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Paul C, Schöttker B, Hartmann M, Friederich HC, Brenner H, Wild B. Gender-specific factors associated with case complexity in middle-aged and older adults-Evidence from a large population-based study. Int J Geriatr Psychiatry 2024; 39:e6113. [PMID: 38877644 DOI: 10.1002/gps.6113] [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: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES To investigate gender-specific factors associated with case complexity in a population-based sample of middle-aged and older adults using a holistic approach to complexity. METHODS Data were derived from the 8-year follow-up home visits of the ESTHER study-a German population-based study in middle-aged and older adults. Cross-sectional analyses were conducted for 2932 persons (aged 57-84). Complexity was assessed by the well-established INTERMED for the elderly interview, which uses a holistic approach to the definition of case complexity. The association between various bio-psycho-social variables and case complexity was analyzed using gender-specific logistic regression models, adjusted for sociodemographic factors (age, marital status, education). RESULTS Prevalence of complexity was 8.3% with significantly higher prevalence in female (10.6%) compared to male (5.8%) participants (p < 0.001). Variables associated with increased odds for complexity in both, women and men were: being divorced (odds ratio [OR] women: 1.86, 95% CI 1.05-3.30; OR men: 3.19, 1.25-8.12), higher total somatic morbidity (women: 1.08, 1.04-1.12; men: 1.06, 1.02-1.11), higher depression severity (women: 1.34, 1.28-1.40; men: 1.35, 1.27-1.44), and higher loneliness scores (women: 1.19, 1.05-1.36; men: 1.23, 1.03-1.47). Women (but not men) with obesity (Body mass index [BMI] ≥30) had higher odds (1.79, 1.11-2.89) for being complex compared to those with a BMI <25. High oxidative stress measured by derivatives of reactive oxygen metabolites in serum was associated with 2.02 (1.09-3.74) higher odds for complexity only in men. CONCLUSIONS This study provides epidemiological evidence on gender differences in prevalence and factors associated with case complexity in middle-aged and older adults. Moreover, this study adds to the holistic understanding of complexity by identifying novel variables linked to complexity among middle-aged and older individuals. These factors include loneliness for both genders, and high oxidative stress for men. These findings should be confirmed in future longitudinal studies.
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Affiliation(s)
- Cinara Paul
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
- DZPG German Centre for Mental Health-Partner Site Heidelberg/Mannheim/Ulm, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
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Gallagher D, Bentley B, Barry A, Fraccola A, Santos R, Glenn A, Howard J, Kamath A, Flanagan K. Development of an Emergency Department Case Management Case-Finding Tool. Prof Case Manag 2024; 29:102-110. [PMID: 37982739 PMCID: PMC10984631 DOI: 10.1097/ncm.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
PURPOSE OF STUDY Identifying emergency department (ED) patients who are at high risk for return visits is an important goal for case management to improve patient care. This quality improvement study describes the development and evaluation of the Emergency Department Case Management Priority Score (EDCMPS), an electronic medical record (EMR)-based "case-finding" system, and its ability to identify these high-risk patients. In addition, the authors present data about its acceptability among emergency department case managers (ED CMs). PRIMARY PRACTICE SETTINGS Emergency departments with case management availability and staffing. METHODOLOGY AND SAMPLE A retrospective analysis at Duke University Hospital ED compared patient data pre- and postimplementation of the EDCMPS. The tool was developed using the LEAN and Plan-Do-Study-Act (PDSA) quality improvement methodologies, with ED CM participation. ED return and hospitalization rates within 7 and 30 days between both methods were compared, and a survey evaluated CM satisfaction with the EDCMPS. RESULTS The 2-month preintervention period (July 1, 2022, to August 31, 2022) included 8,677 patients discharged from the ED, with 897 patients (10.3%) identified as at high risk for return based on the previous manual methodology. In the 3-month postintervention period (September 1, 2022, to November 30, 2022), there were 13,566 patients discharged, with 692 patients (5.1%) identified as at high risk for return using the EDCMPS. The EDCMPS outperformed the manual method, yielding a significantly higher odds ratio (OR) for 7- and 30-day ED return or hospitalization (e.g., 30-day any return OR = 4.21 vs. 1.69). The survey showed broad ED CM agreement on the tool's superior performance, especially in organizing outpatient resources and referring to support programs. However, challenges in securing primary care follow-up, housing, and health insurance applications were identified. The tool's collaborative development approach ensured its fit to ED CM needs, contributing to its success. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE The EDCMPS showcases promise in enhancing ED CM efficiency, with strong frontline staff endorsement. It pinpoints areas needing focus for patient support and has the potential to reduce ED revisits and therefore health care utilization. Its methodology offers insights for similar future implementations in health care institutions.
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Affiliation(s)
- David Gallagher
- Address correspondence to David Gallagher, MD, SFHM, Duke University School of Medicine, DUMC Box 3508, Durham, NC 27710 ()
| | - Barbara Bentley
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Ashley Barry
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Amy Fraccola
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Rosimeire Santos
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Adam Glenn
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - James Howard
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Aparna Kamath
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
| | - Katie Flanagan
- David Gallagher, MD, SFHM, is the Chief Medical Officer for Duke University Hospital and previously was Chief of Hospital Medicine programs. He is Associate Professor of Medicine at Duke University and has published in a variety of hospital-based quality improvement areas. He also works clinically as a hospitalist
- Barbara Bentley, MBA, MSN, RN, CCM, is the Assistant Director of Case Management at Duke University Hospital. She has numerous roles within case management including leadership over Duke Hospital Emergency Department Case Management. She has 20+ years of experience in case management in a variety of settings and responsibilities
- Ashley Barry, MSN, MMCi, RN, is Application Analyst at Duke University Health Technology Solutions. She is a registered nurse with advanced training in medical informatics. She has much experience in clinical project management, quality improvement, and patient safety
- Amy Fraccola, MSN, RN, ACM, is the Director of Case Management at Duke Raleigh Hospital. She has many years of case management leadership experience and before joining Duke she worked at Penn Highlands Healthcare
- Rosimeire Santos, MS, is Data Analytics Engineer with Duke Health and has significant experience in data analysis involving Epic and Cerner Information Systems as well as project management experience at multiple academic medical centers
- Adam Glenn, BSIE, LSSBB, is an Improvement Engineer with Duke University Health System. Adam has expertise in project management, quality improvement, LEAN and Six Sigma methodologies, and change management. He serves as a leader for strategic health system priorities focused on improving quality of care as well as experience for patients and staff
- James Howard, MD, is the Duke Hospital Medicine Nocturnist Associate Medical Director and Assistant Professor of Medicine at Duke School of Medicine. He works clinically as a hospitalist. He has expertise in clinical quality and safety, patient experience, and physician leadership
- Aparna Kamath, MD, is Duke Raleigh Hospital's Medical Director for Quality and works extensively in quality initiatives including mortality, length of stay, and readmissions reduction projects. She is Associate Professor of Medicine at Duke University and has a master's degree in Clinical Investigation
- Katie Flanagan, MSW, LCSW, ACM-SW, is the Assistant Vice President for Care Coordination for Duke University Health System. She has significant training and experience in case management and leadership. She is the current President of the North Carolina Chapter of the American Case Management Association
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Sánchez Martínez MP, Sánchez-Barbadora M, Moreno-Segura N, Beltrá P, Escriche-Escuder A, Martín-San Agustín R. Responsiveness of monopodal postural stability tests in recreational athletes. PeerJ 2024; 12:e16765. [PMID: 38223752 PMCID: PMC10788087 DOI: 10.7717/peerj.16765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/14/2023] [Indexed: 01/16/2024] Open
Abstract
Background Stabilometry, the modified Star Excursion Balance Test (mSEBT) or the Emery balance test (EBT) are reported in the literature to reflect changes after an intervention in monopodal postural stability. Even so, the responsiveness of those tests has not been evaluated after an instability training programme or analysed using multiple statistical indicators of responsiveness. The main aim of this study was to analyse the responsiveness of the stabilometry, mSEBT or EBT. Methods Thirty healthy recreational athletes performed a 4-week programme with three weekly sessions of instability training of the dominant lower limb and were evaluated using stabilometry, mSEBT, and EBT tests. Responsiveness was quantified based on internal and external responsiveness. Results EBT and all parameters in mSEBT for the dominant lower limb showed large internal responsiveness (SRM > 0.8). Furthermore, mSEBT values for the non-dominant lower limb (except anterior displacement) also experienced significant changes with an associated large internal responsiveness. None of the stabilometry platform parameters showed a significant change after the intervention. The ability of the EBT to discriminate between the dominant and non-dominant lower limb (i.e., trained vs untrained, respectively) was generally acceptable (AUCs = 0.708). However, none of the parameters of the mSEBT test showed an acceptable AUC. Conclusions EBT showed a positive responsiveness after instability training compared to mSEBT, which only showed internal responsiveness, or stabilometry platform measures, whose none of the parameters could identify these changes.
