Follow up of people aged 65 and over with a history of emergency admissions: analysis of routine admission data

Abstract

Objective To determine the subsequent pattern of emergency admissions in older people with a history of frequent emergency admissions. Design Analysis of routine admissions data from NHS hospitals using hospital episode statistics (HES) in England. Subjects Individual patients aged ≥ 65, ≥ 75, and ≥ 85 who had at least two emergency admissions in 1997-8. Main outcome measures Emergency admissions and bed use in this "high risk" cohort of patients were counted for the next five years and compared with the general population of the same age. No account was taken of mortality as the analysis was designed to estimate the future use of beds in this high risk cohort. Results Over four to five years, admission rates and bed use in the high risk cohorts fell to the mean rate for older people. Although patients ≥ 65 with two or more such admissions were responsible for 38% of admissions in the index year, they were responsible for fewer than 10% of admissions in the following year and just over 3% five years later. Conclusion Patients with multiple emergency admissions are often identified as a high risk group for subsequent admission and substantial claims are made for interventions designed to avoid emergency admission in such patients. Simply monitoring admission rates cannot assess interventions designed to reduce admission among frail older people as rates fall without any intervention. Comparison with a matched control group is necessary. Wider benefits than reduced admissions should be considered when introducing intensive case management of older people.

Medicaid Patients at High Risk for Frequent Hospital Admission: Real-Time Identification and Remediable Risks

“…In fact, most patients with frequent admissions and concomitant high health care expenditures in 1 year will not have frequent admissions in the next (regression to the mean). 12,13 This phenomenon has been demonstrated both for patients with frequent ED visits and patients with frequent hospital admissions.…”

Predictive risk modelling in health: options for New Zealand and Australia

“…For instance, the costs of patients who are 'expensive' in one 12-month period are likely to be lower in the subsequent year even without intervention. 22 The reasons for this phenomenon include self-limiting illnesses, definitive treatment, change in social circumstances and death. Because of regression to the mean, threshold models tend not to identify those individuals who are at highest risk in the subsequent period.…”

Risk taking in general practice: GP out-of-hours referrals to hospital

“…Admissions to hospital are an increasing source of pressure on the NHS, 1 and unplanned admissions represented 37% of hospital admissions in the UK in 2005-2006. 2 Emergency admissions at night and weekends are distressing for patients and disruptive for hospitals, and many of these admissions result from referrals from GP out-of-hours (OOH) providers. Research has shown that there is a greater than fourfold variation between the top and bottom quartiles in OOH admission rates between GPs working for the same OOH service and caring for the same patient population, 3 suggesting that doctors' decision making varies and plays an important part in determining admission rates.…”