Chronic Comorbidity and Outcomes of Hospital Care

Librero, Julián; Peiró, Salvador; Ordiñana, Rosa

doi:10.1016/s0895-4356(98)00160-7

Cited by 266 publications

(64 citation statements)

References 63 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Prognostic comorbidity was calculated using the Charlson comorbidity index, originally created to help predict long term mortality [36]. The Charlson comorbidity index has been found reliable and valid in predicting mortality and length of hospitalization [37, 38]. The index is a list of 17 conditions, with each condition assigned a weight of 1, 2, 3, or 6, where HIV and metastatic carcinoma give the highest weight of 6 and less severe conditions such as mild liver disease and diabetes without complications give a score of 1.…”

Section: Methodsmentioning

confidence: 99%

Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland

Stenius-Ayoade

Haaramo

Erkkila³

et al. 2017

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundHomelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland.MethodsThe study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs.ResultsDuring the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9–20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5–9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4–10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3–31.2) and SUDs (11.5, 95% CI 5.7–23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes.ConclusionsDual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary health care level emergency rooms are strongly associated with both dual diagnosis and SUDs. Active treatment for SUDs could reduce the amount of emergency visits made by homeless shelter users.

show abstract

Section: Methodsmentioning

confidence: 99%

Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland

Stenius-Ayoade

Haaramo

Erkkila³

et al. 2017

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…Variables included in the study that might be associated with the use of early surgery as well as with the probability of death were: age (divided into four categories: 60-69, 70-79, 80-89 and 90-years-old and over), sex, main diagnosis (grouped into three groups: intracapsular fractures (ICD9CM: 820.0x a 820.1x), trochanteric fractures (ICD9CM: 820.2x a 820.3x) and non-otherwise specified fractures (ICD9CM: 820.8 y 820.9), number of secondary diagnoses (grouped into four categories: 0-1, 2-3, 4-6, and > 6), surgical procedure (distinguishing between fixation and arthroplasty), Risk Mortality Index (RMI) modified from the one used by Majumdar et al [15,30] (unfortunately MBDS does not allow differentiation between comorbidities and complications because it does not record the onset of a diagnosis of complications; see Additional File 1 for codes and weights used), Charlson Comorbidity Index calculated following an adaptation of the Charlson Index [31] for administrative databases [32,33]. Our version, as in other Charlson Index adaptations for administrative databases [34,35], distinguishes between codes defining chronic conditions (always accounted for) and acute conditions (those not to be considered in the current admission but in the following admissions; see Additional File 2 for codes and weights used).…”

Section: Methodsmentioning

confidence: 99%

Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System

Librero

Peiró

Leutscher

et al. 2012

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

BackgroundWhile the benefits or otherwise of early hip fracture repair is a long-running controversy with studies showing contradictory results, this practice is being adopted as a quality indicator in several health care organizations. The aim of this study is to analyze the association between early hip fracture repair and in-hospital mortality in elderly people attending public hospitals in the Spanish National Health System and, additionally, to explore factors associated with the decision to perform early hip fracture repair.MethodsA cohort of 56,500 patients of 60-years-old and over, hospitalized for hip fracture during the period 2002 to 2005 in all the public hospitals in 8 Spanish regions, were followed up using administrative databases to identify the time to surgical repair and in-hospital mortality. We used a multivariate logistic regression model to analyze the relationship between the timing of surgery (< 2 days from admission) and in-hospital mortality, controlling for several confounding factors.ResultsEarly surgery was performed on 25% of the patients. In the unadjusted analysis early surgery showed an absolute difference in risk of mortality of 0.57 (from 4.42% to 3.85%). However, patients undergoing delayed surgery were older and had higher comorbidity and severity of illness. Timeliness for surgery was not found to be related to in-hospital mortality once confounding factors such as age, sex, chronic comorbidities as well as the severity of illness were controlled for in the multivariate analysis.ConclusionsOlder age, male gender, higher chronic comorbidity and higher severity measured by the Risk Mortality Index were associated with higher mortality, but the time to surgery was not.

show abstract

“…In general, multimorbidity includes only CDand its prevalence increases with age [3], [7] and social deprivation [7], [8]. It has been shown to be associated with increased medical consultation, prescription, psychological distress, emergency utilization, hospital length of stay, and mortality rates [9], [10], [11], [12].…”

Section: Introductionmentioning

confidence: 99%

Understanding the Evolution of Multimorbidity: Evidences from the North West Adelaide Health Longitudinal Study (NWAHS)

et al. 2014

View full text Add to dashboard Cite

ObjectiveThe aim of this study is to describe the evolution of multimorbidity.Study Design and SettingData from 1854 South Australians who participated in the North West Adelaide longitudinal Health Study(NWAHS) was collected between baseline (2000–2002) and follow-up (2008–2010). Status for eight chronic diseases (CDs) was determined by biomedical measurement or self-report. Chronic disease (CD) mean age of occurrence and order of appearance was investigated.ResultsThe prevalence of multimorbidity increased from 32% to 64% during the 7.8±1.1 years of follow-up. The estimated mean age of onset of a new CD was significantly older for hypertension, cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) and younger for hypercholesterolemia, asthma and other mental problem. Hypercholesterolemia was more likely to develop as a first than as a subsequent CD (39%vs.16%, p<0.0001) while CVD (1%vs.5%, p<0.0001), diabetes (5%vs.11%, p<0.001) and COPD (6%vs.16%, p<0.0001) were less likely. The presence of mood disorders at baseline was associated with an increased risk of developing other mental disorders (36%vs.12%, p<0.0001), diabetes (18%vs.9%, p<0.01) and asthma (30%vs.21%, p<0.05).ConclusionLongitudinal data could be used to study the evolution of multimorbidity and could provide information on CDs mean age of occurrence, order of appearance and impact on the development of future CDs.

show abstract

Chronic Comorbidity and Outcomes of Hospital Care

Cited by 266 publications

References 63 publications

Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland

Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland

Timing of surgery for hip fracture and in-hospital mortality: a retrospective population-based cohort study in the Spanish National Health System

Understanding the Evolution of Multimorbidity: Evidences from the North West Adelaide Health Longitudinal Study (NWAHS)

Contact Info

Product

Resources

About