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Affiliation(s)
| | | | | | - Patricia Beltrá
- Faculty of Health Sciences, Universidad Europea de Valencia, Valencia, Spain
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Hempel S, Bolshakova M, Hochman M, Jimenez E, Thompson G, Motala A, Ganz DA, Gabrielian S, Edwards S, Zenner J, Dennis B, Chang E. Caring for high-need patients. BMC Health Serv Res 2023; 23:1289. [PMID: 37996845 PMCID: PMC10668484 DOI: 10.1186/s12913-023-10236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE We aimed to explore the construct of "high need" and identify common need domains among high-need patients, their care professionals, and healthcare organizations; and to describe the interventions that health care systems use to address these needs, including exploring the potential unintended consequences of interventions. METHODS We conducted a modified Delphi panel informed by an environmental scan. Expert stakeholders included patients, interdisciplinary healthcare practitioners (physicians, social workers, peer navigators), implementation scientists, and policy makers. The environmental scan used a rapid literature review and semi-structured interviews with key informants who provide healthcare for high-need patients. We convened a day-long virtual panel meeting, preceded and followed by online surveys to establish consensus. RESULTS The environmental scan identified 46 systematic reviews on high-need patients, 19 empirical studies documenting needs, 14 intervention taxonomies, and 9 studies providing construct validity for the concept "high need." Panelists explored the construct and terminology and established that individual patients' needs are unique, but areas of commonality exist across all high-need patients. Panelists agreed on 11 domains describing patient (e.g., social circumstances), 5 care professional (e.g., communication), and 8 organizational (e.g., staffing arrangements) needs. Panelists developed a taxonomy of interventions with 15 categories (e.g., care navigation, care coordination, identification and monitoring) directed at patients, care professionals, or the organization. The project identified potentially unintended consequences of interventions for high-need patients, including high costs incurred for patients, increased time and effort for care professionals, and identification of needs without resources to respond appropriately. CONCLUSIONS Care for high-need patients requires a thoughtful approach; differentiating need domains provides multiple entry points for interventions directed at patients, care professionals, and organizations. Implementation efforts should consider outlined intended and unintended downstream effects on patients, care professionals, and organizations.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA.
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Michael Hochman
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, CA, USA
| | - Elvira Jimenez
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Gina Thompson
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - David A Ganz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | | | | | - James Zenner
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | - Ben Dennis
- Southern California Evidence Review Center, University of Southern California, Los Angeles, USA
| | - Evelyn Chang
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Sehgal A, Scott S, Murry A, Henderson R, Barnabe C, Crowshoe LL. Critically examining health complexity experienced by urban Indigenous peoples in Canada by exploring the factors that allow health complexity to persist: a qualitative study of Indigenous patients in Calgary, Alberta. BMJ Open 2023; 13:e073184. [PMID: 37903604 PMCID: PMC10619072 DOI: 10.1136/bmjopen-2023-073184] [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: 03/01/2023] [Accepted: 10/05/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVES This study aims to identify and critically examine the components of health complexity, and explore the factors that allow it to exist, among urban Indigenous peoples in Canada. DESIGN Qualitative exploration with relational conversations. SETTING Calgary, Alberta, Canada. PARTICIPANTS A total of nine urban Indigenous patients were recruited from a multidisciplinary primary healthcare clinic that serves First Nations, Métis and Inuit peoples. Recruitment and data collection took place between September and November 2021. RESULTS Thematic analysis revealed three main themes, namely: sources of health complexity, psychological responses to adversity, and resilience, strengths, and protective factors. Key sources of health complexity arose from material resource disparities and adverse interpersonal interactions within the healthcare environment, which manifest into psychological distress while strengths and resilience emerged as protective factors. CONCLUSION The healthcare system remains inapt to address complexity among urban Indigenous peoples in Canada. Healthcare violence experienced by Indigenous peoples only further perpetuates health complexity. Future clinical tools to collect information about health complexity among urban Indigenous patients should include questions about the factors defined in this study.
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Affiliation(s)
- Anika Sehgal
- Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sara Scott
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Murry
- Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Rita Henderson
- Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden Lindsay Crowshoe
- Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Barry L, Tighe SM, Griffin A, Ryan D, O'Connor M, Fitzgerald C, Egan S, Galvin R, Meskell P. A qualitative evidence synthesis (QES) exploring the barriers and facilitators to screening in emergency departments using the theoretical domains framework. BMC Health Serv Res 2023; 23:1090. [PMID: 37821877 PMCID: PMC10568862 DOI: 10.1186/s12913-023-10027-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Validated screening tools can be utilised to detect early disease processes and risk factors for disease and adverse outcomes. Consequently, identifying individuals in need of early intervention and targeted assessment can be achieved through the implementation of screening in the ED. Successful implementation can be impacted by a lack of resources and ineffective integration of screening into the clinical workflow. Tailored implementation processes and staff training, which are contextually specific to the ED setting, are facilitators to effective implementation. This review will assist in the identification of barriers and facilitators to screening in the ED using a QES to underpin implementation processes. Healthcare workers engage in screening in the ED routinely. Consequently, this review focused on synthesizing the experience of healthcare workers (HCWs) who are involved in this process. This synthesis is informed by a QES protocol published by the lead author in 2021 (Barry et al., HRB Open Res 3:50, 2021). METHODOLOGY A comprehensive literature search, inclusive of grey literature sources, was undertaken. Initially, an a priori framework of themes was formed to facilitate the interpretation and organisation of search results. A context specific conceptual model was then formulated using "Best fit" framework synthesis which further assisted in the interpretation of data that was extracted from relevant studies. Dual blind screening of search results was undertaken using RAYYAN as a platform. Thirty studies were identified that met the inclusion criteria. Dual appraisal of full text articles was undertaken using CASP, GRADE CERQual assessed confidence of findings and data extraction was performed by two reviewers collaboratively. FINDINGS This is the first known synthesis of qualitative research on HCW's experiences of screening in the ED. Predominantly, the findings illustrate that staff experience screening in the ED as a complex challenging process. The barriers and facilitators identified can be broadly categorised under preconditions to screen, motivations to screen and knowledge and skills to screen. Competing interests in the ED, environmental stressors such as overcrowding and an organisational culture that resists screening were clear barriers. Adequate resources and tailored education to underpin the screening process were clear facilitators. TRIAL REGISTRATION PROSPERO: CRD42020188712 05/07/20.
