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Martin, Glen Philip, Chun Shing Kwok, Harriette Gillian Christine Van Spall, Annabelle Santos Volgman, Erin Michos, Purvi Parwani, Chadi Alraies, Ritu Thamman, Evangelos Kontopantelis, and Mamas Mamas. "Readmission and processes of care across weekend and weekday hospitalisation for acute myocardial infarction, heart failure or stroke: an observational study of the National Readmission Database." BMJ Open 9, no. 8 (August 2019): e029667. http://dx.doi.org/10.1136/bmjopen-2019-029667.
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ObjectivesVariation in hospital resource allocations across weekdays and weekends have led to studies of the ‘weekend effect’ for ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), heart failure (HF) and stroke. However, few studies have explored the ‘weekend effect’ on unplanned readmission. We aimed to investigate 30-day unplanned readmissions and processes of care across weekend and weekday hospitalisations for STEMI, NSTEMI, HF and stroke.DesignWe grouped hospitalisations for STEMI, NSTEMI, HF or stroke into weekday or weekend admissions. Multivariable adjusted ORs for binary outcomes across weekend versus weekday (reference) groups were estimated using logistic regression.SettingWe included all non-elective hospitalisations for STEMI, NSTEMI, HF or stroke, which were recorded in the US Nationwide Readmissions Database between 2010 and 2014.ParticipantsThe analysis sample included 659 906 hospitalisations for STEMI, 1 420 600 hospitalisations for NSTEMI, 3 027 699 hospitalisations for HF, and 2 574 168 hospitalisations for stroke.Main outcome measuresThe primary outcome was unplanned 30-day readmission. As secondary outcomes, we considered length of stay and the following processes of care: coronary angiography, primary percutaneous coronary intervention, coronary artery bypass graft, thrombolysis, brain scan/imaging, thrombectomy, echocardiography and cardiac resynchronisation therapy/implantable cardioverter-defibrillator.ResultsUnplanned 30-day readmission rates were 11.0%, 15.1%, 23.0% and 10.9% for STEMI, NSTEMI, HF and stroke, respectively. Weekend hospitalisations for HF were associated with a statistically significant but modest increase in 30-day readmissions (OR of 1.045, 95% CI 1.033 to 1.058). Weekend hospitalisation for STEMI, NSTEMI or stroke was not associated with increased risk of 30-day readmission.ConclusionThere was no clinically meaningful evidence against the supposition that weekend and weekday hospitalisations have the same 30-day unplanned readmissions. Thirty-day readmission rates were high, especially for HF, which has implications for service provision. Strategies to reduce readmission rates should be explored, regardless of day of hospitalisation.
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Dickins, Marissa, Angela Joe, and Judy A. Lowthian. "Ten-Year Trends and Predictors of Unplanned Hospitalisation in Community-Dwelling Older People Receiving Home-Based Care." Health & Social Care in the Community 2023 (February 9, 2023): 1–13. http://dx.doi.org/10.1155/2023/9332777.
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Older people prefer to remain living in their own home for as long as possible; however, many require support to do so through health and other care services provided in the home. This study aimed to explore the trends in usage of a home-based care service by older people in metropolitan Melbourne and factors associated with unplanned hospitalisations. This longitudinal study analysed episodes of home-based care for people aged ≥65 years between 2006 and 2015. An episode of care was defined as the period of time during which the home care services were provided to the client. Care episodes culminated in a planned discharge from the service or an unplanned hospitalisation. Descriptive statistics and multivariable logistic regression were utilised to investigate the characteristics associated with unplanned hospitalisations. Utilisation of home-based care services over the 10-year period showed an increasing rate of use by people aged ≥85 years and a reduced usage rate by females aged 70–84 years and males 75–79 years old. Of 170,001 episodes of care, 43,608 (25.7%) resulted in an unplanned hospitalisation. Home-based care delivered to people aged ≥85 years showed an increasing rate of episodes ending in an unplanned transfer to the hospital. Between 2006 and 2015, individuals aged 85–89 years displayed a rate increase of 18.7% in episodes ending in an unplanned hospitalisation; for those aged ≥90 years, the rate rise was 43.6%. Factors associated with an unplanned hospitalisation included advancing age, male gender, living alone, cognitive dysfunction, and the complexity of medical issues. Health policy has focussed on providing services to enable older people to remain in their own home. The increasing rate of unplanned hospitalisations for community-dwellers aged ≥85 years suggests more support is required to enable ageing in place.
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Inacio, Maria C., Robert N. Jorissen, Steve Wesselingh, Janet K. Sluggett, Craig Whitehead, John Maddison, John Forward, Alice Bourke, Gillian Harvey, and Maria Crotty. "Predictors of hospitalisations and emergency department presentations shortly after entering a residential aged care facility in Australia: a retrospective cohort study." BMJ Open 11, no. 11 (November 2021): e057247. http://dx.doi.org/10.1136/bmjopen-2021-057247.
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ObjectivesTo: (1) examine the 90-day incidence of unplanned hospitalisation and emergency department (ED) presentations after residential aged care facility (RACF) entry, (2) examine individual-related, facility-related, medication-related, system-related and healthcare-related predictors of these outcomes and (3) create individual risk profiles.DesignRetrospective cohort study using the Registry of Senior Australians. Fine-Gray models estimated subdistribution HRs and 95% CIs. Harrell’s C-index assessed risk models’ predictive ability.Setting and participantsIndividuals aged ≥65 years old entering a RACF as permanent residents in three Australian states between 1 January 2013 and 31 December 2016 (N=116 192 individuals in 1967 RACFs).Predictors examinedIndividual-related, facility-related, medication-related, system and healthcare-related predictors ascertained at assessments or within 90 days, 6 months or 1 year prior to RACF entry.Outcome measures90-day unplanned hospitalisation and ED presentation post-RACF entry.ResultsThe cohort median age was 85 years old (IQR 80–89), 62% (N=71 861) were women, and 50.5% (N=58 714) had dementia. The 90-day incidence of unplanned hospitalisations was 18.0% (N=20 919) and 22.6% (N=26 242) had ED presentations. There were 34 predictors of unplanned hospitalisations and 34 predictors of ED presentations identified, 27 common to both outcomes and 7 were unique to each. The hospitalisation and ED presentation models out-of-sample Harrell’s C-index was 0.664 (95% CI 0.657 to 0.672) and 0.655 (95% CI 0.648 to 0.662), respectively. Some common predictors of high risk of unplanned hospitalisation and ED presentations included: being a man, age, delirium history, higher activity of daily living, behavioural and complex care needs, as well as history, number and recency of healthcare use (including hospital, general practitioners attendances), experience of a high sedative load and several medications.ConclusionsWithin 90 days of RACF entry, 18.0% of individuals had unplanned hospitalisations and 22.6% had ED presentations. Several predictors, including modifiable factors, were identified at the time of care entry. This is an actionable period for targeting individuals at risk of hospitalisations.
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Akugizibwe, Roselyne, Amaia Calderón-Larrañaga, Albert Roso-Llorach, Graziano Onder, Alessandra Marengoni, Alberto Zucchelli, Debora Rizzuto, and Davide L. Vetrano. "Multimorbidity Patterns and Unplanned Hospitalisation in a Cohort of Older Adults." Journal of Clinical Medicine 9, no. 12 (December 10, 2020): 4001. http://dx.doi.org/10.3390/jcm9124001.
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The presence of multiple chronic conditions (i.e., multimorbidity) increases the risk of hospitalisation in older adults. We aimed to examine the association between different multimorbidity patterns and unplanned hospitalisations over 5 years. To that end, 2,250 community-dwelling individuals aged 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) were studied. Participants were grouped into six multimorbidity patterns using a fuzzy c-means cluster analysis. The associations between patterns and outcomes were tested using Cox models and negative binomial models. After 5 years, 937 (41.6%) participants experienced at least one unplanned hospitalisation. Compared to participants in the unspecific multimorbidity pattern, those in the cardiovascular diseases, anaemia and dementia pattern, the psychiatric disorders pattern and the metabolic and sleep disorders pattern presented with a higher hazard of first unplanned hospitalisation (hazard ratio range: 1.49–2.05; p < 0.05 for all), number of unplanned hospitalisations (incidence rate ratio (IRR) range: 1.89–2.44; p < 0.05 for all), in-hospital days (IRR range: 1.91–3.61; p < 0.05 for all), and 30-day unplanned readmissions (IRR range: 2.94–3.65; p < 0.05 for all). Different multimorbidity patterns displayed a differential association with unplanned hospital care utilisation. These findings call for a careful primary care follow-up of older adults with complex multimorbidity patterns.
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Quah, Weiren Charles, Chin Jong Leong, Edward Chong, James Alvin Low, and Heidi Rafman. "Unplanned hospitalisations among subsidised nursing home residents in Singapore: Insights from a data linkage study." Annals of the Academy of Medicine, Singapore 53, no. 11 (November 29, 2024): 657–69. http://dx.doi.org/10.47102/annals-acadmedsg.2024118.
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Introduction: Hospitalisations can pose hazards and may not be an appropriate care setting for frail nursing home (NH) residents. Few studies have quantified the extent of NH resident hospitalisations in Singapore, hence we aimed to address this knowledge gap by studying characteristics of unplanned hospitalisations over a 1-year period. Method: This was a retrospective cohort study of 9922 subsidised residents across 59 NHs in Singapore, with analysis using administrative healthcare data. Key measures included inpatient admission and emergency department visit rates, final discharge diagnoses and estimated costs. We examined correlates of inpatient admissions with a multivariable zero-inflated negative binomial regression model incorporating demographics, institutional characteristics and Charlson Comorbidity Index. Results: There were 6620 inpatient admissions in 2015, equivalent to 2.23 admissions per 1000 resident days, and the majority were repeat admissions (4504 admissions or 68.0%). Male sex (incidence rate ratio [IRR] 1.23), approaching end-of-life (IRR 2.14), hospitalisations in the past year (IRR 2.73) and recent NH admission within the last 6 months (IRR 1.31–1.99) were significantly associated with inpatient admission rate. Top 5 discharge diagnoses were lower respiratory tract infections (27.3%), urinary tract infection (9.3%), sepsis (3.1%), cellulitis (1.9%) and gastroenteritis (1.1%). We estimated the total system cost of admissions of subsidised residents to be SGD40.2 million (USD29.1 million) in 2015. Conclusion: We anticipate that unplanned hospitalisation rate will increase over time, especially with an increasing number of residents who will be cared for in NHs. Our findings provide a baseline to inform stakeholders and develop strategies to address this growing problem.
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Mahadea, D., P. Kotecki, I. Miechowicz, A. Dobrowolska, and P. Eder. "P1138 Long-term Epidemiological Trends in Emergency Hospital Admissions and Hospitalizations of Patients with Inflammatory Bowel Diseases in one of the biggest metropolises in western Poland in years 2010 to 2021." Journal of Crohn's and Colitis 18, Supplement_1 (January 1, 2024): i2037—i2038. http://dx.doi.org/10.1093/ecco-jcc/jjad212.1268.
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Abstract Background A worldwide significant dynamic shift in the incidence and clinical course of Inflammatory Bowel Diseases (IBD) has been observed in the past years. One key indicator that embodies this variability is the necessity for urgent hospitalisation due to exacerbations of Crohn's Disease (CD) and Ulcerative Colitis (UC). The objective of this study was to assess this phenomenon in the Poznan Metropolis, one of the biggest metropolises in western Poland, over a 12-year timeframe. Methods Using the National Health Fund's database, urgent hospitalisations of patients with CD or UC from 2010-2021 were identified, and defined as unplanned admissions to emergency departments and inpatient units in Poznan Metropolis hospitals, which required hospitalisation. The ratio of emergency to planned hospitalisations were compared in two identical timeframes: 2010-2015 vs. 2016-2021 and, additionally, during the COVID-19 pandemic years 2020-2021 vs. 2018-2019. The data were analysed and compared according to diagnosis, age, gender and length of hospitalisation. Results The numbers of urgent and planned hospitalisations in regard to predefined time periods are shown in Table 1. The rate of acute to planned hospitalisations from 2010-2015 vs. 2016-2021 was 27% (809/3006) vs. 44.5% (1131/2540) (p <0.0001). It increased significantly in all defined categories, except for patients over 60 years of age, where an insignificant decrease from 79% to 71% (p=0.4) was noted. Lower hospitalisation rates were observed among men compared to women (2010-2015: 28% vs. 46%; 2016-2021: 25% vs. 43%). The COVID-19 pandemic posed a paramount challenge to global healthcare systems. However, a statistically significant decrease in the rate of urgent to planned hospitalisations was only found in CD patients (47% vs. 34%; p=0.02; Figure 1). No impact on hospitalisation duration was observed during the COVID-19 pandemic as compared to 2018-2019. Conclusion Despite ongoing therapeutic advances, IBD remains a substantial challenge to healthcare systems, as evidenced by the increasing trend in urgent hospitalisations over time, regardless of the diagnosis, particularly among women. The COVID-19 pandemic significantly triggered global economic and healthcare crisis. However, the repercussions on the treatment of IBD patients in our Metropolis were inconsequential.
