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Björkstedt E, Voutilainen A, Auvinen K, Hyttinen V, Jyrkkä J, Mäntyselkä P, Lönnroos E. The role of functioning in predicting nursing home placement or death among older home care patients. Scand J Prim Health Care 2023; 41:478-485. [PMID: 37916677 PMCID: PMC11001308 DOI: 10.1080/02813432.2023.2274333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
OBJECTIVE There have been few studies predicting institutionalization or death in home care settings. We examined risk factors for nursing home placement (NHP) and death among home care patients. DESIGN A prospective one-year follow-up study. SETTINGS AND SUBJECTS Persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293). MAIN OUTCOME MEASURES Risk factors for NHP or death were investigated using Cox proportional hazards model. Explanatory variables included demographics, health status (Charlson Comorbidity Index, CCI), physical (Timed Up and Go, TUG), and cognitive (Mini-Mental State Examination, MMSE) functioning, Basic and Instrumental Activities of Daily Living (BADL, IADL) and mood (Geriatric Depression Scale, GDS-15). RESULTS Of the 293 patients (mean age 82.6 years, 70.6% women), 27 (9.2%) moved to a nursing home and 25 (6.9%) died during the follow-up (mean 350 days). The combined outcome of NHP or death was predicted by BADL (HR 0.73, CI 95% 0.62-0.86), IADL (0.75, 0.65-0.87) MMSE (0.92, 0.87-0.96), and TUG (1.02, 1.01-1.03). NHP alone was predicted by BADL (0.62, 0.50-0.78), IADL (0.57, 0.45-0.73), and MMSE (0.88, 0.82-0.94) and mortality by TUG (1.02, 1.01-1.03). CONCLUSION Basic measures of functioning can be used to identify high-risk patients in home care. Decreasing BADL, IADL and MMSE predict NHP and longer TUG-times death within a year.
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Affiliation(s)
- Eeva Björkstedt
- Department of Primary Health Care, Wellbeing Services County of South Savo, Mikkeli, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Kati Auvinen
- Department of Primary Health Care, Wellbeing Services County of South Savo, Mikkeli, Finland
| | - Virva Hyttinen
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Johanna Jyrkkä
- Information and Development Services Unit, Finnish Medicines Agency FIMEA, Kuopio, Finland
| | - Pekka Mäntyselkä
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Clinical Research and Trials Centre, Kuopio University Hospital, Wellbeing Services County of North Savo, Kuopio, Finland
| | - Eija Lönnroos
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
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2
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Lai YC, Tsai KT, Ho CH, Liao JY, Tseng WZ, Petersen I, Wang YC, Chen YH, Chiou HY, Hsiung CA, Yu SJ, Sampson EL, Chen PJ. Mortality rate and its determinants among people with dementia receiving home healthcare: a nationwide cohort study. Intern Emerg Med 2023; 18:2121-2130. [PMID: 37253992 DOI: 10.1007/s11739-023-03319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
People with dementia (PwD) who receive home healthcare (HHC) may have distressing symptoms, complex care needs and high mortality rates. However, there are few studies investigating the determinants of mortality in HHC recipients. To identify end-of-life care needs and tailor individualized care goals, we aim to explore the mortality rate and its determinants among PwD receiving HHC. We conducted a retrospective cohort study using a Taiwanese national population database. People with new dementia diagnosis in 2007-2016 who received HHC were included. We calculated the accumulative mortality rate and applied Poisson regression model to estimate the risk of mortality for each variable (adjusted risk ratios, aRR) with a 95% confidence interval (CI). We included 95,831 PwD and 57,036 (59.5%) of them died during the follow-up period (30.5% died in the first-year). Among comorbidities, cirrhosis was associated with the highest mortality risks (aRR 1.65, 95% CI 1.49-1.83). Among HHC-related factors, higher visit frequency of HHC (> 2 versus ≦1 times/month, aRR 3.52, 95% CI 3.39-3.66) and higher level of resource utilization group (RUG, RUG 4 versus 1, aRR = 1.38, 95% CI 1.25-1.51) were risk factor of mortality risk. Meanwhile, HHC provided by physician and nurse was related to reduced mortality risk (aRR 0.79, 95% CI 0.77-0.81) compared to those provided by nurse only. Anticipatory care planning and timely end-of life care should be integrated in light of the high mortality rate among PwD receiving HHC. Determinants associated with increased mortality risk facilitate the identification of high risk group and tailoring the appropriate care goals. Trial registration number: ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020.
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Affiliation(s)
- Yi-Chen Lai
- Department of Emergency Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Kang-Ting Tsai
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jung-Yu Liao
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Wei-Zhe Tseng
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Irene Petersen
- Department of Primary Care and Population Sciences, UCL, University College London, London, UK
| | - Yi-Chi Wang
- Department of Family Medicine, Far Eastern Memorial Hospital, New Taipei, Taiwan
| | - Yu-Han Chen
- Department of Family Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Hung-Yi Chiou
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chao Agnes Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Sang-Ju Yu
- Taiwan Society of Home Health Care, Taipei, Taiwan
- Home Clinic Dulan, Taitung, Taiwan
| | - Elizabeth Lesley Sampson
- Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Ping-Jen Chen
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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3
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Li CM, Yang KC, Lee YH, Chen YH, Lin IW, Huang KC. One-Year Medical Utilization and Mortality in Home Health and Nursing Home Care Recipients from Northern Taiwan. J Am Med Dir Assoc 2023; 24:991-996. [PMID: 37268015 DOI: 10.1016/j.jamda.2023.04.028] [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: 01/04/2023] [Revised: 04/25/2023] [Accepted: 04/25/2023] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Home health care (HHC) and nursing home care (NHC) are mainstays of long-term service in the aged population. Therefore, we aimed to investigate the factors associated with 1-year medical utilization and mortality in HHC and NHC recipients in Northern Taiwan. DESIGN This study employed a prospective cohort design. SETTING AND PARTICIPANTS We enrolled 815 HHC and NHC participants who started receiving medical care services from the National Taiwan University Hospital, Beihu Branch between January 2015 and December 2017. METHODS Multivariate Poisson regression modeling was used to quantify the relationship between care model (HHC vs NHC) and medical utilization. Cox proportional-hazards modeling was used to estimate hazard ratios and factors associated with mortality. RESULTS Compared with NHC recipients, HHC recipients had higher 1-year utilization of emergency department services [incidence rate ratio (IRR) 2.04, 95% CI 1.16-3.59] and hospital admissions (IRR 1.49, 95% CI 1.14-1.93), as well as longer total hospital length of stay (LOS) (IRR 1.61, 95% CI 1.52-1.71) and LOS per hospital admission (IRR 1.31, 95% CI 1.22-1.41). Living at home or in a nursing home did not affect the 1-year mortality. CONCLUSIONS AND IMPLICATIONS Compared with NHC recipients, HHC recipients had a higher number of emergency department services and hospital admissions, as well as longer hospital LOS. Policies should be developed to reduce emergency department and hospitalization utilization in HHC recipients.
