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Balqis-Ali NZ, Jawahir S, Chan YM, Lim AWY, Azlan UW, Shaffie SSM, Fun WH, Lee SWH. The impact of long-term care interventions on healthcare utilisation among older persons: a scoping review of reviews. BMC Geriatr 2024; 24:484. [PMID: 38831269 PMCID: PMC11145838 DOI: 10.1186/s12877-024-05097-9] [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: 03/07/2024] [Accepted: 05/20/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND As the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons. METHODS A scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE. RESULTS Thirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91, p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81, p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95, p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76, p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality. CONCLUSION The findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care.
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Affiliation(s)
- Nur Zahirah Balqis-Ali
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Suhana Jawahir
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia.
| | - Yee Mang Chan
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Amanda Wei-Yin Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Ummi Wahidah Azlan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Sal Sabila Mohd Shaffie
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Weng Hong Fun
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Subang Jaya, Selangor, Malaysia
- School of Pharmacy, Taylor's University Lakeside Campus Malaysia, Subang Jaya, Selangor, Malaysia
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Choi JW, Yoo AJ. The Impact of Home-Based Primary Care on Outcomes Among Older Adults in South Korea. J Am Med Dir Assoc 2023; 24:985-990.e2. [PMID: 37060921 DOI: 10.1016/j.jamda.2023.03.009] [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: 02/01/2023] [Revised: 03/04/2023] [Accepted: 03/10/2023] [Indexed: 04/17/2023]
Abstract
OBJECTIVES Although Korea issued a law and developed benefits of National Health Insurance (NHI) to enable the provision of home-based primary care (HBPC) along with implementation of a pilot project for community care for older adults in August 2019, the outcomes of HBPC services were not surveyed in Korea. This study aimed to assess the outcomes of HBPC among older adults. DESIGN Analyses were conducted using data from the National Health Insurance Service in connection with administrative survey data. Difference-in-differences analysis was performed using a generalized estimating equation and Cox proportional hazards model. SETTING AND PARTICIPANTS Overall, 538 older adults who used HBPC services in a pilot project for community care and 2059 propensity score-matched older individuals who did not use HBPC services in Korea were included. METHODS The length of home stay, total costs of NHI, hospitalizations, and admission to long-term care (LTC) facilities were measured as outcomes, and the outcomes of the participants were compared to those of the control group. RESULTS The findings indicated an increase of 8.3 days (95% CI 2.1-14.5) in the length of home stay and a reduction of US$1241 (95% CI -2342 to -139) in total costs of NHI among older adults who used HBPC services compared to the control group. The odds ratio for rates of hospitalization among older adults who utilized HBPC services was 0.77 (95% CI 0.60-0.98) and the hazard ratio for the admission of LTC facilities was 0.12 (95% CI 0.04-0.32) in comparison to the control group. CONCLUSIONS AND IMPLICATIONS The HBPC intervention has resulted in an increased length of home stay and reduced total costs, hospitalizations, and admission to LTC facilities among Korean older adults. In the future, new HBPC models must be developed to provide interprofessional team-based HBPC services with a standardized protocol of service provision.
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Affiliation(s)
- Jae Woo Choi
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea
| | - Ae Jung Yoo
- Community Care Research Center, Health Insurance Research Institute, National Health Insurance Service, Gangwon, Korea.
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Yutong T, Yan Z, Qingyun C, Lixue M, Mengke G, Shanshan W. Information and Communication Technology Based Integrated Care for Older Adults: A Scoping Review. Int J Integr Care 2023; 23:2. [PMID: 37033366 PMCID: PMC10077997 DOI: 10.5334/ijic.6979] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/09/2023] [Indexed: 04/05/2023] Open
Abstract
Background Integrated care is an important initiative to respond positively to the ageing of society and information and communication technology(ICT) plays an important role in facilitating the integration of functional and normative health and social care. The scoping review aims to synthesize evidence on the experience and practice of ICT-based implementation of integrated care for older adults. Methods This study followed the research framework developed by Arksey and O'malley for the scoping review and systematically searched for relevant studies published between 1 January 2000 and 30 March 2022 from nine electronic databases, three specialist journals, three key institutional websites, 11 integrated care project websites, google scholar and references of the studies to be included. Two reviewers independently screened and extracted data and used thematic analysis to sort out and summarize the core elements, hindrances and facilitators of ICT-based integrated care. Results A total of 77 studies were included in this study, including 36 ICT-based practice models of integrated care with seven core elements of implementation including single entry point, comprehensive geriatric assessment, personalized care planning, multidisciplinary case conferences, coordinated care, case management and patient empowerment, which generally had a positive effect on improving quality of life, caregiver burden and primary care resource utilization for older adults, but effectiveness evaluations remained Heterogeneity exists. The barriers and facilitators to ICT-based implementation of integrated care were grouped into four themes: demand-side factors, provider factors, technology factors and system factors. Conclusion The implementation of ICT-based integrated care for the elderly is expected to improve the health status of both the supply and demand of services, but there is still a need to strengthen the supply of human resources, team training and collaboration, ICT systems and financial support in order to promote the wider use of ICT in integrated care.
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Salahub C, Kiran T, Na Y, Sinha SK, Stall NM, Ivers NM, Costa AP, Jones A, Lapointe-Shaw L. Characteristics and practice patterns of family physicians who provide home visits in Ontario, Canada: a cross-sectional study. CMAJ Open 2023; 11:E282-E290. [PMID: 36944429 PMCID: PMC10035667 DOI: 10.9778/cmajo.20220124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Physician home visits are essential for populations who cannot easily access office-based primary care. The objective of this study was to describe the characteristics, practice patterns and physician-level patient characteristics of Ontario physicians who provide home visits. METHODS This was a retrospective cross-sectional study, based on health administrative data, of Ontario physicians who provided home visits and their patients, between Jan. 1, 2019, and Dec. 31, 2019. We selected family physicians who had at least 1 home visit in 2019. Physician demographic characteristics, practice patterns and aggregated patient characteristics were compared between high-volume home visit physicians (the top 5%) and low-volume home visit physicians (bottom 95%). RESULTS A total of 6572 family physicians had at least 1 home visit in 2019. The top 5% of home visit physicians (n = 330) performed 58.6% of all home visits (n = 227 321 out of 387 139). Compared with low-volume home visit physicians (n = 6242), the top 5% were more likely to be male and practise in large urban areas, and rarely saw patients who were enrolled to them (median 4% v. 87.5%, standardized mean difference 1.12). High-volume physicians' home visit patients were younger, had greater levels of health care resource utilization, resided in lower-income and large urban neighbourhoods, and were less likely to have a medical home. INTERPRETATION A small subset of home visit physicians provided a large proportion of home visits in Ontario. These home visits may be addressing a gap in access to primary care for certain patients, but could be contributing to lower continuity of care.
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Affiliation(s)
- Christine Salahub
- Support, Systems, and Outcomes Department (Salahub, Lapointe-Shaw), Toronto General Hospital Research Institute, University Health Network; ICES Central (Kiran, Na, Ivers, Lapointe-Shaw); Institute of Health Policy, Management and Evaluation (Kiran, Sinha, Stall, Ivers, Lapointe-Shaw), and Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Kiran), St Michael's Hospital; Division of General Internal Medicine and Geriatrics (Sinha, Stall, Lapointe-Shaw), University Health Network and Sinai Health System; Department of Medicine (Sinha, Stall, Lapointe-Shaw), University of Toronto; Women's College Institute for Health System Solutions and Virtual Care (Ivers, Lapointe-Shaw), and Department of Family Medicine (Ivers), Women's College Hospital, Toronto, Ont.; ICES McMaster (Costa, Jones); Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Tara Kiran
- Support, Systems, and Outcomes Department (Salahub, Lapointe-Shaw), Toronto General Hospital Research Institute, University Health Network; ICES Central (Kiran, Na, Ivers, Lapointe-Shaw); Institute of Health Policy, Management and Evaluation (Kiran, Sinha, Stall, Ivers, Lapointe-Shaw), and Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Kiran), St Michael's Hospital; Division of General Internal Medicine and Geriatrics (Sinha, Stall, Lapointe-Shaw), University Health Network and Sinai Health System; Department of Medicine (Sinha, Stall, Lapointe-Shaw), University of Toronto; Women's College Institute for Health System Solutions and Virtual Care (Ivers, Lapointe-Shaw), and Department of Family Medicine (Ivers), Women's College Hospital, Toronto, Ont.; ICES McMaster (Costa, Jones); Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Yingbo Na
- Support, Systems, and Outcomes Department (Salahub, Lapointe-Shaw), Toronto General Hospital Research Institute, University Health Network; ICES Central (Kiran, Na, Ivers, Lapointe-Shaw); Institute of Health Policy, Management and Evaluation (Kiran, Sinha, Stall, Ivers, Lapointe-Shaw), and Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Kiran), St Michael's Hospital; Division of General Internal Medicine and Geriatrics (Sinha, Stall, Lapointe-Shaw), University Health Network and Sinai Health System; Department of Medicine (Sinha, Stall, Lapointe-Shaw), University of Toronto; Women's College Institute for Health System Solutions and Virtual Care (Ivers, Lapointe-Shaw), and Department of Family Medicine (Ivers), Women's College Hospital, Toronto, Ont.; ICES McMaster (Costa, Jones); Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Samir K Sinha
- Support, Systems, and Outcomes Department (Salahub, Lapointe-Shaw), Toronto General Hospital Research Institute, University Health Network; ICES Central (Kiran, Na, Ivers, Lapointe-Shaw); Institute of Health Policy, Management and Evaluation (Kiran, Sinha, Stall, Ivers, Lapointe-Shaw), and Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Kiran), St Michael's Hospital; Division of General Internal Medicine and Geriatrics (Sinha, Stall, Lapointe-Shaw), University Health Network and Sinai Health System; Department of Medicine (Sinha, Stall, Lapointe-Shaw), University of Toronto; Women's College Institute for Health System Solutions and Virtual Care (Ivers, Lapointe-Shaw), and Department of Family Medicine (Ivers), Women's College Hospital, Toronto, Ont.; ICES McMaster (Costa, Jones); Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Nathan M Stall
