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Westley-Wise V, Lago L, Mullan J, Facci F, Zingel R, Eagar K. Patterns of morbidity and multimorbidity associated with early and late readmissions in an Australian regional health service. Chronic Illn 2022; 18:86-104. [PMID: 32036681 DOI: 10.1177/1742395319899459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe morbidity and multimorbidity patterns among adults readmitted to an Australian regional health service, in terms of occurrence of the same and different morbidities at index admission and readmission. METHODS This cohort study used hospital admissions data for patients admitted between 1 July 2014 and 30 June 2016 to estimate proportions of unplanned readmissions ('early' within 30 days and 'late' within 1-6 months) with the same and different morbidities as the index admission. Readmission rates were estimated by selected sociodemographic, admission and diagnostic characteristics. RESULTS The majority of early and late readmissions were in different diagnostic groups and for different primary morbidities to the index admission. Only 38.8% of readmissions were in the same major diagnostic group as the index admission and 18.4% in the same Adjacent Diagnosis-Related Group. Twenty one percent of admitted patients were readmitted within six months, with this increasing to 35.3% among multimorbid patients. CONCLUSION With increasing prevalence of multimorbidity, particularly among those at increased risk of readmission, it is essential to step away from a single disease focus in the design of both hospital avoidance and chronic disease management programmes. Holistic interventions and strategies that address multiple chronic conditions are required.
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Affiliation(s)
- Victoria Westley-Wise
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia.,Centre for Health Research Illawarra Shoalhaven Population, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Luise Lago
- Centre for Health Research Illawarra Shoalhaven Population, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Judy Mullan
- Centre for Health Research Illawarra Shoalhaven Population, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Franca Facci
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Rebekah Zingel
- Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Kathy Eagar
- Centre for Health Research Illawarra Shoalhaven Population, Australian Health Services Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
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Waller K, Furber S, Bauman A, Allman-Farinelli M, van den Dolder P, Hayes A, Facci F, Franco L, Webb A, Moses R, Cook R, Gugusheff J, Owen K, Colagiuri S. Effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management for people with type 2 diabetes. A randomized controlled trial. Patient Educ Couns 2021; 104:1736-1744. [PMID: 33334634 DOI: 10.1016/j.pec.2020.11.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Accepted: 11/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Determine the effectiveness and acceptability of a text message intervention (DTEXT) on HbA1c and self-management behaviors for Australian adults with type 2 diabetes. METHODS Using intention to treat analysis and generalized estimating equations, this randomized controlled trial of 395 adults determined change in HbA1c at 3 and 6 months between the intervention and control group. Secondary outcomes included change in nutrition, physical activity, blood lipid profile, body mass index, quality of life, self-efficacy, medication taking and program acceptability. RESULTS No significant difference was observed between the intervention or control group for HbA1c at 3 months (P = 0.23) or 6 months (P = 0.22). Significant improvements were seen in consumption of vegetables at 3 months (P < 0.001) and 6 months (P = 0.04); fruit at 3 months (P = 0.046) and discretionary sweet foods at 3 months (P = 0.02). No other significant effects seen. The intervention demonstrated high rates of acceptability (94.0%) and minimal withdrawal (1.5%). CONCLUSIONS DTEXT was an acceptable text message intervention that improved some nutritional behaviors in people with type 2 diabetes, but did not significantly improve HbA1c or other outcomes. Further research is required to optimize DTEXT. PRACTICE IMPLICATIONS DTEXT provides an acceptable, feasible form of self-management support that may complement existing diabetes care.
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Affiliation(s)
- Karen Waller
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia; School of Health and Society, University of Wollongong, Keiraville, Australia.
| | - Susan Furber
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia; School of Public Health and Community Medicine, University of NSW, Kensington, Australia
| | - Adrian Bauman
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Paul van den Dolder
- Ambulatory and Primary Health Care, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Alison Hayes
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Franca Facci
- Integrated Chronic Disease Management Stream, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Lisa Franco
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Alison Webb
- Illawarra Shoalhaven Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Robert Moses
- Illawarra Shoalhaven Diabetes Service, Illawarra Shoalhaven Local Health District, Wollongong, Australia
| | - Rebecca Cook
- Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Jessica Gugusheff
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Centre for Epidemiology and Evidence, NSW Ministry of Health, St Leonards, Australia
| | - Katherine Owen
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Stephen Colagiuri
- Boden Collaboration of Obesity, Nutrition, Exercise and Eating Disorders. University of Sydney, Sydney, Australia; WHO Collaborating Centre on Physical Activity, Nutrition and Obesity. University of Sydney, Sydney, Australia
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Westley-Wise V, Lago L, Mullan J, Facci F, Zingel R, Eagar K. Trends in unplanned readmissions over 15 years: a regional Australian perspective. AUST HEALTH REV 2019; 44:241-247. [PMID: 30827332 DOI: 10.1071/ah18072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/19/2018] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to assess 15-year trends in unplanned readmissions in an Australian regional health service. Methods Drawing on data held in the Illawarra Health Information Platform (IHIP), this longitudinal retrospective study of adults admitted to hospital between 2001-02 and 2015-16 assessed rates of unplanned all-cause readmissions within 30 days ('early') and 1-6 months ('late') following discharge. Rates were compared over time and between patient groups. Results Age-adjusted early readmission rates declined over the 15 years by an average of 1.3% per annum, whereas late readmission rates increased by an average of 0.6% per annum. Together, there was an overall decline in readmission rates. The entire decline in early readmission rates and a reversal of the increasing trend in late readmission rates occurred since 2010-11. Similar trends occurred across age groups, but were most pronounced among those aged ≥75 years. Conclusions The decline in readmissions since 2010-11 suggests that the region has achieved improvements in discharge planning and in continuity between hospitals and community-based care. These improvements have occurred across broad patient groups. The longitudinal and linked data held in the IHIP provides a unique opportunity to examine patterns of service utilisation at a regional level. What is known about the topic? Published reports of longitudinal trends in readmissions are typically limited by short study periods and narrow criteria used to define study populations and readmissions. Australian longitudinal data suggest rates of early readmission have remained relatively unchanged in recent years, despite the focus on readmission rates as a metric to assess the quality and continuity of care. What does this paper add? This unique longitudinal study reports on long-term readmission trends over 15 years to hospitals within a single geographic area, with trends reported for both early (30-day) and late (1- to 6-month) readmissions by age group and major diagnostic categories. The findings reflect more complex patterns than are typically reported in cross-sectional and more limited longitudinal studies. What are the implications for practitioners? The results suggest improvements at a regional level that may be associated with care during the initial hospitalisation and discharge (reflected particularly in early readmissions) and in the community (reflected particularly in late readmissions). Future investigations will explore specific patient groups and the effects of specific initiatives, services and models of care to better predict those at risk of readmission and to inform translation locally and further afield. The relationship between readmissions and the use of ambulatory services (primary care, emergency department and out-patient) also warrants further investigation.
