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Marsall M, Hornung T, Bäuerle A, Weigl M. Quality of care transition, patient safety incidents, and patients' health status: a structural equation model on the complexity of the discharge process. BMC Health Serv Res 2024; 24:576. [PMID: 38702719 PMCID: PMC11069201 DOI: 10.1186/s12913-024-11047-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 04/25/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The transition of patients between care contexts poses patient safety risks. Discharges to home from inpatient care can be associated with adverse patient outcomes. Quality in discharge processes is essential in ensuring safe transitions for patients. Current evidence relies on bivariate analyses and neglects contextual factors such as treatment and patient characteristics and the interactions of potential outcomes. This study aimed to investigate the associations between the quality and safety of the discharge process, patient safety incidents, and health-related outcomes after discharge, considering the treatments' and patients' contextual factors in one comprehensive model. METHODS Patients at least 18 years old and discharged home after at least three days of inpatient treatment received a self-report questionnaire. A total of N = 825 patients participated. The assessment contained items to assess the quality and safety of the discharge process from the patient's perspective with the care transitions measure (CTM), a self-report on the incidence of unplanned readmissions and medication complications, health status, and sociodemographic and treatment-related characteristics. Statistical analyses included structural equation modeling (SEM) and additional analyses using logistic regressions. RESULTS Higher quality of care transition was related to a lower incidence of medication complications (B = -0.35, p < 0.01) and better health status (B = 0.74, p < 0.001), but not with lower incidence of readmissions (B = -0.01, p = 0.39). These effects were controlled for the influences of various sociodemographic and treatment-related characteristics in SEM. Additional analyses showed that these associations were only constant when all subscales of the CTM were included. CONCLUSIONS Quality and safety in the discharge process are critical to safe patient transitions to home care. This study contributes to a better understanding of the complex discharge process by applying a model in which various contextual factors and interactions were considered. The findings revealed that high quality discharge processes are associated with a lower likelihood of patient safety incidents and better health status at home even, when sociodemographic and treatment-related characteristics are taken into account. This study supports the call for developing individualized, patient-centered discharge processes to strengthen patient safety in care transitions.
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Affiliation(s)
- Matthias Marsall
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany.
| | | | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Matthias Weigl
- Institute for Patient Safety (IfPS), University Hospital Bonn, Bonn, Germany
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Wahyudi ER, Ronoatmodjo S, Setiati S, Besral, Soejono CH, Kuswardhani T, Fitriana I, Marsigit J, Putri SA, Harmany GRT. The risk of rehospitalization within 30 days of discharge in older adults with malnutrition: A meta-analysis. Arch Gerontol Geriatr 2024; 118:105306. [PMID: 38071901 DOI: 10.1016/j.archger.2023.105306] [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: 06/01/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION Malnutrition is a global health problem associated with higher rehospitalization risk, subsequently increasing the risks of adverse complications, and mortality in older individuals. Nevertheless, studies investigating this are still scarce, and even fewer reviewed and aggregated. A number of studies have recently assessed the correlation of malnourishment with rehospitalization among older adults. OBJECTIVE/AIM This systematic review and meta-analysis aimed to elaborate the correlation between malnutrition and 30-day rehospitalization in older adults. METHODS Systematic review was conducted on literatures from Cochrane, ScienceDirect, SpringerLink, Oxford Academic, and MEDLINE according to PRISMA Guideline, investigating the correlation of malnutrition in older adults with rehospitalization, using Malnutrition, Older Adults, and Rehospitalization as keywords. Meta-analysis was done using RevMan, with random-effect analysis model. P values of ≤0.05 were considered statistically significant with results reported as risk ratios (RR), mean differences (MD), 95 % confidence intervals (CI) and I2 statistics. RESULTS Seven literatures were analysed, consisting of 19,340 patients aged 65 or older undergoing hospitalization. Subjects were assessed with screening tools to identify malnutrition. Malnourished subjects are compared to others with normal nutrition; in cohort studies with follow-up period ranging from 3 to 16 months. Malnutrition significantly increased the risks of rehospitalization within 30 days (RR 1.73 [95 % CI 1.10-2.72], p = 0.02, I2 = 56 %), overall rehospitalization at all times (RR 1.33 [95 % CI 1.16-1.52], p < 0.0001, I2 = 75 %), and overall mortality (RR 2.66 [95 % CI 1.09-6.50], p = 0.03, I2 = 94 %). CONCLUSION Malnutrition exhibited significant consequences in older patients regarding the rate of rehospitalization and mortality based on this meta-analysis. Further research is highly encouraged to verify this finding.
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Affiliation(s)
- Edy Rizal Wahyudi
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia; Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Sudarto Ronoatmodjo
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia
| | - Siti Setiati
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia; Center of Clinical Epidemiology and Evidence-Based Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia
| | - Besral
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia
| | - Czeresna Heriawan Soejono
- Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Kampus Baru UI Depok, West Java, Indonesia; Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Tuty Kuswardhani
- Geriatric Division, KSM Department of Internal Medicine, Prof. Ngoerah Hospital, Faculty of Medicine, Universitas Udayana, Denpasar, Bali, Indonesia
| | - Ika Fitriana
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Jessica Marsigit
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia; Faculty of Medicine, Universitas Indonesia, Salemba, Jakarta, Indonesia
| | - Stella Andriana Putri
- Department of Internal Medicine, Dr. Cipto Mangunkusumo Hospital, Salemba, Jakarta, Indonesia
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Leth SV, Graversen SB, Lisby M, StØvring H, SandbÆk A. Patients with repeated acute admissions to somatic departments: sociodemographic characteristics, disease burden, and contact with primary healthcare sector - a retrospective register-based case-control study. Scand J Public Health 2024:14034948241230142. [PMID: 38385163 DOI: 10.1177/14034948241230142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Healthcare systems face escalating capacity challenges and patients with repeated acute admissions strain hospital resources disproportionately. However, studies investigating the characteristics of such patients across all public healthcare providers in a universal healthcare system are lacking. OBJECTIVE To investigate characteristics of patients with repeated acute admissions (three or more acute admissions within a calendar year) in regard to sociodemographic characteristics, disease burden, and contact with the primary healthcare sector. METHODS This matched register-based case-control study investigated repeated acute admissions from 1 January 2014 to 31 December 2018, among individuals, who resided in four Danish municipalities. The study included 6169 individuals with repeated acute admissions, matched 1:4 to individuals with no acute admissions and one to two acute admissions, respectively. Group comparisons were conducted using conditional logistic regression. RESULTS Receiving social benefits increased the odds of repeated acute admissions 9.5-fold compared with no acute admissions (odds ratio (OR) 9.5; 95% confidence interval (CI) 8.5; 10.6) and 3.4-fold compared with one to two acute admissions (OR 3.4; 95% CI 3.1; 3.7). The odds of repeated acute admissions increased with the number of used medications and chronic diseases. Having a mental illness increased the odds of repeated acute admissions 5.8-fold when compared with no acute admissions (OR 5.7; 95% CI 5.2; 6.4) and 2.3-fold compared with one to two acute admissions (OR 2.3; 95% CI 2.1; 2.5). Also, high use of primary sector services (e.g. nursing care) increased the odds of repeated acute admissions when compared with no acute admissions and one to two acute admissions. CONCLUSIONS This study pinpointed key factors encompassing social status, disease burden, and healthcare utilisation as pivotal markers of risk for repeated acute admissions, thus identifying high-risk patients and facilitating targeted intervention.
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Affiliation(s)
- Sara V Leth
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
| | | | - Marianne Lisby
- Research Center for Emergency Medicine, Aarhus University Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Henrik StØvring
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | - Annelli SandbÆk
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
- Department of Public Health, Aarhus University, Denmark
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Parker SM, Aslani P, Harris-Roxas B, Wright MC, Barr M, Doolan-Noble F, Javanparast S, Sharma A, Osborne RH, Cullen J, Harris E, Haigh F, Harris M. Community health navigator-assisted transition of care from hospital to community: protocol for a randomised controlled trial. BMJ Open 2024; 14:e077877. [PMID: 38309760 PMCID: PMC10840031 DOI: 10.1136/bmjopen-2023-077877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION The objective of this parallel group, randomised controlled trial is to evaluate a community health navigator (CHN) intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes. Unplanned hospital readmissions are costly for the health system and negatively impact patients. METHODS AND ANALYSIS Patients are randomised post hospital discharge to the CHN intervention or usual care. A comparison of outcomes between intervention and control groups will use multivariate regression techniques that adjust for age, sex and any independent variables that are significantly different between the two groups, using multiple imputation for missing values. Time-to-event analysis will examine the relationship between seeing a CHN following discharge from the index hospitalisation and reduced rehospitalisations in the subsequent 60 days and 6 months. Secondary outcomes include medication adherence, health literacy, quality of life, experience of healthcare and health service use (including the cost of care). We will also conduct a qualitative assessment of the implementation of the navigator role from the viewpoint of stakeholders including patients, health professionals and the navigators themselves. ETHICS APPROVAL Ethics approval was obtained from the Research Ethics and Governance Office, Sydney Local Health District, on 21 January 2022 (Protocol no. X21-0438 and 2021/ETH12171). The findings of the trial will be disseminated through peer-reviewed journals and national and international conference presentations. Data will be deposited in an institutional data repository at the end of the trial. This is subject to Ethics Committee approval, and the metadata will be made available on request. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN 12622000659707). ARTICLE SUMMARY The objective of this trial is to evaluate a CHN intervention provided to patients aged over 40 years and living with chronic health conditions to transition from hospital inpatient care to their homes.
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Affiliation(s)
- Sharon M Parker
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Parisa Aslani
- Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales, Australia
| | - Ben Harris-Roxas
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael C Wright
- Health Economics Research and Evaluation, University of Technology, Sydney, New South Wales, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - F Doolan-Noble
- General Practice and Rural Health, University of Otago, Dunedin, New Zealand
| | - Sara Javanparast
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Anurag Sharma
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Richard H Osborne
- Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - John Cullen
- Aged Health, Rehabilitation and Chronic Care, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Elizabeth Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Haigh
- Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Saragosa M, Zagrodney KAP, Rabeenthira P, King EC, McKay SM. How Might We Have Known? Using Administrative Data to Predict 30-Day Hospital Readmission in Clients Receiving Home Care Services from 2018 to 2021. Health Serv Insights 2023; 16:11786329231211774. [PMID: 38028118 PMCID: PMC10644727 DOI: 10.1177/11786329231211774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Reducing hospital readmissions can improve individual health outcomes and lower system-level costs. This study aimed to understand the characteristics of home care Personal Support clients who experienced a hospital admission (ie, hospital hold) and to identify factors that predict hospital readmission within 30 days of resuming home care Personal Support services. Methods We conducted a retrospective cohort study using client administrative data from a home healthcare provider organization (2018-2021). The sample included clients (⩾18 years) who received publicly funded Personal Support services and experienced a hospital hold. Descriptive statistics and a binary logistic regression model analyzed the relationship between demographics, hospital service utilization, home care service utilization, and contextual factors on the outcome of 30-day hospital readmission. Results Approximately 17% (n = 662) of all clients with a hospital hold (n = 3992) were readmitted to hospital within 30 days. Compared with non-readmitted clients, those with greater home care Personal Support service intensity after the index hospital hold were less likely to experience a hospital 30-day readmission. In contrast, those with greater acuity, higher assessed care needs, more hospital holds overall, more extended hospital stays (⩾2 weeks), and lower social support had a higher likelihood of 30-day hospital readmission. Conclusion The findings from this study provide a greater understanding of factors associated with home care clients' risk of hospital readmission within 30 days and can be used to inform targeted, evidence-based support to reduce home care clients' hospital readmissions.
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Affiliation(s)
- Marianne Saragosa
- VHA Home HealthCare, Toronto, ON, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
- Science of Care Insitute, Sinai Health, Toronto, ON, Canada
| | - Katherine AP Zagrodney
- VHA Home HealthCare, Toronto, ON, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
- Canadian Health Workforce Network, University of Ottawa, Ottawa, ON, Canada
| | - Prakathesh Rabeenthira
- VHA Home HealthCare, Toronto, ON, Canada
- Public Health Agency of Canada, Toronto, ON, Canada
| | - Emily C King
- VHA Home HealthCare, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sandra M McKay
- VHA Home HealthCare, Toronto, ON, Canada
- Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Ted Rogers School of Management, Toronto Metropolitan University, Toronto, ON, Canada
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Tsai YC, Chen YM, Wen CJ, Wu MC, Chou YC, Chen JH, Lin KP, Chan DC, Lu FP. Multimorbidity and prior falls correlate with risk of 30-day hospital readmission in aged 80+: A prospective cohort study. J Formos Med Assoc 2023; 122:1111-1116. [PMID: 36990860 DOI: 10.1016/j.jfma.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: 05/30/2022] [Revised: 02/16/2023] [Accepted: 03/07/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND/PURPOSE Thirty-day hospital readmission rate significantly raised with advanced age. The performance of existing predictive models for readmission risk remained uncertain in the oldest population. We aimed to examine the effect of geriatric conditions and multimorbidity on readmission risk among older adults aged 80 and over. METHODS This prospective cohort study enrolled patients aged 80 and older discharged from a geriatric ward at a tertiary hospital, with phone follow-up for 12 months. Demographics, multimorbidity, and geriatric conditions were assessed before hospital discharge. Logistic regression models were conducted to analyse risk factors for 30-day readmission. RESULTS Patients readmitted had higher Charlson comorbidity index scores, and were more likely to have falls, frailty, and longer hospital stay, compared to those without 30-day readmission. Multivariate analysis revealed that higher Charlson comorbidity index score was associated with readmission risk. Older patients with a fall history within 12 months had a near 4-fold increase in readmission risk. Severe frailty status before index admission was associated with a higher 30-day readmission risk. Functional status at discharge was not associated with readmission risk. CONCLUSION In addition to multimorbidity, history of falls and frailty were associated with higher hospital readmission risk in the oldest.
