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Nasu K, Miyashita M, Hirooka K, Endo T, Fukahori H. Ambulance use and emergency department visits among people with dementia: A cross-sectional survey. Nurs Health Sci 2023; 25:712-720. [PMID: 37987542 DOI: 10.1111/nhs.13066] [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: 04/07/2023] [Revised: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/22/2023]
Abstract
This study aimed to explore factors associated with ambulance use and emergency department (ED) visits among people with dementia in the month before death. A web-based survey of bereaved family caregivers of people with dementia was conducted in March 2020. Multivariate logistic regression analyses were conducted with ambulance use and ED visits in the month before death as dependent variables. Age and gender of people with dementia and their family caregivers, home care use, decision-makers, comorbidities, degree of independence in daily living, and caregivers' preparedness for death were independent variables. Data were collected from 817 caregivers of people with dementia who had died at hospitals (52.4%), long-term care facilities (25.0%), or own homes (22.4%). Caregivers' lack of preparedness for death was significantly associated with ambulance use in the month before death. Comorbidites and males with dementia were significantly associated with ED visits in the month before death. Better death preparedness of family caregivers may reduce ambulance use for symptoms that can be more effectively addressed by palliative care than acute care for people with dementia.
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Affiliation(s)
- Katsumi Nasu
- Keio Research Institute at SFC, Fujisawa, Japan
- School of Nursing, Yasuda Women's University, Hiroshima, Japan
| | | | - Kayo Hirooka
- Graduate School of Health Care Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuro Endo
- International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Fujisawa, Japan
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Conneely M, Leahy S, O’Connor M, Corey G, Gabr A, Saleh A, Okpaje B, O’ Shaughnessy Í, Synnott A, McCarthy A, Holmes A, Robinson K, Ryan L, Griffin A, Barry L, Trépel D, Ryan D, Galvin R. A Physiotherapy-Led Transition to Home Intervention for Older Adults Following Emergency Department Discharge: A Pilot Feasibility Randomised Controlled Trial (ED PLUS). Clin Interv Aging 2023; 18:1769-1788. [PMID: 37901478 PMCID: PMC10612516 DOI: 10.2147/cia.s413961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/11/2023] [Indexed: 10/31/2023] Open
Abstract
Background Older adults frequently attend the emergency department (ED) and experience high rates of subsequent adverse outcomes including functional decline, ED re-presentation and unplanned hospital admission. The development of effective interventions to prevent such outcomes is a key priority for research and service provision. Our aim was to evaluate the feasibility of a physiotherapy-led integrated care intervention for older adults discharged from the ED (ED PLUS). Patients and Methods Older adults presenting to the ED of a university teaching hospital with undifferentiated medical complaints and discharged within 72 hours were computer randomised in a ratio of 1:1:1 to deliver usual care, Comprehensive Geriatric Assessment (CGA) in the ED, or ED PLUS. ED PLUS is an evidence-based and stakeholder-informed intervention to bridge the care transition between the ED and community by initiating a CGA in the ED and implementing a six-week, multi-component, self-management programme in the patient's home. Feasibility and acceptability were assessed quantitatively and qualitatively. All clinical and process outcomes were assessed by a research nurse blinded to group allocation. Data analyses were primarily descriptive. Results Twenty-nine participants were recruited indicating a 67% recruitment rate. At 6 months, there was 100% retention in the usual care group, 88% in the CGA group and 90% in the ED PLUS group. ED PLUS participants expressed positive feedback, and there was a trend towards improved function and quality of life and less ED revisits and unscheduled hospitalisations in the ED PLUS group. Conclusion ED PLUS bridges the transition of care between the index visit to the ED and the community and is feasible using systematic recruitment strategies. Despite recruitment challenges in the context of COVID-19, the intervention was successfully delivered and well received by participants. There was a lower incidence of functional decline and improved quality of life in the ED PLUS group. Trial Registration The trial was registered in Clinical Trials Protocols and Results System as of 21st July 2021, with registration number NCT04983602.
