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Purchase M, Thériault ÉR, Collicutt B. Ageism Healthcare: Implications for the Psychological Well-Being of Atlantic Canadian Healthcare Professionals. J Appl Gerontol 2024; 43:1355-1365. [PMID: 38512232 PMCID: PMC11323431 DOI: 10.1177/07334648241237099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/19/2023] [Accepted: 02/09/2024] [Indexed: 03/22/2024] Open
Abstract
Ageism in healthcare is related to poor outcomes for older patients. The objective of this study was to evaluate the relationships between ageism and various aspects of the psychological well-being of healthcare professionals in Atlantic Canada. In 2023, an online survey of 294 healthcare professionals from various disciplines was conducted. This survey included items to measure expectations of aging, stress, burnout, emotional dissonance, and well-being. Results indicated that aging expectations were significantly related to burnout, perceived stress, well-being, and emotional dissonance. With the use of a path analysis, emotional dissonance partially mediated relationships between burnout and well-being with stress. However, aging expectations did not significantly predict emotional dissonance. Differences were found across professional groups on ageism. Conclusions support the need for increased awareness to the relationship between ageist attitudes and professionals' well-being, as well as the need for education and interventions to reduce false expectations about the aging process.
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Affiliation(s)
- Madelyn Purchase
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Éric R. Thériault
- Department of Psychology, Cape Breton University, Sydney, NS, Canada
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Liu X, Yang X. Research Progress on Frailty in Elderly People. Clin Interv Aging 2024; 19:1493-1505. [PMID: 39224708 PMCID: PMC11368114 DOI: 10.2147/cia.s474547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024] Open
Abstract
Global aging is rapidly accelerating, which significantly influences the health systems worldwide. Frailty emerges as the most conspicuous hallmark of aging, imposing novel global health challenges. Characterized by a multifaceted decline across physiological system, frailty diminishes an individual's capacity to maintain equilibrium in the presence of stressors, which leads to adverse outcomes such as falls, delirium, and disability. Several screening tools and interventions have been developed to mitigate the harm caused by frailty to human health, but research on frailty in mainland China commences belatedly with scant studies conducted. Therefore, it is imperative to explore screening methods and treatment modalities tailored to the Chinese context, thereby enhancing the older adults' quality of life and advancing social medicine. This review aims to elucidate the evolution, diagnosis, and management of frailty, alongside the challenges it poses, with the overarching goal of guiding future diagnostic and therapeutic endeavors. Specifically, we summarized the mechanisms of frailty and intervention strategies in elderly people, and meanwhile, we evaluated the advantages and disadvantages of different measurement tools.
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Affiliation(s)
- Xiaoming Liu
- Department of Geriatric Medicine, The Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, 250014, People’s Republic of China
| | - Xiaoni Yang
- Department of Traditional Chinese Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, 250014, People’s Republic of China
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Wong ELY, Poon CM, Cheung AWL, Chen FY, Yeoh EK. Relationship between patient experience and hospital readmission: system-level survey with deterministic data linkage method. BMC Med Res Methodol 2022; 22:197. [PMID: 35864472 PMCID: PMC9306034 DOI: 10.1186/s12874-022-01677-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Background Linkage of public healthcare data provides powerful resources for studying from a comprehensive view of quality of care than information for a single administrative database. It is believed that positive patient experiences reflect good quality of health care and may reduce patient readmission. This study aimed to determine the relationship between patient experience and hospital readmission at a system level by linking anonymous experience survey data with de-identified longitudinal hospital administrative admissions data. Methods Data were obtained by linking two datasets with anonymised individual-level records from seven largest-scale acute public hospitals over seven geographical clusters in Hong Kong. Selected records in the two datasets involving patient experience survey (PES) (2013 survey dataset) and healthcare utilization (admissions dataset) were used. Following data cleaning and standardization, a deterministic data linkage algorithm was used to identify pairs of records uniquely matched for a list of identifiers (10 selected variables) between two datasets. If patient’s record from the survey dataset matched with the hospitalization records in the admissions dataset, they were included in the subsequent analyses. Bivariate analyses and multivariable logistic regression models were performed to evaluate the associations between hospital readmission in the next calendar month and patient experience. Results The overall matching rate was 62.1% (1746/2811) for PES participants aged 45 or above from the survey dataset. The average score for overall inpatient experience was 8.10 (SD = 1.53). There was no significant difference between matched patients and unmatched patients in terms of their score for the perception of overall quality of care received during hospitalization (X2 = 6.931, p-value = 0.14) and score for overall inpatient experience (X2 = 7.853, p-value = 0.25). In the multivariable model, readmission through the outpatient department (planned admission) in the next calendar month was significantly associated with a higher score given to the overall quality of care received (adjusted OR = 1.54, 95%CI = 1.09–2.17), while such association was absent for readmission through Accident and Emergency department (adjusted OR = 0.75, 95%CI = 0.50–1.12). Conclusions This study demonstrated the feasibility of routine record linkage, with the limited intrusion of patients’ confidentiality, for evaluating health care quality. It also highlights the significant association between readmission through planned readmission and a higher score for overall quality of care received. A possible explanation might be the perceived better co-ordination between outpatient departments and inpatient service and the well-informed discharge plan given to this group of patients.
