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Howell D, Brazil K. Reaching Common Ground: A Patient-Family-Based Conceptual Framework of Quality EOL Care. J Palliat Care 2019. [DOI: 10.1177/082585970502100104] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Improvement in the quality of end-of-life (EOL) care is a priority health care issue since serious deficiencies in quality of care have been reported across care settings. Increasing pressure is now focused on Canadian health care organizations to be accountable for the quality of palliative and EOL care delivered. Numerous domains of quality EOL care upon which to create accountability frameworks are now published, with some derived from the patient/family perspective. There is a need to reach common ground on the domains of quality EOL care valued by patients and families in order to develop consistent performance measures and set priorities for health care improvement. This paper describes a meta-synthesis study to develop a common conceptual framework of quality EOL care integrating attributes of quality valued by patients and their families.
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Affiliation(s)
- Doris Howell
- Oncology Department, University Health Network, and Faculty of Nursing, University of Toronto, Toronto, Ontario
| | - Kevin Brazil
- Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Verver D, Stoopendaal A, Merten H, Robben P, Wagner C. What are the perceived added values and barriers of regulating long-term care in the home environment using a care network perspective: a qualitative study. BMC Health Serv Res 2018; 18:946. [PMID: 30522469 PMCID: PMC6282343 DOI: 10.1186/s12913-018-3770-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Changes in Dutch policy towards long-term care led to the Dutch Health and Youth Care Inspectorate testing a regulatory framework focusing on care networks around older adults living independently. This regulatory activity involved all care providers and the older adults themselves. METHODS Semi-structured interviews with the older adults, and focus groups with care providers and inspectors were used to assess the perceived added value of, and barriers to the framework. RESULTS The positive elements of this framework were the involvement of the older adults in the regulatory activity, the focus of the framework on care networks and the open character of the conversations with the inspectors. However, applying the framework requires a substantial investment of time. Care providers often did not perceive themselves as being part of a care network around one person and they expressed concerns about financial and privacy issues when thinking in terms of care networks. CONCLUSIONS The experiences of the client were seen as important in regulating long-term care. Regulating care networks as a whole puts cooperation between care providers involved around one person on the agenda. However, barriers for this form of regulation were also perceived and, therefore, careful consideration when and how to regulate care networks is recommended.
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Affiliation(s)
- Didi Verver
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL, 1081 Amsterdam, BT Netherlands
| | - Annemiek Stoopendaal
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 Rotterdam, PA Netherlands
| | - Hanneke Merten
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL, 1081 Amsterdam, BT Netherlands
| | - Paul Robben
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 Rotterdam, PA Netherlands
| | - Cordula Wagner
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL, 1081 Amsterdam, BT Netherlands
- Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR Utrecht, the Netherlands
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Verver D, Merten H, Robben P, Wagner C. Supervision of care networks for frail community dwelling adults aged 75 years and older: protocol of a mixed methods study. BMJ Open 2015; 5:e008632. [PMID: 26307619 PMCID: PMC4550721 DOI: 10.1136/bmjopen-2015-008632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/06/2015] [Accepted: 06/13/2015] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The Dutch healthcare inspectorate (IGZ) supervises the quality and safety of healthcare in the Netherlands. Owing to the growing population of (community dwelling) older adults and changes in the Dutch healthcare system, the IGZ is exploring new methods to effectively supervise care networks that exist around frail older adults. The composition of these networks, where formal and informal care takes place, and the lack of guidelines and quality and risk indicators make supervision complicated in the current situation. METHODS AND ANALYSIS This study consists of four phases. The first phase identifies risks for community dwelling frail older adults in the existing literature. In the second phase, a qualitative pilot study will be conducted to assess the needs and wishes of the frail older adults concerning care and well-being, perception of risks, and the composition of their networks, collaboration and coordination between care providers involved in the network. In the third phase, questionnaires based on the results of phase II will be sent to a larger group of frail older adults (n=200) and their care providers. The results will describe the composition of their care networks and prioritise risks concerning community dwelling older adults. Also, it will provide input for the development of a new supervision framework by the IGZ. During phase IV, a second questionnaire will be sent to the participants of phase III to establish changes of perception in risks and possible changes in the care networks. The framework will be tested by the IGZ in pilots, and the researchers will evaluate these pilots and provide feedback to the IGZ. ETHICS AND DISSEMINATION The study protocol was approved by the Scientific Committee of the EMGO+institute and the Medical Ethical review committee of the VU University Medical Centre. Results will be presented in scientific articles and reports and at meetings.
