Acute Care Reimagined: Home Hospital Care Can Support the Triple Aim and Reduce Health Disparities

Objectives In this paper, we explore and compare types and longitudinal trends of hospital adverse events in Norway and Sweden in the years 2013–2018 with special reference to AEs that contributed to death. Design Acute care hospitals in both countries performed medical record reviews on randomly selected medical records from all eligible admissions. Analysis: Comparison between Norway and Sweden of linear trends from 2013–2018, and percentage rates of admissions with at least one AE according to types and severities. Setting Norway and Sweden have similar socio-economic and demographic characteristics, which constitutes a relevant context for cooperation, comparison and mutual learning. This setting has promoted the use of GTT to monitor national rates of AEs in hospital care in the two countries. Participants 53 367 medical records in Norway and 88 637 medical records in Sweden were reviewed. Results 13.2% of hospital admissions in Norway and 13.1% in Sweden were associated with an AE of all severities (E-I). 0.23% of hospital admissions in Norway and 0.26% in Sweden were associated with an AE that contributed to death (I). The differences between the two countries were not statistically significant. Conclusions There were no significant differences in overall rates (E-I) of AEs in Norway and Sweden, nor in rates of AEs that contributed to death (I). There was no significant change in AEs or fatal AEs in either country over the six-year time period.

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Screening for thyroid disease in women greater than or equal to 50 years of age seeking hospital care: influence of common nonthyroidal illness on serum free thyroxin as determined by analog radioimmunoassay.

Clinical Chemistry ◽

10.1093/clinchem/32.4.603 ◽

1986 ◽

Vol 32 (4) ◽

pp. 603-608 ◽

Cited By ~ 10

Author(s):

E Nyström ◽

K Petersen ◽

G Lindstedt ◽

P A Lundberg

Keyword(s):

Acute Care ◽

Outpatient Clinic ◽

Clinical Setting ◽

Thyroid Disease ◽

Hospital Care ◽

Nonthyroidal Illness ◽

Serum Free ◽

Simple Analog ◽

Acute Medical Care ◽

Medical Outpatients

Abstract We determined free thyroxin (fT4; analog radioimmunoassay) and thyrotropin in serum of women greater than or equal to 50 years of age who were attending a medical casualty ward (n = 363) or a medical outpatient clinic (n = 496), in order to estimate the prevalence of low fT4 results associated with nonthyroidal illness and to screen for previously unknown thyroid disease. Individuals with results outside stated limits were followed up within two to four weeks. Only about 5% of the women seeking acute medical care showed a decrease in fT4 concentration in association with a normal thyrotropin concentration. As expected, this combination was even less common in outpatients. We found a prevalence of previously undiagnosed thyroid disease of clinical significance of 0.8% in medical acute-care cases, 1.8% in medical outpatients. For this clinical setting we regard the simple analog technique as acceptable in spite of the low values reported for some hospitalized patients with nonthyroidal illness.

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Method for Assigning Priority Levels in Acute Care (MAPLe-AC) predicts outcomes of acute hospital care of older persons - a cross-national validation

BMC Medical Informatics and Decision Making ◽

10.1186/1472-6947-11-39 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 3

Author(s):

Anja Noro ◽

Jeffrey W Poss ◽

John P Hirdes ◽

Harriet Finne-Soveri ◽

Gunnar Ljunggren ◽

...

Keyword(s):

Acute Care ◽

Hospital Care ◽

Older Persons ◽

Acute Hospital ◽

Acute Hospital Care ◽

Priority Levels ◽

Cross National

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266 Patient and Carers Experience of an Acute Care at Home Team: A Service Evaluation

Age and Ageing ◽

10.1093/ageing/afz103.166 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii17-iii65

Author(s):

Deborah Toal ◽

DrPatricia McCaffrey

Keyword(s):