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Affiliation(s)
- Eliza Lai-Yi Wong
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Chin-Man Poon
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Annie Wai-Ling Cheung
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Frank Youhua Chen
- Department of Management Sciences, City University of Hong Kong, Hong Kong SAR, China
| | - Eng-Kiong Yeoh
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Wu Y, Fung H, Shum HM, Zhao S, Wong ELY, Chong KC, Hung CT, Yeoh EK. Evaluation of Length of Stay, Care Volume, In-Hospital Mortality, and Emergency Readmission Rate Associated With Use of Diagnosis-Related Groups for Internal Resource Allocation in Public Hospitals in Hong Kong. JAMA Netw Open 2022; 5:e2145685. [PMID: 35119464 PMCID: PMC8817200 DOI: 10.1001/jamanetworkopen.2021.45685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 12/04/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Hong Kong's internal resource allocation system for public inpatient care changed from a global budget system to one based on diagnosis-related groups (DRGs) in 2009 and returned to a global budget system in 2012. Changes in patient and hospital outcomes associated with moving from a DRG-based system to a global budget system for inpatient care have rarely been evaluated. Objective To examine associations between the introduction and discontinuation of DRGs and changes in length of stay, volume of care, in-hospital mortality rates, and emergency readmission rates in the inpatient population in acute care hospitals overall, stratified by age group, and across 5 medical conditions. Design, Setting, and Participants This cross-sectional study included data from patients aged 45 years or older who were hospitalized in public acute care settings in Hong Kong before the introduction (April 2006 to March 2009), during implementation (April 2009 to March 2012), and after discontinuation (April 2012 to November 2014) of the DRG scheme. Data analysis was conducted from January to June 2021. Exposures Public hospitals transitioned from a global budget payment system to a DRG-based system in April 2009 and returned to a global budget system in April 2014. Main Outcomes and Measures The main outcome was the association of use of DRGs with patient-level length of stay, in-hospital mortality rate, 1-month emergency readmission rate, and population-level number of admissions per month. An interrupted time series design was used to estimate changes in the level and slope of outcome variables after introduction and discontinuation of DRGs, accounting for pretrends. Results This study included 7 604 390 patient episodes. Overall, the mean (SD) age of patients was 68.97 (13.20) years, and 52.17% were male. The introduction of DRGs was associated with a 1.77% (95% CI, 1.23%-2.32%) decrease in the mean length of stay, a 2.90% (95% CI, 2.52%-3.28%) increase in the number of patients admitted, a 4.12% (95% CI, 1.89%-6.35%) reduction in in-hospital mortality, and a 2.37% (95% CI, 1.28%-3.46%) decrease in emergency readmissions. Discontinuation of the DRG scheme was associated with a 0.93% (95% CI, 0.42%-1.44%) increase in the mean length of stay and a 1.82% (95% CI, 1.47%-2.17%) reduction in the number of patients treated after adjusting for covariates; no statistically significant change was observed in in-hospital mortality (-0.14%; 95% CI, -2.29% to 2.01%) or emergency readmission rate (-0.29%; 95% CI, -1.30% to 0.71%). Conclusions and Relevance In this cross-sectional study, the introduction of DRGs was associated with shorter lengths of stay and increased hospital volume, and discontinuation was associated with longer lengths of stay and decreased hospital volume. In-hospital mortality and emergency readmission rates did not significantly change after discontinuation of DRGs.
