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Elkjaer M, Primdahl J, Mogensen CB, Brabrand M, Gram B. The quality of life of older adults acutely admitted to the emergency department: A cross-sectional study. Nurs Open 2022; 9:2130-2138. [PMID: 35488717 PMCID: PMC9190686 DOI: 10.1002/nop2.1223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 02/25/2022] [Accepted: 04/03/2022] [Indexed: 11/09/2022] Open
Abstract
AIM To investigate perceptions of individual QoL among acutely admitted older adults and explore whether homecare and readmission were associated with QoL. DESIGN A cross-sectional study at three Danish Emergency Departments. METHODS Semi-structured interviews, using the Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQol-DW) (range 0-100) with patients ≥65 years, were conducted from August 2018 to July 2019. The differences between patients receiving homecare (yes/no) and readmission (yes/no) were tested using linear regression analyses with bootstrap procedures. RESULTS Overall, we included 406 patients, of whom 38% received homecare. The mean SEIQoL-DW-score was 76 (SD = 19). The most important areas of individual QoL were Family, Social activities, Health, Everyday life and Leisure activities. Receiving homecare was associated to a significantly lower QoL score: -8 (SE = 2) and a significantly lower score in the categories Family and Health. There was no association between readmission and QoL.
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Affiliation(s)
- Mette Elkjaer
- Department of Emergency Medicine, University Hospital of Southern Denmark, Aabenraa, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jette Primdahl
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Hospital Sønderjylland, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Christian B Mogensen
- Department of Emergency Medicine, University Hospital of Southern Denmark, 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, Odense University Hospital, Odense, Denmark
| | - Bibi Gram
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Research Unit of Health Sciences, University Hospital of Southern Denmark, Esbjerg, Denmark
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2
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Coatsworth-Puspoky R, Duggleby W, Dahlke S, Hunter K. Unplanned readmission for older persons: A concept analysis. J Adv Nurs 2021; 77:4291-4305. [PMID: 34028852 DOI: 10.1111/jan.14893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this concept analysis is to define and analyse the concept of unplanned readmission to hospital for older persons. DESIGN Review the literature and analyse the concept of unplanned readmission. METHOD Guided by Walker and Avant's eight-stage method of concept analysis, four databases (Ovid MEDLINE, Scopus, CINAHL, and Embase) were searched between 1946 and 2020 for empirical studies focused on older persons with multiple chronic conditions, experiences or perspectives and unplanned readmission. A total of 34 articles (10 quantitative, 17 qualitative, three mixed methods), one concept analysis and three historical articles were included. RESULTS An unplanned readmission is an experience, process and event. The proposed definition of unplanned readmission is an older person's need for acute care treatment for an urgent or emergent health crisis that has occurred after a previous hospitalization(s). Unplanned readmission is characterized by the attributes of older persons' previous hospitalization(s), the urgent or emergent nature of the older persons' health and the older persons' need for acute care hospital services to resolve their health crisis. CONCLUSION Unplanned readmission is a complex concept that is different from planned and emergency visits/admissions and readiness for discharge. These findings provide a link for understanding unplanned readmission as a consequence of discharge readiness. Analysing this concept supports the need for older persons to seek unplanned readmission for acute care treatment of urgent and emergent health crisis, reduces the blame that older persons may feel from questions related to preventability, and stresses the need to include older persons' experiences in the development and expansion of nursing theory, interventions and current understandings of unplanned readmission.
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Affiliation(s)
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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3
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Struja T, Koch D, Haubitz S, Mueller B, Schuetz P, Siepmann T. Quality of life after hospitalization predicts one-year readmission risk in a large Swiss cohort of medical in-patients. Qual Life Res 2021; 30:1863-1871. [PMID: 34003435 DOI: 10.1007/s11136-021-02867-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Estimating the probability of readmission following hospitalization using prediction scores can be complex. Quality of life (QoL) may provide an easy and effective alternative. METHODS Secondary analysis of the prospective "TRIAGE" cohort. All medical in-patients admitted to a Swiss tertiary care institution (2016-2019) ≥18 years with a length of stay of ≥2 days (23,309 patients) were included. EQ-5D VAS, EQ-5D index, and Barthel index were assessed at a single telephone interview 30-day after admission. Patients lost to follow-up were excluded. Readmission was defined as a non-elective hospital stay at our institution >24 h within 1 year after discharge and assessed using area under the curve (AUC) analysis with adjustment for confounders. RESULTS 12,842 patients (43% females, median age 68, IQR 55-78) were included. Unadjusted discrimination was modest at 0.59 (95% CI 0.56-0.62) for EQ-5D VAS. Partially adjusted discrimination (for gender) was identical. Additional adjustment for insurance, Charlson comorbidity index, length of stay, and native language increased the AUC to 0.66 (95% CI 0.63-0.69). Results were robust irrespective of time to event (12, 6 or 3 months). A cut-off in the unadjusted model of EQ-5D VAS of 55 could separate cases with a specificity of 80% and a sensitivity of 30%. CONCLUSION QoL at day 30 after admission can predict one-year readmission risk with similar precision as more intricate tools. It might help for identification of high-risk patients and the design of tailored prevention strategies.