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Affiliation(s)
- Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Siobhán Leahy
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
| | - Margaret O’Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Gillian Corey
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Ahmed Gabr
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Anastasia Saleh
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Blessing Okpaje
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Íde O’ Shaughnessy
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Aoife Synnott
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Aoife McCarthy
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
| | - Alison Holmes
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lorna Ryan
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anne Griffin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Louise Barry
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Dominic Trépel
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Damian Ryan
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - On behalf of Ageing Research Centre Public and Patient Involvement (PPI) Panel of older adults
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
- Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland
- School of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland
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Pulido I, Nunes C, Botelho A, Lopes M, Martins S, Tomé L, Dinis F, Boto P. Comprehensive geriatric assessment of older patients and associated factors of admission to Emergency Departments in pre-covid 19 Era - A Portuguese study. Rev Esp Geriatr Gerontol 2022; 57:250-256. [PMID: 36115748 PMCID: PMC9444501 DOI: 10.1016/j.regg.2022.08.005] [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: 04/09/2020] [Revised: 08/21/2022] [Accepted: 08/29/2022] [Indexed: 11/09/2022]
Abstract
Objectives Identifying frequent users’ (≥3 admissions/year) associated factors in an emergency department (ED), using a comprehensive geriatric assessment (CGA), describing the characteristics of patients over 65 years of age. Methods A cross-sectional study was performed between August 2017 and June 2018 in an ED in Lisbon, Portugal. CGA was applied and completed with clinical records. Clinical, functional, mental and social scores were created based in Portuguese Society of Internal Medicine, and a statistical model was developed. Results CGA was applied to 426 patients over 64 years old in an ED. The mean age was 79.3, 84.7% had multimorbidity. 51.2%, 75.6%, and 40% had dependence on basic, instrumental, and walking activities, respectively. 52% had depressive symptoms, 65.7% had cognitive impairment, 63% were undernourished/at risk for malnutrition. 33.1% were socially at risk. Polypharmacy was present with a use on average of 6.5 drugs daily. Social, clinical, functional, and mental scores were unfavourable in 48.6%, 79.6%, 54.9% and 83.1% of the population, respectively. There were 2.7 hospital admissions/year and 39.9% were frequent ED users (≥3/year). The logistic regression model was weak, but showed that patients with polypharmacy, elevated Charlson Comorbidity index and an impairment nutritional status presented higher risk of being frequent users. Conclusions This study showed that 97.1% of patients had needs that would justify an interventional care plan. This intervention should be extended to primary care and nursing homes. While not providing a robust model, our study has indicated nutritional problems, polypharmacy, and an elevated Charlson index as the features with more weight in frequent users’ admissions.
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Affiliation(s)
- Isabel Pulido
- Consultant Physician in Internal Medicine, Emergency Department, Hospital Santa Maria, Portugal; Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Portugal.
| | - Carla Nunes
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Portugal; Associate Professor of Statistics and Member of the Public Health Research Centre (CISP/UNL), Portugal
| | - Amália Botelho
- Assistant Professor of Clinical Medicine, Researcher in the Comprehensive Health Research Centre (CHRC), Nova Medical School/Faculdade de Ciências Médicas (NMS/FCM), Portugal
| | - Manuel Lopes
- Coordinating Professor, Department of Nursing, University of Évora, Researcher in the Comprehensive Health Research Centre (CHRC), Portugal
| | - Sónia Martins
- Integrated Researcher in the Centre for Health Technology and Services Research (CINTESIS) and the Department of Clinical Neurosciences and Mental Health of the Faculty of Medicine, University of Porto (FMUP), Portugal
| | - Luis Tomé
- Registered Nurse, Masters in Critical Care, Charge Nurse in CHULN Central Emergency Department, Portugal
| | - Francisco Dinis
- Emergency Department Social Worker, Hospital Santa Maria, Portugal
| | - Paulo Boto
- Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Portugal; Assistant Professor, Department of Health Systems Policy and Management and Member of the Public Health Research Centre (CISP/UNL), Portugal
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Conneely M, Leahy S, Dore L, Trépel D, Robinson K, Jordan F, Galvin R. The effectiveness of interventions to reduce adverse outcomes among older adults following Emergency Department discharge: umbrella review. BMC Geriatr 2022; 22:462. [PMID: 35643453 PMCID: PMC9145107 DOI: 10.1186/s12877-022-03007-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/30/2022] [Indexed: 12/04/2022] Open
Abstract
Background Population ageing is increasing rapidly worldwide. Older adults are frequent users of health care services including the Emergency Department (ED) and experience a number of adverse outcomes following an ED visit. Adverse outcomes include functional decline, unplanned hospital admission and an ED revisit. Given these adverse outcomes a number of interventions have been examined to improve the outcomes of older adults following presentation to the ED. The aim of this umbrella review was to evaluate the effectiveness of ED interventions in reducing adverse outcomes in older adults discharged from the ED. Methods Systematic reviews of randomised controlled trials investigating ED interventions for older adults presenting to the ED exploring clinical, patient experience and healthcare utilisation outcomes were included. A comprehensive search strategy was employed in eleven databases and the PROSPERO register up until June 2020. Grey literature was also searched. Quality was assessed using the A MeaSurement Tool to Assess Systematic Reviews 2 tool. Overlap between systematic reviews was assessed using a matrix of evidence table. An algorithm to assign the Grading of Recommendations Assessment, Development and Evaluation to assess the strength of evidence was applied for all outcomes. Results Nine systematic reviews including 29 randomised controlled trials were included. Interventions comprised of solely ED-based or transitional interventions. The specific interventions delivered were highly variable. There was high overlap and low methodological quality of the trials informing the systematic reviews. There is low quality evidence to support ED interventions in reducing functional decline, improving patient experience and improving quality of life. The quality of evidence of the effectiveness of ED interventions to reduce mortality and ED revisits varied from very low to moderate. Results were presented narratively and summary of evidence tables created. Conclusion Older adults are the most important emerging group in healthcare for several economic, social and political reasons. The existing evidence for the effectiveness of ED interventions for older adults is limited. This umbrella review highlights the challenge of synthesising evidence due to significant heterogeneity in methods, intervention content and reporting of outcomes. Higher quality intervention studies in line with current geriatric medicine research guidelines are recommended, rather than the publication of further systematic reviews. Trial registration UMBRELLA REVIEW REGISTRATION: PROSPERO (CRD42020145315). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03007-5.