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Affiliation(s)
- Yushan Wu
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Centre for Health Systems & Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Hong Fung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Chinese University of Hong Kong Medical Centre, Hong Kong Special Administrative Region, Hong Kong, China
| | - Ho-Man Shum
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Centre for Health Systems & Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Shi Zhao
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Eliza Lai-Yi Wong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Centre for Health Systems & Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Ka-Chun Chong
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Centre for Health Systems & Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Chi-Tim Hung
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Centre for Health Systems & Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
| | - Eng-Kiong Yeoh
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
- Centre for Health Systems & Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, Hong Kong, China
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Tang A, Kwok KO, Wei VWI, Chen H, Wong SYS, Tam WWS. Synergistic Effect of Combination Interventions for Methicillin-Resistant Staphylococcus aureus Transmission Control in Nursing Homes: A Computation Modelling Evaluation with Heterogeneous Contact Mixing. Antibiotics (Basel) 2021; 10:227. [PMID: 33668327 PMCID: PMC7996172 DOI: 10.3390/antibiotics10030227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/12/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022] Open
Abstract
The endemic threat of methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes poses a serious and escalating challenge to public health administration in infection control. Nursing homes are considered as major reservoirs for MRSA colonization, with considerable high levels of colonization prevalence. We employed a computation model to evaluate effects of three intervention scenarios on MRSA colonization prevalence rate in nursing homes. Simulations were conducted using a deterministic compartmental model featuring heterogeneous contact matrix between residents and health-care workers (HCWs). Contact parameters were derived from a nursing home survey. Three intervention scenarios were simulated: (1) hand-hygiene compliance by HCWs, (2) screening-and-isolation upon admission, and (3) implementing both interventions at the same time. For every 10% reduction in average contamination duration in HCWs, the estimated average reduction in prevalence rate was 1.29 percentage point compared with the prevalence rate before the intervention was implemented. Screening-and-isolation intervention resulted in an average reduction of 19.04 percentage point in prevalence rate (S.D. = 1.58; 95% CI = 18.90-19.18). In intervention scenario 3, synergistic effects were observed when implementing hand-hygiene compliance by HCWs and screening-and-isolation together. Our results provide evidence showing that implementing multiple interventions together has a synergistic effect on colonization prevalence reduction.
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Affiliation(s)
- Arthur Tang
- Department of Software, Sungkyunkwan University, Suwon 16419, Korea;
| | - Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China; (V.W.I.W.); (S.Y.S.W.)
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong 999077, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518057, China
| | - Vivian Wan In Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China; (V.W.I.W.); (S.Y.S.W.)
| | - Hong Chen
- Centre for Health Protection, Department of Health, Hong Kong 999077, China;
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong 999077, China; (V.W.I.W.); (S.Y.S.W.)
| | - Wilson Wai Sun Tam
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore 117597, Singapore;
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Nowossadeck E, Prütz F, Teti A. Population change and the burden of hospitalization in Germany 2000-2040: Decomposition analysis and projection. PLoS One 2020; 15:e0243322. [PMID: 33306705 PMCID: PMC7732063 DOI: 10.1371/journal.pone.0243322] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 11/18/2020] [Indexed: 11/19/2022] Open
Abstract
Demographic factors, such as population aging and shrinkage, and non-demographic factors, such as hospitalization rate and length of hospital stay, generate challenges for inpatient care. This paper used decomposition analysis to assess how changes in these factors affected the number of hospital treatment days from 2000 to 2015 in Germany. Demographic aging was linked to increases in the number of treatment days for women (+10.0%) and men (+19.2%) and in hospitalization rates for women +6.0% and men +5.4%. However, these increases were offset by decreases in the number of hospital days (women: 16.5%; men: 7.3%) and length of stay (women: -27.4%; men -26.3%). For the projection up to 2040, 12 scenarios were developed (six for women and six for men) using three variants for future population demographics and two variants for future length of stay and hospitalization rates. One of the two variants for future length of stay and hospitalization rates provides for a constant value for the year 2015. For the second of these two variants variant, a logarithmic model was estimated on the basis of values from 2000 to 2015. and the trends were extrapolated using this model until 2040. The strongest overall predicted increase was 18.4% between 2015 and 2040, including a 22.4% increase for men. In two scenarios for women, only slight declines were predicted. All results, both for the decomposition analysis and projection, indicated a moderate but sustained effect of demographic aging on the number of hospital treatment days, leading to a significant increase in hospital treatment days over the study period. Non-demographic factors also had strong influences, especially in shorter time periods, but these effects offset each other over time. The change in the population size in the period under study had very little effect on the number of hospital treatment days.
