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Seizures and emergency department: characteristics and factors of repeat adult attendees. J Neurol 2022; 269:3770-3778. [DOI: 10.1007/s00415-022-11006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/19/2022] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
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Sanatinia R, Burns A, Crome P, Gordon F, Hood C, Lee W, Quirk A, Seers K, Staniszewska S, Zafarani G, Crawford M. Factors associated with shorter length of admission among people with dementia in England and Wales: retrospective cohort study. BMJ Open 2021; 11:e047255. [PMID: 34666999 PMCID: PMC8527135 DOI: 10.1136/bmjopen-2020-047255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify aspects of the organisation and delivery of acute inpatient services for people with dementia that are associated with shorter length of hospital stay. DESIGN AND SETTING Retrospective cohort study of patients admitted to 200 general hospitals in England and Wales. PARTICIPANTS 10 106 people with dementia who took part in the third round of National Audit of Dementia. MAIN OUTCOME MEASURE Length of admission to hospital. RESULTS The median length of stay was 12 days (IQR=6-23 days). People with dementia spent less time in hospital when discharge planning was initiated within 24 hours of admission (estimated effect -0.24, 95% CI: -0.29 to -0.18, p<0.001). People from ethnic minorities had shorter length of stay (difference -0.066, 95% CI: -0.13 to -0.002, p=0.043). Patients with documented evidence of discussions having taken place between their carers and medical staff spent longer in hospital (difference 0.26, 95% CI: 0.21 to 0.32, p<0.001). These associations held true in a subsample of 669 patients admitted with hip fracture and data from 74 hospitals with above average carer-rated quality of care. CONCLUSIONS The way that services for inpatients with dementia are delivered can influence how long they spend in hospital. Initiating discharge planning within the first 24 hours of admission may help reduce the amount of time that people with dementia spend in hospital.
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Affiliation(s)
| | - Alistair Burns
- Division of Neuroscience and Experimental Psychology, The University of Manchester, Manchester, UK
| | - Peter Crome
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Fabiana Gordon
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Chloe Hood
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - William Lee
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Alan Quirk
- CCQI, Royal College of Psychiatrists, London, UK
| | - Kate Seers
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Sophie Staniszewska
- Warwick Research in Nursing, University of Warwick Warwick Medical School, Warwick, UK
| | - Gemma Zafarani
- Division of Psychiatry, Imperial College London, London, UK
| | - Mike Crawford
- Division of Psychiatry, Imperial College London, London, UK
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Morita K, Fukahori H, Ogawara H, Iwagami M, Matsui H, Okura T, Itoh S, Fushimi K, Yasunaga H. Outcomes of a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals: A difference-in-differences analysis of a nationwide retrospective cohort study in Japan. Int J Geriatr Psychiatry 2021; 36:1386-1397. [PMID: 33733528 DOI: 10.1002/gps.5537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/12/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The quality of care for dementia in acute-care settings has been criticised. In 2016, the Japanese universal health insurance system introduced a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals. This study aimed to investigate the effectiveness of this financial incentive scheme on short-term outcomes (in-hospital mortality and 30-day readmission). DESIGN AND METHODS Using a Japanese nationwide inpatient database, we identified older adult patients with moderate-to-severe dementia admitted for pneumonia, heart failure, cerebral infarction, urinary tract infection, intracranial injury or hip fracture from April 2014 to March 2018. We selected 180 propensity score-matched pairs of hospitals that adopted (n = 180 of 185) and that did not adopt (n = 180 of 744) the financial incentive scheme. We then conducted a patient-level difference-in-differences analysis. In a sensitivity analysis, we restricted the postintervention group to patients who actually received dementia care. RESULTS There was no association between a hospital's adoption of the incentive scheme and in-hospital mortality (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.88-1.06; p = 0.48) or 30-day readmission (aOR: 1.04; 95% CI: 0.95-1.14; p = 0.37). Only 29% of patients in hospitals adopting the scheme actually received dementia care. The sensitivity analysis showed that receiving dementia care was associated with decreased in-hospital mortality. CONCLUSIONS The financial incentive scheme to enhance dementia care by dementia specialist teams in Japan may not be working effectively, but the results do suggest that individual dementia care was associated with decreased in-hospital mortality.
