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Zhao Z, Li H, Xing X, Sun W, Ma X, Zhu H. Temporal trends and correlates in multiple hospitalizations among older adults: findings from a nationally representative sample in China. Geriatr Nurs 2024; 58:336-343. [PMID: 38875760 DOI: 10.1016/j.gerinurse.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE This study aims to examine the trends and correlates in multiple hospitalizations among older adults in China. METHODS The data were from the China Health and Retirement Longitudinal Study (CHARLS), and generalized ordered logit model (GOLM) was used to identify the correlates of multiple hospitalizations among older adults aged≥60 years old. RESULTS Between 2011 and 2018, the proportion of older adults having multiple hospitalizations in the past year showed an increasing trend in the total sample (p value for trend = 0.014). Being older, male, illiterate, living in the middle/western region, having higher annual per capita household expenditure, health insurance, multimorbidity, and being depressed were associated with increased odds of multiple hospitalizations. CONCLUSIONS Our findings indicated that older adults with multiple hospitalizations may expect an increasing burden on healthcare system. More efforts are needed to improve health insurance and primary healthcare to reduce avoidable hospitalizations.
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Affiliation(s)
- Ziyin Zhao
- School of Public Health, Peking University, Beijing 100191, China
| | - Huining Li
- School of Public Health, Peking University, Beijing 100191, China
| | - Xing Xing
- School of Public Health, Peking University, Beijing 100191, China
| | - Wenjun Sun
- School of Public Health, Peking University, Beijing 100191, China
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing 100191, China
| | - He Zhu
- China Center for Health Development Studies, Peking University, Beijing 100191, China.
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2
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Gao Q, Mak HW, Fancourt D. Longitudinal associations between loneliness, social isolation, and healthcare utilisation trajectories: a latent growth curve analysis. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02639-9. [PMID: 38429539 DOI: 10.1007/s00127-024-02639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE To explore the longitudinal associations between eight-year trajectories of loneliness, social isolation and healthcare utilisation (i.e. inpatient, outpatient, and nursing home care) in US older adults. METHODS The study used data from the Health and Retirement Study in 2006-2018, which included a nationally representative sample of American adults aged 50 and above (N = 6,832). We conducted latent growth curve models to assess the associations between trajectories of loneliness and isolation and healthcare utilisation over 8 years. RESULTS Independent of sociodemographic and health-related confounders, social deficits were associated with a lower likelihood of baseline physician visits (loneliness β= -0.15, SE = 0.08; social isolation β= -0.19, SE = 0.08), but there was a positive association between loneliness and number of physician visits (β = 0.06, SE = 0.03), while social isolation was associated with extended hospital (β = 0.07, SE = 0.04) and nursing home stays (β = 0.05, SE = 0.02). Longer nursing home stays also predicted better trajectories of loneliness and isolation over time. CONCLUSION Loneliness and social isolation are cross-sectionally related to complex patterns of different types of healthcare. There was no clear evidence that social deficits led to specific trajectories of healthcare utilisation, but nursing home stays may over time help provide social contact, supporting trajectories of isolation and potentially loneliness. Non-clinical services such as social prescribing could have the potential to address unmet social needs and further promote patients' health-seeking profiles for improving healthcare equity.
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Affiliation(s)
- Qian Gao
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- School of Public Health, Imperial College London, London, UK
| | - Hei Wan Mak
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Daisy Fancourt
- Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
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Ekadinata N, Hsu HC, Chen YM, Chuang KY. Effects of social capital on healthcare utilization among older adults in Indonesia. Health Promot Int 2023; 38:daad104. [PMID: 37715938 DOI: 10.1093/heapro/daad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023] Open
Abstract
Social capital potentially affects older adults' access to healthcare services. However, the effects of social capital on the use of various types of healthcare services using longitudinal data have yet to be explored. This study aimed to examine the effects of structural and cognitive social capital on different types of healthcare utilization by older adults in Indonesia. Data were from the Indonesian Family Life Survey (waves 4 and 5) in 2007 and 2014. The sample consisted of participants aged 60 years and older who completed both waves (n = 1374). Healthcare utilization by older adults assessed health posts (posyandu), health checkups, outpatient care and hospital admissions. Social capital consisted of neighborhood trust and community participation. Generalized estimating equation models were used for the analysis. Older adults with high community participation had a higher likelihood of using preventive care in posyandu (OR = 5.848, 95% CI = 2.585-13.232) and health checkup visits (OR = 1.621, 95% CI = 1.116-2.356). Meanwhile, neighborhood trust was related to a higher probability of hospital admissions (OR = 1.255, 95% CI = 1.046-1.505). Social capital significantly affects older adults' preventive and treatment healthcare utilization. Maximizing the availability of social participation and removing barriers to access to preventive and medical care in an age-friendly environment are suggested.
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Affiliation(s)
- Nopryan Ekadinata
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei, Taiwan
- School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Hui-Chuan Hsu
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei, Taiwan
- Research Center of Health Equity, College of Public Health, Taipei Medical University, New Taipei, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kun-Yang Chuang
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei, Taiwan
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Pang RK, Srikanth V, Snowdon DA, Weller CD, Berry B, Braun G, Edwards I, McGee F, Azzopardi R, Andrew NE. Targeted care navigation to reduce hospital readmissions in 'at-risk' patients. Intern Med J 2023; 53:1196-1203. [PMID: 34841635 DOI: 10.1111/imj.15634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Care navigation is commonly used to reduce preventable hospitalisation. The use of Electronic Health Record-derived algorithms may enable better targeting of this intervention for greater impact. AIMS To evaluate if community-based Targeted Care Navigation, supported by an Electronic Health Record-derived readmission risk algorithm, is associated with reduced rehospitalisation. METHODS A propensity score matching cohort (5 comparison to 1 intervention cohort ratio) study was conducted in an 850-bed Victorian public metropolitan health service, Australia, from May to November 2017. Admitted acute care patients with a non-surgical condition, identified as at-risk of hospital readmission using an Electronic Health Record-derived readmission risk algorithm provide by the state health department, were eligible. Targeted Care Navigation involved telephone follow-up support provided for 30 days post-discharge by a registered nurse. The hazard ratio for hospital readmission was calculated at 30, 60 and 90 days post-discharge using multivariable Cox Proportional Hazards regression. RESULTS Sixty-five recipients received care navigation and were matched to 262 people who did not receive care navigation. Excellent matching was achieved with standardised differences between groups being <0.1 for all 11 variables included in the propensity score, including the readmission risk score. The Targeted Care Navigation group had a significantly reduced hazard of readmission at 30 days (hazard ratio 0.34; 95% confidence interval: 0.12, 0.94) compared with the comparison group. The effect size was reduced at 60 and 90 days post-discharge. CONCLUSION We provide preliminary evidence that Targeted Care Navigation supported by an Electronic Health Record-derived readmission risk algorithm may reduce 30-day hospital readmissions.
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Affiliation(s)
- Rebecca K Pang
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Community Care, Community Health, Peninsula Health, Melbourne, Victoria, Australia
| | - Velandai Srikanth
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Professorial Academic Unit, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Professorial Academic Unit, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - Carolina D Weller
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Belinda Berry
- Community Care, Community Health, Peninsula Health, Melbourne, Victoria, Australia
- Community Health, Peninsula Health, Melbourne, Victoria, Australia
| | - Gary Braun
- Department of Medicine, Frankston hospital, Peninsula Health, Melbourne, Victoria, Australia
| | - Iain Edwards
- Community Health, Peninsula Health, Melbourne, Victoria, Australia
| | - Fergus McGee
- Community Care, Community Health, Peninsula Health, Melbourne, Victoria, Australia
- Community Health, Peninsula Health, Melbourne, Victoria, Australia
| | - Ruth Azzopardi
- Rehabilitation, Ageing, Pain and Palliative Care services, Peninsula Health, Melbourne, Victoria, Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Professorial Academic Unit, Frankston Hospital, Peninsula Health, Melbourne, Victoria, Australia
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Geiger I, Schang L, Sundmacher L. Assessing needs-based supply of physicians: a criteria-led methodological review of international studies in high-resource settings. BMC Health Serv Res 2023; 23:564. [PMID: 37259109 DOI: 10.1186/s12913-023-09461-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 04/27/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Many health systems embrace the normative principle that the supply of health services ought to be based on the need for healthcare. However, a theoretically grounded framework to operationalize needs-based supply of healthcare remains elusive. The aim of this paper is to critically assess current methodologies that quantify needs-based supply of physicians and identify potential gaps in approaches for physician planning. To this end, we propose a set of criteria for consideration when estimating needs-based supply. METHODS We conducted searches in three electronic bibliographic databases until March 2020 supplemented by targeted manual searches on national and international websites to identify studies in high-resource settings that quantify needs-based supply of physicians. Studies that exclusively focused on forecasting methods of physician supply, on inpatient care or on healthcare professionals other than physicians were excluded. Additionally, records that were not available in English or German were excluded to avoid translation errors. The results were synthesized using a framework of study characteristics in addition to the proposed criteria for estimating needs-based physician supply. RESULTS 18 quantitative studies estimating population need for physicians were assessed against our criteria. No study met all criteria. Only six studies sought to examine the conceptual dependency between need, utilization and supply. Apart from extrapolations, simulation models were applied most frequently to estimate needs-based supply. 12 studies referred to the translation of need for services with respect to a physician's productivity, while the rest adapted existing population-provider-ratios. Prospective models for estimating future care needs were largely based on demographic predictions rather than estimated trends in morbidity and new forms of care delivery. CONCLUSIONS The methodological review shows distinct heterogeneity in the conceptual frameworks, validity of data basis and modeling approaches of current studies in high-resource settings on needs-based supply of physicians. To support future estimates of needs-based supply, this review provides a workable framework for policymakers in charge of health workforce capacity planning.
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Affiliation(s)
- Isabel Geiger
- Technical University of Munich, Munich, Germany.
- Ludwig-Maximilians-University (LMU) Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Laura Schang
- Pettenkofer School of Public Health, Munich, Germany
| | - Leonie Sundmacher
- Department of Health Economics, Technical University of Munich, Munich, Germany
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LeBlanc M, McGaughey T, Peters PA. Characteristics of High-Resource Health System Users in Rural and Remote Regions: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5385. [PMID: 37047999 PMCID: PMC10094250 DOI: 10.3390/ijerph20075385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/15/2023] [Accepted: 03/29/2023] [Indexed: 06/19/2023]
Abstract
A small proportion of health care users are recognized to use a significantly higher proportion of health system resources, largely due to systemic, inequitable access and disproportionate health burdens. These high-resource health system users are routinely characterized as older, with multiple comorbidities, and reduced access to adequate health care. Geographic trends also emerge, with more rural and isolated regions demonstrating higher rates of high-resource use than others. Despite known geographical discrepancies in health care access and outcomes, health policy and research initiatives remain focused on urban population centers. To alleviate mounting health system pressure from high-resource users, their characteristics must be better understood within the context in which i arises. To examine this, a scoping review was conducted to provide an overview of characteristics of high-resource users in rural and remote communities in Canada and Australia. In total, 21 papers were included in the review. Using qualitative thematic coding, primary findings characterized rural high-resource users as those of an older age; with increased comorbid conditions and condition severity; lower socioeconomic status; and elevated risk behaviors.
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Affiliation(s)
- Michele LeBlanc
- School of Nursing, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Tomoko McGaughey
- Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada
| | - Paul A. Peters
- Department of Health Sciences, Carleton University, Ottawa, ON K1S 5B6, Canada
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Guan J, Leung E, Kwok KO, Chen FY. A hybrid machine learning framework to improve prediction of all-cause rehospitalization among elderly patients in Hong Kong. BMC Med Res Methodol 2023; 23:14. [PMID: 36639745 PMCID: PMC9837949 DOI: 10.1186/s12874-022-01824-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Accurately estimating elderly patients' rehospitalisation risk benefits clinical decisions and service planning. However, research in rehospitalisation and repeated hospitalisation yielded only models with modest performance, and the model performance deteriorates rapidly as the prediction timeframe expands beyond 28 days and for older participants. METHODS A temporal zero-inflated Poisson (tZIP) regression model was developed and validated retrospectively and prospectively. The data of the electronic health records (EHRs) contain cohorts (aged 60+) in a major public hospital in Hong Kong. Two temporal offset functions accounted for the associations between exposure time and parameters corresponding to the zero-inflated logistic component and the Poisson distribution's expected count. tZIP was externally validated with a retrospective cohort's rehospitalisation events up to 12 months after the discharge date. Subsequently, tZIP was validated prospectively after piloting its implementation at the study hospital. Patients discharged within the pilot period were tagged, and the proposed model's prediction of their rehospitalisation was verified monthly. Using a hybrid machine learning (ML) approach, the tZIP-based risk estimator's marginal effect on 28-day rehospitalisation was further validated, competing with other factors representing different post-acute and clinical statuses. RESULTS The tZIP prediction of rehospitalisation from 28 days to 365 days was achieved at above 80% discrimination accuracy retrospectively and prospectively in two out-of-sample cohorts. With a large margin, it outperformed the Cox proportional and linear models built with the same predictors. The hybrid ML revealed that the risk estimator's contribution to 28-day rehospitalisation outweighed other features relevant to service utilisation and clinical status. CONCLUSIONS A novel rehospitalisation risk model was introduced, and its risk estimators, whose importance outweighed all other factors of diverse post-acute care and clinical conditions, were derived. The proposed approach relies on four easily accessible variables easily extracted from EHR. Thus, clinicians could visualise patients' rehospitalisation risk from 28 days to 365 days after discharge and screen high-risk older patients for follow-up care at the proper time.
