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Abdul Rahim K, Shaikh NQ, Lakhdir MPA, Afzal N, Merchant AAH, Mahmood SBZ, Bakhshi SK, Ali M, Samad Z, Haider AH. No healthcare coverage, big problem: lack of insurance for older population associated with worse emergency general surgery outcomes. Trauma Surg Acute Care Open 2024; 9:e001165. [PMID: 38616789 PMCID: PMC11015297 DOI: 10.1136/tsaco-2023-001165] [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: 04/26/2023] [Accepted: 03/20/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Older populations, being a unique subset of patients, have poor outcomes for emergency general surgery (EGS). In regions lacking specialized medical coverage for older patients, disparities in healthcare provision lead to poor clinical outcomes. We aimed to identify factors predicting index admission inpatient mortality from EGS among sexagenarians, septuagenarians, and octogenarians. Methods Data of patients aged >60 years with EGS conditions defined by the American Association for the Surgery of Trauma at primary index admission from 2010 to 2019 operated and non-operated at a large South Asian tertiary care hospital were analyzed. The primary outcome was primary index admission inpatient 30-day mortality. Parametric survival regression using Weibull distribution was performed. Factors such as patients' insurance status and surgical intervention were assessed using adjusted HR and 95% CI with a p-value of <0.05 considered statistically significant. Results We included 9551 primary index admissions of patients diagnosed with the nine most common primary EGS conditions. The mean patient age was 69.55±7.59 years. Overall mortality and complication rates were 3.94% and 42.29%, respectively. Primary index admission inpatient mortality was associated with complications including cardiac arrest and septic shock. Multivariable survival analysis showed that insurance status was not associated with mortality (HR 1.13; 95% CI 0.79, 1.61) after adjusting for other variables. The odds of developing complications among self-paid individuals were higher (adjusted OR 1.17; 95% CI 1.02, 1.35). Conclusion Lack of healthcare coverage for older adults can result in delayed presentation, leading to increased morbidity. Close attention should be paid to such patients for timely provision of treatment. There is a need to expand primary care access and proper management of comorbidities for overall patient well-being. Government initiatives for expanding insurance coverage for older population can further enhance their healthcare access, mitigating the risk of essential treatments being withheld due to financial limitations. Level of evidence III.
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Affiliation(s)
| | | | - Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
| | - Noreen Afzal
- Medical College, The Aga Khan University, Karachi, Pakistan
| | | | | | - Saqib Kamran Bakhshi
- Section of Neurosurgery, Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
| | - Mushyada Ali
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, The Aga Khan University Medical College, Karachi, Pakistan
| | - Adil H Haider
- Department of Community Health Sciences, The Aga Khan University Medical College, Karachi, Pakistan
- Department of Surgery, The Aga Khan University, Medical College, Karachi, Pakistan
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Alfano CM, Pugh TM, Tortorella B, Jacob RA, Mitchell CH, Raj VS. Roadmap for Connecting Cancer Rehabilitation With Survivorship to Improve Patient Outcomes and Clinical Efficiency. Am J Phys Med Rehabil 2024; 103:S10-S15. [PMID: 38364024 DOI: 10.1097/phm.0000000000002373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
ABSTRACT An evolved model of comprehensive cancer care is needed that begins at cancer diagnosis to proactively manage cancer treatment toxicities and optimize patient health, function, and well-being. Building new care models requires connecting oncology, primary care, and specialized clinicians from many disciplines including cancer rehabilitation. Having a vision for an evolved standard of comprehensive cancer care is a requirement, but it is not enough to bring an innovative clinical program to life and sustain it over the long term. To inform the development of new clinical programs, two example programs are presented that successfully integrate cancer rehabilitation services along with details of a three-step process these programs used to facilitate their success and build robust business models that ensure their sustainability. Following the roadmap for growth presented here, gaining input from stakeholders and ensuring their buy-in, leveraging existing programmatic priorities, as well as developing a strategic growth plan can help clinical innovators ensure that new programs anticipate and continually meet the needs of oncology, primary care, subspecialty care, and programs, while addressing the business needs of administrators and improving the experience for patients.
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Affiliation(s)
- Catherine M Alfano
- From the Northwell Health Cancer Institute, New Hyde Park, New York (CMA, BT, RAJ); Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York (CMA); Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, (CMA, RAJ); Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, North Carolina (TMP, CHM, VSR); and Department of Supportive Care, Levine Cancer Institute, Charlotte, North Carolina (TMP, CHM, VSR)
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Philippe AM, Farid R. From inpatient rehabilitation facility to skilled nursing facility to home: A retrospective study of functional recovery. PM R 2024; 16:226-230. [PMID: 37649407 DOI: 10.1002/pmrj.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/25/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Inpatient rehabilitation facility (IRF) care has an inherent goal of discharging patients back into the community. Some patients do not progress sufficiently and require discharge to alternate facilities. No prior studies have examined outcomes for patients requiring skilled nursing facility (SNF) placement after their stay at an IRF. OBJECTIVE To identify functional outcomes of patients who receive combined rehabilitation from IRF and SNF. DESIGN In this retrospective observational study, a semistructured phone call questionnaire evaluated for living situation and aid requirement at two time points: prior to acute hospitalization and following discharge from SNF. SETTING Inpatient rehabilitation facility. PARTICIPANTS Persons who required postacute care stay at an IRF and who at time of discharge were not yet safe to return home, so instead were admitted to a SNF. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Changes in pre- and postmorbid functional status categorized by living situation and aid requirement. RESULTS Forty-three adults completed the study. After a stay at IRF followed by SNF, 58.2% of respondents returned to baseline independence. After IRF and SNF stay, 63.4% of respondents who lived at home prior to acute hospitalization returned home. CONCLUSIONS The findings indicate that those patients who receive further rehabilitation at a SNF following discharge from an IRF have the potential to return to baseline functioning and subsequently return home. These data suggest that using IRFs in conjunction with SNFs might be an effective, patient-centered option for rehabilitation. However, further investigation is required to explore whether these findings may be generalized to a larger sample.