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Affiliation(s)
- Tristan Struja
- Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland. .,Division of Health Care Sciences, Dresden International University, Dresden, Germany.
| | - Daniel Koch
- Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Sebastian Haubitz
- Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland
| | - Beat Mueller
- Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical University Clinic, Kantonsspital Aarau, Tellstrasse, CH-5001, Aarau, Switzerland.,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Timo Siepmann
- Division of Health Care Sciences, Dresden International University, Dresden, Germany.,Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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4
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Schick-Makaroff K, Karimi-Dehkordi M, Cuthbertson L, Dixon D, Cohen SR, Hilliard N, Sawatzky R. Using Patient- and Family-Reported Outcome and Experience Measures Across Transitions of Care for Frail Older Adults Living at Home: A Meta-Narrative Synthesis. THE GERONTOLOGIST 2021; 61:e23-e38. [PMID: 31942997 DOI: 10.1093/geront/gnz162] [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: 06/25/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Our aim was to create a "storyline" that provides empirical explanation of stakeholders' perspectives underlying the use of patient- and family-reported outcome and experience measures to inform continuity across transitions in care for frail older adults and their family caregivers living at home. RESEARCH DESIGN AND METHODS We conducted a meta-narrative synthesis to explore stakeholder perspectives pertaining to use of patient-reported outcome and experience measures (PROMs and PREMs) across micro (patients, family caregivers, and healthcare providers), meso (organizational managers/executives/programs), and macro (decision-/policy-makers) levels in healthcare. Systematic searches identified 9,942 citations of which 40 were included based on full-text screening. RESULTS PROMs and PREMS (54 PROMs; 4 PREMs; 1 with PROM and PREM elements; 6 unspecified PROMs) were rarely used to inform continuity across transitions of care and were typically used independently, rarely together (n = 3). Two overarching traditions motivated stakeholders' use. The first significant motivation by diverse stakeholders to use PROMs and PREMs was the desire to restore/support independence and care at home, predominantly at a micro-level. The second motivation to using PROMs and PREMs was to evaluate health services, including cost-effectiveness of programs and hospital discharge (planning); this focus was rarely at a macro-level and more often split between micro- and meso-levels of healthcare. DISCUSSION AND IMPLICATIONS The motivations underlying stakeholders' use of these tools were distinct, yet synergistic between the goals of person/family-centered care and healthcare system-level goals aimed at efficient use of health services. There is a missed opportunity here for PROMs and PREMs to be used together to inform continuity across transitions of care.
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Affiliation(s)
| | - Mehri Karimi-Dehkordi
- Department of Medicine and Community Health Sciences, University of Calgary, Vancouver
| | - Lena Cuthbertson
- Office of Patient-Centered Measurement, British Columbia, Ministry of Health, Vancouver
| | - Duncan Dixon
- Norma Marion Alloway Library, Trinity Western University, Langley
| | - S Robin Cohen
- Department of Oncology and Medicine, McGill University, Montréal.,Lady Davis Institute, Palliative Care Research, Montréal
| | | | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, Canada.,Sahlgrenska Academy, University of Gothenburg, Sweden
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5
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Health-Related Quality of Life Measured by EQ-5D in Relation to Hospital Stay and Readmission in Elderly Patients Hospitalized for Acute Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155333. [PMID: 32722143 PMCID: PMC7432512 DOI: 10.3390/ijerph17155333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 12/05/2022]
Abstract
We evaluated the predictability of self-reported Health-related quality of life (HRQoL) assessed by the 3-level 5-dimensional Euro-Quality of Life tool (EQ-5D-3L) and the EQ-Visual Analog Scale (EQ-VAS) on clinical outcomes of elderly patients who were admitted to an acute geriatric ward. A total of 102 participants (56.9% men) with a median age of 81.0 years (interquartile range or IQR: 76.0–85.3 years) were studied. The age-adjusted Charlson comorbidity index was 5.0 (IQR: 4.0–6.0) with a median length of stay (LOS) of 9.0 days (IQR: 7.0–15.0 days). No death occurred during hospitalization, and within 30 days after discharge, 15 patients were readmitted. During hospitalization, the EQ-5D-3L index was 0.440 at admission and that improved to 0.648 at discharge (p < 0.001). EQ-VAS scores also improved similarly from 60 to 70 (p < 0.001). Physical, cognitive function, frailty parameters (hand grip strength and walking speed), and nutritional status at admission all improved significantly during hospitalization and were related to EQ-5D-3L index or EQ-VAS scores at discharge. After controlling for relevant factors, EQ-5D-3L index at admission was found to be associated with LOS. In addition, EQ-VAS was marginally related to readmission. HRQoL assessment during hospitalization could be useful to guide clinical practice and to improve outcome.