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Affiliation(s)
- Enno Nowossadeck
- Unit of Social Determinants of Health, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
- * E-mail:
| | - Franziska Prütz
- Unit of Health Reporting, Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Andrea Teti
- Institute for Gerontology, University of Vechta, Vechta, Germany
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Wu T, Yang F, Chan WWL, Lam CLK, Wong CKH. Healthcare utilization and direct medical cost in the years during and after cancer diagnosis in patients with type 2 diabetes mellitus. J Diabetes Investig 2020; 11:1661-1672. [PMID: 32471010 PMCID: PMC7610124 DOI: 10.1111/jdi.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/11/2020] [Accepted: 05/22/2020] [Indexed: 12/11/2022] Open
Abstract
AIMS/INTRODUCTION There is uncertainty about the direct medical costs of type 2 diabetes patients with cancers. MATERIALS AND METHODS A population-based retrospective cohort of 99,915 type 2 diabetes patients from the Hong Kong Hospital Authority between 2006 and 2017 was assembled. A total of 16,869 patients who had an initial cancer diagnosis after type 2 diabetes diagnosis were matched with 83,046 patients without cancer (controls) using a matching ratio of up to one-to-five propensity score-matching method. Patients were divided into four categories according to life expectancy. Healthcare service utilization and direct medical costs during the index year, subsequent years and mortality year were compared between patients with and without cancer in each category. RESULTS Medical costs of cancer patients in the index year ranged from $US27,533 for patients who died in <1 year to $US11,303 for those survived >3 years. Cancer patients had significantly greater expenditures than controls in the index year (all P < 0.001) and subsequent years ($US4,569 vs $US4,155, P < 0.001). Cancer patients also had greater costs in the year of death, and the difference was significant for patients who survived >3 years after the index year ($US32,558 vs $US28,260). For patients in both groups, patients who survived >3 years had significantly lower costs than those who died in <1 year. Costs incurred in the mortality year were greater than those in the index year and subsequent years. Hospitalization accounted for >90% of the medical costs for both groups in the mortality year. CONCLUSIONS Type 2 diabetes patients with cancers incurred greater medical costs in the diagnosis, ensuing and mortality years than type 2 diabetes patients without cancers.
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Affiliation(s)
- Tingting Wu
- Department of Family Medicine and Primary CareThe University of Hong KongHong Kong
| | - Fan Yang
- Centre for Health EconomicsThe University of YorkYorkUK
| | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary CareThe University of Hong KongHong Kong
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary CareThe University of Hong KongHong Kong
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Morgan P, Enticott J, Nikam R, Tracy J. Profile of hospital admissions for adults with cerebral palsy: a retrospective cohort study. Dev Med Child Neurol 2020; 62:939-945. [PMID: 32237152 DOI: 10.1111/dmcn.14533] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/25/2020] [Indexed: 02/06/2023]
Abstract
AIM To retrospectively profile acute hospital admissions for a defined cohort of adults with cerebral palsy (CP). METHOD Five years of health service data were interrogated to identify acute health service use by adults with CP. Admission types were described, admission reasons categorized using International Classification of Diseases, 10th Revision codes, and length of stay (LOS) calculated. Any differences between paediatric and adult subsets were explored. RESULTS Individuals with CP constituted 2922 admissions. Of these, 850 (29%) were adult admissions. There were significant differences between admission reasons for paediatric and adult cohorts, with adults predominantly seeking hospital admission for emergency rather than planned care (emergency reason: adults 62.1%, paediatrics 25.2%; p<0.001). The median adult admission LOS was longer than that of children (p<0.001). The primary diagnosis admission reason in the adult data set was respiratory illness (20%) followed closely by gastrostomy dysfunction (19%). INTERPRETATION Adults with CP predominantly access acute hospital services for emergency health care. A high frequency of admissions is associated with respiratory illness and gastrostomy dysfunction in adults with CP. What this paper adds Adults with cerebral palsy (CP) access acute inpatient services for emergency health care. Hospital admissions are predominantly because of respiratory illness and gastrostomy dysfunction. Admission length of stay is longer for adults than children. Many adults with CP require hospitalization more than once a year.