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Schouten B, Driesen BEJM, Merten H, Burger BHCM, Hartjes MG, Nanayakkara PWB, Wagner C. Experiences and perspectives of older patients with a return visit to the emergency department within 30 days: patient journey mapping. Eur Geriatr Med 2021; 13:339-350. [PMID: 34761369 PMCID: PMC9018642 DOI: 10.1007/s41999-021-00581-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/26/2021] [Indexed: 12/30/2022]
Abstract
Aim To achieve patient-centered care for older patients at the emergency department (ED) it is important to include their perspective and experience, and this can be done through the patient journey method. Findings By mapping the patient journey, we found that waiting times and suboptimal discharge communication are almost always related to a negative experience for older patients. Message The novelty of this study lies within the qualitative patient journey method, which allowed us to include the voice of the patient in issues that have been previously described (i.e. waiting times and discharge communication). We believe this can guide towards patient-centered improvement initiatives that can contribute to a positive ED experience in the future, for example a time-out at the ED and a discharge check list Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00581-6. Purpose Up to 22% of older patients who visit the emergency department (ED) have a return visit within 30 days. To achieve patient-centered care for this group at the ED it is important to involve the patient perspective and strive to provide the best possible experience. The aim of this study was to gain insight into the experiences and perspectives of older patients from initial to return ED visit by mapping their patient journey. Methods We performed a qualitative patient journey study with 13 patients of 70 years and older with a return ED visit within 30 days who presented at the Amsterdam UMC, a Dutch academic hospital. We used semi-structured interviews focusing on the patient experience during their journey and developed a conceptual framework for coding. Results Our sample consisted of 13 older patients with an average age of 80 years, and 62% of them were males. The framework contained a timeline of the patient journey with five chronological main themes, complemented with an ‘experience’ theme, these were divided into 34 subthemes. Health status, social system, contact with the general practitioner, aftercare, discharge and expectations were the five main themes. The experiences regarding these themes differed greatly between patients. The two most prominent subthemes were waiting time and discharge communication, which were mostly related to a negative experience. Conclusions This study provides insight into the experiences and perspectives of older patients from initial to return ED visit. The two major findings were that lack of clarity regarding waiting times and suboptimal discharge communication contributed to negative experiences. Recommendations regarding waiting time (i.e. a two-hour time out at the ED), and discharge communication (i.e. checklist for discharge) could contribute to a positive ED experience and thereby potentially improve patient-centered care. Supplementary Information The online version contains supplementary material available at 10.1007/s41999-021-00581-6.
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Affiliation(s)
- Bo Schouten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, P/O Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Babiche E J M Driesen
- Department of Emergency Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, P/O Box 7057, 1007 MB, Amsterdam, The Netherlands
| | - Brigitte H C M Burger
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mariëlle G Hartjes
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Prabath W B Nanayakkara
- Section General and Acute Internal Medicine, Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, De Boelelaan 1117, P/O Box 7057, 1007 MB, Amsterdam, The Netherlands.,Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Jiang L, Ye L, Dai M, Zhou J, Li Q. Use Andersen's behavior model to explain non-urgent visits in emergency department: A single center study in southwest China. Int Emerg Nurs 2020; 52:100845. [PMID: 32205107 DOI: 10.1016/j.ienj.2020.100845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/26/2019] [Accepted: 01/13/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Non-urgent ED visit was an important contributor of emergency overcrowding. Previous studies showed that patients make non-urgent ED visits for many reasons and their ED use patterns may be influenced by many factors. However, seldom studies were theory-based research aimed to offer a systemic insight regarding this question. METHODS This was a cross-sectional study conducted in the ED of a tertiary hospital in China guided by Andersen's behavior model of health service use. Patients triaged as non-urgent were surveyed using a self-administrated questionnaire to investigate the reasons for ED presentation and associated factors influenced their ED use patterns. RESULTS Perceived severity of illness and urgent treatment need (374, 68.6%), accessible problems to alternative services (144, 26.4%) and referral by medical staffs (134, 24.6%) were most commonly reported reasons for ED presentation. Alternative service attempt before ED presentation was determined by two predisposing factors: education level (OR = 0.638, P < 0.05) and use of nearest medical institution (OR = 1.588, P < 0.05). Prior non-urgent ED use was explained by both predisposing and need factors. They were: nationality (OR = 3.057, P < 0.01), type of health problems (OR = 1.641, P < 0.01) and self-rated health status (OR = 0.769, P < 0.01). CONCLUSION Patients' perceived need of emergency care played an extremely important role in driving ED use although several factors were identified. Future studies aim to decrease non-urgent ED use in China may firstly gain success from patient education programs.