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6
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Jolly TA, Deal AM, Mariano C, Markowski N, Kirk S, Perlmutt MS, Jones F, Choi SK, Nyrop KA, Busby-Whitehead J, Muss H. A Randomized Trial of Real-Time Geriatric Assessment Reporting in Nonelectively Hospitalized Older Adults with Cancer. Oncologist 2020; 25:488-496. [PMID: 31985125 DOI: 10.1634/theoncologist.2019-0581] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/27/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hospitalized older adults have significant geriatric deficits that may lead to poor outcomes. We conducted a randomized trial to investigate the effectiveness of providing clinicians with a real-time geriatric assessment (GA) report in nonelectively hospitalized older patients with cancer. SUBJECTS, MATERIALS, AND METHODS We developed a web-based software platform for administering a modified GA (Cancer 2005;104:1998-2005) to older (>70 years) nonelectively hospitalized patients with pathologically confirmed malignancy. Patients were randomized to have their GA report provided to their treating clinicians (Intervention arm) or not provided (Control arm). RESULTS Our study included 135 patients, median age 76 years, 52% female, 75% white, 21% black, 79% greater than high school education, 59% married, and 17% living alone. All patients had at least one GA-identified deficit, including physical function deficits (90%), cognitive impairment (22%), >5 comorbidities (28%), polypharmacy (>9 medications; 38%), weight loss ≥10% in the past 6 months (40%), anxiety (32%), or depression (30%). There was no difference between the Intervention (6%) and Control arms (9%) in the proportion of patients who were referred by their clinical team for an intervention to address a deficit (p = .53). CONCLUSION Many older nonelectively hospitalized patients with cancer have geriatric deficits that are amenable to evidence-based interventions. Real-time GA reports provided to the care team prior to discharge did not influence provider referral for such interventions. There is a need for systems-level interventions to address deficits in this vulnerable patient population. IMPLICATIONS FOR PRACTICE Geriatric deficits are common in hospitalized older adults with cancer and lead to poor outcomes. Addressing modifiable deficits represents an appealing way to improve outcomes. Widespread geriatrician consultation is impractical owing to resource and personnel constraints. This work tested whether prompt delivery of a mostly self-administered, web-based geriatric assessment report to clinicians improved referral rates for evidence-informed interventions. It confirmed frequent geriatric deficits and high readmission rates in this population but found that real-time geriatric assessment reporting did not influence provider referral for evidence-informed interventions on geriatric assessment identified deficits. These findings highlight the need for systems-level intervention to improve outcomes in this vulnerable patient population.
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Affiliation(s)
- Trevor A Jolly
- Division of Hematology and Oncology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Caroline Mariano
- Royal Columbian Hospital Medical Oncology, New Westminster, British Columbia, Canada
| | - Nicole Markowski
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sharanda Kirk
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Max S Perlmutt
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Franklin Jones
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Suel Ki Choi
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kirsten A Nyrop
- Division of Hematology and Oncology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jan Busby-Whitehead
- Center for Aging and Health/Division of Geriatric Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hyman Muss
- Division of Hematology and Oncology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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7
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Health-related quality of life at hospital discharge as a predictor for 6-month unplanned readmission and all-cause mortality of acutely admitted older medical patients. Qual Life Res 2019; 28:3015-3024. [DOI: 10.1007/s11136-019-02259-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2019] [Indexed: 12/17/2022]
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8
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Prout AJ, Talisa VB, Carcillo JA, Angus DC, Chang CCH, Yende S. Epidemiology of Readmissions After Sepsis Hospitalization in Children. Hosp Pediatr 2019; 9:249-255. [PMID: 30824488 PMCID: PMC6434975 DOI: 10.1542/hpeds.2018-0175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES The decline in hospital mortality in children hospitalized with sepsis has increased the number of survivors. These survivors are at risk for adverse long-term outcomes, including readmission and recurrent or unresolved infections. We described the epidemiology of 90-day readmissions after sepsis hospitalization in children. We tested the hypothesis that a sepsis hospitalization increases odds of 90-day readmissions. METHODS Retrospective cohort analysis of the Nationwide Readmissions Database. We included index unplanned admissions of non-neonatal pediatric patients and described the proportion of readmissions, including those involving infection or sepsis. We performed multivariable analysis to determine the odds of readmission after a sepsis and nonsepsis admission and compared costs of readmission after sepsis and nonsepsis admissions. RESULTS Of 562 817 pediatric admissions, 7634 (1.4%) and 555 183 (98.6%) were discharged alive after admissions with and without sepsis. The rate of 90-day readmission after sepsis was 21.4%: 7.2% and 25.5% in previously healthy and chronically ill patients. The adjusted mean cost during readmission was $7385. Half of readmissions (52.9%) involved recurrent infection or sepsis. Sepsis admissions were associated with higher odds of readmission at 90 days compared with nonsepsis admissions (adjusted odds ratio 1.15, 95% confidence interval 1.08-1.23). The results remained unchanged for 30-day and 6-month readmissions. CONCLUSIONS Readmissions occur after 1 in 5 pediatric sepsis hospitalizations and increase health care costs. Sepsis hospitalization increased odds of readmission and commonly involved recurrent infection or sepsis. Clinicians caring for these patients should consider surveillance for recurrent or unresolved infection, and researchers should explore underlying mechanisms and potential interventions to reduce readmissions.
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Affiliation(s)
- Andrew J Prout
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center
- Departments of Critical Care Medicine and
- Division of Pediatrics
| | - Victor B Talisa
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center
- Departments of Critical Care Medicine and
- Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | | | - Derek C Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center
- Departments of Critical Care Medicine and
| | - Chung-Chou H Chang
- Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and
- Department of Biostatistics, Graduate School of Public Health
| | - Sachin Yende
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center,
- Departments of Critical Care Medicine and
- Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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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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10
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Neil AL, Carr VJ, Mackinnon A, Foley DL, Morgan VA. Health-Related Quality of Life in People Living with Psychotic Illness and Factors Associated with Its Variation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:1002-1009. [PMID: 30098664 DOI: 10.1016/j.jval.2018.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/08/2018] [Accepted: 02/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To establish whether the four-dimensional Assessment of Quality of Life (AQoL-4D) produces robust utility values in adults with psychotic illness, and identify health inequalities compared with the general population. METHODS The AQoL-4D was completed by 1613 individuals with an International Classification of Diseases, Tenth Revision, psychotic illness in the 2010 Australian National Survey of Psychosis. Utilities were assessed for this sample and 20 subgroups, and were compared with general population norms. Modified Cohen d was used as an index of effect size. Utilities were collapsed into 10 health-related quality-of-life (HRQOL) bands or decades. RESULTS HRQOL in people with psychotic illness was half of the maximum achievable utility (half-"full health") with a mean utility of 0.49 (95% confidence interval [CI] 0.48-0.51), and showing substantial variability across subgroups. Participants with essentially normal functioning had the highest mean utility (0.72; 95% CI 0.68-0.77), and those with very poor perceived mental health had the lowest (0.22; 95% CI 0.18-0.26). These subgroups showed the most variability. Negative symptoms also gave rise to substantial variation. Among diagnostic categories, only depressive psychosis had a large effect relative to delusional disorders. The distribution of utilities in people with psychotic illness differed markedly from that in the general population, with 6.8% versus 47.2% having values in the highest decade (>0.90-1.00). Utilities were lower in every age group in people with psychosis. CONCLUSIONS Profound HRQOL impacts are revealed by the AQoL-4D in people with psychotic illness, and marked variations in utilities were observed for key subjective and objective measures. We provide a suite of utility values for economic modeling studies and recommend the AQoL-4D for assessing HRQOL in people with psychotic illness.