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Affiliation(s)
| | - Eman Leung
- grid.10784.3a0000 0004 1937 0482JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kin-on Kwok
- grid.10784.3a0000 0004 1937 0482JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China ,grid.10784.3a0000 0004 1937 0482Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong SAR, China ,grid.10784.3a0000 0004 1937 0482Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Frank Youhua Chen
- Department of Management Sciences, City University of Hong Kong, Hong Kong SAR, China.
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Ridge A, Peterson GM, Nash R. Risk Factors Associated with Preventable Hospitalisation among Rural Community-Dwelling Patients: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16487. [PMID: 36554376 PMCID: PMC9778925 DOI: 10.3390/ijerph192416487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/02/2022] [Accepted: 12/03/2022] [Indexed: 06/17/2023]
Abstract
Potentially preventable hospitalisations (PPHs) are common and increase the burden on already stretched healthcare services. Increasingly, psychosocial factors have been recognised as contributing to PPHs and these may be mitigated through greater attention to social capital. This systematic review investigates the factors associated with PPHs within rural populations. The review was designed, conducted, and reported according to PRISMA guidelines and registered with Prospero (ID: CRD42020152194). Four databases were systematically searched, and all potentially relevant papers were screened at the title/abstract level, followed by full-text review by at least two reviewers. Papers published between 2000-2022 were included. Quality assessment was conducted using Newcastle-Ottawa Scale and CASP Qualitative checklist. Of the thirteen papers included, eight were quantitative/descriptive and five were qualitative studies. All were from either Australia or the USA. Access to primary healthcare was frequently identified as a determinant of PPH. Socioeconomic, psychosocial, and geographical factors were commonly identified in the qualitative studies. This systematic review highlights the inherent attributes of rural populations that predispose them to PPHs. Equal importance should be given to supply/system factors that restrict access and patient-level factors that influence the ability and capacity of rural communities to receive appropriate primary healthcare.
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Affiliation(s)
- Andrew Ridge
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia
- Huon Valley Health Centre, Huonville, TAS 7109, Australia
| | - Gregory M. Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia
| | - Rosie Nash
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS 7000, Australia
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Jiang L, Qiu Q, Zhu L, Wang Z. Identifying Characteristics Associated with the Concentration and Persistence of Medical Expenses among Middle-Aged and Elderly Adults: Findings from the China Health and Retirement Longitudinal Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12843. [PMID: 36232143 PMCID: PMC9564963 DOI: 10.3390/ijerph191912843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
Medical expenses, especially among middle-aged and elderly people, have increased in China over recent decades. However, few studies have analyzed the concentration or persistence of medical expenses among Chinese residents or vulnerable groups with longitudinal survey data. Based on the data of CHARLS (China Health and Retirement Longitudinal Study), this study sought to identify characteristics associated with the concentration and persistence of medical expenses among Chinese middle-aged and elderly adults and to help alleviate medical spending and the operational risk of social medical insurance. Concentration was measured using the cumulative percentages of ranked annual medical expenses and descriptive statistics were used to define the characteristics of individuals with high medical expenses. The persistence of medical expenses and associated factors were estimated using transfer rate calculations and Heckman selection modeling. The results show that total medical expenses were concentrated among a few adults and the concentration increased over time. People in the high medical expense group were more likely to be older, live in urban areas, be less wealthy, have chronic diseases, and attend higher-ranking medical institutions. Lagged medical expenses had a persistent positive effect on current medical expenses and the effect of a one-period lag was strongest. Individuals with chronic diseases during the lagged period had a higher likelihood of experiencing persistent medical expenses. Policy efforts should focus on preventive management, more efficient care systems, improvement of serious illness insurance level, and strengthening the persistent protection effect of social medical insurance to reduce the high medical financial risk and long-term financial healthcare burden in China.
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Affiliation(s)
- Luyan Jiang
- School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China
| | - Qianqian Qiu
- School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China
| | - Lin Zhu
- School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China
| | - Zhonghua Wang
- School of Health Policy & Management, Nanjing Medical University, Nanjing 211166, China
- Public Health Policy and Management Innovation Research Group, Nanjing Medical University, Nanjing 211166, China
- Center for Global Health, Nanjing Medical University, Nanjing 211166, China
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MacRae C, Fisken HW, Lawrence E, Connor T, Pearce J, Marshall A, Lawson A, Dibben C, Mercer SW, Guthrie B. Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic review. BMJ Open 2022; 12:e063441. [PMID: 36192100 PMCID: PMC9535173 DOI: 10.1136/bmjopen-2022-063441] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Multimorbidity is one of the greatest challenges facing healthcare internationally. Emergency department (ED) attendance and hospitalisation rates are higher in people with multimorbidity, but most research focuses on associations with individual characteristics, ignoring household or area mediators of service use. DESIGN Systematic review reported using the synthesis without meta-analysis framework. DATA SOURCES Twelve electronic databases (1 January 2000-21 September 2021): MEDLINE/OVID, Embase, Global Health, PsycINFO, ASSIA, CAB Abstracts, Science Citation Index Expanded/ISI Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, the Cochrane Library, and OpenGrey. ELIGIBILITY CRITERIA Adults aged ≥16 years, with multimorbidity. Exposure(s) were household and/or area determinants of health. Outcomes were ED attendance and/or hospitalisation. The literature search was limited to publications in English. DATA EXTRACTION AND SYNTHESIS Independent double screening of titles and abstracts to select relevant full-text studies. Methodological quality was assessed using an adaptation of the Newcastle-Ottawa Quality Assessment Scale tool. Given high study heterogeneity, narrative synthesis was performed. RESULTS After deduplication, 10 721 titles and abstracts were screened, and 142 full-text articles were reviewed, of which 10 were eligible for inclusion. In people with multimorbidity, household food insecurity was associated with hospitalisation (OR 1.58 (95% CI 1.06 to 2.36) in concordant multimorbidity). People with multimorbidity living in the most versus least deprived areas attended ED more frequently (8.9% (95% CI 8.6 to 9.1) in most versus 6.3% (95% CI 6.1 to 6.6) in least), had higher rates of hospitalisation (26% in most versus 22% in least), and higher probability of hospitalisation (6.4% (95% CI 5.8 to 7.2) in most versus 4.2% (95% CI 3.8 to 4.7) in least). There was non-conclusive evidence that household income is associated with ED attendance and hospitalisation. No statistically significant relationships were found between marital status, living with others with multimorbidity, or rurality with ED attendance or hospitalisation. CONCLUSIONS There is some evidence that household and area contexts mediate associations of multimorbidity with ED attendance and hospitalisation, but firm conclusions are constrained by the small number of studies published and study design heterogeneity. Further research is required on large population samples using robust analytical methods. PROSPERO REGISTRATION NUMBER CRD42021283515.
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Affiliation(s)
- Clare MacRae
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | | | | | - Thomas Connor
- The University of Edinburgh Edinburgh Medical School, Edinburgh, Edinburgh, UK
| | - Jamie Pearce
- Institute of Geography, University of Edinburgh Institute of Geography, Edinburgh, UK
| | - Alan Marshall
- Department of Social Policy, The University of Edinburgh Social Policy, Edinburgh, UK
| | - Andrew Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Chris Dibben
- Institute of Geography, University of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Duminy L, Ress V, Wild EM. Complex community health and social care interventions – Which features lead to reductions in hospitalizations for ambulatory care sensitive conditions? A systematic literature review. Health Policy 2022; 126:1206-1225. [DOI: 10.1016/j.healthpol.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022]
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Ploeg J, Markle-Reid M, Valaitis R, Fisher K, Ganann R, Blais J, Chambers T, Connors R, Gruneir A, Légaré F, MacIntyre J, Montelpare W, Paquette JS, Poitras ME, Riveroll A, Yous ML. The Aging, Community and Health Research Unit Community Partnership Program (ACHRU-CPP) for older adults with diabetes and multiple chronic conditions: study protocol for a randomized controlled trial. BMC Geriatr 2022; 22:99. [PMID: 35120457 PMCID: PMC8814798 DOI: 10.1186/s12877-021-02651-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults (≥65 years) with diabetes and multiple chronic conditions (MCC) (> 2 chronic conditions) experience reduced function and quality of life, increased health service use, and high mortality. Many community-based self-management interventions have been developed for this group, however the evidence for their effectiveness is limited. This paper presents the protocol for a randomized controlled trial (RCT) comparing the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP) to usual care in older adults with diabetes and MCC and their caregivers. METHODS We will conduct a cross-jurisdictional, multi-site implementation-effectiveness type II hybrid RCT. Eligibility criteria are: ≥65 years, diabetes diagnosis (Type 1 or 2) and at least one other chronic condition, and enrolled in a primary care or diabetes education program. Participants will be randomly assigned to the intervention (ACHRU-CPP) or control arm (1:1 ratio). The intervention arm consists of home/telephone visits, monthly group wellness sessions, multidisciplinary case conferences, and system navigation support. It will be delivered by registered nurses and registered dietitians/nutritionists from participating primary care or diabetes education programs and program coordinators from community-based organizations. The control arm consists of usual care provided by the primary care setting or diabetes education program. The primary outcome is the change from baseline to 6 months in mental functioning. Secondary outcomes will include, for example, the change from baseline to 6 months in physical functioning, diabetes self-management, depressive symptoms, and cost of use of healthcare services. Analysis of covariance (ANCOVA) models will be used to analyze all outcomes, with intention-to-treat analysis using multiple imputation to address missing data. Descriptive and qualitative data from older adults, caregivers and intervention teams will be used to examine intervention implementation, site-specific adaptations, and scalability potential. DISCUSSION An interprofessional intervention supporting self-management may be effective in improving health outcomes and client/caregiver experience and reducing service use and costs in this complex population. This pragmatic trial includes a scalability assessment which considers a range of effectiveness and implementation criteria to inform the future scale-up of the ACHRU-CPP. TRIAL REGISTRATION Clinical Trials.gov Identifier NCT03664583 . Registration date: September 10, 2018.