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Affiliation(s)
- Lingjun Jiang
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China; West China School of Nursing, West China Hospital, Sichuan University, China
| | - Lei Ye
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China.
| | - Min Dai
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
| | - Jing Zhou
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
| | - Qin Li
- Department of Emergency Medicine/Institute of Disaster Medicine, West China Hospital, Sichuan University, China
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Liu Z, Tan Y, Liang H, Gu Y, Wang X, Hao Y, Gu J, Hao C. Factors Influencing Residents' Willingness to Contract With General Practitioners in Guangzhou, China, During the GP Policy Trial Phase: A Cross-Sectional Study Based on Andersen's Behavioral Model of Health Services Use. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019845484. [PMID: 31084420 PMCID: PMC6537300 DOI: 10.1177/0046958019845484] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate the current contract rate and residents’
willingness to contract with general practitioner (GP) services in Guangzhou,
China, during the policy trial phase, and also to explore the association of
behavior contract and contract willingness with variables based on Andersen’s
Behavioral Model of Health Services Use (ABM). In total, 160 residents from
community health centers (CHCs) and 202 residents from hospitals were recruited
in this study. The outcome variables were behavior contract and contract
willingness. Based on the framework of ABM, independent variables were
categorized as predisposing factors, enabling factors, need factors, and CHC
service utilization experiences. Univariate and multivariate logistic regression
analysis models were applied to explore the associated factors. Out of 362
participants, 14.4% had contracted with GP services. For those who had not
contracted with GP services, only 16.4% (51 out of 310) claimed they were
willing to do so. The contract rate for community-based participants was
significantly higher than that for hospital-based participants. Major reasons
for not choosing to contract were perceiving no benefit from the service and
concerns about the quality of CHCs. Community health center experiences and
satisfaction were significantly associated with contracting among hospital-based
participants. A need factor (diagnosed with hypertension or diabetes) and CHC
service utilization experiences (have gotten services from the same doctor in
CHCs) were significantly associated with contract willingness among CHC-based
participants. Intervention to improve awareness of GP services may help to
promote this service. Different intervention strategies should be used for
varying resident populations.
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Affiliation(s)
- Zhongqi Liu
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,2 Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Yawen Tan
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,3 Peking University Sixth Hospital/Institute of Mental Health, China
| | - Haiqing Liang
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,4 Haizhu District Center for Disease Control and Prevention, Guangzhou, China
| | - Yijun Gu
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,5 Institute of Clinical Epidemiology and Evidence - based Medicine, Tongji University School of Medicine, Shanghai, China
| | - Xiaowen Wang
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,6 Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yuantao Hao
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,2 Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Jing Gu
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,2 Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Chun Hao
- 1 Department of Medical Statistics and Epidemiology & Sun Yat-sen Global Health Institute, School of Public Health & Institute of State Governance, Sun Yat-sen University, Guangzhou.,2 Health Information Research Center & Guangdong Key Laboratory of Medicine, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
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Jeffery MM, Wolfson J, Meier SK, Dowd BE, Abraham JM, Kane RL. Health Care Service Use Among Elderly Seasonal Migrators. Popul Health Manag 2018; 21:415-421. [PMID: 29393807 DOI: 10.1089/pop.2017.0155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Elderly seasonal migrators share time between homes in different states, presenting challenges for care coordination and patient attribution methods. Medicare has prioritized alternative payment models, putting health care providers at risk for quality and value of services delivered to their attributed patients, regardless of the location of care. Little research is available to guide providers and payers on the service use of seasonal migrators. The authors use claims data on fee-for-service (FFS) Medicare beneficiaries' locations throughout the year to (1) identify seasonal migrators and (2) describe the care they receive in each seasonal home, focusing on primary care and emergency department (ED) visits and the relationships between the two. In all, 5.5% of the Medicare aged FFS population were identified as seasonal migrators, with 4.1% following the traditional snowbird pattern of migration, spending warm months in the north and cold months in the south. Migrators had higher rates of ED visits and primary care treatable (PCT) ED visits than the nonmigratory groups, controlling for location, age, race, sex, Medicaid status, season, and comorbidities. They also had more visits with specialist physicians, more days with outpatient services, and more days seeing a physician in any setting. Having local primary care strongly reduced rates of both PCT ED visits and total ED visits for all migration categories, with the greatest reduction seen in PCT ED visits by migrators (local primary care was associated with a 58% reduction in PCT ED visits by snowbirds and a 65% reduction in PCT ED visits by other migrators).
