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN USA
- Vanderbilt University Medical Center, Center for Clinical Quality and Implementation Research, Nashville, TN USA
| | - Sandra F. Simmons
- Vanderbilt University Medical Center, Center for Quality Aging, Nashville, TN USA
- Division of Geriatrics, Vanderbilt University Medical Center, Nashville, TN USA
- VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center, Nashville, TN USA
- Vanderbilt University Medical Center, Center for Clinical Quality and Implementation Research, Nashville, TN USA
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Sanchez-Rodriguez JR, Escare-Oviedo CA, Olivares VEC, Robles-Molina CR, Vergara-Martínez MI, Jara-Castillo CT. Polifarmacia en adulto mayor, impacto en su calidad de vida. Revision de literatura. Rev Salud Publica (Bogota) 2019; 21:271-277. [DOI: 10.15446/rsap.v21n2.76678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 02/26/2019] [Indexed: 01/14/2023] Open
Abstract
Objetivo Conocer mediante el análisis del estado del conocimiento, el impacto de polifarmacia en calidad de vida de adultos mayores y cuál ha sido el rol de enfermería frente a esta problemática de salud.Métodos Revisión descriptiva de 62 artículos originales de diversos diseños metodológicos, en bases de datos: EBSCO, PubMed, Web of Science, SciELO, Elsevier, SCOPUS y Dialnet.Resultados La polifarmacia en adultos mayores se presenta con mayor frecuencia en el sexo femenino, en personas con bajo nivel de escolaridad, sumados a factores socioeconómico. Un gran porcentaje de adultos mayores presenta efecto cascada en consumo de fármacos, por cantidad de medicamentos consumidos y número de médicos consultados, produciendo interacciones farmacológicas, afectando funcionalidad y calidad de vida.Conclusiones Es necesario mayor control de medicamentos consumidos por adultos mayores, para evitar efectos nocivos. Los profesionales de enfermería deben tener un rol educativo en este grupo etario, para disminuir polifarmacia e impulsar estilos de vida que fomenten el envejecimiento saludable.
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Improving Care Transitions for Hospitalized Veterans Discharged to Skilled Nursing Facilities: A Focus on Polypharmacy and Geriatric Syndromes. Geriatrics (Basel) 2019; 4:geriatrics4010019. [PMID: 31023987 PMCID: PMC6473365 DOI: 10.3390/geriatrics4010019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/31/2019] [Accepted: 02/05/2019] [Indexed: 11/17/2022] Open
Abstract
Geriatric syndromes and polypharmacy are common in older patients discharged to skilled nursing facilities (SNFs) and increase 30-day readmission risk. In a U.S.A. Department of Veterans Affairs (VA)-funded Quality Improvement study to improve care transitions from the VA hospital to area SNFs, Veterans (N = 134) were assessed for geriatric syndromes using standardized instruments as well as polypharmacy, defined as five or more medications. Warm handoffs were used to facilitate the transfer of this information. This paper describes the prevalence of geriatric syndromes, polypharmacy, and readmission rates. Veterans were prescribed an average of 14.7 medications at hospital discharge. Moreover, 75% of Veterans had more than two geriatric syndromes, some of which began during hospitalization. While this effort did not reduce 30-day readmissions, the high prevalence of geriatric syndromes and polypharmacy suggests that future efforts targeting these issues may be necessary to reduce readmissions among Veterans discharged to SNF.