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Affiliation(s)
- Jenny Ploeg
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada.
| | - Maureen Markle-Reid
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Ruta Valaitis
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Kathryn Fisher
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Rebecca Ganann
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Johanne Blais
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine, Local 4617, Québec, G1V 0A6, Canada
| | - Tracey Chambers
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
| | - Robyn Connors
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Room 111, Steel Building, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Andrea Gruneir
- Department of Family Medicine Research Program, University of Alberta, 6-40 University Terrace, Edmonton, Alberta, T6G 2T4, Canada
| | - France Légaré
- VITAM-Centre de recherche en santé durable, Université Laval, Pavillon Landry-Poulin, 2525, Chemin de la Canardière, Quebec City, QC, G1J 0A4, Canada and Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, G1K 7P4, Canada
| | - Janet MacIntyre
- Faculty of Nursing, Room 116, Health Sciences Building, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - William Montelpare
- Margaret and Wallace McCain Chair in Human Development and Health, Department of Applied Human Sciences, Faculty of Science, Room 122, Health Sciences Building, University of Prince Edward Island, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Jean-Sébastien Paquette
- Groupe de Médecine de Famile Universitaire (GMF-U) du Nord de Lanaudière and Department of Family Medicine and Emergency Medicine, Faculty of Medicine Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Local 4617, Québec, G1V 0A6, Canada
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke - Campus Saguenay, 305 Rue Saint Vallier, Chicoutimi, QC, G7H 5H6, Canada
| | - Angela Riveroll
- Department of Applied Human Sciences, Faculty of Science, University of Prince Edward Island, Room 115, Steel Building, 550 University Avenue, Charlottetown, Prince Edward Island, C1A 4P3, Canada
| | - Marie-Lee Yous
- School of Nursing, Aging, Community and Health Research Unit, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSc3N25, Hamilton, Ontario, L8S 4K1, Canada
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Barrenetxea J, Tan KB, Tong R, Chua K, Feng Q, Koh WP, Chen C. Emergency hospital admissions among older adults living alone in the community. BMC Health Serv Res 2021; 21:1192. [PMID: 34732180 PMCID: PMC8567640 DOI: 10.1186/s12913-021-07216-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background Among older adults, living alone is often associated with higher risk of Emergency Department (ED) admissions. However, older adults living alone are very heterogeneous in terms of health. As more older adults choose to live independently, it remains unclear if the association between living alone and ED admissions is moderated by health status. We studied the association between living alone and ED admission outcomes (number of admissions, inpatient days and inpatient costs) among older adults with and without multimorbidity. Methods We used data from 16,785 individuals of the third follow-up of the Singapore Chinese Health Study, a population-based cohort of older Singapore Chinese (mean age: 73(61-96) years). Participants were interviewed face-to-face from 2014 to 2016 for sociodemographic/health factors and followed-up for one year on ED admission outcomes using Singapore Ministry of Health’s Mediclaim Database. We first applied multivariable logistic regression and two-part models to test if living alone is a risk factor for ED admission outcomes. We then ran stratified and joint effect analysis to examine if the associations between living alone and ED admission outcomes were moderated by multimorbidity. Results Compared to living with others, living alone was associated with higher odds of ED admission [Odds Ratio (OR) 1.28, 95 % Confidence Interval(CI) 1.08-1.51)], longer inpatient days (+0.61, 95 %CI 0.25-0.97) and higher inpatient costs (+322 USD, 95 %CI 54-591). The interaction effects of living arrangement and multimorbidity on ED admissions and inpatient costs were not statistically different, whereas the interaction between living arrangements and multimorbidity on inpatient days was borderline significant (p-value for interaction=0.050). Compared to those living with others and without multimorbidity, the relative mean increase was 1.13 inpatient days (95 %CI 0.39-1.86) for those living alone without multimorbidity, and 0.73 inpatient days ( 95 %CI 0.29-1.17) for those living alone with multimorbidity. Conclusions Older adults living alone were at higher risk of ED admission and higher inpatient costs regardless of multimorbidity, while those living alone without multimorbidity had the longest average inpatient days. To enable aging in place while avoiding ED admissions, interventions could provide instrumental support and regular health monitoring to older adults living alone, regardless of their health status.
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Affiliation(s)
- Jon Barrenetxea
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore
| | - Kelvin Bryan Tan
- Ministry of Health, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore
| | | | - Kevin Chua
- Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, SG, Singapore, Singapore
| | - Qiushi Feng
- Department of Sociology & Centre for Family and Population Research, National University of Singapore, Singapore, Singapore
| | - Woon-Puay Koh
- Health Services and Systems Research, Duke-NUS Medical School Singapore, Singapore, Singapore. .,Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, 5 Science Drive 2, 117545, Singapore, Singapore. .,Singapore Institute for Clinical Sciences, Agency for Science Technology and Research, Singapore, Singapore.
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, 117549, Singapore, Singapore.
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Pang RK, Weller CD, Srikanth V, Shannon B, Andrew NE. Community care navigation intervention for people who are at-risk of unplanned hospital presentations. Hippokratia 2021. [DOI: 10.1002/14651858.cd014713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Rebecca K Pang
- Peninsula Clinical School, Central Clinical School; Monash University; Frankston Australia
- Community Care (Hospital Admission Risk Program), Community Health; Peninsula Health; Frankston Australia
| | - Carolina D Weller
- School of Nursing and Midwifery; Monash University; Melbourne Australia
| | - Velandai Srikanth
- Peninsula Clinical School, Central Clinical School; Monash University; Frankston Australia
| | - Brendan Shannon
- Department of Paramedicine; Monash University; Frankston Australia
| | - Nadine E Andrew
- Peninsula Clinical School, Central Clinical School; Monash University; Frankston Australia
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15
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Wu CX, Suresh E, Phng FWL, Tai KP, Pakdeethai J, D'Souza JLA, Tan WS, Phan P, Lew KSM, Tan GYH, Chua GSW, Hwang CH. Effect of a Real-Time Risk Score on 30-day Readmission Reduction in Singapore. Appl Clin Inform 2021; 12:372-382. [PMID: 34010978 DOI: 10.1055/s-0041-1726422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To develop a risk score for the real-time prediction of readmissions for patients using patient specific information captured in electronic medical records (EMR) in Singapore to enable the prospective identification of high-risk patients for enrolment in timely interventions. METHODS Machine-learning models were built to estimate the probability of a patient being readmitted within 30 days of discharge. EMR of 25,472 patients discharged from the medicine department at Ng Teng Fong General Hospital between January 2016 and December 2016 were extracted retrospectively for training and internal validation of the models. We developed and implemented a real-time 30-day readmission risk score generation in the EMR system, which enabled the flagging of high-risk patients to care providers in the hospital. Based on the daily high-risk patient list, the various interfaces and flow sheets in the EMR were configured according to the information needs of the various stakeholders such as the inpatient medical, nursing, case management, emergency department, and postdischarge care teams. RESULTS Overall, the machine-learning models achieved good performance with area under the receiver operating characteristic ranging from 0.77 to 0.81. The models were used to proactively identify and attend to patients who are at risk of readmission before an actual readmission occurs. This approach successfully reduced the 30-day readmission rate for patients admitted to the medicine department from 11.7% in 2017 to 10.1% in 2019 (p < 0.01) after risk adjustment. CONCLUSION Machine-learning models can be deployed in the EMR system to provide real-time forecasts for a more comprehensive outlook in the aspects of decision-making and care provision.
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Affiliation(s)
- Christine Xia Wu
- Quality, Innovation and Improvement, Ng Teng Fong General Hospital, Singapore
| | - Ernest Suresh
- Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | | | - Kai Pik Tai
- Quality, Innovation and Improvement, Ng Teng Fong General Hospital, Singapore
| | | | | | - Woan Shin Tan
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Phillip Phan
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States.,Department of Medicine, National University of Singapore, Singapore
| | - Kelvin Sin Min Lew
- Quality, Innovation and Improvement, Ng Teng Fong General Hospital, Singapore
| | | | | | - Chi Hong Hwang
- Quality, Innovation and Improvement, Ng Teng Fong General Hospital, Singapore
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16
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Harvey G, Pham CT, Inacio MC, Laver K, Lynch EA, Jorissen RN, Karnon J, Bourke A, Forward J, Maddison J, Whitehead C, Rupa J, McNamara C, Crotty M. An integrated knowledge translation approach to address avoidable rehospitalisations and unplanned admissions for older people in South Australia: implementation and evaluation program plan. Implement Sci Commun 2021; 2:36. [PMID: 33827707 PMCID: PMC8025566 DOI: 10.1186/s43058-021-00141-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Repeated admission to hospital can be stressful for older people and their families and puts additional pressure on the health care system. While there is some evidence about strategies to better integrate care, improve older patients’ experiences at transitions of care, and reduce preventable hospital readmissions, implementing these strategies at scale is challenging. This program of research comprises multiple, complementary research activities with an overall goal of improving the care for older people after discharge from hospital. The program leverages existing large datasets and an established collaborative network of clinicians, consumers, academics, and aged care providers. Methods The program of research will take place in South Australia focusing on people aged 65 and over. Three inter-linked research activities will be the following: (1) analyse existing registry data to profile individuals at high risk of emergency department encounters and hospital admissions; (2) evaluate the cost-effectiveness of existing ‘out-of-hospital’ programs provided within the state; and (3) implement a state-wide quality improvement collaborative to tackle key interventions likely to improve older people’s care at points of transitions. The research is underpinned by an integrated approach to knowledge translation, actively engaging a broad range of stakeholders to optimise the relevance and sustainability of the changes that are introduced. Discussion This project highlights the uniqueness and potential value of bringing together key stakeholders and using a multi-faceted approach (risk profiling; evaluation framework; implementation and evaluation) for improving health services. The program aims to develop a practical and scalable solution to a challenging health service problem for frail older people and service providers.
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Affiliation(s)
- Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Clarabelle T Pham
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kate Laver
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Elizabeth A Lynch
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Alice Bourke
- Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - John Forward
- Aged Care, Rehabilitation and Palliative Care Division, Northern Adelaide Local Health Network, Adelaide, Australia
| | - John Maddison
- Medical Services, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Craig Whitehead
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Jesmin Rupa
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia.
| | - Carmel McNamara
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Maria Crotty
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
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Wahl AK, Osborne RH, Larsen MH, Andersen MH, Holter IA, Borge CR. Exploring health literacy needs in Chronic obstructive pulmonary disease (COPD): Associations between demographic, clinical variables, psychological well-being and health literacy. Heart Lung 2021; 50:417-424. [PMID: 33618148 DOI: 10.1016/j.hrtlng.2021.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/25/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND The World Health Organization (WHO) points to health literacy as an important factor in prevention and control of non-communicable diseases (NCDs), including COPD. OBJECTIVE To investigate associations between selected demographic and clinical variables, psychological well-being and health literacy. METHODS Health literacy was measured using the nine domain Health Literacy Questionnaire (HLQ) and one domain from the eHealth Literacy Questionnaire (eHLQ). Using data from a cross-sectional sample of 158 people with COPD, recruited from a hospital-based patient list period (2014-2016), multiple regression analyses were performed. RESULTS The strongest associated variables with health literacy were psychological well-being, measured by the WHO-5 well-being index and education, indicating that higher psychological well-being and educational level are associated with higher levels of health literacy. CONCLUSION The present study highlights the importance of specifically looking to psychological factors in determining potentially health literacy needs among people with COPD.
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Affiliation(s)
- Astrid K Wahl
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway.
| | - Richard H Osborne
- Centre of Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Marie H Larsen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal University College, Oslo, Norway
| | - Marit H Andersen
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Christine R Borge
- Department of Interdisciplinary Health Sciences, University of Oslo, Norway; Lovisenberg Diaconal Hospital, Oslo, Norway
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18
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Longman J, Johnston J, Ewald D, Gilliland A, Burke M, Mutonga T, Passey M. What could prevent chronic condition admissions assessed as preventable in rural and metropolitan contexts? An analysis of clinicians' perspectives from the DaPPHne study. PLoS One 2021; 16:e0244313. [PMID: 33411717 PMCID: PMC7790391 DOI: 10.1371/journal.pone.0244313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/07/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Reducing potentially preventable hospitalisations (PPH) is a priority for health services. This paper describes the factors that clinicians perceived contributed to preventable admissions for angina, diabetes, congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), and what they considered might have been done in the three months leading up to an admission to prevent it. METHODS The study was conducted in a rural and a metropolitan health district in NSW, Australia. Expert Panels reviewed detailed case reports to assess preventability. For those admissions identified as preventable, comments from clinicians indicating what they perceived could have made a difference and/or been done differently to prevent each of the preventable admissions were analysed qualitatively. RESULTS 148 (46%) of 323 admissions were assessed as preventable. Across the two districts, the most commonly identified groups of contributing factors to preventable admissions were: 'Systems issues: Community based services missing or inadequate or not referred to'; 'Patient issues: Problems with adherence/self-management'; and 'Clinician issues: GP care inadequate'. In some instances, important differences drove these groups of factors. For example, in the rural district 'Systems issues: Community based services missing or inadequate or not referred to' was largely driven by social and welfare support services missing/inadequate/not referred to, whereas in the metropolitan district it was largely driven by community nursing, allied health, care coordination or integrated care services missing/inadequate/not referred to. Analyses revealed the complexity of system, clinician and patient factors contributing to each admission. Admissions for COPD (rural) and CHF (metropolitan) admissions showed greatest complexity. DISCUSSION AND CONCLUSION These findings suggest preventability of individual admissions is complex and context specific. There is no single, simple solution likely to reduce PPH. Rather, an approach addressing multiple factors is required. This need for comprehensiveness may explain why many programs seeking to reduce PPH have been unsuccessful.