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Affiliation(s)
- Louise Barry
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Limerick, Ireland.
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Limerick, Ireland.
| | - Sylvia Murphy Tighe
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Limerick, Ireland
| | - Anne Griffin
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Limerick, Ireland
| | - Damien Ryan
- Emergency Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Margaret O'Connor
- Department of Ageing and Therapeutics, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Christine Fitzgerald
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Limerick, Ireland
| | - Siobhan Egan
- Clinical Research Support Unit, University Hospital Limerick, Dooradoyle, Limerick, Ireland
| | - Rose Galvin
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Limerick, Ireland
| | - Pauline Meskell
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Castletroy, Limerick, Ireland
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Haji-Sheikhi F, Fragala MS, Bare LA, Rowland CM, Goldberg SE. Prediction of Future Medical Costs by Modifiable Measures of Health. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:525-534. [PMID: 37408662 PMCID: PMC10319160 DOI: 10.2147/ceor.s406525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/01/2023] [Indexed: 07/07/2023] Open
Abstract
Introduction Strategies to mitigate rising health-care costs are a priority for patients, employers, and health insurers. Yet gaps currently exist in whether health risk assessment can forecast medical claims costs. This study examined the ability of a health quotient (HQ) based on modifiable risk factors, age, sex, and chronic conditions to predict future medical claims spending. Methods The study included 18,695 employees and adult dependents who participated in health assessments and were enrolled in an employer-sponsored health plan. Linear mixed effect models stratified by chronic conditions and adjusted for age and sex were utilized to evaluate the relationship between the health quotient (score of 0-100) and future medical claims spending. Results Lower baseline health quotient was associated with higher medical claims cost over 2 years of follow up. For participants with chronic condition(s), costs were $3628 higher for those with a low health quotient (<73; N = 2673) compared to those with high health quotient (>85; N = 1045), after adjustment for age and sex (P value = 0.004). Each one-unit increase in health quotient was associated with a decrease of $154 (95% CI: 87.4, 220.3) in average yearly medical claims costs during follow up. Discussion This study used a large employee population with 2 years of follow-up data, which provides insights that are applicable to other large employers. Results of this analysis contribute to our ability to predict health-care costs using modifiable aspects of health, objective laboratory testing and chronic condition status.
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8
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Goñi-Navarro A, Mollá-Roig P, de la Fuente-Meira S, Campos Ródenas R. [Translated article] Biopsychosocial Complexity in Patients With Hidradenitis Suppurativa: A Pilot Study of a Psychodermatology Assessment Scale. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T271-T273. [PMID: 36690148 DOI: 10.1016/j.ad.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 12/31/2021] [Indexed: 01/22/2023] Open
Affiliation(s)
- A Goñi-Navarro
- Servicio de Psiquiatría del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - P Mollá-Roig
- Servicio de Psiquiatría del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - S de la Fuente-Meira
- Servicio de Dermatología del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - R Campos Ródenas
- Servicio de Psiquiatría del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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9
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Biopsychosocial Complexity in Patients With Hidradenitis Suppurativa: A Pilot Study of a Psychodermatology Assessment Scale. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:271-273. [PMID: 35963338 DOI: 10.1016/j.ad.2021.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/28/2021] [Accepted: 12/31/2021] [Indexed: 11/21/2022] Open
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de Oliveira CA, Weber B, de Camargo LL, Balco EM, Barros MA, Zanetti ACG, Lobo E, Rzewuska M, de Azevedo-Marques JM. INTERMED's reliability to assess health complexity in primary care: A Brazilian cross-section study. Gen Hosp Psychiatry 2023; 81:89-90. [PMID: 36732206 DOI: 10.1016/j.genhosppsych.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 01/30/2023]
Affiliation(s)
| | | | - Lisa Laredo de Camargo
- Program in Psychiatric Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
| | - Estenifer Marque Balco
- Public Health Postgraduate Program, Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Michel Arantes Barros
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Center for Nursing Research Development, São Paulo, Brazil
| | - Elena Lobo
- Department of Preventive Medicine and Public Health, University of Zaragoza, Spain; Aragon Health Research Institute (IIS-A), Spain
| | - Magdalena Rzewuska
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Aberdeen Center for Health Data Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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11
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Mann J, Devine S, Strivens E. Primary care and the older person with complex needs: reflections on the implementation of a primary–secondary model of integrated care. Aust J Prim Health 2022; 28:469-473. [PMID: 35981911 DOI: 10.1071/py21236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 07/19/2022] [Indexed: 12/13/2022]
Abstract
The demand and complexity of the health needs of older people is growing. Traditionally siloed, condition-centric care is no longer appropriate. It is costly to the Australian health system and life-threatening to the individual. In parallel to demographic change is increasing global awareness of the impact of social, behavioural, and environmental factors on health outcomes. Although significant when not addressed, the amenable nature of many personal contextual factors is an opportunity to improve health and quality of life. A move away from reactive, episodic models of health care delivery towards patient focussed integrated care is required to meet the changing demands of an aging population. This forum article provides a reflection on the current state of integration for older people with complex needs through the lens of a local community facing model: OPEN ARCH. Australia still has some way to go to establishing system level enablers for an integrated approach to care. However, the OPEN ARCH experience furthers the evidence for ground-up approaches of integrated care that can meet the increasing demand and complexity of older people's needs.