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Affiliation(s)
- Yu-Chieh Tsai
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yung-Ming Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chiung-Jung Wen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meng-Chen Wu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chun Chou
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Feng-Ping Lu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Thomas RE, Azzopardi R, Asad M, Tran D. Multi-Year Retrospective Analysis of Mortality and Readmissions Correlated with STOPP/START and the American Geriatric Society Beers Criteria Applied to Calgary Hospital Admissions. Geriatrics (Basel) 2023; 8:100. [PMID: 37887973 PMCID: PMC10606166 DOI: 10.3390/geriatrics8050100] [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: 08/12/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction: The goals of this retrospective cohort study of 129,443 persons admitted to Calgary acute care hospitals from 2013 to 2021 were to ascertain correlations of "potentially inappropriate medications" (PIMs), "potential prescribing omissions" (PPOs), and other risk factors with readmissions and mortality. Methods: Processing and analysis codes were built in Oracle Database 19c (PL/SQL), R, and Excel. Results: The percentage of patients dying during their hospital stay rose from 3.03% during the first admission to 7.2% during the sixth admission. The percentage of patients dying within 6 months of discharge rose from 9.4% after the first admission to 24.9% after the sixth admission. Odds ratios were adjusted for age, gender, and comorbidities, and for readmission, they were the post-admission number of medications (1.16; 1.12-1.12), STOPP PIMs (1.16; 1.15-1.16), AGS Beers PIMs (1.11; 1.11-1.11), and START omissions not corrected with a prescription (1.39; 1.35-1.42). The odds ratios for readmissions for the second to thirty-ninth admission were consistently higher if START PPOs were not corrected for the second (1.41; 1.36-1.46), third (1.41;1.35-1.48), fourth (1.35; 1.28-1.44), fifth (1.38; 1.28-1.49), sixth (1.47; 1.34-1.62), and seventh admission to thirty-ninth admission (1.23; 1.14-1.34). The odds ratios for mortality were post-admission number of medications (1.04; 1.04-1.05), STOPP PIMs (0.99; 0.96-1.00), AGS Beers PIMs (1.08; 1.07-1.08), and START omissions not corrected with a prescription (1.56; 1.50-1.63). START omissions for all admissions corrected with a prescription by a hospital physician correlated with a dramatic reduction in mortality (0.51; 0.49-0.53) within six months of discharge. This was also true for the second (0.52; 0.50-0.55), fourth (0.56; 0.52-0.61), fifth (0.63; 0.57-0.68), sixth (0.68; 0.61-0.76), and seventh admission to thirty-ninth admission (0.71; 0.65-0.78). Conclusions: "Potential prescribing omissions" (PPOs) consisted mostly of needed cardiac medications. These omissions occurred before the first admission of this cohort, and many persisted through their readmissions and discharges. Therefore, these omissions should be corrected in the community before admission by family physicians, in the hospital by hospital physicians, and if they continue after discharge by teams of family physicians, pharmacists, and nurses. These community teams should also meet with patients and focus on patients' understanding of their illnesses, medications, PPOs, and ability for self-care.
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Affiliation(s)
- Roger E. Thomas
- Faculty of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.A.); (D.T.)
| | | | - Mohammad Asad
- Faculty of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.A.); (D.T.)
| | - Dactin Tran
- Faculty of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada; (M.A.); (D.T.)
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Bag Soytas R, Levinoff EJ, Smith L, Doventas A, Morais JA, Veronese N, Soysal P. Predictive Strategies to Reduce the Risk of Rehospitalization with a Focus on Frail Older Adults: A Narrative Review. EPIDEMIOLOGIA 2023; 4:382-407. [PMID: 37873884 PMCID: PMC10594531 DOI: 10.3390/epidemiologia4040035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/16/2023] [Accepted: 09/25/2023] [Indexed: 10/25/2023] Open
Abstract
Frailty is a geriatric syndrome that has physical, cognitive, psychological, social, and environmental components and is characterized by a decrease in physiological reserves. Frailty is associated with several adverse health outcomes such as an increase in rehospitalization rates, falls, delirium, incontinence, dependency on daily living activities, morbidity, and mortality. Older adults may become frailer with each hospitalization; thus, it is beneficial to develop and implement preventive strategies. The present review aims to highlight the epidemiological importance of frailty in rehospitalization and to compile predictive strategies and related interventions to prevent hospitalizations. Firstly, it is important to identify pre-frail and frail older adults using an instrument with high validity and reliability, which can be a practically applicable screening tool. Comprehensive geriatric assessment-based care is an important strategy known to reduce morbidity, mortality, and rehospitalization in older adults and aims to meet the needs of frail patients with a multidisciplinary approach and intervention that includes physiological, psychological, and social domains. Moreover, effective multimorbidity management, physical activity, nutritional support, preventing cognitive frailty, avoiding polypharmacy and anticholinergic drug burden, immunization, social support, and reducing the caregiver burden are other recommended predictive strategies to prevent post-discharge rehospitalization in frail older adults.
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Affiliation(s)
- Rabia Bag Soytas
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Elise J. Levinoff
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Lee Smith
- Center for Health Performance and Wellbeing, Anglia Ruskin University, East Road, Cambridge CB1 1PT, UK
| | - Alper Doventas
- Division of Geriatrics, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul 34320, Turkey;
| | - José A. Morais
- Department of Medicine, Division of Geriatric Medicine, McGill University, Montreal, QC H3G 1A4, Canada; (R.B.S.); (E.J.L.); (J.A.M.)
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, 90133 Palermo, Italy;
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul 34320, Turkey;
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Glans M, Kempen TGH, Jakobsson U, Kragh Ekstam A, Bondesson Å, Midlöv P. Identifying older adults at increased risk of medication-related readmission to hospital within 30 days of discharge: development and validation of a risk assessment tool. BMJ Open 2023; 13:e070559. [PMID: 37536970 PMCID: PMC10401249 DOI: 10.1136/bmjopen-2022-070559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE Developing and validating a risk assessment tool aiming to identify older adults (≥65 years) at increased risk of possibly medication-related readmission to hospital within 30 days of discharge. DESIGN Retrospective cohort study. SETTING The risk score was developed using data from a hospital in southern Sweden and validated using data from four hospitals in the mid-eastern part of Sweden. PARTICIPANTS The development cohort (n=720) was admitted to hospital during 2017, whereas the validation cohort (n=892) was admitted during 2017-2018. MEASURES The risk assessment tool aims to predict possibly medication-related readmission to hospital within 30 days of discharge. Variables known at first admission and individually associated with possibly medication-related readmission were used in development. The included variables were assigned points, and Youden's index was used to decide a threshold score. The risk score was calculated for all individuals in both cohorts. Area under the receiver operating characteristic (ROC) curve (c-index) was used to measure the discrimination of the developed risk score. Sensitivity, specificity and positive and negative predictive values were calculated using cross-tabulation. RESULTS The developed risk assessment tool, the Hospitalisations, Own home, Medications, and Emergency admission (HOME) Score, had a c-index of 0.69 in the development cohort and 0.65 in the validation cohort. It showed sensitivity 76%, specificity 54%, positive predictive value 29% and negative predictive value 90% at the threshold score in the development cohort. CONCLUSION The HOME Score can be used to identify older adults at increased risk of possibly medication-related readmission within 30 days of discharge. The tool is easy to use and includes variables available in electronic health records at admission, thus making it possible to implement risk-reducing activities during the hospital stay as well as at discharge and in transitions of care. Further studies are needed to investigate the clinical usefulness of the HOME Score as well as the benefits of implemented activities.
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Affiliation(s)
- Maria Glans
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Kristianstad-Hässleholm Hospitals, Department of Medications, Region Skåne, Kristianstad, Sweden
| | - Thomas Gerardus Hendrik Kempen
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | - Ulf Jakobsson
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Annika Kragh Ekstam
- Kristianstad-Hässleholm Hospitals, Department of Orthopaedics, Region Skåne, Kristianstad, Sweden
| | - Åsa Bondesson
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Medicines Management and Informatics, Region Skåne, Kristianstad, Sweden
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
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10
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Rasmussen LF, Grode L, Barat I, Gregersen M. Prevalence of factors contributing to unplanned hospital readmission of older medical patients when assessed by patients, their significant others and healthcare professionals: a cross-sectional survey. Eur Geriatr Med 2023; 14:823-835. [PMID: 37222865 PMCID: PMC10206346 DOI: 10.1007/s41999-023-00799-6] [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: 01/30/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To describe the prevalence of factors contributing to readmission of older medical patients perceived by patients, significant others and healthcare professionals and to examine the agreement of factors contributing to readmission. METHODS This cross-sectional survey was conducted at Horsens Regional Hospital from September 2020 to June 2021. Patients aged ≥ 65 years and who were readmitted within 30 days were included. The questionnaire covered eight themes: disease; diagnosing, treatment and care; network; organisation; communication; skills and knowledge; resources; and practical arrangements. Response groups were patients, significant others, GPs, district nurses and hospital physicians. Outcomes were the prevalence of factors contributing to 30-day readmission and inter-rater agreement between respondents. RESULTS In total, 165 patients, 147 significant others, 115 GPs, 75 district nurses and 165 hospital physicians were included. The patients' median age was 79 years (IQR 74-85), and 44% were women. The following were the most prevalent contributing factors: (1) relapse of the condition that caused the index admission, (2) the patient could not manage the symptoms or illness, (3) worsening of other illnesses or conditions, (4) the patient was not fully treated at the time of discharge and (5) the patient's situation was too complex for the medical practice to handle. Kappas ranged from 0.0142 to 0.2421 for patient-significant other dyads and 0.0032 to 0.2459 for GP-hospital physician dyads. CONCLUSION From the perspectives of the included respondents, factors associated with the disease and its management were the most prevalent contributors to readmission for older medical patients. Agreement on the contributing factors was generally low. TRIAL REGISTRATION Clinical trial number NCT05116644. Registration date October 27, 2021.
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Affiliation(s)
- Lisa Fønss Rasmussen
- Department of Research, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark.
| | - Louise Grode
- Department of Medicine, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark
| | - Ishay Barat
- Department of Medicine, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark
| | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8200, Aarhus N, Denmark
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11
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Bhandari S, Dawson AZ, Kobylarz Z, Walker RJ, Egede LE. Interventions to Reduce Hospital Readmissions in Older African Americans: A Systematic Review of Studies Including African American Patients. J Racial Ethn Health Disparities 2023; 10:1962-1977. [PMID: 35913544 PMCID: PMC9889568 DOI: 10.1007/s40615-022-01378-4] [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: 04/22/2022] [Revised: 07/15/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This systematic review aims to summarize interventions that effectively reduced hospital readmission rates for African Americans (AAs) aged 65 and older. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for this review. Studies were identified by searching PubMed for clinical trials on reducing hospital readmission among older patients published between 1 January 1990 and 31 January 2020. Eligibility criteria for the included studies were mean or median age ≥ 65 years, AAs included in the study, randomized clinical trial or quasi-experimental design, presence of an intervention, and hospital readmission as an outcome. RESULTS There were 5270 articles identified and 11 were included in the final review based on eligibility criteria. The majority of studies were conducted in academic centers, were multi-center trials, and included over 200 patients, and 6-90% of participants were older AAs. The length of intervention ranged from 1 week to over a year, with readmission assessed between 30 days and 1 year. Four studies which reported interventions that significantly reduced readmissions included both inpatient (e.g., discharge planning prior to discharge) and outpatient care components (e.g., follow-ups after discharge), and the majority used a multifaceted approach. CONCLUSION Findings from the review suggest successful interventions to reduce readmissions among AAs aged 65 and older should include inpatient and outpatient care components at a minimum. This systematic review showed limited evidence of interventions successfully decreasing readmission in older AAs, suggesting a need for research in the area to reduce readmission disparities and improve overall health.
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Affiliation(s)
- Sanjay Bhandari
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Aprill Z Dawson
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Zacory Kobylarz
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
- Center for Advancing Population Science, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI, 53226, USA.
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12
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Welvaars K, van den Bekerom MPJ, Doornberg JN, van Haarst EP. Evaluating machine learning algorithms to Predict 30-day Unplanned REadmission (PURE) in Urology patients. BMC Med Inform Decis Mak 2023; 23:108. [PMID: 37312177 DOI: 10.1186/s12911-023-02200-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 05/18/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Unplanned hospital readmissions are serious medical adverse events, stressful to patients, and expensive for hospitals. This study aims to develop a probability calculator to predict unplanned readmissions (PURE) within 30-days after discharge from the department of Urology, and evaluate the respective diagnostic performance characteristics of the PURE probability calculator developed with machine learning (ML) algorithms comparing regression versus classification algorithms. METHODS Eight ML models (i.e. logistic regression, LASSO regression, RIDGE regression, decision tree, bagged trees, boosted trees, XGBoost trees, RandomForest) were trained on 5.323 unique patients with 52 different features, and evaluated on diagnostic performance of PURE within 30 days of discharge from the department of Urology. RESULTS Our main findings were that performances from classification to regression algorithms had good AUC scores (0.62-0.82), and classification algorithms showed a stronger overall performance as compared to models trained with regression algorithms. Tuning the best model, XGBoost, resulted in an accuracy of 0.83, sensitivity of 0.86, specificity of 0.57, AUC of 0.81, PPV of 0.95, and a NPV of 0.31. CONCLUSIONS Classification models showed stronger performance than regression models with reliable prediction for patients with high probability of readmission, and should be considered as first choice. The tuned XGBoost model shows performance that indicates safe clinical appliance for discharge management in order to prevent an unplanned readmission at the department of Urology.
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Affiliation(s)
- Koen Welvaars
- Data Science Team, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, the Netherlands.
