1
|
Islam MA, Hassan MZ, Aleem MA, Akhtar Z, Chowdhury S, Ahmmed MK, Rahman M, Rahman MZ, Mah-E-Muneer S, Uzzaman MS, Shirin T, Flora MS, Rahman M, Davis WW, Azziz-Baumgartner E, Iuliano AD, Chowdhury F. Post-discharge mortality among patients hospitalised with severe acute respiratory infection, Bangladesh, 2012-2019: a prospective observational study. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 25:100363. [PMID: 39021479 PMCID: PMC467067 DOI: 10.1016/j.lansea.2024.100363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/09/2023] [Accepted: 01/31/2024] [Indexed: 07/20/2024]
Abstract
Background Enhancing outcomes post-hospitalisation requires an understanding of predictive factors for adverse events. This study aimed to estimate post-discharge mortality rates among patients with severe acute respiratory infection (SARI) in Bangladesh, identify associated factors, and document reported causes of death. Methods From January 2012 to December 2019, we conducted follow-up calls to patients or their families 30 days after discharge to assess the status of patients with SARI. Proportions of deaths within 30 days of discharge were estimated, and a comparative analysis of demographics, clinical characteristics, and influenza illness between decedents and survivors was performed using multivariable Cox regression models. Findings Among 23,360 patients with SARI (median age: 20 years, IQR: 1.5-48, 65% male), 351 (1.5%) died during hospitalisation. Of 23,009 patients alive at discharge, 20,044 (87%) were followed, with 633 (3.2%) deaths within 30 days of discharge. In children (<18 years), difficulty breathing (adjusted hazard ratio [aHR] 1.8; 95% CI 1.1-3.0), longer hospital stay (aHR 1.1; 95% CI 1.1-1.1), and heart diseases (aHR 8.5; 95% CI 3.2-23.1) were associated with higher post-discharge death risk. Among adults (≥18 years), difficulty breathing (aHR 2.3; 95% CI 1.7-3.0), chronic obstructive pulmonary disease (aHR 1.7; 95% CI 1.4-2.2), and intensive care unit admission (aHR 5.2; 95% CI 1.9-14.0) were linked to elevated post-discharge death risk. Influenza virus was detected in 13% (46/351) of in-hospital SARI deaths and 10% (65/633) of post-discharge SARI deaths. Interpretation Nearly one in twenty patients with SARI died during hospitalisation or within 1 month of discharge, with two-thirds of deaths occurring post-discharge. Seasonal influenza vaccination is recommended to mitigate influenza-associated mortality. To enhance post-discharge outcomes, hospitals should consider developing safe-discharge algorithms, reinforcing post-discharge care plans, and establishing outpatient monitoring for recently discharged patients. Funding Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA [U01GH002259].
Collapse
Affiliation(s)
- Md Ariful Islam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Zakiul Hassan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammad Abdul Aleem
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Zubair Akhtar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sukanta Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Kaousar Ahmmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mustafizur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mohammed Ziaur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Syeda Mah-E-Muneer
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - M Salim Uzzaman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | | | - Mahmudur Rahman
- Global Health Development (GHD), The Eastern Mediterranean Public Health Network (EMPHNET), Dhaka, Bangladesh
| | - William W. Davis
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - A. Danielle Iuliano
- Influenza Division, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Fahmida Chowdhury
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| |
Collapse
|
2
|
Beck SH, Eilertsen G, Andersen-Ranberg K, Janssens A, Nielsen DS. In the footstep of the old patient from hospital to home: A qualitative field observation study. Scand J Caring Sci 2024. [PMID: 38610099 DOI: 10.1111/scs.13257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/25/2024] [Accepted: 03/09/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Older people often have multiple health conditions and therefore extended care needs. The transition from the hospital back to their home requires careful planning. The fragmented healthcare system and rapid discharge from the hospital can result in limited involvement of the older patient in the discharge planning process. We aimed to explore how older hospitalised patients experienced the transition from hospital to home and how possibilities and constraints in interactions with relevant parties in the transition affected their everyday lives. METHOD An ethnographic participant observation study including interviews was conducted with 10 older hospitalised patients. The theoretical perspective in the study is critical psychology and data were analysed using the condition-, meaning- and reasoning analysis. RESULTS Three themes were identified: (1) Lost in transition - the person's ability to act is limited, (2) In transition - the relatives become important, (3) At home - the home transforms into a workplace. CONCLUSION Lack of involvement becomes a condition for older patients as some struggle to create meaning in their transition, affecting their everyday lives. The patients experienced their relatives as important as they ensured that the HCPs got to know their values and wishes. This knowledge is important for HCPs working closely with older people both at the hospital and at home ensuring active involvement of the older person with respect and acknowledgement of the older person's wishes, needs, resources and vulnerability.