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Affiliation(s)
- Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - Vaughan J Carr
- Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, St Vincent's Hospital, Sydney, New South Wales, Australia; Neuroscience Research Australia, Sydney, New South Wales, Australia; Department of Psychiatry, School of Clinical Sciences, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - Andrew Mackinnon
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia; Black Dog Institute and University of New South Wales, Randwick, New South Wales, Australia
| | - Debra L Foley
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, Victoria, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, Division of Psychiatry, Medical School, The University of Western Australia, Crawley, Western Australia, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
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11
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Abstract
Introduction A main goals of palliative care is to improve the health-related quality of life (QOL) of patients with advanced illnesses. The objective of this narrative review is to provide an updated synopsis on the use of QOL questionnaires in the palliative care setting. Areas covers Focusing on the palliative cares setting, we will define QOL, discuss how QOL instruments can be used clinically and in research, review approaches to validate these questionnaires, and how they can be used in utility analyses. Expert opinion/commentary Several QOL questionnaires, such as EORTC-QLQ-C30, McGill QOL questionnaire and EQ-5D have been validated in the palliative care setting. However, significant gaps impede their application, including lack of determination of their responsiveness to change and minimal clinically important differences, the need to conduct more psychometric validation on QOL questionnaires among patients at various stages of disease trajectory, and the paucity of studies examining utility and cost-effectiveness. Further research is needed to address these knowledge gaps so QOL questionnaires can be better used to inform clinical practice and research.
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Affiliation(s)
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD D Anderson Cancer Center, Houston, TX, USA, 77030
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12
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Yaghoobzadeh A, Sharif Nia H, Pahlevan Sharif S, Hosseinigolafshani SZ, Mohammadi F, Oveisi S, Allen KA. Role of Sex, Socioeconomic Status, and Emotional Support in Predicting Aging Perception Among Older Adults. Int J Aging Hum Dev 2017; 87:77-89. [PMID: 28859489 DOI: 10.1177/0091415017727211] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Self-perception is found to be a central predictive factor in experiencing successful aging. The aim of this study was to explore the role of sex, socioeconomic status, and emotional support in elders' aging perception. A cross-sectional design was used with 300 older aged participants recruited from 23 clinics and health centers in Qazvin, Iran. Data were collected included questions to elicit demographic information and Barker's aging perception questionnaire. Exploratory multiple linear regression showed that the level of emotional support (β: -12.10; 95% CI: [-20.72, -3.48]), socioeconomic status (β: 2.84; 95% CI: [0.25, 5.43]), and women (β: -4.34; 95% CI: [-6.91, -1.77]) were associated with aging perception among elders. Educational level and marital status did not significantly contribute to the variance of AP. Findings revealed that aging perception was related to individual differences as well as social and emotional factors. Researchers, health-care professionals, and elders may benefit from thinking about old age as an inevitable life stage.
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Affiliation(s)
| | - Hamid Sharif Nia
- 2 School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | | | | | - Fatemeh Mohammadi
- 5 Gerontology, Nursing and Midwifery Faculty, Qazvin University of Medical Sciences, Iran
| | - Sonia Oveisi
- 6 Mother and Child Health, Qazvin University of Medical Sciences, Iran
| | - Kelly A Allen
- 7 Melbourne Graduate School of Education, University of Melbourne, Australia
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Bahramnezhad F, Chalik R, Bastani F, Taherpour M, Navab E. The social network among the elderly and its relationship with quality of life. Electron Physician 2017; 9:4306-4311. [PMID: 28713500 PMCID: PMC5498693 DOI: 10.19082/4306] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 12/24/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Attention to the needs of the elderly is a social necessity, and it seems that evaluating the social network and quality of life of the elderly can be useful in a better understanding of their needs. This study was performed to determine the relationship between the social network and the quality of life of the elderly in the city of Bojnoord in Iran. METHODS In this cross-sectional study, 201 elderly people aged 60 years or more were selected by continuous and consecutive sampling method in Bojnoord, Iran in 2014. Data were collected using demographic questionnaire, Lubben social network scale and LEIPAD elderly quality of life questionnaire. Data were analyzed by SPSS 16 and using descriptive statistics and independent-samples t-test, ANOVA and Pearson product-moment coefficient. RESULTS The results showed that 30.3% of elderly people studied, were subjected to a high risk of isolation. The highest mean in social network dimensions was in the family (19.68%), friends (12.01%) and the neighbors (9.90%), respectively. The mean score for quality of life of the elderly was as moderate to high (63.90±13.73), and among the quality of life dimensions, the highest mean was related to the self-care dimension (15.59%), and the lowest mean was related to the sexual functioning dimension (1.53%). The findings suggested a positive and significant relationship between social network and quality of life in the elderly who were studied (p<0.000, r=0.468). CONCLUSION This study was a step toward understanding the social network status and quality of life of the elderly. It is necessary to say that health care professionals, especially nurses, display a significant role in the community to help people in this regard.