- Department of Orthopaedic Surgery, UMCG, Groningen, Netherlands.
| | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, OLVG, Amsterdam, Netherlands
- Faculty of Behavioural and Movement Sciences, Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
| | - Job N Doornberg
- Department of Orthopaedic Surgery, UMCG, Groningen, Netherlands
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13
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Cilla F, Sabione I, D’Amelio P. Risk Factors for Early Hospital Readmission in Geriatric Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1674. [PMID: 36767038 PMCID: PMC9914102 DOI: 10.3390/ijerph20031674] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/16/2023] [Indexed: 06/18/2023]
Abstract
The number of older patients is constantly growing, and early hospital readmissions in this population represent a major problem from a health, social and economic point of view. Furthermore, the early readmission rate is often used as an indicator of the quality of care. We performed a systematic review of the literature to better understand the risk factors of early readmission (30 and 90 days) in the geriatric population and to update the existing evidence on this subject. The search was carried out on the MEDLINE, EMBASE and PsycINFO databases. Three independent reviewers assessed the potential inclusion of the studies, and then each study was independently assessed by two reviewers using Joanna Briggs Institute critical appraisal tools; any discrepancies were resolved by the third reviewer. Studies that included inpatients in surgical wards were excluded. Twenty-nine studies were included in the review. Risk factors of early readmission can be classified into socio-economic factors, factors relating to the patient's health characteristics, factors related to the use of the healthcare system and clinical factors. Among these risk factors, those linked to patient frailty play an important role, in particular malnutrition, reduced mobility, risk of falls, fatigue and functional dependence. The early identification of patients at higher risk of early readmission may allow for targeted interventions in view of discharge.
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14
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Murmann M, Sinden D, Hsu AT, Thavorn K, Eddeen AB, Sun AH, Robert B. The cost-effectiveness of a nursing home-based transitional care unit for increasing the potential for independent living in the community among hospitalized older adults. J Med Econ 2023; 26:61-69. [PMID: 36514911 DOI: 10.1080/13696998.2022.2156152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE In Canada, a persistent barrier to achieving healthcare system efficiency has been patient days accumulated by individuals with an alternate level of care (ALC) designation. Transitional care units (TCUs) may address the capacity pressures associated with ALC. We sought to assess the cost-effectiveness of a nursing home (NH) based TCU leveraging existing infrastructure to support a hospitalized older adult's transition to independent living at home. METHODS This case-control study included frail, older adults who received care within a function-focused TCU following a hospitalization between 1 March 2018 and 30 June 2019. TCU patients were propensity score matched to hospitalized ALC patients ("usual care"). The primary outcome was days without requiring institutional care six months following discharge, defined as institutional-free days. This was calculated by excluding all days in hospitals, rehabilitation facilities, complex continuing care facilities and NHs. Using the total direct cost of care up to discharge from TCU or hospital, the incremental cost-effectiveness ratio was calculated. RESULTS TCU patients spent, on average, 162.0 days institution-free (95% CI: 156.3-167.6d) within six months days post-discharge, while usual care patients spent 140.6 days institution-free (95% CI: 132.3-148.8d). TCU recipients had a lower total cost of care, by CAN$1,106 (95% CI: $-6,129-$10,319), due to the reduced hospital length of stay (mean [SD] 15.6d [13.3d] for TCU patients and 28.6d [67.4d] days for usual care). TCU was deemed the more cost-effective model of care. LIMITATIONS The main limitation was the potential inclusion of patients not eligible for SAFE in our usual group. To minimize this selection bias, we expanded the geographical pool of ALC patients to patients with SAFE admission potential in other area hospitals. CONCLUSIONS Through rehabilitative and restorative care, TCUs can reduce hospital length of stay, increase potential for independent living, and reduce risk for subsequent institutionalization.
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Affiliation(s)
- Maya Murmann
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Danielle Sinden
- Centre of Excellence in Frailty-Informed Care, Perley Health, Ottawa, Ontario, Canada
| | - Amy T Hsu
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
- Centre of Excellence in Frailty-Informed Care, Perley Health, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kednapa Thavorn
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Anan Bader Eddeen
- ICES uOttawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Annie H Sun
- Bruyère Research Institute, Bruyère Continuing Care, Ottawa, Ontario, Canada
| | - Benoît Robert
- Centre of Excellence in Frailty-Informed Care, Perley Health, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
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15
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Bogh SB, Fløjstrup M, Möller S, Bech M, Lassen AT, Brabrand M, Mogensen CB. Readmission trends before and after a national reconfiguration of emergency departments in Denmark. J Health Serv Res Policy 2023; 28:42-49. [PMID: 35968608 DOI: 10.1177/13558196221108894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE In order to achieve better and more efficient emergency health care, the Danish public hospital system has been reconfigured, with hospital emergency care being centralised into extensive and specialised emergency departments. This article examines how this reconfiguration has affected patient readmission rates. METHODS We included all unplanned hospital admissions (aged ≥18 years) at public, non-psychiatric hospitals in four geographical regions in Denmark between 1 January 2007 and 24 December 2017. Using an interrupted time-series design, we examined trend changes in the readmission rates. In addition to analysing the overall effect, analyses stratified according to admission time of day and weekdays/weekends were conducted. The analyses were adjusted for patient characteristics and other system changes. RESULTS The seven-day readmission rate increased from 2.6% in 2007 to 3.8% in 2017, and the 30-day rate increased from 8.1% to 11.5%. However, the rates were less than what they would have been had the reconfiguration not been introduced. The reconfiguration reduced the seven-day readmission rate by 1.4% annually (hazard ratio [CI 95%] 0.986 [0.981-0.991]) and the 30-day rate by 1% annually (hazard ratio [CI 95%] 0.99 [0.987-0.993]). CONCLUSIONS Reconfiguration reduced the rate of increase in readmissions, but nevertheless readmissions still increased across the study period. It seems hospitals and policymakers will need to identify further ways to reduce patient loads.
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Affiliation(s)
- Søren Bie Bogh
- Odense Patient Exploratory Network (Open), 11286University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - Marianne Fløjstrup
- Department of Emergency Medicine, 6174Hospital of South West Jutland, Esbjerg, Denmark
| | - Sören Möller
- Department of Clinical Research, 532010University of Southern Denmark, Odense, Denmark
| | | | - Annmarie T Lassen
- Department of Emergency Medicine, 306920Odense University Hospital, Odense, Denmark
| | - Mikkel Brabrand
- Department of Emergency Medicine, 306920Odense University Hospital, Odense, Denmark
| | - Christian B Mogensen
- Focused Research Unit in Emergency Medicine, 11286Hospital of Southern Denmark, Aabenraa, Denmark
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Lee JY, Kim KJ, Choi JW, Kim TH, Kim CO. Factors Related to Hospital Readmission of Frail Older Adults in Korea. Yonsei Med J 2022; 63:984-990. [PMID: 36303306 PMCID: PMC9629896 DOI: 10.3349/ymj.2021.0838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Frail older adults have a higher risk of hospital readmission due to decline in physical, functional, and psychological health status. The impact of readmission on individuals, families, or the healthcare system is tremendously devastating. This study aimed to investigate factors associated with hospital readmission of frail older adults. MATERIALS AND METHODS This was a retrospective descriptive study based on multi-professional health assessments found in electronic medical records of patients from a university-affiliated hospital in Seoul, Korea. The participants were 141 older adults who were admitted to the geriatric department with medical problems. Frailty, components of the comprehensive geriatric assessment including nutrition, physical functions, psychological and cognitive status, clinical data including length of hospital stay, and readmission within 30, 90, and 180 days were collected. Survival analysis was performed, and Cox proportional hazard regression model was used to investigate the risk factors for readmission. RESULTS The statistically significant variables at each time point were slightly different. However, at most time points, disease-related problems (i.e., comorbidities and medications) and body functions (i.e., grip strength and physical activity) were included. The median duration until readmission was 27 days, and grip strength was found to be significantly related to readmission (p=0.020). CONCLUSION After discharge, both medical services to manage the medical condition and intervention to maintain physical function are needed to prevent frail older adults from being readmitted to the hospital.
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Affiliation(s)
- Ji Yeon Lee
- Yonsei University College of Nursing and Mo-Im Kim Nursing Research Institute, Seoul, Korea
| | - Kwang Joon Kim
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Won Choi
- Division of Geriatrics, Yonsei University Health System, Seoul, Korea
| | - Tae Hee Kim
- Division of Geriatrics, Yonsei University Health System, Seoul, Korea
| | - Chang Oh Kim
- Division of Geriatrics, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
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17
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de Nooijer K, Van Den Noortgate N, Pype P, Van den Block L, Pivodic L. Palliative care symptoms, concerns and well-being of older people with frailty and complex care needs upon hospital discharge: a cross-sectional study. Palliat Care 2022; 21:173. [PMID: 36203161 PMCID: PMC9540036 DOI: 10.1186/s12904-022-01065-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Little is known about the nature and intensity of palliative care needs of hospitalised older people. We aimed to describe the palliative care symptoms, concerns, and well-being of older people with frailty and complex care needs upon discharge from hospital to home, and to examine the relationship between palliative care symptoms and concerns, and well-being. Methods Cross-sectional study using baseline survey data of a pilot randomised controlled trial. Hospital staff identified patients (≥ 70 years) about to be discharged home, with a clinical frailty score of 5 to 7 and complex needs based on physician-assessment. Patients completed structured interviews, using the Integrated Palliative Care Outcome Scale (IPOS), ICEpop CAPability measure for supportive care (ICECAP-SCM) and IPOS Views on Care quality of life item. We calculated descriptive statistics. Results We assessed 37 older people with complex needs (49% women, mean age 84, standard deviation 6.1). Symptoms rated as causing severe problems were weakness (46%) and poor mobility (40%); 75% reported that their family felt anxious at least occasionally. Of the 17 IPOS items, 41% of patients rated five or more symptoms as causing severe problems, while 14% reported that they were not severely affected by any symptom. 87% expressed feeling supported. There was a negative correlation between symptoms (IPOS) and well-being (ICECAP); r = -0.41. Conclusion We identified a large variety of symptoms experienced by older people identified as having frailty and complex needs upon hospital discharge. Many were severely affected by multiple needs. This population should be considered for palliative care follow-up at home.
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Affiliation(s)
- Kim de Nooijer
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium. .,Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, Brussels, Belgium.
| | - Nele Van Den Noortgate
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Peter Pype
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium.,Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090, Brussels, Belgium
| | - Lara Pivodic
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103, 1090, Brussels, Belgium
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Eriksen AV, Thrane MD, Matzen L, Ryg J, Andersen-Ranberg K. Older patients acutely admitted and readmitted to the same geriatric department: a descriptive cohort study of primary diagnoses and health characteristics. Eur Geriatr Med 2022; 13:1109-1118. [PMID: 35900651 DOI: 10.1007/s41999-022-00670-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Advancing age is associated with increased risk for acute admissions and readmissions. The societal challenges of ageing populations have made the prevention of readmissions come into focus. Readmission may be perceived as the result of inadequate treatment during index admission but may also be caused by the onset of new disease following a generally impaired health of geriatric patients. We aimed at comparing the diagnoses at index and readmission to illuminate this issue. METHODS This is a descriptive, retrospective cohort study of patients acutely admitted and readmitted (within 30 days from discharge) to the same geriatric ward (November 1, 2017-April 30, 2018). Electronic medical records were scrutinised manually for discharge diagnoses and patient characteristics. RESULTS Readmission rate was 10.7% (98 of 918 unique admissions). Mean age was 85.6 (men 56%). About 75% were readmitted with a new acute disease unrelated to index admission, most commonly pneumonia (27%), other infections (22%), and dehydration (14%). The health characteristics were long index length-of-stay (median 7; IQR 5-11), high Charlson Comorbidity Index (CCI ≥ 3, n = 49 (50%), polypharmacy (≥ 5 prescriptions) (94%), and hospitalisations 12 months prior to index admission (57%). KEY CONCLUSIONS The majority of readmitted geriatric patients have contracted a new acute condition. Although being characterised by several adverse health characteristics, prospective studies comparing readmitted and non-readmitted geriatric patients are needed. Still, increasing the awareness of early recognition of acute disease onset in geriatric patients is warranted.
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Affiliation(s)
- Alexander Viktor Eriksen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløwsvej 4, Odense C, 5000, Odense, Denmark
| | - Mikkel Dreier Thrane
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløwsvej 4, Odense C, 5000, Odense, Denmark
| | - Lars Matzen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløwsvej 4, Odense C, 5000, Odense, Denmark
| | - Jesper Ryg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløwsvej 4, Odense C, 5000, Odense, Denmark
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark. .,Department of Geriatric Medicine, Odense University Hospital, J.B. Winsløwsvej 4, Odense C, 5000, Odense, Denmark. .,Department of Public Health, Danish Aging Research Centre, University of Southern Denmark, Odense, Denmark.
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Balancing standardisation and individualisation in transitional care pathways: a meta-ethnography of the perspectives of older patients, informal caregivers and healthcare professionals. BMC Health Serv Res 2022; 22:430. [PMID: 35365140 PMCID: PMC8974038 DOI: 10.1186/s12913-022-07823-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transitional care implies the transfer of patients within or across care settings in a seamless and safe way. For frail, older patients with complex health issues, high-quality transitions are especially important as these patients typically move more frequently within healthcare settings, requiring treatment from different providers. As transitions of care for frail people are considered risky, securing the quality and safety of these transitions is of great international interest. Nevertheless, despite efforts to improve quality in transitional care, research indicates that there is a lack of clear guidance to deal with practical challenges that may arise. The aim of this article is to synthesise older patients, informal caregivers and healthcare professionals' experiences of challenges to achieving high-quality transitional care. METHODS We used the seven-step method for meta-ethnography originally developed by Noblit and Hare. In four different but connected qualitative projects, the authors investigated the challenges to transitional care for older people in the Norwegian healthcare system from the perspectives of older patients, informal caregivers and healthcare professionals. In this paper, we highlight and discuss the cruciality of these challenging issues by synthesising the results from twelve articles. RESULTS The analysis resulted in four themes: i) balancing person-centred versus efficient care, ii) balancing everyday patient life versus the treatment of illness, iii) balancing user choice versus "What Matters to You", and iv) balancing relational versus practical care. These expressed challenges represent tensions at the system, organisation and individual levels based on partial competing assumptions on person-centred-care-inspired individualisation endeavours and standardisation requirements in transitional care. CONCLUSIONS There is an urgent need for a clearer understanding of the tension between standardisation and individualisation in transitional care pathways for older patients to ensure better healthcare quality for patients and more realistic working environments for healthcare professionals. Incorporating a certain professional flexibility within the wider boundary of standardisation may give healthcare professionals room for negotiation to meet patients' individual needs, while at the same time ensuring patient flow, equity and evidence-based practice.
