Health status and health care utilization after discharge from geriatric in-hospital stay - description of a register-based study

Background

This study is the first part of a register-based research program with the overall aim to increase the knowledge of the health status among geriatric patients and to identify risk factors for readmission in this population. The aim of this study was two-fold: 1) to evaluate the validity of the study cohorts in terms of health care utilization in relation to regional cohorts; 2) to describe the study cohorts in terms of health status and health care utilization after discharge.

Methods

The project consist of two cohorts with data from patient records of geriatric in-hospital stays, health care utilization data from Stockholm Regional Healthcare Data Warehouse 6 months after discharge, socioeconomic data from Statistics Sweden. The 2012 cohort include 6710 patients and the 2016 cohort, 8091 patients; 64% are women, mean age is 84 (SD 8).

Results

Mean days to first visit in primary care was 12 (23) and 10 (19) in the 2012 and 2016 cohort, respectively. Readmissions to hospital was 38% in 2012 and 39% in 2016. The validity of the study cohorts was evaluated by comparing them with regional cohorts. The study cohorts were comparable in most cases but there were some significant differences between the study cohorts and the regional cohorts, especially regarding amount and type of primary care.

Conclusion

The study cohorts seem valid in terms of health care utilization compared to the regional cohorts regarding hospital care, but less so regarding primary care. This will be considered in the analyses and when interpreting data in future studies based on these study cohorts. Future studies will explore factors associated with health status and re-admissions in a population with multi-morbidity and disability.

Psychometric Testing of an Instrument About Intimate Partner Violence

This study used step-by-step exploratory factor analysis in the framework of confirmatory factor analysis (EFA/CFA) to evaluate the psychometric properties of the translated and culturally adapted Swedish version of "The Violence Against Women Health Care Provider Survey." The Swedish version of the instrument was needed to measure district nurses' preparedness to encounter women exposed to intimate partner violence. In the first step of EFA/CFA, the eight-factor model was confirmed. The item-total correlations ranged from .22 to 1.01, and Cronbach's alphas from .68 to .71. After removing four items, the corrected item-total correlations ranged from .40 to .97. On the basis of the analysis, we concluded that the Swedish version of the instrument is valid and reliable for evaluating the preparedness of district nurses in Sweden to encounter women exposed to intimate partner violence.

Effects of a stress management program on vital exhaustion and depression in women with coronary heart disease: a randomized controlled intervention study

OBJECTIVES

Psychosocial factors, including depression and vital exhaustion (VE) are associated with adverse outcome in coronary heart disease (CHD). Women with CHD are poor responders to psychosocial treatment and knowledge regarding which treatment modality works in them is limited. This randomized controlled clinical study evaluated the effect of a 1-year stress management program, aimed at reducing symptoms of depression and VE in CHD women.

DESIGN

Patients were 247 women, < or =75 years, recruited consecutively after a cardiac event and randomly assigned to either stress management (20 2-h sessions) and medical care by a cardiologist, or to obtaining usual health care as controls. Measurements at; baseline (6-8 weeks after randomization), 10 weeks (after 10 intervention sessions), 1 year (end of intervention) and 1-2 years follow-up.

RESULTS

For VE, intention to treat analysis showed effects for time (P < 0.001) and time x treatment interaction (P = 0.005), reflecting that both groups improved over time, and that the decrease of VE was more pronounced in the intervention group. However, the level of VE was higher in the intervention group than amongst controls at baseline, 22.7 vs. 19.4 (P = 0.036) but it did not differ later. The change in depressive symptoms did not differ between the groups.

CONCLUSIONS

CHD women attending our program experienced a more pronounced decrease in VE than controls. However, as they had higher baseline levels, due to regression towards the mean we cannot attribute the decrease in VE to the intervention. Whether the program has long-term beneficial effects needs to be evaluated.