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Koppitz AL, Suter-Riederer S, Bieri-Brünig G, Geschwinder H, Senn AK, Spichiger F, Volken T. Prevention Admission into Nursing homes (PAN): study protocol for an explorative, prospective longitudinal pilot study. BMC Geriatr 2022; 22:227. [PMID: 35305555 PMCID: PMC8933976 DOI: 10.1186/s12877-022-02885-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Switzerland, there is a lack of adequate rehabilitation services, and effective coordination, that take into account the multifactorial health risks of older people. The literature shows that the hospitalisation rate in rehabilitation facilities has increased in recent years and that a gender bias exists. Additionally, there is little or no evidence available on the effect that a post-acute care programme might have over an extended period on functioning, quality of life and the informal network of older people. Therefore, the aim of this trial is to evaluate the sustainability of post-acute care within three nursing homes in Zurich, Canton of Zurich, Switzerland. METHODS The Prevention Admission into Nursing homes (PAN) study is a explorative, prospective, longitudinal pilot trial based on a convenience sample of three long-term care facilities in the Swiss Canton of Zurich. The proposed pilot study will examine the effects of a post-acute care programme on people aged ≥65 years with a post-acute care potential ≥ three admitted to any of the three post-acute care units (n = 260). Older people of all sexes admitted to one of the post-acute care units and likely to be discharged to home within 8 weeks will be eligible for participation in the study. The primary endpoint is functionality based on the Barthel Index. The secondary endpoints are independency based on delirium, cognition, mobility, falling concerns, frailty, weight/height/body mass index, post-acute care capability, quality of life, and lastly, the informal network. As part of process evaluation, a qualitative evaluation will be conducted based on constructive grounded theory to specifically analyse how the experience of informal caregivers (n = 30) can contribute to a successful daily life 6 months after discharge. DISCUSSION We expect to observe improved functional status and independence after the post-acute care programme. The qualitative evaluation conducted with caregivers will complement our description of the transition of older people towards living at home. TRIAL REGISTRATION This study is registered in the German Clinical Trials Register under DRKS00016647 (registered on 23.05.2019).
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Affiliation(s)
- Andrea L Koppitz
- School of Health Sciences, Research&Development, University of Applied Science and Arts Western Switzerland HES-SO, Rue des Arsenaux 16a, 1700, Fribourg, Switzerland.
| | | | - Gabriela Bieri-Brünig
- Department of Nursing Homes of the City of Zurich (PZZ), Walchestrasse 31, Post Box 3251, 8021, Zurich, Switzerland
| | - Heike Geschwinder
- Department of Nursing Homes of the City of Zurich (PZZ), Walchestrasse 31, Post Box 3251, 8021, Zurich, Switzerland
| | - Anita Keller Senn
- School of Health Sciences, Research&Development, University of Applied Science and Arts Western Switzerland HES-SO, Rue des Arsenaux 16a, 1700, Fribourg, Switzerland
- Department of Endocrinology and Diabetology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8400, Winterthur, Switzerland
| | - Frank Spichiger
- School of Health Sciences, Research&Development, University of Applied Science and Arts Western Switzerland HES-SO, Rue des Arsenaux 16a, 1700, Fribourg, Switzerland
| | - Thomas Volken
- Institute of Health Science, Research&Development, Zurich University of Applied Sciences ZHAW, Katharina-Sulzer-Platz 9, 8400, Winterthur, Switzerland
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Young DL, Colantuoni E, Friedman LA, Seltzer J, Daley K, Ye B, Brotman DJ, Hoyer EH. Prediction of Disposition Within 48 Hours of Hospital Admission Using Patient Mobility Scores. J Hosp Med 2020; 15:540-543. [PMID: 31869298 DOI: 10.12788/jhm.3332] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/20/2019] [Indexed: 11/20/2022]
Abstract
Delayed hospital discharges for patients needing rehabilitation in a postacute setting can exacerbate hospital-acquired mobility loss, prolong functional recovery, and increase costs. Systematic measurement of patient mobility by nurses early during hospitalization has the potential to help identify which patients are likely to be discharged to a postacute care facility versus home. To test the predictive ability of this approach, a machine learning classification tree method was applied retrospectively to a diverse sample of hospitalized patients (N = 761) using training and validation sets. Compared with patients discharged to home, patients discharged to a postacute facility were older (median, 64 vs 56 years old) and had lower mobility scores at hospital admission (median, 32 vs 41). The final decision tree accurately classified the discharge location for 73% (95% CI, 67%-78%) of patients. This study emphasizes the value of systematically measuring mobility in the hospital and provides a simple decision tree to facilitate early discharge planning.