- Support, Systems, and Outcomes Department (Salahub, Lapointe-Shaw), Toronto General Hospital Research Institute, University Health Network; ICES Central (Kiran, Na, Ivers, Lapointe-Shaw); Institute of Health Policy, Management and Evaluation (Kiran, Sinha, Stall, Ivers, Lapointe-Shaw), and Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Kiran), St Michael's Hospital; Division of General Internal Medicine and Geriatrics (Sinha, Stall, Lapointe-Shaw), University Health Network and Sinai Health System; Department of Medicine (Sinha, Stall, Lapointe-Shaw), University of Toronto; Women's College Institute for Health System Solutions and Virtual Care (Ivers, Lapointe-Shaw), and Department of Family Medicine (Ivers), Women's College Hospital, Toronto, Ont.; ICES McMaster (Costa, Jones); Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Noah M Ivers
- Support, Systems, and Outcomes Department (Salahub, Lapointe-Shaw), Toronto General Hospital Research Institute, University Health Network; ICES Central (Kiran, Na, Ivers, Lapointe-Shaw); Institute of Health Policy, Management and Evaluation (Kiran, Sinha, Stall, Ivers, Lapointe-Shaw), and Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Kiran), St Michael's Hospital; Division of General Internal Medicine and Geriatrics (Sinha, Stall, Lapointe-Shaw), University Health Network and Sinai Health System; Department of Medicine (Sinha, Stall, Lapointe-Shaw), University of Toronto; Women's College Institute for Health System Solutions and Virtual Care (Ivers, Lapointe-Shaw), and Department of Family Medicine (Ivers), Women's College Hospital, Toronto, Ont.; ICES McMaster (Costa, Jones); Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Andrew P Costa
- Support, Systems, and Outcomes Department (Salahub, Lapointe-Shaw), Toronto General Hospital Research Institute, University Health Network; ICES Central (Kiran, Na, Ivers, Lapointe-Shaw); Institute of Health Policy, Management and Evaluation (Kiran, Sinha, Stall, Ivers, Lapointe-Shaw), and Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Kiran), St Michael's Hospital; Division of General Internal Medicine and Geriatrics (Sinha, Stall, Lapointe-Shaw), University Health Network and Sinai Health System; Department of Medicine (Sinha, Stall, Lapointe-Shaw), University of Toronto; Women's College Institute for Health System Solutions and Virtual Care (Ivers, Lapointe-Shaw), and Department of Family Medicine (Ivers), Women's College Hospital, Toronto, Ont.; ICES McMaster (Costa, Jones); Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Aaron Jones
- Support, Systems, and Outcomes Department (Salahub, Lapointe-Shaw), Toronto General Hospital Research Institute, University Health Network; ICES Central (Kiran, Na, Ivers, Lapointe-Shaw); Institute of Health Policy, Management and Evaluation (Kiran, Sinha, Stall, Ivers, Lapointe-Shaw), and Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Kiran), St Michael's Hospital; Division of General Internal Medicine and Geriatrics (Sinha, Stall, Lapointe-Shaw), University Health Network and Sinai Health System; Department of Medicine (Sinha, Stall, Lapointe-Shaw), University of Toronto; Women's College Institute for Health System Solutions and Virtual Care (Ivers, Lapointe-Shaw), and Department of Family Medicine (Ivers), Women's College Hospital, Toronto, Ont.; ICES McMaster (Costa, Jones); Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont
| | - Lauren Lapointe-Shaw
- Support, Systems, and Outcomes Department (Salahub, Lapointe-Shaw), Toronto General Hospital Research Institute, University Health Network; ICES Central (Kiran, Na, Ivers, Lapointe-Shaw); Institute of Health Policy, Management and Evaluation (Kiran, Sinha, Stall, Ivers, Lapointe-Shaw), and Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine and MAP Centre for Urban Health Solutions (Kiran), St Michael's Hospital; Division of General Internal Medicine and Geriatrics (Sinha, Stall, Lapointe-Shaw), University Health Network and Sinai Health System; Department of Medicine (Sinha, Stall, Lapointe-Shaw), University of Toronto; Women's College Institute for Health System Solutions and Virtual Care (Ivers, Lapointe-Shaw), and Department of Family Medicine (Ivers), Women's College Hospital, Toronto, Ont.; ICES McMaster (Costa, Jones); Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.
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Kling SMR, Garvert DW, Lessios AS, Yefimova M, Martin M, Sheffrin M, Winget M. Home-Based Primary Care for Older Adults: Matched Case-Control Evaluation of Program’s Impact on Healthcare Utilization. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2023. [DOI: 10.1177/10848223231151975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Home-based Primary Care (HBPC) is an alternative model for homebound older adults. Healthcare utilization in HBPC was evaluated with a matched case-control design. Medical providers and social workers provided in-home visits. Enrolled patients were matched to controls on age, prior hospitalizations, and frailty risk. Difference-in-differences in utilization of primary care, specialty, and hospital services between 1-year pre- and 1-year post-enrollment were evaluated with hierarchical linear models. Analyses included 117 HBPC cases and 328 controls. HBPC cases had a significant increase in primary care visits compared to controls (7.8 ± 0.6; p < .0001) but significantly decreased utilization of in-clinic primary care visits (−3.2 ± 0.6; p < .0001). In-clinic specialty visits and hospital services did not differ between cases and controls (all p’s ≥ .75). Homebound patients accessed high-touch primary and social care, which is typically unachievable in clinic settings; however, additional work is needed to optimize services and target in-home care to impact healthcare utilization.
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Affiliation(s)
| | | | | | - Maria Yefimova
- Stanford University School of Medicine, Stanford, CA, USA
- Stanford Health Care, Stanford, CA, USA
| | - Marina Martin
- Stanford University School of Medicine, Stanford, CA, USA
| | - Meera Sheffrin
- Stanford University School of Medicine, Stanford, CA, USA
| | - Marcy Winget
- Stanford University School of Medicine, Stanford, CA, USA
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Lapointe-Shaw L, Kiran T, Costa AP, Na Y, Sinha SK, Nelson KE, Stall NM, Ivers NM, Jones A. Physician home visits in Ontario: a cross-sectional analysis of patient characteristics and postvisit use of health care services. CMAJ Open 2022; 10:E732-E745. [PMID: 35944922 PMCID: PMC9377547 DOI: 10.9778/cmajo.20210307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND It is unknown how much of current physician home visit volume is driven by low-complexity or low-continuity visits. Our objectives were to measure physician home visit volumes and costs in Ontario from 2005/06 to 2018/19, and to compare patient characteristics and postvisit use of health care services across home visit types. METHODS This was a retrospective cross-sectional study using health administrative data. We examined annual physician home visit volumes and costs from 2005/06 to 2018/19 in Ontario, and characteristics and postvisit use of health care services of residents who received at least 1 home visit from any physician in 2014/15 to 2018/19. We categorized home visits as palliative, provided to a patient who also received home care services or "other," and compared characteristics and outcomes between groups. RESULTS A total of 4 418 334 physician home visits were performed between 2005/06 and 2018/19. More than half (2 256 667 [51.1%]) were classified as "other" and accounted for 39.1% ($22 million) of total annual physician billing costs. From 2014/15 to 2018/19, of the 413 057 home visit patients, 240 933 (58.3%) were adults aged 65 or more, and 323 283 (78.3%) lived in large urban areas. Compared to the palliative care and home care groups, the "other" group was younger, had fewer comorbidities, and had lower rates of emergency department visits and hospital admissions in the 30 days after the visit. INTERPRETATION About half of physician home visits in 2014/15 to 2018/19 were to patients who were receiving neither palliative care nor home care, a group that was younger and healthier, and had low use of health care services after the visit. There is an opportunity to refine policy tools to target patients most likely to benefit from physician home visits.
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Affiliation(s)
- Lauren Lapointe-Shaw
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont.
| | - Tara Kiran
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Andrew P Costa
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Yingbo Na
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Samir K Sinha
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Katherine E Nelson
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Nathan M Stall
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Noah M Ivers
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
| | - Aaron Jones
- Division of General Internal Medicine and Geriatrics (Lapointe-Shaw, Sinha, Stall), University Health Network and Sinai Health System; Department of Medicine (Lapointe-Shaw, Sinha, Stall), University of Toronto; Women's College Hospital Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Ivers), Women's College Hospital; ICES (Lapointe-Shaw, Kiran, Costa, Na, Nelson, Ivers, Jones); Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Sinha, Stall, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran, Sinha, Ivers), University of Toronto; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Department of Health Research Methods, Evidence, and Impact (Costa, Jones), McMaster University; Centre for Integrated Care (Costa), St. Joseph's Health System, Hamilton, Ont.; Department of Paediatrics (Nelson), The Hospital for Sick Children; Department of Family and Community Medicine (Ivers), Women's College Hospital, Toronto, Ont
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7
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Giguere A, Holroyd-Leduc JM, Straus SE, Urquhart R, Turcotte V, Durand PJ, Turgeon A. Prioritization of indicators of the quality of care provided to older adults with frailty by key stakeholders from five canadian provinces. BMC Geriatr 2022; 22:149. [PMID: 35197016 PMCID: PMC8864862 DOI: 10.1186/s12877-022-02843-9] [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] [Received: 07/29/2021] [Accepted: 02/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background To meet the needs of older adults with frailty better, it is essential to understand which aspects of care are important from their perspective. We therefore sought to assess the importance of a set of quality indicators (QI) for monitoring outcomes in this population. Methods In this mixed-method study, key stakeholders completed a survey on the importance of 36 QIs, and then explained their ratings in a semi-structured interview. Stakeholders included older adults with frailty and their caregivers, healthcare providers (HCPs), and healthcare administrators or policy/decision makers (DMs). We conducted descriptive statistical analyses of quantitative variables, and deductive thematic qualitative analyses of interview transcripts. Results The 42 participants (8 older adults, 18 HCPs, and 16 DMs) rated six QIs as more important: increasing the patients’ quality of life; increasing healthcare staff skills; decreasing patients’ symptoms; decreasing family caregiver burden; increasing patients’ satisfaction with care; and increasing family doctor continuity of care. Conclusions Key stakeholders prioritized QIs that focus on outcomes targeted to patients and caregivers, whereas the current healthcare systems generally focus on processes of care. Quality improvement initiatives should therefore take better account of aspects of care that are important for older adults with frailty, such as having a chance to express their individual goals of care, receiving quality communications from HCPs, or monitoring symptoms that they might not spontaneously describe. Our results point to the need for patient-centred care that is oriented toward quality of life for older adults with frailty. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02843-9.
