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Salaj D, Schultz T, Strang P. Nursing Home Residents With Dementia at End of Life: Emergency Department Visits, Hospitalizations, and Acute Hospital Deaths. J Palliat Med 2024; 27:24-30. [PMID: 37504957 DOI: 10.1089/jpm.2023.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
Background: Most nursing home (NH) residents do not benefit from health care at an emergency room (ER) or inpatient care at an emergency hospital during the end-of-life period. Therefore, a low number of unplanned admissions during the last month of life are considered good quality of care. Objectives: This study examined ER visits, hospital admissions, and place of death in NH residents with and without dementia in the last month of life, with the aim of answering the question, "Are NH residents with dementia provided with equal health care in their last stage of life?" Design: An observational retrospective study of registry data from all NH residents who died during the years 2015-2019, using health care consumption data from the Stockholm Regional Council, Sweden. Results: Dementia was associated with a higher adjusted odds ratio (aOR) for ER visits (aOR 1.32, p < 0.0001) and acute admissions (aOR 1.30, p < 0.0001) (logistic regression, including sensitivity analysis). Being male, young, and having multiple comorbidities (Charlson Comorbidity Index) and frailty (Hospital Frailty Risk Score) were all independently associated with higher aORs for the same outcomes and also with hospital deaths. Conclusion: Dementia is associated with increased ER referrals and acute in-hospital care. Comorbidities and frailty were strongly associated with an increase in hospital deaths. In addition, men are sent to emergency hospitals more frequently than women, and older residents are sent to the hospital to a lesser extent than younger residents, which cannot be explained by the factors studied.
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Affiliation(s)
- Dag Salaj
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Torbjörn Schultz
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- R & D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Fernández-Méndez R, Wong MY, Rastall RJ, Rebollo-Díaz S, Oberg I, Price SJ, Joannides AJ. Improvement of the Efficiency and Completeness of Neuro-Oncology Patient Referrals to a Tertiary Center Through the Implementation of an Electronic Referral System: Retrospective Cohort Study. J Med Internet Res 2020; 22:e15002. [PMID: 32134389 PMCID: PMC7082731 DOI: 10.2196/15002] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/03/2019] [Accepted: 12/16/2019] [Indexed: 12/03/2022] Open
Abstract
Background Quality referrals to specialist care are key for prompt, optimal decisions about the management of patients with brain tumors. Objective This study aimed to determine the impact of introducing a Web-based, electronic referral (eReferral) system to a specialized neuro-oncology center, using a service-developed proforma, in terms of waiting times and information completeness. Methods We carried out a retrospective cohort study based on the review of medical records of referred adult patients, excluding follow-ups. Primary outcome measures were durations of three key phases within the referral pathway and completion rates of six referral fields. Results A total of 248 patients were referred to the specialist center during the study period. Median (IQR) diagnostic imaging to referral intervals were 3 (1-5) days with eReferrals, and 9 (4-19), 19 (14-49), and 8 (4-23) days with paper proforma, paper letter, and internal referrals, respectively (P<.001). Median (IQR) referral to multidisciplinary team decision intervals were 3 (2-7), 2 (1-3), 8 (2-24), and 3 (2-6) days respectively (P=.01). For patients having surgery, median (IQR) diagnostic imaging to surgery intervals were 28 (21-41), 34 (27-51), 104 (69-143), and 32 (15-89) days, respectively (P<.001). Proportions of complete fields differed significantly by referral type in all study fields (all with Ps <.001) except for details of presentation, which were present in all referrals. All study fields were always present in eReferrals, as these are compulsory