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Affiliation(s)
- Chia-Ming Li
- Department of Family Medicine, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuen-Cheh Yang
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Hsuan Lee
- Department of Family Medicine, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsin Chen
- Community and Geriatric Medicine Research Center, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan
| | - I-Wen Lin
- Department of Family Medicine, National Taiwan University Hospital, Beihu Branch, Taipei, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Community and Geriatric Medicine Research Center, National Taiwan University Hospital Beihu Branch, Taipei, Taiwan; Department of Family Medicine, National Taiwan University Hospital, Hsinchu Branch, Hsinchu, Taiwan.
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Vera Salmerón E, Mota Romero E, Domínguez Nogueira C, Rutherford C, Tudela Vázquez MP. [Spanish translation and cross-cultural adaptation of the Pressure Ulcer Quality of Life Questionnaire (PU-QOL).]. Rev Esp Salud Publica 2023; 97:e202304032. [PMID: 37114484 PMCID: PMC10540906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 03/17/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE Pressure ulcers (PU) are the most prevalent of the dependency-related injuries, affecting the quality of life of the patients who suffer them. However, there are no instruments adapted to the Spanish context to evaluate this quality of life. The use of specific tools in Spanish to evaluate the quality of life perceived by patients with PUs is considered an indispensable element for healthcare decisions. The aim of this paper was to translate and culturally adapt the Pressure Ulcer Quality of Life Questionnaire (PU-QOL) into Spanish for the measurement of health-related quality of life in patients with pressure ulcers. METHODS A translation, back-translation, and pre-test method was used on the target population to obtain an adapted version of the original PU-QOL instrument. The area was Primary Care. The participants were fifteen Primary Care patients. Main steps: 1) Direct translation; 2) Synthesis and concordance of versions by an expert committee; 3) Back translation; 4) Consistency of the back translation with the author from the original questionnaire; and 5) Analysis of comprehensibility through cognitive interviews with a sample of patients. RESULTS An instrument to measure perceived quality of life in patients with PU was obtained, composed of ten scales and eighty-three items. The scales and items of the original questionnaire were maintained. Conceptual and semantic analysis produced adjustments in wording, clarification and reformulations adapted to the Spanish context. CONCLUSIONS We present this first phase of translation and cross-cultural adaptation of the PU-QOL questionnaire in Spanish, which could be a useful tool for decision-making on health care in patients with PUs.
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Affiliation(s)
- Eugenio Vera Salmerón
- Centro de Salud Salvador Caballero, Distrito Sanitario Granada-Metropolitano, Servicio Andaluz de Salud. Servicio Andaluz de SaludGranadaSpain
- Instituto de Investigación Biosanitaria (ibs.GRANADA).Instituto de Investigación Biosanitaria (ibs.GRANADA).GranadaSpain
| | - Emilio Mota Romero
- Centro de Salud Salvador Caballero, Distrito Sanitario Granada-Metropolitano, Servicio Andaluz de Salud. Servicio Andaluz de SaludGranadaSpain
- Instituto de Investigación Biosanitaria (ibs.GRANADA).Instituto de Investigación Biosanitaria (ibs.GRANADA).GranadaSpain
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada.Universidad de GranadaGranadaSpain
| | - Carmen Domínguez Nogueira
- Consejería de Salud y Familias, Delegación Territorial de Granada, Inspección Provincial de Servicios Sanitarios.Inspección Provincial de Servicios SanitariosGranadaSpain
| | - Claudia Rutherford
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Care Research Unit (CCRU), The University of Sydney.The University of SydneySidneyAustralia
- Faculty of Science, School of Psychology, Sydney Quality of Life Office, The University of Sydney.The University of SydneySidneyAustralia
| | - María Pilar Tudela Vázquez
- Departamento de Trabajo Social y Servicios Sociales, Facultad de Trabajo Social, Universidad de Granada.Universidad de GranadaGranadaSpain
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5
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Alkeridy WA, Aljasser A, Alayed KM, Alsaad SM, Alqahtani AS, Lim CA, Alamri SH, Mekkawy DZ, Al-Sofiani M. Predictors of Mortality in Home Health Care Service: Data from Saudi Arabia. J Multidiscip Healthc 2022; 15:1997-2005. [PMID: 36101552 PMCID: PMC9464450 DOI: 10.2147/jmdh.s379782] [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: 07/04/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to 1) report the prevalence of chronic conditions among Saudi people receiving long-term home health care (HHC) services, 2) identify the predictors of mortality among individuals receiving long-term HHC services, and 3) study the association between frailty and poor health outcomes among HHC users. Design Retrospective cross-sectional descriptive study. Setting and Participants A total of 555 participants were recruited from HHC services at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. We collected the data from electronic health records (EHR), patient charts, and caregiver interviews for 555 participants included in HHC program from the year 2019 to 2022. Methods Only individuals fulfilling the HHC program’s eligibility criteria were included to the study. A total of 555 participants were included in the analysis. We assessed the functional performance by the Katz activity of daily living and Bristol Activity of Daily Living Scale (BADLS). A trained health care provider assessed frailty using the Clinical Frailty Scale (CFS). We calculated the means and frequency to describe the prevalence of chronic conditions and variables of interest. A Chi-square test or independent-samples t-test was run to determine if there were differences between the alive and deceased individuals. A binary logistic regression model was performed to predict mortality of HHC service recipients. Results The mean age for deceased individuals in HHC was 78.3 years. Over twenty percent of individuals receiving HHC services were readmitted to the hospital. We found that the strongest predictors for mortality were pressure ulcers with an odds ratio of 3.75 and p-value of <0.0001, and the Clinical Frailty Scale, which had an odds ratio of 1.69 and p-value of 0.002, using multivariate regression analysis. Conclusions and Implications In conclusion, our study found that pressure ulcers and frailty are the strongest predictors of mortality for individuals receiving home health care services.