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Affiliation(s)
- Jennifer Mann
- Cairns and Hinterland Hospital and Health Service, PO Box 906, Cairns, Qld 4870, Australia; and College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Qld 4811, Australia
| | - Sue Devine
- College of Public Health, Medicine and Veterinary Sciences, James Cook University, Townsville, Qld 4811, Australia
| | - Edward Strivens
- Cairns and Hinterland Hospital and Health Service, PO Box 906, Cairns, Qld 4870, Australia; and College of Medicine and Dentistry, James Cook University, Townsville, Qld 4811, Australia
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12
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Kaneko H, Hanamoto A, Yamamoto-Kataoka S, Kataoka Y, Aoki T, Shirai K, Iso H. Evaluation of Complexity Measurement Tools for Correlations with Health-Related Outcomes, Health Care Costs and Impacts on Healthcare Providers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16113. [PMID: 36498188 PMCID: PMC9741446 DOI: 10.3390/ijerph192316113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Various tools to measure patient complexity have been developed. Primary care physicians often deal with patient complexity. However, their usefulness in primary care settings is unclear. This study explored complexity measurement tools in general adult and patient populations to investigate the correlations between patient complexity and outcomes, including health-related patient outcomes, healthcare costs, and impacts on healthcare providers. We used a five-stage scoping review framework, searching MEDLINE and CINAHL, including reference lists of identified studies. A total of 21 patient complexity management tools were found. Twenty-five studies examined the correlation between patient complexity and health-related patient outcomes, two examined healthcare costs, and one assessed impacts on healthcare providers. No studies have considered sharing information or action plans with multidisciplinary teams while measuring outcomes for complex patients. Of the tools, eleven used face-to-face interviews, seven extracted data from medical records, and three used self-assessments. The evidence of correlations between patient complexity and outcomes was insufficient for clinical implementation. Self-assessment tools might be convenient for conducting further studies. A multidisciplinary approach is essential to develop effective intervention protocols. Further research is required to determine these correlations in primary care settings.
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Affiliation(s)
- Hiromitsu Kaneko
- Faculty of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
| | | | - Sachiko Yamamoto-Kataoka
- Department of Health Informatics, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Tanaka Asukai-cho 89, Kyoto 606-8226, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Shogoin Kawara-cho 54, Kyoto 606-8507, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Kyoto 606-8501, Japan
| | - Takuya Aoki
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Shogoin Kawara-cho 54, Kyoto 606-8507, Japan
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kokoro Shirai
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Hiroyasu Iso
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
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Bujold M, Pluye P, Légaré F. Decision-making and related outcomes of patients with complex care needs in primary care settings: a systematic literature review with a case-based qualitative synthesis. BMC PRIMARY CARE 2022; 23:279. [PMID: 36352376 PMCID: PMC9644584 DOI: 10.1186/s12875-022-01879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In primary care, patients increasingly face difficult decisions related to complex care needs (multimorbidity, polypharmacy, mental health issues, social vulnerability and structural barriers). There is a need for a pragmatic conceptual model to understand decisional needs among patients with complex care needs and outcomes related to decision. We aimed to identify types of decisional needs among patients with complex care needs, and decision-making configurations of conditions associated with decision outcomes. METHODS We conducted a systematic mixed studies review. Two specialized librarians searched five bibliographic databases (Medline, Embase, PsycINFO, CINAHL and SSCI). The search strategy was conducted from inception to December 2017. A team of twenty crowd-reviewers selected empirical studies on: (1) patients with complex care needs; (2) decisional needs; (3) primary care. Two reviewers appraised the quality of included studies using the Mixed Methods Appraisal Tool. We conducted a 2-phase case-based qualitative synthesis framed by the Ottawa Decision Support Framework and Gregor's explicative-predictive theory type. A decisional need case involved: (a) a decision (what), (b) concerning a patient with complex care needs with bio-psycho-social characteristics (who), (c) made independently or in partnership (how), (d) in a specific place and time (where/when), (e) with communication and coordination barriers or facilitators (why), and that (f) influenced actions taken, health or well-being, or decision quality (outcomes). RESULTS We included 47 studies. Data sufficiency qualitative criterion was reached. We identified 69 cases (2997 participants across 13 countries) grouped into five types of decisional needs: 'prioritization' (n = 26), 'use of services' (n = 22), 'prescription' (n = 12), 'behavior change' (n = 4) and 'institutionalization' (n = 5). Many decisions were made between clinical encounters in situations of social vulnerability. Patterns of conditions associated with decision outcomes revealed four decision-making configurations: 'well-managed' (n = 13), 'asymmetric encounters' (n = 21), 'self-management by default' (n = 8), and 'chaotic' (n = 27). Shared decision-making was associated with positive outcomes. Negative outcomes were associated with independent decision-making. CONCLUSION Our results could extend decision-making models in primary care settings and inform subsequent user-centered design of decision support tools for heterogenous patients with complex care needs.
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Affiliation(s)
- Mathieu Bujold
- Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montreal, Canada.
- Department of Family Medicine, McGill University, Montreal, Canada.
| | - Pierre Pluye
- Department of Family Medicine, McGill University, Montreal, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
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Cohidon C, Gallay E, Wild P, Stiefel F, Bourquin C, Senn N. Identifying complex patients in family medicine for potential benefit from a case manager: a short questionnaire derived from the INTERMED Self-Assessment (IMSA) questionnaire. BMC PRIMARY CARE 2022; 23:276. [PMID: 36333794 PMCID: PMC9636696 DOI: 10.1186/s12875-022-01876-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/13/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022]
Abstract
Purpose To investigate how useful the Intermed-Self Assessment (IMSA) questionnaire and its components were for identifying which patient candidates would benefit most from case management (CM) in general practice. Methods The study was carried out in a group family medicine practice in Lausanne comprising seven GPs and four medical assistants, from February to April 2019. All the patients attending the practice between February and April 2019 were invited to complete the IMSA questionnaire. Additionally, their GPs were asked for their opinions on the potential benefits of each patient being assigned a case manager. Each IMSA item’s value has been assessed as a predictor of GPs’ opinions by using multivariate logistic models. A score including items retained as predictor was built. Results Three hundred and thirty one patients participated in the study (participation rate: 62%). Three items from the 20 item IMSA were sufficient to predict GPs’ opinions about whether their patients could be expected to benefit if assigned a case manager. Those items addressed the patient’s existing chronic diseases (item1), quality of life in relation to existing diseases (item 3), and their social situation (item 9). Using these three items as a score, a cut-off at 4 gave a sensitivity of 70% (ability to correctly identify patients who could benefit from a CM) and specificity of 73% (ability to correctly identify patients who should not benefit from a CM) and concerned about one patient in two. Conclusion Identifying complex patients suitable for case management remains a challenge for primary care professionals. This paper describes a novel approach using a structured process of combining the results of standardized tools such as the one defined in this study, and the experience of the primary care team. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01876-8.
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Affiliation(s)
- Christine Cohidon
- grid.9851.50000 0001 2165 4204Department of Family Medicine, Center for Primary Care and General Medicine (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Emilie Gallay
- grid.9851.50000 0001 2165 4204Department of Family Medicine, Center for Primary Care and General Medicine (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Friedrich Stiefel
- grid.8515.90000 0001 0423 4662Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Céline Bourquin
- grid.8515.90000 0001 0423 4662Psychiatric Liaison Service, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Nicolas Senn
- grid.9851.50000 0001 2165 4204Department of Family Medicine, Center for Primary Care and General Medicine (Unisanté), University of Lausanne, Lausanne, Switzerland
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Sehgal A, Barnabe C, Crowshoe L(L. Patient complexity assessment tools containing inquiry domains important for Indigenous patient care: A scoping review. PLoS One 2022; 17:e0273841. [PMID: 36044532 PMCID: PMC9432764 DOI: 10.1371/journal.pone.0273841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 08/16/2022] [Indexed: 11/21/2022] Open
Abstract
Patient complexity assessment tools (PCATs) are utilized to collect vital information to effectively deliver care to patients with complexity. Indigenous patients are viewed in the clinical setting as having complex health needs, but there is no existing PCAT developed for use with Indigenous patients, although general population PCATs may contain relevant content. Our objective was to identify PCATs that include the inquiry of domains relevant in the care of Indigenous patients with complexity. A scoping review was performed on articles published between 2016 and 2021 to extend a previous scoping review of PCATs. Data extraction from existing frameworks focused on domains of social realities relevant to the care of Indigenous patients. The search resulted in 1078 articles, 82 underwent full-text review, and 9 new tools were identified. Combined with previously known and identified PCATs, only 6 items from 5 tools tangentially addressed the domains of social realities relevant to Indigenous patients. This scoping review identifies a major gap in the utility and capacity of PCATs to address the realities of Indigenous patients. Future research should focus on developing tools to address the needs of Indigenous patients and improve health outcomes.