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Affiliation(s)
- Jo Longman
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
- * E-mail:
| | - Jennifer Johnston
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
| | - Dan Ewald
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
- North Coast Primary Health Network, Ballina, NSW, Australia
| | | | - Michael Burke
- School of Medicine, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Tabeth Mutonga
- Mt Druitt Community Health Centre, Western Sydney Local Health District, Mt Druitt, NSW, Australia
| | - Megan Passey
- University Centre for Rural Health, The University of Sydney, Lismore, NSW, Australia
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Jayakody A, Oldmeadow C, Carey M, Bryant J, Evans T, Ella S, Attia J, Towle S, Sanson-Fisher R. Frequent avoidable admissions amongst Aboriginal and non-Aboriginal people with chronic conditions in New South Wales, Australia: a historical cohort study. BMC Health Serv Res 2020; 20:1082. [PMID: 33238996 PMCID: PMC7690010 DOI: 10.1186/s12913-020-05950-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 11/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander people have high rates of avoidable hospital admissions for chronic conditions, however little is known about the frequency of avoidable admissions for this population. This study examined trends in avoidable admissions among Aboriginal and non-Aboriginal people with chronic conditions in New South Wales (NSW), Australia. METHODS A historical cohort analysis using de-identified linked administrative data of Aboriginal patients and an equal number of randomly sampled non-Aboriginal patients between 2005/06 to 2013/14. Eligible patients were admitted to a NSW public hospital and who had one or more of the following ambulatory care sensitive chronic conditions as a principal diagnosis: diabetic complications, asthma, angina, hypertension, congestive heart failure and/or chronic obstructive pulmonary disease. The primary outcomes were the number of avoidable admissions for an individual in each financial year, and whether an individual had three or more admissions compared with one to two avoidable admissions in each financial year. Poisson and logistic regression models and a test for differences in yearly trends were used to assess the frequency of avoidable admissions over time, adjusting for sociodemographic variables and restricted to those aged ≤75 years. RESULTS Once eligibility criteria had been applied, there were 27,467 avoidable admissions corresponding to 19,025 patients between 2005/06 to 2013/14 (71.2% Aboriginal; 28.8% non-Aboriginal). Aboriginal patients were 15% more likely than non-Aboriginal patients to have a higher number of avoidable admissions per financial year (IRR = 1.15; 95% CI: 1.11, 1.20). Aboriginal patients were almost twice as likely as non-Aboriginal patients to experience three or more avoidable admissions per financial year (OR = 1.90; 95% CI = 1.60, 2.26). There were no significant differences between Aboriginal and non-Aboriginal people in yearly trends for either the number of avoidable admissions, or whether or not an individual experienced three or more avoidable admissions per financial year (p = 0.859; 0.860 respectively). CONCLUSION Aboriginal people were significantly more likely to experience frequent avoidable admissions over a nine-year period compared to non-Aboriginal people. These high rates reflect the need for further research into which interventions are able to successfully reduce avoidable admissions among Aboriginal people, and the importance of culturally appropriate community health care.
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Affiliation(s)
- Amanda Jayakody
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia.
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia.
| | - Christopher Oldmeadow
- CREDITSS-Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Jamie Bryant
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Tiffany Evans
- CREDITSS-Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Stephen Ella
- Nunyara Aboriginal Health Unit, Central Coast Local Health District, Ward Street, Gosford, NSW, 2250, Australia
| | - John Attia
- CREDITSS-Clinical Research Design, Information Technology and Statistical Support Unit, Hunter Medical Research Institute, HMRI Building, New Lambton Heights, NSW, 2305, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Simon Towle
- The Cairns Institute, James Cook University, PO Box 6811, Cairns, QLD, 4870, Australia
| | - Robert Sanson-Fisher
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
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Johnston J, Longman J, Ewald D, King J, Das S, Passey M. Study of potentially preventable hospitalisations (PPH) for chronic conditions: what proportion are preventable and what factors are associated with preventable PPH? BMJ Open 2020; 10:e038415. [PMID: 33168551 PMCID: PMC7654103 DOI: 10.1136/bmjopen-2020-038415] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The proportion of potentially preventable hospitalisations (PPH) which are actually preventable is unknown, and little is understood about the factors associated with individual preventable PPH. The Diagnosing Potentially Preventable Hospitalisations (DaPPHne) Study aimed to determine the proportion of PPH for chronic conditions which are preventable and identify factors associated with chronic PPH classified as preventable. SETTING Three hospitals in NSW, Australia. PARTICIPANTS Community-dwelling patients with unplanned hospital admissions between November 2014 and June 2017 for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes complications or angina pectoris. Data were collected from patients, their general practitioners (GPs) and hospital records. OUTCOME MEASURES Assessments of the preventability of each admission by an Expert Panel. RESULTS 323 admissions were assessed for preventability: 46% (148/323) were assessed as preventable, 30% (98/323) as not preventable and 24% (77/323) as unclassifiable. Statistically significant differences in proportions preventable were found between the three study sites (29%; 47%; 58%; p≤0.001) and by primary discharge diagnosis (p≤0.001).Significant predictors of an admission being classified as preventable were: study site; final principal diagnosis of CHF; fewer diagnoses on discharge; shorter hospital stay; GP diagnosis of COPD; GP consultation in the last 12 months; not having had a doctor help make the decision to go to hospital; not arriving by ambulance; patient living alone; having someone help with medications and requiring help with daily tasks. CONCLUSIONS That less than half the chronic PPH were assessed as preventable, and the range of factors associated with preventability, including site and discharge diagnosis, are important considerations in the validity of PPH as an indicator. Opportunities for interventions to reduce chronic PPH include targeting patients with CHF and COPD, and the provision of social welfare and support services for patients living alone and those requiring help with daily tasks and medication management.
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Affiliation(s)
- Jennifer Johnston
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Jo Longman
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Dan Ewald
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Jonathan King
- The Kirby Institute, Kensington, New South Wales, Australia
| | - Sumon Das
- Child Health Division, Menzies School of Health Research, Casuarina, Northern Territory, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
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Huang M, van der Borght C, Leithaus M, Flamaing J, Goderis G. Patients' perceptions of frequent hospital admissions: a qualitative interview study with older people above 65 years of age. BMC Geriatr 2020; 20:332. [PMID: 32894056 PMCID: PMC7487888 DOI: 10.1186/s12877-020-01748-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 08/31/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Although 'frequent flyer' hospital admissions represent barely 3 to 8% of the total patient population in a hospital, they are responsible for a disproportionately high percentage (12 to 28%) of all admissions. Moreover, hospital admissions are an important contributor to health care costs and overpopulation in various hospitals. The aim of this research is to obtain a deeper insight into the phenomenon of frequent flyer hospital admissions. Our objectives were to understand the patients' perspectives on the cause of their frequent hospital admissions and to identify the perceived consequences of the frequent flyer status. METHODS This qualitative study took place at the University Hospital of Leuven. The COREQ guidelines were followed to provide rigor to the study. Patients were included when they had at least four overnight admissions in the past 12 months, an age above 65 years and hospital admission at the time of the study. Data were collected via semi-structured interviews and encoded in NVivo. RESULTS Thirteen interviews were collected. A total of 17 perceived causes for frequent hospital admission were identified, which could be divided into the following six themes: patient, drugs, primary care, secondary care, home and family. Most of the causes were preventable or modifiable. The perceived consequences of being a frequent flyer were divided into the following six themes: body, daily life functioning, social participation, mental status and spiritual dimension. Negative experiences were linked to frequent flying and could be situated mainly in the categories of social participation, mental status and spiritual dimensions. CONCLUSIONS Frequent hospital admissions may be conceived as an indicator, i.e., a 'red flag', of patients' situations characterized by physical, mental, spiritual and social deprivation in their home situation.
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Affiliation(s)
- Miaolin Huang
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Carolien van der Borght
- Leuven Institute for Healthcare Policy, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Merel Leithaus
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Gerontology and Geriatrics, KU Leuven, Leuven, Belgium
| | - Geert Goderis
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Kapucijnevoer 33 Blok J Bus, 7001 3000, Leuven, Belgium.
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Xia T, Enticott J, Pearce C, Mazza D, Turner LR. Predictors of ED attendance in older patients with chronic disease: a data linkage study. AUST HEALTH REV 2020; 44:550-556. [PMID: 32674754 DOI: 10.1071/ah19169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/19/2019] [Indexed: 11/23/2022]
Abstract
Objective Older people represent a large proportion of emergency department (ED) presentations, with multiple comorbidities a strong predictor of frequent attendance. This study examined associations between the general practice management received by older patients with chronic disease and ED attendance. Methods This retrospective study examined linked data from general practice and ED for patients aged ≥65 years who presented to a general practitioner (GP) between 2010 and 2014. Data from the computerised medical records of patients attending 50 general practice clinics in the inner east Melbourne region ere linked with ED attendance data from the same region. Patients with chronic disease were identified and characteristics of ED versus non-ED attendees were compared. Poisson regression was used to explore factors associated with ED usage. Results During the study period, 67474 patients aged ≥65 years visited a GP, with 63.3% identified as having at least one chronic condition and 21.4% of these having at least one ED presentation. Over 70% of the ED presentations in this group resulted in hospital admissions. The most common diagnoses for ED presentation were cardiovascular disorders, pain and injuries. ED attendance was associated with being aged ≥85 years (incidence rate ratio (IRR) 2.09; 95% confidence interval (CI) 1.96-2.11), higher socioeconomic status (IRR 1.49; 95% CI 1.45-1.53), having a GP management plan (IRR 1.47; 95% CI 1.43-1.52), multimorbidity (IRR 1.53; 95% CI 1.46-1.60), more frequent GP visits (IRR 1.10; 95% CI 1.05-1.15) and having a higher numbers of prescriptions (IRR 1.51; 95% CI 1.44-1.57). Conclusion This study suggests that ED presentation is associated with greater frailty and multimorbidity in patients. Further research is necessary to determine why higher rates of chronic disease management through GP management plans and more frequent visits did not mediate higher rates of presentation and the reasons behind the socioeconomic differences in ED presentation for patients in this age group. What is known about the topic? Increases in the volume and rate of ED presentations by older people will markedly affect emergency and acute hospital care and patient flow as the proportion of older Australians increases. What does this paper add? We used a novel and highly transferable data linkage between data collected from the clinical records of general practice patients and their associated data from ED and hospital settings and examined the relationship between GP management received by older patients with chronic disease and ED attendance. What are the implications for practitioners? Increasing utilisation of GP services may not have an effect on reducing ED attendance, particularly for older patients who may experience poorer overall health.
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Affiliation(s)
- Ting Xia
- Department of General Practice, School of Primary and Allied Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia. ; ; ; ; and Insurance Work and Health Group, Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia; and Corresponding author.
| | - Joanne Enticott
- Department of General Practice, School of Primary and Allied Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia. ; ; ;
| | - Christopher Pearce
- Department of General Practice, School of Primary and Allied Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia. ; ; ; ; and Melbourne East General Practice Network (trading as Outcome Health), 250 Mont Albert Road, Surrey Hills, Vic. 3127, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia. ; ; ;
| | - Lyle R Turner
- Department of General Practice, School of Primary and Allied Health Care, Monash University, 270 Ferntree Gully Road, Notting Hill, Vic. 3168, Australia. ; ; ; ; and The Institute for Urban Indigenous Health, 22 Cox Road, Windsor, Qld 4030, Australia
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Groh CJ, Saunders MM. The Transition From Spousal Caregiver to Widowhood: Quantitative Findings of a Mixed-Methods Study. J Am Psychiatr Nurses Assoc 2020; 26:527-541. [PMID: 32362165 PMCID: PMC8114451 DOI: 10.1177/1078390320917751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND: The number of persons diagnosed with dementia is projected to triple to 14 million by 2050. The significance of these projections is particularly relevant to older women (>65 years), who are more likely to provide dementia caregiving for a husband than vice versa. Research has identified consistent themes around the impact of caregiving during the caregiving experience, yet there is limited research exploring the ongoing impact during the transition to widowhood. Moreover, there is a paucity of research examining differences between rural and urban spousal dementia caregivers. AIMS: The aims were to compare differences between older rural and urban spousal caregivers on physical and mental health factors affecting the transition from caregiver to widow and to identify resources the women used during this transition over 12 months. METHOD: This mixed-methods longitudinal study recruited 13 urban and nine rural female spousal caregivers. Participants were interviewed three times over 12 months. The dependent variables were depression (measured using Center for Epidemiologic Studies Depression Scale), physical and mental functioning (measured using the 12-item Medical Outcomes Study-Short Form Health Survey Version 2). RESULTS: No statistically significant differences were detected between rural and urban female caregivers on the dependent variables. However, rural caregivers scored higher on depression and lower on both physical and mental functioning compared to their urban counterparts. CONCLUSIONS: The findings have clinical and research implications. Psychiatric nurses are well positioned to provide education related to dementia information deficits; implement interventions that facilitate bereavement, resilience, self-care, and identity; advocate for additional services; and conduct larger scale studies with a more diverse sample of female spousal caregivers.