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Affiliation(s)
- Walid A Alkeridy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Medicine, Geriatric Division, University of British Columbia, Vancouver, Canada.,General Administration of Home Health Care, Therapeutic Affairs Deputyship, Riyadh, Saudi Arabia
| | - Arwa Aljasser
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | | | - Saad M Alsaad
- Department of Family & Community medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amani S Alqahtani
- Research department, Saudi Food and Drug Authority, Riyadh, Saudi Arabia
| | - Claire Ann Lim
- Department of Medical Rehabilitation, King Saud Medical City, Riyadh, Saudi Arabia
| | - Sultan H Alamri
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Saudi Geriatrics Society, Riyadh, Saudi Arabia
| | - Doaa Zainhom Mekkawy
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Al-Sofiani
- Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University, Baltimore, MD, USA
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6
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Gaspar S, Peralta M, Budri A, Ferreira C, Gaspar de Matos M. Pressure ulcer risk profiles of hospitalized patients based on the Braden Scale: A cluster analysis. Int J Nurs Pract 2022; 28:e13038. [DOI: 10.1111/ijn.13038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 11/19/2021] [Accepted: 01/02/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Susana Gaspar
- Faculty of Human Kinetics, Aventura Social University of Lisbon Lisbon Portugal
- Faculty of Medicine, Environmental Health Institute (ISAMB) University of Lisbon Lisbon Portugal
| | - Miguel Peralta
- Faculty of Human Kinetics, Aventura Social University of Lisbon Lisbon Portugal
- Faculty of Medicine, Environmental Health Institute (ISAMB) University of Lisbon Lisbon Portugal
- Faculty of Human Kinetics, Interdisciplinary Center for the Study of Human Performance (CIPER) University of Lisbon Lisbon Portugal
| | - Aglécia Budri
- School of Nursing and Midwifery Royal College of Surgeon in Ireland Dublin Ireland
- Skin Wounds and Trauma (SWaT) Research Centre Royal College of Surgeon in Ireland Dublin Ireland
| | - Carlos Ferreira
- Faculty of Human Kinetics, Aventura Social University of Lisbon Lisbon Portugal
- Institute of Education, UIDEF University of Lisbon Lisbon Portugal
| | - Margarida Gaspar de Matos
- Faculty of Human Kinetics, Aventura Social University of Lisbon Lisbon Portugal
- Faculty of Medicine, Environmental Health Institute (ISAMB) University of Lisbon Lisbon Portugal
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Elkjær M, Wolff DL, Primdahl J, Mogensen CB, Brabrand M, Gram B. Older adults who receive homecare are at increased risk of readmission and mortality following a short ED admission: a nationally register-based cohort study. BMC Geriatr 2021; 21:696. [PMID: 34911477 PMCID: PMC8672634 DOI: 10.1186/s12877-021-02644-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Older adults admitted to an emergency department (ED) who are dependent on homecare may be especially challenged with respect to readmission and mortality. This study aimed to assess whether receiving homecare prior admission was associated with readmission or mortality within 30 days of a short ED admission and to explore whether the amount of homecare received was associated with an increased risk of readmission or mortality. METHODS This nationwide register-based cohort study included patients aged 65 or above who were admitted to an ED at any Danish hospital from 1 December 2016 to 30 November 2017 and discharged within 48 h. Data were extracted from national registers through Statistics Denmark. Homecare was categorized into groups; patients without homecare and three groups according to the amount of homecare received per week. Logistic regression analyses were used to explore the association between the four homecare groups and outcomes, readmissions and mortality. RESULTS In total, 80,517 patients (51% female, median age 75 years) were included in the study. Overall, 64,886 patients without homecare, 15,631 (19%) patients received homecare (64% female, median age 83 years), of which 4938 patients received homecare ≤30 min, 4033 received > 30 min to ≤120 min and 6660 received > 120 min per week. The risk of readmission and mortality increased concurrently with the minutes of homecare received: Patients receiving homecare > 120 min per week had the highest odds ratios (ORs) for readmission within 30 days (OR 1.8 95% CI: 1.7-1.9) and mortality within 30 days (OR 4.5 95% CI: 4.1-4.9) compared with patients without homecare. CONCLUSION Receiving homecare was associated with an increased risk of readmission and death following a short ED admission. Collaboration between the ED and primary health care sector in relation to rehabilitation and end-of-life care is essential to improve quality of care for older adults who receive homecare, particularly those receiving homecare > 2 h a week, because of their increased risk of readmission and mortality.
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Affiliation(s)
- Mette Elkjær
- Department of Emergency Medicine, University hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark. .,Research Unit of Health Sciences, Hospital of South West Jutland, Esbjerg, University hospital of Southern Denmark, Esbjerg, Denmark.