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Moorin, Rachael E., David Youens, David B. Preen, Mark Harris, and Cameron M. Wright. "Association between continuity of provider-adjusted regularity of general practitioner contact and unplanned diabetes-related hospitalisation: a data linkage study in New South Wales, Australia, using the 45 and Up Study cohort." BMJ Open 9, no. 6 (June 2019): e027158. http://dx.doi.org/10.1136/bmjopen-2018-027158.
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ObjectiveTo assess the association between continuity of provider-adjusted regularity of general practitioner (GP) contact and unplanned diabetes-related hospitalisation or emergency department (ED) presentation.DesignCross-sectional study.SettingIndividual-level linked self-report and administrative health service data from New South Wales, Australia.Participants27 409 survey respondents aged ≥45 years with a prior history of diabetes and at least three GP contacts between 1 July 2009 and 30 June 2015.Main outcome measuresUnplanned diabetes-related hospitalisations or ED presentations, associated costs and bed days.ResultsTwenty-one per cent of respondents had an unplanned diabetes-related hospitalisation or ED presentation. Increasing regularity of GP contact was associated with a lower probability of hospitalisation or ED presentation (19.9% for highest quintile, 23.5% for the lowest quintile). Conditional on having an event, there was a small decrease in the number of hospitalisations or ED presentations for the low (−6%) and moderate regularity quintiles (−8%), a reduction in bed days (ranging from −30 to −44%) and a reduction in average cost of between −23% and −41%, all relative to the lowest quintile. When probability of diabetes-related hospitalisation or ED presentation was included, only the inverse association with cost remained significant (mean of $A3798 to $A6350 less per individual, compared with the lowest regularity quintile). Importantly, continuity of provider did not significantly modify the effect of GP regularity for any outcome.ConclusionsHigher regularity of GP contact—that is more evenly dispersed, not necessarily more frequent care—has the potential to reduce secondary healthcare costs and, conditional on having an event, the time spent in hospital, irrespective of continuity of provider. These findings argue for the advocacy of regular care, as distinct from solely continuity of provider, when designing policy and financial incentives for GP-led primary care.
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Zhuang, Qingyuan, Joanna SE Chan, Lionel KY See, Jianbang Chiang, Shariff R. Suhaimi, Tallie WL Chua, and Anantharaman Venkataraman. "Characteristics of unplanned hospitalisations among cancer patients in Singapore." Annals of the Academy of Medicine, Singapore 50, no. 12 (December 29, 2021): 882–91. http://dx.doi.org/10.47102/annals-acadmedsg.2021212.
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Introduction: Cancer is a pervasive global problem with significant healthcare utilisation and cost. Emergency departments (EDs) see large numbers of patients with oncologic emergencies and act as “gate-keepers” to subsequent hospital admissions. A proportion of such hospital admissions are rapidly discharged within 2 days and may be potentially avoidable. Methods: Over a 6-month period, we conducted a retrospective audit of active cancer patients presenting to the ED with subsequent admission to the Department of Medical Oncology. Our aims were to identify independent factors associated with a length of stay ≤2 days; and characterise the clinical and resource needs of these short admissions. Results: Among all medical oncology admissions, 24.4% were discharged within 2 days. Compared to longer stayers, patients with short admissions were significantly younger (P=0.010), had lower National Early Warning Scores (NEWS) (P=0.006), and had a lower proportion of gastrointestinal and hepatobiliary cancers (P=0.005). Among short admissions, common presenting medical problems were infections (n=144, 36.3%), pain (n=116, 29.2%), gastrointestinal complaints (n=85, 21.4%) and respiratory complaints (n=76, 19.1%). These admissions required investigations and treatments already available at the ED. Conclusion: Short admissions have low resource needs and may be managed in the ED. This may help save valuable inpatient bed-days and reduce overall healthcare costs. Keywords: Emergency medicine, healthcare use, oncology, palliative care, unplanned cancer admission
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Pereira, Filipa, Henk Verloo, Armin von Gunten, María del Río Carral, Carla Meyer-Massetti, Maria Manuela Martins, and Boris Wernli. "Unplanned nursing home admission among discharged polymedicated older inpatients: a single-centre, registry-based study in Switzerland." BMJ Open 12, no. 3 (March 2022): e057444. http://dx.doi.org/10.1136/bmjopen-2021-057444.
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ObjectiveTo investigate patient characteristics and the available health and drug data associated with unplanned nursing home admission following an acute hospital admission or readmission.DesignA population-based hospital registry study.SettingA public hospital in southern Switzerland (Valais Hospital).ParticipantsWe explored a population-based longitudinal dataset of 14 705 hospital admissions from 2015 to 2018.Outcome measuresSociodemographic, health and drug data, and their interactions predicting the risk of unplanned nursing home admission.ResultsThe mean prevalence of unplanned nursing home admission after hospital discharge was 6.1% (n=903/N=14 705). Our predictive analysis revealed that the oldest adults (OR=1.07 for each additional year of age; 95% CI 1.05 to 1.08) presenting with impaired functional mobility (OR=3.22; 95% CI 2.67 to 3.87), dependency in the activities of daily living (OR=4.62; 95% CI 3.76 to 5.67), cognitive impairment (OR=3.75; 95% CI 3.06 to 4.59) and traumatic injuries (OR=1.58; 95% CI 1.25 to 2.01) had a higher probability of unplanned nursing home admission. The number of International Classification of Diseases, 10th version diagnoses had no significant impact on nursing home admissions, contrarily to the number of prescribed drugs (OR=1.17; 95% CI 1.15 to 1.19). Antiemetics/antinauseants (OR=2.53; 95% CI 1.21 to 5.30), digestives (OR=1.78; 95% CI 1.09 to 2.90), psycholeptics (OR=1.76; 95% CI 1.60 to 1.93), antiepileptics (OR=1.49; 95% CI 1.25 to 1.79) and anti-Parkinson’s drugs (OR=1.40; 95% CI 1.12 to 1.75) were strongly linked to unplanned nursing home admission.ConclusionsNumerous risk factors for unplanned nursing home admission were identified. To prevent the adverse health outcomes that precipitate acute hospitalisations and unplanned nursing home admissions, ambulatory care providers should consider these risk factors in their care planning for older adults before they reach a state requiring hospitalisation.
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Boyde, M., R. Peters, N. New, R. Hwang, T. Ha, and D. Korczyk. "Self-care educational intervention to reduce hospitalisations in heart failure: A randomised controlled trial." European Journal of Cardiovascular Nursing 17, no. 2 (August 23, 2017): 178–85. http://dx.doi.org/10.1177/1474515117727740.
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Background: A variety of educational interventions have been implemented to assist patients with heart failure to maintain their own health, develop self-care behaviours and decrease readmissions. Aims: The purpose of this study was to determine the effectiveness of a multimedia educational intervention for patients with heart failure in reducing unplanned hospital readmissions. Methods: The study, a randomised controlled trial in a large tertiary referral hospital in Australia, recruited 200 patients. Patients diagnosed with heart failure were randomly allocated 1:1 to usual education or a multimedia educational intervention. The multimedia approach began with an individual needs assessment to develop an educational plan. The educational intervention included viewing a DVD, and verbal discussion supported by a written manual with a teach-back evaluation strategy. The primary outcome was all-cause unplanned hospital readmission at 28 days, three months and 12 months post-recruitment. The secondary outcomes were changes in knowledge and self-care behaviours at three months and 12 months post-recruitment. Results: At 12 months, data on 171 participants were analysed. There were 24 participants who had an unplanned hospital readmission in the intervention group compared to 44 participants in the control group ( p=0.005). The self-care educational intervention reduced the risk of readmission at 12 months by 30% (relative risk: 0.703; 95% confidence interval: 0.548–0.903). Conclusion: A targeted multimedia educational intervention can be effective in reducing all-cause unplanned readmissions for people with heart failure.
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Cicek, Meryem, Geva Greenfield, Dasha Nicholls, Azeem Majeed, and Benedict Hayhoe. "Predictors of unplanned emergency hospital admissions among patients aged 65+ with multimorbidity and depression in Northwest London during and after the Covid-19 lockdown in England." PLOS ONE 19, no. 2 (February 23, 2024): e0294639. http://dx.doi.org/10.1371/journal.pone.0294639.
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Introduction Individuals with multimorbidity have an increased likelihood of using unplanned secondary care including emergency department visits and emergency hospitalisations. Those with mental health comorbidities are affected to a greater extent. The Covid-19 pandemic has negatively impacted on psychosocial wellbeing and multimorbidity care, especially among vulnerable older individuals. Aim To examine the risk of unplanned hospital admissions among patients aged 65+ with multimorbidity and depression in Northwest London, England, during- and post-Covid-19 lockdown. Methods Retrospective cross-sectional data analysis with the Discover-NOW database for Northwest London was conducted. The overall sample consisted of 20,165 registered patients aged 65+ with depression. Two time periods were compared to observe the impact of the Covid-19 lockdown on emergency hospital admissions between 23rd March 2020 to 21st June 2021 (period 1) and equivalent-length post-lockdown period from 22nd June 2021 to 19th September 2022 (period 2). Multivariate logistic regression was conducted on having at least one emergency hospital admission in each period against sociodemographic and multimorbidity-related characteristics. Results The odds of having an emergency hospitalisation were greater in men than women (OR = 1.19 (lockdown); OR = 1.29 (post-lockdown)), and significantly increased with age, higher deprivation, and greater number of comorbidities in both periods across the majority of categories. There was an inconclusive pattern with ethnicity; with a statistically significant protective effect among Asian (OR = 0.66) and Black ethnicities (OR = 0.67) compared to White patients during post-lockdown period only. Conclusion The likelihood of unplanned hospitalisation was higher in men than women, and significantly increased with age, higher deprivation, and comorbidities. Despite modest increases in magnitude of risk between lockdown and post-lockdown periods, there is evidence to support proactive case-review by multi-disciplinary teams to avoid unplanned admissions, particularly men with multimorbidity and comorbid depression, patients with higher number of comorbidities and greater deprivation. Further work is needed to determine admission reasons, multimorbidity patterns, and other clinical and lifestyle predictors.
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Kotb, Ahmed, Susanne Armstrong, Ivelin Koev, Ibrahim Antoun, Zakariyya Vali, Gaurav Panchal, Joseph Barker, et al. "Digitally enabled acute care for atrial fibrillation: conception, feasibility and early outcomes of an AF virtual ward." Open Heart 10, no. 1 (June 2023): e002272. http://dx.doi.org/10.1136/openhrt-2023-002272.
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BackgroundAtrial fibrillation (AF) represents a growing healthcare challenge, mainly driven by acute hospitalisations. Virtual wards could be the way forward to manage acute AF patients through remote monitoring, especially with the rise in global access to digital telecommunication and the growing acceptance of telemedicine post-COVID-19.MethodsAn AF virtual ward was implemented as a proof-of-concept care model. Patients presenting acutely with AF or atrial flutter and rapid ventricular response to the hospital were onboarded to the virtual ward and managed at home through remote ECG-monitoring and ‘virtual’ ward rounds, after being given access to a single-lead ECG device, a blood pressure monitor and pulse oximeter with instructions to record daily ECGs, blood pressure, oxygen saturations and to complete an online AF symptom questionnaire. Data were uploaded to a digital platform for daily review by the clinical team. Primary outcomes included admission avoidance, readmission avoidance and patient satisfaction. Safety outcomes included unplanned discharge from the virtual ward, cardiovascular mortality and all-cause mortality.ResultsThere were 50 admissions to the virtual ward between January and August 2022. Twenty-four of them avoided initial hospital admission as patients were directly enrolled to the virtual ward from outpatient settings. A further 25 readmissions were appropriately prevented during virtual surveillance. Patient satisfaction questionnaires yielded 100% positive responses among participants. There were three unplanned discharges from the virtual ward requiring hospitalisation. Mean heart rate on admission to the virtual ward and discharge was 122±26 and 82±27 bpm respectively. A rhythm control strategy was pursued in 82% (n=41) and 20% (n=10) required 3 or more remote pharmacological interventions.ConclusionThis is a first real-world experience of an AF virtual ward that heralds a potential means for reducing AF hospitalisations and the associated financial burden, without compromising on patients’ care or safety.