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Affiliation(s)
- Prue Morgan
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Frankston, Australia
| | - Joanne Enticott
- Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Rujuta Nikam
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Notting Hill, Australia
| | - Jane Tracy
- Centre for Developmental Disability Health, Monash Health Community, Doveton, Australia
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Li J, Chen X, Han X, Zhang G. Spatiotemporal matching between medical resources and population ageing in China from 2008 to 2017. BMC Public Health 2020; 20:845. [PMID: 32493251 PMCID: PMC7268461 DOI: 10.1186/s12889-020-08976-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/24/2020] [Indexed: 11/10/2022] Open
Abstract
Background Globally, the increasingly severe population ageing issue has been creating challenges in terms of medical resource allocation and public health policies. The aim of this study is to address the space-time trends of the population-ageing rate (PAR), the number of medical resources per thousand residents (NMRTR) in mainland China in the past 10 years, and to investigate the spatial and temporal matching between the PAR and NMRTR in mainland China. Methods The Bayesian space-time hierarchy model was employed to investigate the spatiotemporal variation of PAR and NMRTR in mainland China over the past 10 years. Subsequently, a Bayesian Geo-Detector model was developed to evaluate the spatial and temporal matching levels between PAR and NMRTR at national level. The matching odds ratio (OR) index proposed in this paper was applied to measure the matching levels between the two terms in each provincial area. Results The Chinese spatial and temporal matching q-statistic values between the PAR and three vital types of NMRTR were all less than 0.45. Only the spatial matching Bayesian q-statistic values between the PAR and the number of beds in hospital reached 0.42 (95% credible interval: 0.37, 0.48) nationwide. Chongqing and Guizhou located in southwest China had the highest spatial and temporal matching ORs, respectively, between the PAR and the three types of NMRTR. The spatial pattern of the spatial and temporal matching ORs between the PAR and NMRTR in mainland China exhibited distinct geographical features, but the geographical structure of the spatial matching differed from that of the temporal matching between the PAR and NMRTR. Conclusion The spatial and temporal matching degrees between the PAR and NMRTR in mainland China were generally very low. The provincial regions with high PAR largely experienced relatively low spatial matching levels between the PAR and NMRTR, and vice versa. The geographical pattern of the temporal matching between the PAR and NMRTR exhibited the feature of north-south differentiation.
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Affiliation(s)
- Junming Li
- School of Statistics, Shanxi University of Finance and Economics, Wucheng Road 696, Taiyuan, 030006, China.
| | - Xinglin Chen
- School of Statistics, Shanxi University of Finance and Economics, Wucheng Road 696, Taiyuan, 030006, China
| | - Xiulan Han
- School of Statistics, Shanxi University of Finance and Economics, Wucheng Road 696, Taiyuan, 030006, China.
| | - Gehong Zhang
- First Hospital of Shanxi Medical University, Jiefang South Road 85, Taiyuan, 030001, China.
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Randriambelonoro M, Perrin C, Blocquet A, Kozak D, Fernandez JT, Marfaing T, Bolomey E, Benhissen Z, Frangos E, Geissbuhler A, Graf C. Hospital-to-Home Transition for Older Patients: Using Serious Games to Improve the Motivation for Rehabilitation – a Qualitative Study. JOURNAL OF POPULATION AGEING 2020. [DOI: 10.1007/s12062-020-09274-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AbstractTraditional physiotherapy is often perceived as repetitive and boring by patients, leading to issues in maintaining their interest and performing the required exercises. This paper investigates older patients’ engagement and motivation for physical activity using a serious game-based rehabilitation compared to a control group using a standard care therapy, during hospitalization. We conducted a randomized clinical trial with 57 geriatric patients and demonstrated that the serious game-based rehabilitation was as efficient as the standard rehabilitation program in terms of improving their functional capacity. In this paper, we mainly focus on reporting qualitative analysis of the patient’s behavior change thorough the intervention. The intervention lasted 3 weeks. Semi-structured interviews, including all the participants, were conducted before and after the intervention. Patients’ attitudes towards rehabilitation process, physical activity and innovation technology were investigated. Motivation to be active following the intervention were explored. Participants admitted feeling bored at the hospital and only following along the care process routine. Enthusiasm towards the progress brought by technological solution was observed. At the end of the hospital stay, the serious game-based rehabilitation received positive feedback. Patients felt more active and observed significant improvement of their general condition. The analysis suggests that patients participating in the gamified rehabilitation are more motivated. Several recommendations on designing serious game for elderly rehabilitation are proposed.