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Arrighi-Allisan AE, Neifert SN, Gal JS, Deutsch BC, Caridi JM. Discharge Destination as a Predictor of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion. World Neurosurg 2019; 122:e139-e146. [DOI: 10.1016/j.wneu.2018.09.147] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 01/17/2023]
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Nursing home leaders' and nurses' experiences of resources, staffing and competence levels and the relation to hospital readmissions - a case study. BMC Health Serv Res 2018; 18:955. [PMID: 30541632 PMCID: PMC6292004 DOI: 10.1186/s12913-018-3769-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/26/2018] [Indexed: 11/24/2022] Open
Abstract
Background Thirty-day hospital readmissions represent an international challenge leading to increased prevalence of adverse events, reduced quality of care and pressure on healthcare service’s resources and finances. There is a need for a broader understanding of hospital readmissions, how they manifest, and how resources in the primary healthcare service may affect hospital readmissions. The aim of the study was to examine how nurses and nursing home leaders experienced the resource situation, staffing and competence level in municipal healthcare services, and if and how they experienced these factors to influence hospital readmissions. Method The study was conducted as a comparative case study of two municipalities affiliated with the same hospital, chosen for historical differences in readmission rates. Nurses and leaders from four nursing homes participated in focus groups and interviews. Data were analyzed within and across cases. Results The analysis resulted in four common themes, with some variation in each municipality, describing nurses’ and leaders’ experience of the nursing home resource situation, staffing level and competence and their perception of factors affecting hospital readmissions. The nursing home patients were described as becoming increasingly complex with a subsequent need for increased nurse competence. There was variation in competence and staffing between nursing homes, but capacity building was an overall focus. Economic limitations and attempts at saving through cost-cutting were present, but not perceived as affecting patient care and the availability of medical equipment. Several factors such as nurse competence and staffing, physician coverage, and adequate communication and documentation, were recognized as factors affecting hospital readmissions across the municipalities. Conclusion Several factors related to nurses’ and leaders’ experience of the resource situation, staffing and competence level were suggested to affect hospital readmissions and the municipalities were similar in their answers regarding these factors. Patients were perceived as more complex with higher patient mortality forcing long-term nursing homes to shift towards an acute care or palliative function, and short-term nursing homes to function as “small hospitals”, requiring higher nurse competence. Staffing, competence and physician coverage did not seem to have adjusted to the new patient group in some nursing homes. Electronic supplementary material The online version of this article (10.1186/s12913-018-3769-3) contains supplementary material, which is available to authorized users.
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Risk factors for hospital readmission among Swedish older adults. Eur Geriatr Med 2018; 9:603-611. [PMID: 30294396 PMCID: PMC6153697 DOI: 10.1007/s41999-018-0101-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/21/2018] [Indexed: 11/12/2022]
Abstract
Introduction Hospital readmissions of older persons are common and often associated with complex health problems. The objectives were to analyze risk factors for readmission within 30 days from hospital discharge. Methods A prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA) was conducted. During 9 years of follow-up, information on hospitalizations, readmissions and associated diagnoses were obtained from national registers. Logistic regression models controlling for age and sex were conducted to analyze risk factors for readmissions. Results Of the 772 participants, [mean age 69.7 (± 11.1), 84 (63%)] were hospitalized and among these 208 (43%) had one or several readmissions within 30 days during the follow-up period. Most of the readmissions (57%) occurred within the first week; mean days from hospital discharge to readmission was 7.9 (± 6.2). The most common causes of admission and readmission were cardiovascular diseases and tumors. Only 8% of the readmissions were regarded as avoidable admissions. In a multivariate logistic regression, falling within the last 12 months (OR 0.57, p = 0.039) and being a male (OR 1.84, p = 0.006) increased the risk of readmission. Conclusions Most older persons that are readmitted return to hospital within the first week after discharge. Experiencing a fall was a particular risk factor of readmission. Preventive actions should preferably take place already at the hospital to reduce the numbers of readmission. Still, it should be remembered that most readmissions were considered to be necessary.
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Petersen AW, Shah AS, Simmons SF, Shotwell MS, Jacobsen JML, Myers AP, Mixon AS, Bell SP, Kripalani S, Schnelle JF, Vasilevskis EE. Shed-MEDS: pilot of a patient-centered deprescribing framework reduces medications in hospitalized older adults being transferred to inpatient postacute care. Ther Adv Drug Saf 2018; 9:523-533. [PMID: 30181860 PMCID: PMC6116773 DOI: 10.1177/2042098618781524] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/07/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Polypharmacy is common in hospitalized older adults. Deprescribing interventions are not well described in the acute-care setting. The objective of this study was to describe a hospital-based, patient-centered deprescribing protocol (Shed-MEDS) and report pilot results. METHODS This was a pilot study set in one academic medical center in the United States. Participants consisted of a convenience sample of 40 Medicare-eligible, hospitalized patients with at least five prescribed medications. A deprescribing protocol (Shed-MEDS) was implemented among 20 intervention and 20 usual care control patients during their hospital stay. The primary outcome was the total number of medications deprescribed from hospital enrollment. Deprescribed was defined as medication termination or dose reduction. Enrollment medications reflected all prehospital medications and active in-hospital medications. Baseline characteristics and outcomes were compared between the intervention and usual care groups using simple logistic or linear regression for categorical and continuous measures, respectively. RESULTS There was no significant difference between groups in mean age, sex or Charlson comorbidity index. The intervention and control groups had a comparable number of medications at enrollment, 25.2 (±6.3) and 23.4 (±3.8), respectively. The number of prehospital medications in each group was 13.3 (±4.6) and 15.3 (±4.6), respectively. The Shed-MEDS protocol compared with usual care significantly increased the mean number of deprescribed medications at hospital discharge and reduced the total medication burden by 11.6 versus 9.1 (p = 0.032) medications. The deprescribing intervention was associated with a difference of 4.6 [95% confidence interval (CI) 2.5-6.7, p < 0.001] in deprescribed medications and a 0.5 point reduction (95% CI -0.01 to 1.1) in the drug burden index. CONCLUSIONS A hospital-based, patient-centered deprescribing intervention is feasible and may reduce the medication burden in older adults.