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Ha, Ninh Thi, Mark Harris, David Preen, and Rachael Moorin. "Time protective effect of contact with a general practitioner and its association with diabetes-related hospitalisations: a cohort study using the 45 and Up Study data in Australia." BMJ Open 10, no. 4 (April 2020): e032790. http://dx.doi.org/10.1136/bmjopen-2019-032790.
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ObjectivesTo evaluate the relationship between the proportion of time under the potentially protective effect of a general practitioner (GP) captured using the Cover Index and diabetes-related hospitalisation and length of stay (LOS).DesignAn observational cohort study over two 3-year time periods (2009/2010–2011/2012 as the baseline and 2012/2013–2014/2015 as the follow-up).SettingLinked self-report and administrative health service data at individual level from the 45 and Up Study in New South Wales, Australia.ParticipantsA total of 21 965 individuals aged 45 years and older identified with diabetes before July 2009 were included in this study.Main outcome measuresDiabetes-related hospitalisation, unplanned diabetes-related hospitalisation and LOS of diabetes-related hospitalisation and unplanned diabetes-related hospitalisation.MethodsThe average annual GP cover index over a 3-year period was calculated using information obtained from Australian Medicare and hospitalisation. The effect of exposure to different levels of the cover on the main outcomes was estimated using negative binomial models weighted for inverse probability of treatment weight to control for observed covariate imbalance at the baseline period.ResultsPerfect GP cover was observed among 53% of people with diabetes in the study cohort. Compared with perfect level of GP cover, having lower levels of GP cover including high (incidence rate ratio (IRR) 2.8, 95% CI 2.6 to 3.0), medium (IRR 3.2, 95% CI 2.7 to 3.8) and low (IRR 3.1, 95% CI 2.0 to 4.9) were significantly associated with higher number of diabetes-related hospitalisation. Similar association was observed between the different levels of GP cover and other outcomes including LOS for diabetes-related hospitalisation, unplanned diabetes-related hospitalisation and LOS for unplanned diabetes-related hospitalisation.ConclusionsMeasuring longitudinal continuity in terms of time under cover of GP care may offer opportunities to optimise the performance of primary healthcare and reduce secondary care costs in the management of diabetes.
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Aminian, Parmis, Estie Kruger, and Marc Tennant. "Association between Western Australian children’s unplanned dental presentations and the socioeconomic status of their residential area." Australian Health Review 46, no. 2 (December 23, 2021): 217–21. http://dx.doi.org/10.1071/ah21006.
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Objective This study investigated the link between socioeconomic status and unplanned dental presentations at the Perth Children’s Hospital (PCH), as well as the link between the socioeconomic status of unplanned dental patients and any previous admissions to the PCH. Methods Records of 351 unplanned visits to the PCH were collected, including reason for attendance (infection, trauma, other), the patient’s residential location (suburb) and the history of any previous presentations at the PCH. The socioeconomic status of each patient was based on the Index of Relative Socio-Economic Disadvantage, divided into quintiles. Geographic information systems (GIS) were used to spatially map the residential locations of the patients with unplanned dental presentations. QGIS was used to map and geocode the data. Analysis of variance and Chi-squared tests were used to determine associations between subgroups and other variables. Results ‘Unplanned dental presentation’ in this study refers to patients who present without an appointment, including by referral from the emergency department of the PCH or outside the PCH. Approximately two-thirds of unplanned dental presentation among patients from low socioeconomic groups were for dental infection, whereas the major reason for presentation among patients from higher socioeconomic groups was trauma. More than half the patients in low socioeconomic groups had at least one previous presentation at the PCH due to other medical issues. Conclusion Children from low socioeconomic groups, or from outside of Perth, were more likely to present with dental infections, which are mostly preventable at the primary care level; these patients often presented a more significant burden to the health system. Public health interventions should aim to promote preventive oral health care, especially for children from low socioeconomic groups. What is known about the topic? In Western Australia, the most common dental problems requiring hospitalisation among children is dental caries, and children from the lowest socioeconomic backgrounds have the highest prevalence of dental hospitalisations. What does this paper add? Children from lower socioeconomic backgrounds were more likely to have an unplanned presentation at the only tertiary children’s hospital in Western Australia due to dental infection. What are the implications for practitioners? Improved access to public dental services, especially in low socioeconomic areas, and the development of more strategies to reduce unplanned dental presentations at a tertiary hospital are needed.
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Leutgeb, Rüdiger, Sarah Jane Berger, Joachim Szecsenyi, and Gunter Laux. "Potentially avoidable hospitalisations of German nursing home patients? A cross-sectional study on utilisation patterns and potential consequences for healthcare." BMJ Open 9, no. 1 (January 2019): e025269. http://dx.doi.org/10.1136/bmjopen-2018-025269.
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ObjectivesDemand for nursing home (NH) care is soaring due to gains in life expectancy and people living longer with chronic illness and disability. This is dovetailing with workforce shortages across the healthcare profession. Access to timely and appropriate medical care for NH residents is becoming increasingly challenging and can result in potentially avoidable hospitalisations (PAHs). In light of these factors, we analysed PAHs comparing NH patients with non-NH patients.DesignCross-sectional study with claims data from 2015 supplied by a large German health insurance company within the federal state of Baden-Wuerttemberg.SettingOne-year observation of hospitalisation patterns for NH and non-NH patients.Participants3 872 245 of the 10.5million inhabitants of Baden-Wuerttemberg were covered.MethodsPatient data about hospitalisation date, sex, age, nationality, level of care and diagnoses were available. PAHs were defined based on international classification of diseases (ICD-10) diagnoses belonging to ambulatory care sensitive conditions (ACSCs). Adjusted ORs for PAHs for NH patients in comparison with non-NH patients were calculated with multivariable regression models.ResultsOf the 933 242 hospitalisations in 2015, there were 23 982 for 13 478 NH patients and 909 260 for 560 998 non-NH patients. Mean age of hospitalised NH patients and level of care were significantly higher than those of non-NH patients. 6449 PAHs (29.6%) for NH patients and 136 543 PAHs (15.02%) for non-NH patients were identified. The adjusted OR for PAHs was significantly heightened for NH patients in comparison with non-NH patients (OR: 1.22, CI (1.18 to 1.26), p<0.0001). Moreover, we could observe that more than 90% of PAHs with ACSCs were unplanned hospitalisations (UHs).ConclusionsLarge numbers of PAHs for NH patients calls for improved coordination of medical care, especially general practitioner service provision. Introduction of targeted training programmes for physicians and NH staff on health problem management for NH patients could perhaps contribute to reduction of PAHs, predominantly UHs.
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Mitchell, Rebecca, Brian Draper, Lara Harvey, Henry Brodaty, and Jacqueline Close. "56 Examining Fall-Related HIP Fractures in Long-Term Residential Aged Care and the Community: Trends, Health Outcomes and Treatment Costs." Age and Ageing 48, Supplement_4 (December 2019): iv13—iv17. http://dx.doi.org/10.1093/ageing/afz164.56.
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Abstract Background Hip fracture risk is higher for older adults living in residential aged care facilities (RACF) and their health outcomes worse compared to older adults living in the community. Pre-hip fracture residential status is not well recorded within hospital records, necessitating linkage of hospital and residential aged care data to better ascertain residential location pre-fracture. Aim To examine temporal trends, characteristics and health outcomes following a fall-related hip fracture hospitalisation of people living in RACFs to those living in the community. Method A retrospective analysis of fall-related hip fracture hospitalisations of people aged ≥65 years during 2008-2013 in New South Wales, Australia. Linked hospitalisation and RACF data were examined. Negative binomial regression examined the significance of hospitalisation temporal trends. Results There were 28,897 hip fracture hospitalisations and 32.5% were living in RACFs at time of fracture. The hospitalisation rate was 2,180 per 100,000 (95%CI: 2,097.0-2,263.7) for RACF residents and 390 per 100,000 (95%CI 384.8-395.8) for the community-living. Over 5 years, the hospitalisation rate for RACF residents declined by 2.9% annually (95%CI: -4.3 to -1.5). Hospital treatment cost for hip fractures was $958.5 million. Compared to older people living in the community, a higher proportion of RACF residents were aged ≥90 years (36.1% vs 17.2%), were female (75.3% vs 71.8%), had >1 Charlson comorbidity (37.6% vs 35.6%), and had dementia (58.2% vs 14.4%). RACF residents had fewer in-hospital rehabilitation episodes (18.7% vs 60.9%) and a higher proportion of unplanned readmissions (10.6% vs 9.1%) and in-hospital mortality (5.9% vs 3.3%) compared to older people living in the community. Conclusions RACF residents are a vulnerable cohort of older people who experience worse health outcomes and survival post-hip fracture than older people living in the community. Whether access to individualised hip fracture rehabilitation for RACF residents could improve health outcomes should be examined.
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Machowska, Anna, Mark D. Alscher, Satyanarayana Reddy Vanga, Michael Koch, Michael Aarup, Abdul R. Qureshi, Bengt Lindholm, and Peter Rutherford. "Dialysis Access, Infections, and Hospitalisations in Unplanned Dialysis Start Patients: Results from the Options Study." International Journal of Artificial Organs 40, no. 2 (February 2017): 48–59. http://dx.doi.org/10.5301/ijao.5000557.
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Introduction Unplanned dialysis start (UPS) associates with worse clinical outcomes, higher utilisation of healthcare resources, lower chances to select dialysis modality and UPS patients typically commenced in-centre haemodialysis (HD) with central venous catheter (CVC). We evaluated patient outcomes and healthcare utilisation depending on initial dialysis access (CVC or PD catheter) and subsequent pathway of UPS patients. Methods In this study patient demographics, access procedures, hospitalisations, and major infectious complications were analysed over 12 months in 270 UPS patients. PD technique survival and impact of switching from HD to PD was examined along with logistic regression to investigate factors predicting AV fistula formation. Results 72 UPS patients started with PD catheter and 198 with CVC. PD patients were older and more comorbid but had a significantly lower number of access procedures while there was no difference in hospitalisation or major infections. 13/72 initial PD patients switched to HD and 1-year technique survival was 79%. 158/198 patients remained on HD and 73/158 reported permanent access formation. Older age, OR = 0.34 (CI, 0.17-0.68) and cardiac failure, OR = 0.31(CI, 0.13–0.78), were significant negative predictors of receiving fistula. Younger patients, OR = 0.29 (CI, 0.11–0.79) and those who received AVF, OR = 0.11 (CI, 0.03–0.38), had significantly lower odds of death. Discussion UPS with initial PD was possible in many patients and was associated with lower requirement for access procedures. AVF formation in UPS patients starting on HD was associated with better 1-year survival. Modality switching in UPS patients requires careful clinical management, including clinical practice patterns promoting permanent HD access formation.
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Yudi, M., N. Andrianopoulos, J. O’Brien, L. Selkrig, D. Clark, A. Ajani, M. Freeman, et al. "Predictors of Recurrent Acute Coronary Syndrome Hospitalisations and Unplanned Revascularisation Following Acute Myocardial Infarction." Heart, Lung and Circulation 25 (August 2016): S58. http://dx.doi.org/10.1016/j.hlc.2016.06.130.
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Rana, Santu, Truyen Tran, Wei Luo, Dinh Phung, Richard L. Kennedy, and Svetha Venkatesh. "Predicting unplanned readmission after myocardial infarction from routinely collected administrative hospital data." Australian Health Review 38, no. 4 (2014): 377. http://dx.doi.org/10.1071/ah14059.
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Objective Readmission rates are high following acute myocardial infarction (AMI), but risk stratification has proved difficult because known risk factors are only weakly predictive. In the present study, we applied hospital data to identify the risk of unplanned admission following AMI hospitalisations. Methods The study included 1660 consecutive AMI admissions. Predictive models were derived from 1107 randomly selected records and tested on the remaining 553 records. The electronic medical record (EMR) model was compared with a seven-factor predictive score known as the HOSPITAL score and a model derived from Elixhauser comorbidities. All models were evaluated for the ability to identify patients at high risk of 30-day ischaemic heart disease readmission and those at risk of all-cause readmission within 12 months following the initial AMI hospitalisation. Results The EMR model has higher discrimination than other models in predicting ischaemic heart disease readmissions (area under the curve (AUC) 0.78; 95% confidence interval (CI) 0.71–0.85 for 30-day readmission). The positive predictive value was significantly higher with the EMR model, which identifies cohorts that were up to threefold more likely to be readmitted. Factors associated with readmission included emergency department attendances, cardiac diagnoses and procedures, renal impairment and electrolyte disturbances. The EMR model also performed better than other models (AUC 0.72; 95% CI 0.66–0.78), and with greater positive predictive value, in identifying 12-month risk of all-cause readmission. Conclusions Routine hospital data can help identify patients at high risk of readmission following AMI. This could lead to decreased readmission rates by identifying patients suitable for targeted clinical interventions. What is known about the topic? Many clinical and demographic risk factors are known for hospital readmissions following acute myocardial infarction, including multivessel disease, high baseline heart rate, hypertension, diabetes, obesity, chronic obstructive pulmonary disease and psychiatric morbidity. However, combining these risk factors into indices for predicting readmission had limited success. A recent study reported a C-statistic of 0.73 for predicting 30-day readmissions. In a recent American study, a simple seven-factor score was shown to predict hospital readmissions among medical patients. What does this paper add? This paper presents a way to predict readmissions following myocardial infarction using routinely collected administrative data. The model performed better than the recently described HOSPITAL score and a model derived from Elixhauser comorbidities. Moreover, the model uses only data generally available in most hospitals. What are the implications for practitioners? Routine hospital data available at discharges can be used to tailor preventative care for AMI patients, to improve institutional performance and to decrease the cost burden associated with AMI.