Collapse
Affiliation(s)
- Sanne Have Beck
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Grethe Eilertsen
- USN Research Group of Older Peoples' Health, Faculty of Health and Social Sciences, Universitetet I Sørøst-Norge, Drammen, Norway
| | - Karen Andersen-Ranberg
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Astrid Janssens
- Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Public Health, User Perspective and Community-Based Interventions, University of Southern Denmark, Odense, Denmark
- Centre for Research with Patients and Relatives, Odense University Hospital, Odense, Denmark
- University of Exeter Medical School, Exeter, UK
| | - Dorthe Susanne Nielsen
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| |
Collapse
|
3
|
Drummond L, Guiney S, Connolly D, Foley C, O'Connor L, O'Carroll T, Flynn R, Rohde D. Experiences of shared decision making in acute hospitals: A mixed methods secondary analysis of the Irish National Inpatient Experience Survey. PATIENT EDUCATION AND COUNSELING 2023; 113:107755. [PMID: 37099839 DOI: 10.1016/j.pec.2023.107755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/04/2023] [Accepted: 04/12/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION This study explored patient experiences of shared decision making (SDM) in public acute hospitals in Ireland. METHODS Quantitative and qualitative data from three years of the Irish National Inpatient Experience Survey were analysed. Survey questions were mapped to definitions of SDM and subjected to principal components analysis. Three SDM subscales (care on the ward; treatments; discharge) and one overall SDM scale were created. Differences in experiences of SDM by aspects of care and patient group were assessed. Thematic analysis of qualitative responses was undertaken. RESULTS 39,453 patients participated in the survey. The mean SDM experience score was 7.60 ± 2.43. Experience scores were highest on the treatments sub-scale, and lowest during discharge. Patients who had a non-emergency admission, those aged 51-80 years and men had more positive experiences than other groups. Patient comments highlighted that opportunities to clarify information and facilitation of families/caregivers in SDM were found to be lacking. CONCLUSION There were differences in experiences of SDM by aspects of care and patient group. PRACTICE IMPLICATIONS Efforts to improve SDM in acute hospitals are required, particularly at the time of discharge. SDM may be improved by facilitation of more time for discussion between clinicians and patients and/or their families/caregivers.
Collapse
Affiliation(s)
- Linda Drummond
- Health Information and Quality Authority, Dublin, Ireland.
| | | | | | - Conor Foley
- Health Information and Quality Authority, Dublin, Ireland
| | - Laura O'Connor
- Health Information and Quality Authority, Dublin, Ireland
| | | | - Rachel Flynn
- Health Information and Quality Authority, Dublin, Ireland
| | - Daniela Rohde
- Health Information and Quality Authority, Dublin, Ireland
| |
Collapse
|
4
|
Nilsen SM, Asheim A, Carlsen F, Sarheim Anthun K, Vatten LJ, Aam S, Davies NM, Bjørngaard JH. How do busy hospital circumstances affect mortality and readmission within 60 days: A cohort study of 680 000 acute admissions in Norway. Health Policy 2022; 126:808-815. [PMID: 35644720 PMCID: PMC7614243 DOI: 10.1016/j.healthpol.2022.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 02/18/2022] [Accepted: 05/18/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study mortality and readmissions for older patients admitted during more and less busy hospital circumstances. DESIGN Cohort study where we identified patients that were admitted to the same hospital, during the same month and day of the week. We estimated effects of inflow of acute patients and the number of concurrent acute inpatients. Mortality and readmissions were analysed using stratified Cox-regression. SETTING All people 80 years and older acutely admitted to Norwegian hospitals between 2008 and 2016. MAIN OUTCOME MEASURES Mortality and readmissions within 60 days from admission. RESULTS Among 294 653 patients with 685 197 admissions, mean age was 86 years (standard deviation 5). Overall, 13% died within 60 days. An interquartile range difference in inflow of acute patients was associated with a hazard ratio (HR) of 0.99, 95% confidence interval (95% CI) 0.98 to 1.00). There was little evidence of differences in readmissions, but a 7% higher risk (HR 1.07, 95% CI 1.06 to 1.09) of being discharged outside ordinary daytime working hours. CONCLUSIONS Older patients admitted during busier circumstances had similar mortality and readmissions to those admitted during less busy periods. Yet, they showed a higher risk of discharge outside daytime working hours. Despite limited effects of busyness on a hospital level, there could still be harmful effects of local situations.