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Affiliation(s)
- Carla J. Groh
- Carla J. Groh, PhD, PMHNP-BC, FAAN, University of Detroit Mercy, Detroit, MI, USA
| | - Mitzi M. Saunders
- Mitzi M. Saunders, PhD, APRN, CNS-C, University of Detroit Mercy, Detroit, MI, USA
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Heidari Gorji MA, Fatahian A, Farsavian A. The impact of perceived and objective social isolation on hospital readmission in patients with heart failure: A systematic review and meta-analysis of observational studies. Gen Hosp Psychiatry 2019; 60:27-36. [PMID: 31310898 DOI: 10.1016/j.genhosppsych.2019.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/27/2019] [Accepted: 07/02/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Several psychosocial risk factors have been identified that increase the rate of readmission in heart failure (HF) patients. However, the impact of social isolation (SI) on the rate of readmission is unclear. Therefore, the current review focused on the impact of SI on readmission rates of patients with HF. METHODS A Medline-based strategy was applied to search PubMed, SCOPUS, Cochrane library, ProQuest, and Embase from inception until November 15, 2018. We performed a meta-analysis and pooled results using random effects model. The primary outcome was the odds ratio of readmission in HF patients suffering from SI. We examined the impact of both perceived and objective SI on readmission rates. We also examined the differences in readmission rates between these concepts. The secondary outcomes were the incidence of readmission and the prevalence of SI. RESULTS From 3326 titles, 13 studies (n = 6468 participants) were eligible. The mean follow-up period was 13 months. The cumulative incidence for HF-related hospital readmission was 35.47% (95% CI: 34.29-36.67). The pooled prevalence ratio (PR, (95% CI)) was 37.31% (36.14-38.49), 31.51% (30.36-32.68), 32.82% (29.90-35.88), and 39.57% (37.73-41.45) for SI, living alone, lack of social support, and poor social network, respectively. SI was associated with a 55% greater risk of hospital readmission in patients with HF (OR = 1.55; 95% CI = 1.39-1.73; p < .001). Our analysis did not show a significant difference in the rate of hospital readmission between perceived and objective SI. CONCLUSION SI is prevalent in patients with HF and seems to be consistently linked to hospital readmission in HF patients, regardless of how it is measured. Therefore, it is necessary to develop interventions to reduce the burden of SI in patients with HF.
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Affiliation(s)
- M A Heidari Gorji
- Diabetes Research Center, Department of Medical-Surgical Nursing, Nasibeh Faculty of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - A Fatahian
- Department of Cardiology, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - A Farsavian
- Department of Cardiology, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
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25
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Ng SHX, Rahman N, Ang IYH, Sridharan S, Ramachandran S, Wang DD, Tan CS, Toh SA, Tan XQ. Characterization of high healthcare utilizer groups using administrative data from an electronic medical record database. BMC Health Serv Res 2019; 19:452. [PMID: 31277649 PMCID: PMC6612067 DOI: 10.1186/s12913-019-4239-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 06/10/2019] [Indexed: 12/11/2022] Open
Abstract
Background High utilizers (HUs) are a small group of patients who impose a disproportionately high burden on the healthcare system due to their elevated resource use. Identification of persistent HUs is pertinent as interventions have not been effective due to regression to the mean in majority of patients. This study will use cost and utilization metrics to segment a hospital-based patient population into HU groups. Methods The index visit for each adult patient to an Academic Medical Centre in Singapore during 2006 to 2012 was identified. Cost, length of stay (LOS) and number of specialist outpatient clinic (SOC) visits within 1 year following the index visit were extracted and aggregated. Patients were HUs if they exceeded the 90th percentile of any metric, and Non-HU otherwise. Seven different HU groups and a Non-HU group were constructed. The groups were described in terms of cost and utilization patterns, socio-demographic information, multi-morbidity scores and medical history. Logistic regression compared the groups’ persistence as a HU in any group into the subsequent year, adjusting for socio-demographic information and diagnosis history. Results A total of 388,162 patients above the age of 21 were included in the study. Cost-LOS-SOC HUs had the highest multi-morbidity and persistence into the second year. Common conditions among Cost-LOS and Cost-LOS-SOC HUs were cardiovascular disease, acute cerebrovascular disease and pneumonia, while most LOS and LOS-SOC HUs were diagnosed with at least one mental health condition. Regression analyses revealed that HUs across all groups were more likely to persist compared to Non-HUs, with stronger relationships seen in groups with high SOC utilization. Similar trends remained after further adjustment. Conclusion HUs of healthcare services are a diverse group and can be further segmented into different subgroups based on cost and utilization patterns. Segmentation by these metrics revealed differences in socio-demographic characteristics, disease profile and persistence. Most HUs did not persist in their high utilization, and high SOC users should be prioritized for further longitudinal analyses. Segmentation will enable policy makers to better identify the diverse needs of patients, detect gaps in current care and focus their efforts in delivering care relevant and tailored to each segment. Electronic supplementary material The online version of this article (10.1186/s12913-019-4239-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sheryl Hui-Xian Ng
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Nabilah Rahman
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Ian Yi Han Ang
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Srinath Sridharan
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sravan Ramachandran
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Debby D Wang
- Centre for Health Services and Policy Research, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sue-Anne Toh
- Regional Health System Office, National University Health System, Singapore, Singapore
| | - Xin Quan Tan
- Regional Health System Office, National University Health System, Singapore, Singapore. .,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
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26
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Ang IYH, Tan CS, Nurjono M, Tan XQ, Koh GCH, Vrijhoef HJM, Tan S, Ng SE, Toh SA. Retrospective evaluation of healthcare utilisation and mortality of two post-discharge care programmes in Singapore. BMJ Open 2019; 9:e027220. [PMID: 31122989 PMCID: PMC6538026 DOI: 10.1136/bmjopen-2018-027220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To evaluate the impact on healthcare utilisation frequencies and charges, and mortality of a programme for frequent hospital utilisers and a programme for patients requiring high acuity post-discharge care as part of an integrated healthcare model. DESIGN A retrospective quasi-experimental study without randomisation where patients who received post-discharge care interventions were matched 1:1 with unenrolled patients as controls. SETTING The National University Health System (NUHS) Regional Health System (RHS), which was one of six RHS in Singapore, implemented the NUHS RHS Integrated Interventions and Care Extension (NICE) programme for frequent hospital utilisers and the NUHS Transitional Care Programme (NUHS TCP) for high acuity post-discharge care. The programmes were supported by the Ministry of Health in Singapore, which is a city-state nation located in Southeast Asia with a 5.6 million population. PARTICIPANTS Linked healthcare administrative data, for the time period of January 2013 to December 2016, were extracted for patients enrolled in NICE (n=554) or NUHS TCP (n=270) from June 2014 to December 2015, and control patients. INTERVENTIONS For both programmes, teams conducted follow-up home visits and phone calls to monitor and manage patients' post-discharge. PRIMARY OUTCOME MEASURES One-year pre- and post-enrolment healthcare utilisation frequencies and charges of all-cause inpatient admissions, emergency admissions, emergency department attendances, specialist outpatient clinic (SOC) attendances, total inpatient length of stay and mortality rates were compared. RESULTS Patients in NICE had lower mortality rate, but higher all-cause inpatient admission, emergency admission and emergency department attendance charges. Patients in NUHS TCP did not have lower mortality rate, but had higher emergency admission and SOC attendance charges. CONCLUSIONS Both NICE and NUHS TCP had no improvements in 1 year healthcare utilisation across various setting and metrics. Singular interventions might not be as impactful in effecting utilisation without an overhauling transformation and restructuring of the hospital and healthcare system.
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Affiliation(s)
- Ian Yi Han Ang
- Regional Health System Planning Office, National University Health System, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Milawaty Nurjono
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Xin Quan Tan
- Regional Health System Planning Office, National University Health System, Singapore
- National University Singapore Saw Swee Hock School of Public Health, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
- National University Singapore Yong Loo Lin School of Medicine, Singapore
| | - Hubertus Johannes Maria Vrijhoef
- Department of Patient and Care, University Hospital Maastricht, Maastricht, The Netherlands
- Vrije Universiteit Brussels, Brussels, Belgium
- Panaxea b.v., Amsterdam, The Netherlands
| | - Shermin Tan
- Department of Palliative Medicine and Community Transformation Office, Woodlands Health Campus, Singapore
| | - Shu Ee Ng
- National University Singapore Yong Loo Lin School of Medicine, Singapore
- University Medicine Cluster, National University Health System, Singapore
| | - Sue-Anne Toh
- Regional Health System Planning Office, National University Health System, Singapore
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27
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Dai W. Is China facing the social risks associated with reliance on hospitalization for the care of the elderly with chronic diseases? Int J Health Plann Manage 2019; 34:794-805. [DOI: 10.1002/hpm.2738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/27/2018] [Accepted: 01/03/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Weidong Dai
- School of Public AdministrationZhejiang University of Finance and Economics Hangzhou China
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28
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Lawn S, Zabeen S, Rowlands N, Picot S. Hidden care: Revelations of a case-note audit of physical health care in a community mental health service. Int J Ment Health Nurs 2018; 27:1742-1755. [PMID: 29797643 DOI: 10.1111/inm.12479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2018] [Indexed: 12/30/2022]
Abstract
People with severe mental illness (SMI) are widely reported to be at an increased risk of morbidity and premature death due to physical health conditions. Mental health nurses are ideally placed to address physical and mental health comorbidity as part of their day-to-day practice. This study involved an audit of hardcopy and electronic clinical case-notes of a random sample of 100 people with SMI case managed by community mental health service in metropolitan South Australia, to determine how well physical health conditions and risk factors, screening, and follow-up are recorded within their service records. Every contact between 1 July 2015 and 30 June 2016 was read. One-way ANOVA, Scheffe's test, and Fisher's exact test determined any significant associations across audit variables, which included gender, age, income, living arrangement, diagnosis, lifestyle factors, recording of physical health measures, and carer status. A focus on physical health care was evident from everyday case-note records; however, because this information was 'buried' within the plethora of entries and not brought to the fore with other key information about the person's psychiatric needs, it remained difficult to gain a full picture of potential gaps in physical health care for this population. Under-reporting, gaps and inconsistencies in the systematic recording of physical health information for this population are likely to undermine the quality of care they receive from mental health services, the ability of mental health service providers to respond in a timely way to their physical healthcare needs, and their communication with other healthcare providers.
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Affiliation(s)
- Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sara Zabeen
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nikki Rowlands
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Southern Mental Health, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Sharon Picot
- Southern Mental Health, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
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King L, Harrington A, Linedale E, Tanner E. A mixed methods thematic review: Health-related decision-making by the older person. J Clin Nurs 2018; 27:e1327-e1343. [PMID: 29322576 DOI: 10.1111/jocn.14261] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2018] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To undertake a mixed methods thematic literature review that explored how elderly adults approached decision-making in regard to their health care following discharge. BACKGROUND A critical time for appropriate health decisions occurs during hospital discharge planning with nursing staff. However, little is known how the 89% of elderly living at home make decisions regarding their health care. Research into older adults' management of chronic conditions emerges as an important step to potentially encourage symptom monitoring, prevent missed care and detect deterioration. All should reduce the risk of hospital re-admission. DESIGN A mixed methods thematic literature review was undertaken. The structure followed the PRISMA reporting guidelines for systematic reviews recommended by the EQUATOR network. METHODS PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus online databases were searched using keywords, inclusion and exclusion criteria. References drawn from relevant publications, identified by experts and published between 1995 and 2017 were also considered. Twenty-five qualitative, quantitative and mixed methods studies and reviews were critically appraised (CASP 2013) before inclusion in the review. Analysis of each study's findings was undertaken using Braun and Clarke's (2006) steps to identify major themes and sub-themes. RESULTS Four main themes associated with health-related decision-making in the elderly were identified: "the importance of maintaining independence," "decision making style," "management of conditions at home" and "discharge planning." CONCLUSION Health care decision preferences in the elderly emerged as highly complex and influenced by multiple factors. Development of a tool to assess these components has been recommended. RELEVANCE TO CLINICAL PRACTICE Nurses play a vital role in exploring and understanding the influence that maintaining independence has with each patient. This understanding provides an initial step toward development of a tool to assist collaboration between patients and healthcare professionals involved in their care.