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Shannon, Brendan, Kelly-Ann Bowles, Cylie Williams, Tanya Ravipati, Elise Deighton, and Nadine Andrew. "Does a Community Care programme reach a high health need population and high users of acute care hospital services in Melbourne, Australia? An observational cohort study." BMJ Open 13, no. 9 (September 2023): e077195. http://dx.doi.org/10.1136/bmjopen-2023-077195.
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ObjectiveThe Community Care programme is an initiative aimed at reducing hospitalisations and emergency department (ED) presentations among patients with complex needs. We aimed to describe the characteristics of the programme participants and identify factors associated with enrolment into the programme.DesignThis observational cohort study was conducted using routinely collected data from the National Centre for Healthy Ageing data platform.SettingThe study was carried out at Peninsula Health, a health service provider serving a population in Melbourne, Victoria, Australia.ParticipantsWe included all adults with unplanned ED presentation or hospital admission to Peninsula Health between 1 November 2016 and 31 October 2017, the programme’s first operational year.Outcome measuresCommunity Care programme enrolment was the primary outcome. Participants’ demographics, health factors and enrolment influences were analysed using a staged multivariable logistic regression.ResultsWe included 47 148 adults, of these, 914 were enrolled in the Community Care programme. Participants were older (median 66 vs 51 years), less likely to have a partner (34% vs 57%) and had more frequent hospitalisations and ED visits. In the multivariable analysis, factors most strongly associated with enrolment included not having a partner (adjusted OR (aOR) 1.83, 95% CI 1.57 to 2.12), increasing age (aOR 1.01, 95% CI 1.01 to 1.02), frequent hospitalisations (aOR 7.32, 95% CI 5.78 to 9.24), frequent ED visits (aOR 2.0, 95% CI 1.37 to 2.85) and having chronic diseases, such as chronic pulmonary disease (aOR 2.48, 95% CI 2.06 to 2.98), obesity (aOR 2.06, 95% CI 1.39 to 2.99) and diabetes mellitus (complicated) (aOR 1.75, 95% CI 1.44 to 2.13). Residing in aged care home and having high socioeconomic status) independently associated with reduced odds of enrolment.ConclusionsThe Community Care programme targets patients with high-readmission risks under-representation of individuals residing in residential aged care homes warrants further investigation. This study aids service planning and offers valuable feedback to clinicians about programme beneficiaries
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Green, Mark Alan, Martin McKee, Jon Massey, Brian Mackenna, Amir Mehrkar, Seb Bacon, John Macleod, Aziz Sheikh, Syed Ahmar Shah, and Srinivasa Vittal Katikireddi. "Trends in inequalities in avoidable hospitalisations across the COVID-19 pandemic: a cohort study of 23.5 million people in England." BMJ Open 14, no. 1 (January 2024): e077948. http://dx.doi.org/10.1136/bmjopen-2023-077948.
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ObjectiveTo determine whether periods of disruption were associated with increased ‘avoidable’ hospital admissions and wider social inequalities in England.DesignObservational repeated cross-sectional study.SettingEngland (January 2019 to March 2022).ParticipantsWith the approval of NHS England we used individual-level electronic health records from OpenSAFELY, which covered ~40% of general practices in England (mean monthly population size 23.5 million people).Primary and secondary outcome measuresWe estimated crude and directly age-standardised rates for potentially preventable unplanned hospital admissions: ambulatory care sensitive conditions and urgent emergency sensitive conditions. We considered how trends in these outcomes varied by three measures of social and spatial inequality: neighbourhood socioeconomic deprivation, ethnicity and geographical region.ResultsThere were large declines in avoidable hospitalisations during the first national lockdown (March to May 2020). Trends increased post-lockdown but never reached 2019 levels. The exception to these trends was for vaccine-preventable ambulatory care sensitive admissions which remained low throughout 2020–2021. While trends were consistent by each measure of inequality, absolute levels of inequalities narrowed across levels of neighbourhood socioeconomic deprivation, Asian ethnicity (compared with white ethnicity) and geographical region (especially in northern regions).ConclusionsWe found no evidence that periods of healthcare disruption from the COVID-19 pandemic resulted in more avoidable hospitalisations. Falling avoidable hospital admissions has coincided with declining inequalities most strongly by level of deprivation, but also for Asian ethnic groups and northern regions of England.
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Garattini, Silvio Ken, Alessandro Marco Minisini, Francesca Valent, Chiara Riosa, Claudia Andreetta, Giovanni Gerardo Cardellino, Mauro Mansutti, et al. "Effects of the growing prevalence in oncology: A real-world study on the estimated workload." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e14148-e14148. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e14148.
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e14148 Background: The increasing prevalence of cancer patients due to new effective treatments is leading to a growing demand in oncology activities, thus requiring a re-modelling towards more sustainable systems. The aim of this study is to estimate the workload generated by each new cancer patient referred to the Oncology Department of the Academic Cancer Center of Udine, Italy, within the two years from first consultation. Methods: We have utilised our electronic “Data Warehouse” accountability system to retrieve anonymous aggregate data of the 2-year oncology workload generated by each new diagnosis, leading to an initial consultation, occurring between 01.01.2012 and 31.12.2017. Initial consultations with no clinical episode in the following 12 months were excluded. Mean value per patient and standard deviations were calculated for the following clinical activities: treatment sessions, unplanned presentations, hospitalisations, re-assessments, follow-up visits and inpatient oncology advices. The total number of patients treated and of episodes were recorded. Follow-up data was collected up to 31.12.2019. Results: During the observation period, 7,454 newly diagnosed patients were referred to our Oncology Unit, resulting in a total of 92,830 clinical activities occurring over an 8-year period. In 1,788 pts (24.0%) only follow-up was needed; 3,152 pts (42.3%) were referred for adjuvant treatment and 2,514 (33.7%) for advanced disease management. Overall, the mean number of clinical activities per patient within the first 2 years was: 6.04 pre-treatment evaluations (52.9%; SD 8.81; 45,003 total episodes), 2.00 follow-up visits (17.5%; SD 1.89; 14,922 total episodes), 0.42 hospitalisations (3.7%; SD 1.21; 3,141 total episodes), 0.36 inpatient oncology advices (3.2%; SD 0.83; 2,705 total episodes), 1.57 re-assessments (13.8%; SD 2.28; 11,723 total episodes) and 1.02 unplanned presentations (8.9%; SD 2.17; 7,601 total episodes). Subgroup analysis in the different tumors and settings are ongoing. Conclusions: The landscape of cancer care is changing due to the growing prevalence of cancer patients that experience longer overall survival. Trying to estimate the amount of clinical activities generated by any new diagnosis is crucial for implementing new models of oncology management and for programming an adequate workforce supply.
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Heinsbroek, Ellen, Daniel Hungerford, Richard P. D. Cooke, Margaret Chowdhury, James S. Cargill, Naor Bar-Zeev, Neil French, Eleni Theodorou, Baudouin Standaert, and Nigel A. Cunliffe. "Do hospital pressures change following rotavirus vaccine introduction? A retrospective database analysis in a large paediatric hospital in the UK." BMJ Open 9, no. 5 (May 2019): e027739. http://dx.doi.org/10.1136/bmjopen-2018-027739.
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ObjectiveHospitals in the UK are under increasing clinical and financial pressures. Following introduction of childhood rotavirus vaccination in the UK in 2013, rotavirus gastroenteritis (RVGE) hospitalisations reduced significantly. We evaluated changes in ‘hospital pressures’ (demand on healthcare resources and staff) following rotavirus vaccine introduction in a paediatric setting in the UK.DesignRetrospective hospital database analysis between July 2007 and June 2015.SettingA large paediatric hospital providing primary, secondary and tertiary care in Merseyside, UK.ParticipantsHospital admissions aged <15 years. Outcomes were calculated for four different patient groups identified through diagnosis coding (International Classification of Disease, 10th edition) and/or laboratory confirmation: all admissions; any infection, acute gastroenteritis and RVGE.MethodsHospital pressures were compared before and after rotavirus vaccine introduction: these included bed occupancy, hospital-acquired infection rate, unplanned readmission rate and outlier rate (medical patients admitted to surgical wards due to lack of medical beds). Interrupted time-series analysis was used to evaluate changes in bed occupancy.ResultsThere were 116 871 admissions during the study period. Lower bed occupancy in the rotavirus season in the postvaccination period was observed for RVGE (−89%, 95% CI 73% to 95%), acute gastroenteritis (−63%, 95% CI 39% to 78%) and any infection (−23%, 95% CI 15% to 31%). No significant overall reduction in bed occupancy was observed (−4%, 95% CI −1% to 9%). No changes were observed for the other outcomes.ConclusionsRotavirus vaccine introduction was not associated with reduced hospital pressures. A reduction in RVGE hospitalisation without change in overall bed occupancy suggests that beds available were used for a different patient population, possibly reflecting a previously unmet need.Trials registration numberNCT03271593
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Congdon, Peter. "Assessing Impacts on Unplanned Hospitalisations of Care Quality and Access Using a Structural Equation Method: With a Case Study of Diabetes." International Journal of Environmental Research and Public Health 13, no. 9 (September 1, 2016): 870. http://dx.doi.org/10.3390/ijerph13090870.
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Ranasinghe, Isuru, Sadia Hossain, Anna Ali, Dennis Horton, Robert JT Adams, Bernadette Aliprandi-Costa, Christina Bertilone, et al. "SAFety, Effectiveness of care and Resource use among Australian Hospitals (SAFER Hospitals): a protocol for a population-wide cohort study of outcomes of hospital care." BMJ Open 10, no. 8 (August 2020): e035446. http://dx.doi.org/10.1136/bmjopen-2019-035446.
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IntroductionDespite global concerns about the safety and quality of health care, population-wide studies of hospital outcomes are uncommon. The SAFety, Effectiveness of care and Resource use among Australian Hospitals (SAFER Hospitals) study seeks to estimate the incidence of serious adverse events, mortality, unplanned rehospitalisations and direct costs following hospital encounters using nationwide data, and to assess the variation and trends in these outcomes.Methods and analysisSAFER Hospitals is a cohort study with retrospective and prospective components. The retrospective component uses data from 2012 to 2018 on all hospitalised patients age ≥18 years included in each State and Territories’ Admitted Patient Collections. These routinely collected datasets record every hospital encounter from all public and most private hospitals using a standardised set of variables including patient demographics, primary and secondary diagnoses, procedures and patient status at discharge. The study outcomes are deaths, adverse events, readmissions and emergency care visits. Hospitalisation data will be linked to subsequent hospitalisations and each region’s Emergency Department Data Collections and Death Registries to assess readmissions, emergency care encounters and deaths after discharge. Direct hospital costs associated with adverse outcomes will be estimated using data from the National Cost Data Collection. Variation in these outcomes among hospitals will be assessed adjusting for differences in hospitals’ case-mix. The prospective component of the study will evaluate the temporal change in outcomes every 4 years from 2019 until 2030.Ethics and disseminationHuman Research Ethics Committees of the respective Australian states and territories provided ethical approval to conduct this study. A waiver of informed consent was granted for the use of de-identified patient data. Study findings will be disseminated via presentations at conferences and publications in peer-reviewed journals.
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Kumar, Sunil, Parth Godhiwala, Amrutha Garikapati, and Shraddha Jain. "Polypill therapy and frailty in elderly: Time to stop treating everything." Asian Journal of Medical Sciences 12, no. 4 (April 1, 2021): 39–42. http://dx.doi.org/10.3126/ajms.v12i4.33182.