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Affiliation(s)
| | - Rez Farid
- Department of Physical Medicine & Rehabilitation, University of Missouri School of Medicine, Columbia, Missouri, USA
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Scharp D, Hobensack M, Davoudi A, Topaz M. Natural Language Processing Applied to Clinical Documentation in Post-acute Care Settings: A Scoping Review. J Am Med Dir Assoc 2024; 25:69-83. [PMID: 37838000 PMCID: PMC10792659 DOI: 10.1016/j.jamda.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVES To determine the scope of the application of natural language processing to free-text clinical notes in post-acute care and provide a foundation for future natural language processing-based research in these settings. DESIGN Scoping review; reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. SETTING AND PARTICIPANTS Post-acute care (ie, home health care, long-term care, skilled nursing facilities, and inpatient rehabilitation facilities). METHODS PubMed, Cumulative Index of Nursing and Allied Health Literature, and Embase were searched in February 2023. Eligible studies had quantitative designs that used natural language processing applied to clinical documentation in post-acute care settings. The quality of each study was appraised. RESULTS Twenty-one studies were included. Almost all studies were conducted in home health care settings. Most studies extracted data from electronic health records to examine the risk for negative outcomes, including acute care utilization, medication errors, and suicide mortality. About half of the studies did not report age, sex, race, or ethnicity data or use standardized terminologies. Only 8 studies included variables from socio-behavioral domains. Most studies fulfilled all quality appraisal indicators. CONCLUSIONS AND IMPLICATIONS The application of natural language processing is nascent in post-acute care settings. Future research should apply natural language processing using standardized terminologies to leverage free-text clinical notes in post-acute care to promote timely, comprehensive, and equitable care. Natural language processing could be integrated with predictive models to help identify patients who are at risk of negative outcomes. Future research should incorporate socio-behavioral determinants and diverse samples to improve health equity in informatics tools.
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Affiliation(s)
| | | | - Anahita Davoudi
- VNS Health, Center for Home Care Policy & Research, New York, NY, USA
| | - Maxim Topaz
- Columbia University School of Nursing, New York, NY, USA
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Beauvais B, Mileski M, Ramamonjiarivelo Z, Lee KA, Kruse CS, Betancourt J, Pradhan R, Shanmugam R. The Association Between Facility Affiliations and Revenue Generation in Skilled Nursing Facilities - An Exploratory Study. J Multidiscip Healthc 2023; 16:3099-3114. [PMID: 37901598 PMCID: PMC10612498 DOI: 10.2147/jmdh.s433771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 10/11/2023] [Indexed: 10/31/2023] Open
Abstract
Background Although hospitals have been the traditional setting for interventional and rehabilitative care, skilled nursing facilities (SNFs) can offer a high-quality and less costly alternative than hospitals. Unfortunately, the financial health of SNFs is often a matter of concern. To partially address these issues, SNF leaders have increased engagement in a number of affiliations to assist in improving quality and reducing operational costs, including Accountable Care Organizations (ACOs), Health Information Exchanges (HIEs), and participation in Bundled Payment for Care Improvement (BPCI) programs. What is not well understood is what impact these affiliations have on the financial viability of the host organizations. Given these factors, this study aims to identify what association, if any, exists between SNF affiliations and revenue generation. Methods Data from calendar year 2022 for n=13,447 SNFs in the US were assessed using multivariate regression analysis. We evaluated two separate dependent measures of revenue generation capacity: net patient revenue per bed and net patient revenue per discharge and considered three unique facility affiliations including (1) ACOs, (2) HIEs, and (3) BPCI participants. Results Six multivariable linear regressions revealed that ACO affiliation is negatively associated with revenue generation on both dependent measures, while HIE affiliation and BPCI participation reflected mixed results. Conclusion A better understanding of the financial impact of SNFs' affiliations may prove insightful. By carefully considering the value of each affiliation, and how each is applicable to any given market, policymakers, funding agencies, and facility leaders may be able to better position SNFs for more sustainable financial performance in a challenging economic environment.
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Affiliation(s)
- Bradley Beauvais
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Michael Mileski
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Zo Ramamonjiarivelo
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Kimberly Ann Lee
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Jose Betancourt
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Rohit Pradhan
- School of Health Administration, Texas State University, San Marcos, TX, USA
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Teigland C, Pulungan Z, Schinkel J, Agatep BC, Yeh EJ, McDermott M, Silverman SL, Lewiecki EM. Economic and Humanistic Burden Among Medicare-Aged Women With Fragility Fracture in the United States. J Am Med Dir Assoc 2023; 24:1533-1540. [PMID: 37271183 DOI: 10.1016/j.jamda.2023.04.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Describe patient characteristics, health care resource utilization, costs, and humanistic burden of women with Medicare insurance with incident fragility fracture who were admitted to post-acute-care (PAC). DESIGN Retrospective cohort study using 100% Medicare Fee-for-Service (FFS) data. SETTING AND PARTICIPANTS Community-dwelling female Medicare beneficiaries with incident fragility fracture January 1, 2017, to October 17, 2019, resulting in PAC admission to a skilled nursing facility (SNF), home-health care, inpatient-rehabilitation facility, or long-term acute-care hospital. METHODS Patient demographic/clinical characteristics were measured during 1-year baseline. Resource utilization and costs were measured during baseline, PAC event, and PAC follow-up. Humanistic burden was measured among SNF patients with linked Minimum Data Set assessments. Multivariable regression examined predictors of PAC costs after discharge and changes in functional status during SNF stay. RESULTS A total of 388,732 patients were included. Compared with baseline, hospitalization rates were 3.5, 2.4, 2.6, and 3.1 times higher and total costs 2.7, 2.0, 2.5, and 3.6 times higher for SNF, home-health, inpatient-rehabilitation, and long-term acute-care, respectively, following PAC discharge. Utilization of dual-energy X-ray absorptiometry (DXA) and osteoporosis medications remained low: 8.5% to 13.7% received DXA during baseline vs 5.2% to 15.6% following PAC; 10.2% to 12.0% received osteoporosis medication during baseline vs 11.4% to 22.3% following PAC. Dual eligibility for Medicaid (ie, low income) was associated with 12% higher costs; Black patients had 14% higher costs. Activities of daily living scores improved 3.5 points during SNF stay, but Black patients had 1.22-point lower improvement than White patients. Pain intensity scores showed small improvement (-0.8 points). CONCLUSIONS AND IMPLICATIONS Women admitted to PAC with incident fracture had high humanistic burden with little improvement in pain and functional status and significantly higher economic burden after discharge compared with baseline. Disparities in outcomes related to social risk factors were observed, with consistently low utilization of DXA and osteoporosis medications even after fracture. Results indicate a need for improved early diagnosis and aggressive disease management to prevent and treat fragility fractures.
