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Ronksley PE, Scory TD, McRae AD, MacRae JM, Manns BJ, Lang E, Donald M, Hemmelgarn BR, Elliott MJ. Emergency Department Use Among Adults Receiving Dialysis. JAMA Netw Open 2024; 7:e2413754. [PMID: 38809552 PMCID: PMC11137633 DOI: 10.1001/jamanetworkopen.2024.13754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/27/2024] [Indexed: 05/30/2024] Open
Abstract
Importance People with kidney failure receiving maintenance dialysis visit the emergency department (ED) 3 times per year on average, which is 3- to 8-fold more often than the general population. Little is known about the factors that contribute to potentially preventable ED use in this population. Objective To identify the clinical and sociodemographic factors associated with potentially preventable ED use among patients receiving maintenance dialysis. Design, Setting, and Participants This cohort study used linked administrative health data within the Alberta Kidney Disease Network to identify adults aged 18 years or older receiving maintenance dialysis (ie, hemodialysis or peritoneal dialysis) between April 1, 2010, and March 31, 2019. Patients who had been receiving dialysis for more than 90 days were followed up from cohort entry (defined as dialysis start date plus 90 days) until death, outmigration from the province, receipt of a kidney transplant, or end of study follow-up. The Andersen behavioral model of health services was used as a conceptual framework to identify variables related to health care need, predisposing factors, and enabling factors. Data were analyzed in March 2024. Main Outcomes and Measures Rates of all-cause ED encounters and potentially preventable ED use associated with 4 kidney disease-specific ambulatory care-sensitive conditions (hyperkalemia, heart failure, volume overload, and malignant hypertension) were calculated. Multivariable negative binomial regression models were used to examine the association between clinical and sociodemographic factors and rates of potentially preventable ED use. Results The cohort included 4925 adults (mean [SD] age, 60.8 [15.5] years; 3071 males [62.4%]) with kidney failure receiving maintenance hemodialysis (3183 patients) or peritoneal dialysis (1742 patients) who were followed up for a mean (SD) of 2.5 (2.0) years. In all, 3877 patients had 34 029 all-cause ED encounters (3100 [95% CI, 2996-3206] encounters per 1000 person-years). Of these, 755 patients (19.5%) had 1351 potentially preventable ED encounters (114 [95% CI, 105-124] encounters per 1000 person-years). Compared with patients with a nonpreventable ED encounter, patients with a potentially preventable ED encounter were more likely to be in the lowest income quintile (38.8% vs 30.9%; P < .001); to experience heart failure (46.8% vs 39.9%; P = .001), depression (36.6% vs 32.5%; P = .03), and chronic pain (60.1% vs 54.9%; P = .01); and to have a longer duration of dialysis (3.6 vs 2.6 years; P < .001). In multivariable regression analyses, potentially preventable ED use was higher for younger adults (incidence rate ratio [IRR], 1.69 [95% CI, 1.33-2.15] for those aged 18 to 44 years) and patients with chronic pain (IRR, 1.35 [95% CI, 1.14-1.61]), greater material deprivation (IRR, 1.57 [95% CI, 1.16-2.12]), a history of hyperkalemia (IRR, 1.31 [95% CI, 1.09-1.58]), and historically high ED use (ie, ≥3 ED encounters in the prior year; IRR, 1.46 [95% CI, 1.23-1.73). Conclusions and Relevance In this study of adults receiving maintenance dialysis in Alberta, Canada, among those with ED use, 1 in 5 had a potentially preventable ED encounter; reasons for such encounters were associated with both psychosocial and medical factors. The findings underscore the need for strategies that address social determinants of health to avert potentially preventable ED use in this population.
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Affiliation(s)
- Paul E. Ronksley
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Tayler D. Scory
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew D. McRae
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer M. MacRae
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Braden J. Manns
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Eddy Lang
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maoliosa Donald
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R. Hemmelgarn
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Meghan J. Elliott
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Golinelli D, Sanmarchi F, Toscano F, Bucci A, Nante N. Analyzing the 20-year declining trend of hospital length-of-stay in European countries with different healthcare systems and reimbursement models. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024:10.1007/s10754-024-09369-0. [PMID: 38512638 DOI: 10.1007/s10754-024-09369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/10/2024] [Indexed: 03/23/2024]
Abstract
The study aims to investigate the last 20-year (2000-2019) of hospital length of stay (LOS) trends and their association with different healthcare systems (HS) among 25 European countries. A panel dataset was created using secondary data from Eurostat and Global Burden of Disease study databases, with dependent and control variables aggregated at the national level over a period of 20 years. A time trend analysis was conducted using a weighted least squares model for panel data to investigate the association between LOS, HS models [National Health Service (NHS), National Health Insurance, Social Health Insurance (SHI), and Etatist Social Health Insurance], healthcare reimbursement schemes [Prospective Global Budget (PGB), Diagnosis Related Groups (DRG), and Procedure Service Payment (PSP)], and control variables. The study showed a reduction of average LOS from 9.20 days in 2000 to 7.24 in 2019. SHI was associated with a lower LOS compared to NHS (b = - 0.6327, p < 0.05). Both DRG (b = 1.2399, p < 0.05) and PSP (b = 1.1677, p < 0.05) reimbursement models were positively associated with LOS compared to PGB. Our results confirmed the downward trend of LOS in the last 20 years, its multifactorial nature, and the influence of the SHI model of HS. This could be due to the financial incentives present in fee-for-service payment models and the role of competition in creating a market for healthcare services. These results offer insight into the factors influencing healthcare utilization and can inform the design of more effective, efficient, and sustainable HS.