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Affiliation(s)
- Fatemeh Bahramnezhad
- Ph.D. of Nursing, Assistant Professor, Department of Critical Care Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Raheleh Chalik
- M.Sc., Department of Geriatric Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Bastani
- Ph.D. of Nursing, Associate Professor, Department of Geriatric Nursing, Faculty of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Taherpour
- M.Sc. in biostatistics, Faculty of Biostatistics, North Khorasan University of Medical Sciences, Bojnoord, Iran
| | - Elham Navab
- Ph.D. of Nursing, Assistant Professor, Head of Department of Geriatric and Critical Care Nursing, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Saito T, Izawa KP, Matsui N, Arai K, Ando M, Morimoto K, Fujita N, Takahashi Y, Kawazoe M, Watanabe S. Comparison of the measurement properties of the Functional Independence and Difficulty Scale with the Barthel Index in community-dwelling elderly people in Japan. Aging Clin Exp Res 2017; 29:273-281. [PMID: 26988689 DOI: 10.1007/s40520-016-0558-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/02/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND The new Functional Independence and Difficulty Scale (FIDS) is a tool for assessing the performance of basic activities of daily living (BADL). Because many BADL measures already exist, it is important to know whether FIDS can offer added benefit over the existing measures. AIMS This study compared measurement properties between the FIDS and a representative BADL assessment tool, the Barthel Index (BI). METHODS Recruitment of the participants was done on the basis of convenience sampling. Participants were community-dwelling elderly Japanese subjects (n = 314; age ≥65 years) divided into a healthy elderly group [n = 225; subjects not using long-term care insurance (LTCI) services] and frail elderly group (n = 89; subjects using LTCI services). For each group, ceiling effect (percent participation with the maximum score) was calculated, and it was compared between the two scales. Associations between the FIDS, BI and Medical Outcomes Study Short Form 8 Health Survey (SF-8) were evaluated by Spearman correlation coefficient and partial correlations. Partial correlations coefficients to SF-8 were compared between the two scales. RESULTS FIDS showed a relatively small ceiling effect compared to the BI. Compared to the BI, FIDS showed a significant positive partial correlation with the broader aspect of the SF-8 subscales, but the strength of correlation between FIDS and SF-8 was weak to negligible. CONCLUSIONS The FIDS might be less affected by ceiling effect than the BI. Additional studies using a sufficient number of probability samples are needed to clarify whether FIDS has any benefit over BI in terms of correlations with the SF-8.
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Affiliation(s)
- Takashi Saito
- Doctoral Course of Gerontology, Graduate School of Gerontology, J. F. Oberlin University, 3758 Tokiwa-machi, Machida-shi, Tokyo, 194-0294, Japan.
| | - Kazuhiro P Izawa
- Graduate School of Health Sciences, Kobe University, Kobe, Japan
| | - Nobuko Matsui
- Department of Physical Therapy, Tokyo College of Allied Medicine, Tokyo, Japan
| | - Kenji Arai
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
| | - Makoto Ando
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
| | - Kazuhiro Morimoto
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
| | - Naoki Fujita
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
| | - Yuki Takahashi
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
| | - Moe Kawazoe
- Department of Rehabilitation, Visiting Nursing and Rehabilitation Network, Kanagawa, Japan
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15
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Parlevliet JL, MacNeil-Vroomen J, Buurman BM, de Rooij SE, Bosmans JE. Health-Related Quality of Life at Admission Is Associated with Postdischarge Mortality, Functional Decline, and Institutionalization in Acutely Hospitalized Older Medical Patients. J Am Geriatr Soc 2016; 64:761-8. [PMID: 27100574 DOI: 10.1111/jgs.14050] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To assess the independent association between health-related quality of life (HRQOL) at admission and mortality, functional decline, and institutionalization 3 and 12 months after admission in acutely hospitalized older adults. DESIGN Post hoc analysis of data from prospective cohort study, 2006 to 2009, 12-month follow-up. SETTING Eleven medical wards in three hospitals in the Netherlands. PARTICIPANTS Medical patients aged 65 and older acutely hospitalized for 48 hours or longer (N = 473). MEASUREMENTS OUTCOMES mortality, functional decline, and institutionalization, 3 and 12 months after admission. Main determinant was HRQOL (utility based on the EuroQol-5D at admission, reflecting the relative desirability of a particular health state and is measured on a scale from 0 (death) to 1 (full health). Some health states are regarded as being worse than death, resulting in negative utilities, with a minimum of -0.330). Participants were split into two groups based on median utility at admission. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using Cox and logistic regression analyses, adjusted for sociodemographic and health variables. RESULTS Median utility was 0.775 (interquartile range 0.399-0.861). Utility greater than 0.775, indicating high HRQOL, was associated with lower risk of mortality (hazard ratio = 0.38, 95% CI = 0.18-0.83) and functional decline (OR = 0.47, 95% CI = 0.28-0.79) at 3 months in the adjusted models. At 12 months, these associations were statistically significant in the crude models but not in the adjusted models. Utility was not associated with risk of institutionalization at 3 or 12 months. CONCLUSION Higher HRQOL at admission was associated with lower risk of mortality and functional decline 3 months after admission. In older, acutely hospitalized individuals, the EQ-5D may provide a means of risk stratification and may ultimately guide individuals, their families, and professionals in treatment decisions during hospitalization.
