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Bowling CB, Sloane R, Pieper C, Luciano A, Davis BR, Simpson LM, Einhorn PT, Oparil S, Muntner P. Sustained SBP control and long-term nursing home admission among Medicare beneficiaries. J Hypertens 2021; 39:2258-2264. [PMID: 34232161 PMCID: PMC9194789 DOI: 10.1097/hjh.0000000000002926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Sustaining SBP control reduces the risk for cardiovascular events that impair function but its association with nursing home admission has not been well studied. METHODS We conducted an analysis of sustained SBP control and long-term nursing home admissions using data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) linked to Medicare claims restricted to participants with fee-for-service coverage, at least eight study visits with SBP measurements, who were not living in a nursing home during a 48-month baseline BP assessment period (n = 6557). Sustained SBP control was defined as less than 140 mmHg at less than 50%, 50% to less than 75%, 75% to less than 100%, and 100% of visits. Nursing home admissions were identified using the Medicare Long Term Care Minimum Data Set. RESULTS The mean age of participants was 73.8 years and 44.3% were men. Over a median follow-up of 9.2 years, 844 participants (12.8%) had a nursing home admission. Rates of nursing home admission per 100 person-years were 16.3 for participants with SBP control at less than 50%, 14.1 at 50% to less than 75%, 7.8 at 75% to less than 100%, and 5.3 at 100% of visits. Compared with those with sustained SBP control at less than 50% of visits, hazard ratios (95% confidence intervals) for nursing home admission were 0.79 (0.66-0.93), 0.70 (0.58-0.84), and 0.57 (0.44-0.74) among participants with SBP control at 50% to less than 75%, 75% to less than 100%, and 100% of visits, respectively. CONCLUSION Among Medicare beneficiaries in ALLHAT, sustained SBP control was associated with a lower risk of long-term nursing home admission.
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Affiliation(s)
- C. Barrett Bowling
- Durham Veterans Affairs Geriatric Research Education and Clinical Center, Durham Veterans Affairs Medical Center (VAMC), Durham, NC
- Department of Medicine, Duke University, Durham, NC
| | - Richard Sloane
- Center for Study of Aging and Human Development, Duke University, Durham, NC
| | - Carl Pieper
- Center for Study of Aging and Human Development, Duke University, Durham, NC
| | - Alison Luciano
- Center for Study of Aging and Human Development, Duke University, Durham, NC
| | - Barry R. Davis
- The University of Texas School of Public Health, Houston, TX
| | - Lara M. Simpson
- The University of Texas School of Public Health, Houston, TX
| | - Paula T. Einhorn
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, MD
| | - Suzanne Oparil
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
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Sezgin D, O'Caoimh R, O'Donovan MR, Salem MA, Kennelly S, Samaniego LL, Carda CA, Rodriguez-Acuña R, Inzitari M, Hammar T, Holditch C, Bettger JP, Vernon M, Carroll Á, Gradinger F, Perman G, Wilson M, Vella A, Cherubini A, Tucker H, Fantini MP, Onder G, Roller-Wirnsberger R, Gutiérrez-Robledo LM, Cesari M, Bertoluci P, Kieliszek M, van der Vlegel-Brouwer W, Nelson M, Mañas LR, Antoniadou E, Barriere F, Lindblom S, Park G, Pérez I, Alguacil D, Lowdon D, Alkiza ME, Bouzon CA, Young J, Carriazo A, Liew A, Hendry A. Defining the characteristics of intermediate care models including transitional care: an international Delphi study. Aging Clin Exp Res 2020; 32:2399-2410. [PMID: 32430887 DOI: 10.1007/s40520-020-01579-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although there is growing utilisation of intermediate care to improve the health and well-being of older adults with complex care needs, there is no international agreement on how it is defined, limiting comparability between studies and reducing the ability to scale effective interventions. AIM To identify and define the characteristics of intermediate care models. METHODS A scoping review, a modified two-round electronic Delphi study involving 27 multi-professional experts from 13 countries, and a virtual consensus meeting were conducted. RESULTS Sixty-six records were included in the scoping review, which identified four main themes: transitions, components, benefits and interchangeability. These formed the basis of the first round of the Delphi survey. After Round 2, 16 statements were agreed, refined and collapsed further. Consensus was established for 10 statements addressing the definitions, purpose, target populations, approach to care and organisation of intermediate care models. DISCUSSION There was agreement that intermediate care represents time-limited services which ensure continuity and quality of care, promote recovery, restore independence and confidence at the interface between home and acute services, with transitional care representing a subset of intermediate care. Models are best delivered by an interdisciplinary team within an integrated health and social care system where a single contact point optimises service access, communication and coordination. CONCLUSIONS This study identified key defining features of intermediate care to improve understanding and to support comparisons between models and studies evaluating them. More research is required to develop operational definitions for use in different healthcare systems.