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Affiliation(s)
- Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Department of Life Sciences, Health and Healthcare Professions, Link Campus University, Rome, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | - Fabrizio Toscano
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Andrea Bucci
- Department of Economics and Law, University of Macerata, Macerata, Italy
| | - Nicola Nante
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Cummins NM, Barry LA, Garavan C, Devlin C, Corey G, Cummins F, Ryan D, Wallace E, Deasy C, Flynn M, McCarthy G, Galvin R. Clinician consensus on "Inappropriate" presentations to the Emergency Department in the Better Data, Better Planning (BDBP) census: a cross-sectional multi-centre study of emergency department utilisation in Ireland. BMC Health Serv Res 2023; 23:1003. [PMID: 37723478 PMCID: PMC10506270 DOI: 10.1186/s12913-023-09760-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 06/28/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Utilisation of the Emergency Department (ED) for non-urgent care increases demand for services, therefore reducing inappropriate or avoidable attendances is an important area for intervention in prevention of ED crowding. This study aims to develop a consensus between clinicians across care settings about the "appropriateness" of attendances to the ED in Ireland. METHODS The Better Data, Better Planning study was a multi-centre, cross-sectional study investigating factors influencing ED utilisation in Ireland. Data was compiled in patient summary files which were assessed for measures of appropriateness by an academic General Practitioner (GP) and academic Emergency Medicine Consultant (EMC) National Panel. In cases where consensus was not reached charts were assessed by an Independent Review Panel (IRP). At each site all files were autonomously assessed by local GP-EMC panels. RESULTS The National Panel determined that 11% (GP) to 38% (EMC) of n = 306 lower acuity presentations could be treated by a GP within 24-48 h (k = 0.259; p < 0.001) and that 18% (GP) to 35% (EMC) of attendances could be considered "inappropriate" (k = 0.341; p < 0.001). For attendances deemed "appropriate" the admission rate was 47% compared to 0% for "inappropriate" attendees. There was no consensus on 45% of charts (n = 136). Subset analysis by the IRP determined that consensus for appropriate attendances ranged from 0 to 59% and for inappropriate attendances ranged from 0 to 29%. For the Local Panel review (n = 306) consensus on appropriateness ranged from 40 to 76% across ED sites. CONCLUSIONS Multidisciplinary clinicians agree that "inappropriate" use of the ED in Ireland is an issue. However, obtaining consensus on appropriateness of attendance is challenging and there was a significant cohort of complex heterogenous presentations where agreement could not be reached by clinicians in this study. This research again demonstrates the complexity of ED crowding, the introduction of evidence-based care pathways targeting avoidable presentations may serve to alleviate the problem in our EDs.
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Affiliation(s)
- Niamh M Cummins
- School of Medicine, Faculty of Education and Health Sciences, SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health, University of Limerick, Limerick, Ireland.
- Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Louise A Barry
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Carrie Garavan
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
- Department of Nursing and Midwifery, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Collette Devlin
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Gillian Corey
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- Emergency Department, ALERT Limerick EM Education Research Training, University Hospital Limerick, Limerick, Ireland
| | - Fergal Cummins
- School of Medicine, Faculty of Education and Health Sciences, SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health, University of Limerick, Limerick, Ireland
- Emergency Department, ALERT Limerick EM Education Research Training, University Hospital Limerick, Limerick, Ireland
| | - Damien Ryan
- School of Medicine, Faculty of Education and Health Sciences, SLÁINTE Research and Education Alliance in General Practice, Primary Healthcare and Public Health, University of Limerick, Limerick, Ireland
- Emergency Department, ALERT Limerick EM Education Research Training, University Hospital Limerick, Limerick, Ireland
| | - Emma Wallace
- Health Research Board Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Conor Deasy
- Emergency Department, Cork University Hospital, Cork, Ireland
| | - Mary Flynn
- Emergency Medicine Programme, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard McCarthy
- Emergency Department, Cork University Hospital, Cork, Ireland
- Emergency Medicine Programme, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rose Galvin
- Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Ireland
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Satokangas M, Arffman M, Agerholm J, Thielen K, Hougaard CØ, Andersen I, Burström B, Keskimäki I. Performing up to Nordic principles? Geographic and socioeconomic equity in ambulatory care sensitive conditions among older adults in capital areas of Denmark, Finland and Sweden in 2000-2015. BMC Health Serv Res 2023; 23:835. [PMID: 37550672 PMCID: PMC10405465 DOI: 10.1186/s12913-023-09855-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Denmark, Finland and Sweden pursue equity in health for their citizens through universal health care. However, it is unclear if these services reach the older adult population equally across different socioeconomic positions or living areas. Thus, we assessed geographic and socioeconomic equity in primary health care (PHC) performance among the older adults in the capital areas of Denmark (Copenhagen), Finland (Helsinki) and Sweden (Stockholm) in 2000-2015. Hospitalisations for ambulatory care sensitive conditions (ACSC) were applied as a proxy for PHC performance. METHODS We acquired individual level ACSCs for those aged ≥ 45 in 2000-2015 from national hospitalisation registers. To identify whether the disparities varied by age, we applied three age groups (those aged 45-64, 65-75 and ≥ 75). Socioeconomic disparities in ACSCs were described with incidence rate ratios (IRR) and annual rates by education, income and living-alone; and then analysed with biennial concentration indices by income. Geographic disparities were described with biennial ACSC rates by small areas and analysed with two-level Poisson multilevel models. These models provided small area estimates of IRRs of ACSCs in 2000 and their slopes for development over time, between which Pearson correlations were calculated within each capital area. Finally, these models were adjusted for income to distinguish between geographic and socioeconomic disparities. RESULTS Copenhagen had the highest IRR of ACSCs among those aged 45-64, and Helsinki among those aged ≥ 75. Over time IRRs decreased among those aged ≥ 45, but only in Helsinki among those aged ≥ 75. All concentration indices slightly favoured the affluent population but in Stockholm were mainly non-significant. Among those aged ≥ 75, Pearson correlations were low in Copenhagen (-0.14; p = 0.424) but high in both Helsinki (-0.74; < 0.001) and Stockholm (-0.62; < 0.001) - with only little change when adjusted for income. Among those aged ≥ 45 the respective correlations were rather similar, except for a strong correlation in Copenhagen (-0.51, 0.001) after income adjustment. CONCLUSIONS While socioeconomic disparities in PHC performance persisted among older adults in the three Nordic capital areas, geographic disparities narrowed in both Helsinki and Stockholm but persisted in Copenhagen. Our findings suggest that the Danish PHC incorporated the negative effects of socio-economic segregation to a lesser degree.
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Affiliation(s)
- Markku Satokangas
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
- Network of Academic Health Centres and Department of General Practice and Primary Health Care, University of Helsinki, P.O. Box 20, 00014, Helsinki, Finland.
| | - Martti Arffman
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
| | - Janne Agerholm
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Karsten Thielen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Ørsted Hougaard
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ingelise Andersen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ilmo Keskimäki
- Health Economics and Equity in Health Care, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland
- Faculty of Social Sciences, Tampere University, 33014, Tampere, Finland
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Ridge A, Peterson GM, Kitsos A, Seidel BM, Anderson V, Nash R. Potentially preventable hospitalisations in rural community-dwelling patients. Intern Med J 2023; 53:228-235. [PMID: 34564918 DOI: 10.1111/imj.15545] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 07/29/2021] [Accepted: 09/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Potentially preventable hospitalisations (PPH) are a common occurrence. Knowing the factors associated with PPH may allow high-risk patients to be identified and healthcare resources to be better allocated, and these factors may differ between urban and rural locations. AIM To determine factors associated with PPH in an Australian rural population. METHODS A retrospective review of admitted patients' demographic and clinical data was used to describe and model the factors associated with PPH, using an age- and sex-matched control group of non-admitted patients. This study is based in a multi-site rural general practice, Tasmania. The study included patients aged ≥18 years residing in the Huon-Bruny Island region of Tasmania, who were active patients at a rural general practice and were admitted to a public hospital for a PPH between 1 July 2016 and 30 June 2019. Main outcome measure is overnight admission to hospital for a PPH. RESULTS Predictors with a significant odds ratio (OR) in the final model were being single/unmarried (OR 2.43; 95% confidence interval (CI) 1.38-4.28), higher Charlson Comorbidity Index score (OR 1.40; 95% CI 1.13-1.74) and the number of general practice visits in the preceding 12 months (OR 1.09; 95% CI 1.05-1.14). CONCLUSIONS This study found that being single and having a higher comorbidity burden were the strongest independent risk factors for PPH in a rural population. Demographic and socioeconomic factors appeared to be as, if not more, important than medical factors and warrant attention when considering the design of programmes to reduce PPH risk in rural communities.