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Affiliation(s)
- Juliette L Parlevliet
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Janet MacNeil-Vroomen
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Bianca M Buurman
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, the Netherlands
| | - Sophia E de Rooij
- Section of Geriatric Medicine, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, the Netherlands.,Department of Internal Medicine, University Center for Geriatric Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - Judith E Bosmans
- Department of Health Sciences, VU University Amsterdam, the Netherlands.,EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, the Netherlands
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16
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Davis J, Morgans A, Stewart J. Developing an Australian health and aged care research agenda: a systematic review of evidence at the subacute interface. AUST HEALTH REV 2016; 40:420-427. [DOI: 10.1071/ah15005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 09/07/2015] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to systematically review articles describing recent interventions that aimed to improve access and outcomes for older people at the interface between health and aged care, with a focus on subacute care programs of palliative care, rehabilitation, geriatric evaluation and management (GEM) and psychogeriatrics. Methods Australian studies published between 2008 and 2013were evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and National Health and Medical Research Council of Australia (NHMRC) guidelines. Included studies were summarised according to focus areas and results discussed in the current Australian subacute health care context. Results Eleven Australian research articles were identified. Three did not achieve any NHMRC rating level because of methodological approach. Focus areas included: discharge planning; information management or communication; rehabilitation; hospital treatment in residential care; screening and intervention; and Telehealth. Interventions were primarily system centred; only three studies featured patient-level outcome measures. Conclusions There is limited high-quality research investigating the effectiveness of interventions at the health and aged care interface of subacute care. Further research is needed. What is known about the topic? Subacute care offers important healthcare programs for older people, operating at the interface between health and aged care. However, for the most part this has not been subject to research scrutiny. What does this paper add? Identified studies were predominantly hospital oriented and designed to avoid hospital admission and associated costs. Locally integrated, collaborative and multidiscipline based interventions improve system-level outcomes. Alternative and individualised models of care, particularly when provided in their home setting, yields positive outcomes for older people. What are the implications for practitioners? Health and aged care reforms and related research agenda must include the perspectives and experiences of patients and/or carers accessing subacute care programs, yet these are under-reported. The present review highlights opportunities to improve the quality of existing evidence and create a research agenda for the future.
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Functional Status and Hospital Readmissions Using the Medical Expenditure Panel Survey. J Gen Intern Med 2015; 30:965-72. [PMID: 25691236 PMCID: PMC4471038 DOI: 10.1007/s11606-014-3170-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/19/2014] [Accepted: 11/26/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Hospital readmissions are expensive and they may signal poor quality of care. Whether functional status is related to hospital readmissions using a representative U.S sample remains unexplored . OBJECTIVE We aimed to assess the relationship between functional status and all-cause 30-day hospital readmissions using a representative sample of the US population. DESIGN This was a retrospective observational study (2003-2011). PATIENTS The study included 3,772 patients who completed the SF-12 before being hospitalized. Three hundred and eighteen (8.4%) were readmitted within 30 days after being discharged. MEASUREMENTS The Medical Expenditure Panel Survey (MEPS) was employed. Functional status was measured with the Short-Form 12-Item Health Survey Version 2® (SF-12). The probability of being readmitted was estimated using a logistic model controlling for demographic characteristics, comorbid conditions, insurance coverage, physical (PCS) and mental (MCS) summaries of the SF-12, reason for hospitalization, length of hospital stay, region, and residential area. RESULTS A one-unit difference in PCS reduced the odds of readmission by 2% (odds ratio 0.98 [95% CI, 0.97 to 0.99]; p < 0.001), which implies an 18% reduction in the odds of readmissions for a ten-unit difference (one standard deviation) in PCS. The c-statistic of the model was 0.72. CONCLUSION Baseline physical function is associated with hospital readmissions. The SF-12 improves the ability to identify patients at high risk of hospital readmission.
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18
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Mariano C, Williams G, Deal A, Alston S, Bryant AL, Jolly T, Muss HB. Geriatric Assessment of Older Adults With Cancer During Unplanned Hospitalizations: An Opportunity in Disguise. Oncologist 2015; 20:767-72. [PMID: 26032136 DOI: 10.1634/theoncologist.2015-0023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 04/22/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Geriatric assessment (GA) is an important tool for management of older cancer patients; however, GA research has been performed primarily in the outpatient setting. The primary objective of this study was to determine feasibility of GA during an unplanned hospital stay. Secondary objectives were to describe deficits found with GA, to assess whether clinicians recognized and addressed deficits, and to determine 30-day readmission rates. MATERIALS AND METHODS The study was designed as an extension of an existing registry, "Carolina Senior: Registry for Older Patients." Inclusion criteria were age 70 and older and biopsy-proven solid tumor, myeloma, or lymphoma. Patients had to complete the GA within 7 days of nonelective admission to University of North Carolina Hospital. RESULTS A total of 142 patients were approached, and 90 (63%) consented to participation. All sections of GA had at least an 83% completion rate. Overall, 53% of patients reported problems with physical function, 63% had deficits in instrumental activities of daily living, 34% reported falls, 12% reported depression, 31% had ≥10% weight loss, and 12% had abnormalities in cognition. Physician documentation of each deficit ranged from 20% to 46%. Rates of referrals to allied health professionals were not significantly different between patients with and without deficits. The 30-day readmission rate was 29%. CONCLUSION GA was feasible in this population. Hospitalized older cancer patients have high levels of functional and psychosocial deficits; however, clinician recognition and management of deficits were poor. The use of GA instruments to guide referrals to appropriate services is a way to potentially improve outcomes in this vulnerable population. IMPLICATIONS FOR PRACTICE Geriatric assessment (GA) is an important tool in the management of older cancer patients; however, its primary clinical use has been in the outpatient setting. During an unplanned hospitalization, patients are extremely frail and are most likely to benefit from GA. This study demonstrates that hospitalized older adults with cancer have high levels of functional deficits on GA. These deficits are under-recognized and poorly managed by hospital-based clinicians in a tertiary care setting. Incorporation of GA measures during a hospital stay is a way to improve outcomes in this population.