for referral submission. Depending on the data field, level of completeness in the remaining referral types ranged within 69% (65/94) to 87% (82/94), 15% (3/20) to 65% (13/20), and 22% (8/41) to 63% (26/41) in paper proforma, paper letter, and internal referrals, respectively. Conclusions An electronic, Web-based, service-developed specific proforma for neuro-oncology referrals performs significantly better, with shorter waiting times and greater completeness of information than other referral types. A wider application of eReferrals is an important first step to streamlining specialist care pathways and providing excellent care. International Registered Report Identifier (IRRID) RR2-10.2196/10.2196/15002
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Affiliation(s)
- Rocío Fernández-Méndez
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,NIHR Brain Injury MedTech Co-operative, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Mei Yin Wong
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Rebecca J Rastall
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | | | - Ingela Oberg
- Neurosurgery Department, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Stephen J Price
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,NIHR Brain Injury MedTech Co-operative, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Neurosurgery Department, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Alexis J Joannides
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,NIHR Brain Injury MedTech Co-operative, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom.,Obex Technologies, Cambridge, United Kingdom.,Neurosurgery Department, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
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Cianchi G, Lazzeri C, Bonizzoli M, Batacchi S, Di Lascio G, Ciapetti M, Franci A, Chiostri M, Peris A. Activities of an ECMO Center for Severe Respiratory Failure: ECMO Retrieval and Beyond, A 4-Year Experience. J Cardiothorac Vasc Anesth 2019; 33:3056-3062. [PMID: 31072711 DOI: 10.1053/j.jvca.2019.03.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 01/11/2019] [Revised: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Beyond retrieval and management of patients with severe acute respiratory distress syndrome, an extracorporeal membrane oxygenation (ECMO) center also encompasses several other actions, such as on-call consultations, advice, and counseling, to the physicians at the peripheral centers, but few data are available on this topic. Therefore, the authors describe the composite activities of retrieval and counseling of an ECMO center since 2014. DESIGN The referral calls addressed to the authors' ECMO center for patients with respiratory failure were prospectively recorded in a dedicated database. Referral call frequency, patient data, and results of the calls were analyzed. SETTING The 12-bed intensive care unit of Careggi Hospital in Florence, the ECMO referral center for Tuscany, and the center of Italy, with a mobile ECMO team. PARTICIPANTS Patients from intensive care units of peripheral hospitals for whom a referral call was addressed to the authors' ECMO center. INTERVENTIONS Many possible responses were given after a referral call, varying from ECMO team deployment to advice or to refusal. MEASUREMENTS AND MAIN RESULTS From January 1, 2014, to December 31, 2017, 231 calls were received at the authors' ECMO center, of which 220 calls were for acute respiratory failure cases. Throughout the study period the overall number of calls did not vary, but the percentage of ECMO retrievals decreased, whereas the percentage of ARF patients from peripheral hospital admitted to our ECMO center on conventional ventilation increased. Fifty-five patients were treated by the mobile ECMO team and were transferred on ECMO; 59 were admitted on ventilatory support. In flu periods the overall calls were more frequent than in the no-flu periods (171 v 82 calls), and more ECMO retrieval missions were deployed. CONCLUSIONS During the study period, a decreased number of patients retrieved on ECMO was observed, whereas patients transferred on ventilation increased, with an overall unchanged number of referred patients.