Collapse
Affiliation(s)
- Sara Marie Nilsen
- Center for Health Care Improvement, St. Olav's hospital, Trondheim University Hospital, Trondheim, Norway.
| | - Andreas Asheim
- Center for Health Care Improvement, St. Olav’s hospital, Trondheim University Hospital, Trondheim, Norway,Norwegian University of Science and Technology, Department of Mathematical Sciences, Trondheim, Norway
| | - Fredrik Carlsen
- Norwegian University of Science and Technology, Department of Economics, Trondheim, Norway
| | - Kjartan Sarheim Anthun
- Department of Health Research, SINTFF Digital, Trondheim, Norway,Norwegian University of Science and Technology, Department of Public Health and Nursing, Trondheim, Norway
| | - Lars Johan Vatten
- Norwegian University of Science and Technology, Department of Public Health and Nursing, Trondheim, Norway
| | - Stina Aam
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Science, NTNU-Norwegian University of Science and Technology, Trondheim, Norway,Department of Geriatric Medicine, Clinic of Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, BS8 2BN, United Kingdom,Population Health Sciences, Bristol Medical School, University of Bristol, Barley House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom
| | - Johan Håkon Bjørngaard
- Norwegian University of Science and Technology, Department of Public Health and Nursing, Trondheim, Norway,Nord University, Faculty of Nursing and Health Sciences, Levanger, Norway
| |
Collapse
|
5
|
Rameli PM, Rajendran N. Outcomes of complex discharge planning in older adults with complex needs: a scoping review. J Int Med Res 2022; 50:3000605221110511. [PMID: 35903858 PMCID: PMC9340947 DOI: 10.1177/03000605221110511] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this scoping review, we aimed to evaluate the effectiveness of integrated multidisciplinary team discharge planning and identify common outcomes among older adults with complex needs, focusing on a safe transition from the hospital to the community. We performed a literature search for relevant articles using seven electronic databases and agreed search terms. Only articles published in English were included. In total, 23,772 articles were identified, with 27 articles meeting the inclusion criteria. A preponderance of patients aged ≥65 years and women was inferred based on population demographics. Initiatives on complex discharge planning were noted across most Western countries. Common outcomes of complex discharge planning were functionality (n = 11) including frailty (n = 4), quality of life (n = 11), and patient-centered factors including psychosocial needs (n = 9). Various outcomes from complex discharge planning initiatives and pathways were explored in this scoping review. None of the selected studies covered all nine domains of outcome assessment. Further research is needed involving follow-up studies after complex discharge planning interventions to assess their true effectiveness or value.
Collapse
|
6
|
De Brauwer I, Cornette P, D'Hoore W, Lorant V, Verschuren F, Thys F, Aujoulat I. Factors to improve quality for older patients in the emergency department: a qualitative study of patient trajectory. BMC Health Serv Res 2021; 21:965. [PMID: 34521415 PMCID: PMC8442337 DOI: 10.1186/s12913-021-06960-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Managing older people in the emergency department remains a challenge. We aimed to identify the factors influencing the care quality of older patients in the emergency department, to fine-tune future interventions for older people, considering the naturalistic context of the ED. METHODS This is a qualitative study of some 450 h of observations performed in three emergency departments selected for their diverse contexts. We performed seventy observations of older patient trajectories admitted to the emergency department. Themes were extracted from the material using an inductive reasoning approach, to highlight factors positively or negatively influencing management of patient's trajectories, in particular those presenting with typically geriatric syndromes. RESULTS Four themes were developed: no geriatric flow routine; risk of discontinuity of care; unmet basic needs and patient-centered care; complex older patients are unwelcome in EDs. CONCLUSIONS The overall process of care was based on an organ- and flow-centered paradigm, which ignored older people's specific needs and exposed them to discontinuity of care. Their basic needs were neglected and, when their management slowed the emergency department flow, older people were perceived as unwelcome. Findings of our study can inform the development of interventions about the influence of context and organizational factors.
Collapse
Affiliation(s)
- Isabelle De Brauwer
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.