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Affiliation(s)
- Lindy King
- College of Nursing & Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Ann Harrington
- College of Nursing & Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Ecushla Linedale
- College of Nursing & Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Elizabeth Tanner
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Nursing and School of Medicine, Baltimore, MD, USA
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Gholamzadeh S, Khastavaneh M, Khademian Z, Ghadakpour S. The effects of empathy skills training on nursing students' empathy and attitudes toward elderly people. BMC MEDICAL EDUCATION 2018; 18:198. [PMID: 30111312 PMCID: PMC6094453 DOI: 10.1186/s12909-018-1297-9] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/27/2018] [Indexed: 05/10/2023]
Abstract
BACKGROUND Nursing students' empathy and positive attitudes toward elderly people could help provide improved elderly care in their future practice. This study aimed to investigate the effects of empathy skills training on nursing students' empathy and attitudes toward elderly people. METHODS This quasi-experimental study was conducted in Yasuj, Iran in 2014. The sample consisted of 63 students at Hazrat Zeinab Nursing and Midwifery School who were randomly divided into a control (n = 31) and an intervention group (n = 32). The intervention group attended an eight-hour workshop on empathy skills that was presented through lectures, demonstration, group discussions, scenarios, and questioning. The data were collected using the Persian versions of Kogan's Attitudes towards Old People Scale and Jefferson Scale of Physician Empathy-Health Professionals Version. Then, the data were entered into the SPSS software, version 19 and were analyzed using descriptive statistics, chi-square test, t-test, and repeated measures analysis of variance. RESULTS The results showed that the empathy skills training program had a significant impact on the students' mean scores of empathy and attitudes toward elderly people (p < 0.001). The intervention group's mean score of empathy increased from 77.8 (SD = 10.7) before the intervention to 86 (SD = 7.3) immediately after that and 85.2 (SD = 8.9) 2 months later. Their mean score of attitude also increased from 110.8 (SD = 10.9) before the intervention to 155.2 (SD = 23.4) immediately after the intervention and 158.6 (SD = 23.2) 2 months later. Additionally, the empathy and attitude scores of the intervention group were significantly higher than those for control group immediately and 2 months after the intervention. CONCLUSIONS Empathy skills training improved the nursing students' empathy and attitudes towards elderly people. Therefore, empathy training is recommended to be incorporated into the undergraduate nursing curriculum.
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Affiliation(s)
- Sakineh Gholamzadeh
- Community-Based Psychiatric Care Research Center, Shiraz University of Medical Sciences , Shiraz, Iran
| | - Maryam Khastavaneh
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Khademian
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soraya Ghadakpour
- School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Dew R, Wilkes S. Attitudes, perceptions, and behaviours associated with hospital admission avoidance: a qualitative study of high-risk patients in primary care. Br J Gen Pract 2018; 68:e460-e468. [PMID: 29866709 PMCID: PMC6014402 DOI: 10.3399/bjgp18x697493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 03/14/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND There is little evidence documenting the attitudes, experiences, and behavioural factors of high-risk patients who are associated with avoiding hospital. AIM To explore the health, healthcare management, and behavioural factors that contribute to enabling high-risk patients to avoid unplanned hospital admissions. DESIGN AND SETTING This was an in-depth qualitative, primary care, interview study with patients who were registered on the Northumberland High Risk Patient Programme (NHRPP) in Northumberland, UK. METHOD There were 30 participants in this study, of who 21 were high-risk patients and nine were carers, spouses, or relatives. A grounded-theory approach was used to explore themes that emerged from the semi-structured interviews. RESULTS Participants described physical enablers that helped them to avoid hospital including medication, living aids, and resting; however, the benefit of these may be challenged by patient decision making. The strategies that patients used to cope with their health conditions included acceptance, positive reinterpretation, and growth. Participants felt that support networks of family and friends helped them to avoid hospital, although the strain on the spouse should be considered. The majority of patients described having trust and confidence in their healthcare providers, and continuity of care was important to patients. CONCLUSION Reinforcing the importance of the physical enablers, as well as support networks to patients, carers, and healthcare providers, could help patients to avoid hospital. Highlighting the coping strategies that patients use may help patients to manage their health, while promoting continuity of care will also contribute to helping high-risk patients to avoid unplanned hospital admissions.
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Affiliation(s)
- Rosie Dew
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland
| | - Scott Wilkes
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland
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Caughey GE, Hillen JB, Bacon S, Bullock N, Bullock V, Kalisch Ellett L. Implementation of medication-related indicators of potentially preventable hospitalizations in a national chronic disease management program for older patients with multimorbidity. Int J Qual Health Care 2018; 31:133-139. [DOI: 10.1093/intqhc/mzy133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 04/23/2018] [Accepted: 06/06/2018] [Indexed: 12/22/2022] Open
Affiliation(s)
- Gillian E Caughey
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Jodie B Hillen
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | | | | | | | - Lisa Kalisch Ellett
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
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Predicting Risk Factors for 30-Day Readmissions Following Discharge From Post-Acute Care. Prof Case Manag 2018; 23:139-146. [DOI: 10.1097/ncm.0000000000000261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Valtorta NK, Moore DC, Barron L, Stow D, Hanratty B. Older Adults' Social Relationships and Health Care Utilization: A Systematic Review. Am J Public Health 2018; 108:e1-e10. [PMID: 29470115 DOI: 10.2105/ajph.2017.304256] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Deficiencies in older people's social relationships (including loneliness, social isolation, and low social support) have been implicated as a cause of premature mortality and increased morbidity. Whether they affect service use is unclear. OBJECTIVES To determine whether social relationships are associated with older adults' use of health services, independently of health-related needs. SEARCH METHODS We searched 8 electronic databases (MEDLINE, Embase, CINAHL, Web of Science, PsycINFO, Scopus, the Cochrane Library, and the Centre for Reviews and Dissemination) for data published between 1983 and 2016. We also identified relevant sources from scanning the reference lists of included studies and review articles, contacting authors to identify additional studies, and searching the tables of contents of key journals. SELECTION CRITERIA Studies met inclusion criteria if more than 50% of participants were older than 60 years or mean age was older than 60 years; they included a measure of social networks, received social support, or perceived support; and they reported quantitative data on the association between social relationships and older adults' health service utilization. DATA COLLECTION AND ANALYSIS Two researchers independently screened studies for inclusion. They extracted data and appraised study quality by using standardized forms. In a narrative synthesis, we grouped the studies according to the outcome of interest (physician visits, hospital admissions, hospital readmissions, emergency department use, hospital length of stay, utilization of home- and community-based services, contact with general health services, and mental health service use) and the domain of social relationships covered (social networks, received social support, or perceived support). For each service type and social relationship domain, we assessed the strength of the evidence across studies according to the quantity and quality of studies and consistency of findings. MAIN RESULTS The literature search retrieved 26 077 citations, 126 of which met inclusion criteria. Data were reported across 226 678 participants from 19 countries. We identified strong evidence of an association between weaker social relationships and increased rates of readmission to hospital (75% of high-quality studies reported evidence of an association in the same direction). In evidence of moderate strength, according to 2 high-quality and 3 medium-quality studies, smaller social networks were associated with longer hospital stays. When we considered received and perceived social support separately, they were not linked to health care use. Overall, the evidence did not indicate that older patients with weaker social relationships place greater demands on ambulatory care (including physician visits and community- or home-based services) than warranted by their needs. AUTHORS' CONCLUSIONS Current evidence does not support the view that, independently of health status, older patients with lower levels of social support place greater demands on ambulatory care. Future research on social relationships would benefit from a consensus on clinically relevant concepts to measure. Public Health Implications. Our findings are important for public health because they challenge the notion that lonely older adults are a burden on all health and social care services. In high-income countries, interventions aimed at reducing social isolation and loneliness are promoted as a means of preventing inappropriate service use. Our review cautions against assuming that reductions in care utilization can be achieved by intervening to strengthen social relationships.
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Affiliation(s)
- Nicole K Valtorta
- Nicole K. Valtorta, Lynn Barron, Daniel Stow, and Barbara Hanratty are with the Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom. Danielle Collingridge Moore is with the International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Danielle Collingridge Moore
- Nicole K. Valtorta, Lynn Barron, Daniel Stow, and Barbara Hanratty are with the Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom. Danielle Collingridge Moore is with the International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Lynn Barron
- Nicole K. Valtorta, Lynn Barron, Daniel Stow, and Barbara Hanratty are with the Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom. Danielle Collingridge Moore is with the International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Daniel Stow
- Nicole K. Valtorta, Lynn Barron, Daniel Stow, and Barbara Hanratty are with the Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom. Danielle Collingridge Moore is with the International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
| | - Barbara Hanratty
- Nicole K. Valtorta, Lynn Barron, Daniel Stow, and Barbara Hanratty are with the Institute of Health and Society/Newcastle University Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom. Danielle Collingridge Moore is with the International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom
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Lawn S, Zabeen S, Smith D, Wilson E, Miller C, Battersby M, Masman K. Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program. AUST HEALTH REV 2018; 42:542-549. [DOI: 10.1071/ah17099] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 07/10/2017] [Indexed: 11/23/2022]
Abstract
Objective
The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health’s Hospital Admission Risk Program (HARP).
Methods
A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model.
Results
The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P = 0.037) and complex needs (P < 0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P < 0.001), heart disease (P = 0.015) and complex needs (P = 0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs.
Conclusion
The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0–65, had received more targeted care.
What is known about the topic?
Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the individual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation.
What does this paper add?
This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia’s health system.
What are the implications for practitioners?
Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically.
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Baker J, White N, Mengersen K, Rolfe M, Morgan GG. Joint modelling of potentially avoidable hospitalisation for five diseases accounting for spatiotemporal effects: A case study in New South Wales, Australia. PLoS One 2017; 12:e0183653. [PMID: 28854280 PMCID: PMC5576724 DOI: 10.1371/journal.pone.0183653] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 08/08/2017] [Indexed: 11/29/2022] Open
Abstract
Background Three variant formulations of a spatiotemporal shared component model are proposed that allow examination of changes in shared underlying factors over time. Methods Models are evaluated within the context of a case study examining hospitalisation rates for five chronic diseases for residents of a regional area in New South Wales: type II diabetes mellitus (DMII), chronic obstructive pulmonary disease (COPD), coronary arterial disease (CAD), hypertension (HT) and congestive heart failure (CHF) between 2001–2006. These represent ambulatory care sensitive (ACS) conditions, often used as a proxy for avoidable hospitalisations. Using a selected model, the effects of socio-economic status (SES) as a shared component are estimated and temporal patterns in the influence of the residual shared spatial component are examined. Results Choice of model depends upon the application. In the featured application, a model allowing for changing influence of the shared spatial component over time was found to have the best fit and was selected for further analyses. Hospitalisation rates were found to be increasing for COPD and DMII, decreasing for CHF and stable for CAD and HT. SES was substantively associated with hospitalisation rates, with differing degrees of influence for each disease. In general, most of the spatial variation in hospitalisation rates was explained by disease-specific spatial components, followed by the residual shared spatial component. Conclusion Appropriate selection of a joint disease model allows for the examination of temporal patterns of disease outcomes and shared underlying spatial factors, and distinction between different shared spatial factors.
