1
|
Maruster L, van der Zee DJ, Buskens E. Identifying Frequent Health Care Users and Care Consumption Patterns: Process Mining of Emergency Medical Services Data. J Med Internet Res 2021; 23:e27499. [PMID: 34612834 PMCID: PMC8529480 DOI: 10.2196/27499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/02/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Tracing frequent users of health care services is highly relevant to policymakers and clinicians, enabling them to avoid wasting scarce resources. Data collection on frequent users from all possible health care providers may be cumbersome due to patient privacy, competition, incompatible information systems, and the efforts involved. Objective This study explored the use of a single key source, emergency medical services (EMS) records, to trace and reveal frequent users’ health care consumption patterns. Methods A retrospective study was performed analyzing EMS calls from the province of Drenthe in the Netherlands between 2012 and 2017. Process mining was applied to identify the structure of patient routings (ie, their consecutive visits to hospitals, nursing homes, and EMS). Routings are used to identify and quantify frequent users, recognizing frail elderly users as a focal group. The structure of these routes was analyzed at the patient and group levels, aiming to gain insight into regional coordination issues and workload distributions among health care providers. Results Frail elderly users aged 70 years or more represented over 50% of frequent users, making 4 or more calls per year. Over the period of observation, their annual number and the number of calls increased from 395 to 628 and 2607 to 3615, respectively. Structural analysis based on process mining revealed two categories of frail elderly users: low-complexity patients who need dialysis, radiation therapy, or hyperbaric medicine, involving a few health care providers, and high-complexity patients for whom routings appear chaotic. Conclusions This efficient approach exploits the role of EMS as the unique regional “ferryman,” while the combined use of EMS data and process mining allows for the effective and efficient tracing of frequent users’ utilization of health care services. The approach informs regional policymakers and clinicians by quantifying and detailing frequent user consumption patterns to support subsequent policy adaptations.
Collapse
Affiliation(s)
- Laura Maruster
- Faculty of Economics and Business, University of Groningen, Groningen, Netherlands
| | | | - Erik Buskens
- Faculty of Economics and Business, University of Groningen, Groningen, Netherlands.,Health Technology Assessment, Department of Epidemiology, University Medical Center Groningen, Groningen, Netherlands
| |
Collapse
|
2
|
Harvey G, Pham CT, Inacio MC, Laver K, Lynch EA, Jorissen RN, Karnon J, Bourke A, Forward J, Maddison J, Whitehead C, Rupa J, McNamara C, Crotty M. An integrated knowledge translation approach to address avoidable rehospitalisations and unplanned admissions for older people in South Australia: implementation and evaluation program plan. Implement Sci Commun 2021; 2:36. [PMID: 33827707 PMCID: PMC8025566 DOI: 10.1186/s43058-021-00141-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 12/20/2022] Open
Abstract
Background Repeated admission to hospital can be stressful for older people and their families and puts additional pressure on the health care system. While there is some evidence about strategies to better integrate care, improve older patients’ experiences at transitions of care, and reduce preventable hospital readmissions, implementing these strategies at scale is challenging. This program of research comprises multiple, complementary research activities with an overall goal of improving the care for older people after discharge from hospital. The program leverages existing large datasets and an established collaborative network of clinicians, consumers, academics, and aged care providers. Methods The program of research will take place in South Australia focusing on people aged 65 and over. Three inter-linked research activities will be the following: (1) analyse existing registry data to profile individuals at high risk of emergency department encounters and hospital admissions; (2) evaluate the cost-effectiveness of existing ‘out-of-hospital’ programs provided within the state; and (3) implement a state-wide quality improvement collaborative to tackle key interventions likely to improve older people’s care at points of transitions. The research is underpinned by an integrated approach to knowledge translation, actively engaging a broad range of stakeholders to optimise the relevance and sustainability of the changes that are introduced. Discussion This project highlights the uniqueness and potential value of bringing together key stakeholders and using a multi-faceted approach (risk profiling; evaluation framework; implementation and evaluation) for improving health services. The program aims to develop a practical and scalable solution to a challenging health service problem for frail older people and service providers.
Collapse
Affiliation(s)
- Gillian Harvey
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Clarabelle T Pham
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Maria C Inacio
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Kate Laver
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Elizabeth A Lynch
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Robert N Jorissen
- Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Jonathan Karnon
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, Australia
| | - Alice Bourke
- Department of Geriatric and Rehabilitation Medicine, Royal Adelaide Hospital, Adelaide, Australia
| | - John Forward
- Aged Care, Rehabilitation and Palliative Care Division, Northern Adelaide Local Health Network, Adelaide, Australia
| | - John Maddison
- Medical Services, Northern Adelaide Local Health Network, Adelaide, Australia
| | - Craig Whitehead
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
| | - Jesmin Rupa
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia.