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Affiliation(s)
- Caroline Mariano
- Medical Oncology, Royal Columbian Hospital, New Westminister, British Columbia, Canada; Medicine/Hematology-Oncology, Division of Geriatric Medicine, Biostatistics Core, Lineberger Comprehensive Cancer Center, and School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Grant Williams
- Medical Oncology, Royal Columbian Hospital, New Westminister, British Columbia, Canada; Medicine/Hematology-Oncology, Division of Geriatric Medicine, Biostatistics Core, Lineberger Comprehensive Cancer Center, and School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Allison Deal
- Medical Oncology, Royal Columbian Hospital, New Westminister, British Columbia, Canada; Medicine/Hematology-Oncology, Division of Geriatric Medicine, Biostatistics Core, Lineberger Comprehensive Cancer Center, and School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shani Alston
- Medical Oncology, Royal Columbian Hospital, New Westminister, British Columbia, Canada; Medicine/Hematology-Oncology, Division of Geriatric Medicine, Biostatistics Core, Lineberger Comprehensive Cancer Center, and School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ashley Leak Bryant
- Medical Oncology, Royal Columbian Hospital, New Westminister, British Columbia, Canada; Medicine/Hematology-Oncology, Division of Geriatric Medicine, Biostatistics Core, Lineberger Comprehensive Cancer Center, and School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Trevor Jolly
- Medical Oncology, Royal Columbian Hospital, New Westminister, British Columbia, Canada; Medicine/Hematology-Oncology, Division of Geriatric Medicine, Biostatistics Core, Lineberger Comprehensive Cancer Center, and School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
| | - Hyman B Muss
- Medical Oncology, Royal Columbian Hospital, New Westminister, British Columbia, Canada; Medicine/Hematology-Oncology, Division of Geriatric Medicine, Biostatistics Core, Lineberger Comprehensive Cancer Center, and School of Nursing, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, USA
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Hutchinson AF, Graco M, Rasekaba TM, Parikh S, Berlowitz DJ, Lim WK. Relationship between health-related quality of life, comorbidities and acute health care utilisation, in adults with chronic conditions. Health Qual Life Outcomes 2015; 13:69. [PMID: 26021834 PMCID: PMC4446844 DOI: 10.1186/s12955-015-0260-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/08/2015] [Indexed: 01/13/2023] Open
Abstract
Background There is increased interest in developing multidisciplinary ambulatory care models of service delivery to manage patients with complex chronic diseases. These programs are expensive and given limited resources it is important that care is targeted effectively. One potential screening strategy is to identify individuals who report the greatest decrement in health related quality of life (HRQoL) and thus greater need. The aim of this study was to explore the relationship between HRQoL, comorbid conditions and acute health care utilisation. Methods A prospective, longitudinal cohort design was used to evaluate the impact of HRQoL on acute care utilisation rates over three-years of follow-up. Participants were enrolled in chronic disease management programs run by a metropolitan health service in Australia. Baseline data was collected from 2007–2009 and follow-up data until 2012. Administrative data was used to classify patients’ primary reasons for enrolment, number of comorbidities (Charlson Score) and presentations to acute care. At enrolment, HRQoL was measured using the Assessment of Quality of Life (AQoL) instrument, for analysis AQoL scores were dichotomised at two standard deviations below the population norm. Results There were 1999 participants (54 % male) with a mean age of 63 years (range 18–101), enrolled in the study. Participants’ primary health conditions at enrolment were: diabetes 915 (46 %), chronic respiratory disease 463 (23 %), cardiac disease 260 (13 %), peripheral vascular disease, and 181 (9 %) and aged care 180 (9 %). At 1-year multivariate logistic regression models demonstrated that AQOL utility score was not predictive of acute care presentations after adjusting for comorbidities. Over 3-years an AQoL utility score in the lowest quartile was predictive of both ED presentation (OR 1.58, 95 % CI, 1.16–2.13, p = 0.003) and admissions (OR 1.67, 95 % CI.1.21 to 2.30, p = 0.002) after adjusting for differences in age and comorbidities. Conclusion This study found that both HRQoL and comorbidities were predictive of subsequent acute care attendance over 3-years of follow-up. At 1-year, comorbidities was a better predictor of acute care representation than HRQoL. To maximise benefits, programs should initially focus on medical disease management, but subsequently switch to strategies that enhance health independence and raise HRQoL.