| | - Donna Lykke Wolff
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Internal Medicine, University hospital of Southern Denmark, Aabenraa, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Sygehus Sønderjylland, University hospital of Southern Denmark, Aabenraa, Denmark.,Danish Hospital for Rheumatic Diseases, University hospital of Southern Denmark, Sønderborg, Denmark
| | - Christian Backer Mogensen
- Department of Emergency Medicine, University hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Mikkel Brabrand
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Emergency Medicine, University hospital of Southern Denmark, Esbjerg, Denmark.,Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
| | - Bibi Gram
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Research Unit of Health Sciences, Hospital of South West Jutland, Esbjerg, University hospital of Southern Denmark, Esbjerg, Denmark
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Kaneko M, Watanabe T, Fujinuma Y, Yokobayashi K, Matsushima M. Overall mortality in older people receiving physician-led home visits: a multicentre prospective study in Japan. Fam Pract 2021; 38:395-402. [PMID: 33860307 PMCID: PMC8317214 DOI: 10.1093/fampra/cmaa141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Japan has the most rapidly ageing population in the world. The Japanese government has, therefore, promoted physician-led home health care for frail and disabled people. OBJECTIVES To describe mortality among older people receiving physician-led health care at home or at a nursing home in Japan and to identify risk factors. METHODS This was a multicentre prospective cohort study. Participants were aged ≥65 years and had started to receive regular physician-led health care at home or at nursing homes from 13 facilities between 1 February 2013 and 31 January 2016. The observation period ended on 31 January 2017. We used a biopsychosocial approach for exploratory analysis of 13 variables to identify mortality risk factors. RESULTS The median (25th to 75th percentile) observation time was 417 (121-744) days. Of 825 participants, 380 died. The total cumulative survival for 180, 360, 720 and 1440 days was 73.4% (95% confidence interval: 70.2-76.3), 64.2% (60.8-67.5), 52.6% (48.8-56.3) and 34.6% (23.5-46.0). The Kaplan-Meier cumulative survival curve showed a steep drop during the first 6 months of observation. A multivariate Cox proportional hazard model showed that sex (male), high Charlson Comorbidity Index score, low serum albumin level, low Barthel Index score, receipt of oxygen therapy, high Cornell Scale for Depression in Dementia score and non-receipt of public assistance were associated with mortality. CONCLUSIONS Overall mortality in physician-led home visits in Japan was described and mortality risk factors identified. Public assistance receipt was associated with lower mortality.
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Affiliation(s)
- Makoto Kaneko
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo.,Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo.,Department of Family and Community Medicine, Hamamatsu University School of Medicine, Shizuoka.,Primary Care Research Unit, Graduate School of Health Data Science, Yokohama City University, Yokohama
| | - Takamasa Watanabe
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo.,Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo
| | - Yasuki Fujinuma
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo
| | | | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo
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Liao JY, Chen PJ, Wu YL, Cheng CH, Yu SJ, Huang CH, Li CM, Wang YW, Zhang KP, Liu IT, Umegaki H, Hamano J, Mori M, Petersen I, Sampson EL, Hsiung CA. HOme-based Longitudinal Investigation of the multidiSciplinary Team Integrated Care (HOLISTIC): protocol of a prospective nationwide cohort study. BMC Geriatr 2020; 20:511. [PMID: 33246407 PMCID: PMC7694342 DOI: 10.1186/s12877-020-01920-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/18/2020] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The use of home health care (HHC) is increasing worldwide. This may have an impact not only on patients and their caregivers' health but on care resource utilization and costs. We lack information on the impact of HHC on the broader dimensions of health status and care resource utilization. More understanding of the longitudinal HHC impact on HHC patients and caregivers is also needed. Moreover, we know little about the synergy between HHC and social care. Therefore, the present study aims to observe longitudinal changes in health, care resource utilization and costs and caregiving burden among HHC recipients and their caregivers in Taiwan. METHODS A prospective cohort study "Home-based Longitudinal Investigation of the Multidisciplinary Team Integrated Care (HOLISTIC)" will be conducted and 600 eligible patient-caregiver dyads will be recruited and followed with comprehensive quantitative assessments during six home investigations over two years. The measurements include physical function, psychological health, cognitive function, wellbeing, shared decision making and advance care planning, palliative care and quality of dying, caregiving burden, continuity and coordination of care, care resource utilization, and costs. DISCUSSION The HOLISTIC study offers the opportunity to comprehensively understand longitudinal changes in health conditions, care resource utilization and costs and caregiving burden among HHC patients and caregivers. It will provide new insights for clinical practitioners and policymakers. TRIAL REGISTRATION ClinicalTrials.gov Identifier is NCT04250103 which has been registered on 31st January 2020.
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Affiliation(s)
- Jung-Yu Liao
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
| | - Ping-Jen Chen
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, 807, Taiwan.
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, 807, Taiwan.
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, W1T 7NF, UK.
| | - Yu-Lin Wu
- Department of Nursing, St. Mary's Junior College of Medicine, Nursing and Management, Yilan County, 266, Taiwan
| | - Ching-Hsia Cheng
- Department of Social Welfare, National Chung-Cheng University, Chiayi County, 621, Taiwan
| | - Sang-Ju Yu
- Home Clinic Dulan, Taitung County, 959, Taiwan
| | - Chi-Hsien Huang
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi Prefecture, 466-8550, Japan
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, 824, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, 840, Taiwan
| | - Chia-Ming Li
- Department of Family Medicine, National Taiwan University Hospital, Beihu Branch, Taipei City, 108, Taiwan
| | - Ying-Wei Wang
- Health Promotion Administration, Ministry of Health and Welfare, Taipei City, 103, Taiwan
| | | | - I-Te Liu
- Taiwan Society of Home Health Care, Taipei City, 106, Taiwan
| | - Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi Prefecture, 466-8550, Japan
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan
| | - Masanori Mori
- Palliative Care Team, Seirei Mikatahara General Hospital, Shizuoka, 433-8558, Japan
| | - Irene Petersen
- UCL Department of Primary Care and Population Sciences, University College London, London, NW3 2PF, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, W1T 7NF, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Chao A Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, 350, Taiwan
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10
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Burgos-Díez C, Sequera-Requero RM, Tarazona-Santabalbina FJ, Contel-Segura JC, Monzó-Planella M, Santaeugènia-González SJ. Study protocol of a quasi-experimental trial to compare two models of home care for older people in the primary setting. BMC Geriatr 2020; 20:101. [PMID: 32164542 PMCID: PMC7068968 DOI: 10.1186/s12877-020-1497-0] [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: 01/24/2019] [Accepted: 02/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Preventive home visits are suited for patients with reduced mobility, such as older people. Healthcare needs for older patients are expected to increase due to the extended life expectancy estimated in coming years. The implementation of low-cost, patient-centered methodologies may buffer this rise in health care costs without affecting the quality of service. In order to find the best home care model with less investment, this paper describes a study protocol comparing two models of home care for older people. METHODS We describe a quasi-experimental study that compares the outcome of two different home care models already implemented in two primary care centers in Badalona (Barcelona, Spain). The traditional model (control model) is integrated in the sense that is continuous, the same primary care center team looks after its assigned patients both at the center and in preventive home visits. The new functional home care model (study model), consisting of a highly trained team, is specifically designed to meet patient needs and give total attention to preventive home interventions. The study will start and end on the expected dates, June 2018 to October 2020, and include all patients over 65 years old already enrolled in the home care programs of the primary care centers selected. The primary endpoint assessed will be the difference in hospitalization days between patients included in both home care programs. Other variables regarding health status, quality of care and resource utilization will also be compared between the two models. DISCUSSION The study in progress will assess whether a functional and highly trained home care team will meet the ever-aging population needs in terms of cost and health outcomes better than a traditional, integrated one. Lessons learned from this pilot study will provide guidelines for a future model of home care based on the IHI Triple Aim: better care, better health, and lower costs. TRIAL REGISTRATION Registered in ClinicalTrials.gov (Identifier: NCT03461315; March 12, 2018).