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Affiliation(s)
- Anika Sehgal
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden (Lindsay) Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Skoy E, Frenzel O, Eukel H, Lothspeich E, Steig J, Strand M, Werremeyer A. Evaluation of a Program to Screen Patients in Community Pharmacies for Opioid Misuse and Accidental Overdose. Prev Chronic Dis 2022; 19:E41. [PMID: 35834737 PMCID: PMC9336191 DOI: 10.5888/pcd19.220028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Community pharmacies nationwide have adopted new strategies to combat the opioid epidemic. One strategy to prevent opioid misuse and accidental overdose is patient screening to identify those at risk. The purpose of our study was to determine whether such screening in community pharmacies led pharmacy personnel to intervene with patients at risk and to describe the proportion of patients they identified as at risk. Methods We implemented the Opioid and Naloxone Education (ONE) program in North Dakota to give community pharmacies and pharmacists training and tools to provide preventive screening for opioid misuse and accidental overdose before dispensing a prescribed opioid. Data were collected and analyzed from September 15, 2018, through May 15, 2021, to evaluate overall patient risk characteristics for opioid misuse and accidental overdose. Results Of 8,217 patients screened, 3.9% were identified as at high risk for opioid misuse, and 18.3% at risk for accidental overdose. Nearly 1 of 3 screenings (31.7%) indicated opioid medication use in the past 60 days. Pharmacists delivered 1 or more risk-factor–dependent interventions to 41.1% of patients in the study. Following screening, naloxone dispensing in pharmacies increased to 6 times the national average. Conclusion Pharmacy-based patient screening for risk of opioid misuse and accidental overdose led to risk-dependent interventions targeted to individual patients. The tools and risk-dependent interventions applied in the ONE program increased patient awareness of opioid risks and ways to reduce risk. Future studies should examine long-term outcomes, including reduction in overdose, treatment of opioid use disorder, and reduced opioid-related acute care.
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Affiliation(s)
- Elizabeth Skoy
- North Dakota State University School of Pharmacy, PO Box 6050, Dept 2660, Fargo, ND 58108.
| | - Oliver Frenzel
- North Dakota State University School of Pharmacy, Fargo, North Dakota.,North Dakota State University School of Public Health, Fargo, North Dakota
| | - Heidi Eukel
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Emily Lothspeich
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Jayme Steig
- North Dakota State University School of Pharmacy, Fargo, North Dakota
| | - Mark Strand
- North Dakota State University School of Pharmacy, Fargo, North Dakota.,North Dakota State University School of Public Health, Fargo, North Dakota
| | - Amy Werremeyer
- North Dakota State University School of Pharmacy, Fargo, North Dakota
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Opioid risk stratification in the community pharmacy: The utility of the Opioid Risk Tool. Res Social Adm Pharm 2022; 18:4065-4071. [DOI: 10.1016/j.sapharm.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/06/2022] [Accepted: 07/15/2022] [Indexed: 11/20/2022]
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Yokokawa D, Shikino K, Kishi Y, Ikusaka M. Translation and Cross-Cultural Adaptation of the Japanese Version of the INTERMED Self-Assessment Questionnaire (IMSA) for Patient-Case Complexity Assessment. Int J Gen Med 2022; 15:6309-6313. [PMID: 35924175 PMCID: PMC9342889 DOI: 10.2147/ijgm.s369056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Correspondence: Daiki Yokokawa, Department of General Medicine, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba, 260-8677, Japan, Tel/Fax +81-43-224-4758, Email
| | - Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yasuhiro Kishi
- Department of Psychiatry, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
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de Oliveira CA, Weber B, dos Santos JLF, Zucoloto ML, de Camargo LL, Zanetti ACG, Rzewuska M, de Azevedo-Marques JM. Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool. PLoS One 2022; 17:e0263702. [PMID: 35180262 PMCID: PMC8856552 DOI: 10.1371/journal.pone.0263702] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Health complexity includes biological, psychological, social, and health systems. Having complex health needs is associated with poorer clinical outcomes and higher healthcare costs. Care management for people with health complexity is increasingly recommended in primary health care (PHC). The INTERMED complexity assessment grid showed adequate psychometric properties in specialized settings. This study aimed to evaluate INTERMED’s validity and feasibility to assess health complexity in an adult PHC population. Method The biopsychosocial health care needs of 230 consecutive adult patients from three Brazilian PHC services were assessed using the INTERMED interview. Participants with a total score >20 were classified as “complex”. Quality of life was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF); symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); social support using the Medical Outcomes Study—Social Support Survey (MOS-SSS); comorbidity levels using the Charlson Comorbidity Index (CCI). We developed two questionnaires to evaluate health services use, and patient perceived feasibility of INTERMED. Results 42 participants (18.3%) were classified as “complex”. A moderate correlation was found between the total INTERMED score and the total scores of WHOQOL-BREF (rho = - 0.59) and HADS (rho = 0.56), and between the social domains of INTERMED and MOS-SSS (rho = -0.44). After adjustment, the use of PHC (β = 2.12, t = 2.10, p < 0.05), any other health care services (β = 3.05, t = 3.97, p < 0.01), and any medication (β = 3.64, t = 4.16, p < 0.01) were associated with higher INTERMED scores. The INTERMED internal consistency was good (ω = 0.83), and the median application time was 7 min. Patients reported satisfaction with the questions, answers, and application time. Conclusion INTERMED displayed good psychometric values in a PHC population and proved promising for practical use in PHC.
