Post-Acute Care as a Key Component in a Healthcare System for Older Adults

Wang, Yu Chun; Chou, Ming Yueh; Liang, Chih‐Kuang; Peng, Li Ning; Chen, Liang Kung; Loh, Ching‐Hui

doi:10.4235/agmr.19.0009

Cited by 35 publications

(49 citation statements)

References 42 publications

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“…South Korea, meanwhile, still pays for hip fracture surgery with FFS schemes, which give hospitals incentive to keep patients longer and provide more services. The study results confirm the DRG payment scheme in Taiwan is a strong incentive for hospitals to discharge patients early, as has been reported by previous studies [50].…”

Section: Discussionsupporting

confidence: 90%

Variations in hip fracture inpatient care in Japan, Korea, and Taiwan: an analysis of health administrative data

Kim

Cheng

Yamana

et al. 2021

BMC Health Serv Res

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Background Little is known about hip fracture inpatient care in East Asia. This study examined the characteristics of patients, hospitals, and regions associated with delivery of hip fracture surgeries across Japan, Korea, and Taiwan. We also analyzed and compared how the resource use and a short-term outcome of the care in index hospitals varied according to factors in the respective health systems. Methods We developed comparable, nationwide, individual-level health insurance claims datasets linked with hospital- and regional-level statistics across the health systems using common protocols. Generalized linear multi-level analyses were conducted on length of stay (LOS) and total cost of index hospitalization as well as inpatient death. Results The majority of patients were female and aged 75 or older. The standardized LOS of the hospitalization for hip fracture surgery was 32.5 (S.D. = 18.7) days in Japan, 24.7 (S.D. = 12.4) days in Korea, and 7.1 (S.D. = 2.9) days in Taiwan. The total cost per admission also widely varied across the systems. Hospitals with a high volume of hip fracture surgeries had a lower LOS across all three systems, while other factors associated with LOS and total cost varied across countries. Conclusion There were wide variations in resource use for hip fracture surgery in the index hospital within and across the three health systems with similar social health insurance schemes in East Asia. Further investigations into the large variations are necessary, along with efforts to overcome the methodological challenges of international comparisons of health system performance.

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Section: Discussionsupporting

confidence: 90%

Variations in hip fracture inpatient care in Japan, Korea, and Taiwan: an analysis of health administrative data

Kim

Cheng

Yamana

et al. 2021

BMC Health Serv Res

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“… 3 ) The risk factors for readmission have been evaluated widely and include both patient-related factors such as demographic characteristics, diagnosis, comorbidities, and healthcare utilization as well as provider and health system-related factors such as hospital location and healthcare costs. 3 , 4 ) A risk-stratified approach has recently been proposed for identifying patients at high risk of readmission for transitional care interventions, which includes assessments of disease severity, hospital-acquired complications, and stability on discharge. 5 )…”

Section: Introductionmentioning

confidence: 99%

Importance of Geriatric Syndrome Screening within 48 Hours of Hospitalization for Identifying Readmission Risk: A Retrospective Study in an Acute-Care Hospital

Shin

Han

Choi

et al. 2020

Ann Geriatr Med Res

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Background Given the association between geriatric syndrome and hospital readmission, we evaluated the suitability of geriatric syndrome screening for care (GSC) in identifying readmission risk and suggested the appropriate time for GSC. Methods GSC considering cognitive impairment, depression, polypharmacy (five or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence was performed among 2,663 general ward inpatients aged 65 years or older within 48 hours after admission and again before discharge between November 2016 and October 2017. From each patient, fall events, pressure ulcers, potentially inappropriate medication use, and delirium were assessed at admission. Patients were divided into two groups on the basis of readmission within 1 year after the first admission. According to the screening period (at admission and before discharge) and in-hospital decline, we applied receiver operating characteristic curve analysis to compare the prevalence of clinical concerns between the readmission and no-readmission groups. We also used multiple logistic regression analysis to evaluate the risk of readmission according to the presence of geriatric syndrome and clinical outcomes. Results The 782 readmitted patients (29.4%) showed a higher rate of poor GSC than those who were not readmitted. Polypharmacy at admission was significantly correlated with readmission risk (area under the receiver operating characteristic curve=0.602). Fall events (odds ratio [OR]=4.36; 95% confidence interval [CI], 2.36–8.05), urinary incontinence (OR=4.21; 95% CI, 3.28–5.39), and depressive mood (OR=3.88; 95% CI, 2.69–5.59) at admission were risk factors for readmission. Conclusion Geriatric syndromes assessed by GSC at admission was associated with an increased risk of readmission.

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“…We also considered a previous finding that home visiting programs have no effect on older adults with poor health in a previous study. 12 27 Because the same nurse practitioner worked for both this study and a health care program for vulnerable community-dwelling older adults, patients who were already registered in the health care program were excluded from this study. Second, there can be a variety of transitional care models, depending on whether the patient goes home or to another hospital after discharge.…”

Section: Discussionmentioning

confidence: 99%

The Experience of Providing Older Adult Patients with Transitional Care from an Acute Care Hospital to Home in Cooperation with a Public Health Center

et al. 2020

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Background: This study aimed to describe the experience of providing older adult patients with transitional care from an acute care hospital to home in cooperation with a public health center, in order to present the barriers to that care and suggest better organizational methods. Methods: This was a cross-sectional study to show the results of the Geriatric Screening for Care-10 (GSC-10) and outcomes of transitional care. Among 659 hospitalized patients aged 65 years or above who lived in an administrative district, forty-five subjects were enrolled between June 24, 2019 and January 23, 2020. Within 48 hours of admission, using the 10 areas of GSC-10, they were assessed for cognitive impairment, depression, polypharmacy (5 or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence, and were reassessed before discharge. The transitional care plan (containing the treatment summary, the results of the GSC-10 assessment, and the post-discharge plan) was forwarded to a representative of the public health center, who provided continued disease management and various health care services, such as chronic disease and frailty care, and physical rehabilitation. Results: Of all the participants, 64.4% had more than 1 GSC-10 concern. The most prevalent concerns were functional immobility (35.6%) and polypharmacy (22.2%). About 15.6% of the participants were readmitted to a nursing home or hospital. A total of 38 participants received the transitional care intervention. They received an average of 2.7 administered interventions. However, the rate of rejection was high (30.1%) and patients were visited an average of 16.5 days after discharge. Conclusion: Through our experience of providing transitional care from an acute care hospital to home in cooperation with a public health center, we expect that the transitional care suitable for the Korean medical situation could be established and successful.

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Post-Acute Care as a Key Component in a Healthcare System for Older Adults

Cited by 35 publications

References 42 publications

Variations in hip fracture inpatient care in Japan, Korea, and Taiwan: an analysis of health administrative data

Variations in hip fracture inpatient care in Japan, Korea, and Taiwan: an analysis of health administrative data

Importance of Geriatric Syndrome Screening within 48 Hours of Hospitalization for Identifying Readmission Risk: A Retrospective Study in an Acute-Care Hospital

The Experience of Providing Older Adult Patients with Transitional Care from an Acute Care Hospital to Home in Cooperation with a Public Health Center

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