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Affiliation(s)
| | | | | | | | | | | | - Stuart L Silverman
- Cedars-Sinai Medical Center, Los Angeles, CA, USA; OMC Clinical Research Center, Beverly Hills, CA, USA
| | - E Michael Lewiecki
- New Mexico Clinical Research and Osteoporosis Center, Albuquerque, NM, USA
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Tucker K, Zikos D, Vick DJ. Association of Hospital Readmission Rates With Discharge Disposition for Patients With Psychotic Disorders. J Healthc Manag 2023; 68:198-214. [PMID: 37159018 DOI: 10.1097/jhm-d-22-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
GOAL We explored how readmissions may result from patients' lack of access to aftercare services, failure to adhere to psychotropic medication plans, and inability to understand and follow hospital discharge recommendations. We also investigated whether insurance status, demographics, and socioeconomic status are associated with hospital readmissions. This study is important because readmissions contribute to increased personal and hospital expenses and decreased community tenure (the ability to maintain stability between hospital admissions). Addressing hospital readmissions will promote optimal discharge practices beginning on day one of hospital admission. METHODS The study examined the differences in hospital readmission rates for patients with a primary psychotic disorder diagnosis. Discharge data were drawn in 2017 from the Nationwide Readmissions Database. Inclusion criteria included patients aged 0-89 years who were readmitted to a hospital between less than 24 hr and up to 30 days from discharge. Exclusion criteria were principal medical diagnoses, unplanned 30-day readmissions, and discharges against medical advice. The sampling frame included 269,906 weighted number of patients diagnosed with a psychotic disorder treated at one of 2,355 U.S. community hospitals. The sample size was 148,529 unweighted numbers of patients discharged. PRINCIPAL FINDINGS In a logistic regression model, weighted variables were calculated and used to determine an association between the discharge dispositions and readmissions. After controlling for hospital characteristics and patient demographics, we found that the odds for readmission for routine and short-term hospital discharge dispositions decreased for home health care discharges, which indicated that home health care can prevent readmissions. The finding was statistically significant when controlling for payer type and patient age and gender. PRACTICAL APPLICATIONS The findings support home health care as an effective option for patients with severe psychosis. Home health care reduces readmissions and is recommended, when appropriate, as an aftercare service following inpatient hospitalization and may enhance the quality of patient care. Improving healthcare quality involves optimizing, streamlining, and promoting standardized processes in discharge planning and direct transitions to aftercare services.
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Affiliation(s)
- Kariba Tucker
- School of Health Sciences, Central Michigan University, Mount Pleasant, Michigan
| | - Dimitrios Zikos
- School of Health Sciences and Herbert H. & Grace A. Dow College of Health Professions, Central Michigan University
| | - Dan J Vick
- School of Health Sciences and Herbert H. & Grace A. Dow College of Health Professions, Central Michigan University
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Deutsch A, Palmer L, Neumann H, Potelle J, Ignaczak M, McMullen T, Ingber MJ. Characteristics and Outcomes of Medicare Patients Treated in Inpatient Rehabilitation Facilities: 2013-2018. Rehabil Nurs 2023; 48:109-121. [PMID: 37133331 DOI: 10.1097/rnj.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
PURPOSE The aim of this study was to describe the characteristics and outcomes of Medicare patients treated in inpatient rehabilitation facilities (IRFs) in 2013 through 2018. DESIGN A descriptive study was conducted. METHODS A total of 2,907,046 IRF Medicare fee-for-service and Medicare Advantage patient stays that ended in 2013 through 2018 were analyzed. RESULTS The number of Medicare patients treated in IRFs increased by about 9%, from 466,092 in 2013 to 509,475 in 2018. Although IRF patients' age and racial/ethnic composition remained similar across the years, there was a shift in patients' primary rehabilitation diagnosis, with more patients with stroke, neurological conditions, traumatic and nontraumatic brain injury, fewer patients with orthopedic conditions, and fewer coded as having medically complex conditions. Across the years, the percentage of patients discharged to the community was between 73.0% and 74.4%. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING Rehabilitation nurses should have training and expertise in the management of patients with stroke and neurological conditions to provide high-quality IRF care. CONCLUSIONS Between 2013 and 2018, the number of Medicare patients treated in IRFs increased overall. There were more patients with stroke and neurological conditions and fewer patients with orthopedic conditions. Changes to IRF and other post-acute care policies, Medicaid expansion, and alternative payment programs may partially be driving these changes.
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Affiliation(s)
| | - Lauren Palmer
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Waltham, MA, USA
| | - Holly Neumann
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Chicago, IL, USA
| | - John Potelle
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Waltham, MA, USA
| | | | - Tara McMullen
- Division of Post-Acute Care, Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services, Baltimore, MD, USA
| | - Melvin J Ingber
- Comprehensive Health Innovation, Research and Policy Division, RTI International, Research Triangle Park, NC, USA
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Aliberti MJR, Levites MR, Berardo FAN. The impact of the COVID-19 pandemic on delivering post-acute care in a low- to middle-income country. J Am Geriatr Soc 2023; 71:973-977. [PMID: 36318657 PMCID: PMC9877838 DOI: 10.1111/jgs.18106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/14/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Márlon Juliano Romero Aliberti
- Laboratorio de Investigacao Medica em Envelhecimento (LIM‐66), Serviço de Geriatria, Hospital das Clinicas HCFMUSPFaculdade de Medicina da Universidade de Sao PauloSao PauloBrazil
- Research InstituteHospital Sirio‐LibanesSao PauloBrazil
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Uddin T, Ahmed B, Shoma FK. Relations between indoor rehabilitation and basic health services in a developing country. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1001084. [PMID: 36761089 PMCID: PMC9905241 DOI: 10.3389/fresc.2023.1001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/02/2023] [Indexed: 01/26/2023]
Abstract
Background and Introduction: Physical rehabilitation is vital for patients to regain maximum function. Approximately 80% of people with a disability live in developing countries, where they face multiple challenges in rehabilitation. The goal of the study was to conduct an analysis of indoor rehabilitation programs based on the demographics and medical conditions of the admitted patients and to relate to the available basic health and rehabilitation facilities. Methods This was a mixed method study conducted in an inpatient rehabilitation ward of a tertiary level academic university hospital in a developing country. All admitted patients who stayed for a period of minimum two weeks were included in the study. Demographic and clinical data were obtained by means of a retrospective medical record review utilizing a standardized data extraction form. The study was further strengthened by an online literature search for the available documents for analysis, relation, and discussion. Results Among the 1,309 admitted patients was male- female ratio was 10:7, with the majority (31.4%) cases falling between the ages of 46 and 60yrs. Rehabilitation outpatient department was the principal mode of admission (78%), and musculoskeletal and neurological conditions represented the maximum number (79.8%). Majority of patients (60.8%) were discharged home on completion of the rehabilitation program with a large number of patients who were absconded. Poor health budget allocation and lack of prioritization of the rehabilitation sector face multiple challenges, including the rehabilitation team functioning resources, space crisis for expansion which was further impacted by the COVID-19 pandemic. Conclusions The country's current health-related rehabilitation process and socio-demographic variables have a negative relationship. There was a large number of missing data in the medical records and many patients were lost prematurely from the indoor rehabilitation program. Musculoskeletal disorders were common, and the majority of patients were discharged home once the program was completed.