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Background: Frailty is a reversible age-related condition of increased vulnerability and risk of death or unplanned hospitalization. Frailty and polypill therapy are common in elderly, although little is known about the impact, they may have on each other.
Aims and Objective: The study was a prospective observational study, designed with an aim to observe the six-month and one-year outcomes of elderly patients on polypill therapy.
Material and Methods: Three hundred forty-two patients aged more than 60 years on polypill treatment were enrolled in this study, which were on regular follow up in our rural hospital at geriatric units of medicine department.
Results: At the end of one year, 38.1% were in severe frailty (FIRE >0.7) category, out of which death happened at the end of one year were 41.6%. 47.6% required repeated hospitalisations that were on polypill therapy.
Conclusions: A reduction of polypill therapy could be a cautious strategy to prevent and manage frailty. Further research is needed to confirm the possible benefits of reducing polypill in the development, reversion or delay of frailty.
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Smith, Robert W., Kerry Kuluski, Andrew P. Costa, Samir K. Sinha, Richard H. Glazier, Alan Forster, and Lianne Jeffs. "Investigating the effect of sociodemographic factors on 30-day hospital readmission among medical patients in Toronto, Canada: a prospective cohort study." BMJ Open 7, no. 12 (December 2017): e017956. http://dx.doi.org/10.1136/bmjopen-2017-017956.
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ObjectiveTo examine the influence of patient-level sociodemographic factors on the incidence of hospital readmission within 30 days among medical patients in a large Canadian metropolitan city.DesignProspective cohort study.Setting and participantsPatients admitted to the General Internal Medicine service of an urban teaching hospital in Toronto, Canada participated in a survey of sociodemographic information. Patients were not surveyed if deemed medically unstable, receiving care in medical/surgical step-down beds or were isolated for infection control. Included in the final analysis was a diverse cohort of 1427 adult, non-palliative, patients who were discharged home.MeasuresThirteen patient-level sociodemographic variables were examined in relation to time to unplanned all-cause readmission within 30 days. Illness level was accounted for by the following covariates: self-perceived health status, previous hospital utilisation, primary diagnosis case mix group, Charlson Comorbidity Index score and inpatient length of stay.ResultsApproximately, 14.4% (n=205) of patients experienced readmission within 30 days. Sociodemographic factors were not significantly associated with time to readmission in unadjusted and adjusted analyses. Indicators of illness level, namely, previous hospitalisations, were the strongest risk factors for readmission within this cohort. One previous admission (adjusted HR 1.78; 95% CI 1.22 to 2.59, P<0.01) and at least four previous emergency department visits (adjusted HR 2.33; 95% CI 1.46 to 4.43, P<0.01) were associated with increased hazard of readmission within 30 days.ConclusionsPatient-level sociodemographic factors did not influence the incidence of unplanned all-cause readmission within 30 days. Further research is needed to understand the generalisability of our findings and investigate whether contextual factors, such as access to universal health insurance coverage, attenuate the effects of sociodemographic factors.
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Johnston, Jennifer, Jo Longman, Dan Ewald, Jonathan King, Sumon Das, and Megan Passey. "Study of potentially preventable hospitalisations (PPH) for chronic conditions: what proportion are preventable and what factors are associated with preventable PPH?" BMJ Open 10, no. 11 (November 2020): e038415. http://dx.doi.org/10.1136/bmjopen-2020-038415.
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IntroductionThe proportion of potentially preventable hospitalisations (PPH) which are actually preventable is unknown, and little is understood about the factors associated with individual preventable PPH. The Diagnosing Potentially Preventable Hospitalisations (DaPPHne) Study aimed to determine the proportion of PPH for chronic conditions which are preventable and identify factors associated with chronic PPH classified as preventable.SettingThree hospitals in NSW, Australia.ParticipantsCommunity-dwelling patients with unplanned hospital admissions between November 2014 and June 2017 for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes complications or angina pectoris. Data were collected from patients, their general practitioners (GPs) and hospital records.Outcome measuresAssessments of the preventability of each admission by an Expert Panel.Results323 admissions were assessed for preventability: 46% (148/323) were assessed as preventable, 30% (98/323) as not preventable and 24% (77/323) as unclassifiable. Statistically significant differences in proportions preventable were found between the three study sites (29%; 47%; 58%; p≤0.001) and by primary discharge diagnosis (p≤0.001).Significant predictors of an admission being classified as preventable were: study site; final principal diagnosis of CHF; fewer diagnoses on discharge; shorter hospital stay; GP diagnosis of COPD; GP consultation in the last 12 months; not having had a doctor help make the decision to go to hospital; not arriving by ambulance; patient living alone; having someone help with medications and requiring help with daily tasks.ConclusionsThat less than half the chronic PPH were assessed as preventable, and the range of factors associated with preventability, including site and discharge diagnosis, are important considerations in the validity of PPH as an indicator. Opportunities for interventions to reduce chronic PPH include targeting patients with CHF and COPD, and the provision of social welfare and support services for patients living alone and those requiring help with daily tasks and medication management.
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Searle, Ben, Robert O. Barker, Daniel Stow, Gemma F. Spiers, Fiona Pearson, and Barbara Hanratty. "Which interventions are effective at decreasing or increasing emergency department attendances or hospital admissions from long-term care facilities? A systematic review." BMJ Open 13, no. 2 (February 2023): e064914. http://dx.doi.org/10.1136/bmjopen-2022-064914.
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ObjectiveUK long-term care facility residents account for 185 000 emergency hospital admissions each year. Avoidance of unnecessary hospital transfers benefits residents, reduces demand on the healthcare systems but is difficult to implement. We synthesised evidence on interventions that influence unplanned hospital admissions or attendances by long-term care facility residents.MethodsThis is a systematic review of randomised controlled trials. PubMed, MEDLINE, EMBASE, ISI Web of Science, CINAHL and the Cochrane Library were searched from 2012 to 2022, building on a review published in 2013. We included randomised controlled trials that evaluated interventions that influence (decrease or increase) acute hospital admissions or attendances of long-term care facility residents. Risk of bias and evidence quality were assessed using Cochrane Risk Of Bias-2 and Grading of Recommendations Assessment, Development and Evaluation.ResultsForty-three randomised studies were included in this review. A narrative synthesis was conducted and the weight of evidence described with vote counting. Advance care planning and goals of care setting appear to be effective at reducing hospitalisations from long-term care facilities. Other effective interventions, in order of increasing risk of bias, were: nurse practitioner/specialist input, palliative care intervention, influenza vaccination and enhancing access to intravenous therapies in long-term care facilities.ConclusionsFactors that affect hospitalisation and emergency department attendances of long-term care facility residents are complex. This review supports the already established use of advance care planning and influenza vaccination to reduce unscheduled hospital attendances. It is likely that more than one intervention will be needed to impact on healthcare usage across the long-term care facility population. The findings of this review are useful to identify effective interventions that can be combined, as well as highlighting interventions that either need evaluation or are not effective at decreasing healthcare usage.PROSPERO registration numberCRD42020169604.
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van Eijk, Jorna, Kim Luijken, Tiny Jaarsma, Johannes B. Reitsma, Ewoud Schuit, Geert W. J. Frederix, Lineke Derks, et al. "RELEASE-HF study: a protocol for an observational, registry-based study on the effectiveness of telemedicine in heart failure in the Netherlands." BMJ Open 14, no. 1 (January 2024): e078021. http://dx.doi.org/10.1136/bmjopen-2023-078021.
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IntroductionMeta-analyses show postive effects of telemedicine in heart failure (HF) management on hospitalisation, mortality and costs. However, these effects are heterogeneous due to variation in the included HF population, the telemedicine components and the quality of the comparator usual care. Still, telemedicine is gaining acceptance in HF management. The current nationwide study aims to identify (1) in which subgroup(s) of patients with HF telemedicine is (cost-)effective and (2) which components of telemedicine are most (cost-)effective.Methods and analysisThe RELEASE-HF (‘REsponsible roLl-out of E-heAlth through Systematic Evaluation – Heart Failure’) study is a multicentre, observational, registry-based cohort study that plans to enrol 6480 patients with HF using data from the HF registry facilitated by the Netherlands Heart Registration. Collected data include patient characteristics, treatment information and clinical outcomes, and are measured at HF diagnosis and at 6 and 12 months afterwards. The components of telemedicine are described at the hospital level based on closed-ended interviews with clinicians and at the patient level based on additional data extracted from electronic health records and telemedicine-generated data. The costs of telemedicine are calculated using registration data and interviews with clinicians and finance department staff. To overcome missing data, additional national databases will be linked to the HF registry if feasible. Heterogeneity of the effects of offering telemedicine compared with not offering on days alive without unplanned hospitalisations in 1 year is assessed across predefined patient characteristics using exploratory stratified analyses. The effects of telemedicine components are assessed by fitting separate models for component contrasts.Ethics and disseminationThe study has been approved by the Medical Ethics Committee 2021 of the University Medical Center Utrecht (the Netherlands). Results will be published in peer-reviewed journals and presented at (inter)national conferences. Effective telemedicine scenarios will be proposed among hospitals throughout the country and abroad, if applicable and feasible.Trial registration numberNCT05654961.
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Costa, Andrew P., Connie Schumacher, Aaron Jones, Darly Dash, Graham Campbell, Mats Junek, Gina Agarwal, et al. "DIVERT-Collaboration Action Research and Evaluation (CARE) Trial Protocol: a multiprovincial pragmatic cluster randomised trial of cardiorespiratory management in home care." BMJ Open 9, no. 12 (December 2019): e030301. http://dx.doi.org/10.1136/bmjopen-2019-030301.
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IntroductionHome care clients are increasingly medically complex, have limited access to effective chronic disease management and have very high emergency department (ED) visitation rates. There is a need for more appropriate and targeted supportive chronic disease management for home care clients. We aim to evaluate the effectiveness and preliminary cost effectiveness of a targeted, person-centred cardiorespiratory management model.Methods and analysisThe Detection of Indicators and Vulnerabilities of Emergency Room Trips (DIVERT) — Collaboration Action Research and Evaluation (CARE) trial is a pragmatic, cluster-randomised, multicentre superiority trial of a flexible multicomponent cardiorespiratory management model based on the best practice guidelines. The trial will be conducted in partnership with three regional, public-sector, home care providers across Canada. The primary outcome of the trial is the difference in time to first unplanned ED visit (hazard rate) within 6 months. Additional secondary outcomes are to identify changes in patient activation, changes in cardiorespiratory symptom frequencies and cost effectiveness over 6 months. We will also investigate the difference in the number of unplanned ED visits, number of inpatient hospitalisations and changes in health-related quality of life. Multilevel proportional hazard and generalised linear models will be used to test the primary and secondary hypotheses. Sample size simulations indicate that enrolling 1100 home care clients across 36 clusters (home care caseloads) will yield a power of 81% given an HR of 0.75.Ethics and disseminationEthics approval was obtained from the Hamilton Integrated Research Ethics Board as well as each participating site’s ethics board. Results will be submitted for publication in peer-reviewed journals and for presentation at relevant conferences. Home care service partners will also be informed of the study’s results. The results will be used to inform future support strategies for older adults receiving home care services.Trial registration numberNCT03012256.
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Downing, Jennifer, Tanith C. Rose, Pooja Saini, Bashir Matata, Zoe McIntosh, Terence Comerford, Keith Wilson, et al. "Impact of a community-based cardiovascular disease service intervention in a highly deprived area." Heart 106, no. 5 (August 22, 2019): 374–79. http://dx.doi.org/10.1136/heartjnl-2019-315047.
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ObjectiveTo examine the effects on emergency hospital admissions, length of stay and emergency re-admissions of providing a consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service, based in a highly deprived area in the North West of England.MethodsA longitudinal matched controlled study using difference-in-differences analysis compared the change in outcomes in the intervention population, to the change in outcomes in a matched comparison population that had not received the intervention, 5 years before and after implementation. The outcomes were emergency hospitalisations, length of inpatient stay and re-admission rates for cardiovascular disease (CVD).ResultsFindings show that the intervention was associated with 66 fewer emergency CVD admissions per 100 000 population per year (95% CI 22.13 to 108.98) in the post-intervention period, relative to the control group. No significant measurable effects on length of stay or emergency re-admission rates were observed.ConclusionThis consultant-led, community-based cardiovascular diagnostic, treatment and rehabilitation service was associated with a lower rate of emergency hospital admissions in a highly disadvantaged population. Similar approaches could be an effective component of strategies to reduce unplanned hospital admissions.