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Affiliation(s)
- Didi Verver
- Department of Public and Occupational health, EMGO+Institute/VU University Medical Centre, Amsterdam, The Netherlands
| | - Hanneke Merten
- Department of Public and Occupational health, EMGO+Institute/VU University Medical Centre, Amsterdam, The Netherlands
| | - Paul Robben
- Dutch Healthcare Inspectorate (IGZ), Utrecht, The Netherlands
- Institute of Health Policy and Management (iBMG), Erasmus Universiteit Rotterdam, Rotterdam, The Netherlands
| | - Cordula Wagner
- Department of Public and Occupational health, EMGO+Institute/VU University Medical Centre, Amsterdam, The Netherlands
- The Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Gladman J, Harwood R, Conroy S, Logan P, Elliott R, Jones R, Lewis S, Dyas J, Schneider J, Porock D, Pollock K, Goldberg S, Edmans J, Gordon A, Bradshaw L, Franklin M, Whittamore K, Robbins I, Dunphy A, Spencer K, Darby J, Tanajewski L, Berdunov V, Gkountouras G, Foster P, Frowd N. Medical Crises in Older People: cohort study of older people attending acute medical units, developmental work and randomised controlled trial of a specialist geriatric medical intervention for high-risk older people; cohort study of older people with mental health problems admitted to hospital, developmental work and randomised controlled trial of a specialist medical and mental health unit for general hospital patients with delirium and dementia; and cohort study of residents of care homes and interview study of health-care provision to residents of care homes. PROGRAMME GRANTS FOR APPLIED RESEARCH 2015. [DOI: 10.3310/pgfar03040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundThis programme of research addressed shortcomings in the care of three groups of older patients: patients discharged from acute medical units (AMUs), patients with dementia and delirium admitted to general hospitals, and care home residents.MethodsIn the AMU workstream we undertook literature reviews, performed a cohort study of older people discharged from AMU (Acute Medical Unit Outcome Study; AMOS), developed an intervention (interface geriatricians) and evaluated the intervention in a randomised controlled trial (Acute Medical Unit Comprehensive Geriatric Assessment Intervention Study; AMIGOS). In the second workstream we undertook a cohort study of older people with mental health problems in a general hospital, developed a specialist unit to care for them and tested the unit in a randomised controlled trial (Trial of an Elderly Acute care Medical and mental health unit; TEAM). In the third workstream we undertook a literature review, a cohort study of a representative sample of care home residents and a qualitative study of the delivery of health care to care home residents.ResultsAlthough 222 of the 433 (51%) patients recruited to the AMIGOS study were vulnerable enough to be readmitted within 3 months, the trial showed no clinical benefit of interface geriatricians over usual care and they were not cost-effective. The TEAM study recruited 600 patients and there were no significant benefits of the specialist unit over usual care in terms of mortality, institutionalisation, mental or functional outcomes, or length of hospital stay, but there were significant benefits in terms of patient experience and carer satisfaction with care. The medical and mental health unit was cost-effective. The care home workstream found that the organisation of health care for residents in the UK was variable, leaving many residents, whose health needs are complex and unpredictable, at risk of poor health care. The variability of health care was explained by the variability in the types and sizes of homes, the training of care home staff, the relationships between care home staff and the primary care doctors and the organisation of care and training among primary care doctors.DiscussionThe interface geriatrician intervention was not sufficient to alter clinical outcomes and this might be because it was not multidisciplinary and well integrated across the secondary care–primary care interface. The development and evaluation of multidisciplinary and better-integrated models of care is justified. The specialist unit improved the quality of experience of patients with delirium and dementia in general hospitals. Despite the need for investment to develop such a unit, the unit was cost-effective. Such units provide a model of care for patients with dementia and delirium in general hospitals that requires replication. The health status of, and delivery of health care to, care home residents is now well understood. Models of care that follow the principles of comprehensive geriatric assessment would seem to be required, but in the UK these must be sufficient to take account of the current provision of primary health care and must recognise the importance of the care home staff in the identification of health-care needs and the delivery of much of that care.Trial registrationCurrent Controlled Trials ISRCTN21800480 (AMIGOS); ClinicalTrials.gov NCT01136148 (TEAM).FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 3, No. 4. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John Gladman
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Rowan Harwood
- Health Care of Older People, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK
| | - Simon Conroy
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Pip Logan
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Rachel Elliott
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Rob Jones
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Lewis
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Jane Dyas
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Justine Schneider
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Davina Porock
- University at Buffalo School of Nursing, Buffalo, NY, USA
| | - Kristian Pollock
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Sarah Goldberg
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Judi Edmans
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Adam Gordon
- Health Care of Older People, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK
| | - Lucy Bradshaw
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Matthew Franklin
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Katherine Whittamore
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Isabella Robbins
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Aidan Dunphy
- Clinical Research Unit, Leicester Royal Infirmary, Leicester, UK
| | - Karen Spencer
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - Janet Darby
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Lukasz Tanajewski
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Vladislav Berdunov
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Georgios Gkountouras
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Pippa Foster
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Nadia Frowd
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
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McCowan C, Magin P, Clark SA, Guthrie B. An observational study of psychotropic drug use and initiation in older patients resident in their own home or in care. Age Ageing 2013; 42:51-6. [PMID: 22975881 DOI: 10.1093/ageing/afs117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE to compare the prescription of psychotropic medications for patients living in care homes with that for patients living at home. DESIGN AND SETTING retrospective population database study in the Tayside region of Scotland. SUBJECTS 70,297 patients aged ≥65 and followed until death or the end of the study. METHODS examining registered addresses for all people aged 65-99 identified those in care. The prescriptions for a 12-week period was examined and psychotropic drug use compared by their place of residence. Comparisons of prescriptions pre- and post-admission were performed for people admitted to a care home from Jan 2005 to Dec 2006. RESULTS people living in care (4.1%) received 9.80 more prescribed items (P < 0.001) from 1.63 more British National Formulary (BNF) categories (P < 0.001) than people living at home over a 12-week period. They were more likely to receive any psychotropic medication (42 versus 16%, odds ratio (OR) 3.09, 95% CI: 2.79-3.41). Over 70% of 1,715 people admitted to care homes during the study who received psychotropic medication commenced the medication prior to admission. Patients who started anti-psychotics in the 30 days prior to admission were less likely to have stopped them (OR: 0.53, 95% CI: 0.30-0.94). CONCLUSION prolonged prescription of psychotropic medications is commonplace in care home residents. Almost half of the people prescribed antipsychotic drugs received them for a minimum of 6 months. Systematic medication reviews must be established in all care homes to promote safe and effective prescription to this at-risk population.
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Affiliation(s)
- Colin McCowan
- Division of Population Health Sciences, University of Dundee, Mackenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK.