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Lee MC, Wu TY, Huang SJ, Chen YM, Hsiao SH, Tsai CY. Post-acute care for frail older people decreases 90-day emergency room visits, readmissions and mortality: An interventional study. PLoS One 2023; 18:e0279654. [PMID: 36607971 PMCID: PMC9821781 DOI: 10.1371/journal.pone.0279654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND To evaluate the effects of post-acute care (PAC) on frail older adults after acute hospitalization in Taiwan. METHODS This was a multicenter interventional study. Frail patients aged ≥ 75 were recruited and divided into PAC or control group. The PAC group received comprehensive geriatric assessment (CGA) and multifactorial intervention including exercise, nutrition education, and medicinal adjustments for two to four weeks, while the control group received only CGA. Outcome measures included emergency room (ER) visits, readmissions, and mortality within 90 days after PAC. RESULTS Among 254 participants, 205 (87.6±6.0 years) were in the PAC and 49 (85.2±6.0 years) in the control group. PAC for more than two weeks significantly decreased 90-day ER visits (odds ratio [OR] 0.21, 95% confidence interval [CI] 0.10-0.43; p = 0.024), readmissions (OR 0.30, 95% CI 0.16-0.56; p < 0.001), and mortality (OR 0.20, 95% CI 0.04-0.87; p = 0.032). Having problems in self-care was an independent risk factor for 90-day ER visits (OR 2.11, 95% CI 1.17-3.78; p = 0.012), and having problems in usual activities was an independent risk factor for 90-day readmissions (OR 2.69, 95% CI 1.53-4.72; p = 0.001) and mortality (OR 3.16, 95% CI 1.16-8.63; p = 0.024). CONCLUSION PAC program for more than two weeks could have beneficial effects on decreasing ER visits, readmissions, and mortality after an acute illness in frail older patients. Those who perceived severe problems in self-care and usual activities had a higher risk of subsequent adverse outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT Identifier: NCT05452395.
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Affiliation(s)
- Min-Chang Lee
- Center for Athletic Health Management, Renai Branch, Taipei City Hospital, Taipei, Taiwan
- Center for General Education, Taipei University of Marine Technology, Taipei, Taiwan
| | - Tai-Yin Wu
- Department of Family Medicine, Zhongxing Branch, Taipei City Hospital, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
- General Education Center, University of Taipei, Taipei, Taiwan
- * E-mail:
| | - Sheng-Jean Huang
- Taipei City Hospital, Taipei, Taiwan
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan
| | - Sheng-Huang Hsiao
- Department of Neurosurgery, Renai Branch, Taipei City Hospital, Taipei, Taiwan
- Department of Psychology, National Chengchi University, Taipei, Taiwan
| | - Ching-Yao Tsai
- General Education Center, University of Taipei, Taipei, Taiwan
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Business Administration, Fu Jen Catholic University, New Taipei City, Taiwan
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Burton JK, Ciminata G, Lynch E, Shenkin SD, Geue C, Quinn TJ. Understanding Pathways into Care homes using Data (UnPiCD study): a retrospective cohort study using national linked health and social care data. Age Ageing 2022; 51:6964930. [PMID: 36580557 PMCID: PMC9799248 DOI: 10.1093/ageing/afac304] [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: 08/11/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Pathways into care are poorly understood but important life events for individuals and their families. UK policy is to avoid moving-in to care homes from acute hospital settings. This assumes that moves from secondary care represent a system failure. However, those moving to care homes from community and hospital settings may be fundamentally different groups, each requiring differing care approaches. OBJECTIVE To characterise individuals who move-in to a care home from hospital and compare with those moving-in from the community. DESIGN AND SETTING A retrospective cohort study using cross-sectoral data linkage of care home data. METHODS We included adults moving-in to care homes between 1/4/13 and 31/3/16, recorded in the Scottish Care Home Census. Care home data were linked to general and psychiatric hospital admissions, community prescribing and mortality records to ascertain comorbidities, significant diagnoses, hospital resource use, polypharmacy and frailty. Multivariate logistic regression identified predictors of moving-in from hospital compared to from community. RESULTS We included 23,892 individuals moving-in to a care home, 13,564 (56.8%) from hospital and 10,328 (43.2%) from the community. High frailty risk adjusted Odds Ratio (aOR) 5.11 (95% Confidence Interval (CI): 4.60-5.68), hospital discharge with diagnosis of fracture aOR 3.91 (95%CI: 3.41-4.47) or stroke aOR 8.42 (95%CI: 6.90-10.29) were associated with moving-in from hospital. Discharge from in-patient psychiatry was also a highly significant predictor aOR 19.12 (95%CI: 16.26-22.48). CONCLUSIONS Individuals moving-in to care homes directly from hospital are clinically distinct from those from the community. Linkage of cross-sectoral data can allow exploration of pathways into care at scale.
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Affiliation(s)
- Jennifer Kirsty Burton
- Address correspondence to: Jennifer Kirsty Burton, School of Cardiovascular & Metabolic Health, Room 2.42 Level 2, New Lister Building, University of Glasgow, Glasgow Royal Infirmary, Alexandra Parade, Glasgow, G31 2ER, UK. Tel: +44 141 956 0517.
| | - Giorgio Ciminata
- Health Economics and Health Technology Assessment, School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Ellen Lynch
- Social Care Analytical Unit, Health and Social Care Analysis, Scottish Government, Edinburgh, Scotland
| | - Susan D Shenkin
- Ageing and Health Research Group and Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, Scotland
| | - Claudia Geue
- Health Economics and Health Technology Assessment, School of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Terence J Quinn
- Academic Geriatric Medicine, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, Scotland
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[Malnutrition management of hospitalized patients with diabetes/hyperglycemia and sarcopenia]. NUTR HOSP 2022; 39:15-22. [PMID: 36546336 DOI: 10.20960/nh.04507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction Sarcopenia is a multidimensional condition that negatively affects muscle mass, muscle strength, and physical performance. The prevalence of sarcopenia in people with diabetes is much higher than that of the general population, especially in individuals with poor nutritional status. Both sarcopenia and malnutrition are conditions amenable to intervention to improve clinical prognosis. This article describes the results of the expert consensus and the responses of the panelists on the nutritional management in routine clinical practice of patients with diabetes/hyperglycemia hospitalized (non-critically ill) with sarcopenia.