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Affiliation(s)
- Jannah Baker
- Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Australia
- Cooperative Research Centres for Spatial Information, Melbourne, Australia
- The George Institute for Global Health, Sydney, Australia
- * E-mail:
| | - Nicole White
- Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Australia
- Cooperative Research Centres for Spatial Information, Melbourne, Australia
| | - Kerrie Mengersen
- Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Queensland University of Technology, Brisbane, Australia
- Cooperative Research Centres for Spatial Information, Melbourne, Australia
| | - Margaret Rolfe
- University Centre for Rural Health – North Coast, University of Sydney, Lismore, Australia
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Geoffrey G. Morgan
- University Centre for Rural Health – North Coast, University of Sydney, Lismore, Australia
- North Coast Public Health Unit, Mid North Coast Local Health District, New South Wales, Australia
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Características y patrón temporal de reingresos de los pacientes con fibrilación auricular hospitalizados en servicios médicos. Rev Clin Esp 2017; 217:309-314. [PMID: 28460719 DOI: 10.1016/j.rce.2017.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 01/27/2017] [Accepted: 03/07/2017] [Indexed: 11/21/2022]
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Iñiguez Vázquez I, Monte Secades R, Matesanz Fernández M, Romay Lema E, Rubal Bran D, Casariego Vales E. Characteristics and temporal pattern of readmissions of patients with atrial fibrillation hospitalized in medical departments. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bell J, Turbow S, George M, Ali MK. Factors associated with high-utilization in a safety net setting. BMC Health Serv Res 2017; 17:273. [PMID: 28410614 PMCID: PMC5391601 DOI: 10.1186/s12913-017-2209-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/31/2017] [Indexed: 11/16/2022] Open
Abstract
Background Patients with frequent hospital readmissions, or high-utilizer patients (HUPs), are a major driver of rising healthcare costs in the United States. This group has a significant burden of medical illness, but less is known about whether or how social determinants of health may drive their increased healthcare use and poor health outcomes. Our study aimed to define the population of HUPs at a large, safety-net hospital system, to understand how these patients differ from patients who are not HUPs, and to analyze how their demographic, medical, and social factors contribute to their healthcare use and mortality rates. Methods For this case-control study, data were collected via retrospective chart review. We included 247 patients admitted three or more times in a single calendar year between 2011 and 2013 and 247 controls with one or two admissions in a single calendar year matched for age, sex, and year of high-utilization. We used multivariable logistic regression models to understand which demographic, clinical, and social factors were associated with HUP status, and if HUP status was independently associated with mortality. Results The factors that contributed significant odds of being a HUP included having Medicaid (OR 3.34, 95% CI 1.50, 7.44) or Medicare (OR 3.39, 95% CI 1.50, 7.67), having a history of recreational drug use (OR 2.44, 95% 1.36, 4.38), and being homeless (OR 3.73, 95% CI 1.69, 8.23) The mortality rate among HUPs was 22.6% compared to 8.9% among controls (p < 0.0001). Conclusions These data show that social factors are related to high-utilization in this population. Future efforts to understand and improve the health of this population need to incorporate non-clinical patient factors. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2209-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Bell
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Sara Turbow
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA.
| | - Maura George
- Division of General Medicine and Geriatrics, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
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Hodgson LE, Dimitrov BD, Roderick PJ, Venn R, Forni LG. Predicting AKI in emergency admissions: an external validation study of the acute kidney injury prediction score (APS). BMJ Open 2017; 7:e013511. [PMID: 28274964 PMCID: PMC5353262 DOI: 10.1136/bmjopen-2016-013511] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Hospital-acquired acute kidney injury (HA-AKI) is associated with a high risk of mortality. Prediction models or rules may identify those most at risk of HA-AKI. This study externally validated one of the few clinical prediction rules (CPRs) derived in a general medicine cohort using clinical information and data from an acute hospitals electronic system on admission: the acute kidney injury prediction score (APS). DESIGN, SETTING AND PARTICIPANTS External validation in a single UK non-specialist acute hospital (2013-2015, 12 554 episodes); four cohorts: adult medical and general surgical populations, with and without a known preadmission baseline serum creatinine (SCr). METHODS Performance assessed by discrimination using area under the receiver operating characteristic curves (AUCROC) and calibration. RESULTS HA-AKI incidence within 7 days (kidney disease: improving global outcomes (KDIGO) change in SCr) was 8.1% (n=409) of medical patients with known baseline SCr, 6.6% (n=141) in those without a baseline, 4.9% (n=204) in surgical patients with baseline and 4% (n=49) in those without. Across the four cohorts AUCROC were: medical with known baseline 0.65 (95% CIs 0.62 to 0.67) and no baseline 0.71 (0.67 to 0.75), surgical with baseline 0.66 (0.62 to 0.70) and no baseline 0.68 (0.58 to 0.75). For calibration, in medicine and surgical cohorts with baseline SCr, Hosmer-Lemeshow p values were non-significant, suggesting acceptable calibration. In the medical cohort, at a cut-off of five points on the APS to predict HA-AKI, positive predictive value was 16% (13-18%) and negative predictive value 94% (93-94%). Of medical patients with HA-AKI, those with an APS ≥5 had a significantly increased risk of death (28% vs 18%, OR 1.8 (95% CI 1.1 to 2.9), p=0.015). CONCLUSIONS On external validation the APS on admission shows moderate discrimination and acceptable calibration to predict HA-AKI and may be useful as a severity marker when HA-AKI occurs. Harnessing linked data from primary care may be one way to achieve more accurate risk prediction.
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Affiliation(s)
- L E Hodgson
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
- Anaesthetics Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - B D Dimitrov
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - P J Roderick
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, UK
| | - R Venn
- Anaesthetics Department, Western Sussex Hospitals NHS Foundation Trust, Worthing, UK
| | - L G Forni
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Wilson DM, Low G. Lifelong Health and Health Services Use: A New Focus for Gerontological Nursing Research and Practice. J Gerontol Nurs 2017; 43:28-32. [PMID: 27598266 DOI: 10.3928/00989134-20160727-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 06/29/2016] [Indexed: 11/20/2022]
Abstract
It is commonly believed that older adults are often ill and therefore high users of health services. A pilot study involving adults 60 and older living in the Canadian province of Alberta was conducted to (a) raise interest in the concepts of lifelong health and health services use; (b) develop a lifelong health data collection tool; (c) obtain information about lifelong and recent health services use, and self-perceived lifelong and current health; and (d) reveal links (if any) between perceived health and lifelong health services use. A questionnaire was developed, pilot tested, and posted for completion by 100 volunteers. Most older adults reported good or very good current and lifelong health. Comorbidities and low finances were associated with higher health services use. These findings suggest community-dwelling older adults may be healthy currently and throughout their lives. Gerontological nursing research, practice, and advocacy are needed because myths about aging must be addressed to refocus attention on the importance of lifelong health promotion for older adults. [Journal of Gerontological Nursing, 43(2), 28-32.].
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High-Cost Patients: Hot-Spotters Don't Explain the Half of It. J Gen Intern Med 2017; 32:28-34. [PMID: 27480529 PMCID: PMC5215147 DOI: 10.1007/s11606-016-3790-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 05/17/2016] [Accepted: 06/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Understanding resource utilization patterns among high-cost patients may inform cost reduction strategies. OBJECTIVE To identify patterns of high-cost healthcare utilization and associated clinical diagnoses and to quantify the significance of hot-spotters among high-cost users. DESIGN Retrospective analysis of high-cost patients in 2012 using data from electronic medical records, internal cost accounting, and the Centers for Medicare and Medicaid Services. K-medoids cluster analysis was performed on utilization measures of the highest-cost decile of patients. Clusters were compared using clinical diagnoses. We defined "hot-spotters" as those in the highest-cost decile with ≥4 hospitalizations or ED visits during the study period. PARTICIPANTS AND EXPOSURE A total of 14,855 Medicare Fee-for-service beneficiaries identified by the Medicare Quality Resource and Use Report as having received 100 % of inpatient care and ≥90 % of primary care services at Cleveland Clinic Health System (CCHS) in Northeast Ohio. The highest-cost decile was selected from this population. MAIN MEASURES Healthcare utilization and diagnoses. KEY RESULTS The highest-cost decile of patients (n = 1486) accounted for 60 % of total costs. We identified five patient clusters: "Ambulatory," with 0 admissions; "Surgical," with a median of 2 surgeries; "Critically Ill," with a median of 4 ICU days; "Frequent Care," with a median of 2 admissions, 3 ED visits, and 29 outpatient visits; and "Mixed Utilization," with 1 median admission and 1 ED visit. Cancer diagnoses were prevalent in the Ambulatory group, care complications in the Surgical group, cardiac diseases in the Critically Ill group, and psychiatric disorders in the Frequent Care group. Most hot-spotters (55 %) were in the "frequent care" cluster. Overall, hot-spotters represented 9 % of the high-cost population and accounted for 19 % of their overall costs. CONCLUSIONS High-cost patients are heterogeneous; most are not so-called "hot-spotters" with frequent admissions. Effective interventions to reduce costs will require a more multi-faceted approach to the high-cost population.
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Low LL, Liu N, Wang S, Thumboo J, Ong MEH, Lee KH. Predicting frequent hospital admission risk in Singapore: a retrospective cohort study to investigate the impact of comorbidities, acute illness burden and social determinants of health. BMJ Open 2016; 6:e012705. [PMID: 27742630 PMCID: PMC5073633 DOI: 10.1136/bmjopen-2016-012705] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the impact of comorbidities, acute illness burden and social determinants of health on predicting the risk of frequent hospital admissions. DESIGN Multivariable logistic regression was used to associate the predictive variables extracted from electronic health records and frequent hospital admission risk. The model's performance of our predictive model was evaluated using a 10-fold cross-validation. SETTING A single tertiary hospital in Singapore. PARTICIPANTS All adult patients admitted to the hospital between 1 January 2013 and 31 May 2014 (n=25 244). MAIN OUTCOME MEASURE Frequent hospital admissions, defined as 3 or more inpatient admissions within 12 months of discharge. Area under the receiver operating characteristic curve (AUC) of the predictive model, and the sensitivity, specificity and positive predictive values for various cut-offs. RESULTS 4322 patients (17.1%) met the primary outcome. 11 variables were observed as significant predictors and included in the final regression model. The strongest independent predictor was treatment with antidepressants in the past 1 year (adjusted OR 2.51, 95% CI 2.26 to 2.78). Other notable predictors include requiring dialysis and treatment with intravenous furosemide during the index admission. The predictive model achieved an AUC of 0.84 (95% CI 0.83 to 0.85) for predicting frequent hospital admission risk, with a sensitivity of 73.9% (95% CI 72.6% to 75.2%), specificity of 79.1% (78.5% to 79.6%) and positive predictive value of 42.2% (95% CI 41.1% to 43.3%) at the cut-off of 0.235. CONCLUSIONS We have identified several predictors for assessing the risk of frequent hospital admissions that achieved high discriminative model performance. Further research is necessary using an external validation cohort.
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Affiliation(s)
- Lian Leng Low
- Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Singapore
- Family Medicine Program, Duke-NUS Medical School, Singapore, Singapore
| | - Nan Liu
- Singapore Health Services, Health Services Research Centre, Singapore, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Sijia Wang
- Integrated Health Information Systems, Singapore, Singapore
| | - Julian Thumboo
- Singapore Health Services, Health Services Research Centre, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Kheng Hock Lee
- Department of Family Medicine & Continuing Care, Singapore General Hospital, Singapore, Singapore
- Family Medicine Program, Duke-NUS Medical School, Singapore, Singapore
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Lichtl C, Gewalt SC, Noest S, Szecsenyi J, Bozorgmehr K. Potentially avoidable and ambulatory care sensitive hospitalisations among forced migrants: a protocol for a systematic review and meta-analysis. BMJ Open 2016; 6:e012216. [PMID: 27660319 PMCID: PMC5051512 DOI: 10.1136/bmjopen-2016-012216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION There is an increasing number of forced migrants globally, including refugees, asylum seekers, internally displaced persons and undocumented migrants. According to international law, forced migrants should enjoy access to health services free of discrimination equivalent to the host population, but they face barriers to healthcare worldwide. This may lead to a delay in care and result in preventable hospital treatment, referred to as potentially preventable hospitalisation (PPH) or ambulatory care sensitive hospitalisation (ACSH). There is as yet no overview of the prevalence of PPH in different countries and groups of forced migrants, and it is unknown whether the concept has been used among these migrant groups. We aim to systematically review the evidence (1) on the prevalence of PPH among forced migrants and (2) on differences in the prevalence of PPH between forced migrants and the general host population. METHODS AND ANALYSIS A systematic review will be conducted searching databases (PubMed/MEDLINE, Web of Science/Knowledge, Cochrane Library, CINAHL, Google Scholar) and the internet (Google). INCLUSION CRITERIA observational studies on forced migrants reporting PPH or ACSH with or without comparison groups published in the English or German language. EXCLUSION CRITERIA studies on general migrant groups or hospitalisations without clear reference to avoidability. STUDY SELECTION titles, abstracts and full texts will be screened in duplicate for eligibility. Data on the prevalence of PPH/ACSH among forced migrants, as well as any reported prevalence differences between host populations, will be systematically extracted. Quality appraisal will be performed using standardised checklists. The evidence will be synthesised in tabular form and by means of forest plots. A meta-analysis will be performed only among homogeneous studies (in terms of design and population). ETHICS AND DISSEMINATION Ethical clearance is not necessary (secondary research). The results will be disseminated via publication in open access journals, conferences and public media. PROSPERO REGISTRATION NUMBER CRD42016037081.