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Affiliation(s)
- Daniel L Young
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Department of Physical Therapy, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lisa Aronson Friedman
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jason Seltzer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Kelly Daley
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Bingqing Ye
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
| | - Daniel J Brotman
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Erik H Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
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Kollbrunner L, Rost M, Koné I, Zimmermann B, Padrutt Y, Wangmo T, Elger B. Acute and transitional care or rehabilitation? Retrospective analysis of discharge planning from a municipal hospital in Switzerland. BMC Health Serv Res 2020; 20:712. [PMID: 32746810 PMCID: PMC7397668 DOI: 10.1186/s12913-020-05547-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/15/2020] [Indexed: 11/27/2022] Open
Abstract
Background Due to rising health care costs, in 2012 Switzerland introduced SwissDRG, a reimbursement system for hospitals based on lump sum per case. To circumvent possible negative consequences like reduction in length of stay, acute and transitional care (ATC) was anchored into the law (Federal act on health insurance) in 2011. ATC as a discharge option is applicable to patients who physicians deem will not fulfill rehabilitation criteria, but are unable to return home and are in need of temporary professional nursing care. ATC is associated with higher out of pocket costs to the patient than rehabilitation. Since social service workers are responsible for organizing discharge for patients with ongoing care needs after hospitalization, the aim of this study was to investigate how social service workers manage patient discharge in light of the new discharge option ATC. Methods Data was collected from 423 medical records of inpatients from Zurich’s municipal hospital, Triemli, discharged to ATC or rehabilitation, in 2016. We compared the two groups using inferential statistics and qualitatively analyzed written statements from social service workers. Results Our results showed that patients discharged to rehabilitation had a higher total number of discussions, but a shorter duration of discussions. Patients discharged to rehabilitation faced more delays, mainly due to unavailability of beds in rehabilitation centers. Conflicts concerning discharge arose mainly because of costs, discharge placement and too early discharge. Conclusions Our findings demonstrate how important social service workers are in providing information to patients about different discharge options. The newness of SwissDRG and ATC is still likely to cause longer discussion times and, consequently, more workload for social service workers. Only a small fraction of patients disagreed with their place of discharge, mostly due to financial reasons.
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Affiliation(s)
- Lara Kollbrunner
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Bettina Zimmermann
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Yvonne Padrutt
- Institute of legal science, University of Zurich, Treichlerstrasse 10, 8032 Zürich, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Bernice Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Center for legal medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland
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Wangmo T, Padrutt Y, Koné I, Gächter T, Elger BS, Leu A. Practicality of Acute and Transitional Care and its consequences in the era of SwissDRG: a focus group study. BMC Health Serv Res 2019; 19:374. [PMID: 31196075 PMCID: PMC6567569 DOI: 10.1186/s12913-019-4220-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 06/05/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Switzerland recently introduced Acute and Transitional Care (ATC) as a new financing option and a preventive measure to mitigate potential side effects of Swiss Diagnosis Related Group (SwissDRG). The goal of ATC was to support patients who after acute treatment at a hospital require temporary increased professional care. However, evidence is lacking as to the practicality of ATC. METHODS Using qualitative focus group methodology, we sought to understand the implementation and use of ATC. A purposive sample of forty-two professionals from five Swiss cantons participated in this study. We used a descriptive thematic approach to analyse the data. RESULTS Our findings first reveal that ATC's implementation differs in the five cantons (i.e. federal states). In two cantons, only ambulatory variant of ATC is used; in one canton only stationary ATC has been created, and two cantons had both ambulatory and stationary ATC but preferred the latter. Second, there are intrinsic practical challenges associated with ATC, which include physicians' lack of familiarity with ATC and its regulatory limitations. Finally, participants felt that due to shorter hospital stays because of SwissDRG, premature discharge of patients with complex care needs to stationary ATC takes place. This development does not fit the nursing home concept of care tailored to long-term patients. CONCLUSION This empirical study underscores that there is a strong need to improve ATC so that it is uniformly implemented throughout the country and its application is streamlined. In light of the newness of ATC as well as SwissDRG, their impact on the quality of care received by patients is yet to be fully understood. Empirical evidence is necessary to improve these two measures.
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Affiliation(s)
- Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Yvonne Padrutt
- Faculty of Law, University of Zurich, Zurich, Switzerland
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Thomas Gächter
- Faculty of Law, University of Zurich, Zurich, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Center for Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Agnes Leu
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Department Health Sciences, Kalaidos University of Applied Sciences, Zurich, Switzerland
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