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Fiore F, Cacciatore S, Tupputi S, Agostino C, Montenero R, Spaziani G, Elmi D, Medei M, Antocicco M, Mammarella F, Taddei E, Manes-Gravina E, Bernabei R, Landi F. A Case of Ralstonia pickettii Bloodstream Infection and the Growing Problem of Healthcare Associated Infections in Frail Older Adults. Ann Geriatr Med Res 2022; 26:363-366. [PMID: 36472066 PMCID: PMC9830072 DOI: 10.4235/agmr.22.0114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022] Open
Abstract
Frailty is a clinically measurable state of vulnerability to developing increased dependency and/or mortality when exposed to a stressor. Chronic diseases, aggressive treatments, antibiotic overuse, microbiota changes, immune senescence, and increased use of medical devices and implants (i.e., central lines and catheters) expose modern patients to healthcare-associated infections (HAIs), multidrug-resistant bacteria, and new and unusual opportunistic pathogens. Older adults are among the main victims of HAIs and are associated with high costs, disability, morbidity, and mortality. Ralstonia pickettii is an emerging opportunistic pathogen that causes rare nosocomial infections in frail individuals. Herein, we present a case of bloodstream infection caused by R. pickettii in an 88-year-old woman with a relatively mild course. In addition to describing this unusual finding, this report discusses the problem of HAIs in older adults. Older age, comorbidities, and hospital admissions were among the main risk factors for HAIs. Adherence to guidelines, training, auditing, and surveillance is crucial for reducing the burden of HAIs in acute settings. Furthermore, avoiding incongruous hospitalizations would have positive implications both for preventing HAIs and improving patient quality of life.
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Affiliation(s)
- Francesca Fiore
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Stefano Cacciatore
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy,Corresponding Author Stefano Cacciatore, MD Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go A. Gemelli 8, 00168, Rome, Italy E-mail:
| | - Salvatore Tupputi
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Clara Agostino
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rossella Montenero
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Spaziani
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Elmi
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Martina Medei
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Manuela Antocicco
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Federica Mammarella
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Eleonora Taddei
- Department of Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Ester Manes-Gravina
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Landi
- Department of Geriatrics and Orthopedics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Kajander-Unkuri S, Kämäräinen P, Hartikainen T, Turjamaa R. Effectiveness of a combined web-based and simulation-based continuing education on home-care professionals' competence to evaluate older people's acute care needs in Finland. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1765-e1774. [PMID: 34644436 DOI: 10.1111/hsc.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/18/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
Home-care professionals need competences to ensure that they evaluate their older peoples' health conditions, especially in acute care situations. This study aims to investigate the effectiveness of combined web-based and simulation-based continuing education on home-care professionals' competence regarding evaluating older people's needs for acute care. A quasi-experimental pre-test-post-test study was conducted with home-care professionals who were working in older people's care in Finland. Home-care professionals (N = 254) had participated in combined web-based and simulation-based continuing education in 2017-2019. Data were collected using a questionnaire developed for this study before (n = 171) and after (n = 83) the education. The data were analysed statistically. The mean competence score was 3.22 ± 0.51 before the education and 3.92 ± 0.57 after the education. Improvements were detected in overall competence and in all eight subscales. Improvements were highest in health assessment and consultation and the lowest in type 2 diabetes, but this was already the highest level of self-assessed competence in the pre-test assessment. The combined web-based and simulation-based continuing education was effective in increasing the home-care professionals' competence in evaluating older people's needs for acute care. Evaluating older people's needs for acute care should be embedded in curricula and continuing education programmes.
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Affiliation(s)
- Satu Kajander-Unkuri
- Department of Nursing Science, University of Turku, Turku, Finland
- Diaconia University of Applied Sciences, Helsinki, Finland
| | - Pauliina Kämäräinen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
- Social and Health Services, City of Kuopio, Finland
| | | | - Riitta Turjamaa
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
- Savonia University of Applied Sciences, Kuopio, Finland
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16
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Koppitz AL, Suter-Riederer S, Bieri-Brünig G, Geschwinder H, Senn AK, Spichiger F, Volken T. Prevention Admission into Nursing homes (PAN): study protocol for an explorative, prospective longitudinal pilot study. BMC Geriatr 2022; 22:227. [PMID: 35305555 PMCID: PMC8933976 DOI: 10.1186/s12877-022-02885-z] [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: 06/01/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Switzerland, there is a lack of adequate rehabilitation services, and effective coordination, that take into account the multifactorial health risks of older people. The literature shows that the hospitalisation rate in rehabilitation facilities has increased in recent years and that a gender bias exists. Additionally, there is little or no evidence available on the effect that a post-acute care programme might have over an extended period on functioning, quality of life and the informal network of older people. Therefore, the aim of this trial is to evaluate the sustainability of post-acute care within three nursing homes in Zurich, Canton of Zurich, Switzerland. METHODS The Prevention Admission into Nursing homes (PAN) study is a explorative, prospective, longitudinal pilot trial based on a convenience sample of three long-term care facilities in the Swiss Canton of Zurich. The proposed pilot study will examine the effects of a post-acute care programme on people aged ≥65 years with a post-acute care potential ≥ three admitted to any of the three post-acute care units (n = 260). Older people of all sexes admitted to one of the post-acute care units and likely to be discharged to home within 8 weeks will be eligible for participation in the study. The primary endpoint is functionality based on the Barthel Index. The secondary endpoints are independency based on delirium, cognition, mobility, falling concerns, frailty, weight/height/body mass index, post-acute care capability, quality of life, and lastly, the informal network. As part of process evaluation, a qualitative evaluation will be conducted based on constructive grounded theory to specifically analyse how the experience of informal caregivers (n = 30) can contribute to a successful daily life 6 months after discharge. DISCUSSION We expect to observe improved functional status and independence after the post-acute care programme. The qualitative evaluation conducted with caregivers will complement our description of the transition of older people towards living at home. TRIAL REGISTRATION This study is registered in the German Clinical Trials Register under DRKS00016647 (registered on 23.05.2019).
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Affiliation(s)
- Andrea L Koppitz
- School of Health Sciences, Research&Development, University of Applied Science and Arts Western Switzerland HES-SO, Rue des Arsenaux 16a, 1700, Fribourg, Switzerland.