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Affiliation(s)
- Camila Almeida de Oliveira
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Bernardete Weber
- Registered Nurse, Hospital do Coração (HCor), São Paulo City, Brazil
| | | | - Miriane Lucindo Zucoloto
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Lisa Laredo de Camargo
- Postgraduate Program in Psychiatric Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, São Paulo, Brazil
| | - Magdalena Rzewuska
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Aberdeen Centre for Health Data Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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Beauchet O, Cooper-Brown LA, Lubov J, Allali G, Afilalo M, Launay CP. "Emergency Room Evaluation and Recommendations" (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER 2 Database. Front Neurol 2022; 12:767285. [PMID: 35069410 PMCID: PMC8770802 DOI: 10.3389/fneur.2021.767285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The Emergency Room Evaluation and Recommendation (ER2) is an application in the electronic medical file of patients visiting the Emergency Department (ED) of the Jewish General Hospital (JGH; Montreal, Quebec, Canada). It screens for older ED visitors at high risk of undesirable events. The aim of this study is to examine the performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], positive likelihood ratio [LR+], negative likelihood ratio [LR-] and area under the receiver operating characteristic curve [AUROC]) of the ER2 high-risk level and its "temporal disorientation" item alone to screen for major neurocognitive disorders in older ED visitors at the JGH. Methods: Based on a cross-sectional design, 999 older adults (age 84.9 ± 5.6, 65.1% female) visiting the ED of the JGH were selected from the ER2 database. ER2 was completed upon the patients' arrival at the ED. The outcomes were ER2's high-risk level, the answer to ER2's temporal disorientation item (present vs. absent), and the diagnosis of major neurocognitive disorders (yes vs. no) which was confirmed when it was present in a letter or other files signed by a physician. Results: The sensitivities of both ER2's high-risk level and temporal disorientation item were high (≥0.91). Specificity, the PPV, LR+, and AROC were higher for the temporal disorientation item compared to ER2's high-risk level, whereas a highest sensitivity, LR-, and NPV were obtained with the ER2 high-risk level. Both area under the receiver operating characteristic curves were high (0.71 for ER2's high-risk level and 0.82 for ER2 temporal disorientation item). The odds ratios (OR) of ER2's high-risk level and of temporal disorientation item for the diagnosis of major neurocognitive disorders were positive and significant with all OR above 18, the highest OR being reported for the temporal disorientation item in the unadjusted model [OR = 26.4 with 95% confidence interval (CI) = 17.7-39.3]. Conclusion: Our results suggest that ER2 and especially its temporal disorientation item may be used to screen for major neurocognitive disorders in older ED users.
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Affiliation(s)
- Olivier Beauchet
- Department of Medicine, University of Montreal, Montreal, QC, Canada.,Research Center of the Geriatric University Institute of Montreal, Montreal, QC, Canada.,Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Joshua Lubov
- Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
| | - Gilles Allali
- Division of Neurology, Department of Neurosciences, Geneva University Hospitals, Geneva, Switzerland.,Leenaards Memory Center, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Marc Afilalo
- Emergency Department, Jewish General Hospital, McGill University, Montreal, QC, Canada
| | - Cyrille P Launay
- Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
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21
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Yoshioka-Maeda K, Kono A. Factors related to complex care needs of older adults in community-based integrated care centers in Japan: A cross-sectional study. Jpn J Nurs Sci 2021; 18:e12440. [PMID: 34196480 DOI: 10.1111/jjns.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/03/2021] [Accepted: 05/24/2021] [Indexed: 11/26/2022]
Abstract
AIM This study aimed to identify the factors related to complex care needs of older adults in community-based integrated care centers. METHODS We sent 936 self-reported questionnaires to community-based integrated care center directors in the Kinki region of Japan. These questionnaires included questions not only about the directors' demographic data, but also regarding the sociodemographic, psychosocial, and family-related dimensions of the older adults in the community centers. The directors divided their cases into two categories: "Complex cases" and "Straightforward cases." We compared the intergroup differences and examined the factors related to complex care needs in older adults. RESULTS A total of 232 directors responded. Complex cases were significantly associated with younger age, poor health conditions, and having a family member who needs care, as compared to straightforward cases where these associations were not present. Logistic regression showed that in older adults, factors of refusing support or social services, social isolation, and trouble with neighbors were associated with their complexities. Additionally, family members with a high likelihood of refusing social services, older adults without a key family member, and difficulties in forming their consensus regarding care were associated with older adults' complexities. CONCLUSION Older adults with complex care needs could have the risk of self-neglect, and their families faced difficulties in supporting them as family members. Healthcare professions should carefully assess these factors and develop needs-oriented services for them without their family support as an upstream intervention.
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Affiliation(s)
- Kyoko Yoshioka-Maeda
- Department of Health Promotion, National Institute of Public Health, Saitama, Japan
| | - Ayumi Kono
- Department of Home Health Nursing, Osaka City University, Osaka, Japan
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22
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Schonfeld L, Bell J, Goldsworthy M, Kip K, Gum AM, Conner KO, Green O, Wagoner F, Parkinson K, Melling KA, Markwood S. Screening and Priority-Setting to Determine Home- and Community-Based Aging Services for Older Floridians. J Appl Gerontol 2021; 41:699-708. [PMID: 33978527 DOI: 10.1177/07334648211012508] [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] [Indexed: 01/08/2023] Open
Abstract
The National Aging Network serves millions of older Americans seeking home- and community-based services, but places others on waitlists due to limited resources. Little is known about how states determine service delivery and waitlists. We therefore conducted a process evaluation and analyzed data from one five-county Area Agency on Aging in Florida, where an algorithm calculates clients' priority scores for service delivery. From 23,225 screenings over 5.5 years, clients with higher priority scores were older, married, living with caregivers, and had more health problems and needs for assistance. Approximately 51% received services (e.g., meals/nutrition, case management, caregiver support), 11% were eligible/being enrolled, and 38% remained on waitlists. Service status was complex due to multiple service enrollments and terminations, funding priorities, and transfers to third-party providers. More research is needed regarding how other states determine eligibility and deliver services, potentially informing national standards that promote optimal health in older Americans.
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Affiliation(s)
| | | | | | - Kevin Kip
- University of Pittsburgh Medical Center, PA, USA
| | | | | | | | | | | | | | - Sandy Markwood
- National Association of Area Agencies on Aging, Washington, DC, USA
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23
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Hudon C, Bisson M, Dubois MF, Chiu Y, Chouinard MC, Dubuc N, Elazhary N, Sabourin V, Vanasse A. CONECT-6: a case-finding tool to identify patients with complex health needs. BMC Health Serv Res 2021; 21:157. [PMID: 33596929 PMCID: PMC7891167 DOI: 10.1186/s12913-021-06154-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Early identification of patients with chronic conditions and complex health needs in emergency departments (ED) would enable the provision of services better suited to their needs, such as case management. A case-finding tool would ultimately support ED teams to this end and could reduce the cost of services due to avoidable ED visits and hospitalizations. The aim of this study was to develop and validate a short self-administered case-finding tool in EDs to identify patients with chronic conditions and complex health needs in an adult population. Methods This prospective development and initial validation study of a case-finding tool was conducted in four EDs in the province of Quebec (Canada). Adult patients with chronic conditions were approached at their third or more visit to the ED within 12 months to complete a self-administered questionnaire, which included socio-demographics, a comorbidity index, the reference standard INTERMED self-assessment, and 12 questions to develop the case-finding tool. Significant variables in bivariate analysis were included in a multivariate logistic regression analysis and a backward elimination procedure was applied. A receiver operating characteristic (ROC) curve was developed to identify the most appropriate threshold score to identify patients with complex health needs. Results Two hundred ninety patients participated in the study. The multivariate analysis yielded a six-question tool, COmplex NEeds Case-finding Tool – 6 (CONECT-6), which evaluates the following variables: low perceived health; limitations due to pain; unmet needs; high self-perceived complexity; low income; and poor social support. With a threshold of two or more positive answers, the sensitivity was 90% and specificity 66%. The positive and negative predictive values were 49 and 75% respectively. Conclusions The case-finding process is the essential characteristic of case management effectiveness. This study presents the first case-finding tool to identify adult patients with chronic conditions and complex health needs in ED. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06154-4.