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Affiliation(s)
- Carolina Burgos-Díez
- Department of Surgery and Surgical Specializations, Faculty of Medicine, University of Barcelona (PC 08036), Barcelona, Catalonia Spain
- Primary Care Center Apenins, Badalona Serveis Assistencials, Badalona, Catalonia Spain
| | | | | | | | - Marià Monzó-Planella
- Department of Surgery and Surgical Specializations, Faculty of Medicine, University of Barcelona (PC 08036), Barcelona, Catalonia Spain
| | - Sebastià Josep Santaeugènia-González
- Chronic Care Program, Ministry of Health, Barcelona, Catalonia Spain
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Societal Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), C. Miquel Martí i Pol, 1, 08500 Vic, Spain
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11
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Vera-Salmerón E, Rutherford C, Dominguez-Nogueira C, Tudela-Vázquez MP, Costela-Ruiz VJ, Gómez-Pozo B. Monitoring Immobilized Elderly Patients Using a Public Provider Online System for Pressure Ulcer Information and Registration (SIRUPP): Protocol for a Health Care Impact Study. JMIR Res Protoc 2019; 8:e13701. [PMID: 31407669 PMCID: PMC6709896 DOI: 10.2196/13701] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pressure ulcers represent a major challenge to patient safety in the health care context, presenting high incidence (from 7% to 14% in Spain) and increased financial costs (€400-600 million/year) in medical treatment. Moreover, they are a significant predictor of mortality. The prevention of pressure ulcers in long-term care centers and patients' own homes is proposed as a priority indicator of health care quality. Early stage risk assessment and database recording are both crucial aspects of prevention, classification, diagnosis, and treatment. OBJECTIVE This project proposes a 3-year study of immobilized patients residing in the Granada-Metropolitan Primary Healthcare District (DSGM) and monitored via the Pressure Ulcer Information and Registration System (SIRUPP, Spanish initials). The project aims to estimate the incidence of PUs among immobilized elderly patients, analyze the health-related quality of life of these patients by using the Pressure Ulcer Quality of Life (PU-QoL) instrument in a sample of 250 patients, determine the average time to complete wound healing, estimate the rate of pressure ulcers-associated mortality, and assess the predictive value of the Braden and Mini Nutritional Assessment risk measurement scales in a sample of 1700 patients. METHODS The DSGM runs SIRUPP, which is linked to patients' electronic health records. Currently, 17,104 immobilized patients are monitored under this system. Health-related quality of life will be measured by patient self-reports using the Spanish Pressure Ulcer Quality of Life questionnaire, following cross-cultural adaptation and psychometric validation with respect to the English-language version. RESULTS The project commenced in June 2017 and is expected to conclude in April 2020. CONCLUSIONS This study addresses two main health outcomes-the time needed for wound healing and the mortality associated with pressure ulcers-both of which might be accounted for by variations in clinical practice and the health-related quality of life of patients with pressure ulcers. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13701.
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Affiliation(s)
- Eugenio Vera-Salmerón
- Distrito Sanitario Granada-Metropolitano (Servicio Andaluz de Salud), Armilla, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.,Unidades Asistenciales Churriana de la Vega y Peligros, Granada, Spain
| | - Claudia Rutherford
- Beckett Senior Research Fellow Quality of Life Office, University of Sydney, Sydney, Australia
| | | | - María Pilar Tudela-Vázquez
- Distrito Sanitario Granada-Metropolitano (Servicio Andaluz de Salud), Armilla, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
| | - Victor J Costela-Ruiz
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Granada, Granada, Spain
| | - Basilio Gómez-Pozo
- Distrito Sanitario Granada-Metropolitano (Servicio Andaluz de Salud), Armilla, Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain.,Unidad Interniveles de Prevención Promoción y Vigilancia de la Salud, Granada, Spain
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12
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Peel A, Gutmanis I, Bon T. Disparities in health outcomes among seniors without a family physician in the North West Local Health Integration Network: a retrospective cohort study. CMAJ Open 2019; 7:E94-E100. [PMID: 30782772 PMCID: PMC6380899 DOI: 10.9778/cmajo.20180004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The relationship between having a family physician and in-hospital and postdischarge health outcomes among older adults is unclear. We ascertained the proportion of seniors who did not have a family physician and were admitted to an Ontario tertiary care centre, and we determined the association between having/not having a family physician and in-hospital mortality, 1-year mortality and readmission after live discharge. METHODS This was a retrospective cohort study of community-dwelling seniors who were admitted to a medical service at Thunder Bay Regional Health Sciences Centre. We conducted regression analyses adjusted for demographic factors, prior health care utilization, and factors associated with the index admission to determine the association between family physician status and the study outcomes. RESULTS Among the 12 033 seniors admitted to hospital between Apr. 1, 2004, and Mar. 31, 2013, 40.7% lacked a family physician. Among those without a family physician, 8.0% (390/4899) died during the index admission and 15.8% (714/4509) died in the subsequent year. Adjusted regression models showed that not having a family physician was significantly associated with in-hospital mortality (odds ratio 1.56, 95% confidence interval [CI] 1.33-1.83). Regression models of all-cause 1-year mortality and readmission also suggested that lack of a family physician was associated with detrimental health outcomes (hazard ratio 1.14, 95% CI 1.04-1.26; subdistribution hazard ratio 1.17, 95% CI 1.10-1.24, respectively). INTERPRETATION Elders without family physicians were disadvantaged during their hospital admission as well as in the subsequent year. Additional interventions aimed at increasing the proportion of seniors admitted to hospital who are connected with a family physician are warranted.