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Kongensgaard R, Hansen TK, Krogseth M, Gregersen M. Impact of involvement of relatives in early home visits by a hospital-led geriatric team. Geriatr Nurs 2022; 45:64-68. [PMID: 35338833 DOI: 10.1016/j.gerinurse.2022.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate whether the involvement of relatives in home visits by a geriatric team post-discharge is associated with unplanned readmissions in severely frail patients living alone. METHODS A quality improvement project evaluating outcomes from routine care of patients who were severely frail, 65+ years, living alone, and visited at home by a geriatric team after discharge from acute hospital admission. We compared patients who did and did not have relatives attending the visit. Data were analyzed by logistic regression. RESULTS Of 437 patients with a mean age of 85.0 (±7.8) years 73% had severe comorbidity, 68% had a low functional ability, and 100 patients (23%) had relatives attending. Attendance of relatives was associated with a lower unplanned 30-day readmission rate (10% vs. 18%, adjusted odds ratio: 0.48 (0.23-1.00) p=0.05). CONCLUSION Results highlights the importance of involvement of relatives in care planning in the severely frail older patients living alone.
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Affiliation(s)
- Rikke Kongensgaard
- Department of Geriatrics, Aarhus University Hospital, 8200 Aarhus N, Denmark.
| | | | - Maria Krogseth
- University of South-Eastern Norway, 3045 Drammen, Norway
| | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, 8200 Aarhus N, Denmark
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Walsh TS, Pauley E, Donaghy E, Thompson J, Barclay L, Parker RA, Weir C, Marple J. Does a screening checklist for complex health and social care needs have potential clinical usefulness for predicting unplanned hospital readmissions in intensive care survivors: development and prospective cohort study. BMJ Open 2022; 12:e056524. [PMID: 35321894 PMCID: PMC8943772 DOI: 10.1136/bmjopen-2021-056524] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Intensive care (ICU) survivors are at high risk of long-term physical and psychosocial problems. Unplanned hospital readmission rates are high, but the best way to triage patients for interventions is uncertain. We aimed to develop and evaluate a screening checklist to help predict subsequent readmissions or deaths. DESIGN A checklist for complex health and social care needs (CHSCNs) was developed based on previous research, comprising six items: multimorbidity; polypharmacy; frequent previous hospitalisations; mental health issues; fragile social circumstances and impaired activities of daily living. Patients were considered to have CHSCNs if two or more were present. We prospectively screened all ICU discharges for CHSCNs for 12 months. SETTING ICU, Royal Infirmary, Edinburgh, UK. PARTICIPANTS ICU survivors over a 12-month period (1 June 2018 and 31 May 2019). INTERVENTIONS None. OUTCOME MEASURE Readmission or death in the community within 3 months postindex hospital discharge. RESULTS Of 1174 ICU survivors, 937 were discharged alive from the hospital. Of these 253 (27%) were classified as having CHSCNs. In total 28% (266/937) patients were readmitted (N=238) or died (N=28) within 3 months. Among CHSCNs patients 45% (n=115) patients were readmitted (N=105) or died (N=10). Patients without CHSCNs had a 22% readmission (N=133) or death (N=18) rate. The checklist had: sensitivity 43% (95% CI 37% to 49%), specificity 79% (95% CI 76% to 82%), positive predictive value 45% (95% CI 41% to 51%), and negative predictive value 78% (95% CI 76% to 80%). Relative risk of readmission/death for patients with CHSCNs was 2.06 (95% CI 1.69 to 2.50), indicating a pretest to post-test probability change of 28%-45%. The checklist demonstrated high inter-rater reliability (percentage agreement ≥87% for all domains; overall kappa, 0.84). CONCLUSIONS Early evaluation of a screening checklist for CHSCNs at ICU discharge suggests potential clinical usefulness, but this requires further evaluation as part of a care pathway.
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Affiliation(s)
- Timothy Simon Walsh
- Critical Care Medicine; Usher Institute of Population Health Sciences, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Ellen Pauley
- Department of Anaesthesia, Critical Care & Pain Medicine, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Eddie Donaghy
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
| | - Joanne Thompson
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
| | - Lucy Barclay
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
| | | | - Christopher Weir
- Usher Institute of Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - James Marple
- Department of Anaesthesia, Critical Care & Pain Medicine, NHS Lothian, Edinburgh, UK
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Xie F, Liu N, Yan L, Ning Y, Lim KK, Gong C, Kwan YH, Ho AFW, Low LL, Chakraborty B, Ong MEH. Development and validation of an interpretable machine learning scoring tool for estimating time to emergency readmissions. EClinicalMedicine 2022; 45:101315. [PMID: 35284804 PMCID: PMC8904223 DOI: 10.1016/j.eclinm.2022.101315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/22/2022] [Accepted: 02/07/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Emergency readmission poses an additional burden on both patients and healthcare systems. Risk stratification is the first step of transitional care interventions targeted at reducing readmission. To accurately predict the short- and intermediate-term risks of readmission and provide information for further temporal risk stratification, we developed and validated an interpretable machine learning risk scoring system. METHODS In this retrospective study, all emergency admission episodes from January 1st 2009 to December 31st 2016 at a tertiary hospital in Singapore were assessed. The primary outcome was time to emergency readmission within 90 days post discharge. The Score for Emergency ReAdmission Prediction (SERAP) tool was derived via an interpretable machine learning-based system for time-to-event outcomes. SERAP is six-variable survival score, and takes the number of emergency admissions last year, age, history of malignancy, history of renal diseases, serum creatinine level, and serum albumin level during index admission into consideration. FINDINGS A total of 293,589 ED admission episodes were finally included in the whole cohort. Among them, 203,748 episodes were included in the training cohort, 50,937 episodes in the validation cohort, and 38,904 in the testing cohort. Readmission within 90 days was documented in 80,213 (27.3%) episodes, with a median time to emergency readmission of 22 days (Interquartile range: 8-47). For different time points, the readmission rates observed in the whole cohort were 6.7% at 7 days, 10.6% at 14 days, 13.6% at 21 days, 16.4% at 30 days, and 23.0% at 60 days. In the testing cohort, the SERAP achieved an integrated area under the curve of 0.737 (95% confidence interval: 0.730-0.743). For a specific 30-day readmission prediction, SERAP outperformed the LACE index (Length of stay, Acuity of admission, Charlson comorbidity index, and Emergency department visits in past six months) and the HOSPITAL score (Hemoglobin at discharge, discharge from an Oncology service, Sodium level at discharge, Procedure during the index admission, Index Type of admission, number of Admissions during the last 12 months, and Length of stay). Besides 30-day readmission, SERAP can predict readmission rates at any time point during the 90-day period. INTERPRETATION Better performance in risk prediction was achieved by the SERAP than other existing scores, and accurate information about time to emergency readmission was generated for further temporal risk stratification and clinical decision-making. In the future, external validation studies are needed to evaluate the SERAP at different settings and assess their real-world performance. FUNDING This study was supported by the Singapore National Medical Research Council under the PULSES Center Grant, and Duke-NUS Medical School.
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Affiliation(s)
- Feng Xie
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Nan Liu
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Institute of Data Science, National University of Singapore, Singapore
- Corresponding author at: Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore.
| | - Linxuan Yan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Yilin Ning
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Ka Keat Lim
- School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
| | - Changlin Gong
- Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Heng Kwan
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
| | - Andrew Fu Wah Ho
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore
- Department of Post-Acute and Continuing Care, Outram Community Hospital, Singapore
- SingHealth Duke-NUS Family Medicine Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Bibhas Chakraborty
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- Department of Statistics and Data Science, National University of Singapore, Singapore
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, United States
| | - Marcus Eng Hock Ong
- Programme in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, 169857, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore
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Kretschmer R, Trögner J, Schindlbeck M, Schmitz P. [Postoperative multiprofessional comprehensive treatment]. DER ORTHOPADE 2022; 51:98-105. [PMID: 35029699 DOI: 10.1007/s00132-021-04208-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In orthogeriatric centers, postoperative, multiprofessional comprehensive treatment has proven to be an effective component in the convalescence of geriatric patients. The aim of the treatment is to minimize the perioperative risk and safely achieve individual rehabilitation goals in the acute inpatient stay. To meet the needs of geriatric patients, in addition to changes in the spatial division and design, primarily adjustments to the team composition and the procedural processes are required. THERAPEUTIC STRATEGIES An interdisciplinary and multiprofessional team (orthopedics/traumatology, geriatrics, nursing, physiotherapy, occupational therapy, social services, psychology, speech therapy, …) uses geriatric assessments in regular team meetings to collect and analyze the current rehabilitation status of patients; ICF-based goals are formulated and the therapy is adapted to individual needs. Here, too, the focus is on recording the individual risk (comorbidities, mental status, polypharmacy, malnutrition, fragility) and avoiding preventable complications. Multiprofessional strategies for avoiding or treating postoperative delirium are particularly important. In addition, maintaining patients' autonomy is the top priority, so that they can be released from the acute inpatient stay strengthened for follow-up treatment or their home environment. The establishment of orthogeriatric comanagement in acute inpatient facilities is an important component in the process chain, from which many geriatric patients benefit in the context of postoperative recovery.
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Affiliation(s)
- Rainer Kretschmer
- HSD - Hochschule Döpfer, Prüfeninger Str. 20, 93049, Regensburg, Deutschland. .,Alterstraumazentrum CURA, Klinik für Unfallchirurgie, Caritas Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Deutschland.
| | - Jens Trögner
- Klinik für Innere Medizin III - Geriatrie und Frührehabilitation, Klinikum St. Marien Amberg, Amberg, Deutschland
| | | | - Paul Schmitz
- Alterstraumazentrum CURA, Klinik für Unfallchirurgie, Caritas Krankenhaus St. Josef, Landshuter Str. 65, 93053, Regensburg, Deutschland
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The association between geriatric treatment and 30-day readmission risk among medical inpatients aged ≥75 years with multimorbidity. PLoS One 2022; 17:e0262340. [PMID: 34995327 PMCID: PMC8741041 DOI: 10.1371/journal.pone.0262340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 12/22/2021] [Indexed: 11/27/2022] Open
Abstract
Background Readmission to hospital is frequent among older patients and reported as a post-discharge adverse outcome. The effect of treatment in a geriatric ward for acutely admitted older patients on mortality and function is well established, but less is known about the possible influence of such treatment on the risk of readmission, particularly in the oldest and most vulnerable patients. Our aim was to assess the risk for early readmission for multimorbid patients > 75 years treated in a geriatric ward compared to medical wards and to identify risk factors for 30-day readmissions. Methods Prospective cohort study of patients acutely admitted to a medical department at a Norwegian regional hospital. Eligible patients were community-dwelling, multimorbid, receiving home care services, and aged 75+. Patients were consecutively included in the period from 1 April to 31 October 2012. Clinical data were retrieved from the referral letter and medical records. Results We included 227 patients with a mean (SD) age of 86.0 (5.7) years, 134 (59%) were female and 59 (26%) were readmitted within 30 days after discharge. We found no statistically significant difference in readmission rate between patients treated in a geriatric ward versus other medical wards. In adjusted Cox proportional hazards regression analyses, lower age (hazard ratio (95% confidence interval) 0.95 (0.91–0.99) per year), female gender (2.17 (1.15–4.00)) and higher MMSE score (1.03 (1.00–1.06) per point) were significant risk factors for readmission. Conclusions Lower age, female gender and higher cognitive function were the main risk factors for 30-day readmission to hospital among old patients with multimorbidity. We found no impact of geriatric care on the readmission rate.
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Edelstein J, Walker R, Middleton A, Reistetter T, Gary KW, Reynolds S. Higher Frequency of Acute Occupational Therapy Services Is Associated With Reduced Hospital Readmissions. Am J Occup Ther 2022; 76:23119. [PMID: 34964838 DOI: 10.5014/ajot.2022.048678] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Hospital readmissions are associated with poor patient outcomes, including higher risk for mortality, nutritional concerns, deconditioning, and higher costs. OBJECTIVE To evaluate how acute occupational therapy service delivery factors affect readmission risk. DESIGN Cross-sectional, retrospective study. SETTING Single academic medical center. PARTICIPANTS Medicare inpatients with a diagnosis included in the Hospital Readmissions Reduction Program (HRRP; N = 17,618). Data were collected from medical records at a large urban hospital in southeastern Wisconsin. Outcomes and Measures: Logistic regression models were estimated to examine the association between acute occupational therapy service delivery factors and odds of readmission. In addition, the types of acute occupational therapy services for readmitted versus not-readmitted patients were compared. RESULTS Patients had significantly higher odds of readmission if they received occupational therapy services while hospitalized (odds ratio [OR] = 1.18, 95% confidence interval [CI] [1.07, 1.31]). However, patshients who received acute occupational therapy services had significantly lower odds of readmission if they received a higher frequency (OR = 0.99, 95% CI [0.99,1.00]) of acute occupational therapy services. A significantly higher proportion of patients who were not readmitted, compared with patients who were readmitted, received activities of daily living (ADL) or self-care training (p < .01). CONCLUSIONS AND RELEVANCE For patients with HRRP-qualifying diagnoses who received acute occupational therapy services, higher frequency of acute occupational therapy services was linked with lower odds of readmission. Readmitted patients were less likely to have received ADL or self-care training while hospitalized. What This Article Adds: Identifying factors of acute occupational therapy services that reduce the odds of readmission for Medicare patients may help to improve patient outcomes and further define occupational therapy's role in the U.S. quality-focused health care system.