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Pobrotyn P, Susło R, Witczak IT, Rypicz Ł, Drobnik J. An analysis of the costs of treating aged patients in a large clinical hospital in Poland under the pressure of recent demographic trends. Arch Med Sci 2020; 16:666-671. [PMID: 32399116 PMCID: PMC7212232 DOI: 10.5114/aoms.2018.81132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/25/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aging of modern societies increases the general healthcare burden due to the growing demand for inpatient services, which lack adequate financing. MATERIAL AND METHODS Data concerning the costs of 312,250 hospitalizations at University Clinical Hospital in Wrocław, Poland in the years 2012-2015 were analyzed according to the age of the patients: below 65 years and 65 years and older, with subgroups (65-74, 75-84 and 85 years and older). RESULTS The mean length of stay (LOS) differed significantly for patients below 65 years and for patients 65 years old or older (3.5 vs. 4.7 person-days); over the 4 years covered by our data, these increased by 0.4 person-days, mostly among patients 85 years and older (by 0.7 person-days). The mean direct cost of hospitalization differed significantly for patients below 65 years and those 65 years or older (PLN 4,907.12 vs. PLN 6,357.15). The mean cost of laboratory tests and radiologic diagnostics was significantly higher among those in the 65+ group, and the difference had a rising trend. The differences between age groups in cost-related hospitalization characteristics and direct hospitalization costs that have been suggested by the medical literature have also been confirmed in Poland. CONCLUSIONS The mean hospitalization costs of patients aged 65 years and older in Poland are higher than for younger patients due to longer LOS and more complex and expensive treatment, especially laboratory and radiologic diagnostics, which is increasingly common in the oldest age groups. This demands an urgent systemic solution, especially in terms of adjusted financing of elderly patients' hospital treatment.
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Affiliation(s)
- Piotr Pobrotyn
- Management, University Clinical Hospital, Wroclaw, Poland
| | - Robert Susło
- Gerontology Unit, Public Health Department, Health Sciences Faculty, Wroclaw Medical University, Wroclaw, Poland
| | - Izabela T. Witczak
- Economics and Quality in Health Care Unit, Public Health Department, Health Sciences Faculty, Wroclaw Medical University, Wroclaw, Poland
| | - Łukasz Rypicz
- Economics and Quality in Health Care Unit, Public Health Department, Health Sciences Faculty, Wroclaw Medical University, Wroclaw, Poland
| | - Jarosław Drobnik
- Gerontology Unit, Public Health Department, Health Sciences Faculty, Wroclaw Medical University, Wroclaw, Poland
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The impact of an ageing population on the required hospital capacity: results from forecast analysis on administrative data. Eur Geriatr Med 2019; 10:697-705. [DOI: 10.1007/s41999-019-00219-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
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Wu X, Law CK, Yip PSF. A Projection of Future Hospitalisation Needs in a Rapidly Ageing Society: A Hong Kong Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030473. [PMID: 30736289 PMCID: PMC6388233 DOI: 10.3390/ijerph16030473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 12/02/2022]
Abstract
To assess the impact of ageing on hospitalisation in a rapidly ageing society. A study using retrospective and prospective data was conducted using hospitalisation data with age-specific admission rates in the period from 2001–2010 and demographic data from the period of 2001–2066 by the United Nations. The Hong Kong Special Administrative Region (SAR) with a 7 million population experiences extreme low fertility (1.1 children per woman) and long life expectancy (84 years old). Days of hospitalisation: For the period 2010–2066, the length of stay (LOS) in the age group 85+ is projected to increase by 555.3% while the LOS for the whole population is expected to increase by only 134.4% and by ageing only. In 2010, the proportion in the LOS contributed to by the oldest age group (85+) was 15%. In 2066, this proportion is projected to nearly triple (42%). Around 70% of the projected days of hospitalisation would be taken by people aged 75 years and above. It is projected that this phenomenon would be converted to a more balanced structure when the demographic transition changes into a more stable distribution. Apparently, the impact of ageing on the public hospital system has not been well understood and prepared. The determined result provides insight into monitoring the capacity of the hospital system to cope with a rapidly changing demographic society. It provides empirical evidence of the impact of ageing on the public hospitalisation system. It gives a long term projection up to the year 2066 while the situation would be different from the transient period of 2016–2030. The analysis adopts a fixed rate approach, which assumes the LOS to be only driven by demographic factors, while any improvements in health technologies and health awareness are not accounted for. Only inpatient data from the Hospital Authority were used, nonetheless, they are the best available for the study. Due to the limitation of data, proximity to death is not controlled in conducting this analysis.
