Hospital readmissions in frail older people

Craven, E.; Conroy, Simon

doi:10.1017/s0959259815000064

Cited by 17 publications

(13 citation statements)

References 21 publications

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“…Recent studies have examined causes and risk factors associated with higher hospital readmissions including the effects of shortened lengths of stay, premature discharge, unpreventable progression or exacerbation of existing or chronic conditions, age, polypharmacy, and poor nutrition (Craven & Conroy, 2015; Daras et al, 2018; García-Pérez et al, 2011; Joosten et al, 2014; Kahlon et al, 2015; Sternberg et al, 2011). Other studies have examined the impact of socioeconomic factors on hospital readmission rates and demonstrated correlations between higher readmission rates and gender, ethnicity, and income (Anderson & Steinberg, 1985; Silverstein et al, 2008).…”

Section: Background and Objectivesmentioning

confidence: 99%

Frailty Is Associated With Early Hospital Readmission in Older Medical Patients

Stillman

Beecher

2019

J Appl Gerontol

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Given the pervasiveness of frailty and its negative effects on health care–related outcomes, we evaluated patient frailty and comorbidity and determined the relationship between these measures and the probability of early readmission and length of hospital stay. Our retrospective analysis includes 435 patients evaluated using the Reported Edmonton Frailty Scale and the Age-Adjusted Charlson Comorbidity Index. We found that frailty as measured by the Reported Edmonton Frailty Scale was a significant predictor of hospital readmission and length of stay, and frailty outperformed the explanatory power of our comorbidity metric. One unit of increase in the Reported Edmonton Frailty Scale increased the odds of readmission by a factor of 1.12 (95% confidence interval [CI]: [1.04, 1.20]), and an increase of 10 units tripled the odds of readmission (odds ratio = 3.02, 95% CI: [1.48, 6.24]). These findings underscore the importance of prompt identification and management of frailty by bedside clinicians.

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Section: Background and Objectivesmentioning

confidence: 99%

Frailty Is Associated With Early Hospital Readmission in Older Medical Patients

Stillman

Beecher

2019

J Appl Gerontol

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“…Shorter lengths of hospital stay potentially compound this as people are discharged home with on-going care needs, such as medication monitoring, wound care treatment, and limited mobility [8,9]. This transition is particularly risky for older adults who are more likely to have multiple comorbidities and complex health and/or social care needs [10]. As such, improving the quality and safety of transitional care is a national and global priority [11,12].…”

Section: Introductionmentioning

confidence: 99%

Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives

Baxter¹,

Shannon²,

Murray³

et al. 2020

BMC Health Serv Res

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Background: Transitions of care are often risky, particularly for older people, and shorter hospital stays mean that patients can go home with ongoing care needs. Most previous research has focused on fundamental system flaws, however, care generally goes right far more often than it goes wrong. We explored staff perceptions of how high performing general practice and hospital specialty teams deliver safe transitional care to older people as they transition from hospital to home. Methods: We conducted a qualitative study in six general practices and four hospital specialties that demonstrated exceptionally low or reducing readmission rates over time. Data were also collected across four community teams that worked into or with these high-performing teams. In total, 157 multidisciplinary staff participated in semistructured focus groups or interviews and 9 meetings relating to discharge were observed. A pen portrait approach was used to explore how teams across a variety of different contexts support successful transitions and overcome challenges faced in their daily roles. Results: Across healthcare contexts, staff perceived three key themes to facilitate safe transitions of care: knowing the patient, knowing each other, and bridging gaps in the system. Transitions appeared to be safest when all three themes were in place. However, staff faced various challenges in doing these three things particularly when crossing boundaries between settings. Due to pressures and constraints, staff generally felt they were only able to attempt to overcome these challenges when delivering care to patients with particularly complex transitional care needs. Conclusions: It is hypothesised that exceptionally safe transitions of care may be delivered to patients who have particularly complex health and/or social care needs. In these situations, staff attempt to know the patient, they exploit existing relationships across care settings, and act to bridge gaps in the system. Systematically reinforcing such enablers may improve the delivery of safe transitional care to a wider range of patients. Trial registration: The study was registered on the UK Clinical Research Network Study Portfolio (references 35272 and 36174).

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“…Another Chinese study showed that their proposed 36‐item frailty index was a valuable predictor for death or hospital readmission in 3‐year period (Hao et al, ). Nevertheless, until recently, the studies referred to surrogate variables instead of the already existing frailty indexes (Craven & Conroy, ), such as the use of dementia as surrogates of frailty in (Rampersad et al, ).…”

Section: Discussionmentioning

confidence: 99%

Modelling hospital readmissions under frailty conditions for healthy aging

et al. 2019

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In the current context of an aging population in many developed countries, the issue of healthy aging is at the forefront of the political, scientific, and technological concerns. The frailty accompanying the late years of elderly people (>70 years old) deserves special consideration due to its great economical and personal costs and the workload imposed on the health care system. Hospital readmissions under a short time after hospital discharge are one of the sources of concern, and much effort is being devoted to their prediction for better care of the elder and optimized resource management. In this paper, we consider the prediction of readmissions for patients that are evaluated positively in the frailty scales. The computational experiments are carried out over a gender‐balanced cohort of 645 patients recruited at the University Hospital of Alava. We report machine‐learning prediction results of the readmission before the standard readmission limit of 30 days. We apply an upsampling technique to correct for class imbalance. Results are positive, encouraging further research and the creation of larger cohorts in international efforts.

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Hospital readmissions in frail older people

Abstract: Background: The majority of hospital in-patients are older people, and many of these are at increased risk of readmission, which can be an adverse outcome for the patient. Currently there is poor understanding as to how best to reduce the risk of readmission.

Cited by 17 publications

References 21 publications

Frailty Is Associated With Early Hospital Readmission in Older Medical Patients

Frailty Is Associated With Early Hospital Readmission in Older Medical Patients

Delivering exceptionally safe transitions of care to older people: a qualitative study of multidisciplinary staff perspectives

Modelling hospital readmissions under frailty conditions for healthy aging

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