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Affiliation(s)
- Kojiro Morita
- Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiroki Fukahori
- Division of Gerontological Nursing, Faculty of Nursing and Medical Care, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Hirofumi Ogawara
- Major in Nursing, Graduate School of Health Management, Keio University, Fujisawa-shi, Kanagawa, Japan
| | - Masao Iwagami
- Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Toru Okura
- Yamato Homecare Clinic Osaki, Osaki-shi, Miyagi, Japan
| | - Sakiko Itoh
- Department of Gerontological Nursing and Care System Development, Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Casafont C, Risco E, Piazuelo M, Ancín-Pagoto M, Cobo-Sánchez JL, Solís-Muñoz M, Zabalegui A. Care of older people with Cognitive Impairment or Dementia Hospitalized in Traumatology Units (CARExDEM): a quasi-experiment. BMC Geriatr 2020; 20:246. [PMID: 32677894 PMCID: PMC7367239 DOI: 10.1186/s12877-020-01633-5] [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: 01/07/2020] [Accepted: 06/25/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In our context, as in other European countries, care of patients with cognitive disorders or dementia still represents a major challenge in hospital settings. Thus, there is a need to ensure quality and continuity of care, avoiding preventable readmissions, which involve an increase in public expenses. Healthcare professionals need to acquire the necessary knowledge and skills to care for hospitalized patients with cognitive disorders and dementia. METHODS A quasi-experimental design with repeated observations, taken at baseline, post-intervention, and at one and three months post-intervention, in people hospitalized with cognitive disorders or dementia. The study will be carried out in four general hospitals in Spain and will include 430 PwD and their caregivers. The intervention was previously developed using the Balance of Care methodology where nurses, physicians, social workers and informal caregivers identified the best practices for this specific care situation. We aim to personalize the intervention, as recommended in the literature. The study has an innovative approach that includes new technologies and previous scientific evidence. Valid, reliable instruments will be used to measure the intervention outcomes. Quality of care and comorbidity will be analyzed based on the use of restraints and psychotropic medication, pain control, falls, functional capacity and days of hospitalization. Continuity of care will be measured based on post-discharge emergency hospital visits, visits to specialists, cost, and inter-sectorial communication among healthcare professionals and informal caregivers. Statistical analysis will be performed to analyze the effect of the intervention on quality of care, comorbidity and continuity of care for patients with dementia. DISCUSSION Our aim is to helping healthcare professionals to improve the management of cognitive disorders or dementia care during hospitalization and the quality of care, comorbidity and continuity of care in patients with dementia and their informal caregivers. Moving towards dementia-friendly environments is vital to achieving the optimum care outcomes. TRIAL REGISTRATION Registered in Clinical Trials. ClinicalTrials.gov Identifier: NCT04048980 retrospectively registered on the 6th August 2019. https://clinicaltrials.gov/ Protocol Record HCB/2017/0499. SPONSOR Hospital Clinic Barcelona.