| | | | - Gabriela Bieri-Brünig
- Department of Nursing Homes of the City of Zurich (PZZ), Walchestrasse 31, Post Box 3251, 8021, Zurich, Switzerland
| | - Heike Geschwinder
- Department of Nursing Homes of the City of Zurich (PZZ), Walchestrasse 31, Post Box 3251, 8021, Zurich, Switzerland
| | - Anita Keller Senn
- School of Health Sciences, Research&Development, University of Applied Science and Arts Western Switzerland HES-SO, Rue des Arsenaux 16a, 1700, Fribourg, Switzerland
- Department of Endocrinology and Diabetology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
| | - Frank Spichiger
- School of Health Sciences, Research&Development, University of Applied Science and Arts Western Switzerland HES-SO, Rue des Arsenaux 16a, 1700, Fribourg, Switzerland
| | - Thomas Volken
- Institute of Health Science, Research&Development, Zurich University of Applied Sciences ZHAW, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland
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The IMPACT of Transitional Care Management in Sepsis. Crit Care Med 2022; 50:525-527. [PMID: 35191876 DOI: 10.1097/ccm.0000000000005336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shaw A, Cabrejo PT, Adamczyk A, Mulcahey MJ. Reducing Hospital Readmissions of Older Adults Pursuing Postacute Care at Skilled Nursing Facilities: A Scoping Review. Am J Occup Ther 2022; 76:23144. [PMID: 34997839 DOI: 10.5014/ajot.2022.049082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Unplanned hospital readmissions can profoundly affect older adults' quality of life and the financial status of skilled nursing facilities (SNFs). Although many clinical practices focus on reforming these issues, occupational therapy's involvement remains unclear. OBJECTIVE To explore clinical practices aimed at reducing hospital readmissions of older adults pursuing postacute care (PAC) at SNFs and describe how they align with occupational therapy's scope of practice. DATA SOURCES We searched CINAHL, Scopus, PubMed, and OTseeker for articles published from January 2011 to February 2020. Study Selection and Data Collection: We conducted a scoping review of peer-reviewed articles with functional outcomes of clinical practices reducing unplanned hospital readmissions of patients older than age 65 yr pursuing PAC services in SNFs. Trained reviewers completed the title and abstract screens, full-text reviews, and data extraction. FINDINGS Thirteen articles were included and focused on five areas: risk and medical disease management and follow-up, hospital-to-SNF transition, enhanced communication and care, function, and nutrition. Early coordination of care and early identification of patients' needs and risk of readmission were common features. All clinical practices aligned with occupational therapy domains and processes, but only 1 study specified occupational therapy as part of the research team. CONCLUSIONS AND RELEVANCE Comprehensive, multipronged clinical practices encompassing care coordination and early identification and management of acute conditions are critical in reducing preventable readmissions among older adults pursuing PAC services in SNFs. Further research is needed to support occupational therapy's value in preventing hospital readmissions of older adults in this setting. What This Article Adds: This scoping review maps the presence of occupational therapy's domains and processes in the clinical practices that reduce hospital readmissions of older adults pursuing PAC services in SNFs. Findings provide occupational therapy practitioners with opportunities to assume roles beyond direct patient care, research, advocate, and publish more, thereby increasing their presence and adding value to occupational therapy interventions that reduce hospital readmissions.
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Affiliation(s)
- Antoinette Shaw
- Antoinette Shaw, OTD, OTR/L, is Director of Rehabilitation Services, Genesis Healthcare Corporation, Catonsville, MD;
| | - Pamela Talero Cabrejo
- Pamela Talero Cabrejo, OTD, OTR/L, is Adjunct Assistant Professor, Post-Professional Occupational Therapy Program, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| | - Abby Adamczyk
- Abby Adamczyk, MLIS, AHIP, is Professional Librarian, Thomas Jefferson University, Philadelphia, PA
| | - M J Mulcahey
- MJ Mulcahey, PhD, OTR/L, is Professor of Occupational Therapy, Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
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Papanicolas I, Figueroa JF, Schoenfeld AJ, Riley K, Abiona O, Arvin M, Atsma F, Bernal‐Delgado E, Bowden N, Blankart CR, Deeny S, Estupiñán‐Romero F, Gauld R, Haywood P, Janlov N, Knight H, Lorenzoni L, Marino A, Or Z, Penneau A, Shatrov K, Stafford M, van de Galien O, van Gool K, Wodchis W, Jha AK. Differences in health care spending and utilization among older frail adults in high-income countries: ICCONIC hip fracture persona. Health Serv Res 2021; 56 Suppl 3:1335-1346. [PMID: 34390254 PMCID: PMC8579209 DOI: 10.1111/1475-6773.13739] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/06/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study explores differences in spending and utilization of health care services for an older person with frailty before and after a hip fracture. DATA SOURCES We used individual-level patient data from five care settings. STUDY DESIGN We compared utilization and spending of an older person aged older than 65 years for 365 days before and after a hip fracture across 11 countries and five domains of care as follows: acute hospital care, primary care, outpatient specialty care, post-acute rehabilitative care, and outpatient drugs. Utilization and spending were age and sex standardized.. DATA COLLECTION/EXTRACTION METHODS The data were compiled by the International Collaborative on Costs, Outcomes, and Needs in Care (ICCONIC) across 11 countries as follows: Australia, Canada, England, France, Germany, the Netherlands, New Zealand, Spain, Sweden, Switzerland, and the United States. PRINCIPAL FINDINGS The sample ranged from 1859 patients in Spain to 42,849 in France. Mean age ranged from 81.2 in Switzerland to 84.7 in Australia. The majority of patients across countries were female. Relative to other countries, the United States had the lowest inpatient length of stay (11.3), but the highest number of days were spent in post-acute care rehab (100.7) and, on average, had more visits to specialist providers (6.8 per year) than primary care providers (4.0 per year). Across almost all sectors, the United States spent more per person than other countries per unit ($13,622 per hospitalization, $233 per primary care visit, $386 per MD specialist visit). Patients also had high expenditures in the year prior to the hip fracture, mostly concentrated in the inpatient setting. CONCLUSION Across 11 high-income countries, there is substantial variation in health care spending and utilization for an older person with frailty, both before and after a hip fracture. The United States is the most expensive country due to high prices and above average utilization of post-acute rehab care.