Acute Care ◽

Hospital Care ◽

Treatment Plan ◽

Service Evaluation ◽

X Rays ◽

Home Team ◽

Small Areas ◽

Assessment And Treatment ◽

Care At Home ◽

At Home

Abstract Background The Aim of the Acute Care at Home Team is to provide acute care to over 65's in the patient's own home, providing assessment and treatment of acute conditions such as pneumonia, urinary sepsis and heart failure. It is a multidisciplinary team that works together to streamline services to enable a patient to stay safely in their own home. A full comprehensive geriatric assessment is carried out in all patients to help improve patient outcomes. The patients have full access to in patient services such as scans, and x-rays. All blood tests are treated as urgent to ensure the patient is in no way disadvantaged by being treated by acute care at home compared with hospital care. The aims and objectives are to explore patient and family experiences and identify any areas for improvement. Methods A service users and carers experience Questionnaire (N=31) was used to gain insight into how satisfied the patient or family were with the service and what the experience was like having the team come into their home. Results Patient satisfaction with this Acute Care at Home Team was reported at 100%. Patients were happy with the care they received, 100% of patients were happy with staff's knowledge of their condition and treatment plan. All of the respondents stated they would both recommend the service and use it again. The qualitative responses were in keeping with 100% satisfaction in that they were positive in nature. Conclusion This service evaluation has shown that patient and carer experience of this Acute Care at Home Team is a positive one, with 100% satisfaction levels. There are some small areas to be improved upon, however the results show this service is providing the over 65 population with a good experience of being treated at home as an alternative to hospital care when acutely unwell.

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Scoping and testing rural acute care at home: a simulation analysis

BMJ Innovations ◽

10.1136/bmjinnov-2020-000592 ◽

2021 ◽

pp. bmjinnov-2020-000592

Author(s):

David M Levine ◽

Meghna P Desai ◽

Joseph B Ross ◽

Natalie Como ◽

Steve Holley

Keyword(s):

Acute Care ◽

Rural Areas ◽

Hospital Care ◽

Simulation Analysis ◽

Chronically Ill ◽

Urban Environments ◽

Simulation Laboratory ◽

Proper Patient Selection ◽

Chronically Ill Patients ◽

At Home

PurposeHospital-level care provided at home improves patient outcomes, yet nearly all programmes function in urban environments. It remains unknown whether rural home hospital care can be feasibly delivered.MethodsBased on prior stakeholder learning and detailed landscape analyses of various rural areas across the country, we re-engineered the workflows, personnel and technology needed to respond to many of the challenges of delivering acute care in rural homes. We performed a preliminary ‘mock admission’ in a simulation laboratory with actor feedback, followed by mock admissions in rural homes in Utah of chronically ill patients who feigned acute illness. We employed rapid cycle feedback from clinicians, patients and their caregivers and qualitative analysis of participant feedback.FindingsFollowing rapid cycle feedback in the simulation laboratory and rural homes, mock admission, daily rounds and discharge were successfully conducted. Technology performed to laboratory-determined specifications but presented challenges. Patients noted significant comfort with and preference for rural home hospital care, while clinicians also preferred the model with the caveat that proper patient selection was paramount. Patients and clinicians perceived rural home hospital as safe. Clinicians noted rural home hospital workflows were feasible after streamlining remote and in-home roles.ConclusionsRural home hospital care is technically feasible, well-received and desired. It requires testing with acutely ill adults in rural settings.

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The Prevalence of Health Care–Associated Infection in Older People in Acute Care Hospitals

Infection Control and Hospital Epidemiology ◽

10.1086/660871 ◽

2011 ◽

Vol 32 (8) ◽

pp. 763-767 ◽

Cited By ~ 16

Author(s):

Shona Cairns ◽

Jacqui Reilly ◽

Sally Stewart ◽

Debbie Tolson ◽

Jon Godwin ◽

...