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Affiliation(s)
- Molly Moore Jeffery
- 1 Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Division of Health Care Policy and Research, Mayo Clinic , Rochester, Minnesota
| | - Julian Wolfson
- 2 Division of Biostatistics, School of Public Health, University of Minnesota , Minneapolis, Minnesota
| | - Sarah K Meier
- 3 RTI International , Washington, District of Columbia
| | - Bryan E Dowd
- 4 Division of Health Policy and Management, School of Public Health, University of Minnesota , Minneapolis, Minnesota
| | - Jean M Abraham
- 4 Division of Health Policy and Management, School of Public Health, University of Minnesota , Minneapolis, Minnesota
| | - Robert L Kane
- 4 Division of Health Policy and Management, School of Public Health, University of Minnesota , Minneapolis, Minnesota
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9
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Gasperini B, Cherubini A, Pierri F, Barbadoro P, Fedecostante M, Prospero E. Potentially preventable visits to the emergency department in older adults: Results from a national survey in Italy. PLoS One 2017; 12:e0189925. [PMID: 29267333 PMCID: PMC5739429 DOI: 10.1371/journal.pone.0189925] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 12/05/2017] [Indexed: 11/24/2022] Open
Abstract
Background Despite older adults use emergency department more appropriately than other age groups, there is a significant share of admissions that can be considered potentially preventable. Objective To identify socio-demographic characteristics and health care resources use of older adults admitted to emergency department for a potentially preventable visit. Design Data come from the Multipurpose Survey “Health conditions and use of health services”, edition 2012–2013. A stratified multi-stage probability design was used to select a sample using municipal lists of households. Subject 50474 community dwelling Italians were interviewed. In this analysis, 27003 subjects aged 65 years or older were considered. Methods Potentially preventable visits were defined as an emergency department visit that did not result in inpatient admission. Independent variables were classified based on the socio-behavioral model of Andersen-Newman. Descriptive statistics and a logistic regression model were developed. Results In the twelve months before the interview 3872 subjects (14.3%) had at least one potentially preventable visit. Factors associated with an increased risk of a potentially preventable visit were older age (75–84 years: OR 1.096, CI 1.001–1.199; 85+years: OR 1.022, CI 1.071–1.391), at least one hospital admission (OR 3.869, IC 3.547–4.221), to waive a visit (OR 1.188, CI 1.017–1.389) or an exam (OR 1.300, CI 1.077–1.570). Factors associated with a lower risk were female gender (OR 0.893, CI 0.819–0.975), area of residence (Center: OR 0.850; CI 0.766–0.943; Islands: OR 0.617, CI 0.539–0.706, South: OR 0.560; CI 0.505–0.622), private paid assistance (OR 0.761, CI 0.602–0.962); a better health-related quality of life (PCS score 46–54: OR 0.744, CI 0.659–0.841; PCS score >55: OR 0.746, CI 0.644–0.865). Conclusions Our study identified several characteristics associated with an increased risk of potentially preventable visits to the emergency department. This might allow the development of specific interventions to prevent the access of at risk subjects to the emergency department.
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Affiliation(s)
- Beatrice Gasperini
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
- Department of Geriatrics and Rehabilitation, Santa Croce Hospital, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Fano, Italy
- * E-mail:
| | - Antonio Cherubini
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS-INRCA, Ancona, Italy
| | - Francesca Pierri
- Department of Economy, Section of Statistics, University of Perugia, Perugia, Italy
| | - Pamela Barbadoro
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Massimiliano Fedecostante
- Geriatria, Accettazione geriatrica e Centro di ricerca per l’invecchiamento, IRCCS-INRCA, Ancona, Italy
| | - Emilia Prospero
- Department of Biomedical Sciences and Public Health, Section of Hygiene, Preventive Medicine and Public Health, Università Politecnica delle Marche, Ancona, Italy
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Venkatesh AK, Mei H, Kocher KE, Granovsky M, Obermeyer Z, Spatz ES, Rothenberg C, Krumholz HM, Lin Z. Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications. Acad Emerg Med 2017; 24:422-431. [PMID: 27864915 DOI: 10.1111/acem.13140] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 11/15/2016] [Accepted: 11/15/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Administrative claims data sets are often used for emergency care research and policy investigations of healthcare resource utilization, acute care practices, and evaluation of quality improvement interventions. Despite the high profile of emergency department (ED) visits in analyses using administrative claims, little work has evaluated the degree to which existing definitions based on claims data accurately captures conventionally defined hospital-based ED services. We sought to construct an operational definition for ED visitation using a comprehensive Medicare data set and to compare this definition to existing operational definitions used by researchers and policymakers. METHODS We examined four operational definitions of an ED visit commonly used by researchers and policymakers using a 20% sample of the 2012 Medicare Chronic Condition Warehouse (CCW) data set. The CCW data set included all Part A (hospital) and Part B (hospital outpatient, physician) claims for a nationally representative sample of continuously enrolled Medicare fee-for-services beneficiaries. Three definitions were based on published research or existing quality metrics including: 1) provider claims-based definition, 2) facility claims-based definition, and 3) CMS Research Data Assistance Center (ResDAC) definition. In addition, we developed a fourth operational definition (Yale definition) that sought to incorporate additional coding rules for identifying ED visits. We report levels of agreement and disagreement among the four definitions. RESULTS Of 10,717,786 beneficiaries included in the sample data set, 22% had evidence of ED use during the study year under any of the ED visit definitions. The definition using provider claims identified a total of 4,199,148 ED visits, the facility definition 4,795,057 visits, the ResDAC definition 5,278,980 ED visits, and the Yale definition 5,192,235 ED visits. The Yale definition identified a statistically different (p < 0.05) collection of ED visits than all other definitions including 17% more ED visits than the provider definition and 2% fewer visits than the ResDAC definition. Differences in ED visitation counts between each definition occurred for several reasons including the inclusion of critical care or observation services in the ED, discrepancies between facility and provider billing regulations, and operational decisions of each definition. CONCLUSION Current operational definitions of ED visitation using administrative claims produce different estimates of ED visitation based on the underlying assumptions applied to billing data and data set availability. Future analyses using administrative claims data should seek to validate specific definitions and inform the development of a consistent, consensus ED visitation definitions to standardize research reporting and the interpretation of policy interventions.