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Affiliation(s)
- Anik Giguere
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada. .,Quebec Excellence Centre on Aging, Quebec, Canada. .,VITAM - Research Centre on Sustainable Health (Centre de recherche en santé durable), 2480, chemin de la Canardière, QC, G1J 0A4, Québec, Canada.
| | | | - Sharon E Straus
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada
| | | | - Pierre J Durand
- Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
| | - Alexis Turgeon
- Population Health and Optimal Health Practices Research Unit, Division of Critical Care Medicine, CHU de Quebec - Université Laval Research Centre, Université Laval, Quebec, Canada
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8
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Montano AR, Cornell PY, Gravenstein S. Barriers and facilitators to interprofessional collaborative practice for community-dwelling older adults: An integrative review. J Clin Nurs 2021; 32:1534-1548. [PMID: 34405476 DOI: 10.1111/jocn.15991] [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: 05/07/2021] [Revised: 06/28/2021] [Accepted: 07/23/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim of this integrative review was to synthesise empirical reports of interprofessional collaborative practice (IPCP) for community-dwelling older adults and uncover barriers and facilitators related to its success as a model of care for this population. BACKGROUND IPCP is a model of care that has demonstrated positive outcomes for community-dwelling older adults. However, a summary of barriers and facilitators to IPCP models has not been presented. METHODS An integrative review using the method posited by Whittemore and Knafl was completed to identify barriers and facilitators to IPCP for community-dwelling older adults. The literature search was reported following PRISMA guidelines. RESULTS Four themes emerged as barriers to IPCP: (1) A (Potential) Logistical Nightmare, (2) All About the Money, (3) If We Can't Test It, Can We Recommend It? and (4) Challenging for the Team, Challenging for the Client. Three themes emerged as facilitators to IPCP: (1) Reducing Resource Waste, (2) The "C" in IPCP and (3) What Matters Most. CONCLUSIONS IPCP models for community-dwelling older adults must adapt to the setting of care and client needs. Interprofessional education opportunities for team members facilitate effective IPCP. Healthcare policies and funding structures need to address IPCP for community-dwelling older adults for this model to be successful and sustainable. RELEVANCE TO CLINICAL PRACTICE Nurses participate on and lead IPCP teams caring for community-dwelling older adults and, therefore, need to be aware of barriers and facilitators to this model of care.
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Affiliation(s)
- Anna-Rae Montano
- Brown University School of Public Health, Providence, RI, USA.,Providence VA Medical Center, Providence, RI, USA
| | - Portia Y Cornell
- Brown University School of Public Health, Providence, RI, USA.,Providence VA Medical Center, Providence, RI, USA
| | - Stefan Gravenstein
- Brown University School of Public Health, Providence, RI, USA.,Providence VA Medical Center, Providence, RI, USA.,Brown University Warren Alpert Medical School, Providence, RI, USA
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9
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Zimbroff RM, Ornstein KA, Sheehan OC. Home-based primary care: A systematic review of the literature, 2010-2020. J Am Geriatr Soc 2021; 69:2963-2972. [PMID: 34247383 DOI: 10.1111/jgs.17365] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/07/2021] [Accepted: 06/12/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although more than seven million older adults struggle or are unable to leave their homes independently, only a small minority access home-based primary care (HBPC). Despite substantial growth of HBPC, fueled by growing evidence supporting positive patient outcomes and cost savings, the population remains dramatically underserved and many evidence gaps still exist around scope of practice and key issues in care delivery and quality. Understanding the current state of the field is critical to the delivery of high-quality home-based care. METHODS We conducted a systematic search of the peer-reviewed literature on HBPC, published between January 2010 and January 2020, using Medline, CINAHL, Embase, Web of Science, and Scopus online libraries. All studies were evaluated by two members of the research team, and key findings were extracted. RESULTS The initial search yielded 1730 unique studies for screening. Of these initial results, 1322 were deemed not relevant to this review. Of the 408 studies deemed potentially relevant, 79 were included in the study. Researchers identified five overarching themes: the provision of HBPC, the composition of care teams, HBPC outcomes, the role of telehealth, and emergency preparedness efforts. CONCLUSION The need and desire for growth of HBPC has been highlighted by the recent COVID-19 pandemic. Current research on HBPC finds a diverse scope of practice, successful use of interdisciplinary teams, positive outcomes, and increasing interest in telehealth with many areas ripe for further research.
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Affiliation(s)
- Robert M Zimbroff
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Katherine A Ornstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, New York, USA
| | - Orla C Sheehan
- Division of Geriatric Medicine and Gerontology, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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10
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Kim SA, Babazono A, Jamal A, Li Y, Liu N. Comparison of care utilisation and medical institutional death among older adults by home care facility type: a retrospective cohort study in Fukuoka, Japan. BMJ Open 2021; 11:e041964. [PMID: 33853793 PMCID: PMC8054107 DOI: 10.1136/bmjopen-2020-041964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We compared the care services use and medical institutional deaths among older adults across four home care facility types. DESIGN This was a retrospective cohort study. SETTING We used administrative claims data from April 2014 to March 2017. PARTICIPANTS We included 18 347 residents of Fukuoka Prefecture, Japan, who received home care during the period, and aged ≥75 years with certified care needs of at least level 3. Participants were categorised based on home care facility use (ie, general clinics, Home Care Support Clinics/Hospitals (HCSCs), enhanced HCSCs with beds and enhanced HCSCs without beds). PRIMARY AND SECONDARY OUTCOME MEASURES We used generalised linear models (GLMs) to estimate care utilisation and the incidence of medical institutional death, as well as the potential influence of sex, age, care needs level and Charlson comorbidity index as risk factors. RESULTS The results of GLMs showed the inpatient days were 54.3, 69.9, 64.7 and 75.0 for users of enhanced HCSCs with beds, enhanced HCSCs without beds, HCSCs and general clinics, respectively. Correspondingly, the numbers of home care days were 63.8, 51.0, 57.8 and 29.0. Our multivariable logistic regression model estimated medical institutional death rate among participants who died during the study period (n=9919) was 2.32 times higher (p<0.001) for general clinic users than enhanced HCSCs with beds users (relative risks=1.69, p<0.001). CONCLUSIONS Participants who used enhanced HCSCs with beds had a relatively low inpatient utilisation, medical institutional deaths, and a high utilisation of home care and home-based end-of-life care. Findings suggest enhanced HCSCs with beds could reduce hospitalisation days and medical institutional deaths. Our study warrants further investigations of home care as part of community-based integrated care.
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Affiliation(s)
- Sung-A Kim
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Aziz Jamal
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- International Business & Management, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Yunfei Li
- Department of Healthcare Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ning Liu
- Preventive Medicine and Community Health, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
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11
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Cox MB, McGregor MJ, Huggins M, Moorhouse P, Mallery L, Bauder K. Evaluation of an initiative to improve advance care planning for a home-based primary care service. BMC Geriatr 2021; 21:97. [PMID: 33530930 PMCID: PMC7852206 DOI: 10.1186/s12877-021-02035-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Advance care planning (ACP) is a process that enables individuals to describe, in advance, the kind of health care they would want in the future. There is evidence that ACP reduces hospital-based interventions, especially at the end of life. ACP for frail older adults is especially important as this population is more likely to use hospital services but less likely to benefit from resource intensive care. Our study goal was to evaluate whether an approach to ACP developed for frail older adults, known as the Palliative and Therapeutic Harmonization or PATH, demonstrated an improvement in ACP. Methods The PATH approach was adapted to a primary care service for homebound older adults in Vancouver, Canada. This retrospective chart review collected surrogate measures related to ACP from 200 randomly selected patients enrolled in the service at baseline (prior to June 22, 2017), and 114 consecutive patients admitted to the program after implementation of the PATH ACP initiative (October 1, 2017 to May 1, 2018). We compared the following surrogate markers of ACP before and after implementation of the PATH model, chart documentation of: frailty stage, substitute decision-maker, resuscitation decision, and hospitalization decision. A composite ACP documentation score that ascribed one point for each of the above four measures (range 0 to 4) was also compared. For those with documented resuscitation and hospitalization decisions, the study examined patient/ substitute decision-maker expressed preferences for do-not-resuscitate and do-not-hospitalize, before and after implementation. Results We found the following changes in ACP-related documentation before and after implementation: frailty stage (27.0% versus 74.6%, p < .0001); substitute decision-maker (63.5% versus 71.9%, p = 0.128); resuscitation decision documented (79.5% versus 67.5%, p = 0.018); and hospitalization decision documented (61.5% versus 100.0%, p < .0001); mean (standard deviation) composite ACP documentation score (2.32 (1.16) versus 3.14 (1.11), p < .0001). The adjusted odds ratios (95% confidence intervals) for an expressed preference of do-not-resuscitate and do-not-hospitalize after implementation were 0.87 (0.35, 2.15) and 3.14 (1.78, 5.55), respectively. Conclusions Results suggest partial success in implementing the PATH approach to ACP in home-based primary care. Key contextual enablers and barriers are important considerations for successful implementation.