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Affiliation(s)
- Alexandrea Peel
- Division of Geriatric Medicine (Peel), Department of Medicine, Schulich School of Medicine & Dentistry; Lawson Health Research Institute (Gutmanis), London, Ont.; Northern Ontario School of Medicine (Bon); Thunder Bay Regional Health Sciences Centre and St. Joseph's Care Group (Bon), Thunder Bay, Ont.
| | - Iris Gutmanis
- Division of Geriatric Medicine (Peel), Department of Medicine, Schulich School of Medicine & Dentistry; Lawson Health Research Institute (Gutmanis), London, Ont.; Northern Ontario School of Medicine (Bon); Thunder Bay Regional Health Sciences Centre and St. Joseph's Care Group (Bon), Thunder Bay, Ont
| | - Trevor Bon
- Division of Geriatric Medicine (Peel), Department of Medicine, Schulich School of Medicine & Dentistry; Lawson Health Research Institute (Gutmanis), London, Ont.; Northern Ontario School of Medicine (Bon); Thunder Bay Regional Health Sciences Centre and St. Joseph's Care Group (Bon), Thunder Bay, Ont
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13
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Quercioli C, Nisticò F, Troiano G, Maccari M, Messina G, Barducci M, Carriero G, Golinelli D, Nante N. Developing a new predictor of health expenditure: preliminary results from a primary healthcare setting. Public Health 2018; 163:121-127. [PMID: 30142482 DOI: 10.1016/j.puhe.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 06/13/2018] [Accepted: 07/10/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Risk adjustment is a widely used tool for health expenditure prediction and control. Early approaches for estimating health expenditure were based on patient demographic variables alone, whereas more recent models incorporate patient information, such as chronic medical conditions, clinical diagnoses, and self-reported health status. Many studies have investigated the health expenditure predictive capacity of single demographic, morbidity, or health-related quality of life measures, but the best models prove to be those that include them all. The aim of this study was to develop an index that combines measures of perceived health and disease severity and to compare its efficacy in predicting health expenditure with that of the measures taken individually. STUDY DESIGN This is a linked cross-sectional study. METHODS In 2009 and 2010, the health-related quality of life questionnaire SF-36 (8 scales, two indices: Physical Component Summary [PCS] and Mental Component Summary [MCS]) was distributed to 886 patients of general practitioners in the Province of Siena, Italy. Severity of diseases was calculated for each patient using the Charlson Index (CH-I) and Cumulative Illness Rating Scale Severity Index (CIRS-SI). Siena Local Health Unit 2012 data on health expenditure were obtained for each patient. Multivariate linear regression was applied to test the performance of severity (CH-I, CIRS-SI) and perceived health (PCS and MCS) measures in predicting health expenditure. The indexes that predicted health expenditure best were then combined in a new tool, and its expenditure predictive capacity was tested. RESULTS The best health expenditure predictors proved to be PCS and SI (R2 = 0.15 and R2 = 0.17, respectively). When combined in a new index (PCS-SI), better predictive capacity of health expenditure was obtained than with the two single measures separately (R2 = 0.19). CONCLUSIONS A multidimensional indicator proved to be a better predictor of healthcare expenditure than single health measures.
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Affiliation(s)
- C Quercioli
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy; Healthcare Management - Local Health Unit 7, Piazza Rosselli 26, 53100, Siena, Italy.
| | - F Nisticò
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy
| | - G Troiano
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy
| | - M Maccari
- Healthcare Management - Local Health Unit 7, Piazza Rosselli 26, 53100, Siena, Italy
| | - G Messina
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy; Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro, 53100, Siena, Italy
| | - M Barducci
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy
| | - G Carriero
- General Practice - Local Health Unit 7, Piazza Rosselli 26, 53100, Siena, Italy
| | - D Golinelli
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy
| | - N Nante
- Postgraduate School of Public Health, University of Siena, Via Aldo Moro, 53100, Siena, Italy; Department of Molecular and Developmental Medicine, University of Siena, Via Aldo Moro, 53100, Siena, Italy
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14
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Sinn CLJ, Betini RSD, Wright J, Eckler L, Chang BW, Hogeveen S, Turcotte L, Hirdes JP. Adverse Events in Home Care: Identifying and Responding with interRAI Scales and Clinical Assessment Protocols. Can J Aging 2018; 37:60-69. [PMID: 29306338 PMCID: PMC5851050 DOI: 10.1017/s0714980817000538] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 06/17/2017] [Indexed: 11/06/2022] Open
Abstract
Outcomes of adverse events in home care are varied and multifactorial. This study tested a framework combining two health measures to identify home care recipients at higher risk of long-term care placement or death within one year. Both measures come from the Resident Assessment Instrument-Home Care (RAI-HC), a standardized comprehensive clinical assessment. Persons scoring high in the Method for Assigning Priority Levels (MAPLe) algorithm and Changes in Health, End-stage disease, Signs and Symptoms (CHESS) scale were at the greatest risk of placement or death and more than twice as likely to experience either outcome earlier than others. The target group was more likely to trigger mood, social relationship, and caregiver distress issues, suggesting mental health and psychosocial interventions might help in addition to medical care and/or personal support services. Home care agencies can use this framework to identify home care patients who may require a more intensive care coordinator approach.