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Abstract
RÉSUMÉCet article cherche à établir le potentiel d'évaluation des programmes d'une base de données sur les soins de longue durée dans la communauté. Les données proviennent d'un projet-pilote sur la qualité et la clientèle du Health Care Financing Administration, incluant tous les établissements couverts par Medicare/ Medicaid de cinq états américains entre 1992 et 1994. À l'aide du Minimum Data Set, 70 000 résidents de plus de 65 ans souffrant d'insuffisance cardiaque globale ont été identifiés. L'analyse préliminaire de la pharmacothérapie de l'insuffisance cardiaque globale et de ses effets sur le déclin des fonctions physiques est présentée. L'état des fonctions physiques, mesuré par le taux de déclin des activités instrumentales de la vie quotidienne des patients qui suivent une thérapie combinée s'améliore par rapport à ceux qui prennent seulement de la digoxine ou des inhibiteurs de l'enzyme convertissant l'angiotensine. La disponibilité d'un ensemble de donnees sur la population fournit done une méthode d'évaluation des politiques et des pratiques courantes.
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Béland F, Bergman H, Lebel P, Dallaire L, Fletcher J, Tousignant P, Contandriopoulos AP. Integrated Services for Frail Elders (SIPA): A Trial of a Model for Canada. Can J Aging 2010. [DOI: 10.1353/cja.2006.0019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
ABSTRACTLe complexe formé par les maladies chroniques, les épisodes de maladies aiguës, les déficiences physiologiques, les incapacités fonctionnelles et les problèmes cognitifs dominent les personnes âgées fragiles. Elles comptent sur l'aide des programmes sociaux et de Santé qui, au Canada, sont encore fragmentés. Le SIPA (Services intégrés pour les personnes âgées fragiles) est un modèle de services intégrés basé sur des services de proximité, une équipe multidisciplinaire et un gestionnaire de cas qui détiennent la responsabilité clinique de l'ensemble des services sociaux et de Santé requis, la capacité de mobiliser des ressources en fonction des besoins et l'application de protocole de soins. Le projet de démonstration SIPA a utilisé un devis expérimental avec assignation aléatoire de 1230 participants, de deux quartiers de Montréal, dans un groupe expérimental et un groupe témoin. Les coûts des services institutionnels ont été de 4270$; inférieur dans le SIPA comparés au groupe témoin, les coûts des services de proximité ont été supérieurs de 3394$;. La proportion des personnes en attente d'hébergement en hôpitaux de courte durée a été deux fois plus élevée dans le groupe témoin que dans le groupe SIPA. Les coûts des hospitalisations de courte durée des personnes du SIPA avec incapacité dans les activités de la vie quotidienne ont été inférieurs d'au moins 4000$; à ceux des personnes du groupe témoin. En conclusion, l'expérimentation SIPA démontre qu'il est possible de s'engager dans des projets de démonstration ambitieux et rigoureux au Canada. Ces résultats ont été obtenus sans augmentation des coûts globaux des services sociaux et de santé, sans diminution de la Qualité des soins et sans augmentation du fardeau des personnes âgées et de leurs proches.
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Béland F, Bergman H, Lebel P, Dallaire L, Fletcher J, Contandriopoulos AP, Tousignant P. Des services intégrés pour les personnes âgées fragiles (SIPA): expérimentation d'un modèle pour le Canada. Can J Aging 2010. [DOI: 10.1353/cja.2006.0018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
ABSTRACTThe complex formed by chronic illness, episodes of acute illness, physiological disabilities, functional limitations, and cognitive problems is prevalent among frail elderly persons. These individuals rely on assistance from social and health care programs, which in Canada are still fragmented. SIPA (Services intégrés pour les personnes âgées fragiles) is an integrated service model based on community services, a multidisciplinary team, case management that retains clinical responsibility for all the health and social services required, and the capacity to mobilize resources as required and according to the care protocol. The SIPA demonstration project used an experimental design, with random allocation of the 1,230 participants from two areas of Montreal to an experimental and a control group. The costs of institutional services were $4,270 less for those in the SIPA group compared to the control group; the costs of community care were $3,394 more. The proportion of persons waiting in acute care hospitals for nursing home placement was twice as high in the control group as in the SIPA group. The costs of acute hospitalizations for persons in the SIPA group with ADL disabilities were at least $4,000 lower than those for persons in the control group. In conclusion, the SIPA trial showed that it is possible to undertake ambitious and rigorous demonstration projects in Canada. These results were obtained without an increase in the overall costs of health and social services, without reducing the quality of care, and without increasing the burden on elderly persons and their relatives.
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Fostering participation of general practitioners in integrated health services networks: incentives, barriers, and guidelines. BMC Health Serv Res 2009; 9:48. [PMID: 19292905 PMCID: PMC2664801 DOI: 10.1186/1472-6963-9-48] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2008] [Accepted: 03/17/2009] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND While the active participation of general practitioners (GPs) in integrated health services networks (IHSNs) plays a critical role in their success, little is known about the incentives and barriers to their actual participation. METHODS Data were gathered through semi-structured interviews and a mail survey with GPs enrolled in SIPA (system of integrated care for older persons) at 2 sites in Montreal. A total of 61 GPs completed the questionnaire, from which 22 were randomly selected for the qualitative study, with active and non-active participation in the IHSN. RESULTS The key themes associated with GP participation were clinician characteristics, consequences perceived at the outset, the SIPA implementation process, relationships with the SIPA team and professional consequences. The incentive factors reported were collaborative practices, high rates of elderly and SIPA patients in their clienteles, concerns about SIPA, the selection of frail elderly patients, close relationships with the case manager, the perceived efficacy of SIPA, and improved professional practices. Barriers to GP participation included high expectations, GP recruitment, lack of information on SIPA, difficult relationships with SIPA geriatricians and deterioration of physician-patient relationships. Four profiles of participation were identified: 2 groups of participants active in SIPA and 2 groups of participants not active in SIPA. The active GPs were familiar with collaborative practices, had higher IHSN patient rates, expressed more concerns than expectations, reported satisfactory relationships with case managers and perceived the efficacy of SIPA. Both active and non-active GPs reported quality care in the IHSN and improved professional practice. CONCLUSION Throughout the implementation process, the participation of GPs in an IHSN depends on numerous professional (clinician characteristics) and organizational factors (GP recruitment, relationships with case managers). Our study provides guiding principles for establishing future integrated models of care. It suggests practical guidelines to support the active participation of GPs in these networks such as physicians with collaborative practices, recruitment of significant number of patients per physicians, the information provided and the accompaniment by geriatricians.