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Affiliation(s)
- Giovanni Cianchi
- Intensive Care Unit and Regional ECMO Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Chiara Lazzeri
- Intensive Care Unit and Regional ECMO Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Manuela Bonizzoli
- Intensive Care Unit and Regional ECMO Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Batacchi
- Intensive Care Unit and Regional ECMO Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Gabriella Di Lascio
- Intensive Care Unit and Regional ECMO Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Ciapetti
- Intensive Care Unit and Regional ECMO Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Franci
- Intensive Care Unit and Regional ECMO Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marco Chiostri
- Intensive Care Unit and Regional ECMO Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Stanciu MA, Law RJ, Nafees S, Hendry M, Yeo ST, Hiscock J, Lewis R, Edwards RT, Williams NH, Brain K, Brocklehurst P, Carson-Stevens A, Dolwani S, Emery J, Hamilton W, Hoare Z, Lyratzopoulos G, Rubin G, Smits S, Vedsted P, Walter F, Wilkinson C, Neal RD. Development of an intervention to expedite cancer diagnosis through primary care: a protocol. BJGP Open 2018; 2:bjgpopen18X101595. [PMID: 30564728 PMCID: PMC6189786 DOI: 10.3399/bjgpopen18x101595] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/16/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND GPs can play an important role in achieving earlier cancer diagnosis to improve patient outcomes, for example through prompt use of the urgent suspected cancer referral pathway. Barriers to early diagnosis include individual practitioner variation in knowledge, attitudes, beliefs, professional expectations, and norms. AIM This programme of work (Wales Interventions and Cancer Knowledge about Early Diagnosis [WICKED]) will develop a behaviour change intervention to expedite diagnosis through primary care and contribute to improved cancer outcomes. DESIGN & SETTING Non-experimental mixed-method study with GPs and primary care practice teams from Wales. METHOD Four work packages will inform the development of the behaviour change intervention. Work package 1 will identify relevant evidence-based interventions (systematic review of reviews) and will determine why interventions do or do not work, for whom, and in what circumstances (realist review). Work package 2 will assess cancer knowledge, attitudes, and behaviour of GPs, as well as primary care teams' perspectives on cancer referral and investigation (GP survey, discrete choice experiment [DCE], interviews, and focus groups). Work package 3 will synthesise findings from earlier work packages using the behaviour change wheel as an overarching theoretical framework to guide intervention development. Work package 4 will test the feasibility and acceptability of the intervention, and determine methods for measuring costs and effects of subsequent behaviour change in a randomised feasibility trial. RESULTS The findings will inform the design of a future effectiveness trial, with concurrent economic evaluation, aimed at earlier diagnosis. CONCLUSION This comprehensive, evidence-based programme will develop a complex GP behaviour change intervention to expedite the diagnosis of symptomatic cancer, and may be applicable to countries with similar healthcare systems.
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Affiliation(s)
- Marian Andrei Stanciu
- Research Officer, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Rebecca-Jane Law
- Research Officer, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Sadia Nafees
- Research Project Support Officer, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Maggie Hendry
- Research Fellow, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Seow Tien Yeo
- Research Fellow, Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Julia Hiscock
- Research Fellow, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Ruth Lewis
- Research Fellow in Health Sciences Research, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Rhiannon T Edwards
- Professor of Health Economics, Centre for Health Economics and Medicines Evaluation (CHEME), Bangor University, Bangor, UK
| | - Nefyn H Williams
- Professor in Primary Care, Department of Health Services Research, University of Liverpool, Liverpool, UK
| | - Katherine Brain
- Professor, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Brocklehurst
- Professor in Health Services Research, North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Andrew Carson-Stevens
- Clinical Reader, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Sunil Dolwani
- Senior Clinical Lecturer, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Jon Emery
- Professor of Primary Care Cancer Research, Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Australia
| | - William Hamilton
- Professor of Primary Care Diagnostics, Discovery Research Group, University of Exeter, Exeter, UK
| | - Zoe Hoare
- Principal Trial Statistician, North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Georgios Lyratzopoulos
- Professor of Cancer Epidemiology, Department of Behavioural Science and Health, University College London, London, UK
| | - Greg Rubin
- Professor of General Practice and Primary Care, Institute of Health and Society, University of Newcastle, Newcastle, UK