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Affiliation(s)
- Duygu Sezgin
- College of Medicine, Nursing and Health Sciences, National University of Ireland Galway, Galway City, Ireland
| | - Rónán O'Caoimh
- Department of Geriatric Medicine, Mercy University Hospital Cork, Cork City, Ireland.
| | - Mark R O'Donovan
- Clinical Sciences Institute, National University of Ireland Galway, Galway City, Ireland
| | | | - Siobhán Kennelly
- Older Person's Programme, Health Service Executive, Dublin, Ireland
| | | | | | | | - Marco Inzitari
- Parc Sanitari Pere Virgili, Vall D'Hebrón Institute of Research (VHIR), and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teija Hammar
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | | | | | - Martin Vernon
- NHS England, London, England
- Manchester University NHS Foundation Trust, London, England
| | - Áine Carroll
- University College Dublin, Dublin, Ireland
- National Rehabilitation Hospital, Dún Laoghaire, County Dublin, Ireland
| | - Felix Gradinger
- University of Plymouth, Plymouth, England
- Torbay and South Devon NHS Foundation Trust, Torbay, England
| | - Gaston Perman
- Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martin Wilson
- Raigmore Hospital Inverness NHS Highland, Inverness, Scotland
| | - Antoine Vella
- Department of Geriatric Medicine, University of Malta, Msida, Malta
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di Ricerca Per L'invecchiamento, IRCCS INRCA, Ancona, Italy
| | - Helen Tucker
- Community Hospitals Association (UK), University of Winchester, Winchester, England
| | - Maria Pia Fantini
- Post-Graduate Medical School in Hygiene and Preventive Medicine, Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Graziano Onder
- Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy
| | | | | | - Matteo Cesari
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università Degli Studi di Milano, Milan, Italy
| | - Paula Bertoluci
- Alves Pereira, Public Health School, University of São Paulo (FSP/USP), São Paulo, Brazil
| | - Magdalena Kieliszek
- Center for Innovation and Technology Transfer, Medical University of Lodz, Lodz, Poland
| | | | - Michelle Nelson
- Lunenfeld-Tanenbaum Research Institute, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | | | - François Barriere
- Pilote MAIA 13 Projets Parcours Pays Salonais, Pays Salonais, France
| | - Sebastian Lindblom
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Grace Park
- Fraser Health Authority, British Columbia, Canada
| | - Isidoro Pérez
- Regional Ministry of Health and Families of Andalusia (CSFJA), Seville, Spain
| | - Dolores Alguacil
- Andalusian Health Service (Servicio Andaluz de Salud, SAS), Seville, Spain
| | | | | | | | | | - Ana Carriazo
- Regional Ministry of Health and Families of Andalusia (CSFJA), Seville, Spain
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
- Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | - Anne Hendry
- NHS Lanarkshire, Glasgow, Scotland
- University of the West of Scotland, Glasgow, Scotland
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Sezgin D, O'Caoimh R, Liew A, O'Donovan MR, Illario M, Salem MA, Kennelly S, Carriazo AM, Lopez-Samaniego L, Carda CA, Rodriguez-Acuña R, Inzitari M, Hammar T, Hendry A. The effectiveness of intermediate care including transitional care interventions on function, healthcare utilisation and costs: a scoping review. Eur Geriatr Med 2020; 11:961-974. [PMID: 32754841 PMCID: PMC7402396 DOI: 10.1007/s41999-020-00365-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/11/2020] [Indexed: 11/30/2022]
Abstract
Aim This scoping review examined the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Findings While some studies report positive outcomes on hospital utilisation, the evidence is limited for their effectiveness on emergency department attendances, institutionalisation, function, and cost-effectiveness. Message Intermediate care including transitional care interventions were associated with reduced hospital stay but this finding was not universal. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users. Background and aim Intermediate care describes services, including transitional care, that support the needs of middle-aged and older adults during care transitions and between different settings. This scoping review aimed to examine the effectiveness of intermediate care including transitional care interventions for middle-aged and older adults on function, healthcare utilisation, and costs. Design A scoping review of the literature was conducted including studies published between 2002 and 2019 with a transitional care and/or intermediate care intervention for adults aged ≥ 50. Searches were performed in CINAHL, Cochrane Library, EMBASE, Open Grey and PubMed databases. Qualitative and quantitative approaches were employed for data synthesis. Results In all, 133 studies were included. Interventions were grouped under four models of care: (a) Hospital-based transitional care (n = 8), (b) Transitional care delivered at discharge and up to 30 days after discharge (n = 70), (c) Intermediate care at home (n = 41), and (d) Intermediate care delivered in a community hospital, care home or post-acute facility (n = 14). While these models were associated with a reduced hospital stay, this was not universal. Intermediate including transitional care services combined with telephone follow-up and coaching support were reported to reduce short and long-term hospital re-admissions. Evidence for improved ADL function was strongest for intermediate care delivered by an interdisciplinary team with rehabilitation at home. Study design and types of interventions were markedly heterogenous, limiting comparability. Conclusions Although many studies report that intermediate care including transitional care models reduce hospital utilisation, results were mixed. There is limited evidence for the effectiveness of these services on function, institutionalisation, emergency department attendances, or on cost-effectiveness. Electronic supplementary material The online version of this article (10.1007/s41999-020-00365-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Duygu Sezgin
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland.
| | - Rónán O'Caoimh
- Department of Geriatric Medicine, Mercy University Hospital Cork, Cork, Ireland.,Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland
| | - Aaron Liew
- Clinical Sciences Institute, National University of Ireland Galway, Galway, Ireland.,Department of Endocrinology, Portiuncula University Hospital, Ballinasloe, Co Galway, Ireland
| | | | - Maddelena Illario
- Campania Region Health Innovation Unit, and Federico II Department of Public Health, Naples, Italy
| | | | - Siobhán Kennelly
- Royal College of Surgeons in Ireland Connolly Hospital, Dublin and Health Service Executive, Dublin, Ireland
| | | | | | - Cristina Arnal Carda
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall D'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Marco Inzitari
- REFiT Barcelona Research Group, Parc Sanitari Pere Virgili and Vall D'Hebron Institute of Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Teija Hammar
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Anne Hendry
- NHS Lanarkshire, Bothwell, UK.,School of Health and Life Sciences, University of the West of Scotland, Hamilton, UK
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