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Affiliation(s)
- Arjun K. Venkatesh
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
- Yale New Haven Hospital-Center for Outcomes Research and Evaluation; New Haven CT
| | - Hao Mei
- Yale New Haven Hospital-Center for Outcomes Research and Evaluation; New Haven CT
| | - Keith E. Kocher
- Department of Emergency Medicine and Institute for Healthcare Policy and Innovation; University of Michigan; Ann Arbor MI
| | | | - Ziad Obermeyer
- Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
| | - Erica S. Spatz
- Department of Internal Medicine and Division of Cardiology; Yale University School of Medicine; New Haven CT
- Yale New Haven Hospital-Center for Outcomes Research and Evaluation; New Haven CT
| | - Craig Rothenberg
- Department of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Harlan M. Krumholz
- Department of Internal Medicine and Division of Cardiology; Yale University School of Medicine; New Haven CT
- Yale New Haven Hospital-Center for Outcomes Research and Evaluation; New Haven CT
| | - Zhenqui Lin
- Yale New Haven Hospital-Center for Outcomes Research and Evaluation; New Haven CT
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11
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Jeffery MM, Bellolio MF, Wolfson J, Abraham JM, Dowd BE, Kane RL. Validation of an algorithm to determine the primary care treatability of emergency department visits. BMJ Open 2016; 6:e011739. [PMID: 27566637 PMCID: PMC5013457 DOI: 10.1136/bmjopen-2016-011739] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES We propose a new claims-computable measure of the primary care treatability of emergency department (ED) visits and validate it using a nationally representative sample of Medicare data. STUDY DESIGN AND SETTING This is a validation study using 2011-2012 Medicare claims data for a nationally representative 5% sample of fee-for-service beneficiaries to compare the new measure's performance to the Ballard variant of the Billings algorithm in predicting hospitalisation and death following an ED visit. OUTCOMES Hospitalisation within 1 day or 1 week of an ED visit; death within 1 week or 1 month of an ED visit. RESULTS The Minnesota algorithm is a strong predictor of hospitalisations and deaths, with performance similar to or better than the most commonly used existing algorithm to assess the severity of ED visits. The Billings/Ballard algorithm is a better predictor of death within 1 week of an ED visit; this finding is entirely driven by a small number of ED visits where patients appear to have been dead on arrival. CONCLUSIONS The procedure-based approach of the Minnesota algorithm allows researchers to use the clinical judgement of the ED physician, who saw the patient to determine the likely severity of each visit. The Minnesota algorithm may thus provide a useful tool for investigating ED use in Medicare beneficiaries.
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Affiliation(s)
- Molly Moore Jeffery
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Julian Wolfson
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jean M Abraham
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Bryan E Dowd
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Robert L Kane
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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12
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Hullick C, Conway J, Higgins I, Hewitt J, Dilworth S, Holliday E, Attia J. Emergency department transfers and hospital admissions from residential aged care facilities: a controlled pre-post design study. BMC Geriatr 2016. [PMID: 27175921 DOI: 10.1186/s12877–016-0279-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older people living in Residential Aged Care Facilities (RACF) are a vulnerable, frail and complex population. They are more likely than people who reside in the community to become acutely unwell, present to the Emergency Department (ED) and require admission to hospital. For many, hospitalisation carries with it risks. Importantly, evidence suggests that some admissions are avoidable. A new collaborative model of care, the Aged Care Emergency Service (ACE), was developed to provide clinical support to nurses in the RACFs, allowing residents to be managed in place and avoid transfer to the ED. This paper examines the effects of the ACE service on RACF residents' transfer to hospital using a controlled pre-post design. METHODS Four intervention RACFs were matched with eight control RACFs based on number of total beds, dementia specific beds, and ratio of high to low care beds in Newcastle, Australia, between March and November 2011. The intervention consisted of a clinical care manual to support care along with a nurse led telephone triage line, education, establishing goals of care prior to ED transfer, case management when in the ED, along with the development of collaborative relationships between stakeholders. Outcomes included ED presentations, length of stay, hospital admission and 28-day readmission pre- and post-intervention. Generalised estimating equations were used to estimate mean differences in outcomes between intervention and controls RACFs, pre- and post-intervention means, and their interaction, accounting for repeated measures and adjusting for matching factors. RESULTS Residents had a mean age of 86 years. ED presentations ranged between 16 and 211 visits/100 RACF beds/year across all RACFs. There was no overall reduction in ED presentations (OR = 1.17, p = 0.56) with the ACE intervention. However, when compared to the controls, the intervention group reduced their ED length of stay by 45 min (p = 0.0575), and was 40 % less likely to be admitted to hospital, . The latter was highly significant (p = 0.0012). CONCLUSIONS Transfers to ED and admission to hospital are common for residents of RACFs. This study has demonstrated that a complex multi-strategy intervention led by nursing staff can successfully reduce hospital admissions for older people living in Residential Aged Care Facilities. By defining goals of care prior to transfer to the ED, clinicians have the opportunity to better deliver care that patients require. Integrated care requires accountability from multiple stakeholders. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registration number is ACTRN12616000588493 It was registered on 6(th) May 2016.