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Affiliation(s)
| | | | | | - Lorri Eckler
- Central Local Health Integration
Network, Richmond Hill, ON
| | | | - Sophie Hogeveen
- School of Public Health and Health
Systems, University of Waterloo
| | - Luke Turcotte
- School of Public Health and Health
Systems, University of Waterloo
| | - John P. Hirdes
- School of Public Health and Health
Systems, University of Waterloo
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15
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Prediction of the Incidence of Falls and Deaths Among Elderly Nursing Home Residents: The SENIOR Study. J Am Med Dir Assoc 2018; 19:18-24. [DOI: 10.1016/j.jamda.2017.06.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 06/16/2017] [Accepted: 06/16/2017] [Indexed: 12/16/2022]
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16
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González-Ortega M, Gené-Badia J, Kostov B, García-Valdecasas V, Pérez-Martín C. Randomized trial to reduce emergency visits or hospital admissions using telephone coaching to complex patients. Fam Pract 2017; 34:219-226. [PMID: 27920119 DOI: 10.1093/fampra/cmw119] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Comorbidity remains a matter of international interest, given growing prevalence of chronic conditions. OBJECTIVE To evaluate the impact that adding a telephone coaching intervention by a family physician to usual care has on reducing resource consumption and improving health status, caregiver burden and quality of life among complex chronic patients (CCP) compared with usual care. METHODS A randomized controlled trial was conducted on a random sample of CCP from three primary care teams in Barcelona. Patients were randomly allocated into intervention or control groups. Evaluations were conducted at baseline and after six-month follow-up. Intervention patients were phoned twice a month by a family physician. Both groups received usual care. Primary endpoint was change in total number of urgent visits per patient. Secondary endpoints were changes in health and mental status, quality of life and caregiver burden. RESULTS Hundred and sixty-one CCP were included. During follow-up, 9 patients died and 2 were lost. At baseline, patients' characteristics and resource consumption were similar for both groups. After six months, urgent visits per patient decreased in intervention (1.27 baseline versus 0.89 follow-up, P = 0.091) and control (1.06 baseline versus 0.86 follow-up, P = 0.422) groups, mean difference 0.18 [confidence interval (CI) 95% -0.48 to 0.84]. Intervention patients improved in the physical component of the SF-12 questionnaire, while worsening in control patients, mean difference 4.71 (CI 95% -9.03 to -0.41). Differences were not found in the rest of the endpoints. CONCLUSION The intervention did not reduce urgent visits among CCP neither improved patient's health.
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Affiliation(s)
| | - Joan Gené-Badia
- Institut Català de la Salut, Barcelona, Spain.,Consorci d'Atenció Primària de Salut Barcelona Esquerra, Barcelona, Spain.,Medicine Department, University of Barcelona, Barcelona, Spain
| | - Belchin Kostov
- Transverse group for research in primary care, IDIBAPS, Barcelona, Spain
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17
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Ferrer A, Formiga F, Sanz H, Almeda J, Padrós G. Multimorbidity as specific disease combinations, an important predictor factor for mortality in octogenarians: the Octabaix study. Clin Interv Aging 2017; 12:223-231. [PMID: 28184153 PMCID: PMC5291453 DOI: 10.2147/cia.s123173] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The population is aging and multimorbidity is becoming a common problem in the elderly. OBJECTIVE To explore the effect of multimorbidity patterns on mortality for all causes at 3- and 5-year follow-up periods. MATERIALS AND METHODS A prospective community-based cohort (2009-2014) embedded within a randomized clinical trial was conducted in seven primary health care centers, including 328 subjects aged 85 years at baseline. Sociodemographic variables, sensory status, cardiovascular risk factors, comorbidity, and geriatric tests were analyzed. Multimorbidity patterns were defined as combinations of two or three of 16 specific chronic conditions in the same individual. RESULTS Of the total sample, the median and interquartile range value of conditions was 4 (3-5). The individual morbidities significantly associated with death were chronic obstructive pulmonary disease (COPD; hazard ratio [HR]: 2.47; 95% confidence interval [CI]: 1.3; 4.7), atrial fibrillation (AF; HR: 2.41; 95% CI: 1.3; 4.3), and malignancy (HR: 1.9; 95% CI: 1.0; 3.6) at 3-year follow-up; whereas dementia (HR: 2.04; 95% CI: 1.3; 3.2), malignancy (HR: 1.84; 95% CI: 1.2; 2.8), and COPD (HR: 1.77; 95% CI: 1.1; 2.8) were the most associated with mortality at 5-year follow-up, after adjusting using Barthel functional index (BI). The two multimorbidity patterns most associated with death were AF, chronic kidney disease (CKD), and visual impairment (HR: 4.19; 95% CI: 2.2; 8.2) at 3-year follow-up as well as hypertension, CKD, and malignancy (HR: 3.24; 95% CI: 1.8; 5.8) at 5 years, after adjusting using BI. CONCLUSION Multimorbidity as specific combinations of chronic conditions showed an effect on mortality, which would be higher than the risk attributable to individual morbidities. The most important predicting pattern for mortality was the combination of AF, CKD, and visual impairment after 3 years. These findings suggest that a new approach is required to target multimorbidity in octogenarians.
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Affiliation(s)
- Assumpta Ferrer
- Primary Healthcare Department, Centre 'El Plà', DAP Metropolitana Sud ICS
| | - Francesc Formiga
- Geriatric Unit, Internal Medicine Service, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona; Bellvitge Biomedical Research Department Institute, IDIBELL, L'Hospitalet de Llobregat
| | - Héctor Sanz
- ISGlobal, Barcelona Ctr Int Health Res (CRESIB), Hospital Clínic - Barcelona University
| | - Jesús Almeda
- Support Unit Research for Primary Care, Primary Health Care Department of Costa Ponent, IDIAP, ICS; CIBER Department of Epidemiology Service (CIBERESP)
| | - Glòria Padrós
- Clinical Laboratory Department, L'Hospitalet de Llobregat, Barcelona, Spain
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18
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Umegaki H, Asai A, Kanda S, Maeda K, Shimojima T, Nomura H, Kuzuya M. Factors associated with unexpected admissions and mortality among low-functioning older patients receiving home medical care. Geriatr Gerontol Int 2017; 17:1623-1627. [DOI: 10.1111/ggi.12943] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/04/2016] [Accepted: 09/20/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Hiroyuki Umegaki
- Department of Community Healthcare and Geriatrics; Nagoya University Graduate School of Medicine; Nagoya Aichi Japan
| | | | - Shigeru Kanda
- Minami Health-Medical Cooperative Kaname Hospital; Nagoya Aichi Japan
| | - Keiko Maeda
- Department of Home Medical Care; Mokuren Clinic; Nagoya Aichi Japan
| | | | | | - Masafumi Kuzuya
- Department of Community Healthcare and Geriatrics; Nagoya University Graduate School of Medicine; Nagoya Aichi Japan
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19
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Matozinhos FP, Velasquez-Melendez G, Tiensoli SD, Moreira AD, Gomes FSL. Factors associated with the incidence of pressure ulcer during hospital stay. Rev Esc Enferm USP 2017; 51:e03223. [DOI: 10.1590/s1980-220x2016015803223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 01/26/2017] [Indexed: 12/30/2022] Open
Abstract
Abstract OBJECTIVE Estimating the incidence rate of pressure ulcers and verifying factors associated with this occurrence in a cohort of hospitalized patients. METHOD This is a cohort study in which the considered outcome was the time until pressure ulcer occurrence. Estimated effect of the variables on the cumulative incidence ratio of the outcome was performed using the Cox proportional hazards model. Variable selection occurred via the Logrank hypothesis test. RESULTS The sample consisted of 442 adults, with 25 incidents of pressure ulcers. Patients with high scores on the Braden scale presented a higher risk of pressure ulcer incidence when compared to those classified into the low score category. CONCLUSION These results reinforce the importance of using the Braden Scale to assist in identifying patients more likely to develop pressure ulcers.