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Affiliation(s)
- Andrew Ridge
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.,Huon Valley Health Centre, Huonville, Tasmania, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Alex Kitsos
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Bastian M Seidel
- Huon Valley Health Centre, Huonville, Tasmania, Australia.,School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Vinah Anderson
- Huon Valley Health Centre, Huonville, Tasmania, Australia.,School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Rosie Nash
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Cressman AM, Purohit U, Shadowitz E, Etchells E, Weinerman A, Gerson D, Shojania KG, Stroud L, Wong BM, Shadowitz S. Potentially avoidable admissions to general internal medicine at an academic teaching hospital: an observational study. CMAJ Open 2023; 11:E201-E207. [PMID: 36854457 PMCID: PMC9981162 DOI: 10.9778/cmajo.20220020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Identifying potentially avoidable admissions to Canadian hospitals is an important health system goal. With general internal medicine (GIM) accounting for 40% of hospital admissions, we sought to develop a method to identify potentially avoidable admissions and characterize patient, provider and health system factors. METHODS We conducted an observational study of GIM admissions at our institution from August 2019 to February 2020. We defined potentially avoidable admissions as admissions that could be managed in an appropriate and safe manner in the emergency department or ambulatory setting and asked staff physicians to screen admissions daily and flag candidates as potentially avoidable admissions. For each candidate, we prepared a case review and debriefed with members of the admitting team. We then reviewed each candidate with our research team, assigned an avoidability score (1 [low] to 4 [high]) and identified contributing factors for those with scores of 3 or more. RESULTS We screened 601 total admissions and staff physicians flagged 117 (19.5%) of these as candidate potential avoidable admissions. Consensus review identified 67 candidates as potentially avoidable admissions (11.1%, 95% confidence interval 8.8%-13.9%); these patients were younger (mean age 65 yr v. 72 yr), had fewer comorbidities (Canadian Institute for Health Information Case Mix Group+ 0.42 v. 1.14), had lower resource-intensity weighting scores (0.72 v. 1.50) and shorter hospital lengths of stay (29 h v. 105 h) (p < 0.01). Common factors included diagnostic and therapeutic uncertainty, perceived need for short-term monitoring, government directive of a 4-hour limit for admission decision-making and subspecialist request to admit. INTERPRETATION Our prospective method of screening, flagging and case review showed that 1 in 9 GIM admissions were potentially avoidable. Other institutions could consider adapting this methodology to ascertain their rate of potentially avoidable admissions and to understand contributing factors to inform improvement endeavours.
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Affiliation(s)
- Alex M Cressman
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont.
| | - Ushma Purohit
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Ellen Shadowitz
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Edward Etchells
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Adina Weinerman
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Darren Gerson
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Kaveh G Shojania
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Lynfa Stroud
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Brian M Wong
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
| | - Steve Shadowitz
- Department of Medicine (Cressman, Purohit, Etchells, Weinerman, Gerson, Shojania, Stroud, Wong, S. Shadowitz), University of Toronto; Division of General Internal Medicine (Cressman, E. Shadowitz, Etchells, Weinerman, Shojania, Stroud, Wong, S. Shadowitz), Sunnybrook Health Sciences Centre; The Centre for Quality Improvement and Patient Safety (Etchells, Weinerman, Shojania, Wong); Wilson Centre for Education Research (Stroud); Toronto, Ont
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Duminy L, Ress V, Wild EM. Complex community health and social care interventions – Which features lead to reductions in hospitalizations for ambulatory care sensitive conditions? A systematic literature review. Health Policy 2022; 126:1206-1225. [DOI: 10.1016/j.healthpol.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 11/04/2022]
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Engel L, Hwang K, Panayiotou A, Watts JJ, Mihalopoulos C, Temple J, Batchelor F. Identifying patterns of potentially preventable hospitalisations in people living with dementia. BMC Health Serv Res 2022; 22:794. [PMID: 35725546 PMCID: PMC9208182 DOI: 10.1186/s12913-022-08195-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 06/14/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Older Australians make up 46% of all potentially preventable hospitalisations (PPHs) and people living with dementia are at significantly greater risk. While policy reforms aim to reduce PPHs, there is currently little evidence available on what drives this, especially for people living with dementia. This study examines patterns of PPHs in people living with dementia to inform service delivery and the development of evidence-based interventions. METHODS We used the Victorian Admitted Episodes Dataset from Victoria, Australia, to extract data for people aged 50 and over with a diagnosis of dementia between 2015 and 2016. Potentially avoidable admissions, known as ambulatory care sensitive conditions (ACSCs), were identified. The chi-square test was used to detect differences between admissions for ACSCs and non-ACSCs by demographic, geographical, and administrative factors. Predictors of ACSCs admissions were analysed using univariate and multiple logistic regression. RESULTS Of the 8156 hospital records, there were 3884 (48%) ACSCs admissions, of which admissions for urinary tract infections accounted for 31%, followed by diabetes complications (21%). Mean bed-days were 8.26 for non-ACSCs compared with 9.74 for ACSCs (p ≤ 0.001). There were no differences between admissions for ACSCs and non-ACSCs by sex, marital status, region (rural vs metro), and admission source (private accommodation vs residential facility). Culture and language predicted ASCS admission rates in the univariate regression analyses, with ACSC admission rates increasing by 20 and 29% if English was not the preferred language or if an interpreter was required, respectively. Results from the multiple regression analysis confirmed that language was a significant predictor of ACSC admission rates. CONCLUSIONS Improved primary health care may help to reduce the most common causes of PPHs for people living with dementia, particularly for those from culturally and linguistically diverse backgrounds.