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Siddiqi N, Young J, Cheater FM, Harding RA. Educating staff working in long-term care about delirium: the Trojan horse for improving quality of care? J Psychosom Res 2008; 65:261-6. [PMID: 18707949 DOI: 10.1016/j.jpsychores.2008.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 05/09/2008] [Accepted: 05/15/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aimed to design a multicomponent intervention to improve delirium care in long-term care facilities for older people in the UK and to identify the levers and barriers to its implementation in practice. METHODS The research incorporated the theoretical phase and Phase 1 of the Medical Research Council's framework. We designed a multicomponent intervention based on the evidence for effective interventions for delirium and for changing practice. We refined the intervention with input from care home staff and field visits to homes. Our intervention incorporated the following features: targeting risk factors for delirium, a 'delirium practitioner' functioning as a facilitator, an education package for care home staff, staff working groups at each home to identify barriers to improving delirium care and to produce tailored solutions, a local champion identified from the working groups, consultation, liaison with other professionals, and audit or feedback. The delirium practitioner recorded her experiences of delivering the intervention in a contemporaneous log. This was analysed using framework analysis to determine the levers and barriers to implementation. RESULTS We introduced a multicomponent intervention for delirium in six care homes in Leeds. Levers to implementation included flexibility, tailoring training to staff needs, engendering pride and ownership amongst staff, and minimising extra work. Barriers included time constraints, poor organization, and communication problems. CONCLUSION We were able to design and deliver an evidence-based multicomponent intervention for delirium that was acceptable to staff. The next steps are to establish its feasibility and effectiveness in modifying outcomes for residents of care homes.
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Affiliation(s)
- Najma Siddiqi
- Leeds Institute of Health Sciences, University of Leeds, UK
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Onder G, Liperoti R, Bernabei R, Landi F. Case management, preventive strategies, and caregiver attitudes among older adults in home care: results of the ADHOC study. J Am Med Dir Assoc 2008; 9:337-41. [PMID: 18519115 DOI: 10.1016/j.jamda.2008.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 01/30/2008] [Accepted: 02/06/2008] [Indexed: 11/30/2022]
Abstract
BACKGROUND Among older adults, integration of health services in a continuum of care with case management programs was shown to reduce progression of functional decline, hospitalization, and institutionalization. We hypothesized that such an approach may also result in a higher rate of use of preventive strategies and lower caregiver distress. METHODS Data were from the baseline assessment of the AgeD in HOme Care project, a study enrolling subjects aged 65 years or older receiving home care in Europe. Preventive strategies considered were: (1) blood pressure measured in the last 2 years; (2) influenza vaccination in the last 2 years; (3) medication reviewed in the last 180 days. RESULTS Mean age of participants was 82.3 years and 2971 (74%) were women; 1539 (38%) received home care program based on case management. Overall, 1350 (88%) of 1539 participants in the case manager group and 2046 (83%) of 2468 of those in the no case manager group had blood pressure measured in the last 2 years (P < .001). After adjusting for potential confounders, this result was still statistically significant (OR 1.31, 95% CI: 1.08-1.59). Similarly, more participants in the case manager groups received influenza vaccination (1083/1539 [70%] versus 1293/2468 [52%], P < .001) and had medication reviewed (312/1539 [20%] versus 356/2468 [15%], P < .001) compared with those in the no case manager group and these associations were confirmed after adjusting for confounders (OR: vaccination 2.08, 95% CI: 1.81-2.39; medication review 1.69, 95% CI 1.42-2.01). Furthermore, the caregivers of subjects in case manager group were less likely to be unable to continue in caring activities (49/1320 [4%] versus 134/2129 [6%], P = .01) and less dissatisfied (28/1320 [2%] versus 83/1129 [4%], P < .001) compared with those in the no case manager group. CONCLUSIONS Home care services based on case management approach result in a higher rate of use of preventive strategies and lower burden for caregivers.
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Affiliation(s)
- Graziano Onder
- Department of Gerontology, Geriatrics and Physiatry, Catholic University of Sacred Heart, Roma, Italy
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Onder G, Liperoti R, Soldato M, Carpenter I, Steel K, Bernabei R, Landi F. Case management and risk of nursing home admission for older adults in home care: results of the AgeD in HOme Care Study. J Am Geriatr Soc 2007; 55:439-44. [PMID: 17341249 DOI: 10.1111/j.1532-5415.2007.01079.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore the relationship between a case management approach and the risk of institutionalization in a large European population of frail, old people in home care. DESIGN Retrospective cohort study. SETTING Eleven European countries. PARTICIPANTS Three thousand two hundred ninety-two older adults receiving home care (mean age 82.3+/-7.3). MEASUREMENTS Data on nursing home admission were collected every 6 months for 1 year. RESULTS One thousand one hundred eighty-four (36%) persons received a home care program based on case management, and 2,108 (64%) received a traditional care approach (no case manager). During the 1-year follow-up, 81 of 1,184 clients (6.8%) in the case management group and 274 of 2,108 (13%) in the traditional care group were admitted to a nursing home (P<.001). After adjusting for potential confounders, the risk of nursing home admission was significantly lower for participants in the case management group than for those in a traditional care model (adjusted odds ratio=0.56, 95% confidence interval=0.43-0.63). CONCLUSION Home care services based on a case management approach reduce risk of institutionalization and likely lower costs.