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Affiliation(s)
- Michelle B Cox
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Margaret J McGregor
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. .,HomeViVE Program, Vancouver General Hospital, Vancouver, BC, Canada.
| | - Madison Huggins
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Paige Moorhouse
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Laurie Mallery
- Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Katie Bauder
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
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Yu Z, Gallant AJ, Cassidy CE, Boulos L, Macdonald M, Stevens S. Case Management Models and Continuing Care: A Literature Review across nations, settings, approaches, and assessments. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2020. [DOI: 10.1177/1084822320954394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Older adults accessing continuing care often have multiple chronic conditions. Research suggests that case management is a promising approach to reduce health care expenditure and improve patient outcomes. To optimize healthcare delivery, an examination of existing case management models and their effectiveness is essential. This literature review was conducted using Joanna Briggs Institute (JBI) methods to explore case management models for older adults accessing continuing care services. Searches were conducted in PubMed and CINAHL from 2010 to 2018. A total of 37 articles were included in this review. Approaches to case management are diverse with respect to composition of care providers, method of care provision, and location of care. Findings from 27 quantitative studies demonstrated that nurse-led and interdisciplinary team case management models that include home visits can effectively reduce hospital admission/readmission while lowering costs. Mixed results were found on the impact of case management on patient satisfaction, ED visits, quality of life, length of stay, self-efficacy, social integration and caregiver burden. Among 10 qualitative studies, 3 facilitators for quality case management were identified that include receiving care at home, building trusting relationships, and improving self-efficacy. Based on these findings, we conclude that nurse-led and interdisciplinary team case management can effectively reduce hospital admission of frail older adults while lowering costs, particularly within home care settings.
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Affiliation(s)
- Ziwa Yu
- Dalhousie University, Halifax, Canada
| | | | | | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, NS, Canada
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13
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Ng KYY, Leung GYC, Tey AJY, Chaung JQ, Lee SM, Soundararajan A, Yow KS, Ngiam NHW, Lau TC, Wong SF, Wong CH, Koh GCH. Bridging the intergenerational gap: the outcomes of a student-initiated, longitudinal, inter-professional, inter-generational home visit program. BMC MEDICAL EDUCATION 2020; 20:148. [PMID: 32393249 PMCID: PMC7216381 DOI: 10.1186/s12909-020-02064-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Older persons consume disproportionately more healthcare resources than younger persons. Tri-Generational HomeCare (TriGen), a service-learning program, aims to reduce hospital admission rates amongst older patients with frequent admissions. The authors evaluated the educational and patient outcomes of TriGen. METHODS Teams consisting of healthcare undergraduates and secondary school (SS) students - performed fortnightly home visits to patients over 6 months. Self-administered scales were used to evaluate the educational outcomes in knowledge and attitudes towards the older people and nine domains of soft skills pre- and post-intervention. Patients' reported satisfaction and clinical outcomes were also assessed. RESULTS Two hundred twenty-six healthcare undergraduates and 359 SS students participated in the program from 2015 to 2018. Response rates were 80.1 and 62.4% respectively. One hundred six patients participated in TriGen. There was a significant increase in Kogan's Attitudes towards Old People Scale (KOP) scores for healthcare undergraduates and SS students with a mean increase of 12.8 (95%CI: 9.5-16.2, p < 0.001) and 8.3 (95%CI: 6.2-10.3, p < 0.001) respectively. There was a significant increase in Palmore Facts on Aging Quiz (PFAQ) score for SS students but not for healthcare undergraduates. Most volunteers reported that TriGen was beneficial across all nine domains assessed. There was also a significant decrease in hospital admission rates (p = 0.006) and emergency department visits (p = 0.004) during the 6-month period before and after the program. Fifty-one patients answered the patient feedback survey. Of this, more than 80% reported feeling less lonely and happier. CONCLUSION TriGen, a student-initiated, longitudinal, inter-generational service-learning program consisting of SS students and healthcare undergraduates can reduce ageism, develop soft skills, inculcate values amongst SS students and healthcare undergraduates. In addition, TriGen potentially reduces hospital admissions and emergency department visits, and loneliness amongst frequently admitted older patients.
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Affiliation(s)
- Kennedy Yao Yi Ng
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Angeline Jie-Yin Tey
- Department of Intensive Care Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Jia Quan Chaung
- Changi Naval Base, Singapore Armed Forces, Singapore, Singapore
| | - Si Min Lee
- Department of General Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Ka Shing Yow
- Department of General Surgery, Changi General Hospital, Singapore, Singapore
| | | | - Tang Ching Lau
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Hospital, Singapore, Singapore
| | - Sweet Fun Wong
- Populational Health and Community Transformation, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Chek Hooi Wong
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Department of Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
- Geriatric Education and Research Institute, Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 117549, Singapore.
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore.
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14
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Rosenberg T, Montgomery P, Hay V, Lattimer R. Using frailty and quality of life measures in clinical care of the elderly in Canada to predict death, nursing home transfer and hospitalisation - the frailty and ageing cohort study. BMJ Open 2019; 9:e032712. [PMID: 31722953 PMCID: PMC6858169 DOI: 10.1136/bmjopen-2019-032712] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the value of using frailty measures in primary care for predicting death, nursing home transfer (NHT) and hospital admission. DESIGN Cohort study. SETTING AND PARTICIPANTS All 380 people, mean age 88.4, living in the community and receiving home-based primary geriatric care from one practice in Victoria, Canada. INTERVENTIONS/MEASUREMENTS A 60 min baseline assessment which included: Clinical Frailty Scale (CFS), EuroQol EQ-5D-5L (EQ-5D), EuroQol Visual Analogue Scale (EQ-VAS) and Gait Speed (Gaitspeed). OUTCOMES Death, NHT and hospital admission. RESULTS During 18 months of follow-up, there were 39 (10.3%) deaths, 48 (12.6%) NHTs and 93 (24.5%) individuals admitted to hospital. All three outcomes were predicted by: CFS Level 6+7/4+5 (HR death 5.92, 95% CI 3.12 to 11.22, NHT 6.00, 95% CI 3.37 to 10.66 and hospital admission 2.92, 95% CI 1.93 to 4.40); EQ-5D Quintile 1/Quintile 5 (death 6.26, 95% CI 2.11 to 18.62; NHT 3.18, 95% CI 1.29 to 7.82 and hospital admission 2.94, 95% CI 1.47 to 5.87); EQ-VAS Q1/Q5 (death 7.0, 95% CI 2.34 to 20.93; NHT 3.38, 95% CI 1.22 to 9.35 and hospital admission 6.69, 95% CI 3.20 to 13.99) and Gaitspeed (death 5.87, 95% CI 1.78 to 19.34; NHT 8.51, 95% CI 3.18 to 22.79 and hospital admission 11.05, 95% CI 5.45 to 22.40). Medical diagnoses, multiple comorbidities and polypharmacy were weaker predictors of these outcomes. Cox regression analyses showed CFS (adjusted HR 2.88, 95% CI 1.23 to 6.68), EQ-VAS (0.96, 95% CI 0.93 to 0.98), estimated glomerular filtration rate (0.97, 95% CI 0.95 to 1.00) and haemoglobin (0.97, 95% CI 0.94 to 0.99) were independently associated with death. Gaitspeed (0.13, 95% CI 0.03 to 0.57), Geriatric Depression Scale (1.39, 95% CI 1.07 to 1.82) and dementia diagnosis (4.61, 95% CI 1.86 to 11.44) were associated with NHT. Only CFS (1.75, 95% CI 1.21 to 2.51) and EQ-VAS (0.98, 95% CI 0.96 to 0.99) were associated with hospital admission. No other diagnoses, polypharmacy nor multiple comorbidities predicted these outcomes. CONCLUSIONS For elderly people, standardised simple measures of frailty and health status were stronger predictors of death, NHT and hospital admission than medical diagnoses. Consideration should be given to adding these measures into usual medical care for this age group.
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Affiliation(s)
- Ted Rosenberg
- Family Practice, The University of British Columbia Faculty of Medicine, Victoria, British Columbia, Canada
| | - Patrick Montgomery
- Geriatriac Medicine (Retired), The University of British Columbia Faculty of Medicine, Victoria, British Columbia, Canada
| | - Vikki Hay
- Home Team Medical Services, Victoria, British Columbia, Canada
| | - Rory Lattimer
- Home Team Medical Services, Victoria, British Columbia, Canada
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Stoop A, Lette M, van Gils PF, Nijpels G, Baan CA, de Bruin SR. Comprehensive geriatric assessments in integrated care programs for older people living at home: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e549-e566. [PMID: 31225946 PMCID: PMC6852049 DOI: 10.1111/hsc.12793] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/10/2019] [Accepted: 05/16/2019] [Indexed: 06/09/2023]
Abstract
In many integrated care programs, a comprehensive geriatric assessment (CGA) is conducted to identify older people's problems and care needs. Different ways for conducting a CGA are in place. However, it is still unclear which CGA instruments and procedures for conducting them are used in integrated care programs, and what distinguishes them from each other. Furthermore, it is yet unknown how and to what extent CGAs, as a component of integrated care programs, actually reflect the main principles of integrated care, being comprehensiveness, multidisciplinarity and person-centredness. Therefore, the objectives of this study were to: (a) describe and compare different CGA instruments and procedures conducted within integrated care programs for older people living at home, and (b) describe how the principles of integrated care were applied in these CGAs. A scoping review of the scientific literature on CGAs in the context of integrated care was conducted for the period 2006-2018. Data were extracted on main characteristics of the identified CGA instruments and procedures, and on how principles of integrated care were applied in these CGAs. Twenty-seven integrated care programs were included in this study, of which most were implemented in the Netherlands and the United States. Twenty-one different CGAs were identified, of which the EASYcare instrument, RAI-HC/RAI-CHA and GRACE tool were used in multiple programs. The majority of CGAs seemed to reflect comprehensiveness, multidisciplinarity and person-centredness, although the way and extent to which principles of integrated care were incorporated differed between the CGAs. This study highlights the high variability of CGA instruments and procedures used in integrated care programs. This overview of available CGAs and their characteristics may promote (inter-)national exchange of CGAs, which could enable researchers and professionals in choosing from the wide range of existing CGAs, thereby preventing them from unnecessarily reinventing the wheel.