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Affiliation(s)
- Lidia Engel
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St. Kilda Road, Melbourne, VIC 3004 Australia ,grid.1021.20000 0001 0526 7079Deakin University, Burwood, Australia
| | - Kerry Hwang
- grid.429568.40000 0004 0382 5980National Ageing Research Institute, Parkville, Australia ,grid.1008.90000 0001 2179 088XThe University of Melbourne, Parkville, Australia
| | - Anita Panayiotou
- grid.429568.40000 0004 0382 5980National Ageing Research Institute, Parkville, Australia ,grid.1008.90000 0001 2179 088XThe University of Melbourne, Parkville, Australia ,Safer Care Victoria, Melbourne, Australia
| | | | - Cathrine Mihalopoulos
- grid.1002.30000 0004 1936 7857School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St. Kilda Road, Melbourne, VIC 3004 Australia ,grid.1021.20000 0001 0526 7079Deakin University, Burwood, Australia
| | - Jeromey Temple
- grid.1008.90000 0001 2179 088XThe University of Melbourne, Parkville, Australia
| | - Frances Batchelor
- grid.1021.20000 0001 0526 7079Deakin University, Burwood, Australia ,grid.429568.40000 0004 0382 5980National Ageing Research Institute, Parkville, Australia ,grid.1008.90000 0001 2179 088XThe University of Melbourne, Parkville, Australia
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9
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Cummins NM, Barry LA, Garavan C, Devlin C, Corey G, Cummins F, Ryan D, Cronin S, Wallace E, McCarthy G, Galvin R. The “better data, better planning” census: a cross-sectional, multi-centre study investigating the factors influencing patient attendance at the emergency department in Ireland. BMC Health Serv Res 2022; 22:471. [PMID: 35397588 PMCID: PMC8994521 DOI: 10.1186/s12913-022-07841-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 03/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background Internationally Emergency Department (ED) crowding is a significant health services delivery issue posing a major risk to population health. ED crowding affects both the quality and access of health services and is associated with poorer patient outcomes and increased mortality rates. In Ireland the practising of “Corridor Medicine” and “Trolley Crises” have become prevalent. The objectives of this study are to describe the demographic and clinical profile of patients attending regional EDs and to investigate the factors influencing ED utilisation in Ireland. Methods This was a multi-centre, cross-sectional study and recruitment occurred at a selection of urban and rural EDs (n = 5) in Ireland throughout 2020. At each site all adults presenting over a 24 h census period were eligible for inclusion. Clinical data were collected via electronic records and a questionnaire provided information on demographics, healthcare utilisation, service awareness and factors influencing the decision to attend the ED. Results Demographics differed significantly between ED sites in terms of age (p ≤ 0.05), socioeconomic status (p ≤ 0.001), and proximity of health services (p ≤ 0.001). Prior to ED attendance 64% of participants accessed community health services. Most participants (70%) believed the ED was the “best place” for emergency care or attended due to lack of awareness of other services (30%). Musculoskeletal injuries were the most common reason for presentation to the ED in this study (24%) and almost a third of patients (31%) reported presenting to the ED for an x-ray or scan. Conclusions This study has identified regional and socioeconomic differences in the drivers of ED presentations and factors influencing ED attendance in Ireland from the patient perspective. Improved awareness of, and provision of alternative care pathways could potentially decrease ED attendances, which would be important in the context of reducing ED crowding during the COVID-19 pandemic. New strategies for integration of acute care in the community must acknowledge and plan for these issues as a universal approach is unlikely to be implemented successfully due to regional factors. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07841-6.
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Becker NV, Karmakar M, Tipirneni R, Ayanian JZ. Trends in Hospitalizations for Ambulatory Care-Sensitive Conditions During the COVID-19 Pandemic. JAMA Netw Open 2022; 5:e222933. [PMID: 35297972 PMCID: PMC8931555 DOI: 10.1001/jamanetworkopen.2022.2933] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE The association of the COVID-19 pandemic with the quality of ambulatory care is unknown. Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are a well-studied measure of the quality of ambulatory care; however, they may also be associated with other patient-level and system-level factors. OBJECTIVE To describe trends in hospital admissions for ACSCs in the prepandemic period (March 2019 to February 2020) compared with the pandemic period (March 2020 to February 2021). DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of adults enrolled in a commercial health maintenance organization in Michigan included 1 240 409 unique adults (13 011 176 person-months) in the prepandemic period and 1 206 361 unique adults (12 759 675 person-months) in the pandemic period. EXPOSURE COVID-19 pandemic (March 2020 to February 2021). MAIN OUTCOMES AND MEASURES Adjusted relative risk (aRR) of ACSC hospitalizations and intensive care unit stays for ACSC hospitalizations and adjusted incidence rate ratio of the length of stay of ACSC hospitalizations in the prepandemic (March 2019 to February 2020) vs pandemic (March 2020 to February 2021) periods, adjusted for patient age, sex, calendar month of admission, and county of residence. RESULTS The study population included 1 240 409 unique adults (13 011 176 person-months) in the prepandemic period and 1 206 361 unique adults (12 759 675 person-months) in the pandemic period, in which 51.3% of person-months (n = 6 547 231) were for female patients, with a relatively even age distribution between the ages of 24 and 64 years. The relative risk of having any ACSC hospitalization in the pandemic period compared with the prepandemic period was 0.72 (95% CI, 0.69-0.76; P < .001). This decrease in risk was slightly larger in magnitude than the overall reduction in non-ACSC, non-COVID-19 hospitalization rates (aRR, 0.82; 95% CI, 0.81-0.83; P < .001). Large reductions were found in the relative risk of respiratory-related ACSC hospitalizations (aRR, 0.54; 95% CI, 0.50-0.58; P < .001), with non-statistically significant reductions in diabetes-related ACSCs (aRR, 0.91; 95% CI, 0.83-1.00; P = .05) and a statistically significant reduction in all other ACSC hospitalizations (aRR, 0.79; 95% CI, 0.74-0.85; P < .001). Among ACSC hospitalizations, no change was found in the percentage that included an intensive care unit stay (aRR, 0.99; 95% CI, 0.94-1.04; P = .64), and no change was found in the length of stay (adjusted incidence rate ratio, 1.02; 95% CI, 0.98-1.06; P = .33). CONCLUSIONS AND RELEVANCE In this cross-sectional study of adults enrolled in a large commercial health maintenance organization plan, the COVID-19 pandemic was associated with reductions in both non-ACSC and ACSC hospitalizations, with particularly large reductions seen in respiratory-related ACSCs. These reductions were likely due to many patient-level and health system-level factors associated with hospitalization rates. Further research into the causes and long-term outcomes associated with these reductions in ACSC admissions is needed to understand how the pandemic has affected the delivery of ambulatory and hospital care in the US.