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Affiliation(s)
- Graziano Onder
- Department of Gerontology, Catholic University Sacred Heart, Rome, Italy.
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Béland F, Bergman H, Lebel P, Clarfield AM, Tousignant P, Contandriopoulos AP, Dallaire L. A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2006; 61:367-73. [PMID: 16611703 DOI: 10.1093/gerona/61.4.367] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Care for elderly persons with disabilities is usually characterized by fragmentation, often leading to more intrusive and expensive forms of care such as hospitalization and institutionalization. There has been increasing interest in the ability of integrated models to improve health, satisfaction, and service utilization outcomes. METHODS A program of integrated care for vulnerable community-dwelling elderly persons (SIPA [French acronym for System of Integrated Care for Older Persons]) was compared to usual care with a randomized control trial. SIPA offered community-based care with local agencies responsible for the full range and coordination of community and institutional (acute and long-term) health and social services. Primary outcomes were utilization and public costs of institutional and community care. Secondary outcomes included health status, satisfaction with care, caregiver burden, and out-of-pocket expenses. RESULTS Accessibility was increased for health and social home care with increased intensification of home health care. There was a 50% reduction in hospital alternate level inpatient stays ("bed blockers") but no significant differences in utilization and costs of emergency department, hospital acute inpatient, and nursing home stays. For all study participants, average community costs per person were C dollar 3390 higher in the SIPA group but institutional costs were C dollar 3770 lower with, as hypothesized, no difference in total overall costs per person in the two groups. Satisfaction was increased for SIPA caregivers with no increase in caregiver burden or out-of-pocket costs. As expected, there was no difference in health outcomes. CONCLUSIONS Integrated systems appear to be feasible and have the potential to reduce hospital and nursing home utilization without increasing costs.
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Partington L. The challenges in adopting care pathways for the dying for use in care homes. Int J Older People Nurs 2006; 1:51-5. [DOI: 10.1111/j.1748-3743.2006.00009.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Landi F, Onder G, Cesari M, Barillaro C, Lattanzio F, Carbonin PU, Bernabei R. Comorbidity and social factors predicted hospitalization in frail elderly patients. J Clin Epidemiol 2004; 57:832-6. [PMID: 15551473 DOI: 10.1016/j.jclinepi.2004.01.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Studies on factors predicting the hospital admission of geriatric patients have reported different findings. The present study was undertaken to examine the rate of hospitalization among a large sample of frail elderly people living in the community and to identify the most important clinical and patient-centered factors associated with the hospital admission. STUDY DESIGN AND SETTING This is an observational cohort study. All patients (n = 1,291) in six Italian home health care agencies were assessed by a trained staff who collected data on the Minimum Data Set for Home Care (MDS-HC) form. We constructed a longitudinal database including MDS-HC data and information on hospital utilization by each patient. RESULTS During the follow-up of 12 months, the rate of hospitalization was about 26% of the studied sample. Persons living alone were more likely to have a hospital admission than those living with an informal caregiver (odds ratio OR = 2.59, 95% confidence interval CI = 1.82-3.69). Similarly, persons with economic hardship were more frequently hospitalized than those without these problems(OR = 3.01, 95% CI = 1.75-5.18). Comorbidity and previous hospital admission were associated with a higher risk to be hospitalized, too. CONCLUSION Our results support the hypothesis that a mix of social and health problems are independent predictors of hospitalization. Identification of those factors that best predict hospital admissions and readmissions gives direction for potential interventions and further research toward reducing unnecessary hospitalizations.
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Affiliation(s)
- Francesco Landi
- Instituto di Medicina Interna e Geriatria, Centro Medicina dell'Invecchiamento, Universitá Cattolica del Sacro Cuore, Rome, Italy.
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Abstract
This article outlines the health needs of older nursing home residents and identifies the case for the role of an older people's specialist nurse within a multidisciplinary care homes support team (CHST). This model has been successfully introduced in the London boroughs of Lambeth, Southwark and Lewisham as a response to the profile of local health need among care home residents and changes in national policy such as the introduction of NHS-funding nursing care. The structure of the CHST is described, and the older people's specialist nurse is discussed in detail. The emergent role of the older people's specialist nurse as key to managing the interface between the nursing homes and primary care is highlighted as a key benefit of this unique role.