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Affiliation(s)
- Annerieke Stoop
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
- Scientific Center for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgthe Netherlands
| | - Manon Lette
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
| | - Paul F. van Gils
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
| | - Giel Nijpels
- Amsterdam Public Health Research Institute, Department of General Practice and Elderly Care MedicineAmsterdam UMC ‐ VU University AmsterdamAmsterdamthe Netherlands
| | - Caroline A. Baan
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
- Scientific Center for Transformation in Care and Welfare (Tranzo)University of TilburgTilburgthe Netherlands
| | - Simone R. de Bruin
- Centre for NutritionPrevention and
Health ServicesNational Institute for Public Health and the EnvironmentBilthoventhe Netherlands
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16
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Liljas AEM, Brattström F, Burström B, Schön P, Agerholm J. Impact of Integrated Care on Patient-Related Outcomes Among Older People - A Systematic Review. Int J Integr Care 2019; 19:6. [PMID: 31367205 PMCID: PMC6659761 DOI: 10.5334/ijic.4632] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 07/10/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The growing number of older adults with multiple needs increases the pressure to reform existing healthcare systems. Integrated care may be part of such reforms. The aim of this systematic review was to identify important patient-related outcomes of integrated care provided to older adults. METHODS A systematic search of 5 databases to identify studies comprising older adults assessing hospital admission, length of hospital stay, hospital readmission, patient satisfaction and mortality in integrated care settings. Retrieved literature was analysed employing a narrative synthesis. RESULTS Twelve studies were included (2 randomised controlled trials, 7 quasi-experimental design, 2 comparison studies, 1 survey evaluation). Five studies investigated patient satisfaction, 9 hospital admission, 7 length of stay, 3 readmission and 5 mortality. Findings show that integrated care tends to have a positive impact on hospital admission rates, some positive impact on length of stay and possibly also on readmission and patient satisfaction but not on mortality. CONCLUSIONS Integrated care may reduce hospital admission rates and lengths of hospital stay. However due to lack of robust findings, the effectiveness of integrated care on patient-related outcomes in later life remain largely unknown. Further research is needed to establish the effect of integrated care on these patient-related outcomes. PROSPERO REGISTRATION NUMBER CRD42018110491.
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Affiliation(s)
- Ann E. M. Liljas
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SE
| | - Fanny Brattström
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SE
| | - Bo Burström
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SE
- Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, Stockholm, SE
| | - Pär Schön
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, SE
| | - Janne Agerholm
- Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, SE
- Centre for Epidemiology and Community Medicine, Stockholm County Council Health Services, Stockholm, SE
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Wu S, Mulcahy J, Kasper JD, Kan HJ, Weiner JP. Comparing Survey-Based Frailty Assessment to Medicare Claims in Predicting Health Outcomes and Utilization in Medicare Beneficiaries. J Aging Health 2019; 32:764-777. [PMID: 31148491 DOI: 10.1177/0898264319851995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To assess two models for the prediction of health utilization and functions using standardized in-person assessments of frailty and administrative claims-based geriatric risk measures among Medicare fee-for-service beneficiaries aged 65 years and above. Methods: Outcomes of hospitalizations, death, and functional help were investigated for participants in the 2011 National Health and Aging Trends Study. For each outcome, multivariable logistic regression model was used to investigate claims-based geriatric risk and survey-based frailty. Results: Both claims-based and survey-based models showed moderate discrimination. The c-statistic of the standardized frailty models ranged from 0.67 (for any hospitalization) to 0.84 (for any IADL [instrumental activities of daily living] help). Models using administrative data ranged from 0.71 (for any hospitalization) to 0.81 (for any IADL help). Discussion: Models based on existing administrative data appear to be as discriminate as survey-based models. Health care providers and insurance plans can effectively apply existing data resources to help identify high-risk individuals for potential care management interventions.
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Affiliation(s)
- Shannon Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Mulcahy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judith D Kasper
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Hong J Kan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Dang S, Ruiz DI, Klepac L, Morse S, Becker P, Levy CR, Kinosian B, Edes TE. Key Characteristics for Successful Adoption and Implementation of Home Telehealth Technology in Veterans Affairs Home-Based Primary Care: An Exploratory Study. Telemed J E Health 2019; 25:309-318. [DOI: 10.1089/tmj.2018.0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stuti Dang
- Miami Veterans Affairs Healthcare System, Miami, Florida
- Miami Veterans Affairs Geriatric Research Education and Clinical Center, Miami, Florida
- Division of Geriatrics and Palliative Care, University of Miami Miller School of Medicine, Miami, Florida
| | - Diana I. Ruiz
- Miami Veterans Affairs Healthcare System, Miami, Florida
- Miami Veterans Affairs Geriatric Research Education and Clinical Center, Miami, Florida
| | - Lauren Klepac
- Geriatrics and Extended Care, Office of Clinical Operations and Management, U.S. Department of Veterans Affairs, Washington, District of Columbia
| | - Susan Morse
- Home & Community Based Care, Stratton Veterans Affairs Medical Center, Albany, New York
| | - Peggy Becker
- Geriatrics and Extended Care, New England Veterans Health Care System, Bedford, Massachusetts
| | - Cari R. Levy
- Denver-Seattle Center of Innovation, Denver Veterans Affairs Medical Center, Denver, Colorado
- Division of Health Care Policy and Research, School of Medicine, University of Colorado, Aurora, Colorado
| | - Bruce Kinosian
- Division of Geriatrics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Geriatrics and Extended Care Data Analysis Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Thomas E. Edes
- Geriatrics and Extended Care, Office of Clinical Operations and Management, U.S. Department of Veterans Affairs, Washington, District of Columbia
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19
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Hermsen LAH, Hoogendijk EO, van der Wouden JC, Smalbrugge M, Leone SS, van der Horst HE, Dekker J. Self-perceived care needs in older adults with joint pain and comorbidity. Aging Clin Exp Res 2018; 30:449-455. [PMID: 28688079 PMCID: PMC5911275 DOI: 10.1007/s40520-017-0795-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/26/2017] [Indexed: 12/03/2022]
Abstract
Background The aim of this study was to explore self-perceived care needs and determinants of identified needs in older adults with joint pain and comorbidity. Methods This is a cross-sectional study using baseline data from a cohort study of older adults in the Netherlands (≥65 years) with joint pain and comorbidity (n = 407). We used the Camberwell Assessment of Need for the Elderly (CANE) to assess self-perceived care needs. Regression analyses were conducted to examine the associations between needs and sociodemographic factors (age, gender, partner status and educational level), physical factors (pain intensity, comorbidity, frailty and physical functioning) and psychosocial factors (anxiety, depression and social support). Results Older adults with joint pain and comorbidity reported on average 4.0 care needs out of 13 CANE items, of which 0.3 were unmet. High levels of environmental and physical needs were reported, such as needs with regard to physical illness (91%), household (61%) and mobility/falls (53%). However, most of these needs were met. Only few people reported psychosocial needs, but a large proportion of these needs was unmet, especially regarding company (66.7%) and daytime activities (37%). Psychosocial needs were more often present in frail participants (OR 2.40, 95% CI 1.25–4.61), and those with less perceived social support (OR 1.05, 95% CI 1.01–1.08) and more depressive symptoms (OR 1.17, 95% CI 1.07–1.26). Discussion/Conclusions Unmet needs are mainly present in the psychosocial domain. Specific attention targeted at these unmet needs may improve psychosocial well-being of older adults with joint pain and comorbidity.
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Affiliation(s)
- Lotte A H Hermsen
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Emiel O Hoogendijk
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands.
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Martin Smalbrugge
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Stephanie S Leone
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- Public Mental Health, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Joost Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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20
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McGregor MJ, Cox MB, Slater JM, Poss J, McGrail KM, Ronald LA, Sloan J, Schulzer M. A before-after study of hospital use in two frail populations receiving different home-based services over the same time in Vancouver, Canada. BMC Health Serv Res 2018; 18:248. [PMID: 29622006 PMCID: PMC5887263 DOI: 10.1186/s12913-018-3040-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/19/2018] [Indexed: 11/14/2022] Open
Abstract
Background As individuals age, they are more likely to experience increasing frailty and more frequent use of hospital services. First, we explored whether initiating home-based primary care in a frail homebound cohort, influenced hospital use. Second, we explored whether initiating regular home care support for personal care with usual primary care, in a second somewhat less frail cohort, influenced hospital use. Methods This was a before-after retrospective cohort study of two frail populations in Vancouver, Canada using administrative data to assess the influence of two different services started in two different cohorts over the same time period. The participants were 246 recipients of integrated home-based primary care and 492 recipients of home care followed between July 1st, 2008 and June 30th, 2013 before and after starting their respective services. Individuals in each group were linked to their hospital emergency department visit and discharge abstract records. The main outcome measures were mean emergency department visit and hospital admission rates per 1000 patient days for 21 months before versus the period after receipt of services, and the adjusted incidence rate ratios (IRRs) on these outcomes post receipt of service. Results Before versus after starting integrated home-based primary care, emergency department visit rates per 1000 patient days (95% confidence intervals) were 4.1 (3.8, 4.4) versus 3.7 (3.3, 4.1), and hospital admissions rates were 2.3 (2.1, 2.5) versus 2.2 (1.9, 2.5). Before versus after starting home care, emergency department visit rates per 1000 patient days (95% confidence intervals) were 3.0 (2.8, 3.2) versus 4.0 (3.7, 4.3) visits and hospital admissions rates were 1.3 (1.2, 1.4) versus 1.9 (1.7, 2.1). Home-based primary care IRRs were 0.91 (0.72, 1.15) and 0.99 (0.76, 1.27) and home care IRRs were 1.34 (1.15, 1.56) and 1.46 (1.22, 1.74) for emergency department visits and hospital admissions respectively. Conclusions After enrollment in integrated home-based primary care, emergency department visit and hospital admission rates stabilized. After starting home care with usual primary care, emergency department visit and hospital admission rates continued to rise.