Keyword(s):

Health Care ◽

Urinary Tract ◽

Older People ◽

Acute Care ◽

Hospital Care ◽

Age Groups ◽

Acute Care Hospitals ◽

Gastrointestinal Infections ◽

Health Care Associated Infection ◽

Tract Infections

Objective.To determine the prevalence of health care-associated infection (HAI) in older people in acute care hospitals, detailing the specific types of HAI and specialties in which these are most prevalent.Design.Secondary analysis of the Scottish National Healthcare Associated Infection Prevalence Survey data set.Patients and Setting.All inpatients in acute care (n = 11,090) in all acute care hospitals in Scotland (n = 45).Results.The study found a linear relationship between prevalence of HAI and increasing age (P<.0001) in hospital inpatients in Scotland. Urinary tract infections and gastrointestinal infections represented the largest burden of HAI in the 75–84- and over-85-year age groups, and surgical-site infections represented the largest burden in inpatients under 75 years of age. The prevalence of urinary catheterization was higher in each of the over-65 age groups (P<.0001). Importantly, this study reveals that a high prevalence of HAI in inpatients over the age of 65 years is found across a range of specialties within acute hospital care. An increased prevalence of HAI was observed in medical, orthopedic, and surgical specialties.Conclusions.HAI is an important outcome indicator of acute inpatient hospital care, and our analysis demonstrates that HAI prevalence increases linearly with increasing age (P<.0001). Focusing interventions on preventing urinary tract infection and gastrointestinal infections would have the biggest public health benefit. To ensure patient safety, the importance of age as a risk factor for HAI cannot be overemphasized to those working in all areas of acute care.

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Nursing Graduates and Quality of Acute Hospital Care in 33 OECD Countries: Evidence From Generalized Linear Models and Data Envelopment Analysis

SAGE Open Nursing ◽

10.1177/23779608211005217 ◽

2021 ◽

Vol 7 ◽

pp. 237796082110052

Author(s):

Arshia Amiri

Keyword(s):

Acute Care ◽

Hospital Care ◽

Clinical Effectiveness ◽

Acute Hospital ◽

Nursing Graduates ◽

Graduate Nurses ◽

New Graduate Nurses ◽

Acute Hospital Care ◽

New Graduate

Background There is a lack of cross-national research to examine the role of new graduate nurses in improving the quality of nursing care and patient outcomes. Purpose To measure the role and clinical effectiveness of new graduate nurses in improving the quality of acute hospital care in the members of Organisation for Economic Co-operation and Development (OECD). Methods The total number of nursing graduates per 100,000 population and three OECD’s Health Care Quality Indicators (HCQI) in acute care including 30-day in-hospital and out-of-hospital mortality rates per 100 patients based on acute myocardial infarction (MORTAMIO), hemorrhagic stroke (MORTHSTO) and ischemic stroke (MORTISTO) were collected in 33 OECD countries. Four control variables including the number of medical graduates, practicing nurses and doctors densities per 1000 population (proxies for other health professions) and the total number of Computed Tomography scanners per one million population (proxy of medical technology level) were added in investigations. The statistical technique of Generalized Linear Models (GLM) and Data Envelopment Analysis (DEA) were used in data analysis. Results Results of GLM confirm the existence of meaningful association between the density of nursing graduates and improving the quality of acute care i.e. a 1% rise in the number of nursing graduates in year 2015 reduced MORTAMIO, MORTHSTO and MORTISTO by 1.11%, 0.08% and 0.46%, respectively. According to the result of DEA, clinical effectiveness of new graduate nurses – i.e. reaching the higher clinical outcomes with the same staffing level – in reducing mortality rates in patients with life-threatening conditions were at highest level in Luxembourg, Finland, Japan, Italy, Norway, Sweden and Switzerland. Conclusions Higher staffing level of new graduate nurses associates with better patient outcomes in acute care, although the clinical effectiveness of nursing graduates – associated with the level of education and practice – is the determinant factor of improving the quality of acute hospital care and patient survival rates in OECD.