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Affiliation(s)
- Claudia Casafont
- Consultant Nurse in Research, Hospital Clinic Barcelona, Assistant lecturer Universitat de Barcelona, Villarroel, 170, 08036 Barcelona, Spain
| | - Ester Risco
- Associate Nursing Director. Hospital d’Atenció Intermèdia Parc Sanitari Pere Virgili, Esteve Terrades,30, 08023 Barcelona, Spain
| | - Mercè Piazuelo
- Nurse Unit Manager in Traumatology Unit, Hospital Clinic Barcelona, Villarroel, 170, 08036 Barcelona, Spain
| | - Marta Ancín-Pagoto
- Vice director of Nursing Care in Complejo Hospitalario de Navarra, Pabellón G. Irunlarrea,3, 31008 Pamplona, Spain
| | - José Luis Cobo-Sánchez
- Consultant Nurse in Research, Hospital Universitario Marqués de Valdecilla, Santander. Pabellón 16 Planta baja. Avenida Valdecilla s/n., 39008 Santander, Spain
| | - Montserrat Solís-Muñoz
- Head of the Care Research Unit, Puerta de Hierro Majadahonda University Hospital. Head of the Nursing and Health Care Research Group, Puerta de Hierro-Segovia de Arana Health Research Institute, Joaquín Rodrigo, 2, 28222 Madrid, Majadahonda Spain
| | - Adelaida Zabalegui
- Vice director of Research and Education in Nursing in Hospital Clinic Barcelona, Assistant lecturer Universitat de Barcelona, Escala 1 planta 7. Villarroel 170, 08036 Barcelona, Spain
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Goldsmith LP, Smith JG, Clarke G, Anderson K, Lomani J, Turner K, Gillard S. What is the impact of psychiatric decision units on mental health crisis care pathways? Protocol for an interrupted time series analysis with a synthetic control study. BMC Psychiatry 2020; 20:185. [PMID: 32326915 PMCID: PMC7178744 DOI: 10.1186/s12888-020-02581-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The UK mental health system is stretched to breaking point. Individuals presenting with mental health problems wait longer at the ED than those presenting with physical concerns and finding a bed when needed is difficult - 91% of psychiatric wards are operating at above the recommended occupancy rate. To address the pressure, a new type of facility - psychiatric decision units (also known as mental health decision units) - have been introduced in some areas. These are short-stay facilities, available upon referral, targeted to help individuals who may be able to avoid an inpatient admission or lengthy ED visit. To advance knowledge about the effectiveness of this service for this purpose, we will examine the effect of the service on the mental health crisis care pathway over a 4-year time period; the 2 years proceeding and following the introduction of the service. We use aggregate service level data of key indicators of the performance of this pathway. METHODS Data from four mental health Trusts in England will be analysed using an interrupted time series (ITS) design with the primary outcomes of the rate of (i) ED psychiatric presentations and (ii) voluntary admissions to mental health wards. This will be supplemented with a synthetic control study with the same primary outcomes, in which a comparable control group is generated for each outcome using a donor pool of suitable National Health Service Trusts in England. The methods are well suited to an evaluation of an intervention at a service delivery level targeting population-level health outcome and the randomisation or 'trialability' of the intervention is limited. The synthetic control study controls for national trends over time, increasing our confidence in the results. The study has been designed and will be carried out with the involvement of service users and carers. DISCUSSION This will be the first formal evaluation of psychiatric decision units in England. The analysis will provide estimates of the effect of the decision units on a number of important service use indicators, providing much-needed information for those designing service pathways. TRIAL REGISTRATION primary registry: isrctn.com Identifying number: ISRCTN77588384 Link: Date of registration in primary registry: 27/02/2020. PRIMARY SPONSOR St George's, University of London, Cramner Road, Tooting, SW17 ORE. Primary contact: Joe Montebello.
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Affiliation(s)
- L P Goldsmith
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK.
| | - J G Smith
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - G Clarke
- The Health Foundation, 8 Salisbury Square, London, UK
| | - K Anderson
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - J Lomani
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - K Turner
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
| | - S Gillard
- Population Health Research Institute, St George's, University of London, Cramner Road, Tooting, London, SW17 0RE, UK
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Sanatinia R, Crawford MJ, Quirk A, Hood C, Gordon F, Crome P, Staniszewska S, Zafarani G, Hammond S, Burns A, Seers K. Identifying features associated with higher-quality hospital care and shorter length of admission for people with dementia: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Concerns have repeatedly been expressed about the quality of inpatient care that people with dementia receive. Policies and practices have been introduced that aim to improve this, but their impact is unclear.
Aims
To identify which aspects of the organisation and delivery of acute inpatient services for people with dementia are associated with higher-quality care and shorter length of stay.
Design
Mixed-methods study combining a secondary analysis of data from the third National Audit of Dementia (2016/17) and a nested qualitative exploration of the context, mechanism and outcomes of acute care for people with dementia.
