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Background: Multiple hospital admissions, especially those related to chronic disease, represent a particular challenge to the acute health care sector in Australia.Objective: To determine whether a nurse-led chronic disease management model of transitional care reduced readmissions to acute care. Design:A quasi-experimental controlled trial. Setting:A large tertiary metropolitan teaching hospital. Participants: 166 general medical patients aged у65 years with either a history of readmissions to acute care or multiple medical comorbidities.Intervention: Implementation of a chronic disease management model of transitional care aimed at improving patient management and reducing readmissions to acute care. Main outcome measures:Readmission rates and emergency department presentation rates at 3-and 6-month follow up. Secondary outcome measures include quality of life, discharge destination, and primary health care service utilisation.Results: There was no difference in readmission rates, emergency department presentation rates, quality of life, discharge destination or primary health care service utilisation. The difficulties inherent in evaluating this type of multifactorial intervention are discussed and consideration is given to patient factors, the difficulty of influencing readmission rates, and local system issues. Conclusion:The outcomes of this study reflect the tension that exists between implementing multifaceted integrated health service programs and attempting to evaluate them within complex and changing environments using robust research

Objective Among patients with rheumatoid arthritis (RA), cardiovascular mortality is increased compared with the rate among unaffected peers. In this study, 30‐day mortality rates following a first acute cardiovascular event (myocardial infarction or stroke) were compared between RA patients and the general population. Methods All cases of a first acute cardiovascular event between July 1, 2001 and November 30, 2003 in Victoria, Australia were identified from hospital discharge data. Individuals were classified as having RA when an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) or an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification code for RA was recorded at the index admission or during the previous 5 years. Thirty‐day mortality rates were determined from linkage to the state death registry. Results A total of 29,924 patients experienced a first cardiovascular event during the study period, 359 (1.2%) of whom had RA. Thirty‐day cardiovascular mortality was 17.6% in RA patients versus 10.8% in non‐RA patients. In fully adjusted models, the odds ratio (OR) for cardiovascular death in RA patients following a first acute cardiovascular event was 1.6 (95% confidence interval [95% CI] 1.2–2.2). Analysis of index event subgroups revealed that this increased case fatality rate in patients with RA was accounted for almost entirely by excess deaths following myocardial infarction. The adjusted ORs for cardiovascular death in RA after myocardial infarction and stroke were 1.9 (95% CI 1.3–2.7) and 1.2 (95% CI 0.7–2.0), respectively. Conclusion RA patients have a substantially increased risk of 30‐day case fatality following myocardial infarction, but not stroke, compared with non‐RA patients. This higher case fatality rate is likely to contribute to the observed overall excess of cardiovascular deaths in RA populations.

Objective:To determine the contributing factors that lead to increased length of stay (LOS) of patients with dementia. Methods: A case-controlled study in a tertiary metropolitan hospital general medical unit was conducted. Patients were aged 65 and over, 26 cases with dementia were identified and 26 controls without dementia were randomly selected. Results: The mean (± SD) LOS for patients with dementia was significantly longer than for those without dementia (20.59 ± 15.38 days vs. 9.6 ± 6.45 days, P = 0.02). In addition to dementia, severity of illness, referral to the aged care assessment team, and day of week admitted were also significant independent predictors of increased LOS. Conclusion: Reasons for increased LOS of patients with dementia remain unclear. Cognitive impairment due to dementia is likely to increase within the context of an increasing and ageing population. Specific strategies may be required within in-hospital clinical pathways to assist the needs of this group.