| | - Stephanie Smits
- Research Associate, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Peter Vedsted
- Professor, Research Director, Department of Public Health, Research Centre for Cancer Diagnosis, Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- Professor, Research Director, Department of Clinical Medicine, University Clinic for Innovative Health Care Delivery, Silkeborg Hospital, Aarhus University, Aarhus, Denmark
| | - Fiona Walter
- Principal Researcher in Primary Care Cancer Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Clare Wilkinson
- Professor of General Practice, North Wales Centre for Primary Care Research, Bangor University, Wrexham, UK
| | - Richard D Neal
- Professor of Primary Care Oncology, Academic Unit of Primary Care, Institute of Health Sciences, University of Leeds, Leeds, UK
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Abstract
BACKGROUND In 2006, Burkina Faso set up a policy to subsidize the cost of obstetric and neonatal emergency care. This policy has undoubtedly increased attendance at all levels of the health pyramid. The aim of this study was to measure the capacity of referral hospitals' maternity services to cope with the demand for health services after the implementation of this policy. METHODS This study was conducted in three referral health centres (CMAs, CHRs, and CHUs). The CHU Yalgado Ouédraogo (tertiary level) and the CMA in Sector 30 (primary level) were selected as health facilities in the capital, along with the Kaya CHR (secondary level). At each health facility, the study included official maternity ward staff only. We combined the two occupational categories (nurses and midwives) because they perform the same activities in these health facilities. We used the WISN method recommended by WHO to assess the availability of nurses and midwives. RESULTS Nurses and midwives represented 38% of staff at the University Hospital, 65% in the CHR and 80% in the CMA. The number of nurses and midwives needed for carrying out the activities in the maternity ward in the University Hospital and the CMA is greater than the current workforce, with WISN ratio of 0.68 and 0.79 respectively. In the CHR, the current workforce is greater than the number required (WISN ratio = 2). CONCLUSION This study showed a shortage of nurses and midwives in two health facilities in Ouagadougou, which confirms that there is considerable demand. At the Kaya CHR, there is currently enough staff to handle the workload in the maternity ward, which may indicate a need to expand the analysis to other health facilities to determine whether a redistribution of health human resources is warranted.
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Affiliation(s)
- Antarou Ly
- Département de santé publique, Institut de recherche en Sciences de la santé (IRSS), 03 BP 7192 Ouagadougou, Burkina Faso
| | - Séni Kouanda
- Département de santé publique, Institut de recherche en Sciences de la santé (IRSS), 03 BP 7192 Ouagadougou, Burkina Faso
- Kaya health and Demographic surveillance system, Kaya HDSS, Kaya, Burkina Faso
- Institut Africain de santé publique, 12 BP 50 Ouagadougou, Burkina Faso
| | - Valéry Ridde
- Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada
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Latinovic R, Gulliford M, Ridsdale L. Headache and migraine in primary care: consultation, prescription, and referral rates in a large population. J Neurol Neurosurg Psychiatry 2006; 77:385-7. [PMID: 16484650 PMCID: PMC2077680 DOI: 10.1136/jnnp.2005.073221] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2005] [Revised: 07/13/2005] [Accepted: 08/17/2005] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS Headache is the most common new neurological symptom seen by general practitioners and neurologists. This study describes headache consultation, prescription, and referral rates in a large sample of UK general practices. METHODS Analysis of data from patients > or = 15 years registered at 253 UK general practices diagnosed with headache/migraine from 1992 to 2000. Rates were age standardised using the European standard population for reference. RESULTS There were 13.2 million patient years of observation. Headache consultation rates were 6.4/100 patients/year in women and 2.5 in men. They were highest at 15-24 years (15.8/100 in women; 5.8/100 in men), decreasing with age. Antimigraine drugs were prescribed at 36.7% of consultations for women and 26.6% for men. Among referrals to specialists, 55% were to neurology and 30% to general medicine. The neurology referral rate in patients with headache was 2.1/100, and was higher in men (2.7/100) than women (1.9/100). CONCLUSIONS These results provide precise age specific and age standardised estimates for headache consulting in general practice, in addition to prescribing and referral to specialist care. Consultation rates are highest in young women; hospital referrals peak in middle aged men. Research is needed into reasons for referral, and on better ways of delivering headache services.
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Affiliation(s)
- R Latinovic
- Division of Health and Social Care Research, King's College London, 5 Lambeth Walk, London SE11 6SP, UK
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