Setting
Quantitative data from 200 general hospitals in England and Wales and qualitative data from six general hospitals in England that were purposively selected based on their performance in the audit.
Participants
Quantitative data from clinical records of 10,106 people with dementia who had an admission to hospital lasting ≥ 72 hours and 4688 carers who took part in a cross-sectional survey of carer experience. Qualitative data from interviews with 56 hospital staff and seven carers of people with dementia.
Main outcome measures
Length of stay, quality of assessment and carer-rated experience.
Results
People with dementia spent less time in hospital when discharge planning was initiated within 24 hours of admission. This is a challenging task when patients have complex needs, and requires named staff to take responsibility for co-ordinating the discharge and effective systems for escalating concerns when obstacles arise. When trust boards review delayed discharges, they can identify recurring problems and work with local stakeholders to try to resolve them. Carers of people with dementia play an important role in helping to ensure that hospital staff are aware of patient needs. When carers are present on the ward, they can reassure patients and help make sure that they eat and drink well, and adhere to treatment and care plans. Clear communication between staff and family carers can help ensure that they have realistic expectations about what the hospital staff can and cannot provide. Dementia-specific training can promote the delivery of person-centred care when it is made available to a wide range of staff and accompanied by ‘hands-on’ support from senior staff.
Limitations
The quantitative component of this research relied on audit data of variable quality. We relied on carers of people with dementia to explore aspects of service quality, rather than directly interviewing people with dementia.
Conclusions
If effective support is provided by senior managers, appropriately trained staff can work with carers of people with dementia to help ensure that patients receive timely and person-centred treatment, and that the amount of time they spend in hospital is minimised.
Future work
Future research could examine new ways to work with carers to co-produce aspects of inpatient care, and to explore the relationship between ethnicity and quality of care in patients with dementia.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 22. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Mike J Crawford
- Centre for Psychiatry, Imperial College London, London, UK
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Alan Quirk
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Chloe Hood
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Fabiana Gordon
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Peter Crome
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sophie Staniszewska
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Gemma Zafarani
- Centre for Psychiatry, Imperial College London, London, UK
| | - Sara Hammond
- Centre for Psychiatry, Imperial College London, London, UK
| | - Alistair Burns
- Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Kate Seers
- Warwick Research in Nursing, Warwick Medical School, University of Warwick, Coventry, UK
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Balasundaram B, Yoon PS, Rosario BH, Kam JW, Tan LMY, Varman S. Geriatric psychiatry liaison programme in a Singapore public hospital geriatric ward setting: descriptive and evaluation study on delirium and dementia. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105819869031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background: Comprehensive geriatric psychiatry liaison services are in early and evolving stages in Singapore. A description and evaluation of a geriatric psychiatry liaison programme in geriatric wards was undertaken describing programme activity and clinical outcomes in patients with neurocognitive disorders. Dementia training and staff upskilling are also discussed. Methods: This study included all referred patients by the geriatric team in Changi General Hospital over a one-year period from 15 June 2017 to 14 June 2018. As measures of good clinical practice, diagnosis of delirium and new diagnosis of dementia made during the inpatient admission following liaison consultation were included in the study. Patient-related outcomes that included length of stay (LOS), institutionalisation rates and in-hospital mortality were evaluated. Results: Dementia (53%), delirium (49%) and depression (28%) were the commonest diagnoses in this study. Dementia was newly diagnosed in 30% of cases. The median LOS in those with delirium was 19 days; 19% with a delirium diagnosis had new institutionalisation rates. In-hospital mortality in this study was 2%. Conclusions: The geriatric psychiatry liaison programme in geriatric wards in Changi General Hospital improved detection rates of delirium and new diagnoses of dementia. It also reports increased LOS and new institutionalisation rates in those with a diagnosis of delirium. Nursing staff education in neurocognitive disorders is enhanced. This article has outlined the importance of team-based care, joint specialist care and staff training in recognition of delirium and dementia in an acute hospital setting to improve outcomes for older patients.