| | - Pascale Cornette
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - William D'Hoore
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Vincent Lorant
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| | - Franck Verschuren
- Institute of Experimental and Clinical Research (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Frédéric Thys
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium.,Institute of Experimental and Clinical Research (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Isabelle Aujoulat
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
| |
Collapse
|
7
|
Borgen IMH, Røe C, Brunborg C, Tenovuo O, Azouvi P, Dawes H, Majdan M, Ranta J, Rusnak M, Wiegers EJA, Tverdal C, Jacob L, Cogné M, von Steinbuechel N, Andelic N. Care transitions in the first 6months following traumatic brain injury: Lessons from the CENTER-TBI study. Ann Phys Rehabil Med 2021; 64:101458. [PMID: 33246186 DOI: 10.1016/j.rehab.2020.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/26/2020] [Accepted: 10/29/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND No large international studies have investigated care transitions during or after acute hospitalisations for traumatic brain injury (TBI). OBJECTIVES To characterise various TBI-care pathways and the number of associated transitions during the first 6 months after TBI and to assess the impact of these on functional TBI outcome controlled for demographic and injury-related factors. METHODS This was a cohort study of patients with TBI admitted to various trauma centres enrolled in the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study. Number of transitions and specific care pathways were identified. Multiple logistic regression analyses were used to assess the impact of number of transitions and care pathways on functional outcome at 6 months post-injury as assessed by the Glasgow Outcome Scale-Extended (GOSE). RESULTS In total, 3133 patients survived the acute TBI-care pathway and had at least one documented in-hospital transition at 6-month follow-up. The median number of transitions was 3 (interquartile range 2-3). The number of transitions did not predict functional outcome at 6 months (odds ratio 1.08, 95% confidence interval 1.09-1.18; P=0.063). A total of 378 different care pathways were identified; 8 were identical for at least 100 patients and characterized as "common pathways". Five of these common care pathways predicted better functional outcomes at 6 months, and the remaining 3 pathways were unrelated to outcome. In both models, increased age, violence as the cause of injury, pre-injury presence of systemic disease, both intracranial and overall injury severity, and regions of Southern/Eastern Europe were associated with unfavourable functional outcomes at 6 months. CONCLUSIONS A high number of different and complex care pathways was found for patients with TBI, particularly those with severe injuries. This high number and variety of care pathway possibilities indicates a need for standardisation and development of "common data elements for TBI care pathways" for future studies. STUDY REGISTRATION ClinicalTrials.gov NCT02210221.
Collapse
Affiliation(s)
- Ida M H Borgen
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Olli Tenovuo
- Turku Brain Injury Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Philippe Azouvi
- AP-HP, GH Paris-Saclay, Hopital Raymond Poincaré, Garches and Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
| | - Helen Dawes
- Oxford Brookes University, health and life sciences, Oxford, UK
| | - Marek Majdan
- Trnava University, Faculty of Health Sciences and Social Work, Department of Public Health, Institute for Global Health and Epidemiology, Slovakia
| | - Jukka Ranta
- VTT Technical Research Centre of Finland Ltd, Finland
| | - Martin Rusnak
- Trnava University, Faculty of Health Sciences and Social Work, Department of Public Health, Institute for Global Health and Epidemiology, Slovakia
| | - Eveline J A Wiegers
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Cathrine Tverdal
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
| | - Mélanie Cogné
- University Hospital of Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Germany
| | - Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway
| | | |
Collapse
|
8
|
Rognan SE, Kälvemark-Sporrong S, Bengtsson KR, Lie HB, Andersson Y, Mowé M, Mathiesen L. Empowering the patient? Medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway. BMJ Open 2021; 11:e044850. [PMID: 34193483 PMCID: PMC8246347 DOI: 10.1136/bmjopen-2020-044850] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Effective communication and patient empowerment before hospital discharge are important steps to ensure medication safety. Patients discharged from hospitals are often expected to assume self-management, frequently without healthcare personnel (HCP) having ensured patients' knowledge, motivation and/or skills. In this substudy of a larger study, we explore how patients experience medication communication during encounters with HCPs and how they are empowered at hospital discharge. DESIGN This is a qualitative case study. Data collection was done through qualitative observations of patient-HCP encounters, semistructured interviews with patients and drug reconciliation. Data were analysed using content analysis. SETTING An internal medicines ward at a university hospital in Norway. PARTICIPANTS Nine patients aged 49-90 years were included close to the day of discharge. RESULTS The analysis revealed the following themes: (1) patient-centred care (PCC), which included 'understanding and involvement in the patient-as-person', 'establishment of a therapeutic alliance', and 'sharing power and responsibility'; and (2) biomedical (conventional) care, including the subthemes 'HCPs in power and control' and 'optimising medical outcomes, following guidelines'. Even though the elements of PCC were observed in several encounters, overall communication was not sufficiently fostering patient empowerment. Spending time with patients and building relations based on mutual trust seemed undervalued. CONCLUSIONS The results provide a broader understanding of how patients experience medication communication at hospital discharge. Both the patients and the HCPs appear to be inculcated with biomedical traditions and are uncertain about the roles and opportunities associated with PCC. Attention should be paid to patient preferences and to the core elements of the PCC model from admission to discharge to empower patients in medication self-management.