| | - Carmel McNamara
- Adelaide Nursing School, University of Adelaide, Adelaide, Australia
| | - Maria Crotty
- Division of Rehabilitation, Aged and Palliative Care, College of Medicine and Public Health, Flinders Medical Centre, Flinders University, Adelaide, Australia
| |
Collapse
|
3
|
Westgård T, Andersson Hammar I, Dahlin-Ivanoff S, Wilhelmson K. Can Comprehensive Geriatric Assessment Meet Frail Older People's Needs? Results from the Randomized Controlled Study CGA-Swed. Geriatrics (Basel) 2020; 5:E101. [PMID: 33291834 PMCID: PMC7768486 DOI: 10.3390/geriatrics5040101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The comprehensive geriatric assessment (CGA) designed to manage frail older people requiring acute medical care, is responsible for diagnostics, assessment, treatment, and planning while addressing a person's medical, psychological, social, and functional capabilities. The aim was to investigate if CGA had an impact on frail older people's activities of daily living (ADL) status, self-rated health, and satisfaction with hospital care. METHODS A two-armed design with frail people aged 75 or older who required an unplanned hospital admission were randomized to either the CGA ward or to an acute medical ward. Analyses were made based on the intention-to-treat principle (ITT). The primary outcome was ADL. Data were analyzed using Chi-square and odds ratio. A subgroup analysis was performed due to non-adherence and contamination. RESULTS One-hundred and fifty-five people participated in the study; 78 in the intervention and 77 in the control. Participants in the intervention group had a higher odds ratio of reporting having received written information and felt that care met their needs during their hospital stay. No additional statistically significant results for the primary or secondary outcomes in the ITT analysis were achieved. CONCLUSION Participants felt that the care they received with the CGA ward met their needs. The lack of additional results supporting the CGA could be due to difficulties performing pragmatic intervention trials in clinical hospital settings, and because a CGA during one hospital stay is probably not enough to have long-term effects.
Collapse
Affiliation(s)
- Theresa Westgård
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (I.A.H.); (K.W.)
- Centre of Aging and Health-AGECAP, University of Gothenburg, 405 30 Gothenburg, Sweden;
| | - Isabelle Andersson Hammar
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (I.A.H.); (K.W.)
- Centre of Aging and Health-AGECAP, University of Gothenburg, 405 30 Gothenburg, Sweden;
| | - Synneve Dahlin-Ivanoff
- Centre of Aging and Health-AGECAP, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Katarina Wilhelmson
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden; (I.A.H.); (K.W.)
- Centre of Aging and Health-AGECAP, University of Gothenburg, 405 30 Gothenburg, Sweden;
- Department of Geriatrics, The Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| |
Collapse
|
4
|
Harvey G, Dollard J, Marshall A, Mittinty MM. Creating the Right Sort of Ship to Achieve Integrated Care: A Response to Recent Commentaries. Int J Health Policy Manag 2019; 8:317-318. [PMID: 31204449 PMCID: PMC6571490 DOI: 10.15171/ijhpm.2019.04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 12/02/2022] Open
Affiliation(s)
- Gill Harvey
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | - Joanne Dollard
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Amy Marshall
- Adelaide Nursing School, University of Adelaide, Adelaide, SA, Australia
| | | |
Collapse
|
5
|
Woo J, Yang X, Tin Lui L, Li Q, Fai Cheng K, Fan Y, Yau F, Lee APW, Lee JSW, Fung E. Utility of the FRAIL Questionnaire in Detecting Heart Failure with Preserved Ejection Fraction. J Nutr Health Aging 2019; 23:373-377. [PMID: 30932136 DOI: 10.1007/s12603-019-1158-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To test the utility of the FRAIL questionnaire as a screening tool for heart failure. DESIGN Cross sectional study. SETTING Chinese older people in Hong Kong. PARTICIPANTS Participants aged 60 years and over were recruited from a territory-wide primary care needs assessment for older people based in community centers as well as two nonacute hospitals. MEASUREMENTS Questionnaire administered included the five-item FRAIL scale, and information regarding sociodemographic data, smoking and alcohol use, history of cardiovascular disease and diabetes, and heart failure symptoms. Handgrip strength, walking speed and 6 minute walk distance were recorded. Cardiac assessment included electrocardiogram, echocardiography, and blood assay for N-terminal prohormone of B-type natriuretic peptide (NT-proBNP). RESULTS The prevalence of diastolic dysfunction was high, being 52% in the robust group, increasing to 65% in the pre-frail and 85% in the frail group. This finding is accompanied by a corresponding increase in NT-proBNP from 64.18 pg/ml in the robust group, to 118.57 pg/ml in the pre-frail and 167.98 pg/ml in the frail group. Three of the five components of the FRAIL scale, fatigue, resistance and ambulation, were associated with increased odds ratios of diastolic dysfunction among those aged 75 years and older, while resistance alone was associated with increased odds ratio among those less than 75 years old. CONCLUSION Frailty is associated with heart failure with preserved ejection fraction (HFpEF), and frailty screening may be used to detect undiagnosed HFpEF. The findings support the proposal that HFpEF be considered a geriatric syndrome.
Collapse
Affiliation(s)
- J Woo
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T. Hong Kong, Tel: 852-3505-3493, Fax: 852-2637-3852,
| | | | | | | | | | | | | | | | | | | |
Collapse
|