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Affiliation(s)
- Jessica Edelstein
- Jessica Edelstein, PhD, OTR/L, is Occupational Therapy Postdoctoral Fellow, Department of Occupational Therapy, Colorado State University, Fort Collins. At the time of the study, Edelstein was Occupational Therapist, Department of Rehabilitation, Froedtert Hospital, Milwaukee, WI, and PhD Student, Virginia Commonwealth University, Richmond, VA;
| | - Rebekah Walker
- Rebekah Walker, PhD, is Associate Professor, Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, and Associate Director, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Addie Middleton
- Addie Middleton, PhD, DPT, is Clinician Scientist, New England Geriatric Research and Clinical Center, Veterans Affairs Boston Healthcare System, Boston, MA
| | - Timothy Reistetter
- Timothy Reistetter, PhD, OTR, FAOTA, is Associate Dean of Research and Professor, School of Health Professions, Department of Occupational Therapy, University of Texas Health Science Center at San Antonio
| | - Kelli Williams Gary
- Kelli Williams Gary, PhD, MPH, OTR/L, is Associate Professor, Department of Rehabilitation Counseling, Virginia Commonwealth University, Richmond
| | - Stacey Reynolds
- Stacey Reynolds, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, Virginia Commonwealth University, Richmond
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Edelstein J, Middleton A, Walker R, Reistetter T, Reynolds S. Impact of Acute Self-Care Indicators and Social Factors on Medicare Inpatient Readmission Risk. Am J Occup Ther 2022; 76:23120. [PMID: 34964839 DOI: 10.5014/ajot.2022.049084] [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] Open
Abstract
IMPORTANCE Readmissions are costly for Medicare and are associated with poor patient outcomes. OBJECTIVE To determine whether two domains relevant to acute occupational therapy practice-self-care status and social factors-were associated with readmissions for Medicare patients in the Medicare Hospital Readmissions Reduction Program (HRRP). DESIGN Cross-sectional, retrospective study. SETTING Single academic medical center. PARTICIPANTS Medicare inpatients with a diagnosis included in the HRRP (N = 17,618). Outcomes and Measures: Three logistic regression models were estimated to examine the associations among (1) self-care status and 30-day readmission, (2) social support and 30-day readmission, and (3) housing situation and 30-day readmission. Subgroup analyses were conducted for the individual HRRP diagnoses. RESULTS No associations were found between acute self-care status, social support, or housing situation and 30-day readmission when all HRRP diagnoses were examined together. However, higher levels of independence with self-care were significantly associated with reduced odds of readmission for patients with pneumonia. CONCLUSIONS AND RELEVANCE The findings for patients with pneumonia are consistent with those of other studies done in the acute care setting. Deficiencies in acute occupational therapy documentation may have affected the findings for the other HRRP diagnoses. What This Article Adds: This study is the first to examine the association between acute self-care status (as documented by acute care occupational therapy practitioners) and readmission.
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Affiliation(s)
- Jessica Edelstein
- Jessica Edelstein, PhD, OTR/L, is Occupational Therapy Postdoctoral Fellow, Department of Occupational Therapy, Colorado State University, Fort Collins. At the time of the study, Edelstein was Occupational Therapist, Department of Rehabilitation, Froedtert Hospital, Milwaukee, WI, and PhD Student, Virginia Commonwealth University, Richmond;
| | - Addie Middleton
- Addie Middleton, PhD, DPT, is Clinician Scientist, New England Geriatric Research and Clinical Center, U.S Department of Veterans Affairs Boston Healthcare System, Boston, MA
| | - Rebekah Walker
- Rebekah Walker, PhD, is Associate Professor, Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, and Associate Director, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Timothy Reistetter
- Timothy Reistetter, PhD, OTR, FAOTA, is Associate Dean of Research and Professor, School of Health Professions, Department of Occupational Therapy, University of Texas Health Science Center at San Antonio
| | - Stacey Reynolds
- Stacey Reynolds, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, Virginia Commonwealth University, Richmond
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Lin MH, Wang KY, Chen CH, Hu FW. Factors associated with 14-day hospital readmission in frail older patients: A case-control study. Geriatr Nurs 2021; 43:146-150. [PMID: 34890955 DOI: 10.1016/j.gerinurse.2021.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/04/2022]
Abstract
Frailty is a key predictor of readmission among older patients. However, studies on the factors associated with readmission of frail older patients are lacking. This study aims to examine factors associated with 14-day hospital readmission in frail older patients. A retrospective case-control study was conducted. Patients were eligible for inclusion if they were age 65 and over and if their Clinical Frailty Scale (CFS) score was above 4. A total of 210 frail older patients were included. Patients who had partners, experienced a fall within 6 months before hospitalization, had pressure injuries, received surgery or chemotherapy, and received rehabilitation therapy from a physical therapist during hospitalization had increased odds of being readmitted to the hospital within 14 days. Moreover, patients receiving comprehensive geriatric assessment (CGA) services during hospitalization showed a significantly reduced risk of readmission. Adapting CGA and developing continuity care plans from hospitals to the community are crucial.
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Affiliation(s)
- Mei-He Lin
- Department of Nursing, College of Health Sciences, Chang Jung Christian University, Tainan City, Taiwan, ROC; Department of Nursing, Tzu Hui Institute of Technology, Pingtung County, Taiwan, ROC
| | - Kuei-Ying Wang
- Department of Nursing, College of Health Sciences, Chang Jung Christian University, Tainan City, Taiwan, ROC
| | - Ching-Huey Chen
- Department of Nursing, College of Health Sciences, Chang Jung Christian University, Tainan City, Taiwan, ROC
| | - Fang-Wen Hu
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, Shengli Rd., North District, Tainan City 70403, Taiwan, ROC.
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Steinmeyer Z, Piau A, Thomazeau J, Kai SHY, Nourhashemi F. Mortality in hospitalised older patients: the WHALES short-term predictive score. BMJ Support Palliat Care 2021:bmjspcare-2021-003258. [PMID: 34824134 DOI: 10.1136/bmjspcare-2021-003258] [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: 06/25/2021] [Accepted: 09/11/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop and validate the WHALES screening tool predicting short-term mortality (3 months) in older patients hospitalised in an acute geriatric unit. METHODS Older patients transferred to an acute geriatric ward from June 2017 to December 2018 were included. The cohort was divided into two groups: derivation (n=664) and validation (n=332) cohorts. Cause for admission in emergency room, hospitalisation history within the previous year, ongoing medical conditions, cognitive impairment, frailty status, living conditions, presence of proteinuria on a urine strip or urine albumin-to-creatinine ratio and abnormalities on an ECG were collected at baseline. Multiple logistic regressions were performed to identify independent variables associated with mortality at 3 months in the derivation cohort. The prediction score was then validated in the validation cohort. RESULTS Five independent variables available from medical history and clinical data were strongly predictive of short-term mortality in older adults including age, sex, living in a nursing home, unintentional weight loss and self-reported exhaustion. The screening tool was discriminative (C-statistic=0.74 (95% CI: 0.67 to 0.82)) and had a good fit (Hosmer-Lemeshow goodness-of-fit test (X2 (3)=0.55, p=0.908)). The area under the curve value for the final model was 0.74 (95% CI: 0.67 to 0.82). CONCLUSIONS AND IMPLICATIONS The WHALES screening tool is a short and rapid tool predicting 3-month mortality among hospitalised older patients. Early identification of end of life may help appropriate timing and implementation of palliative care.
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Affiliation(s)
- Zara Steinmeyer
- Geriatrics, CHU, Toulouse, France
- UMR 1295, Paul Sabatier University Toulouse III, INSERM, Toulouse, France
| | - Antoine Piau
- Geriatrics, CHU, Toulouse, France
- UMR 1295, Paul Sabatier University Toulouse III, INSERM, Toulouse, France
| | | | - Samantha Huo Yung Kai
- UMR 1295, Paul Sabatier University Toulouse III, INSERM, Toulouse, France
- Methodological Research Support Unit, CHU Toulouse, Toulouse, France
| | - Fati Nourhashemi
- Geriatrics, CHU, Toulouse, France
- UMR 1295, Paul Sabatier University Toulouse III, INSERM, Toulouse, France
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Hansen TK, Pedersen LH, Shahla S, Damsgaard EM, Bruun JM, Gregersen M. Effects of a new early municipality-based versus a geriatric team-based transitional care intervention on readmission and mortality among frail older patients - a randomised controlled trial. Arch Gerontol Geriatr 2021; 97:104511. [PMID: 34479071 DOI: 10.1016/j.archger.2021.104511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 01/22/2023]
Abstract
Purpose Previous studies reported reduced risk of readmission, mortality and shorter length of hospital stay (LOS) among geriatric patients receiving an early (<24h), hospital-based geriatric team intervention after discharge. The objective of this study was to compare a novel, early municipality-based, nurse-led and general practitioner (GP)-supported transitional care intervention (TCI) to an established hospital-based TCI among frail, older, geriatric patients. Material and methods A randomised controlled trial was conducted within a single geriatric department and the adjacent municipality. Inclusion criteria: acutely admitted, frail patients 75+ years old. Eligible patients were randomly allocated (1:1) to the two TCIs. Primary outcome was 30-day unplanned readmission. Secondary outcomes were 90-day all-cause mortality and LOS. Stratified analysis according to type of dwelling was made. Odds ratios (OR) with 95% confidence intervals (CI), and number needed to treat (NNT) were reported. Results 3,103 patients (median age (IQR): 85 (80-90); 57% female) were included. Readmission rates were 22% in the municipality-based intervention (n=332/1,545), and 18% in the hospital-based intervention (n=276/1,558); OR was 1.27, 95% CI (1.06-1.52), p=0.008 and NNT=27. OR for cohabiting patients was 1.47, 95% CI (1.02-2.08); p=0.035. No significant difference was observed in mortality (22% vs. 21%; OR=1.05, 95% CI (0.89-1.25), p=0.577) or LOS (median (IQR): 6 (2-8) vs. 6 (2-8) days, p=0.1787). Conclusions The new municipality-based, nurse-led and GP-supported intervention was inferior to the hospital-based geriatric team intervention in preventing 30-day readmission among frail, geriatric patients. There was no significant difference between the two interventions in regard to 90-day mortality or LOS.
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Affiliation(s)
| | | | - Seham Shahla
- Medical Department, Randers Regional Hospital, Randers, Denmark
| | - Else Marie Damsgaard
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jens Meldgaard Bruun
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Merete Gregersen
- Department of Geriatrics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Goh KH, Wang L, Yeow AYK, Ding YY, Au LSY, Poh HMN, Li K, Yeow JJL, Tan GYH. Prediction of Readmission in Geriatric Patients From Clinical Notes: Retrospective Text Mining Study. J Med Internet Res 2021; 23:e26486. [PMID: 34665149 PMCID: PMC8564665 DOI: 10.2196/26486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 06/30/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022] Open
Abstract
Background Prior literature suggests that psychosocial factors adversely impact health and health care utilization outcomes. However, psychosocial factors are typically not captured by the structured data in electronic medical records (EMRs) but are rather recorded as free text in different types of clinical notes. Objective We here propose a text-mining approach to analyze EMRs to identify older adults with key psychosocial factors that predict adverse health care utilization outcomes, measured by 30-day readmission. The psychological factors were appended to the LACE (Length of stay, Acuity of the admission, Comorbidity of the patient, and Emergency department use) Index for Readmission to improve the prediction of readmission risk. Methods We performed a retrospective analysis using EMR notes of 43,216 hospitalization encounters in a hospital from January 1, 2017 to February 28, 2019. The mean age of the cohort was 67.51 years (SD 15.87), the mean length of stay was 5.57 days (SD 10.41), and the mean intensive care unit stay was 5% (SD 22%). We employed text-mining techniques to extract psychosocial topics that are representative of these patients and tested the utility of these topics in predicting 30-day hospital readmission beyond the predictive value of the LACE Index for Readmission. Results The added text-mined factors improved the area under the receiver operating characteristic curve of the readmission prediction by 8.46% for geriatric patients, 6.99% for the general hospital population, and 6.64% for frequent admitters. Medical social workers and case managers captured more of the psychosocial text topics than physicians. Conclusions The results of this study demonstrate the feasibility of extracting psychosocial factors from EMR clinical notes and the value of these notes in improving readmission risk prediction. Psychosocial profiles of patients can be curated and quantified from text mining clinical notes and these profiles can be successfully applied to artificial intelligence models to improve readmission risk prediction.
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Affiliation(s)
- Kim Huat Goh
- Nanyang Business School, Nanyang Technological University, Singapore, Singapore
| | - Le Wang
- City University of Hong Kong, Hong Kong, Hong Kong
| | | | - Yew Yoong Ding
- Tan Tock Seng Hospital, Singapore, Singapore.,Geriatric Education and Research Institute, Singapore, Singapore
| | | | | | - Ke Li
- Medical Informatics, National University Health System, Singapore, Singapore
| | | | - Gamaliel Yu Heng Tan
- Ng Teng Fong General Hospital, Singapore, Singapore.,Medical Informatics, National University Health System, Singapore, Singapore
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Armitage MN, Srivastava V, Allison BK, Williams MV, Brandt-Sarif M, Lee G. A prospective cohort study of two predictor models for 30-day emergency readmission in older patients. Int J Clin Pract 2021; 75:e14478. [PMID: 34107148 DOI: 10.1111/ijcp.14478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/06/2021] [Indexed: 11/27/2022] Open
Abstract
AIM To undertake a prospective study of the accuracy of two models (LACE and BOOST) in predicting unplanned hospital readmission in older patients (>75 years). METHODS Data were collected from a single centre prospectively on 110 patients over 75 years old admitted to the acute medical unit. Follow-up was conducted at 30 days. The primary outcome was the c-statistic for both models. RESULTS The readmission rate was 32.7% and median age 82 years, and both BOOST and LACE scores were significantly higher in those readmitted compared with those who were not. C-statistics were calculated for both tools with BOOST score 0.667 (95% CI 0.559-0.775, P = .005) and LACE index 0.685 (95% CI 0.579-0.792, P = .002). CONCLUSION In this prospective study, both the BOOST and LACE scores were found to be significant yet poor, predictive models of hospital readmission. Recent hospitalisation (within the previous 6 months) was found to be the most significant contributing factor.
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Affiliation(s)
| | | | | | | | | | - Geraldine Lee
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Teo K, Yong CW, Chuah JH, Hum YC, Tee YK, Xia K, Lai KW. Current Trends in Readmission Prediction: An Overview of Approaches. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2021; 48:1-18. [PMID: 34422543 PMCID: PMC8366485 DOI: 10.1007/s13369-021-06040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/30/2021] [Indexed: 12/03/2022]
Abstract
Hospital readmission shortly after discharge threatens the quality of patient care and leads to increased medical care costs. In the United States, hospitals with high readmission rates are subject to federal financial penalties. This concern calls for incentives for healthcare facilities to reduce their readmission rates by predicting patients who are at high risk of readmission. Conventional practices involve the use of rule-based assessment scores and traditional statistical methods, such as logistic regression, in developing risk prediction models. The recent advancements in machine learning driven by improved computing power and sophisticated algorithms have the potential to produce highly accurate predictions. However, the value of such models could be overrated. Meanwhile, the use of other flexible models that leverage simple algorithms offer great transparency in terms of feature interpretation, which is beneficial in clinical settings. This work presents an overview of the current trends in risk prediction models developed in the field of readmission. The various techniques adopted by researchers in recent years are described, and the topic of whether complex models outperform simple ones in readmission risk stratification is investigated.