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Affiliation(s)
- Nicky Hayes
- King's College Hospital NHS Trust and Care Homes Support Team, Southwark Primary Care Trust, London
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Fahey T, Montgomery AA, Barnes J, Protheroe J. Quality of care for elderly residents in nursing homes and elderly people living at home: controlled observational study. BMJ 2003; 326:580. [PMID: 12637404 PMCID: PMC151522 DOI: 10.1136/bmj.326.7389.580] [Citation(s) in RCA: 152] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To assess the quality of care given to elderly people and compare the care given to residents in nursing homes with those living in their own homes. DESIGN Controlled observational study. SETTING Primary care, Bristol. SUBJECTS Elderly individuals (aged > or =65 years) registered with three general practices, of whom 172 were residents in nursing homes (cases) and 526 lived at home (matched controls). MAIN OUTCOME MEASURES The quality of clinical care given to patients was measured against explicit standards. Quality indicators were derived from national sources and agreed with participating general practitioners. RESULTS The overall standard of care was inadequate when judged against the quality indicators, irrespective of where patients lived. The overall prescribing of beneficial drugs for some conditions was deficient--for example, only 38% (11/29) (95% confidence interval 20% to 58%) of patients were prescribed beta blockers after myocardial infarction. The proportion of patients with heart disease or diabetes who had had their blood pressure measured in the past two years (heart disease) or past year (diabetes) was lower among those living in nursing homes: for heart disease, 74% (17/23) v 96% (122/127) (adjusted odds ratio 0.18, 0.04 to 0.75); for diabetes, 62% (8/13) v 96% (50/52) (adjusted odds ratio 0.05, 0.01 to 0.38). In terms of potentially harmful prescribing, significantly more patients in nursing homes were prescribed neuroleptic medication (28% (49/172) v 11% (56/526) (3.82, 2.37 to 6.17)) and laxatives (39% (67/172) v 16% (85/526) (2.79, 1.79 to 4.36)). Nursing home residents were less likely to have the appropriate diagnostic Read code linked to their prescribed neuroleptic drug (0.22, 0.07 to 0.71). CONCLUSIONS The quality of medical care that elderly patients receive in one UK city, particularly those in nursing homes, is inadequate. We suggest that better coordinated care for these patients would avoid the problems of overuse of unnecessary or harmful drugs, underuse of beneficial drugs, and poor monitoring of chronic disease.
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Affiliation(s)
- Tom Fahey
- Tayside Centre for General Practice, University of Dundee, Dundee DD2 4AD.
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Jacobs S. Addressing the problems associated with general practitioners' workload in nursing and residential homes: findings from a qualitative study. Br J Gen Pract 2003; 53:113-9. [PMID: 12817356 PMCID: PMC1314510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Caring for older people in residential and nursing homes makes major demands on general practitioners (GPs). AIM To investigate the perceptions and experiences of home managers and GPs of the provision of general medical services for older residents. DESIGN OF STUDY In-depth qualitative study. SETTING Forty-two nursing and residential homes in five locations in England, interviewing home managers and eight of their residents' GPs. METHOD Semi-structured face-to-face and telephone interviews. RESULTS Most homes endorse principles of continuity of care and patient choice. Although many homes therefore deal with a large number of GPs, with the inherent difficulties of coordinating care and duplication of GP effort, limitations in residents' choice of GP result in the majority of residents in many homes being registered with only one or two practices. Contracts between homes and GPs may provide opportunities for improving medical care but do not guarantee additional services and have implications for patient choice and residents' fees. Visits on request form the bulk of GPs' workload in homes but can be hard to obtain for residents and may not be appropriate. Regular weekly surgeries are preferred by many homes but may have additional workload implications for GPs. CONCLUSION The assumption that patient choice and continuity in medical care are paramount for older people in nursing and residential homes is questioned. While recognition of the additional workload for GPs working in these settings is necessary, this should be accompanied by additional NHS remuneration. Further research is urgently required to identify which models of GP provision would most benefit both residents and GPs.
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Affiliation(s)
- Sally Jacobs
- National Primary Care Research and Development Centre, University of Manchester.
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Goodman C, Woolley R, Knight D. District nurses' experiences of providing care in residential care home settings. J Clin Nurs 2003; 12:67-76. [PMID: 12519252 DOI: 10.1046/j.1365-2702.2003.00678.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Little research describes the involvement and contribution of primary health care services in residential homes, despite policy and research concerns that older people in residential homes are a vulnerable population for whom care must be improved. The aim of this research was to explore the actual and potential contribution of primary care nurses in residential homes for older people, particularly district nurses. Five focus groups were held with district nurses in one county in England, to explore how participants represented their views, values and experiences of working in residential homes. Our major finding was the importance of context in shaping the experience of district nursing involvement. General practitioner attachment determined the frequency of visiting homes and affected workload. District nurses had regular contact with residential homes for discrete nursing tasks, but appropriateness of referrals and input was not agreed. The focus group discussions with district nurses revealed how problematic their work in residential homes was and a lack of consensus about their role. The data suggested that uncertainty about providing care in a setting that straddles the health and social care, public and private divide, and anxieties about managing their workload overshadowed their acknowledged concerns about the older people in residential care homes. Further research is needed to substantiate the findings, obtain residents' views and address issues of how to achieve integrated and equitable health and social care for this group.
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Affiliation(s)
- Claire Goodman
- Primary Care Nursing Research Unit, Department of Primary Care and Population Sciences, University and Kings College London, London, UK.
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Xie H, Chaussalet TJ, Thompson WA, Millard PH. Modelling decisions of a multidisciplinary panel for admission to long-term care. Health Care Manag Sci 2002; 5:291-5. [PMID: 12437278 DOI: 10.1023/a:1020338308191] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This paper describes a modelling study of a multidisciplinary review panel which is responsible for matching levels of long-term care to the needs of older people. The study aims to understand the decision making process of the review panel and to predict placement decisions based on an applicant's attributes. Data were collected from cases notes presented to the London Borough of Merton review panel. A model predicting placement of an individual to residential home, nursing home or long-stay nursing care was built using logistic regression. and correctly predicts 78% of placement decisions. The model can be used as a means of checking the consistency of the review panel's placement decisions.
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Affiliation(s)
- H Xie
- Health and Social Care Modelling Group, Cavendish School of Computer Science, University of Westminster, London, UK.