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Affiliation(s)
- Catherine Hudon
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada.
| | - Mathieu Bisson
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Marie-France Dubois
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Yohann Chiu
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Maud-Christine Chouinard
- Nursing Faculty, University of Montreal, Pavillon Marguerite-d'Youville, C.P. 6128 succ. Centre-ville, Montréal, QC, H3C 3J7, Canada
| | - Nicole Dubuc
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Nicolas Elazhary
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
| | - Véronique Sabourin
- Integrated University Health and Social Services Centre of Saguenay-Lac-Saint-Jean, 225 rue Saint-Vallier, Chicoutimi, Quebec, G7H 5H6, Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, University of Sherbrooke, 3001 12e Avenue N, Sherbrooke, QC, J1H 5H3, Canada
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Burrus C, Vuistiner P, Léger B, Stiefel F, Rivier G, Luthi F. The self-assessment INTERMED predicts healthcare and social costs of orthopaedic trauma patients with persistent impairments. Clin Rehabil 2020; 35:135-144. [PMID: 32851861 PMCID: PMC7814092 DOI: 10.1177/0269215520949170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To use the self-assessment INTERMED questionnaire to determine the relationship between biopsychosocial complexity and healthcare and social costs of patients after orthopaedic trauma. Design: Secondary prospective analysis based on the validation study cohort of the self-assessment INTERMED questionnaire. Setting: Inpatients orthopaedic rehabilitation with vocational aspects. Subjects: In total, 136 patients with chronic pain and impairments were included in this study: mean (SD) age, 42.6 (10.7) years; 116 men, with moderate pain intensity (51/100); suffering from upper (n = 55), lower-limb (n = 51) or spine (n = 30) pain after orthopaedic trauma; with minor or moderate injury severity (severe injury for 25). Main measures: Biopsychosocial complexity, assessed with the self-assessment INTERMED questionnaire, and other confounding variables collected prospectively during rehabilitation. Outcome measures (healthcare costs, loss of wage costs and time for fitness-to-work) were collected through insurance files after case settlements. Linear multiple regression models adjusted for age, gender, pain, trauma severity, education and employment contract were performed to measure the influence of biopsychosocial complexity on the three outcome variables. Results: High-cost patients were older (+3.6 years) and more anxious (9.0 vs 7.3 points at HADS-A), came later to rehabilitation (+105 days), and showed higher biopsychosocial complexity (+3.2 points). After adjustment, biopsychosocial complexity was significantly associated with healthcare (ß = 0.02; P = 0.003; expß = 1.02) and social costs (ß = 0.03; P = 0.006, expß = 1.03) and duration before fitness-to-work (ß = 0.04; P < 0.001, expß = 1.04). Conclusion: Biopsychosocial complexity assessed with the self-assessment INTERMED questionnaire is associated with higher healthcare and social costs.
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Affiliation(s)
- Cyrille Burrus
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland.,Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Philippe Vuistiner
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Bertrand Léger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Friedrich Stiefel
- Service of liaison psychiatry, Lausanne University and Lausanne University Hospital, Lausanne, VD, Switzerland
| | - Gilles Rivier
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - François Luthi
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland.,Institute for Research in Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland.,Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
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25
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Paoloni-Giacobino A, Luthi F, Stenz L, Le Carré J, Vuistiner P, Léger B. Altered BDNF Methylation in Patients with Chronic Musculoskeletal Pain and High Biopsychosocial Complexity. J Pain Res 2020; 13:1289-1296. [PMID: 32581570 PMCID: PMC7276326 DOI: 10.2147/jpr.s251782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/07/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose The INTERMED instrument, which was developed to measure patient's biopsychosocial (BPS) complexity, represents a powerful diagnostic and therapeutic tool. Epigenetic changes are the interface between signals from the environment and genetic modifications, affecting gene expression, in particular, by DNA methylation of CpG dinucleotides in promotor regions of the corresponding genes. The brain-derived neurotrophic factor (BDNF) gene plays a crucial role in the central sensitization (CS) of pain. In this study, we hypothesized that chronic pain modifies the methylation levels of the BDNF gene in a manner that is interconnected with the BPS status. Patients and Methods Fifty-eight chronic musculoskeletal pain patients (CMSP) were enrolled in the study. DNA was extracted from blood samples, the methylation levels of 13 CpG sites in the BDNF promoter were measured by pyrosequencing, and association studies with various patient parameters and the INTERMED scores were performed. Results Interestingly, a negative correlation (-0.40) was found between the total INTERMED scores and the average CpG methylation values of the BDNF gene, but no correlation was observed with the severity of pain, degree of anxiety, depression, or kinesiophobia and catastrophism. Moreover, the association was independent of age, sex and level of comorbidities. Conclusion This result shows that CMSP, in association with its biopsychosocial context, epigenetically decreases the degree of methylation of the BDNF promoter and should therefore increase the level of BDNF transcription. It also suggests a role of the INTERMED tool to detect a relationship between the BPS complexity and the epigenetic control of a target gene. The possible upregulation of BDNF expression might be, at least in part, the signal for chronic pain-induced central sensitization (CS). This could partly explain why patients with a higher level of complexity feel more pain than those with lower complexity.
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Affiliation(s)
- Ariane Paoloni-Giacobino
- Medicine Faculty, Department of Genetic Medicine and Development, Geneva University, Geneva, Switzerland
| | - François Luthi
- Institute for Research in Rehabilitation, Clinique romande de réadaptation, Sion, Switzerland.,Department of Musculoskeletal Rehabilitation, Clinique romande de réadaptation, Sion, Switzerland.,Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
| | - Ludwig Stenz
- Medicine Faculty, Department of Genetic Medicine and Development, Geneva University, Geneva, Switzerland
| | - Joane Le Carré
- Institute for Research in Rehabilitation, Clinique romande de réadaptation, Sion, Switzerland.,Department of Medical Research, Clinique romande de réadaptation, Sion, Switzerland
| | - Philippe Vuistiner
- Institute for Research in Rehabilitation, Clinique romande de réadaptation, Sion, Switzerland.,Department of Medical Research, Clinique romande de réadaptation, Sion, Switzerland
| | - Bertrand Léger
- Institute for Research in Rehabilitation, Clinique romande de réadaptation, Sion, Switzerland.,Department of Medical Research, Clinique romande de réadaptation, Sion, Switzerland
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26
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Silva HSD, Gutierrez BAO. Care complexity in hospitalized elderly according to cognitive performance. Rev Bras Enferm 2019; 72:134-139. [PMID: 31826202 DOI: 10.1590/0034-7167-2018-0357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/21/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to investigate possible differences in care complexity, functional performance and biopsychosocial and health system aspects among hospitalized elderly with or without cognitive decline. METHOD quantitative, cross-sectional and analytical study in which was used the INTERMED method and cognitive and functional screening scales. We investigated 384 elderly patients admitted to a medical and surgical clinic of a University Hospital located in São Paulo/SP. RESULTS cognitive decline was present in 40.1% of the sample, most of them were longer-lived elderly individuals with less schooling and income, more dependent in activities of daily living and had greater vulnerability in different domains of INTERMED. After adjustments, the elderly with cognitive decline presented greater vulnerability in the psychological domain. CONCLUSION the relationship between cognitive decline and psychological vulnerability highlights the need to adopt long-term care based on involvement of the family, health team and different services, thereby maximizing the quality of care.