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Affiliation(s)
- Célina Lichtl
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Sandra Claudia Gewalt
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Noest
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Kayvan Bozorgmehr
- Department of General Practice & Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Low LL, Tay WY, Ng MJM, Tan SY, Liu N, Lee KH. Frequent hospital admissions in Singapore: clinical risk factors and impact of socioeconomic status. Singapore Med J 2016; 59:39-43. [PMID: 27311740 DOI: 10.11622/smedj.2016110] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Frequent admitters to hospitals are high-cost patients who strain finite healthcare resources. However, the exact risk factors for frequent admissions, which can be used to guide risk stratification and design effective interventions locally, remain unknown. Our study aimed to identify the clinical and sociodemographic risk factors associated with frequent hospital admissions in Singapore. METHODS An observational study was conducted using retrospective 2014 data from the administrative database at Singapore General Hospital, Singapore. Variables were identified a priori and included patient demographics, comorbidities, prior healthcare utilisation, and clinical and laboratory variables during the index admission. Multivariate logistic regression analysis was used to identify independent risk factors for frequent admissions. RESULTS A total of 16,306 unique patients were analysed and 1,640 (10.1%) patients were classified as frequent admitters. On multivariate logistic regression, 16 variables were independently associated with frequent hospital admissions, including age, cerebrovascular disease, history of malignancy, haemoglobin, serum creatinine, serum albumin, and number of specialist outpatient clinic visits, emergency department visits, admissions preceding index admission and medications dispensed at discharge. Patients staying in public rental housing had a 30% higher risk of being a frequent admitter after adjusting for demographics and clinical conditions. CONCLUSION Our study, the first in our knowledge to examine the clinical risk factors for frequent admissions in Singapore, validated the use of public rental housing as a sensitive indicator of area-level socioeconomic status in Singapore. These risk factors can be used to identify high-risk patients in the hospital so that they can receive interventions that reduce readmission risk.
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Affiliation(s)
- Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.,Family Medicine Clerkship, Duke-NUS Medical School, Singapore
| | - Wei Yi Tay
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.,Family Medicine Clerkship, Duke-NUS Medical School, Singapore
| | - Matthew Joo Ming Ng
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.,Family Medicine Clerkship, Duke-NUS Medical School, Singapore
| | - Shu Yun Tan
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.,Family Medicine Clerkship, Duke-NUS Medical School, Singapore
| | - Nan Liu
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Kheng Hock Lee
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore.,Family Medicine Clerkship, Duke-NUS Medical School, Singapore
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Establishing a pragmatic framework to optimise health outcomes in heart failure and multimorbidity (ARISE-HF): A multidisciplinary position statement. Int J Cardiol 2016; 212:1-10. [PMID: 27015641 PMCID: PMC5646657 DOI: 10.1016/j.ijcard.2016.03.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/07/2016] [Indexed: 12/31/2022]
Abstract
Background Multimorbidity in heart failure (HF), defined as HF of any aetiology and multiple concurrent conditions that require active management, represents an emerging problem within the ageing HF patient population worldwide. Methods To inform this position paper, we performed: 1) an initial review of the literature identifying the ten most common conditions, other than hypertension and ischaemic heart disease, complicating the management of HF (anaemia, arrhythmias, cognitive dysfunction, depression, diabetes, musculoskeletal disorders, renal dysfunction, respiratory disease, sleep disorders and thyroid disease) and then 2) a review of the published literature describing the association between HF with each of the ten conditions. From these data we describe a clinical framework, comprising five key steps, to potentially improve historically poor health outcomes in this patient population. Results We identified five key steps (ARISE-HF) that could potentially improve clinical outcomes if applied in a systematic manner: 1) Acknowledge multimorbidity as a clinical syndrome that is associated with poor health outcomes, 2) Routinely profile (using a standardised protocol — adapted to the local health care system) all patients hospitalised with HF to determine the extent of concurrent multimorbidity, 3) Identify individualised priorities and person-centred goals based on the extent and nature of multimorbidity, 4) Support individualised, home-based, multidisciplinary, case management to supplement standard HF management, and 5) Evaluate health outcomes well beyond acute hospitalisation and encompass all-cause events and a person-centred perspective in affected individuals. Conclusions We propose ARISE-HF as a framework for improving typically poor health outcomes in those affected by multimorbidity in HF.
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Abstract
OBJECTIVE The objectives were to synthesize cumulative findings across three critical ethnographic, community-partnered studies in the southwestern United States and to describe the process of meta-ethnography for that analysis. DESIGN AND SAMPLE The meta-ethnography followed the design of Noblit and Hare for constructing an analysis of composite data, informed by community-based participatory research and Stringer's ethnographic strategies of Look-Think-Act. The three studies occurred in rural settings of Colorado and New Mexico, engaging 129 total participants, along with community organizations and agencies as partners. METHODS Methods consisted of detailed review of each original study, mapping of major concepts and themes, and general analysis, interpretation, and synthesis across the studies. RESULTS Overall themes were: health is the capacity to care for oneself and do work, meaningful relationships are key in health care interactions, patterns of discrimination persist in rural settings, poor literacy and health literacy are barriers, and food insecurity is a growing concern for older rural adults. CONCLUSIONS Resolutions involve practice, policy, and research and must incorporate all stakeholder groups in rural settings; a participatory approach is critical to prioritize and impact existing inequities; and work is needed to extend education and understanding of multiple cultures, groups, customs, and rural contexts.
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Matesanz-Fernández M, Monte-Secades R, Íñiguez-Vázquez I, Rubal-Bran D, Guerrero-Sande H, Casariego-Vales E. Characteristics and temporal pattern of the readmissions of patients with multiple hospital admissions in the medical departments of a general hospital. Eur J Intern Med 2015; 26:776-81. [PMID: 26604106 DOI: 10.1016/j.ejim.2015.09.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 09/22/2015] [Accepted: 09/28/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients with multiple hospital admissions represent a small percentage of total hospitalizations but result in a considerable proportion of the healthcare expenditure. There are no studies that have analyzed their long-term clinical evolution. OBJECTIVES To study the characteristics, temporal patterns of readmissions and clinical evolution of patients with multiple hospital admission in the long term. METHODS A retrospective study was conducted of all hospital admissions in the medical area of the Hospital of Lugo (Spain) between January 1, 2000 and December 31, 2012, based on data from the center's minimum basic data set. RESULTS A total of 139,249 hospital admissions for 62,515 patients were studied. Six hospital admissions were recorded for 6.4% of the patients. The overall mortality rate was 16% (9982 patients). The readmissions rate steadily increased with each new admission, from 48% after the first event to 74.6% after the fifth. The rate of hospital readmission before 30days increased from 18.3% in the second admission to 36.3% in the sixth. The number of chronic diseases increased from 3.1 (SD, 2) in the first hospital admission up to 4.9 (2.8) in the sixth. The Department of Internal Medicine treated a third of all hospital admissions. In the sixth hospitalization, conditions associated with admission in Internal Medicine were CIRS score, age, heart failure, COPD, dementia, diabetes, atrial fibrillation and anemia. CONCLUSIONS Patients with multiple hospital admissions are complex patients whose temporal pattern of readmissions changes with time, such that each hospital admission constitutes a factor facilitating the next.
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Affiliation(s)
- María Matesanz-Fernández
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
| | - Rafael Monte-Secades
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
| | - Iria Íñiguez-Vázquez
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
| | - Davis Rubal-Bran
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
| | - Héctor Guerrero-Sande
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
| | - Emilio Casariego-Vales
- Department of Internal Medicine, Lucus Augusti University Hospital, Ulises Romero 1, 27003 Lugo, Spain.
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Passey ME, Longman JM, Johnston JJ, Jorm L, Ewald D, Morgan GG, Rolfe M, Chalker B. Diagnosing Potentially Preventable Hospitalisations (DaPPHne): protocol for a mixed-methods data-linkage study. BMJ Open 2015; 5:e009879. [PMID: 26597867 PMCID: PMC4663419 DOI: 10.1136/bmjopen-2015-009879] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Rates of potentially preventable hospitalisations (PPH) are used as a proxy measure of effectiveness of, or access to community-based health services. The validity of PPH as an indicator in Australia has not been confirmed. Available evidence suggests that patient-related, clinician-related and systems-related factors are associated with PPH, with differences between rural and metropolitan settings. Furthermore, the proportion of PPHs which are actually preventable is unknown. The Diagnosing Potentially Preventable Hospitalisations study will determine the proportion of PPHs for chronic conditions that are deemed preventable and identify potentially modifiable factors driving these, in order to develop effective interventions to reduce admissions and improve measures of health system performance. METHODS AND ANALYSIS This mixed methods data linkage study of approximately 1000 eligible patients with chronic PPH admissions to one metropolitan and two regional hospitals over 12 months will combine data from multiple sources to assess the: extent of preventability of chronic PPH admissions; validity of the Preventability Assessment Tool (PAT) in identifying preventable admissions; factors contributing to chronic PPH admissions. Data collected from patients (quantitative and qualitative methods), their general practitioners, hospital clinicians and hospital records, will be linked with routinely collected New South Wales (NSW) Admitted Patient Data Collection, the NSW Registry of Births, Death and Marriages death registration and Australian Bureau of Statistics mortality data. The validity of the PAT will be assessed by determining concordance between clinician assessment and that of a 'gold standard' panel. Multivariable logistic regression will identify the main predictor variables of admissions deemed preventable, using study-specific and linked data. ETHICS AND DISSEMINATION The NSW Population and Health Services Research Ethics Committee granted ethical approval. Dissemination mechanisms include engagement of policy stakeholders through a project Steering Committee, and the production of summary reports for policy and clinical audiences in addition to peer-review papers.
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Affiliation(s)
- Megan E Passey
- University Centre for Rural Health-North Coast, University of Sydney, Lismore, New South Wales, Australia
| | - Jo M Longman
- University Centre for Rural Health-North Coast, University of Sydney, Lismore, New South Wales, Australia
| | - Jennifer J Johnston
- University Centre for Rural Health-North Coast, University of Sydney, Lismore, New South Wales, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Dan Ewald
- North Coast Primary Health Network, Ballina, New South Wales, Australia
| | - Geoff G Morgan
- University Centre for Rural Health-North Coast, University of Sydney, Lismore, New South Wales, Australia
| | - Margaret Rolfe
- University Centre for Rural Health-North Coast, University of Sydney, Lismore, New South Wales, Australia
| | - Bronwyn Chalker
- Mid North Coast Local Health District, South West Rocks, New South Wales, Australia
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Longman JM, Passey ME, Ewald DP, Rix E, Morgan GG. Admissions for chronic ambulatory care sensitive conditions - a useful measure of potentially preventable admission? BMC Health Serv Res 2015; 15:472. [PMID: 26475293 PMCID: PMC4608278 DOI: 10.1186/s12913-015-1137-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 10/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Potentially preventable hospital admission (an admission deemed to be potentially preventable given appropriate care in the community-based healthcare setting) has been a topic of international research attention for almost three decades. Recently this has been largely driven by the imperative to reduce ever-increasing unplanned hospital admissions. However, identifying potentially preventable admissions is difficult. As a result, the population level indicator of admissions for ambulatory care sensitive conditions (ACSCs) has been used as a proxy measure for potentially preventable admission. The adoption of this measure has become common, and in Australia, the rate of admissions for chronic ACSCs is now an important component of measuring health system performance and accountability, and is directly linked to funding. Admission for a chronic ACSC is also used to identify individuals for targeting of interventions to reduce preventable admissions. DISCUSSION Hospital admission for chronic ACSCs is a population measure based on admission diagnoses, it therefore should not be used to identify individual preventable admissions. At present we are unable to determine individual admissions that are deemed to be preventable or, therefore, articulate the factors associated with admissions which are preventable. As we are currently unable to identify individual admissions that are preventable, little is understood about the underlying causes and factors contributing to preventable admissions. A means of assessing preventability of individual admissions is required. Only then can we explore the antecedents, and patient and clinician perspectives on preventable admissions. Until we have a clearer understanding of this, our capacity to inform policy and program development remains compromised.
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Affiliation(s)
- Jo M Longman
- University Centre for Rural Health - North Coast, University of Sydney, PO Box 3074, Lismore, NSW, 2480, Australia.
| | - Megan E Passey
- University Centre for Rural Health - North Coast, University of Sydney, PO Box 3074, Lismore, NSW, 2480, Australia.
| | - Dan P Ewald
- North Coast Primary Health Network, Lismore, 2480, Australia.
| | - Elizabeth Rix
- University Centre for Rural Health - North Coast, University of Sydney, PO Box 3074, Lismore, NSW, 2480, Australia.
| | - Geoffrey G Morgan
- University Centre for Rural Health - North Coast, University of Sydney, PO Box 3074, Lismore, NSW, 2480, Australia.
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