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Affiliation(s)
- Anastasia F Hutchinson
- Northern Clinical Research Centre, Northern Health, 185 Cooper Street, 3076, Epping, Victoria, Australia. .,Centre for Quality Patient Safety Research, School of Nursing & Midwifery, Deakin University, Victoria, Australia.
| | - Marnie Graco
- Northern Clinical Research Centre, Northern Health, 185 Cooper Street, 3076, Epping, Victoria, Australia. .,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia.
| | - Tshepo Mokuedi Rasekaba
- Northern Clinical Research Centre, Northern Health, 185 Cooper Street, 3076, Epping, Victoria, Australia. .,Primary Care Research Unit, General Practice and Primary Health Care Academic Unit, The University of Melbourne, Melbourne, Australia.
| | - Sumit Parikh
- Northern Clinical Research Centre, Northern Health, 185 Cooper Street, 3076, Epping, Victoria, Australia.
| | | | - Wen Kwang Lim
- Northern Clinical Research Centre, Northern Health, 185 Cooper Street, 3076, Epping, Victoria, Australia. .,Department of Medicine and Aged Care, Northern Health & Department of Medicine, The University of Melbourne, Melbourne, Australia.
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Cobo CMS. The influence of institutionalization on the perception of autonomy and quality of life in old people. Rev Esc Enferm USP 2014; 48:1013-9. [DOI: 10.1590/s0080-623420140000700008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the influence exercised by institutionalization on the autonomy and perception of quality of life among the institutionalized elderly. Method The study is quasi-experimental (interrupted time series) and longitudinal. The sample is composed for 104 elderly people who went into a three nursing home in Santander, Spain. To assess the quality of life and dependence two scales were used: the Barthel Index and Lawton Index. Results There was an important relationship between autonomy and independence and their deterioration due to their institutionalisation, such as the physical and social aspects. Conclusion It´s important to point out that the dependence of the elderly is a complex phenomenon, which admits many types of intervention, including the customary ones referring to more classic welfare actions which tend to supplant the absence of autonomy in everyday life by facilitating services and attention to make up for this need, without having to resort to institutionalization.
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21
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Georgopoulou S, Efraimidou S, MacLennan SJ, Ibrahim F, Cox T. Antiphospholipid (Hughes) syndrome: description of population and health-related quality of life (HRQoL) using the SF-36. Lupus 2014; 24:174-9. [DOI: 10.1177/0961203314551809] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective Antiphospholipid (Hughes) syndrome (APS) affects mainly women 15 to 50 years of age and is responsible for approximately 20% of strokes in people <40 years. Little is known about the psychological burden of this long-term condition. We investigated HRQoL in APS. Methods We conducted a cross-sectional survey involving 270 members of the Hughes Syndrome Foundation worldwide. Data included HRQoL (SF-36), demographics, and APS-related self-reported major issues. Response rate was 60%. Results T-tests indicated significantly worse mean scores for seven of the eight domains of the SF-36 in secondary antiphospholipid syndrome (SAPS) compared to primary antiphospholipid syndrome (PAPS), e.g. bodily pain t(263) = 6.10 p < 0.001 except for mental health t(267) = 1.95 p = 0.053. PAPS appeared to be associated with poorer HRQoL in most mental health domains but overall better physical domains compared to systemic lupus erythematosus (SLE) alone. SAPS appeared to have a more adverse impact on HRQoL compared to PAPS and SLE. Major issues identified: pain and fatigue, lack of health care professional/public awareness, and medication unpredictability. Conclusion HRQoL in PAPS appears to be generally better than SLE and SAPS in physical domains, but poorer in mental domains. APS patients might need more social support in terms of information and awareness of the condition to improve their coping strategies.
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Affiliation(s)
- S Georgopoulou
- Academic Department of Rheumatology, King’s College London, London, United Kingdom
| | - S Efraimidou
- Centre for Sustainable Working Life, School of Business, Economics & Informatics, Birkbeck University of London, London, United Kingdom
| | - S J MacLennan
- Academic Urology Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - F Ibrahim
- Academic Department of Rheumatology, King’s College London, London, United Kingdom
| | - T Cox
- Centre for Sustainable Working Life, School of Business, Economics & Informatics, Birkbeck University of London, London, United Kingdom
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22
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Challen L, Kelso C, Gandhi B. Association between Prescription Drug Benefit and Hospital Readmission Rates. Hosp Pharm 2014; 49:449-54. [DOI: 10.1310/hpj4905-449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine whether primary care medicine clinic (PCMC) patients with a prescription drug benefit were associated with a lower rate of hospital readmissions. Methods This study was a retrospective, single-center, cohort study of PCMC patients who had at least 1 hospital readmission in 2011. Eligible patients were divided into 2 groups: patients without prescription drug benefits and patients with prescription drug benefits. Results Three hundred fifty-two patients met our inclusion criteria. The number of hospital readmissions for patients with a prescription drug benefit was higher than those with no prescription drug benefit (2.453 ± 2.49 vs 1.88 ± 1.91; P = .052). The length of index admission and the length of hospital readmission in days were higher in patients with no prescription drug benefits (index admission, 5.29 ± 6.38 vs 4.59 ± 4.50; P = .428) (readmission, 5.31 ± 5.90 vs 4.48 ± 4.33, P = .166). The number of days to readmission was higher in those with drug benefits (58.12 ± 63.54 vs 53.39 ± 53.47; P = .316). When patient data were separated by CCI scores, it was noted that patients with pharmacy benefits had significantly more hospital readmissions in each CCI score category except for patients with a CCI of 6. Conclusion Although not statistically significant, patients with prescription drug benefits had more hospital readmissions but shorter hospital lengths of stay. Significant data linking hospital readmissions and prescription insurance benefits, if found in future studies, would provide helpful guidance to health care systems.
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Affiliation(s)
- Laura Challen
- Department of Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, Missouri
| | - Christine Kelso
- Barnes-Jewish Hospital's Primary Care Medicine Clinic, St. Louis, Missouri
| | - Bhumi Gandhi
- St. Louis College of Pharmacy, St. Louis, Missouri
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