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Health Disparities in Delirium

Innovation in Aging ◽

10.1093/geroni/igab046.568 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 148-148

Author(s):

Robert Dicks ◽

Jimmy Choi ◽

Christine Waszynski ◽

Kadesha Collins-Fletcher ◽

Beth Taylor ◽

...

Keyword(s):

Health Disparities ◽

Acute Care ◽

Health Disparity ◽

Age Groups ◽

High Specificity ◽

Confusion Assessment Method ◽

Assessment Method ◽

Mitigation Strategies ◽

Chi Square ◽

Increased Risk

Abstract Racial and ethnic minority populations in the US experience greater cumulative disease burden, as well as social and economic barriers, stressors, and limited advocacy/access to culturally informed healthcare. This increased risk burden is expected to be associated with an increased risk for delirium during acute care encounters. Previous studies on health disparity and delirium are limited and report equivocal findings regarding delirium incidence, possibly related to sample bias or non-validated measures. Risk for delirium during acute care in health disparity populations (HDP) that include Black African Americans (BAA) and Hispanic-Latinx (HL) has not been systematically studied using validated measures. We conducted a retrospective analysis utilizing our delirium program (ADAPT) registry that systematically assessed all hospitalized patients through their entire hospital stay for the years 2018-2019 (36K patients, 80% NHW, 11% HL, 9% BAA). The Confusion Assessment Method (CAM and CAM-ICU) and Richmond Agitation Sedation Scale (RASS) were used as screening assessments to identify delirium. We know from previous studies that negative CAM results in our environment have high specificity. The incidence of delirium between populations was compared using a chi-square test. Delirium incidence was higher in HDP (BAA combined with HL) compared to NHW in 71-80yo (16.0% vs 12.6%, p=0.003). Delirium incidence was not different in all other age groups compared; <65yo (p=0.191), 61-70yo (p=0.223), 81-90yo (p=0.644). Understanding the association, or lack thereof, between health disparities, ethnic and race-based risks for delirium is expected to provide important insights into more focused delirium assessment, prevention and mitigation strategies in these populations.

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Intended and unintended changes in length of stay following reconfiguration of emergency care departments

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab008 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Søren Bie Bogh ◽

Marianne Fløjstrup ◽

Sören Möller ◽

Mickael Bech ◽

Søren Paaske Johnsen ◽

...

Keyword(s):

Length Of Stay ◽

Acute Care ◽

Hospital Care ◽

Time Of Day ◽

Acute Hospital ◽

Downward Trend ◽

Care Organization ◽

Acute Hospital Care ◽

Time Ratio ◽

Overnight Stays

Abstract Background The Danish health-care system has witnessed noticeable changes in the acute hospital care organization. The reconfiguration includes closing hospitals, centralizing acute care functions and investing in new buildings and equipment. Objective To examine the impact on the length of stay (LOS) and the proportion of overnight stays for hospitalized acute care patients. Methods This nationwide interrupted time series examined trend changes in LOS and overnight stay. Admissions were stratified based on admission time (weekdays/weekends and time of day), age and the level of co-morbidity Results In 2007–2016, the global average LOS declined 2.9% per year (adjusted time ratio [CI (confidence interval) 95%] 0.971 [0.970–0.971]). The reconfiguration was overall not associated with change in trend of LOS (time ratio [CI 95%] 1.001 [1.000–1.002]). When admissions were stratified for either weekdays or weekends, the reconfiguration was associated with reduction of the underlying downward trend for weekdays (time ratio [CI 95%] 1.004 [1.003–1.005]) and increased downward trend for weekend admissions (time ratio [CI 95%] 0.996 [0.094–0.098]). Admissions at night were associated with a 0.7% trend change in LOS (time ratio [CI 95%] 0.993 [0.991–0.996]). The reconfiguration was not associated with trend changes for overnight stays. Conclusion The nationwide reconfiguration of acute hospital care was overall not associated with change in trend for the registered LOS and no change in trend for overnight stays. However, the results varied according to hospitalization time, where admissions during weekends and nights after the reconfiguration were associated with shortened LOS.

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