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Affiliation(s)
- Nora V. Becker
- Division of General Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Monita Karmakar
- Division of General Medicine, University of Michigan Medical School, Ann Arbor
| | - Renuka Tipirneni
- Division of General Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - John Z. Ayanian
- Division of General Medicine, University of Michigan Medical School, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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11
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Naseer M, J McKee K, Ehrenberg A, Schön P, Dahlberg L. Individual and contextual predictors of emergency department visits among community-living older adults: a register-based prospective cohort study. BMJ Open 2022; 12:e055484. [PMID: 35140159 PMCID: PMC8830250 DOI: 10.1136/bmjopen-2021-055484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To examine the extent to which contextual factors explain emergency department (ED) visits and ED revisits, additional to that explained by individual factors. DESIGN A register-based prospective cohort study. SETTING Swedish region of Dalarna. PARTICIPANTS Participants were 16 543 community-living adults aged 80 or older who were residents of the Dalarna region of Sweden, excluding older adults who moved out of Dalarna or into residential care during the study period. OUTCOME MEASURES Dependent variables were initial ED visit, and at least one ED revisit within 30 days of an initial ED visit. RESULTS Approximately 36% of the participants visited the ED during the study period with 18.9% returning to the ED within 30 days. For both initial ED visits and ED revisits, the addition of contextual factors to models containing individual factors significantly improved model fit (p<0.001; p<0.022) and the amount of variance explained in the outcome. In the final models, initial ED visit was significantly associated with older age, number of chronic diseases, receipt of home help, number of primary care visits, proportion of 80+ in the population and shorter distance to the ED; while an ED revisit was significantly associated with greater use of social care, number of hospital admissions and disposition (discharged; admitted to hospital) at initial ED visit. CONCLUSION Contextual factors explain variance in initial ED visit, additional to that explained by individual factors alone, which indicates inequitable access to ED care. These findings suggest considering local variations in contextual factors in order to improve health-related outcomes among older adults.
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Affiliation(s)
- Mahwish Naseer
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kevin J McKee
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Anna Ehrenberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Pär Schön
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lena Dahlberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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12
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Dundar C, Yaylaoglu SD. Non-emergent care visits in a turkish tertiary care emergency department after 2008 health policy changes: review and analysis. Arch Public Health 2022; 80:31. [PMID: 35039087 PMCID: PMC8762921 DOI: 10.1186/s13690-022-00787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background The Turkish government liberalized national healthcare policies in 2008 enabling Turkish citizens to seek general care in hospital emergency departments (ED). The number of ED visits has exceeded the total population every year for the last ten years. To explain this phenomenon and to identify trends and risk factors for non-emergent visits, we retrospectively reviewed the ED records of a tertiary hospital and the Turkish Ministry of Health bulletin. Methods This retrospective record-based study was conducted at a tertiary hospital in Samsun province of Turkey. A total of 87,528 records of adult patients who visited the ED between January 1 and December 31, 2017, were included in this study. We evaluated the pattern of ED use for non-emergent patients by age, gender, nationality, time of visit, means of arrival, ICD (International Classification of Diseases) diagnostic codes, triage codes, number of repeated and out-of-hours visits. We used the Turkish Ministry of Health statistics bulletins to compare the number of ED visits across the country by year. Results The non-emergent visit rate in ED was found 9.9%. The rate of non-emergent ED visits was significantly higher in the 18-44 age group, in the female gender, and in those who arrived at the ED without an ambulance. The number of non-emergent visits was very similar between weekends and weekdays but was significantly higher in working hours on weekdays than out-of-hours (p<0.001). The most frequent diagnostic code was “Pain, unspecified” (R52) and the rate of repeat visits was 14.8% of non-emergent ED visits. According to binary logistic analysis, non-emergency visits were associated with 18-44 age group (OR = 2.75), female gender (OR = 1.11) and non-ambulance transportation (OR = 9.86). Conclusions Our results showed that the 18-44 age group and female gender seek care in the ED for non-emergent problems more than the other parts of the population. The numbers of ED visits in the last decade continued to increase regardless of population growth. The health policy changes may have facilitated access to rapid physical and laboratory examination but also an exacerbation of the free-rider problem in ED services.
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Affiliation(s)
- Cihad Dundar
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey.
| | - Seydanur Dal Yaylaoglu
- Department of Public Health, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
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Zhuang Q, Chan JSE, See LKY, Chiang J, Suhaimi SR, Chua TWL, Venkataraman A. Characteristics of unplanned hospitalisations among cancer patients in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:882-891. [PMID: 34985100 DOI: 10.47102/annals-acadmedsg.2021212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Cancer is a pervasive global problem with significant healthcare utilisation and cost. Emergency departments (EDs) see large numbers of patients with oncologic emergencies and act as "gate-keepers" to subsequent hospital admissions. A proportion of such hospital admissions are rapidly discharged within 2 days and may be potentially avoidable. METHODS Over a 6-month period, we conducted a retrospective audit of active cancer patients presenting to the ED with subsequent admission to the Department of Medical Oncology. Our aims were to identify independent factors associated with a length of stay ≤2 days; and characterise the clinical and resource needs of these short admissions. RESULTS Among all medical oncology admissions, 24.4% were discharged within 2 days. Compared to longer stayers, patients with short admissions were significantly younger (P=0.010), had lower National Early Warning Scores (NEWS) (P=0.006), and had a lower proportion of gastrointestinal and hepatobiliary cancers (P=0.005). Among short admissions, common presenting medical problems were infections (n=144, 36.3%), pain (n=116, 29.2%), gastrointestinal complaints (n=85, 21.4%) and respiratory complaints (n=76, 19.1%). These admissions required investigations and treatments already available at the ED. CONCLUSION Short admissions have low resource needs and may be managed in the ED. This may help save valuable inpatient bed-days and reduce overall healthcare costs.
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Affiliation(s)
- Qingyuan Zhuang
- Division of Supportive and Palliative Care, National Cancer Centre, Singapore
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14
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The Cost Consequences of the Gold Coast Integrated Care Programme. Int J Integr Care 2021; 21:9. [PMID: 34611459 PMCID: PMC8447978 DOI: 10.5334/ijic.5542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/02/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction The Australian Gold Coast Integrated Care programme trialled a model of care targeting those with chronic and complex conditions at highest risk of hospitalisation with the goal of producing the best patient outcomes at no additional cost to the healthcare system. This paper reports the economic findings of the trial. Methods A pragmatic non-randomised controlled study assessed differences between patients enrolled in the programme (intervention group) and patients who received usual care (control group), in health service utilisation, including Medicare Benefits Schedule and Pharmaceutical Benefits Scheme claims, patient-reported outcome measures, including health-related quality of life, mortality risk, and cost. Results A total of 1,549 intervention participants were enrolled and matched on the basis of patient level data to 3,042 controls. We found no difference in quality of life between groups, but a greater decrease in capability, social support and satisfaction with care scores and higher hospital service use for the intervention group, leading to a greater cost to the healthcare system of AUD$6,400 per person per year. In addition, the per person per year cost of being in the GCIC programme was AUD$8,700 equating to total healthcare expenditures of AUD$15,100 more for the intervention group than the control group. Conclusion The GCIC programme did not show value for money, incurring additional costs to the health system and demonstrating no significant improvements in health-related quality of life. Because patient recruitment was gradual throughout the trial, we had only one year of complete data for analysis which may be too short a period to determine the true cost-consequences of the program.