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Affiliation(s)
- Bharathi Balasundaram
- Medical Centre Department of Psychological Medicine, Changi General Hospital, Singapore
| | | | | | - Jia Wen Kam
- Clinical Trials and Research Unit, Changi General Hospital, Singapore
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Singh I, Edwards C, Duric D, Rasuly A, Musa SO, Anwar A. Dementia in an Acute Hospital Setting: Health Service Research to Profile Patient Characteristics and Predictors of Adverse Clinical Outcomes. Geriatrics (Basel) 2019; 4:geriatrics4010007. [PMID: 31023975 PMCID: PMC6473705 DOI: 10.3390/geriatrics4010007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 12/27/2018] [Accepted: 12/28/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Patients with dementia often have other associated medical co-morbidities resulting in adverse outcomes. The National Audit of Dementia (NAD) in the UK showed a wide variation in the quality and clinical care for acute dementia patients. This study aims to record the clinical profile and benchmark clinical outcomes of acute dementia patients admitted within Aneurin Bevan University Health Board, Wales (UK). METHODS This was a retrospective observational study based on analysis of the existing data for all acute dementia patients. Ethical approval was not required for this service evaluation. RESULTS In 2016, a total of 1770 dementia patients had 2474 acute admissions. We studied 1167 acute admissions (953 dementia patients) from 1st January 2016⁻30th June 2016. The mean age was 84.5 ± 7.8 years (females = 63.5%). Mean Charlson comorbidity index and the number of drugs were 6.0 ± 1.5 and 5.1 ± 2.1. 15.4% (147/953) patients were on antipsychotics. Overall mean hospital stay was 19.4 ± 27.2 days. 30-days readmission rate was 17.2% (138/800) with a mean hospital stay of 14.6 ± 17.9 days. 3.4% (32/953) patients were excluded due to a coding error. 70.3% (n = 670/953) were previously living in their own homes and only 26.3% (n = 251/953) were admitted from care homes. 59.5% patients (n = 399/670) were discharged back to their homes and 21.6% (145/670) were discharged to a new care home, which represents an approximately 1.68 times higher rate of new care home occupancy than the patients being originally admitted from a care home. Overall inpatient was 16.0% (153/953). 30-days and one-year mortality were 22.3% (213/953) and 49.2% (469/953) respectively. The observed mortality rates between patients admitted from home or from a care home were highly significant for one-year mortality (p < 0.001). The inpatient falls rate was significantly higher (1.8 times) as compared to overall general medical inpatient falls rate. CONCLUSION Acute patients with dementia have a higher risk of adverse outcomes and the impact of hospitalisation. Prompt comprehensive geriatric assessment and quality improvement initiatives are needed to improve clinical outcomes and to enhance the quality of care.
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Affiliation(s)
- Inderpal Singh
- Consultant Geriatrician, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
| | - Chris Edwards
- Department of Dermatology, St Wollas Hospital, Aneurin Bevan University Health Board, Newport NP20 4SZ, UK.
| | - Daniel Duric
- Speciality Doctor, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
| | - Aman Rasuly
- Speciality Doctor, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
| | - Sabdat Oziohu Musa
- Speciality Doctor, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
| | - Anser Anwar
- Speciality Doctor, Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales CF82 7EP, UK.
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de Silva PN. Use of appropriate technology to improve mental health service delivery. Br J Hosp Med (Lond) 2018; 79:682-685. [PMID: 30526096 DOI: 10.12968/hmed.2018.79.12.682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reviews currently available appropriate technologies which have been used in mental health, in order to reduce confusion and delay. Confusion (for example when and where to refer) can lead to error and waste. Similarly delay impacts quality and accessibility of the whole range of mental health services. As most secondary care mental health services use electronic patient records, it is arguably easier to apply technology in this speciality. However, consideration needs to be given to confidentiality and data security. Doctors of all specialities will be exposed to 'new' technologies over the next decade, and need to be aware of the direction of travel and its implications.