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Affiliation(s)
- Kareen Teo
- Department of Biomedical Engineering, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ching Wai Yong
- Department of Biomedical Engineering, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Joon Huang Chuah
- Department of Electrical Engineering, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yan Chai Hum
- Department of Mechatronics and Biomedical Engineering, Universiti Tunku Abdul Rahman, 43000 Sungai Long, Malaysia
| | - Yee Kai Tee
- Department of Mechatronics and Biomedical Engineering, Universiti Tunku Abdul Rahman, 43000 Sungai Long, Malaysia
| | - Kaijian Xia
- Changshu Institute of Technology, Changshu, 215500 Jiangsu China
| | - Khin Wee Lai
- Department of Biomedical Engineering, Universiti Malaya, 50603 Kuala Lumpur, Malaysia
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Thomsen K, Fournaise A, Matzen LE, Andersen-Ranberg K, Ryg J. Does geriatric follow-up visits reduce hospital readmission among older patients discharged to temporary care at a skilled nursing facility: a before-and-after cohort study. BMJ Open 2021; 11:e046698. [PMID: 34389564 PMCID: PMC8365788 DOI: 10.1136/bmjopen-2020-046698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hospital readmission is a burden to patients, relatives and society. Older patients with frailty are at highest risk of readmission and its negative outcomes. OBJECTIVE We aimed at examining whether follow-up visits by an outgoing multidisciplinary geriatric team (OGT) reduces unplanned hospital readmission in patients discharged to a skilled nursing facility (SNF). DESIGN A retrospective single-centre before-and-after cohort study. SETTING AND PARTICIPANTS Study population included all hospitalised patients discharged from a Danish geriatric department to an SNF during 1 January 2016-25 February 2020. To address potential changes in discharge and readmission patterns during the study period, patients discharged from the same geriatric department to own home were also assessed. INTERVENTION OGT visits at SNF within 7 days following discharge. Patients discharged to SNF before 12 March 2018 did not receive OGT (-OGT). Patients discharged to SNF on or after 12 March 2018 received the intervention (+OGT). MAIN OUTCOME MEASURES Unplanned hospital readmission between 4 hours and 30 days following initial discharge. RESULTS Totally 847 patients were included (440 -OGT; 407 +OGT). No differences were seen between the two groups regarding age, sex, activities of daily living (ADLs), Charlson Comorbidity Index (CCI) or 30-day mortality. The cumulative incidence of readmission was 39.8% (95% CI 35.2% to 44.8%, n=162) in -OGT and 30.2% (95% CI 25.8% to 35.2%, n=113) in +OGT. The unadjusted risk (HR (95% CI)) of readmission was 0.68 (0.54 to 0.87, p=0.002) in +OGT compared with -OGT, and remained significantly lower (0.72 (0.57 to 0.93, p=0.011)) adjusting for age, length of stay, sex, ADL and CCI. For patients discharged to own home the risk of readmission remained unchanged during the study period. CONCLUSION Follow-up visits by OGT to patients discharged to temporary care at an SNF significantly reduced 30-day readmission in older patients.
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Affiliation(s)
- Katja Thomsen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Anders Fournaise
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
- Department of Cross-sectoral Collaboration, Region of Southern Denmark, Vejle, Denmark
| | - Lars Erik Matzen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Jesper Ryg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
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Glans M, Kragh Ekstam A, Jakobsson U, Bondesson Å, Midlöv P. Medication-related hospital readmissions within 30 days of discharge-A retrospective study of risk factors in older adults. PLoS One 2021; 16:e0253024. [PMID: 34111185 PMCID: PMC8191889 DOI: 10.1371/journal.pone.0253024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/26/2021] [Indexed: 12/29/2022] Open
Abstract
Background Previous studies have shown that approximately 20% of hospital readmissions can be medication-related and 70% of these readmissions are possibly preventable. This retrospective medical records study aimed to find risk factors associated with medication-related readmissions to hospital within 30 days of discharge in older adults (≥65 years). Methods 30-day readmissions (n = 360) were assessed as being either possibly or unlikely medication-related after which selected variables were used to individually compare the two groups to a comparison group (n = 360). The aim was to find individual risk factors of possibly medication-related readmissions focusing on living arrangements, polypharmacy, potentially inappropriate medication therapy, and changes made to medication regimens at initial discharge. Results A total of 143 of the 360 readmissions (40%) were assessed as being possibly medication-related. Charlson Comorbidity Index (OR 1.15, 95%CI 1.5–1.25), excessive polypharmacy (OR 1.74, 95%CI 1.07–2.81), having adjustments made to medication dosages at initial discharge (OR 1.63, 95%CI 1.03–2.58) and living in your own home, alone, were variables identified as risk factors of such readmissions. Living in your own home, alone, increased the odds of a possibly medication-related readmission 1.69 times compared to living in your own home with someone (p-value 0.025) and 2.22 times compared to living in a nursing home (p-value 0.037). Conclusion Possibly medication-related readmissions within 30 days of discharge, in patients 65 years and older, are common. The odds of such readmissions increase in comorbid, highly medicated patients living in their own home, alone, and if having medication dosages adjusted at initial discharge. These results indicate that care planning before discharge and the provision of help with, for example, managing medications after discharge, are factors especially important if aiming to reduce the amount of medication-related readmissions among this population. Further research is needed to confirm this hypothesis.
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Affiliation(s)
- Maria Glans
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Medications, Region Skåne Office for Hospitals in Northeastern Skåne, Kristianstad, Sweden
- * E-mail:
| | - Annika Kragh Ekstam
- Department of Orthopaedics, Region Skåne Office for Hospitals in Northeastern Skåne, Kristianstad, Sweden
| | - Ulf Jakobsson
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Åsa Bondesson
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Medicines Management and Informatics in Skåne County, Malmö, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences Malmö, Center for Primary Health Care Research, Lund University, Malmö, Sweden
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Erlang AS, Schjødt K, Linde JKS, Jensen AL. An observational study of older patients' experiences of involvement in discharge planning. Geriatr Nurs 2021; 42:855-862. [PMID: 34090231 DOI: 10.1016/j.gerinurse.2021.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/30/2021] [Accepted: 04/01/2021] [Indexed: 01/10/2023]
Abstract
The discharge of older patients is complex and healthcare professionals focus more on organizational and coordinating tasks rather than on patient involvement. The study aims to describe older medical patients' experiences of involvement in discharge planning and to identify associations between their experiences of involvement and readmissions. This observational study included 210 older medical inpatients from a Danish university hospital. Data were collected from a questionnaire survey and the patients' medical records. Involvement was measured using the subscales: information, communication, participation, time of discharge, relatives & general impression. Most participants reported receiving the overall information needed before discharge. There was a lack of specific information, regarding medicine and symptoms. Fewer participants reported positively on participation. 23.8% of the participants were readmitted within 30 days. Longer hospitalization, comorbidities and less perceived information were associated with a higher risk of readmission. There were associations between patient involvement and the 30-day readmission rate.
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Affiliation(s)
- Anne Snoghøj Erlang
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital.99 Palle Juul-Jensens Boulevard, 8200 Aarhus N, Denmark.
| | - Karina Schjødt
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital.99 Palle Juul-Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Jakob Kau Starup Linde
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital.99 Palle Juul-Jensens Boulevard, 8200 Aarhus N, Denmark
| | - Annesofie Lunde Jensen
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital.99 Palle Juul-Jensens Boulevard, 8200 Aarhus N, Denmark
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Lekan DA, Jenkins M, McCoy TP, Mohanty S, Manda P, Yasin R. Hospital Readmission Outcomes by Frailty Risk in Adults in Behavioral Health Acute Care. J Psychosoc Nurs Ment Health Serv 2021; 59:27-39. [PMID: 34142911 DOI: 10.3928/02793695-20210427-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the current retrospective study was to determine whether frailty is predictive of 30-day readmission in adults aged ≥50 years who were admitted with a psychiatric diagnosis to a behavioral health hospital from 2013 to 2017. A total of 1,063 patients were included. A 26-item frailty risk score (FRS-26-ICD) was constructed from electronic health record (EHR) data. There were 114 readmissions. Cox regression modeling for demographic characteristics, emergent admission, comorbidity, and FRS-26-ICD determined prediction of time to readmission was modest (incremental area under the receiver operating characteristic curve = 0.671). The FRS-26-ICD was a significant predictor of readmission alone and in models with demographics and emergent admission; however, only the Elixhauser Comorbidity Index was significantly related to hazard of readmission adjusting for other factors (adjusted hazard ratio = 1.26, 95% confidence interval [1.17, 1.37]; p < 0.001), whereas FRS-26-ICD became non-significant. Frailty is a relevant syndrome in behavioral health that should be further studied in risk prediction and incorporated into care planning to prevent hospital readmissions. [Journal of Psychosocial Nursing and Mental Health Services, xx(x), xx-xx.].
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Carrillo-Garcia P, Garmendia-Prieto B, Cristofori G, Montoya IL, Hidalgo JJ, Feijoo MQ, Cortés JJB, Gómez-Pavón J. Health status in survivors older than 70 years after hospitalization with COVID-19: observational follow-up study at 3 months. Eur Geriatr Med 2021; 12:1091-1094. [PMID: 34057701 PMCID: PMC8165338 DOI: 10.1007/s41999-021-00516-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To analyze factors associated with mortality at 3 months and readmissions, functional and cognitive decline, anorexia and affective disorders in patients aged > 70 years surviving after hospital admission for SARS-CoV-2. METHODS Patients aged > 70 years, discharged after hospitalization with COVID-19. OUTCOME VARIABLES mortality, readmissions, functional and cognitive impairment, anorexia and mood disorder. RESULTS 165 cases at 3 months after hospital discharge, 8.5% died and 20% required at least one hospital readmission. The presence of severe dependence at discharge (BI < 40) was associated at 3 months with a higher risk of mortality (OR 5.08; 95% CI 1.53-16.91) and readmissions (OR 4.53; 95% CI 1.96-10.49). The post-hospitalization functional deterioration was associated with persistence of deterioration at 3 months (OR 24.57; 95% CI 9.24-65.39), cognitive deterioration (OR 2.32; 95% CI 1.03-5.25) and affective (OR 4.40; 95% CI 1.84-10.55) CONCLUSIONS: Loss function in older people after hospitalization by COVID-19 may contribute to identify patients with a higher risk of sequelae in the short term that require closer follow-up.
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Affiliation(s)
- Pamela Carrillo-Garcia
- Department of Geriatric, Hospital Central de la Cruz Roja, San José y Santa Adela, Avenida Reina Victoria 26, 28003, Madrid, Spain.
| | - Blanca Garmendia-Prieto
- Department of Geriatric, Hospital Central de la Cruz Roja, San José y Santa Adela, Avenida Reina Victoria 26, 28003, Madrid, Spain
| | - Giovanna Cristofori
- Department of Geriatric, Hospital Central de la Cruz Roja, San José y Santa Adela, Avenida Reina Victoria 26, 28003, Madrid, Spain
| | - Isabel Lozano Montoya
- Department of Geriatric, Hospital Central de la Cruz Roja, San José y Santa Adela, Avenida Reina Victoria 26, 28003, Madrid, Spain
| | - Javier Jaramillo Hidalgo
- Department of Geriatric, Hospital Central de la Cruz Roja, San José y Santa Adela, Avenida Reina Victoria 26, 28003, Madrid, Spain
| | - Maribel Quezada Feijoo
- Cardiology Department, Hospital Central de la Cruz Roja, San José y Santa Adela, Madrid, Spain
| | - Juan José Baztán Cortés
- Department of Geriatric, Hospital Central de la Cruz Roja, San José y Santa Adela, Avenida Reina Victoria 26, 28003, Madrid, Spain
| | - Javier Gómez-Pavón
- Department of Geriatric, Hospital Central de la Cruz Roja, San José y Santa Adela, Avenida Reina Victoria 26, 28003, Madrid, Spain
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Malnutrition and depression as predictors for 30-day unplanned readmission in older patient: a prospective cohort study to develop 7-point scoring system. BMC Geriatr 2021; 21:256. [PMID: 33865312 PMCID: PMC8052844 DOI: 10.1186/s12877-021-02198-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Readmission is related to high cost, high burden, and high risk for mortality in geriatric patients. A scoring system can be developed to predict the readmission of older inpatients to perform earlier interventions and prevent readmission. METHODS We followed prospectively inpatients aged 60 years and older for 30 days, with initial comprehensive geriatric assessment (CGA) on admission in a tertiary referral centre. Patients were assessed with CGA tools consisting of FRAIL scale (fatigue, resistance, ambulation, illness, loss of weight), the 15-item Geriatric Depression Scale, Mini Nutritional Assessment short-form (MNA-SF), the Barthel index for activities of daily living (ADL), Charlson Comorbidity Index (CCI), caregiver burden based on 4-item Zarit Burden Index (ZBI), and cognitive problem with Abbreviated Mental Test (AMT). Demographic data, malignancy diagnosis, and number of drugs were also recorded. We excluded data of deceased patients and patients transferred to other hospitals. We conducted stepwise multivariate regression analysis to develop the scoring system. RESULTS Thirty-day unplanned readmission rate was 37.6 %. Among 266 patients, 64.7 % of them were malnourished, and 46.5 % of them were readmitted. About 24 % were at risk for depression or having depressed mood, and 53.1 % of them were readmitted. In multivariate analysis, nutritional status (OR 2.152, 95 %CI 1.151-4.024), depression status (OR 1.884, 95 %CI 1.071-3.314), malignancy (OR 1.863 95 %CI 1.005-3.451), and functional status (OR 1.584, 95 %CI 0.885-2.835) were included in derivation of 7 score system. The scoring system had maximum score of 7 and incorporated malnutrition (2 points), depression (2 points), malignancy (2 points), and dependent functional status (1 point). A score of 3 or higher suggested 82 % probability of readmission within 30 days following discharge. Area under the curve (AUC) was 0.694 (p = 0.001). CONCLUSIONS Malnutrition, depression, malignancy and functional problem are predictors for 30-day readmission. A practical CGA-based 7 scoring system had moderate accuracy and strong calibration in predicting 30-day unplanned readmission for older patients.