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21
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Landi F, Onder G, Tua E, Carrara B, Zuccalá G, Gambassi G, Carbonin P, Bernabei R. Impact of a new assessment system, the MDS-HC, on function and hospitalization of homebound older people: a controlled clinical trial. J Am Geriatr Soc 2001; 49:1288-93. [PMID: 11890486 DOI: 10.1046/j.1532-5415.2001.49264.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the impact of a new assessment system, the Minimum Data Set for Home Care (MDS-HC), on the functional status and hospitalization rates of frail, community-dwelling older people. DESIGN Single-blind randomized trial with 1-year follow-up. SETTING Bergamo, Italy. PARTICIPANTS All 187 subjects who were eligible for home care services delivered by two Health Districts between September 1998 and April 1999. INTERVENTION Random allocation to an intervention group undergoing MDS-HC assessment or to a control group receiving conventional geriatric assessment with Barthel, Lawton and Brody, and Mini-Mental State Examination (MMSE) scales. MEASUREMENTS Hospitalization, health services use and costs, and variations in functional status. RESULTS Survival analysis indicated that the intervention group was admitted to the hospital later and less often than were controls (relative risk = 0.49, 95% confidence interval = 0.56-0.97). Health services were used to the same extent, but intervention subjects used more in-home help services. Total costs for the intervention group were 21% lower than for the control group. The adjusted mean scores of the activities of daily living index (51.7+/-36.1 vs 46.3+/-33.7; P = .05) and MMSE (19.9+/-8.9 vs 19.2+/-10.7; P = .03) were significantly improved in the intervention group as compared with the control group. CONCLUSIONS The MDS-HC assessment instrument may provide a cost-saving approach to reducing institutionalization and functional decline in older people living in the community.
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Affiliation(s)
- F Landi
- Department of Gerontology and Geriatrics, Catholic University of Sacred Heart, Rome, Italy
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22
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Jacobs S, Glendinning C. The twilight zone? NHS services for older people in residential and nursing homes. QUALITY IN AGEING AND OLDER ADULTS 2001. [DOI: 10.1108/14717794200100012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Stone SP, Kibbler CC, Bowman C, Stott D. Controlling infection in British nursing homes. It is time for a national strategy. BMJ (CLINICAL RESEARCH ED.) 2001; 322:506. [PMID: 11230053 PMCID: PMC1119723 DOI: 10.1136/bmj.322.7285.506] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Specialist palliative care providers are seeking to transfer the principles of palliative care to more general care settings in order to meet the needs of people with diseases other than cancer. To prepare nursing home staff to provide palliative care increasing numbers of educational initiatives are now being offered. This paper explores some of the assumptions that underpin these initiatives. Recommendations are made that recognize the expertise already held within nursing homes and propose a collaborative approach to promote the appropriate integration of palliative care with nursing home practice.
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Affiliation(s)
- K A Froggatt
- Macmillan Practice Development Unit, Centre for Cancer and Palliative Care Studies, Institute of Cancer Research, c/o Royal Marsden NHS Trust, Fulham Road, London SW3 6JJ, UK.
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Bowman CE, Elford J, Dovey J, Campbell S, Barrowclough H. Acute hospital admissions from nursing homes: some may be avoidable. Postgrad Med J 2001; 77:40-2. [PMID: 11123394 PMCID: PMC1741862 DOI: 10.1136/pmj.77.903.40] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A retrospective survey of acute hospital admissions from nursing homes over a year to a district hospital revealed high overall hospital admission rates and wide variations of admission rates from similar homes. Medical admissions dominated, infections and poorly controlled heart failure being notably common. A significant proportion of admissions may have been avoided by active chronic disease management, together with better information for doctors responding to emergency calls and specialist support programmes facilitating in situ treatment.
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Affiliation(s)
- C E Bowman
- Department of Clinical Geratology, Weston General Hospital, Weston-super-Mare, Avon BS23 4TQ, UK
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26
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Affiliation(s)
- David Black
- Consultant Geriatrician and Medical Director, Queen Marys Hospital, Sidcup
| | - Clive Bowman
- Consultant Physician and Geratologist, International institute on Health & Ageing, University of Bristol
| | - Martin Severs
- Professor in Elderly Health Care, Queen Alexandra Hospital, Cosham
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Landi F, Gambassi G, Pola R, Tabaccanti S, Cavinato T, Carbonin PU, Bernabei R. Impact of integrated home care services on hospital use. J Am Geriatr Soc 1999; 47:1430-4. [PMID: 10591237 DOI: 10.1111/j.1532-5415.1999.tb01562.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the effect of a home care program based on comprehensive geriatric assessment and case management on hospital use and costs among frail older individuals. DESIGN Quasi-experimental study with a 6-month follow-up. SETTING Vittorio Veneto, a town in northern Italy. PARTICIPANTS One hundred fifteen frail older people who applied for integrated home care services. INTERVENTION Each patient was assessed with the Minimum Data Set for Home Care, and, subsequently, a case manager and a multidisciplinary team delivered social and health care services as indicated. MAIN OUTCOME MEASURES We determined the hospital admissions and days spent in the hospital for all subjects during the first 6 months after the implementation of the home care program and compared them with the rate of hospitalization that the same patients had experienced in the 6 months preceding the implementation of the program. RESULTS After the implementation of the integrated home care program, there was a significant reduction in the number of hospitalizations compared with pre-implementation (56% vs 46%, respectively; P < .001), associated with a reduction in the number of hospital days, both at the individual patient level (28+/-23 days vs 18+/-15 days, respectively; P < .01) and for each admission (16+/-12 days vs 12+/-8 days, respectively; P < .01). This resulted in a 29% cost reduction with an estimated savings of $1260 per patient. CONCLUSIONS The implementation of an integrated home care program based on the use of a comprehensive geriatric assessment instrument guided by a case manager has a significant impact on hospitalization and is cost-effective.