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Affiliation(s)
| | - Jose F. Figueroa
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Andrew J. Schoenfeld
- Department of Orthopedic SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Kristen Riley
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Olukorede Abiona
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyAustralia
| | - Mina Arvin
- Scientific Center for Quality of HealthcareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | - Femke Atsma
- Scientific Center for Quality of HealthcareRadboud University Medical Center, Radboud Institute for Health SciencesNijmegenThe Netherlands
| | | | - Nicholas Bowden
- Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | - Carl Rudolf Blankart
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
- Hamburg Center for Health EconomicsUniversität HamburgHamburgGermany
| | | | | | - Robin Gauld
- Otago Business SchoolUniversity of OtagoDunedinNew Zealand
| | - Philip Haywood
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyAustralia
| | - Nils Janlov
- The Swedish Agency for Health and Care Services AnalysisStockholmSweden
| | | | - Luca Lorenzoni
- Health DivisionOrganisation for Economic Co‐operation and Development (OECD)ParisFrance
| | - Alberto Marino
- Department of Health PolicyLondon School of EconomicsLondonUK
- Health DivisionOrganisation for Economic Co‐operation and Development (OECD)ParisFrance
| | - Zeynep Or
- Institute for Research and Documentation in Health Economics (IRDES)ParisFrance
| | - Anne Penneau
- Institute for Research and Documentation in Health Economics (IRDES)ParisFrance
| | - Kosta Shatrov
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
| | | | | | - Kees van Gool
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyAustralia
| | - Walter Wodchis
- Institute of Health Policy Management & EvaluationUniversity of TorontoTorontoCanada
| | - Ashish K. Jha
- Brown School of Public HealthProvidenceRhode IslandUSA
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20
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Dutzi I, Schwenk M, Kirchner M, Jooss E, Bauer JM, Hauer K. Influence of Cognitive Impairment on Rehabilitation Received and Its Mediating Effect on Functional Recovery. J Alzheimers Dis 2021; 84:745-756. [PMID: 34569955 DOI: 10.3233/jad-210620] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cognitive impairment (CI) has been reported to negatively impact rehabilitation outcomes. Knowledge about differences in rehabilitation received in dependence of CI as a potential mediating factor is limited. OBJECTIVE To analyze whether CI affects amount and frequency of rehabilitation received and if associations between CI and rehabilitation outcome are mediated by the provided amount of therapy. METHODS Observational cohort study in ward-based geriatric rehabilitation consecutively including 373 patients (mean age 82.0±6.69 years, mean MMSE 23.66±5.31). Outcome measures were amount, frequency, and type of multi-professional therapy sessions and rehabilitation outcome assessed with the Barthel Index (BI). Cognitive status was measured with the Mini-Mental-State Examination (MMSE) classifying three patient subgroups according to cognitive status. RESULTS Patients with more severe CI received least total therapy hours (TTH) (MMSE < 17, 13.67±6.58 versus MMSE 17-26, 16.12±7.19 and MMSE > 26, 17.79±8.88 h, p = 0.014) and were less often included in occupational therapy (MMSE < 17, 48.9%versus MMSE 17-26, 65.5%and MMSE > 26, 71.4%, p = 0.019) and group-based physiotherapy (MMSE < 17, 73.3%versus MMSE 17-26, 88.5%and MMSE > 26, 81.2%, p = 0.027). Regression models showed that CI negatively impacted TTH (β= 0.24, p = 0.003) and rehabilitation outcome (β= 0.41, p = 0.008). In the mediation model, TTH accounted for 23.18%(p < 0.001) of the relationship between CI and rehabilitation outcome. CONCLUSION Cognitive impairment negatively impacted rehabilitation received. The lower TTH partly mediated the negative association between CI and rehabilitation outcome. Future research should identify specific barriers to therapy provision and optimal length, intensity, and dosage of rehabilitation programs to optimize rehabilitation outcomes in CI.
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Affiliation(s)
- Ilona Dutzi
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, Heidelberg, Germany
| | - Michael Schwenk
- Network Aging Research, University of Heidelberg, Heidelberg, Germany.,Department of Clinical Gerontology, Robert-Bosch Hospital, Stuttgart, Germany
| | - Marietta Kirchner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Eva Jooss
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, Heidelberg, Germany
| | - Jürgen M Bauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, Heidelberg, Germany.,Centre for Geriatric Medicine, University of Heidelberg, Heidelberg, Germany
| | - Klaus Hauer
- Department of Geriatric Research, AGAPLESION Bethanien Hospital, Heidelberg, Germany
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21
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Plys E, Morrow CD, Portz JD, Jones CD, Piper C, Boxer RS. Psychological interventions with older adults during inpatient postacute rehabilitation: A systematic review. Rehabil Psychol 2021; 66:233-247. [PMID: 34472922 PMCID: PMC8622202 DOI: 10.1037/rep0000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Older adults in inpatient postacute care settings report high rates of depression and anxiety. Psychological interventions address these symptoms through educational, cognitive, behavioral, relaxation, and/or psychosocial approaches. The purpose of this study was to systematically evaluate the quality of existing literature on psychological interventions for depression and/or anxiety among older adults during an inpatient postacute care stay. Method: Medline, Embase, Cochrane Library, CINAHL, PsycINFO, and Google Scholar were searched for key concepts. Studies were included that (a) sampled skilled nursing facility or inpatient rehabilitation facility patients, (b) evaluated a psychological intervention, (c) measured depression and/or anxiety symptoms before and after interventions, and (d) had a mean or median age of 65+. Two raters assessed articles for inclusion and risk of bias. Results: Search strategies identified 7,506 articles for screening; nine met inclusion criteria. Included studies varied by study design, intervention type, and methodological quality. Only one study had low overall risk of bias. Four studies demonstrated preliminary treatment benefits for depression symptoms; none reported benefits for anxiety symptoms. Conclusions: Most of the included studies were limited by small sample size and high risk of bias. Thus, currently, there is insufficient evidence to support the effectiveness of psychological interventions for depression or anxiety among older adults during an inpatient postacute care stay. The authors offer a detailed discussion of methodological limitations, empirical gaps, and future directions to develop this body of literature. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Evan Plys
- Department of Psychiatry, University of Colorado School of Medicine
| | - Cynthia D Morrow
- Health Systems Management and Policy, Colorado School of Public Health
| | - Jennifer D Portz
- Division of General Internal Medicine, University of Colorado School of Medicine
| | - Christine D Jones
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System
| | - Christi Piper
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus
| | - Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente of Colorado
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22
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Kim H, Cheng SH, Yamana H, Lee S, Yoon NH, Lin YC, Fushimi K, Yasunaga H. Variations in hip fracture inpatient care in Japan, Korea, and Taiwan: an analysis of health administrative data. BMC Health Serv Res 2021; 21:694. [PMID: 34256758 PMCID: PMC8278699 DOI: 10.1186/s12913-021-06621-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about hip fracture inpatient care in East Asia. This study examined the characteristics of patients, hospitals, and regions associated with delivery of hip fracture surgeries across Japan, Korea, and Taiwan. We also analyzed and compared how the resource use and a short-term outcome of the care in index hospitals varied according to factors in the respective health systems. METHODS We developed comparable, nationwide, individual-level health insurance claims datasets linked with hospital- and regional-level statistics across the health systems using common protocols. Generalized linear multi-level analyses were conducted on length of stay (LOS) and total cost of index hospitalization as well as inpatient death. RESULTS The majority of patients were female and aged 75 or older. The standardized LOS of the hospitalization for hip fracture surgery was 32.5 (S.D. = 18.7) days in Japan, 24.7 (S.D. = 12.4) days in Korea, and 7.1 (S.D. = 2.9) days in Taiwan. The total cost per admission also widely varied across the systems. Hospitals with a high volume of hip fracture surgeries had a lower LOS across all three systems, while other factors associated with LOS and total cost varied across countries. CONCLUSION There were wide variations in resource use for hip fracture surgery in the index hospital within and across the three health systems with similar social health insurance schemes in East Asia. Further investigations into the large variations are necessary, along with efforts to overcome the methodological challenges of international comparisons of health system performance.