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Been, Jasper V., Daniel F. Mackay, Christopher Millett, Ireneous Soyiri, Constant P. van Schayck, Jill P. Pell, and Aziz Sheikh. "Smoke-free legislation and paediatric hospitalisations for acute respiratory tract infections: national quasi-experimental study with unexpected findings and important methodological implications." Tobacco Control 27, e2 (October 27, 2017): e160-e166. http://dx.doi.org/10.1136/tobaccocontrol-2017-053801.
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ObjectivesWe investigated whether Scottish implementation of smoke-free legislation was associated with a reduction in unplanned hospitalisations or deaths (‘events’) due to respiratory tract infections (RTIs) among children.DesignInterrupted time series (ITS).Setting/participantsChildren aged 0–12 years living in Scotland during 1996–2012.InterventionNational comprehensive smoke-free legislation (March 2006).Main outcome measureAcute RTI events in the Scottish Morbidity Record-01 and/or National Records of Scotland Death Records.Results135 134 RTI events were observed over 155 million patient-months. In our prespecified negative binomial regression model accounting for underlying temporal trends, seasonality, sex, age group, region, urbanisation level, socioeconomic status and seven-valent pneumococcal vaccination status, smoke-free legislation was associated with an immediate rise in RTI events (incidence rate ratio (IRR)=1.24, 95% CI 1.20 to 1.28) and an additional gradual increase (IRR=1.05/year, 95% CI 1.05 to 1.06). Given this unanticipated finding, we conducted a number of post hoc exploratory analyses. Among these, automatic break point detection indicated that the rise in RTI events actually preceded the smoke-free law by 16 months. When accounting for this break point, smoke-free legislation was associated with a gradual decrease in acute RTI events: IRR=0.91/year, 95% CI 0.87 to 0.96.ConclusionsOur prespecified ITS approach suggested that implementation of smoke-free legislation in Scotland was associated with an increase in paediatric RTI events. We were concerned that this result, which contradicted published evidence, was spurious. The association was indeed reversed when accounting for an unanticipated antecedent break point in the temporal trend, suggesting that the legislation may in fact be protective. ITS analyses should be subjected to comprehensive robustness checks to assess consistency.
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Robijn, Annelies L., Bronwyn K. Brew, Megan E. Jensen, Gustaf Rejnö, Cecilia Lundholm, Vanessa E. Murphy, and Catarina Almqvist. "Effect of maternal asthma exacerbations on perinatal outcomes: a population-based study." ERJ Open Research 6, no. 4 (October 2020): 00295–2020. http://dx.doi.org/10.1183/23120541.00295-2020.
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BackgroundAlthough there is a growing body of literature about the impact of asthma exacerbations during pregnancy on adverse perinatal outcomes, it is still unclear whether asthma exacerbations themselves or asthma severity are the driving factor for negative outcomes. This study aimed to estimate the associations between maternal asthma exacerbations and perinatal outcomes, and whether this differed by asthma treatment regime as a proxy for severity.MethodsWe included births of women with asthma in Sweden from July 2006 to November 2013 (n=33 829). Asthma exacerbations were defined as unplanned emergency visits/hospitalisations or a short course of oral corticosteroids. Adjusted odds ratios (aOR) were estimated for the associations between exacerbations during pregnancy and perinatal outcomes (small for gestational age (SGA), preterm birth, birthweight and mode of delivery), stratified by preconception treatment regime.ResultsExacerbations occurred in 1430 (4.2%) pregnancies. Exacerbations were associated with reduced birthweight (aOR 1.45, 95% CI 1.24–1.70), and elective (aOR 1.50, 95% CI 1.25–1.79) and emergency caesarean section (aOR 1.35, 95% CI 1.13–1.61). Multiple exacerbations were associated with a 2.6-fold increased odds of SGA (95% CI 1.38–4.82). Amongst women treated prepregnancy with combination therapy (proxy for moderate–severe asthma), exacerbators were at increased odds of elective (aOR 1.69, 95% CI 1.30–2.2) and emergency (aOR 1.62, 95% CI 1.26–2.08) caesarean section, and SGA (aOR 1.74, 95% CI 1.18–2.57) versus non-exacerbators.ConclusionMaternal asthma exacerbations increase the risk of SGA and caesarean sections, particularly in women with multiple exacerbations or moderate–severe asthma. Adequate antenatal asthma care is needed to reduce exacerbations and reduce risks of poor outcomes.
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Wilson, Andrew M., Allan B. Clark, Anthony Cahn, Edwin R. Chilvers, William Fraser, Matthew Hammond, David M. Livermore, et al. "Co-trimoxazole to reduce mortality, transplant, or unplanned hospitalisation in people with moderate to very severe idiopathic pulmonary fibrosis: the EME-TIPAC RCT." Efficacy and Mechanism Evaluation 8, no. 9 (July 2021): 1–110. http://dx.doi.org/10.3310/eme08090.
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Background Idiopathic pulmonary fibrosis is an irreversible fibrosing lung disorder with a poor prognosis. Current treatments slow the rate of decline in lung function and may influence survival, but they have a significant side-effect profile and so additional therapeutic options are required. People with idiopathic pulmonary fibrosis have altered innate immunity and altered lung microbiota, with the bacterial burden relating to mortality. Two randomised controlled trials have demonstrated beneficial effects with co-trimoxazole (SEPTRIN®; Essential Generics Ltd, Egham, UK; Chemidex Generics Ltd, Egham, UK), with the suggestion of an improvement in rates of survival. Objectives To determine the clinical efficacy of co-trimoxazole in people with moderate to severe idiopathic pulmonary fibrosis. Design A Phase II, double-blind, placebo-controlled, parallel-group, randomised multicentre study. Setting UK specialist interstitial lung disease centres. Participants Patients who were randomised had idiopathic pulmonary fibrosis diagnosed by a multidisciplinary team. In addition, patients had significant breathlessness (i.e. a Medical Research Council Dyspnoea Scale score of > 1) and impaired lung function (i.e. a forced vital capacity of < 75% predicted). Patients could be taking licensed medication for idiopathic pulmonary fibrosis, but were excluded if they had significant comorbidities, including airflow obstruction. Intervention Oral co-trimoxazole, 960 mg twice per day (two 480-mg tablets twice per day), compared with placebo tablets (two tablets twice per day) for a median of 27 months (range 12–42 months). Otherwise, both trial groups had standard care. Main outcome measures The primary outcome was the time to death (all causes), transplant or first non-elective hospital admission. Secondary outcomes were the individual components of the primary end point and the number of respiratory-related events. Questionnaires (the King’s Brief Interstitial Lung Disease questionnaire; the Medical Research Council Dyspnoea Scale; EuroQol-5 Dimensions, five-level version; the Leicester Cough Questionnaire; and the Cough Symptom Score) and lung function tests (forced vital capacity and diffusing capacity for carbon monoxide) were undertaken at baseline and at 12 months. Results The trial randomised a total of 342 (295 male) patients (active treatment group, n = 170; placebo group, n = 172), using minimisation for hospital and receipt of licensed antifibrotic medication, from 39 UK hospitals. The patients had a mean (standard deviation) age of 71.3 years (7.47 years) and a mean forced vital capacity of 2.25 l (0.56 l). A total of 137 (40%) patients were taking pirfenidone (Esbriet, Roche Holding AG, Basel, Switzerland) and 116 (34%) were taking nintedanib (Ofev®, Boehringer Ingelheim, Brackness, UK). There was one post-randomisation exclusion from the co-trimoxazole group, but no withdrawals. There was no difference in the time to event for the composite primary end point (co-trimoxazole: hazard ratio 1.2, 95% confidence interval 0.9 to 1.6; p = 0.319). Likewise, there was no difference in other event outcomes, lung function measurements or patient-reported outcomes, other than a beneficial effect on the total Leicester Cough Questionnaire score, the social domain of the Leicester Cough Questionnaire score and the chest domain of the King’s Brief Interstitial Lung Disease questionnaire in the adjusted analysis. The repeated-measures analysis showed a significant overall difference in Cough Symptom Score. There were significantly more reports of nausea, but fewer reports of diarrhoea, with co-trimoxazole; however, differences in frequency of hyperkalaemia, rash and headache were not significant. The limitations of the trial were that it was not possible to evaluate the lung microbiota, there were missing data for secondary end points and there was no health economic analysis. Conclusion These results suggest that co-trimoxazole does not reduce the likelihood of death or number of hospitalisations among people with idiopathic pulmonary fibrosis with moderate to severe idiopathic pulmonary fibrosis. Further work is required to evaluate the effect in subgroups of individuals with idiopathic pulmonary fibrosis or the effect of antibiotics with different antibacterial properties. Trial registration Current Controlled Trials ISRCTN17464641. Funding This project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 9. See the NIHR Journals Library for further project information.
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Walsh, Timothy Simon, Ellen Pauley, Eddie Donaghy, Joanne Thompson, Lucy Barclay, Richard Anthony Parker, Christopher Weir, and James Marple. "Does a screening checklist for complex health and social care needs have potential clinical usefulness for predicting unplanned hospital readmissions in intensive care survivors: development and prospective cohort study." BMJ Open 12, no. 3 (March 2022): e056524. http://dx.doi.org/10.1136/bmjopen-2021-056524.
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ObjectivesIntensive care (ICU) survivors are at high risk of long-term physical and psychosocial problems. Unplanned hospital readmission rates are high, but the best way to triage patients for interventions is uncertain. We aimed to develop and evaluate a screening checklist to help predict subsequent readmissions or deaths.DesignA checklist for complex health and social care needs (CHSCNs) was developed based on previous research, comprising six items: multimorbidity; polypharmacy; frequent previous hospitalisations; mental health issues; fragile social circumstances and impaired activities of daily living. Patients were considered to have CHSCNs if two or more were present. We prospectively screened all ICU discharges for CHSCNs for 12 months.SettingICU, Royal Infirmary, Edinburgh, UK.ParticipantsICU survivors over a 12-month period (1 June 2018 and 31 May 2019).InterventionsNone.Outcome measureReadmission or death in the community within 3 months postindex hospital discharge.ResultsOf 1174 ICU survivors, 937 were discharged alive from the hospital. Of these 253 (27%) were classified as having CHSCNs. In total 28% (266/937) patients were readmitted (N=238) or died (N=28) within 3 months. Among CHSCNs patients 45% (n=115) patients were readmitted (N=105) or died (N=10). Patients without CHSCNs had a 22% readmission (N=133) or death (N=18) rate. The checklist had: sensitivity 43% (95% CI 37% to 49%), specificity 79% (95% CI 76% to 82%), positive predictive value 45% (95% CI 41% to 51%), and negative predictive value 78% (95% CI 76% to 80%). Relative risk of readmission/death for patients with CHSCNs was 2.06 (95% CI 1.69 to 2.50), indicating a pretest to post-test probability change of 28%–45%. The checklist demonstrated high inter-rater reliability (percentage agreement ≥87% for all domains; overall kappa, 0.84).ConclusionsEarly evaluation of a screening checklist for CHSCNs at ICU discharge suggests potential clinical usefulness, but this requires further evaluation as part of a care pathway.
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Previsdomini, Marco, Andreas Perren, Alessandro Chiesa, Mark Kaufmann, Hans Pargger, Roger Ludwig, and Bernard Cerutti. "Changes in diagnostic patterns and resource utilisation in Swiss adult ICUs during the first two COVID-19 waves: an exploratory study." Swiss Medical Weekly 154, no. 2 (February 5, 2024): 3589. http://dx.doi.org/10.57187/s.3589.
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BACKGROUND AND AIM: The coronavirus disease 2019 (COVID-19) outbreak deeply affected intensive care units (ICUs). We aimed to explore the main changes in the distribution and characteristics of Swiss ICU patients during the first two COVID-19 waves and to relate these figures with those of the preceding two years. METHODS: Using the national ICU registry, we conducted an exploratory study to assess the number of ICU admissions in Switzerland and their changes over time, characteristics of the admissions, the length of stay (LOS) and its trend over time, ICU mortality and changes in therapeutic nursing workload and hospital resources in 2020 and compare them with the average figures in 2018 and 2019. RESULTS: After analysing 242,935 patient records from all 84 certified Swiss ICUs, we found a significant decrease in admissions (–9.6%, corresponding to –8005 patients) in 2020 compared to 2018/2019, with an increase in the proportion of men admitted (61.3% vs 59.6%; p <0.001). This reduction occurred in all Swiss regions except Ticino. Planned admissions decreased from 25,020 to 22,021 in 2020 and mainly affected the neurological/neurosurgical (–14.9%), gastrointestinal (–13.9%) and cardiovascular (–9.3%) pathologies. Unplanned admissions due to respiratory diagnoses increased by 1971 (+25.2%), and those of patients with acute respiratory distress syndrome (ARDS) requiring isolation reached 9973 (+109.9%). The LOS increased by 20.8% from 2.55 ± 4.92 days (median 1.05) in 2018/2019 to 3.08 ± 5.87 days (median 1.11 days; p <0.001), resulting in an additional 19,753 inpatient days. The nine equivalents of nursing manpower use score (NEMS) of the first nursing shift (21.6 ± 9.0 vs 20.8 ± 9.4; p <0.001), the total NEMS per patient (251.0 ± 526.8 vs 198.9 ± 413.8; p <0.01) and mortality (5.7% vs 4.7%; p <0.001) increased in 2020. The number of ICU beds increased from 979 to 1012 (+3.4%), as did the number of beds equipped with mechanical ventilators (from 773 to 821; +6.2%). CONCLUSIONS: Based on a comprehensive national data set, our report describes the profound changes triggered by COVID-19 over one year in Swiss ICUs. We observed an overall decrease in admissions and a shift in admission types, with fewer planned hospitalisations, suggesting the loss of approximately 3000 elective interventions. We found a substantial increase in unplanned admissions due to respiratory diagnoses, a doubling of ARDS cases requiring isolation, an increase in ICU LOS associated with substantial nationwide growth in ICU days, an augmented need for life-sustaining therapies and specific therapeutic resources and worse outcomes.