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Son YJ, Kim GO, Lee YM, Oh M, Choi J. Predictors of Early and Late Unplanned Intensive Care Unit Readmission: A Retrospective Cohort Study. J Nurs Scholarsh 2021; 53:400-407. [PMID: 33783100 DOI: 10.1111/jnu.12657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Intensive care unit (ICU) readmission is considered one of the major quality indicators of critical care. Reducing ICU readmission can improve patients' outcomes and optimize health resources, but there are limited data on the predictors of unplanned ICU readmission. This study aimed to identify the risk factors associated with unplanned ICU readmission within 48 hr (early) and after 48 hr (late) from ICU discharge. DESIGN Retrospective cohort study. METHODS Data were collected from patients' electronic medical records in a 24-bed medical ICU at a tertiary academic medical center in Busan, South Korea. Among all the patients admitted to the medical ICU (n = 1,033) between January 2015 and December 2017, 739 eligible patients were analyzed. A multivariable multinomial logistic regression model was conducted to identify predictors of ICU readmission. FINDINGS Out of the 739 patients analyzed, 66 (8.9%) were readmitted to the medical ICU: 13 (1.8%) as early readmission and 53 (7.1%) as late readmission. Two significant predictors were identified for early readmission: ICU admission from the ward (odds ratio [OR] = 4.14; 95% confidence interval [CI] 1.25, 13.67) and mechanical ventilation support >14 days (OR = 13.25; 95% CI 1.78, 98.89). For late ICU admission, there were four risk factors: ICU admission from the ward (OR = 2.69; 95% CI 1.44, 5.05), tracheostomy placement (OR = 3.58; 95% CI 1.49, 8.59), mechanical ventilation support >14 days (OR = 4.77; 95% CI 1.67, 13.63), and continuous renal replacement therapy (OR = 4.57; 95% CI 2.42, 8.63). CONCLUSIONS To prevent unplanned ICU readmission in patients at high risk, it is necessary to investigate further the role of clinical judgment and communication within the ICU clinical team and institutional-level support regarding ICU readmission events. CLINICAL RELEVANCE Both ICU nurses and nurses in post-ICU settings should be aware of the potential risk factors associated with early and late ICU readmission. Predictors and readmission strategies may be different for early and late readmissions. Prospective multicenter studies are needed to examine how these factors influence post-ICU outcomes.
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Affiliation(s)
- Youn-Jung Son
- Lambda Alpha-at-Large, Professor, Red Cross College of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Gi-Ock Kim
- Charge Nurse, Inje University Busan Paik Hospital, Busan, Republic of Korea
| | - Yun Mi Lee
- Professor, College of Nursing, Institute of Health Science Research, Inje University, Busan, Republic of Korea
| | - Minkyung Oh
- Associate Professor, Department of Pharmacology, Inje University College of Medicine, Busan, Republic of Korea
| | - JiYeon Choi
- Lambda Alpha-at-Large, Assistant Professor, Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, South Korea
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Kerminen HM, Jäntti PO, Valvanne JNA, Huhtala HSA, Jämsen ERK. Risk factors of readmission after geriatric hospital care: An interRAI-based cohort study in Finland. Arch Gerontol Geriatr 2021; 94:104350. [PMID: 33516078 DOI: 10.1016/j.archger.2021.104350] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/02/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To identify risk factors for readmission after geriatric hospital care. METHODS A retrospective cohort study of 1,167 community-dwelling patients aged ≥70 years who were hospitalised in two geriatric hospitals and discharged to their homes over a three-year period. We combined the results of the interRAI-post acute care instrument (interRAI-PAC) with hospital discharge records. Factors associated with readmissions within 90 days following discharge were analysed using logistic regression analysis. RESULTS The patients' mean age was 84.5 (SD 6.2) years, and 71% (n = 827) were women. The 90-day readmission rate was 29.5%. The risk factors associated with readmission in the univariate analysis were as follows: age, admission from home vs. acute care hospital, Alzheimer's disease, unsteady gait, fatigue, unstable conditions, Activities of Daily Living Hierarchy Scale (ADLH) score, Cognitive Performance Scale (CPS) score, body mass index (BMI), frailty index, bowel incontinence, hearing difficulties, and poor self-rated health. In the multivariable analysis, age of ≥90 years, ADLH ≥1, unsteady gait, BMI <25 or ≥30 kg/m 2 , and frailty remained as risk factors for readmission. Surgical operation during the treatment period was associated with a lower readmission risk. CONCLUSIONS AND IMPLICATIONS InterRAI-PAC performed upon admission to geriatric hospitals revealed patient-related risk factors for readmission. Based on the identified risk factors, we recommend that the patient's functional ability, activities of daily living (ADL) needs, and individual factors underlying ADL disability, as well as nutritional and mobility problems should be carefully addressed and managed during hospitalization to diminish the risk for readmission.
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Affiliation(s)
- Hanna M Kerminen
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland; Tampere University Hospital, Centre of Geriatrics, Elämänaukio 2, 33520 Tampere, Finland.
| | - Pirkko O Jäntti
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland
| | - Jaakko N A Valvanne
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland
| | - Heini S A Huhtala
- Tampere University, Faculty of Social Sciences, P.O. Box 100, 33014, Tampere University, Finland
| | - Esa R K Jämsen
- Tampere University, Faculty of Medicine and Health Technology, and the Gerontology Research Centre (GEREC), P.O. Box 100, 33014 Tampere University, Finland; Tampere University Hospital, Centre of Geriatrics, Elämänaukio 2, 33520 Tampere, Finland
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Visade F, Babykina G, Lamer A, Defebvre MM, Verloop D, Ficheur G, Genin M, Puisieux F, Beuscart JB. Importance of previous hospital stays on the risk of hospital re-admission in older adults: a real-life analysis of the PAERPA study population. Age Ageing 2021; 50:141-146. [PMID: 32687169 DOI: 10.1093/ageing/afaa139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/14/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND consideration of the first hospital re-admission only and failure to take account of previous hospital stays, which are the two significant limitations when studying risk factors for hospital re-admission. The objective of the study was to use appropriate statistical models to analyse the impact of previous hospital stays on the risk of hospital re-admission among older patients. METHODS an exhaustive analysis of hospital discharge and health insurance data for a cohort of patients participating in the PAERPA ('Care Pathways for Elderly People at Risk of Loss of Personal Independence') project in the Hauts de France region of France. All patients aged 75 or over were included. All data on hospital re-admissions via the emergency department were extracted. The risk of unplanned hospital re-admission was estimated by applying a semiparametric frailty model, the risk of death by applying a time-dependent semiparametric Cox regression model. RESULTS a total of 24,500 patients (median [interquartile range] age: 81 [77-85]) were included between 1 January 2015 and 31 December 2017. In a multivariate analysis, the relative risk (95% confidence interval [CI]) of hospital re-admission rose progressively from 1.8 (1.7-1.9) after one previous hospital stay to 3.0 (2.6-3.5) after five previous hospital stays. The relative risk [95%CI] of death rose slowly from 1.1 (1.07-1.11) after one previous hospital stay to 1.3 (1.1-1.5) after five previous hospital stays. CONCLUSION analyses of the risk of hospital re-admission in older adults must take account of the number of previous hospital stays. The risk of death should also be analysed.
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Affiliation(s)
- Fabien Visade
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
- Department of Geriatrics, Lille Catholic Hospitals, University of Lille, Lomme F-59160, France
| | - Genia Babykina
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Antoine Lamer
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | | | | | - Grégoire Ficheur
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Michael Genin
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - François Puisieux
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
| | - Jean-Baptiste Beuscart
- University of Lille, EA2694—Evaluation des Technologies de Santé et des Pratiques Médicales, Lille F-59000, France
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Fønss Rasmussen L, Grode LB, Lange J, Barat I, Gregersen M. Impact of transitional care interventions on hospital readmissions in older medical patients: a systematic review. BMJ Open 2021; 11:e040057. [PMID: 33419903 PMCID: PMC7799140 DOI: 10.1136/bmjopen-2020-040057] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To identify and synthesise available evidence on the impact of transitional care interventions with both predischarge and postdischarge elements on readmission rates in older medical patients. DESIGN A systematic review. METHOD Inclusion criteria were: medical patients ≥65 years or mean age in study population of ≥75 years; interventions were transitional care interventions between hospital and home with both predischarge and postdischarge components; outcome was hospital readmissions. Studies were excluded if they: included other patient groups than medical patients, included patients with only one diagnosis or patients with only psychiatric disorders. PubMed, The Cochrane Library, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Web of Science were searched from January 2008 to August 2019. Study selection at title level was undertaken by one author; the remaining selection process, data extraction and methodological quality assessment were undertaken by two authors independently. A narrative synthesis was performed, and effect sizes were estimated. RESULT We identified 1951 records and included 11 studies: five randomised trials, four non-randomised controlled trials and two pre-post cohort studies. The 11 studies represent 15 different interventions and 29 outcome results measuring readmission rates within 7-182 days after discharge. Twenty-two of the 29 outcome results showed a drop in readmission rates in the intervention groups compared with the control groups. The most significant impact was seen when interventions were of high intensity, lasted at least 1 month and targeted patients at risk. The methodological quality of the included studies was generally poor. CONCLUSION Transitional care interventions reduce readmission rates among older medical patients although the impact varies at different times of outcome assessment. High-quality studies examining the impact of interventions are needed, preferably complimented by a process evaluation to refine and improve future interventions. PROSPERO REGISTRATION NUMBER CRD42019121795.
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Affiliation(s)
- Lisa Fønss Rasmussen
- Department of Research and Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Louise Bang Grode
- Department of Research and Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
| | - Jeppe Lange
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Department of Orthopedic Surgery, Regional Hospital Horsens, Horsens, Denmark
| | - Ishay Barat
- Department of Research and Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
- Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
| | - Merete Gregersen
- Departments of Geriatrics, Aarhus University Hospital, Aarhus, Denmark
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The use of laboratory-identified event surveillance to classify adverse outcomes due to Clostridioides difficile infection in Canadian long-term care facilities. Infect Control Hosp Epidemiol 2020; 42:557-564. [PMID: 33222722 DOI: 10.1017/ice.2020.1269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Adverse outcomes following Clostridioides difficile infection (CDI) are not often reported for long-term care facility (LTCF) residents. We focused on the adverse outcomes due to CDI identified in Alberta LTCFs. METHODS All positive Clostridioides difficile stool specimens identified by laboratory-identified (LabID) event surveillance in Alberta from 2011 to 2018, along with Alberta Continuing Care Information System, were used to define CDI in Alberta LTCFs. CDI cases were classified as long-term care onset, hospital onset, and community onset. Laboratory records were linked to provincial databases to analyze acute-care admissions and mortality within 30-day post CDI. Age, sex, case classification, episode, and operator type, were investigated using logistic regression. RESULTS Overall, 902 CDI cases were identified in 762 LTCF residents. Of all CDI events, 860 (95.3%) were long-term care onset, 38 (4.2%) were hospital onset, and 4 (0.4%) were community onset. The CDI rate was 2.0 of 100,000 resident days. In total, 157 residents (20.6%) had 30-day all-cause mortality, 126 CDI cases (14.0%) had 30-day all-cause acute-care admissions. The 30-day all-cause mortality rate was significantly higher in residents aged >80 versus ≤80 years (24.9 vs 12.3 per 100 residents; P < .05). Residents aged >80 years, with hospital-onset CDI, and those staying in private or voluntary LTCFs were more likely to have 30-day all-cause acute-care admissions. CONCLUSIONS The prevalence of CDI adverse outcomes is in LTCFs was found to be high using LabID event surveillance. Annual review of CDI adverse outcomes using LabID event can minimize the burden of surveillance and standardize the process across all Alberta LTCFs.
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Gilbert T, Occelli P, Rabilloud M, Poupon-Bourdy S, Riche B, Touzet S, Bonnefoy M. A Nurse-Led Bridging Program to Reduce 30-Day Readmissions of Older Patients Discharged From Acute Care Units. J Am Med Dir Assoc 2020; 22:1292-1299.e5. [PMID: 33229305 DOI: 10.1016/j.jamda.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/03/2020] [Accepted: 09/08/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Older hospitalized patients are at high risk of early readmissions, requiring the implementation of enhanced coordinated transition programs on discharge. The objective of this study was to evaluate the impact of a nurse-led transition bridging program on the rate of unscheduled readmissions of older patients within 30 days from discharge from geriatric acute care units. DESIGN A stepped-wedge cluster randomized trial. SETTING AND PARTICIPANTS Seven hundred five patients aged ≥75 years hospitalized in one of 10 acute geriatric units, with at least 2 readmission risk-screening criteria (derived from the Triage Risk Screening Tool), were included from July 2015 to August 2016. METHODS The intervention condition consisted in a nurse-led hospital-to-home bridging program with 4 weeks postdischarge follow-up (2 home visits and 2 telephone calls). Unscheduled hospital readmission or emergency department (ED) visits were compared in intervention and control condition within 30 days from discharge. RESULTS The rate of 30-day readmission or ED visit was 15.5% in the intervention condition vs 17.6% in the control condition [hazard ratio stratified on clusters: 0.61 (upper limit unilateral 95% confidence interval = 1.11), P = .09]. Rate of presence of professional caregivers was increased in the intervention condition (P < .001). CONCLUSIONS AND IMPLICATIONS Although the intervention resulted in an increase in the rate of implementation of a package of care at the 4-week of follow-up, we could not demonstrate a reduction in the rate of 30-day readmissions or ED visits of older patients at risk of readmission. These findings support the evaluation of this type of program on the longer term.