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Affiliation(s)
- Hongsoo Kim
- Graduate School of Public Health Department of Public Health Science, Institute of Health and Environment, & Institute of Aging, Seoul National University, Seoul, 08826, South Korea.
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seyune Lee
- Graduate School of Public Health, Department of Public Health Sciences, Seoul National University, Seoul, South Korea
| | - Nan-He Yoon
- Division of Social Welfare and Health Administration, Wonkwang University, Iksan, Jeonbuk, South Korea
| | - Yi-Chieh Lin
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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23
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Flanagan J, Boltz M, Ji M. A Predictive Model of Intrinsic Factors Associated with Long-Stay Nursing Home Care After Hospitalization. Clin Nurs Res 2020; 30:654-661. [PMID: 33371742 DOI: 10.1177/1054773820985276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to build a predictive model with intrinsic factors measured upon admission to skilled nursing facilities (SNFs) post-acute care (PAC) to identify older adults transferred from SNFs to long-term care (LTC) instead of home. We analyzed data from Massachusetts in 23,662 persons admitted to SNFs from PAC in 2013. Explanatory logistic regression analysis identified single "intrinsic predictors" related to LTC placement. To assess overfitting, the logistic regression predictive model was cross-validated and evaluated by its receiver operating characteristic (ROC) curve. A 12-variable predictive model with "intrinsic predictors" demonstrated both high in-sample and out-of-sample predictive accuracy in the receiver operating characteristic ROC and area under the ROC among patients at risk of LTC placement. This predictive model may be used for early identification of patients at risk for LTC after hospitalization in order to support targeted rehabilitative approaches and resource planning.
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Affiliation(s)
- Jane Flanagan
- Boston College, Chestnut Hill, MA, USA.,Massachusetts General Hospital, Boston, MA, USA
| | - Marie Boltz
- Penn State College of Nursing, University Park, PA, USA
| | - Ming Ji
- University of South Florida, FL, USA
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Shin J, Han SH, Choi J, Kim YS, Lee J. The Experience of Providing Older Adult Patients with Transitional Care from an Acute Care Hospital to Home in Cooperation with a Public Health Center. J Korean Med Sci 2020; 35:e348. [PMID: 33045771 PMCID: PMC7550231 DOI: 10.3346/jkms.2020.35.e348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 08/20/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND This study aimed to describe the experience of providing older adult patients with transitional care from an acute care hospital to home in cooperation with a public health center, in order to present the barriers to that care and suggest better organizational methods. METHODS This was a cross-sectional study to show the results of the Geriatric Screening for Care-10 (GSC-10) and outcomes of transitional care. Among 659 hospitalized patients aged 65 years or above who lived in an administrative district, forty-five subjects were enrolled between June 24, 2019 and January 23, 2020. Within 48 hours of admission, using the 10 areas of GSC-10, they were assessed for cognitive impairment, depression, polypharmacy (5 or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence, and were reassessed before discharge. The transitional care plan (containing the treatment summary, the results of the GSC-10 assessment, and the post-discharge plan) was forwarded to a representative of the public health center, who provided continued disease management and various health care services, such as chronic disease and frailty care, and physical rehabilitation. RESULTS Of all the participants, 64.4% had more than 1 GSC-10 concern. The most prevalent concerns were functional immobility (35.6%) and polypharmacy (22.2%). About 15.6% of the participants were readmitted to a nursing home or hospital. A total of 38 participants received the transitional care intervention. They received an average of 2.7 administered interventions. However, the rate of rejection was high (30.1%) and patients were visited an average of 16.5 days after discharge. CONCLUSION Through our experience of providing transitional care from an acute care hospital to home in cooperation with a public health center, we expect that the transitional care suitable for the Korean medical situation could be established and successful.
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Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
| | - Seol Heui Han
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Neurology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Jaekyung Choi
- Department of Family Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
| | - Yoon Sook Kim
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Quality Improvement, Konkuk University Medical Center, Seoul, Korea
| | - Jongmin Lee
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Rehabilitation Medicine, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Korea.
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Shin J, Han SH, Choi J, Kim YS, Lee J. Importance of Geriatric Syndrome Screening within 48 Hours of Hospitalization for Identifying Readmission Risk: A Retrospective Study in an Acute-Care Hospital. Ann Geriatr Med Res 2020; 24:83-90. [PMID: 32743328 PMCID: PMC7370791 DOI: 10.4235/agmr.20.0017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/20/2020] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Given the association between geriatric syndrome and hospital readmission, we evaluated the suitability of geriatric syndrome screening for care (GSC) in identifying readmission risk and suggested the appropriate time for GSC. METHODS GSC considering cognitive impairment, depression, polypharmacy (five or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence was performed among 2,663 general ward inpatients aged 65 years or older within 48 hours after admission and again before discharge between November 2016 and October 2017. From each patient, fall events, pressure ulcers, potentially inappropriate medication use, and delirium were assessed at admission. Patients were divided into two groups on the basis of readmission within 1 year after the first admission. According to the screening period (at admission and before discharge) and in-hospital decline, we applied receiver operating characteristic curve analysis to compare the prevalence of clinical concerns between the readmission and no-readmission groups. We also used multiple logistic regression analysis to evaluate the risk of readmission according to the presence of geriatric syndrome and clinical outcomes. RESULTS The 782 readmitted patients (29.4%) showed a higher rate of poor GSC than those who were not readmitted. Polypharmacy at admission was significantly correlated with readmission risk (area under the receiver operating characteristic curve=0.602). Fall events (odds ratio [OR]=4.36; 95% confidence interval [CI], 2.36-8.05), urinary incontinence (OR=4.21; 95% CI, 3.28-5.39), and depressive mood (OR=3.88; 95% CI, 2.69-5.59) at admission were risk factors for readmission. CONCLUSION Geriatric syndromes assessed by GSC at admission was associated with an increased risk of readmission.
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Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
| | - Seol-Heui Han
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Neurology, Konkuk University Medical Center, Seoul, Korea
| | - Jaekyung Choi
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
| | - Yoon-Sook Kim
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Quality Improvement, Konkuk University Medical Center, Seoul, Korea
| | - Jongmin Lee
- Research Institute on Healthy Aging, Konkuk University Medical Center, Seoul, Korea
- Department of Rehabilitation Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Jung HW, Won CW, Lim JY. Annals of Geriatric Medicine and Research as a Space of for Developing Research Ideas into Better Clinical Practices for Older Adults in Emerging Countries. Ann Geriatr Med Res 2019; 23:157-159. [PMID: 32743305 PMCID: PMC7370759 DOI: 10.4235/agmr.19.0044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/06/2019] [Accepted: 12/08/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Hee-Won Jung
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Chang Won Won
- Department of Family Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
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