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Affiliation(s)
- Carolyn Hullick
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,John Hunter Hospital, Hunter New England Health, Locked Bag 1, HRMC, NSW, 2310, Newcastle, Australia. .,Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia.
| | - Jane Conway
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,University of New England, Armidale, NSW, 2351, Australia
| | - Isabel Higgins
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,John Hunter Hospital, Hunter New England Health, Locked Bag 1, HRMC, NSW, 2310, Newcastle, Australia.,Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia
| | - Jacqueline Hewitt
- John Hunter Hospital, Hunter New England Health, Locked Bag 1, HRMC, NSW, 2310, Newcastle, Australia
| | - Sophie Dilworth
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia
| | - Elizabeth Holliday
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia
| | - John Attia
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,John Hunter Hospital, Hunter New England Health, Locked Bag 1, HRMC, NSW, 2310, Newcastle, Australia.,Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia
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13
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Hullick C, Conway J, Higgins I, Hewitt J, Dilworth S, Holliday E, Attia J. Emergency department transfers and hospital admissions from residential aged care facilities: a controlled pre-post design study. BMC Geriatr 2016; 16:102. [PMID: 27175921 PMCID: PMC4866019 DOI: 10.1186/s12877-016-0279-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older people living in Residential Aged Care Facilities (RACF) are a vulnerable, frail and complex population. They are more likely than people who reside in the community to become acutely unwell, present to the Emergency Department (ED) and require admission to hospital. For many, hospitalisation carries with it risks. Importantly, evidence suggests that some admissions are avoidable. A new collaborative model of care, the Aged Care Emergency Service (ACE), was developed to provide clinical support to nurses in the RACFs, allowing residents to be managed in place and avoid transfer to the ED. This paper examines the effects of the ACE service on RACF residents' transfer to hospital using a controlled pre-post design. METHODS Four intervention RACFs were matched with eight control RACFs based on number of total beds, dementia specific beds, and ratio of high to low care beds in Newcastle, Australia, between March and November 2011. The intervention consisted of a clinical care manual to support care along with a nurse led telephone triage line, education, establishing goals of care prior to ED transfer, case management when in the ED, along with the development of collaborative relationships between stakeholders. Outcomes included ED presentations, length of stay, hospital admission and 28-day readmission pre- and post-intervention. Generalised estimating equations were used to estimate mean differences in outcomes between intervention and controls RACFs, pre- and post-intervention means, and their interaction, accounting for repeated measures and adjusting for matching factors. RESULTS Residents had a mean age of 86 years. ED presentations ranged between 16 and 211 visits/100 RACF beds/year across all RACFs. There was no overall reduction in ED presentations (OR = 1.17, p = 0.56) with the ACE intervention. However, when compared to the controls, the intervention group reduced their ED length of stay by 45 min (p = 0.0575), and was 40 % less likely to be admitted to hospital, . The latter was highly significant (p = 0.0012). CONCLUSIONS Transfers to ED and admission to hospital are common for residents of RACFs. This study has demonstrated that a complex multi-strategy intervention led by nursing staff can successfully reduce hospital admissions for older people living in Residential Aged Care Facilities. By defining goals of care prior to transfer to the ED, clinicians have the opportunity to better deliver care that patients require. Integrated care requires accountability from multiple stakeholders. TRIAL REGISTRATION The Australian New Zealand Clinical Trials Registration number is ACTRN12616000588493 It was registered on 6(th) May 2016.
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Affiliation(s)
- Carolyn Hullick
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,John Hunter Hospital, Hunter New England Health, Locked Bag 1, HRMC, NSW, 2310, Newcastle, Australia. .,Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia.
| | - Jane Conway
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,University of New England, Armidale, NSW, 2351, Australia
| | - Isabel Higgins
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,John Hunter Hospital, Hunter New England Health, Locked Bag 1, HRMC, NSW, 2310, Newcastle, Australia.,Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia
| | - Jacqueline Hewitt
- John Hunter Hospital, Hunter New England Health, Locked Bag 1, HRMC, NSW, 2310, Newcastle, Australia
| | - Sophie Dilworth
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia
| | - Elizabeth Holliday
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia
| | - John Attia
- The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,John Hunter Hospital, Hunter New England Health, Locked Bag 1, HRMC, NSW, 2310, Newcastle, Australia.,Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW, 2305, Australia
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14
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Reynolds GL, Fisher DG, Dyo M, Huckabay LM. Using the Bem and Klein Grid Scores to Predict Health Services Usage by Men. Behav Med 2016; 42:143-9. [PMID: 27337618 PMCID: PMC4979744 DOI: 10.1080/08964289.2016.1154003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We examined the association between scores on the Bem Sex Roles Inventory (BSRI), Klein Sexual Orientation Grid, and utilization of hospital inpatient services, emergency departments, and outpatient clinic visits in the past 12 months among 53 men (mean age 39 years). The femininity subscale score on the BSRI, ever having had gonorrhea and age were the three variables identified in a multivariate linear regression significantly predicting use of total health services. This supports the hypothesis that sex roles can assist our understanding of men's use of health services.