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Affiliation(s)
- Thomas Gilbert
- Service de médecine gériatrique, Hospices Civils de Lyon, Groupement Hospitalier Sud, CHU de Lyon, Bénite-Pierre Cedex, France; HESPER, EA 7425 Université Claude Bernard lyon 1, Lyon 8 Cedex, France.
| | - Pauline Occelli
- HESPER, EA 7425 Université Claude Bernard lyon 1, Lyon 8 Cedex, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche clinique et Epidémiologique, Lyon, France
| | - Muriel Rabilloud
- Université de Lyon, F-69000, Lyon, France; Université Lyon 1, Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Stéphanie Poupon-Bourdy
- HESPER, EA 7425 Université Claude Bernard lyon 1, Lyon 8 Cedex, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche clinique et Epidémiologique, Lyon, France
| | - Benjamin Riche
- Université de Lyon, F-69000, Lyon, France; Université Lyon 1, Villeurbanne, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique et Bioinformatique, Lyon, France; CNRS, UMR 5558, Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, Villeurbanne, France
| | - Sandrine Touzet
- HESPER, EA 7425 Université Claude Bernard lyon 1, Lyon 8 Cedex, France; Hospices Civils de Lyon, Pôle Santé Publique, Service de Recherche clinique et Epidémiologique, Lyon, France
| | - Marc Bonnefoy
- Service de médecine gériatrique, Hospices Civils de Lyon, Groupement Hospitalier Sud, CHU de Lyon, Bénite-Pierre Cedex, France; Université de Lyon, F-69000, Lyon, France; Université Lyon 1, Villeurbanne, France; CarMeN, U1060 INSERM, Oullins Cedex, France
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Glans M, Kragh Ekstam A, Jakobsson U, Bondesson Å, Midlöv P. Risk factors for hospital readmission in older adults within 30 days of discharge - a comparative retrospective study. BMC Geriatr 2020; 20:467. [PMID: 33176721 PMCID: PMC7659222 DOI: 10.1186/s12877-020-01867-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The area of hospital readmission in older adults within 30 days of discharge is extensively researched but few studies look at the whole process. In this study we investigated risk factors related, not only to patient characteristics prior to and events during initial hospitalisation, but also to the processes of discharge, transition of care and follow-up. We aimed to identify patients at most risk of being readmitted as well as processes in greatest need of improvement, the goal being to find tools to help reduce early readmissions in this population. METHODS This comparative retrospective study included 720 patients in total. Medical records were reviewed and variables concerning patient characteristics prior to and events during initial hospital stay, as well as those related to the processes of discharge, transition of care and follow-up, were collected in a standardised manner. Either a Student's t-test, χ2-test or Fishers' exact test was used for comparisons between groups. A multiple logistic regression analysis was conducted to identify variables associated with readmission. RESULTS The final model showed increased odds of readmission in patients with a higher Charlson Co-morbidity Index (OR 1.12, p-value 0.002), excessive polypharmacy (OR 1.66, p-value 0.007) and living in the community with home care (OR 1.61, p-value 0.025). The odds of being readmitted within 30 days increased if the length of stay was 5 days or longer (OR 1.72, p-value 0.005) as well as if being discharged on a Friday (OR 1.88, p-value 0.003) or from a surgical unit (OR 2.09, p-value 0.001). CONCLUSION Patients of poor health, using 10 medications or more regularly and living in the community with home care, are at greater risk of being readmitted to hospital within 30 days of discharge. Readmissions occur more often after being discharged on a Friday or from a surgical unit. Our findings indicate patients at most risk of being readmitted as well as discharging routines in most need of improvement thus laying the ground for further studies as well as targeted actions to take in order to reduce hospital readmissions within 30 days in this population.
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Affiliation(s)
- Maria Glans
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden. .,Department of Medications, Region Skåne Office for Hospitals in Northeastern Skåne, SE-291 85, Kristianstad, Sweden.
| | - Annika Kragh Ekstam
- Department of Orthopaedics, Region Skåne Office for Hospitals in Northeastern Skåne, SE-291 85, Kristianstad, Sweden
| | - Ulf Jakobsson
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden
| | - Åsa Bondesson
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden.,Department of Medicines Management and Informatics in Skåne County, SE-291 85, Kristianstad, Sweden
| | - Patrik Midlöv
- Department of Clinical Sciences in Malmö, Center for Primary Health Care Research, Lund University, Clinical Research Center, Box 50332, 20213, Malmö, Sweden
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Conroy T, Heuzenroeder L, Feo R. In-hospital interventions for reducing readmissions to acute care for adults aged 65 and over: An umbrella review. Int J Qual Health Care 2020; 32:414-430. [PMID: 32558919 DOI: 10.1093/intqhc/mzaa064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
Abstract
PURPOSE The aim of this umbrella review was to synthesize existing systematic review evidence on the effectiveness of in-hospital interventions to prevent or reduce avoidable hospital readmissions in older people (≥65 years old). DATA SOURCES A comprehensive database search was conducted in May 2019 through MEDLINE, EMBASE, CINAHL, the JBI Database of Systematic Reviews, DARE and Epistemonikos. STUDY SELECTION Systematic reviews and other research syntheses, including meta-analyses, exploring the effectiveness of hospital-based interventions to reduce readmissions for people aged 65 and older, irrespective of gender or clinical condition, were included for review. If a review did not exclusively focus on this age group, but data for this group could be extracted, then it was considered for inclusion. Only reviews in English were included. DATA EXTRACTION Data extracted for each review included the review objective, participant details, setting and context, type of studies, intervention type, comparator and findings. RESULTS OF DATA SYNTHESIS Twenty-nine reviews were included for analysis. Within these reviews, 11 intervention types were examined: in-hospital medication review, discharge planning, comprehensive geriatric assessment, early recovery after surgery, transitional care, interdisciplinary team care, in-hospital nutrition therapy, acute care geriatric units, in-hospital exercise, postfall interventions for people with dementia and emergency department-based palliative care. Except for discharge planning and transitional care, none of the interventions significantly reduced readmissions among older adults. CONCLUSION There is limited evidence to support the effectiveness of existing hospital-based interventions to reduce readmissions for people aged 65 and older.
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Affiliation(s)
- Tiffany Conroy
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
| | - Louise Heuzenroeder
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Rebecca Feo
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Caring Futures Institute, Flinders University, Adelaide, South Australia, Australia
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A Case-Control Study of the Sub-Acute Care for Frail Elderly (SAFE) Unit on Hospital Readmission, Emergency Department Visits and Continuity of Post-Discharge Care. J Am Med Dir Assoc 2020; 22:544-550.e2. [PMID: 32943339 DOI: 10.1016/j.jamda.2020.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In Canada, alternate-level-of-care (ALC) beds in hospitals may be used when patients who do not require the intensity of services provided in an acute care setting are waiting to be discharged to a more appropriate care setting. However, when there is a lack of care options for patients waiting to be discharged, it contributes to prolonged hospital stays and bottlenecks in the health care system manifested as "hallway medicine." We examined the effectiveness of a function-focused transitional care program, the Sub-Acute care for Frail Elderly (SAFE) Unit, in reducing the length of stay (LOS) in hospital, as well as post-discharge acute care use and continuity of care. DESIGN Case-control study. SETTING AND PARTICIPANTS A 450-bed nursing home located in Ontario, Canada, where the SAFE Unit is based. The study population included frail, older patients aged 60 years and older who received care in the SAFE Unit between March 1, 2018, and February 28, 2019 (n = 153) to controls comprising of other hospitalized patients (n = 1773). METHODS We linked facility-level to provincial health administrative databases on hospital admissions and emergency department (ED) visits, and the Ontario Health Insurance Plan claims database for physician billings to investigated the LOS during the index hospitalization, 30-day odds of post-discharge ED visits, hospital readmission, and follow-up with family physicians. RESULTS SAFE patients had a median hospital LOS of 13 days [interquartile range (IQR): 8-19 days], with 75% having fewer than 1 day in an ALC bed. In comparison, the median LOS in the control group was 15 days (IQR: 10-24 days), with one-third of those days spent in an ALC bed (median: 5 days, IQR: 3-10 days). SAFE patients were more likely (64.1%) to be discharged home than control patients (46.3%). Both groups experienced similar 30-day odds of ED visits, hospital readmission and follow-up with a family physician. CONCLUSIONS AND IMPLICATIONS Frail older individuals in the SAFE Unit experienced shorter hospital stays, were less likely to be discharged to settings other than home and had similar 30-day acute care outcomes as control patients post-discharge.
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Baxter R, Shannon R, Murray J, O’Hara JK, Sheard L, Cracknell A, Lawton R. Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives. BMC Health Serv Res 2020; 20:780. [PMID: 32831038 PMCID: PMC7444052 DOI: 10.1186/s12913-020-05641-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Transitions of care are often risky, particularly for older people, and shorter hospital stays mean that patients can go home with ongoing care needs. Most previous research has focused on fundamental system flaws, however, care generally goes right far more often than it goes wrong. We explored staff perceptions of how high performing general practice and hospital specialty teams deliver safe transitional care to older people as they transition from hospital to home. METHODS We conducted a qualitative study in six general practices and four hospital specialties that demonstrated exceptionally low or reducing readmission rates over time. Data were also collected across four community teams that worked into or with these high-performing teams. In total, 157 multidisciplinary staff participated in semi-structured focus groups or interviews and 9 meetings relating to discharge were observed. A pen portrait approach was used to explore how teams across a variety of different contexts support successful transitions and overcome challenges faced in their daily roles. RESULTS Across healthcare contexts, staff perceived three key themes to facilitate safe transitions of care: knowing the patient, knowing each other, and bridging gaps in the system. Transitions appeared to be safest when all three themes were in place. However, staff faced various challenges in doing these three things particularly when crossing boundaries between settings. Due to pressures and constraints, staff generally felt they were only able to attempt to overcome these challenges when delivering care to patients with particularly complex transitional care needs. CONCLUSIONS It is hypothesised that exceptionally safe transitions of care may be delivered to patients who have particularly complex health and/or social care needs. In these situations, staff attempt to know the patient, they exploit existing relationships across care settings, and act to bridge gaps in the system. Systematically reinforcing such enablers may improve the delivery of safe transitional care to a wider range of patients. TRIAL REGISTRATION The study was registered on the UK Clinical Research Network Study Portfolio (references 35272 and 36174 ).
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Affiliation(s)
- Ruth Baxter
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Rosemary Shannon
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | - Jenni Murray
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
| | | | | | - Alison Cracknell
- Leeds Centre for Older People’s Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rebecca Lawton
- Yorkshire Quality and Safety Research Group, Bradford Institute for Health Research, Bradford, UK
- School of Psychology, University of Leeds, Leeds, UK
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Panahpour Eslami N, Nguyen J, Navarro L, Douglas M, Bann M. Factors associated with low-acuity hospital admissions in a public safety-net setting: a cross-sectional study. BMC Health Serv Res 2020; 20:775. [PMID: 32838764 PMCID: PMC7446119 DOI: 10.1186/s12913-020-05456-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/22/2020] [Indexed: 11/16/2022] Open
Abstract
Background Given system-level focus on avoidance of unnecessary hospitalizations, better understanding admission decision-making is of utility. Our study sought to identify factors associated with hospital admission versus discharge from the Emergency Department (ED) for a population of patients who were assessed as having low medical acuity at time of decision. Methods Using an institutional database, we identified ED admission requests received from March 1, 2018 to Feb 28, 2019 that were assessed by a physician at the time of request as potentially inappropriate based on lack of medical acuity. Focused chart review was performed to extract data related to patient demographics, socioeconomic information, measures of illness, and system-level factors such as previous healthcare utilization and day/time of presentation. A binary logistic regression model was constructed to correlate patient and system factors with disposition outcome of admission to the hospital versus discharge from the ED. Physician-reported contributors to admission decision-making and chief complaint/reason for admission were summarized. Results A total of 349 (77.2%) of 452 calls resulted in admission to the hospital and 103 (22.8%) resulted in discharge from the ED. Predictors of admission included age over 65 (OR 3.5 [95%CI 1.1–11.6], p = 0.039), homelessness (OR 3.3 [95% CI 1.7–6.4], p=0.001), and night/weekend presentation (OR 2.0 [95%CI 1.1–3.5], p = 0.020). The most common contributing factors to the decision to admit reported by the responding physician included: lack of outpatient social support (35.8% of admissions), homelessness (33.0% of admissions), and substance use disorder (23.5% of admissions). Conclusions Physician medical decision-making regarding the need for hospitalization incorporates consideration of individual patient characteristics, social setting, and system-level barriers. Interventions aimed at reducing unnecessary hospitalizations, especially those involving patients with low medical acuity, should focus on underlying unmet needs and involve a broad set of perspectives.
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Affiliation(s)
| | | | | | | | - Maralyssa Bann
- Division of GIM/Hospital Medicine, Harborview Medical Center, 325 9th Avenue, Box 359780, Seattle, WA, 98104, USA. .,Department of Medicine, University of Washington School of Medicine, Seattle, USA.
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Olsson A, Berglöv A, Sjölund BM. "Longing to be independent again" - A qualitative study on older adults' experiences of life after hospitalization. Geriatr Nurs 2020; 41:942-948. [PMID: 32709373 DOI: 10.1016/j.gerinurse.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 11/30/2022]
Abstract
It is important to support older adults' independence after hospitalization and, thus, to increase their perceived quality of life. The present descriptive study took a qualitative approach and aimed to describe older adults' experiences of their life situation after hospital discharge. Fifteen individuals (≥65 years) from two regional hospitals in central Sweden were interviewed between October 2015 and January 2016 in their own home following hospital discharge. The interview data were analyzed using manifest and latent qualitative content analysis. The analysis revealed one theme: "Longing to be independent again" based on four categories: `Dependent on other people and aids´, `Obstacles, impediments and limitations in daily life´, Adapt to the situation´ and `Psychological and physical values´. Understanding older adults' experiences of life after hospitalization is also a prerequisite for being able to provide person-centered care.
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Affiliation(s)
- Annakarin Olsson
- Faculty of Health and Occupational Studies, University of Gävle, 80176 Gävle, Sweden.
| | | | - Britt-Marie Sjölund
- Faculty of Health and Occupational Studies, University of Gävle, 80176 Gävle, Sweden; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
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