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Affiliation(s)
- Alec W. Petersen
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
| | - Avantika S. Shah
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
| | - Sandra F. Simmons
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Geriatrics, Vanderbilt University
Medical Center, Nashville, TN, USA
- Geriatric Research Education and Clinical
Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | | | | | - Amy P. Myers
- Pharmaceutical Services, Vanderbilt University
Medical Center, Nashville, TN, USA
| | - Amanda S. Mixon
- Geriatric Research Education and Clinical
Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
- Section of Hospital Medicine, Vanderbilt
University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation
Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Susan P. Bell
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Geriatrics, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Cardiovascular Medicine, Vanderbilt
University Medical Center, Nashville, TN, USA
| | - Sunil Kripalani
- Section of Hospital Medicine, Vanderbilt
University Medical Center, Nashville, TN, USA
- Center for Clinical Quality and Implementation
Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John F. Schnelle
- Center for Quality Aging, Vanderbilt University
Medical Center, Nashville, TN, USA
- Division of Geriatrics, Vanderbilt University
Medical Center, Nashville, TN, USA
- Geriatric Research Education and Clinical
Center, VA Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Eduard E. Vasilevskis
- Vanderbilt Center for Health Services Research,
Center for Quality Aging, Division of General Internal Medicine and Public
Health, Geriatric Research Education and Clinical Center, VA Tennessee
Valley, 2525 West End Ave, Suite 450, Nashville, TN 37203, USA
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Fabbietti P, Di Stefano G, Moresi R, Cassetta L, Di Rosa M, Fimognari F, Bambara V, Ruotolo G, Castagna A, Ruberto C, Lattanzio F, Corsonello A. Impact of potentially inappropriate medications and polypharmacy on 3-month readmission among older patients discharged from acute care hospital: a prospective study. Aging Clin Exp Res 2018; 30:977-984. [PMID: 29128999 DOI: 10.1007/s40520-017-0856-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 11/07/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Polypharmacy and potentially inappropriate medications (PIMs) are known to affect several negative outcomes in older patients. However, studies comparatively assessing polypharmacy and PIMs in relation to readmission are distinctively lacking. AIMS To compare the impact of polypharmacy and PIMs on 3-month readmission among older patients discharged from acute care hospital. METHODS Our series consisted of 647 patients consecutively enrolled in a multicenter observational study. The outcome of the study was the occurrence of any admission during the 3-month follow-up after discharge. Polypharmacy was defined as use of more than eight medications. PIMs were identified using 2015 version of Beers and Screening Tool of Older Persons Prescriptions (STOPP) criteria. Statistical analysis was performed using logistic regression models. RESULTS After adjusting for potential confounders, polypharmacy (OR 2.72, 95% CI 1.48-4.99) was found associated with the outcome, while Beers (OR 0.85, 95% CI 0.46-1.56), STOPP (OR 1.60, 95% CI 0.85-3.01), or combined Beers and STOPP violations (OR 0.99, 95% CI 0.57-1.74) were not. The association between polypharmacy and 3-month readmission was confirmed in logistic regression models including Beers (OR 2.88, 95% CI 1.55-5.34), STOPP (OR 2.64, 95% CI 1.43-4.87), or combined Beers and STOPP violations (OR 2.80, 95% CI 1.51-5.21). DISCUSSION Besides confirming that polypharmacy should be considered as a marker for readmission risk among older patients discharged from acute care hospital, our findings suggest that the association between polypharmacy and 3-month readmission is substantially independent of use of PIMs. CONCLUSIONS Polypharmacy, but not PIMs was significantly associated with readmission. Hospitalization should always be considered as a clue to individuate unnecessary polypharmacy and to reduce the burden of medications whenever possible.
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