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Taylor, Monica L., Emma E. Thomas, Centaine L. Snoswell, Anthony C. Smith, and Liam J. Caffery. "Does remote patient monitoring reduce acute care use? A systematic review." BMJ Open 11, no. 3 (March 2021): e040232. http://dx.doi.org/10.1136/bmjopen-2020-040232.
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ObjectiveChronic diseases are associated with increased unplanned acute hospital use. Remote patient monitoring (RPM) can detect disease exacerbations and facilitate proactive management, possibly reducing expensive acute hospital usage. Current evidence examining RPM and acute care use mainly involves heart failure and omits automated invasive monitoring. This study aimed to determine if RPM reduces acute hospital use.MethodsA systematic literature review of PubMed, Embase and CINAHL electronic databases was undertaken in July 2019 and updated in October 2020 for studies published from January 2015 to October 2020 reporting RPM and effect on hospitalisations, length of stay or emergency department presentations. All populations and disease conditions were included. Two independent reviewers screened articles. Quality analysis was performed using the Joanna Briggs Institute checklist. Findings were stratified by outcome variable. Subgroup analysis was undertaken on disease condition and RPM technology.ResultsFrom 2050 identified records, 91 studies were included. Studies were medium-to-high quality. RPM for all disease conditions was reported to reduce admissions, length of stay and emergency department presentations in 49% (n=44/90), 49% (n=23/47) and 41% (n=13/32) of studies reporting each measure, respectively. Remaining studies largely reported no change. Four studies reported RPM increased acute care use. RPM of chronic obstructive pulmonary disease (COPD) was more effective at reducing emergency presentation than RPM of other disease conditions. Similarly, invasive monitoring of cardiovascular disease was more effective at reducing hospital admissions versus other disease conditions and non-invasive monitoring.ConclusionRPM can reduce acute care use for patients with cardiovascular disease and COPD. However, effectiveness varies within and between populations. RPM’s effect on other conditions is inconclusive due to limited studies. Further analysis is required to understand underlying mechanisms causing variation in RPM interventions. These findings should be considered alongside other benefits of RPM, including increased quality of life for patients.PROSPERO registration numberCRD42020142523.
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Pound, Catherine M., Jaime McDonald, Ken Tang, Gillian Seidman, Radha Jetty, Sarah Zaidi, and Amy C. Plint. "Dexamethasone versus prednisone for children receiving asthma treatment in the paediatric inpatient population: protocol for a feasibility randomised controlled trial." BMJ Open 8, no. 12 (December 2018): e025630. http://dx.doi.org/10.1136/bmjopen-2018-025630.
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IntroductionAsthma exacerbations are a leading cause of paediatric hospitalisations. Corticosteroids are key in the treatment of asthma exacerbations. Most current corticosteroids treatment regimens for children admitted with asthma exacerbation consist of a 5-day course of prednisone or prednisolone. However, these medications are associated with poor taste and significant vomiting, resulting in poor compliance with the treatment course. While some centres already use a short course of dexamethasone for treating children hospitalised with asthma, there is no evidence to support this practice in the inpatient population.Methods and analysisThis single-site, pragmatic, feasibility randomised controlled trial will determine the feasibility of a non-inferiority trial, comparing two treatment regimens for children admitted to the hospital and receiving asthma treatment. Children 18 months to 17 years presenting to a Canadian tertiary care centre will be randomised to receive either a short course of dexamethasone or a longer course of prednisone/prednisolone once admitted to the inpatient units. The primary clinical outcome for this feasibility study will be readmission to hospital or repeat emergency department visits, or unplanned visits to primary healthcare providers for asthma symptoms within 4 weeks of hospital discharge. Feasibility outcomes will include recruitment and allocation success, compliance with study procedures, retention rate, and safety and tolerability of study medications. We plan on recruiting 51 children, and between-group comparisons of the clinical outcome will be conducted to gain insights on probable effect sizes.Ethics and disseminationResearch Ethics Board approval has been obtained for this study. The results of this study will inform a multisite trial comparing prednisone/prednisolone to dexamethasone in inpatient asthma treatment, which will have the potential to improve the delivery of asthma care, by improving compliance with a mainstay of treatment. Results will be disseminated through peer-reviewed publications, organisations and meetings.Trial registration numberNCT03133897; Pre-results.
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Pereira, Filipa, Carla Meyer-Massetti, María del Río Carral, Armin von Gunten, Boris Wernli, and Henk Verloo. "Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study." BMJ Open 13, no. 9 (September 2023): e072738. http://dx.doi.org/10.1136/bmjopen-2023-072738.
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ObjectiveThis study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs).DesignExplanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously.SettingHospital and community healthcare in the French-speaking part of Switzerland.ParticipantsThe quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge.ResultsQuantitative results from older adults’ profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices.ConclusionBy linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders’ perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.
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Beckman, Adam L., Maike Tietschert, Andrew Old, E. John Orav, Sara J. Singer, and Jose F. Figueroa. "High-performing primary care clinics across high-need, high-cost Medicare populations." BMJ Open Quality 12, no. 3 (July 2023): e002271. http://dx.doi.org/10.1136/bmjoq-2023-002271.
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BackgroundTo reduce spending and improve quality, some primary care clinics in the USA have focused on high-need, high-cost (HNHC) Medicare beneficiaries, which include clinically distinct subpopulations: older adults with frailty, adults under 65 years with disability and beneficiaries with major complex chronic conditions. Nationally, the extent to which primary care clinics are high-performing ‘Bright Spots’—clinics that achieve favourable outcomes at lower costs across HNHC beneficiary subpopulations—is not known.ObjectiveTo determine the prevalence of primary care clinics that perform highly on commonly used cost or quality measures for HNHC subpopulations.Design and participantsCross-sectional study using Medicare claims data from 2014 to 2015.Main measuresAnnual spending, avoidable hospitalisations for ambulatory care-sensitive conditions, treat-and-release emergency department visits, all-cause 30-day unplanned hospital readmission rates and healthy days at home. Clinics were high performing when they ranked in the top quartile of performance for ≥4 measures for an HNHC subpopulation. ‘Bright Spot’ clinics were in the top quartile of performance for ≥4 measures across all the HNHC subpopulations.Key resultsA total of 2770 primary care clinics cared for at least 10 beneficiaries from each of the three HNHC subpopulations (adults under 65 with disability, older adults with frailty and beneficiaries with major complex chronic conditions). Less than 4% of clinics were high performing for each HNHC subpopulation; <0.5% of clinics were in the top quartile for all five measures for a given subpopulation. No clinics met the definition of a primary care ‘Bright Spot’.ConclusionsHigh-performing primary care clinics that achieved favourable health outcomes or lower costs across subpopulations of HNHC beneficiaries in the Medicare programme in 2015 were rare. Efforts are needed to support primary care clinics in providing optimal care to HNHC subpopulations.
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Koehler, Friedrich, Kerstin Koehler, Oliver Deckwart, Sandra Prescher, Karl Wegscheider, Sebastian Winkler, Eik Vettorazzi, et al. "Telemedical Interventional Management in Heart Failure II (TIM-HF2), a randomised, controlled trial investigating the impact of telemedicine on unplanned cardiovascular hospitalisations and mortality in heart failure patients: study design and description." European Journal of Heart Failure 20, no. 10 (September 19, 2018): 1485–93. http://dx.doi.org/10.1002/ejhf.1300.
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Holland, Anne E., Arwel W. Jones, Ajay Mahal, Natasha A. Lannin, Narelle Cox, Graham Hepworth, Paul O'Halloran, and Christine F. McDonald. "Implementing a choice of pulmonary rehabilitation models in chronic obstructive pulmonary disease (HomeBase2 trial): protocol for a cluster randomised controlled trial." BMJ Open 12, no. 4 (April 2022): e057311. http://dx.doi.org/10.1136/bmjopen-2021-057311.
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IntroductionThere is compelling evidence that either centre-based or home-based pulmonary rehabilitation improves clinical outcomes in chronic obstructive pulmonary disease (COPD). There are known health service and personal barriers which prevent potentially eligible patients from accessing the benefits of pulmonary rehabilitation. The aim of this hybrid effectiveness-implementation trial is to examine the effects of offering patients a choice of pulmonary rehabilitation locations (home or centre) compared with offering only the traditional centre-based model.Method and analysisThis is a two-arm cluster randomised, controlled, assessor-blinded trial of 14 centre-based pulmonary rehabilitation services allocated to intervention (offering choice of home-based or centre-based pulmonary rehabilitation) or control (continuing to offer centre-based pulmonary rehabilitation only), stratified by centre-based programme setting (hospital vs non-hospital). 490 participants with COPD will be recruited. Centre-based pulmonary rehabilitation will be delivered according to best practice guidelines including supervised exercise training for 8 weeks. At intervention sites, the home-based pulmonary rehabilitation will be delivered according to an established 8-week model, comprising of one home visit, unsupervised exercise training and telephone calls that build motivation for exercise participation and facilitate self-management. The primary outcome is all-cause, unplanned hospitalisations in the 12 months following rehabilitation. Secondary outcomes include programme completion rates and measurements of 6-minute walk distance, chronic respiratory questionnaire, EQ-5D-5L, dyspnoea-12, physical activity and sedentary time at the end of rehabilitation and 12 months following rehabilitation.Direct healthcare costs, indirect costs and changes in EQ-5D-5L will be used to evaluate cost-effectiveness. A process evaluation will be undertaken to understand how the choice model is implemented and explore sustainability beyond the clinical trial.Ethics and disseminationAlfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients across Australia with support from national lung charities and societies.Trial registration numberNCT04217330.
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Archambault, P. M., H. Vaillancourt, V. Drouin, A. Dupuis, C. McGinn, J. Rivard, L. Bernier, et al. "P009: Improving elderly care transitions through the local adaptation and implementation of the Acute Care for Elderly (ACE) program." CJEM 19, S1 (May 2017): S80. http://dx.doi.org/10.1017/cem.2017.211.
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Introduction: Decreasing readmission rates and return emergency department (ED) visits represent a major challenge for health organizations. Seniors are especially vulnerable to discharge adverse events which can result in unplanned readmissions and loss of physical, functional and/or cognitive capacity. The ACE Collaborative is a national quality improvement initiative that aims to improve care of elderly patients. We aimed to adapt Mount Sinai’s Care Transitions program to our local context in order to decrease avoidable readmissions and ED visits among seniors. Methods: We performed a prospective pre/post implementation cohort study. We recruited frail elderly hospitalized patients (≥50 years old) discharged to home and at risk of readmission (modified LACE index score≥7/12). We excluded patients being discharged to long-term nursing homes or institutions. Our intervention is based on selected strategic ACE Care Transitions best practices: transition coach, telehealth personal response services and a structured discharge checklist. The intervention is offered to selected patients before hospital discharge. Our primary outcome is a 30-day post-discharge composite of hospital readmission and return ED visit rate. Our secondary outcomes are functional autonomy, satisfaction with care transition, quality of life, caregiver strain and healthcare resource use at recruitment and at 30-days follow-up. Hospital-level administrative data is also collected to measure global effect of practice changes. Results: The project is currently ongoing and preliminary results are available for the pre-implementation cohort only. Patients in this cohort (n=33) were mainly men (61%), aged 75±10 years and presented an OARS score (Activities of Daily Living instrument that ranges from 0-28) of 5.6±4.9. At 30 days post-discharge, the patients in our cohort had a 42.4% readmission rate (14 hospitalisations) and a 54.5% return ED visit rate (18 visits). For the same time period, readmission and return ED rates for all patients in the same corresponding age-group at the hospital level were 14.4% and 21.9%, respectively. Further results for our post-intervention cohort will be presented at CAEP 2017. Conclusion: Our cohort of elderly patients have high readmission and return ED visit rates. Our ongoing quality improvement project aims to decrease these readmissions and ED visits.