Collapse
Affiliation(s)
- Stine Eidhammer Rognan
- Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Oslo, Norway
- Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway
| | - Sofia Kälvemark-Sporrong
- Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
- Department of Pharmacy, Uppsala University, Uppsala, Sweden
| | | | | | - Yvonne Andersson
- Hospital Pharmacies Enterprise, South-Eastern Norway, Oslo, Norway
| | - Morten Mowé
- Division of Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Liv Mathiesen
- Department of Pharmacy, University of Oslo, Oslo, Norway
| |
Collapse
|
9
|
Aaltonen M, El Adam S, Martin-Matthews A, Sakamoto M, Strumpf E, McGrail K. Dementia and Poor Continuity of Primary Care Delay Hospital Discharge in Older Adults: A Population-Based Study From 2001 to 2016. J Am Med Dir Assoc 2020; 22:1484-1492.e3. [PMID: 33358723 DOI: 10.1016/j.jamda.2020.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVES Delayed discharge, remaining in acute care longer than medically necessary, reflects less than optimal use of hospital care resources and can have negative implications for patients. We studied (1) the change over time in delayed discharge in people with and without dementia, and (2) the association of delayed discharge with discharge destination and with the continuity of primary care prior to urgent admission. DESIGN A retrospective population-based study. SETTING AND PARTICIPANTS Delayed discharge after urgent admission and length of delayed discharge were studied in all hospital users aged ≥70 years with at least 1 urgent admission in British Columbia, Canada, in years 2001/02, 2005/06, 2010/11, and 2015/16 (N = 276,299). METHODS Linked administrative data provided by Population Data BC were analyzed using generalized estimating equations (GEE), logistic regression analysis, and negative binomial regression analyses. RESULTS Delayed discharge increased among people with dementia and decreased among people without dementia, whereas the length of delay decreased among both. Dementia was the strongest predictor of delayed discharge [odds ratio 4.76; 95% confidence interval (CI) 4.59-4.93], whereas waiting for long-term care placement [incidence rate ratio (IRR) 1.56; 95% CI 1.50-1.62] and dementia (IRR 1.50; 95% CI 1.45-1.54) predicted a higher number of days of delay. Continuity and quantity of care with the same physician before urgent admission was associated with a decreased risk of delayed discharge, especially in people with dementia. CONCLUSIONS AND IMPLICATIONS This study demonstrates the need for better system integration and patient-centered care especially for people with dementia. Population aging will likely increase the number of patients at risk of delayed discharge. Delayed discharge is associated with both the patient's complex needs and the inability of the system to meet these needs during and after urgent care. Sufficient investments are needed in both primary care and long-term care resources to reduce delayed discharges.
Collapse
Affiliation(s)
- Mari Aaltonen
- Faculty of Social Sciences and Gerontology Research Center, Tampere University, Tampere, Finland; Department of Sociology, The University of British Columbia, Vancouver, British Columbia, Canada.
| | - Shiraz El Adam
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Martin-Matthews
- Department of Sociology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mariko Sakamoto
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Erin Strumpf
- Department of Epidemiology, Biostatistics, and Occupational Health, and Department of Economics, McGill University, Montreal, Quebec, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
10
|
Considine J, Berry D, Sprogis SK, Newnham E, Fox K, Darzins P, Rawson H, Street M. Understanding the patient experience of early unplanned hospital readmission following acute care discharge: a qualitative descriptive study. BMJ Open 2020; 10:e034728. [PMID: 32439693 PMCID: PMC7247374 DOI: 10.1136/bmjopen-2019-034728] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To understand from a patient and carer perspective: (1) what features of the discharge process could be improved to avoid early unplanned hospital readmission (within 72 hours of acute care discharge) and (2) what elements of discharge planning could have enhanced the discharge experience. DESIGN A qualitative descriptive design was used. Study data were collected using semi-structured interviews that were transcribed verbatim and analysed using inductive thematic analysis. Data related to participant characteristic were collected by medical record audit and summarised using descriptive statistics. SETTING Three acute care hospitals from one health service in Australia. PARTICIPANTS Patients who had an early unplanned hospital readmission and/or their carers, if present during the interviews and willing to participate, with patient permission. FINDINGS Thirty interviews were conducted (23 patients only; 6 patient and carer dyads; 1 carer only). Five themes were constructed: 'experiences of care', 'hearing and being heard', 'what's wrong with me', 'not just about me' and 'all about going home'. There was considerable variability in patients' and carers' experiences of hospital care, discharge processes and early unplanned hospital readmission. Features of the discharge process that could be improved to potentially avoid early unplanned hospital readmission were better communication, optimal clinical care including ensuring readiness for discharge and shared decision-making regarding discharge timing and goals on returning home. The discharge experience could have been enhanced by improved communication between patients (and carers) and the healthcare team, not rushing the discharge process and a more coordinated approach to patient transport home from hospital. CONCLUSIONS The study findings highlight the complexities of the discharge process and the importance of effective communication, shared decision-making and carer engagement in optimising hospital discharge and reducing early unplanned hospital readmissions.