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Affiliation(s)
- Prasanna N de Silva
- Consultant Psychiatrist, Monkwearmouth Hospital, Northumberland, Tyne and Wear NHS Foundation Trust, Sunderland SR5 1NB and Honorary Senior Lecturer, Department of Health Sciences and Wellbeing, Sunderland University, Sunderland
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House A, Guthrie E, Walker A, Hewsion J, Trigwell P, Brennan C, Crawford M, Murray CC, Fossey M, Hulme C, Martin A, Quirk A, Tubeuf S. A programme theory for liaison mental health services in England. BMC Health Serv Res 2018; 18:742. [PMID: 30261875 PMCID: PMC6161457 DOI: 10.1186/s12913-018-3539-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/13/2018] [Indexed: 11/11/2022] Open
Abstract
Background Mechanisms by which liaison mental health services (LMHS) may bring about improved patient and organisational outcomes are poorly understood. A small number of logic models have been developed, but they fail to capture the complexity of clinical practice. Method We synthesised data from a variety of sources including a large national survey, 73 in-depth interviews with acute and liaison staff working in hospitals with different types of liaison mental health services, and relevant local, national and international literature. We generated logic models for two common performance indicators used to assess organisational outcomes for LMHS: response times in the emergency department and hospital length of stay for people with mental health problems. Results We identified 8 areas of complexity that influence performance, and 6 trade-offs which drove the models in different directions depending upon the balance of the trade-off. The logic models we developed could only be captured by consideration of more than one pass through the system, the complexity in which they operated, and the trade-offs that occurred. Conclusions Our findings are important for commissioners of liaison services. Reliance on simple target setting may result in services that are unbalanced and not patient-centred. Targets need to be reviewed on a regular basis, together with other data that reflect the wider impact of the service, and any external changes in the system that affect the performance of LMHS, which are beyond their control.
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Affiliation(s)
- Allan House
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Elspeth Guthrie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Andrew Walker
- Clinical Research Network National Coordinating Centre, National Institute of Health Research Clinical Research Network, Leeds, UK
| | - Jenny Hewsion
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Peter Trigwell
- National Inpatient Centre for Psychological Medicine, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mike Crawford
- Faculty of Medicine, Department of Medicine, Imperial College, London, UK
| | | | - Matt Fossey
- Veterans and Families Institute for Military Research, Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
| | - Claire Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Adam Martin
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Alan Quirk
- College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Sandy Tubeuf
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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[Prevalence of dementia in university hospitals : Analysis of ICD-10 coding in 5 university hospitals in Germany over a 2-year period]. Z Gerontol Geriatr 2018; 52:575-581. [PMID: 30076440 DOI: 10.1007/s00391-018-1433-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/30/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Demographic changes result in a higher prevalence of patients suffering from dementia in hospital. In Germany, epidemiological data of this target group are scarce and prevalence rates from university hospitals (UH) are not available. The prevalence rates and distribution were analyzed on the basis of ICD-10-GM (German modification) routine data METHOD: A secondary analysis on ICD-10-GM main and secondary diagnoses of dementia from 2014 and 2015 from 5 UH was performed. All patients admitted to hospital for at least 24 h and ≥18 years old (2014 n = 187,168; 2015 n = 189,040) were included. A descriptive analysis for the >69-year-old group was carried out (2014, n = 67,111; 2015; n = 67,824). RESULTS The 1‑year prevalence (2014/2015) for all 5 UH for patients ≥18 years old was 1.3%/1.4% and for the >69-year-old group, 3.3%/3.5%. The prevalence rates between the five UH varied: for patients ≥18 years the range was 0.44-2.16% (2014) and 0.44-2.77% (2015) and for >69-year-olds 1.16-5.52% (2014) and 1.16-7.06% (2015). Most cases were correlated with major diagnostic categories of traumatology, cardiology, gastroenterology and neurology. CONCLUSION Analysis of ICD-10-GM routine data can provide an indication of the prevalence of dementia in UH. Results of the >69-year-olds varied greatly between participating UH. The reasons for this might be different healthcare tasks, especially with respect to geriatric patients; however, it is also possible that assessment procedures are not standardized and unreliable and therefore the coding is invalid. A standardized procedure for the identification of people suffering from dementia is necessary.