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Trinh T, Elfergani A, Bann M. Qualitative analysis of disposition decision making for patients referred for admission from the emergency department without definite medical acuity. BMJ Open 2021; 11:e046598. [PMID: 34261682 PMCID: PMC8281073 DOI: 10.1136/bmjopen-2020-046598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To map the physician approach when determining disposition for a patient who presents without the level of definite medical acuity that would generally warrant hospitalisation. DATA SOURCES/STUDY SETTING Since 2018, our US academic county hospital/trauma centre has maintained a database in which hospitalists ('triage physicians') document the rationale and outcomes of requests for admission to the acute care medical ward during each shift. STUDY DESIGN Narrative text from the database was analysed using a grounded theory approach to identify major themes and subthemes, and a conceptual model of the admission decision-making process was constructed. PARTICIPANTS Database entries were included (n=300) if the admission call originated from the emergency department and if the triage physician characterised the request as potentially inappropriate because the patient did not have definite medical acuity. RESULTS Admission decision making occurs in three main phases: evaluation of unmet needs, assessment of risk and re-evaluation. Importantly, admission decision making is not solely based on medical acuity or clinical algorithms, and patients without a definite medical need for admission are hospitalised when physicians believe a potential issue exists if discharged. In this way, factors such as homelessness, substance use disorder, frailty, etc, contribute to admission because they raise concern about patient safety and/or barriers to appropriate treatment. Physician decision making can be altered by activities such as care coordination, advocacy by the patient or surrogate, interactions with other physicians or a change in clinical trajectory. CONCLUSIONS The decision to admit ultimately remains a clinical determination constructed between physician and patient. Physicians use a holistic process that incorporates broad consideration of the patient's medical and social needs with emphasis on risk assessment; thus, any analysis of hospitalisation trends or efforts to impact such should seek to understand this individual-level decision making.
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Affiliation(s)
- Tina Trinh
- University of Washington, Seattle, Washington, USA
| | | | - Maralyssa Bann
- Division of General Internal Medicine/Hospital Medicine, Department of Medicine, Harborview Medical Center, Seattle, Washington, USA
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
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16
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Walsh ME, Cronin S, Boland F, Ebell MH, Fahey T, Wallace E. Geographical variation of emergency hospital admissions for ambulatory care sensitive conditions in older adults in Ireland 2012-2016. BMJ Open 2021; 11:e042779. [PMID: 33952537 PMCID: PMC8103372 DOI: 10.1136/bmjopen-2020-042779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Ambulatory care sensitive (ACS) conditions are those for which intensified primary care management could potentially prevent emergency admissions. This study aimed to quantify geographical variation in emergency admissions with ACS conditions in older adults and explore factors influencing variation. DESIGN Repeated cross-sectional study. SETTING 34 public hospitals in the Ireland. PARTICIPANTS Adults aged ≥65 years hospitalised for seven ACS conditions between 2012 and 2016 (chronic obstructive pulmonary disease, congestive heart failure (CHF), diabetes, angina, pyelonephritis/urinary tract infections (UTIs), dehydration and pneumonia). PRIMARY OUTCOME MEASURE Age and sex standardised emergency admission rates (SARs) per 1000 older adults. ANALYSIS Age and sex SARs were calculated for 21 geographical areas. Extremal quotients and systematic components of variance (SCV) quantified variation. Spatial regression analyses was conducted for SARs with unemployment, urban population proportion, hospital turnover, supply of general practitioners (GPs), and supply of hospital-based specialists as explanatory variables. RESULTS Over time, an increase in UTI/pyelonephritis SARs was seen while SARs for angina and CHF decreased. Geographic variation was moderate overall and high for dehydration and angina (SCV=11.7-50.0). For all conditions combined, multivariable analysis showed lower urban population (adjusted coefficient: -2.2 (-3.4 to -0.9, p<0.01)), lower GP supply (adjusted coefficient: -5.5 (-8.2 to -2.9, p<0.01)) and higher geriatrician supply (adjusted coefficient: 3.7 (0.5 to 6.9, p=0.02)) were associated with higher SARs. CONCLUSIONS Future research should evaluate methods of preventing admissions for ACS conditions among older adults, including how resources are allocated at a local level.
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Affiliation(s)
- Mary E Walsh
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Sinead Cronin
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Fiona Boland
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark H Ebell
- Epidemiology and Biostatistics, University of Georgia, Athens, Georgia, USA
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Emma Wallace
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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van den Broek S, Heiwegen N, Verhofstad M, Akkermans R, van Westerop L, Schoon Y, Hesselink G. Preventable emergency admissions of older adults: an observational mixed-method study of rates, associative factors and underlying causes in two Dutch hospitals. BMJ Open 2020; 10:e040431. [PMID: 33444202 PMCID: PMC7682455 DOI: 10.1136/bmjopen-2020-040431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Older adults are hospitalised from the emergency department (ED) without potentially needing hospital care. Knowledge about rates, associative factors and causes of these preventable emergency admissions (PEAs) is limited. This study aimed to determine the rates, associative factors and causes for PEAs of older adults. DESIGN A mixed-method observational study. SETTING The EDs of two Dutch hospitals. PARTICIPANTS 492 patients aged >70 years and hospitalised from the ED. MEASUREMENTS Quantitative data were retrospectively extracted from the electronical medical record over a 1-month period. Admissions were classified (non)preventable based on a standardised approach. Univariate and multivariate multilevel logistic regression analyses were performed to identify possible associations between PEAs and demographic, clinical and care process factors. Qualitative data were prospectively collected by email and telephone interviews and analysed thematically to explore hospital physician's perceived causes for the identified PEAs. RESULTS Of the 492 included cases, 86 (17.5%) were classified as PEA. Patients with a higher age (adjusted OR 1.04, 95% CI 1.01 to 1.08; p=0.04), a low urgency classification (adjusted OR 1.89, 95% CI 1.14 to 3.15; p=0.01), and attending the ED in the weekend (adjusted OR 2.02, 95% CI 1.22 to 3.37; p<0.01) were associated with an increased likelihood of a PEA. 49 physicians were interviewed by telephone and email. Perceived causes for PEAs were related to patient's attitudes (eg, postponement of medical care at home), provider's attitudes (eg, deciding for admission after family pressure), health system deficiencies (eg, limited access to community services during out-of-hours and delayed access to inpatient diagnostic resources) and poor communication between primary care and hospital professionals about patient treatment preferences. CONCLUSIONS Our findings contribute to existing evidence that many emergency admissions of older adults are preventable, thereby indicating a possible source of unnecessary expensive, and potentially harmful, hospital care.