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Affiliation(s)
- Margaret J McGregor
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. .,UBC Centre for Health Services and Policy Research, Vancouver, Canada. .,UBC School of Population and Public Health, Vancouver, Canada. .,Vancouver Coastal Health's Research Institute's Centre for Epidemiology and Evaluation, Vancouver, Canada.
| | - Michelle B Cox
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Jay M Slater
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,Community Geriatric Programs, VCH, Vancouver, Canada
| | - Jeff Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Kimberlyn M McGrail
- UBC Centre for Health Services and Policy Research, Vancouver, Canada.,UBC School of Population and Public Health, Vancouver, Canada
| | - Lisa A Ronald
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - John Sloan
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Michael Schulzer
- Pacific Parkinson's Research Centre, Vancouver, Canada.,Vancouver Coastal Health's Research Institute's Centre for Epidemiology and Evaluation, Vancouver, Canada
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Rosenberg T, Lattimer R, Montgomery P, Wiens C, Levy L. The relationship of SSRI and SNRI usage with interstitial lung disease and bronchiectasis in an elderly population: a case-control study. Clin Interv Aging 2017; 12:1977-1984. [PMID: 29200837 PMCID: PMC5702166 DOI: 10.2147/cia.s144263] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The association between interstitial lung disease (ILD) and selective serotonin reuptake inhibitors and serotonin norepinephrine reuptake inhibitors (SSRI/SNRI) has been previously described in published case reports. However, its prevalence may be more common than expected. We examined the association between SSRI/SNRI usage and presence of ILD and or bronchiectasis (ILD/B) in an elderly population. Methods We conducted a retrospective case series and case–control study involving all 296 eligible elderly patients in one primary care geriatric practice in Victoria, BC, Canada. Cases required the presence of ILD/B on computed tomography (CT) or chest X-ray (CXR). Cases were excluded if they had other causes for ILD/B on CXR or CT such as exposure to known pneumotoxic drugs, metastatic cancer, rheumatoid lung disease, sarcoidosis, previous pulmonary tuberculosis, or pneumoconiosis. Data were abstracted from the patients’ medical record. The exposure variable was standardized cumulative person-month (p-m) dose of SSRI/SNRI. The study was approved by the Clinical Research Ethics Board of University of British Columbia with a waiver of informed consent. Results A total of 12 cases and 273 controls were identified. Their mean ages were 89.0 and 88.7 years, respectively (p=0.862). A total of 10/12 cases and 99/273 controls were exposed to SSRI/SNRI. The odds ratio was 8.79, 95% confidence interval 2.40–32.23 (p=0.001). The median p-m exposure to SSRI/SNRI was 110.0 months for cases and 29.5 for controls (p=0.003). Conclusion SSRIs and SNRIs were significantly associated with the risk of ILD/B in this elderly population. Because of their widespread usage, further studies should be done to validate these findings. Prescribers should cautiously monitor patients for development of insidious pulmonary symptoms when these drugs are used.
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Affiliation(s)
- Ted Rosenberg
- Department of Family Medicine, University of British Columbia and Island Medical Program, Victoria, BC
| | | | - Patrick Montgomery
- Division of Geriatric Medicine, University of British Columbia, Victoria, BC
| | - Christian Wiens
- Geriatric Psychiatry, University of British Columbia, Victoria, BC
| | - Liran Levy
- Lung Transplant Program, Toronto General Hospital, Toronto, ON, Canada
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22
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Increasing primary health-care services are associated with acute short-term hospitalization of Danes aged 70 years and older. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Palmer K, Marengoni A, Forjaz MJ, Jureviciene E, Laatikainen T, Mammarella F, Muth C, Navickas R, Prados-Torres A, Rijken M, Rothe U, Souchet L, Valderas J, Vontetsianos T, Zaletel J, Onder G. Multimorbidity care model: Recommendations from the consensus meeting of the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). Health Policy 2017; 122:4-11. [PMID: 28967492 DOI: 10.1016/j.healthpol.2017.09.006] [Citation(s) in RCA: 151] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 03/20/2017] [Accepted: 09/08/2017] [Indexed: 12/20/2022]
Abstract
Patients with multimorbidity have complex health needs but, due to the current traditional disease-oriented approach, they face a highly fragmented form of care that leads to inefficient, ineffective, and possibly harmful clinical interventions. There is limited evidence on available integrated and multidimensional care pathways for multimorbid patients. An expert consensus meeting was held to develop a framework for care of multimorbid patients that can be applied across Europe, within a project funded by the European Union; the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS). The experts included a diverse group representing care providers and patients, and included general practitioners, family medicine physicians, neurologists, geriatricians, internists, cardiologists, endocrinologists, diabetologists, epidemiologists, psychologists, and representatives from patient organizations. Sixteen components across five domains were identified (Delivery of Care; Decision Support; Self Management Support; Information Systems and Technology; and Social and Community Resources). The description and aim of each component are described in these guidelines, along with a summary of key characteristics and relevance to multimorbid patients. Due to the lack of evidence-based recommendations specific to multimorbid patients, this care model needs to be assessed and validated in different European settings to examine specifically how multimorbid patients will benefit from this care model, and whether certain components have more importance than others.
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Affiliation(s)
- Katie Palmer
- The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy.
| | - Alessandra Marengoni
- The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Viale Europa 23, 25123, Brescia, Italy
| | - Maria João Forjaz
- National School of Public Health, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain
| | - Elena Jureviciene
- Vilnius University Hospital Santariskiu Klinikos (VULSK), g. 2, Vilnius, Lithuania
| | - Tiina Laatikainen
- National Institute for Health and Welfare, University of Eastern Finland, Finland; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Finland
| | - Federica Mammarella
- The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy
| | - Christiane Muth
- Institute of General Practice, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, D-60590 Frankfurt/Main, Germany
| | - Rokas Navickas
- Vilnius University Hospital Santariskiu Klinikos (VULSK), g. 2, Vilnius, Lithuania
| | - Alexandra Prados-Torres
- Aragon Health Sciences Institute, IIS Aragón, REDISSEC (ISCIII), University of Zaragoza, Pl +2, Paseo Isabel La Católica 1-3, 50009 Zaragoza, Spain
| | - Mieke Rijken
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, The Netherlands
| | - Ulrike Rothe
- Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Laurène Souchet
- European Patients' Forum (EPF) 31 rue du Commerce, 1000 Brussels, Belgium
| | - Jose Valderas
- Health Services & Policy Research, University of Exeter, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, United Kingdom
| | - Theodore Vontetsianos
- Sotiria General Hospital/1st RHA of Attica, Athens, 152 Mesogion Av., Athens 11527, Greece
| | - Jelka Zaletel
- National Institute of Public Health, Trubarjeva 2, 1000 Ljubljana, Slovenia
| | - Graziano Onder
- The Italian Medicines Agency (AIFA), 181 via del Tritone, 00187, Rome, Italy; Department of Geriatrics, Centre on Aging (CEMI), Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
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Gougeon L, Johnson J, Morse H. Interprofessional collaboration in health care teams for the maintenance of community-dwelling seniors' health and well-being in Canada: A systematic review of trials. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.xjep.2017.02.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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How’s Your Health at Home: Frail Homebound Patients Reported Health Experience and Outcomes. Can J Aging 2017; 36:273-285. [PMID: 28558857 DOI: 10.1017/s0714980817000186] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
RÉSUMÉPour notre sondage, nous avons utilisé une méthodologie mixte basée sur le Web (How’s Your Health – Frail) pour examiner la santé des adultes fragiles (78% âgés de 80 ans et plus) inscrits à un programme de soins primaires à domicile à Vancouver, au Canada. Soixante pour cent des répondants admissibles ont participé, représentant plus d’un quart (92/350, 26,2%) de tous les individus qui reçoivent le service. Malgré des niveaux élevés de co-morbidité et de dépendance fonctionnelle, 50% ont jugé leur santé aussi bonne, très bonne ou excellente. Les ratios de cotes ajustés pour l’auto-évaluation de sa santé positive étaient de 7,50, 95 pour cent d’intervalle de confiance (IC) [1,09, 51,81] et 4,85, 95% CI [1,02, 22,95] pour l’absence de symptômes gênants et le pouvoir de parler à la famille ou amis, respectivement. Des réponses narratives aux questions sur la fin de vie et la vie avec une maladie sont également décrites. Les résultats suggèrent que l’accent mis sur la gestion des symptômes, et le soutien des contacts sociaux, peut améliorer la santé des personnes âgées fragiles.