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Affiliation(s)
- Xueyuan Wu
- Department of Economics, The University of Melbourne, Parkville, VIC 3010, Australia.
| | - Chi-Kin Law
- Centre for Applied Health Economics, Menzies Health Institute Queensland, School of Medicine, Griffith University, Nathan, QLD 4111, Australia.
| | - Paul Siu Fai Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China.
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Population-based estimates of the burden of pneumonia hospitalizations in Hong Kong, 2011-2015. Eur J Clin Microbiol Infect Dis 2019; 38:553-561. [PMID: 30684165 DOI: 10.1007/s10096-018-03459-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 12/17/2018] [Indexed: 12/11/2022]
Abstract
Up-to-date data on the burden of disease are important to identify patients with unmet needs and to optimize healthcare resources. We aimed to characterize the burden of pneumonia hospitalizations in Hong Kong and inform targeted healthcare policies for pneumonia control in the era of global aging. This was a population-based study using a territory-wide administrative electronic health record system that covers all public hospitals of Hong Kong. Patients admitted to public hospitals, from 2011 to 2015, with a diagnosis of pneumonia at discharge were identified based on the International Classification of Diseases-Ninth Revision-Clinical Modification Codes (480-486 and 487.0). Incidence, inpatient case-fatality, all-cause fatality, 28-day readmission, hospital length of stay, and healthcare costs were assessed for seven age strata. We identified 323,992 patients (median age 80 years, 44.4% female) with hospitalized pneumonia (organism unspecified 84.2%; bacterial pneumonia 12.3%; viral pneumonia 2.5%; others 1.0%). Annual incidence was 955.1 per 100,000 population, with a 10.6% decrease from 2011 to 2015. Case-fatality, all-cause fatality, and 28-days readmission risks were 13.8, 21.6, and 19.5%, respectively. The average hospital length of stay was 14.1 days with corresponding direct costs of $9348 USD per episode in the monetary value of 2015. Individuals aged ≥ 65 years accounted for over 75% of pneumonia-related hospitalizations, 90% of deaths, and the majority of healthcare costs. Hospitalized pneumonia represents a considerable health and economic burden in Hong Kong, especially in older adults. The study provides a population-level baseline estimate for further cost-effective evaluation of targeted strategies for pneumonia control.
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Poon CM, Wong ELY, Chau PYK, Yau SY, Yeoh EK. Management decision of hospital surge: assessing seasonal upsurge in inpatient medical bed occupancy rate among public acute hospitals in Hong Kong. QJM 2019; 112:11-16. [PMID: 30295857 DOI: 10.1093/qjmed/hcy217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There were recurrent upsurges in demand for public hospital services in Hong Kong. An understanding of the contribution of some possible factors for the rise in health care burden would help to inform hospital management strategies. AIM To evaluate the utilization patterns of hospitalizations in medical wards among public acute hospitals in Hong Kong during surge periods. DESIGN Retrospective study. METHODS By extracting the information in press releases between 2014 and 2018, descriptive statistics about medical ward occupancy situation during six surge periods were generated. A time series model was constructed to estimate the occupancy rate at each hospital and assess its relationship with the intensity of seasonal influenza activity, extreme weather, day of week and long holidays. RESULTS There was a significant increase in the number of admissions to medical wards in all six surge periods. A significant variation in occupancy rate between weekdays and geographic regions was observed. The occupancy rate in 10, out of 15, hospitals was significantly associated with the influenza activity, while there was limited effect of weather on the occupancy rate. A significant holiday effect was observed during Christmas and Chinese New Year, resulting in a lower bed occupancy rate. CONCLUSIONS A differential burden in public hospitals during surge periods was reported. Contingency bed and staff management shall be tailored to individual hospitals, given their differences in the determinants for inpatient bed occupancy.