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Affiliation(s)
| | - Nikki Heiwegen
- Emergency Department, Radboudumc, Nijmegen, Gelderland, Netherlands
| | | | - Reinier Akkermans
- Department of Primary and Community Care, Radboudumc, Nijmegen, Gelderland, Netherlands
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Yvonne Schoon
- Emergency Department, Radboudumc, Nijmegen, Gelderland, Netherlands
- Department of Geriatrics, Radboudumc, Nijmegen, Gelderland, Netherlands
| | - Gijs Hesselink
- Emergency Department, Radboudumc, Nijmegen, Gelderland, Netherlands
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, Netherlands
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Partanen VM, Arffman M, Manderbacka K, Keskimäki I. Mortality related to ambulatory care sensitive hospitalisations in Finland. Scand J Public Health 2020; 48:839-846. [PMID: 32755271 DOI: 10.1177/1403494820944722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims: Hospitalisations for ambulatory care sensitive conditions are used as an outcome indicator of access to and quality of primary care. Evidence on mortality related to these hospitalisations is scarce. This study analysed the effect of ambulatory care sensitive condition hospitalisations to subsequent mortality and time or geographical trends in the mortality indicating variations in ambulatory care sensitive conditions outcomes. Methods: This retrospective cohort study used individual-level data from national registers concerning ambulatory care sensitive condition hospitalisations. Crude and age-adjusted 365-day mortality rates for the first ambulatory care sensitive condition-related admission were calculated for vaccine-preventable, acute, and chronic ambulatory care sensitive conditions separately, and for three time periods stratified by gender. The mortality rates were also compared to mortality in the general Finnish population to assess the excess mortality related to ambulatory care sensitive condition hospitalisations. Results: The data comprised a total of 712,904 ambulatory care sensitive condition hospital admissions with the crude 365-day mortality rate of 14.2 per 100 person-years. Mortality for those hospitalised for vaccine-preventable conditions was approximately 10-fold compared to the general population and four-fold in chronic and acute conditions. Of the 10 most common ambulatory care sensitive conditions, bacterial pneumonia and influenza and congestive heart failure were associated with highest age-standardised mortality rates. Conclusions: Hospitalisations for ambulatory care sensitive conditions were shown to be associated with excess mortality in patients compared to the general population. Major differences in mortality were found between different types of ambulatory care sensitive condition admissions. There were also minor differences in mortality between hospital districts. These differences are important to consider when using preventable hospital admissions as an indicator of primary care performance.
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Affiliation(s)
| | - Martti Arffman
- Service System Research, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kristiina Manderbacka
- Service System Research, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Ilmo Keskimäki
- Service System Research, Finnish Institute for Health and Welfare, Helsinki, Finland.,Faculty of Social Sciences, Tampere University, Tampere, Finland
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Browne JP. The drivers and impact of emergency care reconfiguration in Ireland: Results from a large mixed-methods research programme. Future Healthc J 2020; 7:33-37. [PMID: 32104763 DOI: 10.7861/fhj.2019-0065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ireland, like many countries, has reconfigured emergency care in recent years towards a more centralised model. Although centralisation is presented as 'evidence-based', the relevance of this evidence is challenged by groups which hold values beyond those implicit in the literature. The Study of the Impact of Reconfiguration on Emergency and Urgent Care Networks (SIREN) programme was funded to evaluate the development and performance of emergency and urgent care systems in Ireland. SIREN found that the drivers of reconfiguration in Ireland are based on safety and efficiency claims which are highly contestable. Reconfiguration was not associated with improvements in safety or efficiency and may have exacerbated the growing capacity challenges for acute hospitals. These findings are consistent with UK research. Our study adds to an emerging literature on the interaction between a narrow technocratic approach to health system planning and the perspectives of the public and patients.
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McDarby G, Smyth B. Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC). BMJ Open 2019; 9:e028744. [PMID: 31694843 PMCID: PMC6858209 DOI: 10.1136/bmjopen-2018-028744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND In 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs). OBJECTIVE To measure the impact of ACSCs on acute hospital capacity in the Irish public system and identify specific care areas for enhanced primary care provision. DESIGN National Hospital In-patient Enquiry System data were used to calculate 2011-2016 standardised bed day rates for selected ACSC conditions. A prioritisation exercise was undertaken to identify the most significant contributors to bed days within our hospital system. Poisson regression was used to determine change over time using incidence rate ratios (IRR). RESULTS In 2016 ACSCs accounted for almost 20% of acute public hospital beds (n=871 328 bed days) with adults over 65 representing 69.1% (n=602 392) of these. Vaccine preventable conditions represented 39.1% of ACSCs. Influenza and pneumonia were responsible for 99.8% of these, increasing by 8.2% (IRR: 1.02; 95% CI 1.02 to 1.03) from 2011 to 2016. Pyelonephritis represented 47.6% of acute ACSC bed days, increasing by 46.5% (IRR: 1.07; 95% CI 1.06 to 1.08) over the 5 years examined. CONCLUSIONS Prioritisation for targeted investment in integrated care programmes is enabled through analysis of ACSC's in terms of acute hospital bed days. This analysis demonstrates that primary care investment in integrated care programmes for respiratory ACSC's from prevention to rehabilitation at scale could assist with bed capacity in acute hospitals in Ireland. In adults 65 years and over, including chronic obstructive pulmonary disease patients, the current analysis supports targeting community based pulmonary rehabilitation including pneumococcal and influenza vaccination programmes in order to reduce the burden of infection and hospitalisations. Further exploration of pyelonephritis is necessary in order to ascertain patient profile and appropriateness of admissions.
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Affiliation(s)
- Geraldine McDarby
- Planning for Health Group, Department of Public Health, HSE West, Health Services Executive, Galway, Ireland
| | - Breda Smyth
- Planning for Health Group, Department of Public Health, HSE West, Health Services Executive, Galway, Ireland
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Cram P. Hospital Length of Stay … A Measure of What, Exactly? Med Care 2019; 57:751-752. [PMID: 31415346 PMCID: PMC6742542 DOI: 10.1097/mlr.0000000000001198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Peter Cram
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, ON Canada
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
- North American Observatory on Health Systems and Policies, Institute for Health Policy, Management, and Evaluation, University of Toronto
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22
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McHugh S, Droog E, Foley C, Boyce M, Healy O, Browne JP. Understanding the impetus for major systems change: A multiple case study of decisions and non-decisions to reconfigure emergency and urgent care services. Health Policy 2019; 123:728-736. [PMID: 31208824 DOI: 10.1016/j.healthpol.2019.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The optimal organisation of emergency and urgent care services (EUCS) is a perennial problem internationally. Similar to other countries, the Health Service Executive in Ireland pursued EUCS reconfiguration in response to quality and safety concerns, unsustainable costs and workforce issues. However, the implementation of reconfiguration has been inconsistent at a regional level. Our aim was to identify the factors that led to this inconsistency. METHODS Using a multiple case study design, six case study regions represented full, partial and little/no reconfiguration at emergency departments (EDs). Data from documents and key stakeholder interviews were analysed using a framework approach with cross-case analysis. RESULTS The impetus to reconfigure ED services was triggered by patient safety events, and to a lesser extent by having a region-specific plan and an obvious starting point for changes. However, the complexity of the next steps and political influence impeded reconfiguration in several regions. Implementation was more strategic in regions that reconfigured later, facilitated by clinical leadership and "lead-in time" to plan and sell changes. CONCLUSION While the global shift towards centralisation of EUCS is driven by universal challenges, decisions about when, where and how much to implement are influenced by local drivers including context, people and politics. This can contribute to a public perception of inequity and distrust in proposals for major systems change.