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Schamess A, Foraker R, Kretovics M, Barnes K, Beatty S, Bose-Brill S, Tayal N. Reduced emergency room and hospital utilization in persons with multiple chronic conditions and disability receiving home-based primary care. Disabil Health J 2017; 10:326-333. [DOI: 10.1016/j.dhjo.2016.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 09/14/2016] [Accepted: 10/07/2016] [Indexed: 02/04/2023]
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Smith-Carrier T, Sinha SK, Nowaczynski M, Akhtar S, Seddon G, Pham TNT. It 'makes you feel more like a person than a patient': patients' experiences receiving home-based primary care (HBPC) in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:723-733. [PMID: 27287281 DOI: 10.1111/hsc.12362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 06/06/2023]
Abstract
The lack of effective systems to appropriately manage the health and social care of frail older adults - especially among those who become homebound - is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care - which the office-based alternative provides little guarantee - and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population.
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Affiliation(s)
- Tracy Smith-Carrier
- School of Social Work, King's University College at Western University, London, Ontario, Canada
| | - Samir K Sinha
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Johns Hopkins University School of Medicine, Balitmore, Maryland, USA
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Nowaczynski
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- House Calls: Interdisciplinary Healthcare for Homebound Seniors, SPRINT Senior Care, Toronto, Ontario, Canada
| | - Sabrina Akhtar
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Home-Based Care Program, Toronto Western Family Health Team, Toronto, Ontario, Canada
| | - Gayle Seddon
- Toronto Central Community Care Access Centre, Toronto, Ontario, Canada
| | - Thuy-Nga Tia Pham
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- South East Toronto Family Health Team, Toronto, Ontario, Canada
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Di Pollina L, Guessous I, Petoud V, Combescure C, Buchs B, Schaller P, Kossovsky M, Gaspoz JM. Integrated care at home reduces unnecessary hospitalizations of community-dwelling frail older adults: a prospective controlled trial. BMC Geriatr 2017; 17:53. [PMID: 28196486 PMCID: PMC5310012 DOI: 10.1186/s12877-017-0449-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 02/11/2017] [Indexed: 11/27/2022] Open
Abstract
Background Care of frail and dependent older adults with multiple chronic conditions is a major challenge for health care systems. The study objective was to test the efficacy of providing integrated care at home to reduce unnecessary hospitalizations, emergency room visits, institutionalization, and mortality in community dwelling frail and dependent older adults. Methods A prospective controlled trial was conducted, in real-life clinical practice settings, in a suburban region in Geneva, Switzerland, served by two home visiting nursing service centers. Three hundred and one community-dwelling frail and dependent people over 60 years old were allocated to previously randomized nursing teams into Control (N = 179) and Intervention (N = 122) groups: Controls received usual care by their primary care physician and home visiting nursing services, the Intervention group received an additional home evaluation by a community geriatrics unit with access to a call service and coordinated follow-up. Recruitment began in July 2009, goals were obtained in July 2012, and outcomes assessed until December 2012. Length of follow-up ranged from 5 to 41 months (mean 16.3). Primary outcome measure was the number of hospitalizations. Secondary outcomes were reasons for hospitalizations, the number and reason of emergency room visits, institutionalization, death, and place of death. Results The number of hospitalizations did not differ between groups however, the intervention led to lower cumulative incidence for the first hospitalization after the first year of follow-up (69.8%, CI 59.9 to 79.6 versus 87 · 6%, CI 78 · 2 to 97 · 0; p = .01). Secondary outcomes showed that the intervention compared to the control group had less frequent unnecessary hospitalizations (4.1% versus 11.7%, p = .03), lower cumulative incidence for the first emergency room visit, 8.3%, CI 2.6 to 13.9 versus 23.2%, CI 13.1 to 33.3; p = .01), and death occurred more frequently at home (44.4 versus 14.7%; p = .04). No significant differences were found for institutionalization and mortality. Conclusions Integrated care that included a home visiting multidisciplinary geriatric team significantly reduced unnecessary hospitalizations, emergency room visits and allowed more patients to die at home. It is an effective tool to improve coordination and access to care for frail and dependent older adults. Trial registration Clinical Trials.gov Identifier: NCT02084108. Retrospectively registered on March 10th 2014.
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Affiliation(s)
- Laura Di Pollina
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 1, avenue Calas, Geneva, 1206, Switzerland.
| | - Idris Guessous
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 1, avenue Calas, Geneva, 1206, Switzerland. .,Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
| | - Véronique Petoud
- Institution genevoise de maintien à domicile (IMAD), Carouge, Switzerland
| | - Christophe Combescure
- Clinical Research Centre and Division of Clinical-Epidemiology, Department of Health and Community Medicine, University of Geneva and Geneva University Hospitals, Geneva, Switzerland
| | - Bertrand Buchs
- Association des médecins genevois (AMG), Geneva, Switzerland
| | | | - Michel Kossovsky
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 1, avenue Calas, Geneva, 1206, Switzerland
| | - Jean-Michel Gaspoz
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, Geneva University Hospitals, 1, avenue Calas, Geneva, 1206, Switzerland
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Feng MC, Murphy MR, Mlinac M. Independent Living Capacity Evaluation in Home-Based Primary Care: Considerations and Outcomes of a Quality Improvement Project. Clin Gerontol 2017; 40:51-62. [PMID: 28111494 PMCID: PMC5245922 DOI: 10.1080/07317115.2016.1210272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This article describes results of a quality improvement project review of 5 years of capacity evaluations for independent living conducted in one Home-Based Primary Care (HBPC) Program. METHODS A retrospective chart review was conducted for all patients evaluated for independent living capacity through the Boston VA HBPC Program (N = 25) to identify differences in outcomes for those with and without capacity. Descriptive information included referral sources, capacity decisions, time remaining in the home, and trajectory of patients following evaluation. RESULTS All patients evaluated had been diagnosed with a cognitive disorder, and on average, a relatively lower prevalence of mental illness compared with the national HBPC population. Referrals were made primarily by the HBPC team. Patients with capacity were found to have remained in their home longer than those who lacked capacity. CONCLUSIONS Referral for a higher level of care was typically only recommended when no further intervention could be implemented and active risk in the home could not be managed. CLINICAL IMPLICATIONS In home capacity evaluations are complex and challenging, yet results help family and HBPC team support patients' preferences for staying in their own home as long as possible.
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Affiliation(s)
| | - Margaret R Murphy
- VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - Michelle Mlinac
- VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
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Zhang J, Abrashkin KA, Poku A, Smith KL. Be Prepared: Emergency and After-Hours Calls in a Program for Frail Community-Dwelling Older Adults. J Am Geriatr Soc 2016; 64:e231-e233. [DOI: 10.1111/jgs.14460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jenny Zhang
- Department of Internal Medicine; Hofstra-Northwell School of Medicine; Hempstead New York
| | - Karen A. Abrashkin
- Department of Internal Medicine; Hofstra-Northwell School of Medicine; Hempstead New York
| | - Asantewaa Poku
- Department of Internal Medicine; Hofstra-Northwell School of Medicine; Hempstead New York
| | - Kristofer L. Smith
- Department of Internal Medicine; Hofstra-Northwell School of Medicine; Hempstead New York
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Effectiveness of comprehensive care programs for patients with multiple chronic conditions or frailty: A systematic literature review. Health Policy 2016; 120:818-32. [DOI: 10.1016/j.healthpol.2016.04.002] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 12/21/2022]
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Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement. Int J Cardiol 2016; 212:1-10. [PMID: 27015641 PMCID: PMC5646657 DOI: 10.1016/j.ijcard.2016.03.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/07/2016] [Indexed: 12/31/2022]
Abstract
Background Multimorbidity in heart failure (HF), defined as HF of any aetiology and multiple concurrent conditions that require active management, represents an emerging problem within the ageing HF patient population worldwide. Methods To inform this position paper, we performed: 1) an initial review of the literature identifying the ten most common conditions, other than hypertension and ischaemic heart disease, complicating the management of HF (anaemia, arrhythmias, cognitive dysfunction, depression, diabetes, musculoskeletal disorders, renal dysfunction, respiratory disease, sleep disorders and thyroid disease) and then 2) a review of the published literature describing the association between HF with each of the ten conditions. From these data we describe a clinical framework, comprising five key steps, to potentially improve historically poor health outcomes in this patient population. Results We identified five key steps (ARISE-HF) that could potentially improve clinical outcomes if applied in a systematic manner: 1) Acknowledge multimorbidity as a clinical syndrome that is associated with poor health outcomes, 2) Routinely profile (using a standardised protocol — adapted to the local health care system) all patients hospitalised with HF to determine the extent of concurrent multimorbidity, 3) Identify individualised priorities and person-centred goals based on the extent and nature of multimorbidity, 4) Support individualised, home-based, multidisciplinary, case management to supplement standard HF management, and 5) Evaluate health outcomes well beyond acute hospitalisation and encompass all-cause events and a person-centred perspective in affected individuals. Conclusions We propose ARISE-HF as a framework for improving typically poor health outcomes in those affected by multimorbidity in HF.
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Riegel B, Masterson Creber R, Hill J, Chittams J, Hoke L. Effectiveness of Motivational Interviewing in Decreasing Hospital Readmission in Adults With Heart Failure and Multimorbidity. Clin Nurs Res 2016; 25:362-77. [PMID: 26743119 DOI: 10.1177/1054773815623252] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Hospitalizations are common in heart failure (HF). Multimorbidity, defined as ≥2 comorbid conditions, drives many readmissions. The purpose of this pilot study was to test the effectiveness of motivational interviewing (MI) in decreasing these hospital readmissions. We enrolled 100 hospitalized HF patients into a randomized controlled trial, randomizing in a 2:1 ratio: intervention (n = 70) and control (n = 30). The intervention group received MI tailored to reports of self-care during one home visit and three to four follow-up phone calls. After 3 months, 34 participants had at least one hospital readmission. The proportion of patients readmitted for a condition unrelated to HF was lower in the intervention (7.1%) compared with the control group (30%, p = .003). Significant predictors of a non-HF readmission were intervention group, age, diabetes, and hemoglobin. Together, these variables explained 35% of the variance in multimorbidity readmissions. These preliminary results are promising in suggesting that MI may be an effective method of decreasing multimorbidity hospital readmissions in HF patients.