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Affiliation(s)
- C M Poon
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
- Stanley Ho Centre for Emerging Infectious Diseases, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - E L Y Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - P Y K Chau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - S Y Yau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - E K Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
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Nowossadeck E, Prütz F. [Regional differences in the development of hospitalizations : An effect of different demographic trends?]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:358-366. [PMID: 29374298 DOI: 10.1007/s00103-018-2695-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Population aging and population decline in many regions of the Federal Republic of Germany are key elements of demographic change. In the regions concerned there is a rising number of older people and, simultaneously, a declining population. So far, the consequences of regional shrinkage and growth for inpatient care don't seem to have been analysed very well. This paper analyses the influence of population aging and declining/increasing population (demographic factors) as well as other, non-demographic factors on the number of hospitalizations in Germany and the Federal States since 2000.One result of the analysis is that there are major differences between the Federal States. The analysis shows, for example, an increase of hospitalizations in Berlin while in Saxony-Anhalt the number of hospitalizations declines. The increase in Berlin was the result of population aging and, to a lower extent, an increase in population. In Saxony-Anhalt the declining population resulted in a decreasing number of hospitalizations. Population aging and non-demographic factors were not able to compensate this trend.Overall, the effect of demographic factors on the number of hospitalizations remains constant over time. Short-term changes of hospitalizations are due to non-demographic factors, such as epidemiological trends, (for example trends of incidence or prevalence), or structural changes of health care service (for example patients shifting between different sectors of health care or the introduction of new reimbursement systems).
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Affiliation(s)
- Enno Nowossadeck
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland.
| | - Franziska Prütz
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, General-Pape-Str. 62-66, 12101, Berlin, Deutschland
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Li J, Yip BHK, Leung C, Chung W, Kwok KO, Chan EYY, Yeoh E, Chung P. Screening for latent and active tuberculosis infection in the elderly at admission to residential care homes: A cost-effectiveness analysis in an intermediate disease burden area. PLoS One 2018; 13:e0189531. [PMID: 29293514 PMCID: PMC5749681 DOI: 10.1371/journal.pone.0189531] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) in the elderly remains a challenge in intermediate disease burden areas like Hong Kong. Given a higher TB burden in the elderly and limited impact of current case-finding strategy by patient-initiated pathway, proactive screening approaches for the high-risk group could be optimal and increasingly need targeted economic evaluations. In this study, we examined whether and under what circumstance the screening strategies are cost-effective compared with no screening strategy for the elderly at admission to residential care homes. METHODS A decision analytic process based on Markov model was adopted to evaluate the cost-effectiveness of four strategies: (i) no screening, (ii) TB screening (CXR) and (iii) TB screening (Xpert) represent screening for TB in symptomatic elderly by chest X-ray and Xpert® MTB/RIF respectively, and (iv) LTBI/TB screening represents screening for latent and active TB infection by QuantiFERON®-TB Gold In-Tube and chest X-ray. The target population was a hypothetical cohort of 65-year-old people, using a health service provider perspective and a time horizon of 20 years. The outcomes were direct medical costs, life-years and quality-adjusted life-years (QALYs) measured by incremental cost-effectiveness ratio (ICER). RESULTS In the base-case analysis, no screening was the most cost-saving; TB screening (CXR) was dominated by TB screening (Xpert); LTBI/TB screening resulted in more life-years and QALYs accrued. The ICERs of LTBI/TB screening were US$19,712 and US$29,951 per QALY gained compared with no screening and TB screening (Xpert), respectively. At the willingness-to-pay threshold of US$50,000 per QALY gained, LTBI/TB screening was the most cost-effective when the probability of annual LTBI reactivation was greater than 0.155% and acceptability of LTBI/TB screening was greater than 38%. In 1,000 iterations of Monte Carlo simulation, the probabilities of no screening, TB screening (CXR), TB screening (Xpert), and LTBI/TB screening to be cost-effective were 0, 1.3%, 20.1%, and 78.6% respectively. CONCLUSIONS Screening for latent and active TB infection in Hong Kong elderly people at admission to residential care homes appears to be highly effective and cost-effective. The key findings may be the next key factor to bring down TB endemic in the elderly population among intermediate TB burden areas.
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Affiliation(s)
- Jun Li
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Benjamin H. K. Yip
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Chichiu Leung
- Tuberculosis and Chest Service, Department of Health, Hong Kong, China
| | - Wankyo Chung
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Kin On Kwok
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Emily Y. Y. Chan
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Engkiong Yeoh
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
| | - Puihong Chung
- Jockey School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, China
- * E-mail:
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