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Affiliation(s)
- Sheena McHugh
- School of Public Health, University College Cork, Western Rd, Cork, Ireland.
| | - E Droog
- South/South West Hospital Group, Erinville, Western Road, Cork, Ireland
| | - Conor Foley
- School of Public Health, University College Cork, Western Rd, Cork, Ireland
| | - M Boyce
- School of Public Health, University College Cork, Western Rd, Cork, Ireland
| | - O Healy
- South/South West Hospital Group, Erinville, Western Road, Cork, Ireland
| | - J P Browne
- School of Public Health, University College Cork, Western Rd, Cork, Ireland
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23
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Nicholson E, McDonnell T, Hamza M, Barrett M, Brunsdon C, Bury G, Charlton M, Collins C, Deasy C, De Brun A, Fitzsimons J, Galligan M, Hensey C, Kiernan F, McAuliffe E. Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol. HRB Open Res 2019; 2:11. [PMID: 32104777 PMCID: PMC7016877 DOI: 10.12688/hrbopenres.12897.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 11/20/2022] Open
Abstract
There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents’ and families’ preferences and decision making when seeking unscheduled paediatric healthcare. Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients’ behaviour.
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Affiliation(s)
- Emma Nicholson
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Therese McDonnell
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Moayed Hamza
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Michael Barrett
- Chilren's Health Ireland at Crumlin, Dublin 12, Ireland.,UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.,National Children's Research Centre, Crumlin, Dublin 12, Ireland
| | - Christopher Brunsdon
- National Centre for Geocomputation, National University of Ireland, Maynooth, Maynooth, Co Kildare, Ireland
| | - Gerard Bury
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Martin Charlton
- National Centre for Geocomputation, National University of Ireland, Maynooth, Maynooth, Co Kildare, Ireland
| | - Claire Collins
- Irish College of General Practitioners, Dublin 2, Ireland
| | | | - Aoife De Brun
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - John Fitzsimons
- Children's Health Ireland at Temple Street, Dublin 1, Ireland
| | - Marie Galligan
- UCD School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - Conor Hensey
- Children's Health Ireland at Temple Street, Dublin 1, Ireland
| | - Fiona Kiernan
- UCD Geary Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - Eilish McAuliffe
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
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Nicholson E, McDonnell T, Hamza M, Barrett M, Brunsdon C, Bury G, Charlton M, Collins C, Deasy C, De Brun A, Fitzsimons J, Galligan M, Hensey C, Kiernan F, McAuliffe E. Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol. HRB Open Res 2019. [DOI: 10.12688/hrbopenres.12897.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents’ and families’ preferences and decision making when seeking unscheduled paediatric healthcare. Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies such as Sláintecare that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients’ behaviour.
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25
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Hodgson K, Deeny SR, Steventon A. Ambulatory care-sensitive conditions: their potential uses and limitations. BMJ Qual Saf 2019; 28:429-433. [PMID: 30819838 DOI: 10.1136/bmjqs-2018-008820] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 11/04/2022]
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Boyle S, Dennehy R, Healy O, Browne J. Development of performance indicators for systems of urgent and emergency care in the Republic of Ireland: Systematic review and consensus development exercise. HRB Open Res 2018. [PMID: 32002501 DOI: 10.12688/hrbopenres.12805.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives: To develop a set of performance indicators to monitor the performance of emergency and urgent care systems in the Republic of Ireland. Design: This study comprised of an update of a previously performed systematic review and a formal consensus development exercise. Results: Initial literature searches yielded 2339 article titles. After further searches, sixty items were identified for full-text review. Following this review, fifty-seven were excluded. Three articles were identified for inclusion in the systematic review. These papers produced 42 unique indicators for consideration during the consensus development exercise. In total, 17 indicators had a median of greater than 7 following the meeting and met our pre-specified criterion for acceptable consensus. Discussion: Using this systematic review and nominal group consensus development exercise, we have identified a set of 17 indicators, which a consensus of different experts regard as potentially good measures of the performance of urgent and emergency care systems in Ireland.
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Affiliation(s)
- Siobhan Boyle
- School of Public Health, University College Cork, Cork, Ireland
| | - Rebecca Dennehy
- School of Public Health, University College Cork, Cork, Ireland
| | - Orla Healy
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
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Boyle S, Dennehy R, Healy O, Browne J. Development of performance indicators for systems of urgent and emergency care in the Republic of Ireland: Systematic review and consensus development exercise. HRB Open Res 2018; 1:6. [PMID: 32002501 PMCID: PMC6973523 DOI: 10.12688/hrbopenres.12805.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2018] [Indexed: 11/20/2022] Open
Abstract
Objectives: To develop a set of performance indicators to monitor the performance of emergency and urgent care systems in the Republic of Ireland. Design: This study comprised of an update of a previously performed systematic review and a formal consensus development exercise. The literature search was conducted in PubMed and covered the period 2008 to 2014. The results of the review were used to inform a consensus group of 17 national experts on urgent and emergency care in Ireland. The consensus development exercise comprised an online survey followed by a face-to-face nominal group technique meeting. During this meeting participants had the opportunity to revise their preferences for different indicators after listening to the views of other group members. A final online survey was then used to confirm the preferences of participants. Results: Initial literature searches yielded 2339 article titles. After further searches, sixty items were identified for full-text review. Following this review, fifty-seven were excluded. Three articles were identified for inclusion in the systematic review. These papers produced 42 unique indicators for consideration during the consensus development exercise. In total, 17 indicators had a median of greater than 7 following the meeting and met our pre-specified criterion for acceptable consensus. Discussion: Using this systematic review and nominal group consensus development exercise, we have identified a set of 17 indicators, which a consensus of different experts regard as potentially good measures of the performance of urgent and emergency care systems in Ireland. Pragmatic implications are discussed with reference to three subsequently performed original studies which used some of the indicators
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Affiliation(s)
- Siobhan Boyle
- School of Public Health, University College Cork, Cork, Ireland
| | - Rebecca Dennehy
- School of Public Health, University College Cork, Cork, Ireland
| | - Orla Healy
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - John Browne
- School of Public Health, University College Cork, Cork, Ireland
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