Collapse
Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Victoria, Australia
| | - Debra Berry
- Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Victoria, Australia
- School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Stephanie K Sprogis
- School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Evan Newnham
- Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Karen Fox
- Eastern Health, Box Hill, Victoria, Australia
| | - Peteris Darzins
- Eastern Health, Box Hill, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Helen Rawson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety-Monash Health Partnership, Clayton, Victoria, Australia
| | - Maryann Street
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety-Eastern Health Partnership, Box Hill, Victoria, Australia
| |
Collapse
|
11
|
Lilleheie I, Debesay J, Bye A, Bergland A. Experiences of elderly patients regarding participation in their hospital discharge: a qualitative metasummary. BMJ Open 2019; 9:e025789. [PMID: 31685492 PMCID: PMC6858187 DOI: 10.1136/bmjopen-2018-025789] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Ageing patients are discharged from the hospital 'quicker and sicker' than before, and hospital discharge is a critical step in patient care. Older patients form a particularly vulnerable group due to multimorbidity and frailty. Patient participation in healthcare is influenced by government policy and an important part of quality improvement of care. There is need for greater insights into the complexity of patient participation for older patients in discharge processes based on aggregated knowledge. OBJECTIVE The aim of this study was to review reported evidence concerning the experiences of older patients aged 65 years and above regarding their participation in the hospital discharge process. METHODS We conducted a qualitative metasummary. Systematic searches of Medline, Embase, Cinahl, PsycINFO and SocINDEX were conducted. Data from 18 studies were included, based on specific selection criteria. All studies explored older patients' experience of participation during the discharge process in hospital, but varied when it came to type of discharge and diagnosis. The data were categorised into themes by using thematic analysis. RESULTS Our analysis indicated that participation in the discharge process varied among elderly patients. Five themes were identified: (1) complexity of the patients state of health, (2) management and hospital routines, (3) the norm and preference of returning home, (4) challenges of mutual communication and asymmetric relationships and (5) the significance of networks. CONCLUSIONS Collaboration between different levels in the health systems and user-friendly information between staff, patient and families are crucial. The complexity of patient participation for this patient group should be recognised to enhance user involvement during discharge from hospital. Interventions or follow-up studies of how healthcare professionals can improve their communication skills and address the tension between client-centred goals and organisational priorities are requested. Organisational structure may need to be restructured to ensure the participation of elderly patients.
Collapse
Affiliation(s)
- Ingvild Lilleheie
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Jonas Debesay
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Asta Bye
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Astrid Bergland
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| |
Collapse
|
12
|
Davis SF, Silvester A, Barnett D, Farndon L, Ismail M. Hearing the voices of older adult patients: processes and findings to inform health services research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2019; 5:11. [PMID: 30834143 PMCID: PMC6385442 DOI: 10.1186/s40900-019-0143-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/12/2019] [Indexed: 05/13/2023]
Abstract
PLAIN ENGLISH SUMMARY Whilst Patient and Public Involvement and Engagement (PPIE) are widely regarded as critical to developing clinical research, there is a perception that older adults may not be able to contribute and there is less emphasis on gaining a wide range of opinions before developing research questions or projects; for example an organisational change. This PPIE initiative used three PPIE processes including existing panels and wider networking to access older adults in the community who had used the hospital services and been discharged. Older adults expressed a range of views about their experience of discharge planning and this provided an important perspective on patients' research priorities associated with their personal independence. Efforts were taken to ensure representative views across a cross section of the population. As a result of this initial PPIE, a permanent, co-ordinated 'elders' panel has been established to ensure a representation of older adult views for research, service development and evaluation. This panel has permanent, fully supported members who provide reflection and feedback on any projects and programmes relating to older people's services in the City. ABSTRACT Background Clinical academic research and service improvement is planned using Patient and Public Involvement and Engagement (PPIE) but older PPIE participants are consulted less often due to the perception that they are vulnerable or hard to engage. Objectives To consult frail older adults about a recently adopted service, discharge to assess (D2A), and to prioritise services improvements and research topics associated with the design and delivery of discharge from hospital. To use successive PPIE processes to enable a permanent PPIE panel to be established. Participants Following guidance from an established hospital PPI panel 27 older adult participants were recruited. Participants from Black, Asian and Minority Ethnic (BAME) communities, affluent and non-affluent areas and varied social circumstances were included. Methods Focus groups and individual interviews were conducted in participants own homes or nearby social venues. Results Priorities for discharge included remaining independent despite often feeling lonely at home; to remain in hospital if needed; and for services to ensure effective communication with families. The main research priority identified was facilitating independence, whilst establishing a permanent PPIE panel involving older adults was viewed favourably. Conclusions Taking a structured approach to PPIE enabled varied older peoples' voices to express their priorities and concerns into early discharge from hospital, as well as enabling the development of health services research into hospital discharge planning and management. Older people as participants identified research priorities after reflecting on their experiences. Listening and reflection enabled researchers to develop a new "Community PPIE Elders Panel" to create an enduring PPIE infrastructure for frail older housebound people to engage in research design, development and dissemination.