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Impact of Hospital Design on Acutely Unwell Patients with Dementia. Geriatrics (Basel) 2017; 2:geriatrics2010004. [PMID: 31011015 PMCID: PMC6371082 DOI: 10.3390/geriatrics2010004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 12/29/2016] [Accepted: 01/09/2017] [Indexed: 12/19/2022] Open
Abstract
Increasing emphasis on patient privacy and satisfaction has seen more 100% single-room hospitals opened across the UK. Few studies have addressed the impact of these new hospital designs (single rooms) on clinical outcomes specifically for acutely unwell frail patients with dementia. The objective of this study was to profile and compare the clinical outcomes of acutely unwell patients with dementia admitted to two different hospital environments. This prospective observation study was conducted for 100 dementia patients admitted at Ysbyty Ystrad Fawr (hospital with 100% single rooms) and Royal Gwent Hospital (traditional multi-bed wards) under the same University Health Board. The length of stay (LoS) was significantly longer for patients admitted to single rooms. The clinical profile of the patients was similar in both hospitals and has no association with LoS. There was no significant difference in terms of incidence of inpatient falls, fall-related injury, discharge to a new care home, 30-day readmission, or mortality. The single room environment appears to influence LoS, as previously reported; however, following the introduction of quality improvement initiatives to prevent inpatient falls, single rooms do not appear to be associated with higher inpatient fall incidence. We propose more research to understand the relationship between single rooms and LoS.
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Singh I, Fernando P, Griffin J, Edwards C, Williamson K, Chance P. Clinical outcome and predictors of adverse events of an enhanced older adult psychiatric liaison service: Rapid Assessment Interface and Discharge (Newport). Clin Interv Aging 2016; 12:29-36. [PMID: 28053514 PMCID: PMC5192058 DOI: 10.2147/cia.s104278] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Hospitals are currently admitting an increasing number of older people, and more than one-third could have an underlying mental health problem. The existing Older Adult Mental Health (OAMH) liaison service was increasingly unable to meet the escalating needs of older and frail patients. Therefore, the service was modernized and enhanced on an “invest-to-save” principle to provide a prompt holistic assessment for older adults with mental health problems. The objective of this study was a service evaluation to appraise clinical outcome, minimize the length of stay, and measure the predictors of adverse outcomes to streamline this enhanced service. Materials and methods Patient demographics, social care needs, comorbidity burden (Charlson comorbidity index, CCI), and functional status (Barthel index, BI) were recorded from November 2014 to February 2015. Frailty status (frailty index, FI) was measured by an index (Rockwood index) of accumulated deficits. The outcomes were compared with the previous OAMH liaison service data over the same period a year earlier. Results The new Rapid Assessment Interface and Discharge service assessed 339 patients compared to 179 by the previous liaison team over the 4-month period. Mean age was 82.18±8.04 years, with 60% women; preadmission BI was 14.96±4.35, and admission BI was 11.38±5.73 (P<0.001, paired t-test); mean CCI was 1.66±1.53, and mean FI was 0.34±0.99, and 80% were on polypharmacy. The direct discharges from front door were increased by 7%. The mean hospital stay reduced from 35 to 20 days in acute site and from 108 to 47 days in long-stay wards. The cost benefits were based on the mean reduction in hospital stay (41.8 days) and admission reduction (2.2 days), leading to a total annualized bed savings of 44 days. FI was the most highly significant factor between patient groups with a good and poor outcome (P=0.00003, independent groups t-test, t=−4.38, df 98). Conclusion Prompt mental health assessments for acutely unwell frail older people are not only cost effective but also improve clinical outcomes.