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Affiliation(s)
- Grace L. Reynolds
- Center for Behavioral Research & Services, California State University, Long Beach ,Health Care Administration Department, California State University, Long Beach
| | - Dennis G. Fisher
- Center for Behavioral Research & Services, California State University, Long Beach ,Psychology Department, California State University, Long Beach
| | - Melissa Dyo
- School of Nursing, California State University, Long Beach
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Karam G, Radden Z, Berall LE, Cheng C, Gruneir A. Efficacy of emergency department-based interventions designed to reduce repeat visits and other adverse outcomes for older patients after discharge: A systematic review. Geriatr Gerontol Int 2015; 15:1107-17. [PMID: 26171554 PMCID: PMC5008161 DOI: 10.1111/ggi.12538] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2015] [Indexed: 11/30/2022]
Abstract
AIM There is an urgent need for effective geriatric interventions to meet the health service demands of the growing older population. In this paper, we systematically review and update existing literature on interventions within emergency departments (ED) targeted towards reducing ED re-visits, hospitalizations, nursing home admissions and deaths in older patients after initial ED discharge. METHODS Databases Medline, CINAHL, Embase and Web of Science were searched to identify all articles published up to June 2012 that focused on older adults in the ED, included a comparison group, and reported quantitative results in four primary outcomes: ED re-visits, hospitalizations, nursing home admissions and death after initial ED discharge. RESULTS Of the 2826 titles screened, just nine studies met our inclusion criteria. The studies varied in their design and outcome measurements such that results could not be combined. Two trends surfaced: (i) more intensive interventions more frequently resulted in reduced adverse outcomes than did simple referral intervention types; and (ii) among the lowest intensity, referral-based interventions, studies that used a validated prediction tool to identify high-risk patients more frequently reported improved outcomes than those that did not use such a tool. CONCLUSION Of the few studies that met the inclusion criteria, there was a lack of consistency and clarity in study designs and evaluative outcomes. Despite this, more intensive interventions that followed patients beyond a referral and the use of a clinical risk prediction tool appeared to be associated with improved outcomes. The dearth of rigorous evaluations with standardized methodologies precludes further recommendations.
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Affiliation(s)
- Grace Karam
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Zoe Radden
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Laura E Berall
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Catherine Cheng
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrea Gruneir
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
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Abstract
A definitive place exists for the CC in the emergency department to effectively manage and provide patient- and family-centered care and appropriately utilize institutional resources. This focused ED care coordination benefits the institution through avoidance of unnecessary admissions and their associated costs. It is also a victory for patients and families who achieve the health care services that they truly need, and they are a more satisfied group as they realize their voices are heard and their concerns are addressed. Moreover, the entire ED team benefits when the actions of the CC meet the standard of the "right care, right time, and right way."
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Maclean JC, Xu H, French MT, Ettner SL. Mental health and high-cost health care utilization: new evidence from Axis II disorders. Health Serv Res 2013; 49:683-704. [PMID: 24117342 DOI: 10.1111/1475-6773.12107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To analyze the associations between Axis II (A2) disorders and two measures of health care utilization with relatively high cost: emergency department (ED) episodes and hospital admissions. DATA SOURCE/STUDY SETTING Wave I (2001/2002) and Wave II (2004/2005) of the National Longitudinal Survey on Alcohol and Related Conditions (NESARC). STUDY DESIGN A national probability sample of adults. Gender-stratified regression analysis adjusted for a range of covariates associated with health care utilization. DATA COLLECTION The target population of the NESARC is the civilian noninstitutionalized population aged 18 years and older residing in the United States. The cumulative survey response rate is 70.2 percent with a response rate of 81 percent (N=43,093) in Wave I and 86.7 percent (N=34,653) in Wave II. PRINCIPAL FINDINGS Both men and women with A2 disorders are at elevated risk for ED episodes and hospital admissions. Associations are robust after adjusting for a rich set of confounding factors, including Axis I (clinical) psychiatric disorders. We find evidence of a dose-response relationship, while antisocial and borderline disorders exhibit the strongest associations with both measures of health care utilization. CONCLUSIONS This study provides the first published estimates of the associations between A2 disorders and high-cost health care utilization in a large, nationally representative survey. The findings underscore the potential implications of these disorders on health care expenditures.
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Affiliation(s)
- Johanna Catherine Maclean
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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18
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The association between the availability of ambulatory care and non-emergency treatment in emergency medicine departments: a comprehensive and nationwide validation. Health Policy 2013; 110:271-9. [PMID: 23290382 DOI: 10.1016/j.healthpol.2012.12.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 12/02/2012] [Accepted: 12/04/2012] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To quantify dynamic availability of ambulatory care, and to examine possible associations with non-emergency treatments in emergency departments (EDs). METHODS Longitudinal data from the Taiwan National health Insurance Research Database were used to evaluate 749,584 emergency-medicine cases occurring between 2005 and 2010 according to a modified New York University algorithm. Multivariable-cumulative-logistic-regression analysis with generalized estimating-equation methods was used to determine associations between availability of ambulatory care and the urgency of patients' medical needs during ED visits. RESULTS More than half (53.04%) of the ED visits that were evaluated in our study were classified as non-emergencies, and over half of these occurred despite a high availability of ambulatory care facilities (median > 96%). Compared with patients in areas with a low availability of ambulatory care, patients in areas of medium to high availability showed approximately 0.8 times lower odds ratios for associations with non-emergency ED visits. CONCLUSIONS Non-emergency ED visits may be reduced by increasing the availability of ambulatory care facilities in areas with deficits in the availability of such facilities. However, increasing the availability of ambulatory care by raising the number of available ambulatory care physicians or the number of ambulatory care facilities may not reduce non-emergency ED visits in areas with medium to high availability of ambulatory care facilities.
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