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27
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Gum AM, Green O, Schonfeld L, Conner K, Rigg KK, Wagoner F, Melling KA, Parkinson K. Longitudinal Analysis of Mortality for Older Adults Receiving or Waiting for Aging Network Services. J Am Geriatr Soc 2019; 68:519-525. [PMID: 31657010 DOI: 10.1111/jgs.16232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 09/09/2019] [Accepted: 09/23/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVES For older adults screened by an Area Agency on Aging (AAA) in the National Aging Network, we aimed to examine the 12-month mortality rate for wait-listed callers compared with those who received services within 12 months, and to assess whether the mortality rate differed according to how quickly they received services. DESIGN The design was a longitudinal analysis of 3 years of AAA administrative data, using survival analysis. SETTING The data source was administrative data from an AAA spanning a five-county region in west central Florida. PARTICIPANTS All older adults (age 60 y and older) screened for service eligibility from July 15, 2013, to August 15, 2015, who completed initial screening during the study period were included (N = 6288). MEASUREMENTS The outcome was mortality within 12 months of the initial screening. Covariates included demographics, caregiver status, health status, access to healthcare, and AAA service status. RESULTS In the first survival analysis, the strongest predictor was waiting for services compared with receiving services; waiting increased the odds to die vs not to die by 141%, after controlling for health status and other covariates. In the second survival analysis, those who received services within 0 to 3 months had a higher mortality risk compared with those who received services within 6 to 9 months or 9 to 12 months. CONCLUSION Older adults placed on aging service waiting lists may be at a greater risk of mortality within 12 months than those receiving services. Given that rapid receipt of services was less protective than receiving services later, those prioritized to receive services quickly may be at very high risk of adverse outcomes. Findings raise the possibility that aging services may lower mortality, although additional services may benefit those waiting long periods for services, as well as those eligible for services rapidly. Research is needed to replicate and extend these findings. J Am Geriatr Soc 68:519-525, 2020.
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Affiliation(s)
- Amber M Gum
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida
| | - Ohad Green
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida
| | - Lawrence Schonfeld
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida
| | - Kyaien Conner
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida
| | - Khary K Rigg
- Department of Mental Health Law and Policy, University of South Florida, Tampa, Florida
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Powden CJ, Dodds TK, Gabriel EH. THE RELIABILITY OF THE STAR EXCURSION BALANCE TEST AND LOWER QUARTER Y-BALANCE TEST IN HEALTHY ADULTS: A SYSTEMATIC REVIEW. Int J Sports Phys Ther 2019; 14:683-694. [PMID: 31598406 PMCID: PMC6769278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Dynamic balance is often an important criterion used during lower extremity musculoskeletal injury prediction, prevention, and rehabilitation processes. Methods to assess lower extremity dynamic balance include the Star Excursion Balance Test (SEBT) and Lower Quarter Y-Balance Test (YBT). Due to the importance of dynamic balance it is imperative to establish reliable quantification techniques. PURPOSE To conduct a systematic review to assess the reliability and responsiveness of the SEBT/YBT. STUDY DESIGN Systematic Review. METHODS Electronic databases (PubMed, MEDLINE, CINAHL, and SPORTDiscus) were searched from inception to August 2018. Included studies examined the intra- and inter-rater reliability of the SEBT/YBT in healthy adults. Two investigators independently assessed methodological quality, level of evidence and strength of recommendation with the Qualtiy Appraisal of Reliability Studies (QAREL) scale. Relative intra and inter-rater reliability was examined through intraclass correlation coefficients (ICC) and responsiveness was evaluated through minimal detectable change (MDC). Data was analyzed based on reach direction (Anterior, Posteromedial, and Posterolateral) and normalization (normalized and non-normalized). Additionally, data were then synthesized using the strength of recommendation taxonomy to provide a grade of recommendation. RESULTS A total of nine studies were included in this review. Six studies examined the inter-rater reliability and seven assessed intra-rater reliability. The included studies had a median QAREL score of 66.89% (range = 55.56% to 75.00%) and 59.03% (range = 33.33 to 66.67%) for inter and intra-rater reliability respectively. Median ICC values for inter-rater reliability were 0.88 (Range = 0.83 - 0.96), 0.87 (range = 0.80 - 1.00), and 0.88 (range = 0.73 - 1.00) for the anterior, posteromedial, and posterolateral directions respectively. Median ICC values for intra-rater reliability were 0.88 (Range = 0.84 - 0.93), 0.88 (Range = 0.85 - 0.94), and 0.90 (Range = 0.68 - 0.94) for the anterior, posteromedial, and posterolateral directions, respectively. CONCLUSIONS There is grade A evidence to support that the SEBT/YBT have excellent inter and intra-rater reliability when used in healthy adults. Furthermore, minimal detectable change values have been provided that can be used in practice to aid clinical decision making. Future research is needed to assess the reliability, responsiveness, and validity of the SEBT/YBT in pathologic populations. LEVEL OF EVIDENCE 1a.
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Affiliation(s)
- Cameron J. Powden
- Department of Athletic Training, University of Indianapolis, Indianapolis, IN, USA
| | - Teralyn K. Dodds
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terra Haute, IN, USA
| | - Emily H. Gabriel
- Department of Athletic Training, Mercer University, Macon, GA, USA
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29
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Gutierrez BAO, Silva HSD, Chubaci RYS, Borja-Oliveira CR. Complexity of care of hospitalized older adults and its relationship with sociodemographic characteristics and functional independence. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.190167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objectives: To investigate the relationship between the complexity of care of hospitalized older adults and sociodemographic and functional independence characteristics. Method: A quantitative cross-sectional and descriptive study was carried out in the medical and surgical clinics of the University Hospital of the Universidade de São Paulo, in the state of São Paulo SP, Brazil. A total of 382 older adults were assessed through a socio-demographic inventory, the Mini Mental State Exam, the Katz Index of Independence in Activities of Daily Living and the Interdisciplinary Medicine Instrument Method. Results: The complexity of care of participants was associated with the female sex (p=0.003), not having a partner (p=0.003), having a lower income (p=0.022), cognitive decline (p<0.001) and dependence in basic activities of daily living (BADL) (p<0.001). In the multiple logistic regression model, variables such as the female sex (OR=1.76; p=0.018), dependence in one or more activities of daily living (OR=1.26; p<0.001) and cognitive decline (OR=3.31; p<0.001) remained associated with complexity of care. Conclusion: The complexity of care of hospitalized older adults, as it is associated with limitations in BADL and cognitive decline, requires actions by the interprofessional team to ensure the rehabilitation, integration of long-term care and planning of care resources for older patients. Thus, it is necessary to adopt integrated services that include home care and care networks for the elderly, in order to provide qualified post-hospital discharge care and promote the health of the hospitalized older population.
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