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Affiliation(s)
- Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | | | - Julia Hill
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Jesse Chittams
- University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Linda Hoke
- Hospital of the University of Pennsylvania, Philadelphia, USA
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Laudisio A, Marzetti E, Franceschi F, Bernabei R, Zuccalà G. Disability is associated with emergency room visits in the elderly: a population-based study. Aging Clin Exp Res 2015; 27:663-71. [PMID: 25680781 DOI: 10.1007/s40520-015-0324-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 01/24/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Emergency room (ER) visits and hospitalizations of elderly subjects with chronic comorbidities, often disabled, are increasing. AIMS The aim of the present study was to assess whether among older subjects functional disability is associated with increased ER visits and hospitalization rates. METHODS We assessed the association of functional ability with 1-year ER visits and hospitalization rates in all 342 subjects aged 75+ living in Tuscania (Italy) in 2004. Functional ability was estimated using the Katz' activities of daily living (ADLs), and the Lawton and Brody scale for the instrumental activities of daily living (IADLs). Functional disability was defined as the dependence for two or more ADLs or IADLs. RESULTS According to Cox regression, disability in ADLs was associated with increased risk of ER visits (RR 2.12; 95 % CI 1.11-4.08; P = .023) but not of hospital admission (RR 1.50; 95 % CI .80-2.80; P = .208). Also, in Poisson regression, ADLs disability predicted the number of ER visits (IRR 2.56; 95 % CI 1.48-4.40; P = .001). DISCUSSION Disability is associated with increased risk of ER visits, but not of subsequent hospitalization in community-dwelling elderly, independent of clinical conditions. Dedicated studies are needed to evaluate the impact of social interventions for disabled elderly on ER access rates. CONCLUSIONS Emergency Departments should implement innovative triage procedures to identify older patients with disability who gain access to ER, to recognize and classify any unmet social needs.
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Affiliation(s)
- Alice Laudisio
- Department of Gerontology, Campus Bio-Medico University, Via Álvaro del Portillo, 200, 00128, Rome, Italy.
| | - Emanuele Marzetti
- Department of Gerontology and Geriatrics, Catholic University of Medicine, Rome, Italy
| | | | - Roberto Bernabei
- Department of Gerontology and Geriatrics, Catholic University of Medicine, Rome, Italy
| | - Giuseppe Zuccalà
- Emergency Department, Catholic University of Medicine, Rome, Italy
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Fan L, Lukin W, Zhao J, Sun J, Hou XY. Interventions targeting the elderly population to reduce emergency department utilisation: a literature review. Emerg Med J 2014; 32:738-43. [DOI: 10.1136/emermed-2014-203770] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 11/27/2014] [Indexed: 11/03/2022]
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Stall N, Nowaczynski M, Sinha SK. Systematic review of outcomes from home-based primary care programs for homebound older adults. J Am Geriatr Soc 2014; 62:2243-51. [PMID: 25371236 DOI: 10.1111/jgs.13088] [Citation(s) in RCA: 127] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the effect of home-based primary care for homebound older adults on individual, caregiver, and systems outcomes. DESIGN A systematic review of home-based primary care interventions for community-dwelling older adults (aged ≥65) using the Cochrane, PubMed, and MEDLINE databases from the earliest available date through March 15, 2014. Studies were included if the house calls visitor was the ongoing primary care provider and if the intervention measured emergency department visits, hospitalizations, hospital beds days of care, long-term care admissions, or long-term care bed days of care. SETTING Home-based primary care programs. PARTICIPANTS Homebound community-dwelling older adults (N = 46,154). MEASUREMENTS Emergency department visits, hospitalizations, hospital bed days of care, long-term care admissions, long-term care bed days of care, costs, program design, and individual and caregiver quality of life and satisfaction with care. RESULTS Of 357 abstracts identified, nine met criteria for review. The nine interventions were all based in North America, with five emerging from the Veterans Affairs system. Eight of nine programs demonstrated substantial effects on at least one inclusion outcome, with seven programs affecting two outcomes. Six interventions shared three core program components: interprofessional care teams, regular interprofessional care meetings, and after-hours support. CONCLUSION Specifically designed home-based primary care programs may substantially affect individual, caregiver and systems outcomes. Adherence to the core program components identified in this review could guide the development and spread of these programs.
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Affiliation(s)
- Nathan Stall
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Naslund JA, Sauter AH, Gutman G, Beattie BL. Increased health service utilization costs in the year prior to institutionalization: findings from the canadian study of health and aging. Can Geriatr J 2014; 17:45-52. [PMID: 24883162 PMCID: PMC4038535 DOI: 10.5770/cgj.17.82] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The objective of this study was to characterize patterns of formal health service utilization costs during older adults' transition from community to institutional care. METHODS Participants were 127 adults (age ≥ 65) from the British Columbia sample (N = 2,057) of the Canadian Study of Health and Aging who transitioned from community to institutional care between 1991 and 2001. Health service utilization costs were measured using Cost-Per-Day-At-Risk at five time points: > 12 months, 6-12 months, and ≤ 6 months preinstitutionalization, and ≤ 6 months and 6-12 months postinstitutionalization. Cost-Per-Day-At-Risk was measured for Continuing Care, Medical Services Plan, and PharmaCare costs by calculating total health service use over time, divided by the number of days the participant was alive. RESULTS Significant differences in Cost-Per-Day-At-Risk were observed for Continuing Care, Medical Services Plan, and PharmaCare costs over time. All health service utilization costs increased significantly during the 6-12 months and ≤ 6 months prior to institutionalization. Postinstitutionalization Continuing Care costs continued to increase at ≤ 6 months before decreasing at 6-12 months, while decreases occurred for Medical Services Plan and PharmaCare costs relative to preinstitutionalization costs. CONCLUSIONS The increases in costs observed during the year prior to institutionalization, characterized by a flurry of health service utilization, provide evidence of distinct cost patterns over the transition period.
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Affiliation(s)
- John A. Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Hanover, NH, USA
| | - Agnes H. Sauter
- University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Gloria Gutman
- Gerontology Research Center, Simon Fraser University Vancouver Campus, Vancouver, BC, Canada
| | - B. Lynn Beattie
- Department of Medicine, Division of Geriatric Medicine, University of British Columbia, Vancouver, BC, Canada
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P. Sloan J. Joining up care around the individual – lessons from Vancouver. JOURNAL OF INTEGRATED CARE 2014. [DOI: 10.1108/jica-11-2013-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to describe lessons learned from a homecare practice for frail elderly people.
Design/methodology/approach
– It is strictly a description of a point of view in respect of care of frailty designed to avoid institution.
Findings
– Generally, frail elderly patients choose care focused on comfort and function as opposed to the traditional systematic healthcare goals of rescue and prevention. This choice should be respected.
Research limitations/implications
– There are no formal research findings.
Practical implications
– Cost-saving as well as improvement in care is possible through team-based relationship-oriented homecare of the frail elderly where that care emphasizes comfort and function.
Originality/value
– This paper is authored by Dr John Sloan and is entirely original.
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Emergency department visit rates and patterns in Canada's Vancouver coastal health region. Can J Aging 2014; 33:154-62. [PMID: 24690211 DOI: 10.1017/s0714980814000038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This study used administrative health data to describe emergency department (ED) visits by residents from assisted living and nursing home facilities in the Vancouver Coastal Health region, British Columbia. We compared ED visit rates, the distribution of visits per resident, and ED dispositions of the assisted living and nursing home populations over a 3-year period (2005-2008). There were 13,051 individuals in our study population. Visit rates (95% confidence interval) were 124.8 (118.1-131.7) and 64.1 (62.9-65.3) visits per 100 resident years in assisted living and nursing home facilities respectively. A smaller proportion of ED visits by assisted living residents resulted in hospital admission compared to nursing home residents (45% vs. 48%, p < .01). The ED visit rate among assisted living residents is significantly higher compared to that among nursing home residents. Future research is needed into the underlying causes for this finding.
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Abstract
To make a difference to patients who increasingly suffer multiple chronic conditions, in a healthcare system that is capable of providing excellent care but is often ineffective and at cross-purposes in its application, means being prepared to take a different approach not only to the delivery of patient care, but to the education of physicians and other healthcare professionals. The model we must now practice and teach is one that emphasizes collaboration and prevention, quality and efficiency. Changes in practice recommended by the 2001 US Institute of Medicine report are being implemented system-wide, following the enactment of the US Patient Protection and Affordable Care Act. This paper discusses the evolving needs of patients with chronic psychiatric illness, and the psychiatrist's role in a rapidly changing healthcare landscape as a care provider, an interdisciplinary role model, and educator. In an aging population in which multi-morbidity is the norm, episodic, crisis-driven care is prohibitively expensive and does not serve patients well. Yet we still teach that model of care. The medications we prescribe for psychiatric illness, particularly antipsychotics, can cause and/or aggravate some of the commonest chronic medical illnesses; psychiatric educators must address the management of these complications. The management of chronic psychiatric illness in multi-morbid patients demands that we practice and teach a 'whole patient' approach to care, preferably delivered as part of a patient-centred team. The Affordable Care Act has mandated and created opportunities for new models designed to facilitate this, and a paradigm shift is needed in medical education. Clinicians must become adept at identifying underlying and contributing factors and collaborating with the patient, other providers, and the patient's family and significant others. Psychiatric formulation and patient care rely on these principles; we must now teach their application to other specialties, disciplines and professions.
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Affiliation(s)
- Deirdre Johnston
- Department of Psychiatry and Behavioural Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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