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Muñoz M, Real J, Del Val J, Vinyoles E, Mundet X, Frigola-Capell E, Llauger M, Orfila F, Domingo M, Verdú-Rotellar J. Determinants of survival and hospitalization in older, heart failure patients receiving home healthcare. Int J Cardiol 2016; 207:145-9. [DOI: 10.1016/j.ijcard.2016.01.170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/16/2015] [Accepted: 01/09/2016] [Indexed: 12/22/2022]
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Abstract
Chronic care management describes the services provided to patients with two or more chronic conditions that pose risks of exacerbation, clinical deterioration, or death. These services extend beyond the typical face-to-face office visit and require coordination and oversight by a physician or other qualified health-care professional to maintain and modify as necessary a comprehensive and multidisciplinary plan of care. New codes for 2015 describe chronic care management services per calendar month. While the new services acknowledge the role and importance of coordination by primary care providers, they are also appropriate for specialists who oversee the management of all of the chronic conditions of a patient and provide access, education, care coordination, communication, and health information exchange with other providers.
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Affiliation(s)
- Steve G Peters
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Mayo Foundation for Medical Education and Research, Rochester, MN.
| | - Kari S Bunkers
- Department of Family Medicine, Mayo Clinic Health System, Owatonna, MN
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22
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Evolución de la prevalencia de úlceras por presión en un hospital de agudos de tercer nivel (2006-2013). ACTA ACUST UNITED AC 2015; 30:135-41. [DOI: 10.1016/j.cali.2015.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 11/21/2022]
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23
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Gould L, Abadir P, Brem H, Carter M, Conner-Kerr T, Davidson J, DiPietro L, Falanga V, Fife C, Gardner S, Grice E, Harmon J, Hazzard WR, High KP, Houghton P, Jacobson N, Kirsner RS, Kovacs EJ, Margolis D, McFarland Horne F, Reed MJ, Sullivan DH, Thom S, Tomic-Canic M, Walston J, Whitney JA, Williams J, Zieman S, Schmader K. Chronic wound repair and healing in older adults: current status and future research. J Am Geriatr Soc 2015; 63:427-38. [PMID: 25753048 DOI: 10.1111/jgs.13332] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Older adults are more likely to have chronic wounds than younger people, and the effect of chronic wounds on quality of life is particularly profound in this population. Wound healing slows with age, but the basic biology underlying chronic wounds and the influence of age-associated changes on wound healing are poorly understood. Most studies have used in vitro approaches and various animal models, but observed changes translate poorly to human healing conditions. The effect of age and accompanying multimorbidity on the effectiveness of existing and emerging treatment approaches for chronic wounds is also unknown, and older adults tend to be excluded from randomized clinical trials. Poorly defined outcomes and variables; lack of standardization in data collection; and variations in the definition, measurement, and treatment of wounds also hamper clinical studies. The Association of Specialty Professors, in conjunction with the National Institute on Aging and the Wound Healing Society, held a workshop, summarized in this article, to explore the current state of knowledge and research challenges, engage investigators across disciplines, and identify research questions to guide future study of age-associated changes in chronic wound healing.
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Affiliation(s)
- Lisa Gould
- Wound Recovery and Hyperbaric Medicine Center, Kent Hospital, Warwick, Rhode Island
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Gould L, Abadir P, Brem H, Carter M, Conner-Kerr T, Davidson J, DiPietro L, Falanga V, Fife C, Gardner S, Grice E, Harmon J, Hazzard WR, High KP, Houghton P, Jacobson N, Kirsner RS, Kovacs EJ, Margolis D, McFarland Horne F, Reed MJ, Sullivan DH, Thom S, Tomic-Canic M, Walston J, Whitney J, Williams J, Zieman S, Schmader K. Chronic wound repair and healing in older adults: current status and future research. Wound Repair Regen 2015; 23:1-13. [PMID: 25486905 DOI: 10.1111/wrr.12245] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 11/19/2014] [Indexed: 12/21/2022]
Abstract
The incidence of chronic wounds is increased among older adults, and the impact of chronic wounds on quality of life is particularly profound in this population. It is well established that wound healing slows with age. However, the basic biology underlying chronic wounds and the influence of age-associated changes on wound healing are poorly understood. Most studies have used in vitro approaches and various animal models, but observed changes translate poorly to human healing conditions. The impact of age and accompanying multi-morbidity on the effectiveness of existing and emerging treatment approaches for chronic wounds is also unknown, and older adults tend to be excluded from randomized clinical trials. Poorly defined outcomes and variables, lack of standardization in data collection, and variations in the definition, measurement, and treatment of wounds also hamper clinical studies. The Association of Specialty Professors, in conjunction with the National Institute on Aging and the Wound Healing Society, held a workshop, summarized in this paper, to explore the current state of knowledge and research challenges, engage investigators across disciplines, and identify key research questions to guide future study of age-associated changes in chronic wound healing.
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Affiliation(s)
- Lisa Gould
- Wound Recovery and Hyperbaric Medicine Center, Kent Hospital, Warwick, Rhode Island
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