Collapse
Affiliation(s)
- Sally Fowler Davis
- Sheffield Hallam University and Sheffield Teaching Hospitals NHS Foundation Trust, Montgomery House, 32 Collegiate Crescent, Sheffield, S10 2BR UK
| | - Anne Silvester
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Deborah Barnett
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lisa Farndon
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | |
Collapse
|
13
|
Risk factors for hospital readmission among Swedish older adults. Eur Geriatr Med 2018; 9:603-611. [PMID: 30294396 PMCID: PMC6153697 DOI: 10.1007/s41999-018-0101-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/21/2018] [Indexed: 11/12/2022]
Abstract
Introduction Hospital readmissions of older persons are common and often associated with complex health problems. The objectives were to analyze risk factors for readmission within 30 days from hospital discharge. Methods A prospective study with a multifactorial approach based on the population-based longitudinal Swedish Adoption/Twin Study of Aging (SATSA) was conducted. During 9 years of follow-up, information on hospitalizations, readmissions and associated diagnoses were obtained from national registers. Logistic regression models controlling for age and sex were conducted to analyze risk factors for readmissions. Results Of the 772 participants, [mean age 69.7 (± 11.1), 84 (63%)] were hospitalized and among these 208 (43%) had one or several readmissions within 30 days during the follow-up period. Most of the readmissions (57%) occurred within the first week; mean days from hospital discharge to readmission was 7.9 (± 6.2). The most common causes of admission and readmission were cardiovascular diseases and tumors. Only 8% of the readmissions were regarded as avoidable admissions. In a multivariate logistic regression, falling within the last 12 months (OR 0.57, p = 0.039) and being a male (OR 1.84, p = 0.006) increased the risk of readmission. Conclusions Most older persons that are readmitted return to hospital within the first week after discharge. Experiencing a fall was a particular risk factor of readmission. Preventive actions should preferably take place already at the hospital to reduce the numbers of readmission. Still, it should be remembered that most readmissions were considered to be necessary.
Collapse
|
14
|
Rojas-García A, Turner S, Pizzo E, Hudson E, Thomas J, Raine R. Impact and experiences of delayed discharge: A mixed-studies systematic review. Health Expect 2017; 21:41-56. [PMID: 28898930 PMCID: PMC5750749 DOI: 10.1111/hex.12619] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 11/27/2022] Open
Abstract
Background The impact of delayed discharge on patients, health‐care staff and hospital costs has been incompletely characterized. Aim To systematically review experiences of delay from the perspectives of patients, health professionals and hospitals, and its impact on patients’ outcomes and costs. Methods Four of the main biomedical databases were searched for the period 2000‐2016 (February). Quantitative, qualitative and health economic studies conducted in OECD countries were included. Results Thirty‐seven papers reporting data on 35 studies were identified: 10 quantitative, 8 qualitative and 19 exploring costs. Seven of ten quantitative studies were at moderate/low methodological quality; 6 qualitative studies were deemed reliable; and the 19 studies on costs were of moderate quality. Delayed discharge was associated with mortality, infections, depression, reductions in patients’ mobility and their daily activities. The qualitative studies highlighted the pressure to reduce discharge delays on staff stress and interprofessional relationships, with implications for patient care and well‐being. Extra bed‐days could account for up to 30.7% of total costs and cause cancellations of elective operations, treatment delay and repercussions for subsequent services, especially for elderly patients. Conclusions The poor quality of the majority of the research means that implications for practice should be cautiously made. However, the results suggest that the adverse effects of delayed discharge are both direct (through increased opportunities for patients to acquire avoidable ill health) and indirect, secondary to the pressures placed on staff. These findings provide impetus to take a more holistic perspective to addressing delayed discharge.
Collapse
Affiliation(s)
- Antonio Rojas-García
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Simon Turner
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Elena Pizzo
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - Emma Hudson
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| | - James Thomas
- Institute of Education EPPI-Centre, University College London, London, UK
| | - Rosalind Raine
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, UK
| |
Collapse
|
15
|
Åberg AC, Ehrenberg A. Inpatient geriatric care in Sweden-Important factors from an inter-disciplinary team perspective. Arch Gerontol Geriatr 2017. [PMID: 28623800 DOI: 10.1016/j.archger.2017.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to describe factors of importance for the quality of inpatient geriatric care from an inter-disciplinary team perspective, an area that has not been previously studied to our knowledge. The study design was qualitative descriptive with data being collected from focus-group interviews with members of geriatric care teams. The data collection was conducted at a Swedish university hospital with 69 beds for geriatric care. It comprised five group interviews with a total of 32 staff members, including representatives of all the seven professions working with geriatric care. Data was analysed using qualitative content analysis and a thematic framework approach. Three main themes were identified as being perceived as characterising important factors essential for quality geriatric care: Interactive assessment processes, A holistic care approach, and Proactive non-hierarchical interaction. Aspects of Time and Goal-Orientation were additionally running like common threads through these themes and informed them. Accessibility, open communication, and staff continuity were experienced as prerequisites for well-functioning teamwork. Including patients and relatives in care planning and implementation was seen as essential for good care, but was at risk due to budget cuts that imposed shortened hospital stays. To meet the care demands of the growing population of older frail people, more specialised team-based care according to the concept of Comprehensive Geriatric Assessment - which is possibly best provided by older-friendly hospitals - appears as a constructive solution for reaching high degrees of both staff and patient satisfaction in geriatric care. More research is needed in this area.