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Kessler, Romain, Pere Casan-Clara, Dieter Koehler, Silvia Tognella, Jose Luis Viejo, Roberto W. Dal Negro, Salvador Díaz-Lobato, et al. "COMET: a multicomponent home-based disease-management programme versus routine care in severe COPD." European Respiratory Journal 51, no. 1 (January 2018): 1701612. http://dx.doi.org/10.1183/13993003.01612-2017.
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The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPD disease management intervention for severe COPD patients.The study was an international open-design clinical trial in COPD patients (forced expiratory volume in 1 s <50% of predicted value) randomised 1:1 to the disease management intervention or to the usual management practices at the study centre. The disease management intervention included a self-management programme, home telemonitoring, care coordination and medical management. The primary end-point was the number of unplanned all-cause hospitalisation days in the intention-to-treat (ITT) population. Secondary end-points included acute care hospitalisation days, BODE (body mass index, airflow obstruction, dyspnoea and exercise) index and exacerbations. Safety end-points included adverse events and deaths.For the 157 (disease management) and 162 (usual management) patients eligible for ITT analyses, all-cause hospitalisation days per year (mean±sd) were 17.4±35.4 and 22.6±41.8, respectively (mean difference −5.3, 95% CI −13.7 to −3.1; p=0.16). The disease management group had fewer per-protocol acute care hospitalisation days per year (p=0.047), a lower BODE index (p=0.01) and a lower mortality rate (1.9% versus 14.2%; p<0.001), with no difference in exacerbation frequency. Patient profiles and hospitalisation practices varied substantially across countries.The COMET disease management intervention did not significantly reduce unplanned all-cause hospitalisation days, but reduced acute care hospitalisation days and mortality in severe COPD patients.
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Kwok, Chun Shing, Mary Norine Walsh, Annabelle Volgman, Mirvat Alasnag, Glen Philip Martin, Diane Barker, Ashish Patwala, Rodrigo Bagur, David L. Fischman, and Mamas A. Mamas. "Discharge against medical advice after hospitalisation for acute myocardial infarction." Heart 105, no. 4 (September 12, 2018): 315–21. http://dx.doi.org/10.1136/heartjnl-2018-313671.
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BackgroundDischarge against medical advice (AMA) occurs infrequently but is associated with poor outcomes. There are limited descriptions of discharges AMA in national cohorts of patients with acute myocardial infarction (AMI). This study aims to evaluate discharge AMA in AMI and how it affects readmissions.MethodsWe conducted a cohort study of patients with AMI in USA in the Nationwide Readmission Database who were admitted between the years 2010 and 2014. Descriptive statistics were presented for variables according to discharge home or AMA. The primary end point was all-cause 30-day unplanned readmissions and their causes.Results2663 019 patients were admitted with AMI of which 10.3% (n=162 070) of 1569 325 patients had an unplanned readmission within 30 days. The crude rate of discharge AMA remained stable between 2010 and 2014 at 1.5%. Discharge AMA was an independent predictor of unplanned all-cause readmissions (OR 2.27 95% CI 2.14 to 2.40); patients who discharged AMA had >twofold increased crude rate of readmission for AMI (30.4% vs 13.4%) and higher crude rate of admissions for neuropsychiatric reasons (3.2% vs 1.3%). After adjustment, discharge AMA was associated with increased odds of readmissions for AMI (OR 3.65 95% CI 3.31 to 4.03, p<0.001). We estimate that there are 1420 excess cases of AMI among patients who discharged AMA.ConclusionsDischarge AMA occurs in 1.5% of the population with AMI and these patients are at higher risk of early readmissions for re-infarction. Interventions should be developed to reduce discharge AMA in high-risk groups and initiate interventions to avoid adverse outcomes and readmission.
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Tamisier, Renaud, Thibaud Damy, Jean-Marc Davy, Johan A. Verbraecken, Sébastien Bailly, Florent Lavergne, Alain Palot, Frédéric Goutorbe, Jean-Louis Pépin, and Marie-Pia d'Ortho. "Cohort profile: FACE, prospective follow-up of chronic heart failure patients with sleep-disordered breathing indicated for adaptive servo ventilation." BMJ Open 10, no. 7 (July 2020): e038403. http://dx.doi.org/10.1136/bmjopen-2020-038403.
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PurposeFACE is a prospective cohort study designed to assess the effect of adding adaptive servoventilation (ASV) to standard care on morbidity and mortality in patients with chronic heart failure (HF) with preserved (HFpEF), mid-range (HFmrEF) or reduced ejection fraction (HFrEF) who have sleep-disordered breathing (SDB) with an indication for ASV. We describe the study design, ongoing data collection and baseline participant characteristics.ParticipantsConsecutive patients with HFpEF, HFmrEF or HFrEF plus SDB with central sleep apnoea (CSA) and indication for ASV were enrolled in the study cohort between November 2009 and December 2018; the ASV group includes those treated with ASV and the control group consists of patients who refused ASV or stopped treatment early. Follow-up is based on standard clinical practice, with visits at inclusion, after 3, 12 and 24 months of follow-up. Primary endpoint is the time to first event: all-cause death or unplanned hospitalisation (or unplanned prolongation of a planned hospitalisation) for worsening of HF, cardiovascular death or unplanned hospitalisation for worsening of HF, and all-cause death or all-cause unplanned hospitalisation.Findings to date503 patients have been enrolled, mean age of 72 years, 88% male, 31% with HFrEF. HF was commonly of ischaemic origin, and the number of comorbidities was high. SDB was severe (median Apnoea–Hypopnoea Index 42/hour), and CSA was the main indication for ASV (69%). HF was highly symptomatic; most patients were in NYHA class II (38%) or III (29%).Future plansPatient follow-up is ongoing. Given the heterogeneous nature of the enrolled population, a decision was made to use latent class analysis to define homogeneous patient subgroups, and then evaluate outcomes by cluster, and in the ASV and control groups (overall and within patient clusters). First analysis will be performed after 3 months, a second analysis at the 2-year follow-up.Trial registration numberNCT01831128.
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Downs, Murna, Alan Blighe, Robin Carpenter, Alexandra Feast, Katherine Froggatt, Sally Gordon, Rachael Hunter, et al. "A complex intervention to reduce avoidable hospital admissions in nursing homes: a research programme including the BHiRCH-NH pilot cluster RCT." Programme Grants for Applied Research 9, no. 2 (February 2021): 1–200. http://dx.doi.org/10.3310/pgfar09020.
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Background An unplanned hospital admission of a nursing home resident distresses the person, their family and nursing home staff, and is costly to the NHS. Improving health care in care homes, including early detection of residents’ health changes, may reduce hospital admissions. Previously, we identified four conditions associated with avoidable hospital admissions. We noted promising ‘within-home’ complex interventions including care pathways, knowledge and skills enhancement, and implementation support. Objectives Develop a complex intervention with implementation support [the Better Health in Residents in Care Homes with Nursing (BHiRCH-NH)] to improve early detection, assessment and treatment for the four conditions. Determine its impact on hospital admissions, test study procedures and acceptability of the intervention and implementation support, and indicate if a definitive trial was warranted. Design A Carer Reference Panel advised on the intervention, implementation support and study documentation, and engaged in data analysis and interpretation. In workstream 1, we developed a complex intervention to reduce rates of hospitalisation from nursing homes using mixed methods, including a rapid research review, semistructured interviews and consensus workshops. The complex intervention comprised care pathways, approaches to enhance staff knowledge and skills, implementation support and clarity regarding the role of family carers. In workstream 2, we tested the complex intervention and implementation support via two work packages. In work package 1, we conducted a feasibility study of the intervention, implementation support and study procedures in two nursing homes and refined the complex intervention to comprise the Stop and Watch Early Warning Tool (S&W), condition-specific care pathways and a structured framework for nurses to communicate with primary care. The final implementation support included identifying two Practice Development Champions (PDCs) in each intervention home, and supporting them with a training workshop, practice development support group, monthly coaching calls, handbooks and web-based resources. In work package 2, we undertook a cluster randomised controlled trial to pilot test the complex intervention for acceptability and a preliminary estimate of effect. Setting Fourteen nursing homes allocated to intervention and implementation support (n = 7) or treatment as usual (n = 7). Participants We recruited sufficient numbers of nursing homes (n = 14), staff (n = 148), family carers (n = 95) and residents (n = 245). Two nursing homes withdrew prior to the intervention starting. Intervention This ran from February to July 2018. Data sources Individual-level data on nursing home residents, their family carers and staff; system-level data using nursing home records; and process-level data comprising how the intervention was implemented. Data were collected on recruitment rates, consent and the numbers of family carers who wished to be involved in the residents’ care. Completeness of outcome measures and data collection and the return rate of questionnaires were assessed. Results The pilot trial showed no effects on hospitalisations or secondary outcomes. No home implemented the intervention tools as expected. Most staff endorsed the importance of early detection, assessment and treatment. Many reported that they ‘were already doing it’, using an early-warning tool; a detailed nursing assessment; or the situation, background, assessment, recommendation communication protocol. Three homes never used the S&W and four never used care pathways. Only 16 S&W forms and eight care pathways were completed. Care records revealed little use of the intervention principles. PDCs from five of six intervention homes attended the training workshop, following which they had variable engagement with implementation support. Progression criteria regarding recruitment and data collection were met: 70% of homes were retained, the proportion of missing data was < 20% and 80% of individual-level data were collected. Necessary rates of data collection, documentation completion and return over the 6-month study period were achieved. However, intervention tools were not fully adopted, suggesting they would not be sustainable outside the trial. Few hospitalisations for the four conditions suggest it an unsuitable primary outcome measure. Key cost components were estimated. Limitations The study homes may already have had effective approaches to early detection, assessment and treatment for acute health changes; consistent with government policy emphasising the need for enhanced health care in homes. Alternatively, the implementation support may not have been sufficiently potent. Conclusion A definitive trial is feasible, but the intervention is unlikely to be effective. Participant recruitment, retention, data collection and engagement with family carers can guide subsequent studies, including service evaluation and quality improvement methodologies. Future work Intervention research should be conducted in homes which need to enhance early detection, assessment and treatment. Interventions to reduce avoidable hospital admissions may be beneficial in residential care homes, as they are not required to employ nurses. Trial registration Current Controlled Trials ISRCTN74109734 and ISRCTN86811077. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 2. See the NIHR Journals Library website for further project information.
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Maitin-Casalis, N., T. Neeman, and A. Thomson. "Protective effect of advanced age on post-ERCP pancreatitis and unplanned hospitalisation." Internal Medicine Journal 45, no. 10 (October 2015): 1020–25. http://dx.doi.org/10.1111/imj.12844.
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Maharani, Asri, David R. Sinclair, Andrew Clegg, Barbara Hanratty, James Nazroo, Gindo Tampubolon, Chris Todd, Raphael Wittenberg, Terence W. O’Neill, and Fiona E. Matthews. "The association between frailty, care receipt and unmet need for care with the risk of hospital admissions." PLOS ONE 19, no. 9 (September 27, 2024): e0306858. http://dx.doi.org/10.1371/journal.pone.0306858.
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Background Frailty is characterised by a decline in physical, cognitive, energy, and health reserves and is linked to greater functional dependency and higher social care utilisation. However, the relationship between receiving care, or receiving insufficient care among older people with different frailty status and the risk of unplanned admission to hospital for any cause, or the risk of falls and fractures remains unclear. Methods and findings This study used information from 7,656 adults aged 60 and older participating in the English Longitudinal Study of Ageing (ELSA) waves 6–8. Care status was assessed through received care and self-reported unmet care needs, while frailty was measured using a frailty index. Competing-risk regression analysis was used (with death as a potential competing risk), adjusted for demographic and socioeconomic confounders. Around a quarter of the participants received care, of which approximately 60% received low levels of care, while the rest had high levels of care. Older people who received low and high levels of care had a higher risk of unplanned admission independent of frailty status. Unmet need for care was not significantly associated with an increased risk of unplanned admission compared to those receiving no care. Older people in receipt of care had an increased risk of hospitalisation due to falls but not fractures, compared to those who received no care after adjustment for covariates, including frailty status. Conclusions Care receipt increases the risk of hospitalisation substantially, suggesting this is a group worthy of prevention intervention focus.