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Affiliation(s)
- Inderpal Singh
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board
| | - Priya Fernando
- Department of Geriatric Medicine, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board
| | - Jane Griffin
- Royal Gwent Hospital, Aneurin Bevan University Board
| | - Chris Edwards
- Royal Gwent Hospital, Aneurin Bevan University Board
| | - Kathryn Williamson
- Department of Old Age Psychiatry, Ysbyty Ystrad Fawr, Aneurin Bevan University Health Board, Wales, UK
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Sutcliffe CL, Jasper R, Roe B, Jolley D, Crook A, Challis DJ. Inter-professional perspectives of dementia services and care in England: Outcomes of a focus group study. DEMENTIA 2014; 15:1002-20. [PMID: 25169885 DOI: 10.1177/1471301214548692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many people living with dementia are supported at home using a variety of health and social care services. This paper reports the findings from a focus group study undertaken with staff in community mental health teams to explore areas for improvement in relation to national policies and recommendations for dementia care. Two focus groups were held with staff (n = 23) in 2011 to discuss topics including service delivery, information and communication, and provision of health and community care for people with dementia. Respondents identified problems with information sharing and incompatible electronic systems; inflexibility in home care services; and poor recognition of dementia in hospital settings. General practitioners had developed a greater awareness of the disease and some community services worked well. They felt that budgetary constraints and a focus on quality indicators impeded good dementia care. Key areas suggested by staff for improvements in dementia care included the implementation of more flexible services, dementia training for health and social care staff, and better quality care in acute hospital settings.
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Affiliation(s)
| | - Rowan Jasper
- Personal Social Services Research Unit, University of Manchester, UK
| | - Brenda Roe
- Evidence-based Practice Research Centre, Edge Hill University, UK; Personal Social Services Research Unit, University of Manchester, UK
| | - David Jolley
- Personal Social Services Research Unit, University of Manchester, UK
| | - Anthony Crook
- Formerly Personal Social Services Research Unit, University of Manchester, UK
| | - David J Challis
- Personal Social Services Research Unit, University of Manchester, UK
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Daiello LA, Gardner R, Epstein-Lubow G, Butterfield K, Gravenstein S. Association of dementia with early rehospitalization among Medicare beneficiaries. Arch Gerontol Geriatr 2014; 59:162-8. [PMID: 24661400 DOI: 10.1016/j.archger.2014.02.010] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 02/25/2014] [Accepted: 02/28/2014] [Indexed: 01/22/2023]
Abstract
Preventable hospital readmissions have been recognized as indicators of hospital quality, a source of increased healthcare expenditures, and a burden for patients, families, and caregivers. Despite growth of initiatives targeting risk factors associated with potentially avoidable hospital readmissions, the impact of dementia on the likelihood of rehospitalization is poorly characterized. Therefore, the primary objective of this retrospective cohort study was to investigate whether dementia was an independent predictor of 30-day readmissions. Administrative claims data for all admissions to Rhode Island hospitals in 2009 was utilized to identify hospitalizations of Medicare fee-for-service beneficiaries with a diagnosis of Alzheimer's Disease or other dementias. Demographics, measures of comorbid disease burden, and other potential confounders were extracted from the data and the odds of 30-day readmission to any United States hospital was calculated from conditional logistic regression models. From a sample of 25,839 hospitalizations, there were 3908 index admissions of Medicare beneficiaries who fulfilled the study criteria for a dementia diagnosis. Nearly 20% of admissions (n=5133) were followed by a readmission within thirty days. Hospitalizations of beneficiaries with a dementia diagnosis were more likely to be followed by a readmission within thirty days (adjusted odds ratio (AOR) 1.18; 95% CI, 1.08, 1.29), compared to hospitalizations of those of without dementia. Controlling for discharge site of care did not attenuate the association (AOR 1.21; 95% CI, 1.10, 1.33).
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Affiliation(s)
- Lori A Daiello
- Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI, USA; Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital, Providence, RI, USA.
| | - Rebekah Gardner
- Healthcentric Advisors, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Gary Epstein-Lubow
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA; Butler Hospital, Geriatric Psychiatry, Providence, RI, USA
| | | | - Stefan Gravenstein
- Healthcentric Advisors, Providence, RI, USA; Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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