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Affiliation(s)
- Victoria Westley-Wise
- Illawarra Shoalhaven Local Health District, Level 1, 67-71 King Street, Warrawong, NSW 2502, Australia. ; ; and Centre for Health Services Research Illawarra Shoalhaven Population, University of Wollongong, Building 234, Innovation Campus, Wollongong, NSW 2522, Australia. , ; and Corresponding author.
| | - Luise Lago
- Centre for Health Services Research Illawarra Shoalhaven Population, University of Wollongong, Building 234, Innovation Campus, Wollongong, NSW 2522, Australia. ,
| | - Judy Mullan
- Centre for Health Services Research Illawarra Shoalhaven Population, University of Wollongong, Building 234, Innovation Campus, Wollongong, NSW 2522, Australia. ,
| | - Franca Facci
- Illawarra Shoalhaven Local Health District, Level 1, 67-71 King Street, Warrawong, NSW 2502, Australia. ;
| | - Rebekah Zingel
- Illawarra Shoalhaven Local Health District, Level 1, 67-71 King Street, Warrawong, NSW 2502, Australia. ;
| | - Kathy Eagar
- Australian Health Services Research Institute, University of Wollongong, Building 234, Innovation Campus, Wollongong, NSW 2522, Australia.
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Waller K, Furber S, Bauman A, Allman-Farinelli M, van den Dolder P, Hayes A, Facci F, Franco L, Webb A, Moses R, Colagiuri S. DTEXT - text messaging intervention to improve outcomes of people with type 2 diabetes: protocol for randomised controlled trial and cost-effectiveness analysis. BMC Public Health 2019; 19:262. [PMID: 30832638 PMCID: PMC6399841 DOI: 10.1186/s12889-019-6550-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 02/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Diabetes prevalence is rapidly increasing, with type 2 diabetes predicted to be the leading contributor of non-communicable disease in Australia by 2020. It is anticipated that rates of type 2 diabetes will continue to increase if factors such as overweight and obesity, low physical activity and poor nutrition are not addressed. The majority of Australians with type 2 diabetes do not meet the guidelines for optimal diabetes management, and access to diabetes education is limited. This highlights the need for new interventions that can reduce existing barriers to diabetes education, attain greater population reach and support self-management strategies for people with type 2 diabetes. Mobile phone text messages have shown promising results as an intervention for people with chronic disease. They have the ability to achieve high levels of engagement and broad population reach, whilst requiring minimal resources. There is however, no evidence on the effect of text messaging to improve the health of people with type 2 diabetes in Australia. METHODS/DESIGN This randomised controlled trial aims to investigate if a 6 month text message intervention (DTEXT) can lead to improvements in glycated haemoglobin (HbA1c) and diabetes self-management among Australian residents in New South Wales (NSW) with type 2 diabetes. Community dwelling adults (n = 340) will be recruited with the primary outcome being change in HbA1c at 6 months. Secondary outcomes include behaviour change for diabetes self-management, self-efficacy, quality of life and intervention acceptability. An economic evaluation will be conducted using a funder plus patient perspective. DISCUSSION This study will provide evidence on the effectiveness and cost effectiveness of a text message intervention to reduce HbA1c and enhance self-management of type 2 diabetes in the Australian population. If successful, this intervention could be used as a model to complement and extend existing diabetes care in the Australian health care system. TRIAL REGISTRATION The study has been registered with the Australian New Zealand Clinical Trials Registry, Trial ID: ACTRN12617000416392 . Registered: 23 March 2017.
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Affiliation(s)
- Karen Waller
- Illawarra Shoalhaven Local Health District, Warrawong, Australia.
| | - Susan Furber
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | | | | | | | | | - Franca Facci
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Lisa Franco
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Alison Webb
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
| | - Robert Moses
- Illawarra Shoalhaven Local Health District, Warrawong, Australia
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