Collapse
Affiliation(s)
- Anna Cristina Åberg
- School of Education, Health and Social Studies, Dalarna University, Sweden; Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, Sweden.
| | - Anna Ehrenberg
- School of Education, Health and Social Studies, Dalarna University, Sweden; School of Health Sciences, Örebro University, Örebro, Sweden
| |
Collapse
|
16
|
Georgiadis A, Corrigan O, Speed E. Frontline Healthcare Staffs’ Experience of Organizing Complex Hospital Discharges: An Ethnographic Study. ETHICS & BEHAVIOR 2016. [DOI: 10.1080/10508422.2016.1200977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
17
|
Ekdahl AW, Alwin J, Eckerblad J, Husberg M, Jaarsma T, Mazya AL, Milberg A, Krevers B, Unosson M, Wiklund R, Carlsson P. Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months. J Am Med Dir Assoc 2016; 17:263-8. [PMID: 26805750 DOI: 10.1016/j.jamda.2015.12.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/27/2015] [Accepted: 12/03/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To compare the effects of care based on comprehensive geriatric assessment (CGA) as a complement to usual care in an outpatient setting with those of usual care alone. The assessment was performed 36 months after study inclusion. DESIGN Randomized, controlled, assessor-blinded, single-center trial. SETTING A geriatric ambulatory unit in a municipality in the southeast of Sweden. PARTICIPANTS Community-dwelling individuals aged ≥ 75 years who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion. Participants were randomized to the intervention group (IG) or control group (CG). INTERVENTION Participants in the IG received CGA-based care for 24 to 31 months at the geriatric ambulatory unit in addition to usual care. OUTCOME MEASURES Mortality, transfer to nursing home, days in hospital, and total costs of health and social care after 36 months. RESULTS Mean age (SD) of participants was 82.5 (4.9) years. Participants in the IG (n = 208) lived 69 days longer than did those in the CG (n = 174); 27.9% (n = 58) of participants in the IG and 38.5% (n = 67) in the CG died (hazard ratio 1.49, 95% confidence interval 1.05-2.12, P = .026). The mean number of inpatient days was lower in the IG (15.1 [SD 18.4]) than in the CG (21.0 [SD 25.0], P = .01). Mean overall costs during the 36-month period did not differ between the IG and CG (USD 71,905 [SD 85,560] and USD 65,626 [SD 66,338], P = .43). CONCLUSIONS CGA-based care resulted in longer survival and fewer days in hospital, without significantly higher cost, at 3 years after baseline. These findings add to the evidence of CGA's superiority over usual care in outpatient settings. As CGA-based care leads to important positive outcomes, this method should be used more extensively in the treatment of older people to meet their needs.
Collapse
Affiliation(s)
- Anne W Ekdahl
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Department of Research and Education, Helsingborg Hospital, Helsingborg, Skåne Region, Sweden.
| | - Jenny Alwin
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - Jeanette Eckerblad
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Magnus Husberg
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Amelie Lindh Mazya
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden; Department of Geriatric Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Anna Milberg
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Advanced Home Care and Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Barbro Krevers
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| | - Mitra Unosson
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Rolf Wiklund
- Department of Analysis of Health Care, Östergötland Region, Linköping, Sweden
| | - Per Carlsson
- Department of Medical and Health Sciences, Faculty of Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, Sweden
| |
Collapse
|
18
|
van der Meide H, Olthuis G, Leget C. Feeling an outsider left in uncertainty - a phenomenological study on the experiences of older hospital patients. Scand J Caring Sci 2014; 29:528-36. [DOI: 10.1111/scs.12187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 09/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Gert Olthuis
- Radboud University Medical Centre Nijmegen; Nijmegen The Netherlands
| | - Carlo Leget
- University of Humanistic Studies; Utrecht The Netherlands
| |
Collapse
|
19
|
De Brauwer I, D’Hoore W, Swine C, Thys F, Beguin C, Cornette P. Changes in the clinical features of older patients admitted from the emergency department. Arch Gerontol Geriatr 2014; 59:175-80. [DOI: 10.1016/j.archger.2014.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/28/2014] [Accepted: 03/17/2014] [Indexed: 11/28/2022]
|
20
|
Ekdahl A. The organisation of hospitals and the remuneration systems are not adapted to frail old patients giving them bad quality of care and the staff feelings of guilt and frustration. Eur Geriatr Med 2014. [DOI: 10.1016/j.eurger.2013.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|