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Affiliation(s)
- F Landi
- Istituto di Medicina Interna e Geriatria, Centro di Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy
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Bowman C, Johnson M, Venables D, Foote C, Kane RL. Geriatric care in the United Kingdom: aligning services to needs. BMJ (CLINICAL RESEARCH ED.) 1999; 319:1119-22. [PMID: 10531110 PMCID: PMC1116908 DOI: 10.1136/bmj.319.7217.1119] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/1999] [Indexed: 11/04/2022]
Affiliation(s)
- C Bowman
- International Institute on Health and Ageing, University of Bristol, Bristol BS8 1TX.
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Landi F, Lattanzio F, Gambassi G, Zuccalà G, Sgadari A, Panfilo M, Ruffilli MP, Bernabei R. A model for integrated home care of frail older patients: the Silver Network project. SILVERNET-HC Study Group. AGING (MILAN, ITALY) 1999; 11:262-72. [PMID: 10605615 DOI: 10.1007/bf03339667] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Home care programs for the treatment of frail elderly have been developed in many countries around the world. In the Silver Network project all services are provided in an integrated fashion by one "single entry" center, differently from the traditional fee-for-service or not integrated systems. The delivery of health and social services for frail elderly individuals are integrated and coordinated by a case manager who uses a "second generation" assessment instrument, the Minimum Data Set for Home Care (MDS-HC). We describe the principal clinical and functional characteristics of nearly 1300 patients admitted between 1997 and 1998 to such an integrated home care program in eleven Italian Health Agencies. The database, derived from the serial MDS-HC assessments of each patient, provides a unique opportunity to delineate the different criteria for eligibility for home care, and compare the selected populations of the participating Health Agencies.
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Affiliation(s)
- F Landi
- Institute of Internal Medicine and Geriatrics, Catholic University of Sacred Heart, Roma, Italy.
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30
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Kavanagh S, Knapp M. Primary care arrangements for elderly people in residential and nursing homes. BMJ (CLINICAL RESEARCH ED.) 1999; 318:666. [PMID: 10066217 PMCID: PMC1115100 DOI: 10.1136/bmj.318.7184.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Turrell AR, Castleden CM, Freestone B. Long stay care and the NHS: discontinuities between policy and practice. BMJ (CLINICAL RESEARCH ED.) 1998; 317:942-4. [PMID: 9756820 PMCID: PMC1113989 DOI: 10.1136/bmj.317.7163.942] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A R Turrell
- University of Sheffield, Trent Institute for Health Services Research, Sheffield S1 4DA.
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Kavanagh S, Knapp M. The impact on general practitioners of the changing balance of care for elderly people living in institutions. BMJ (CLINICAL RESEARCH ED.) 1998; 317:322-7. [PMID: 9685280 PMCID: PMC28627 DOI: 10.1136/bmj.317.7154.322] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe utilisation of general practitioners by elderly people resident in communal establishments; to examine variations in general practitioner utilisation and estimate the likely impact of the "downsizing" of long stay provision in NHS hospitals. DESIGN Secondary analyses of the survey of disability among adults in communal establishments conducted by the Office of Population Censuses and Surveys in 1986, and projection to present day. SETTING Nationally representative sample of communal establishments in Great Britain. SUBJECTS Disabled residents aged 65 or more without mental handicap. RESULTS Residents with higher levels of disability, disorders of the digestive system, resident in smaller local authority homes or larger voluntary residential homes were more likely to consult a general practitioner. For those who consulted, higher levels of disability and morbidity and residence in a private nursing home or a larger private residential home were all associated with greater general practitioner utilisation. Overall, when residents' characteristics and size of home was controlled for, residents in nursing homes had greater predicted utilisation than those in residential care homes. People who would previously have been cared for in NHS hospitals and are now cared for in nursing homes have high predicted utilisation due to their greater morbidity and disability. CONCLUSION The "downsizing" of NHS provision for elderly people has increased demand on general practitioners by 160 whole time equivalents per year in Britain.
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Affiliation(s)
- S Kavanagh
- Personal Social Services Research Unit, University of Kent, Canterbury, Kent CT2 7NF.
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Bernabei R, Landi F, Gambassi G, Sgadari A, Zuccala G, Mor V, Rubenstein LZ, Carbonin P. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ (CLINICAL RESEARCH ED.) 1998; 316:1348-51. [PMID: 9563983 PMCID: PMC28532 DOI: 10.1136/bmj.316.7141.1348] [Citation(s) in RCA: 290] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community. DESIGN Randomised study with 1 year follow up. SETTING Town in northern Italy (Rovereto). SUBJECTS 200 older people already receiving conventional community care services. INTERVENTION Random allocation to an intervention group receiving integrated social and medical care and case management or to a control group receiving conventional care. MAIN OUTCOME MEASURES Admission to an institution, use and costs of health services, variations in functional status. RESULTS Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls (hazard ratio 0.69; 95% confidence interval 0.53 to 0.91). Health services were used to the same extent, but control subjects received more frequent home visits by general practitioners. In the intervention group the estimated financial savings were in the order of 1125 ($1800) per year of follow up. The intervention group had improved physical function (activities of daily living score improved by 5.1% v 13.0% loss in controls; P<0.001). Decline of cognitive status (measured by the short portable mental status questionnaire) was also reduced (3.8% v 9.4%; P<0.05). CONCLUSION Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the community.
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Affiliation(s)
- R Bernabei
- Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
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Dutt D. Care for the growing number of elderly people in developing countries needs to be addressed. BMJ (CLINICAL RESEARCH ED.) 1998; 316:1387-8. [PMID: 9564008 PMCID: PMC1113087 DOI: 10.1136/bmj.316.7141.1387a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Primrose WR. Community institutional care for frail elderly people. "Unitary care" homes might be the answer. BMJ (CLINICAL RESEARCH ED.) 1998; 316:780. [PMID: 9529434 PMCID: PMC1112743 DOI: 10.1136/bmj.316.7133.780a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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