scholarly journals COVID-19 risk factors amongst 14,786 care home residents: An observational longitudinal analysis including daily community positive test rates of COVID-19, hospital stays, and vaccination status in Wales (UK) between 1st September 2020 and 1st May 2021.

2021 ◽  
Author(s):  
Joe Hollinghurst ◽  
Robyn Hollinghurst ◽  
Laura North ◽  
Amy Mizen ◽  
Ashley Akbari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Hospital Admissions ◽  
Care Home ◽  
Vaccination Status ◽  
Care Homes ◽  
Positive Test ◽  
Care Providers ◽  
Specialist Care ◽  
Individual Level

Objectives: Determine individual level risk factors for care home residents testing positive for SARS-CoV-2. Study Design: Longitudinal observational cohort study using individual-level linked data. Setting: Care home residents in Wales (United Kingdom) between 1st September 2020 and 1st May 2021. Participants: 14,786 older care home residents (aged 65+). Our dataset consisted of 2,613,341 individual-level daily observations within 697 care homes. Methods: We estimated odds ratios (ORs [95% confidence interval]) using multilevel logistic regression models. Our outcome of interest was a positive SARS-CoV-2 polymerase chain reaction (PCR) test. We included time dependent covariates for the estimated community positive test rate of COVID-19, hospital admissions, and vaccination status. Additional covariates were included for age, positive PCR tests prior to the study, sex, frailty (using the hospital frailty risk score), and specialist care home services. Results: The multivariable logistic regression model indicated an increase in age (OR 1.01 [1.00,1.01] per year of age), community positive test rate (OR 1.13 [1.12,1.13] per percent increase in positive test rate), hospital inpatients (OR 7.40 [6.54,8.36]), and residents in care homes with non-specialist dementia care (OR 1.42 [1.01,1.99]) had an increased odds of a positive test. Having a positive test prior to the observation period (OR 0.58 [0.49,0.68]) and either one or two doses of a vaccine (0.21 [0.17,0.25] and 0.05 [0.02,0.09] respectively) were associated with a decreased odds of a positive test. Conclusions: Our findings suggest care providers need to stay vigilant despite the vaccination rollout, and extra precautions should be taken when caring for the most vulnerable. Furthermore, minimising potential COVID-19 infection for care home residents admitted to hospital should be prioritised.

scholarly journals COVID-19 infection and attributable mortality in UK care homes: cohort study using active surveillance and electronic records (March–June 2020)

2021 ◽  
Author(s):  
Peter F Dutey-Magni ◽  
Haydn Williams ◽  
Arnoupe Jhass ◽  
Greta Rait ◽  
Fabiana Lorencatto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Care Home ◽  
Case Fatality ◽  
Epidemiological Data ◽  
Care Homes ◽  
Attributable Mortality ◽  
Term Care ◽  
Individual Level ◽  
Staffing Ratios

Abstract Background epidemiological data on COVID-19 infection in care homes are scarce. We analysed data from a large provider of long-term care for older people to investigate infection and mortality during the first wave of the pandemic. Methods cohort study of 179 UK care homes with 9,339 residents and 11,604 staff. We used manager-reported daily tallies to estimate the incidence of suspected and confirmed infection and mortality in staff and residents. Individual-level electronic health records from 8,713 residents were used to model risk factors for confirmed infection, mortality and estimate attributable mortality. Results 2,075/9,339 residents developed COVID-19 symptoms (22.2% [95% confidence interval: 21.4%; 23.1%]), while 951 residents (10.2% [9.6%; 10.8%]) and 585 staff (5.0% [4.7%; 5.5%]) had laboratory-confirmed infections. The incidence of confirmed infection was 152.6 [143.1; 162.6] and 62.3 [57.3; 67.5] per 100,000 person-days in residents and staff, respectively. Sixty-eight percent (121/179) of care homes had at least one COVID-19 infection or COVID-19-related death. Lower staffing ratios and higher occupancy rates were independent risk factors for infection. Out of 607 residents with confirmed infection, 217 died (case fatality rate: 35.7% [31.9%; 39.7%]). Mortality in residents with no direct evidence of infection was twofold higher in care homes with outbreaks versus those without (adjusted hazard ratio: 2.2 [1.8; 2.6]). Conclusions findings suggest many deaths occurred in people who were infected with COVID-19, but not tested. Higher occupancy and lower staffing levels were independently associated with risks of infection. Protecting staff and residents from infection requires regular testing for COVID-19 and fundamental changes to staffing and care home occupancy.

scholarly journals National Early Warning Scores And COVID-19 Deaths In Care Homes: An Ecological Time Series Study

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 962-963
Author(s):  
Daniel Stow ◽  
Robert Barker ◽  
Fiona Matthews ◽  
Barbara Hanratty
Keyword(s):  
Time Series ◽  
Oxygen Saturation ◽  
Respiratory Rate ◽  
Early Warning ◽  
Disease Surveillance ◽  
Care Home ◽  
Outcome Data ◽  
Care Homes ◽  
Individual Level ◽  
Early Warning Scores

Abstract Tracking COVID-19 infections in the care home population has been challenging, because of the limited availability of testing and varied disease presentation. We consider whether National Early Warning Scores (NEWS/NEWS2) could contribute to COVID-19 surveillance in care homes. We analysed NEWS measurements from care homes in England (December 2019 to May 2020). We estimated pre-COVID (baseline) levels for NEWS and NEWS components using 80th and 20th centile scores for measurements before March 2020. We used time-series to compare the proportion of above-baseline NEWS to area-matched reports of registered deaths in care home residents from the Office for National Statistics We analysed 29,656 anonymised NEWS from 6,464 people in 480 care home units across 46 local authority areas. From March 23rd to May 20th, there were 5,753 deaths (1,532 involving COVID-19, 4,221 other causes) in corresponding geographical areas. A rise in the proportion of above-baseline NEWS was observed from March 16th 2020. The proportion of above-baseline oxygen saturation, respiratory rate and temperature measurements also increased approximately two weeks before peaks in deaths. We conclude that NEWS could contribute to disease surveillance in care homes during the COVID-19 pandemic. Oxygen saturation, respiratory rate and temperature could be prioritised as they appear to signal rise in mortality almost as well as total NEWS. This study reinforces the need to collate data from care homes, to monitor and protect residents’ health. Further work using individual level outcome data is needed to evaluate the role of NEWS in the early detection of resident illness.

scholarly journals Malnutrition in the UK: where does it begin?

2010 ◽  
Vol 69 (4) ◽  
pp. 465-469 ◽  
Author(s):  
C. A. Russell ◽  
M. Elia
Keyword(s):  
High Risk ◽  
Hospital Admissions ◽  
Care Home ◽  
Healthcare Services ◽  
Care Homes ◽  
Sheltered Housing ◽  
Nutrition Screening ◽  
Good Opportunity ◽  
Outpatient Departments ◽  
The Uk

More than 3 million individuals are estimated to be at risk of malnutrition in the UK, of whom about 93% live in the community. BAPEN's Nutrition Screening Week surveys using criteria based on the ‘Malnutrition Universal Screening Tool’ (‘MUST’) revealed that 28% of individuals on admission to hospital and 30–40% of those admitted to care homes in the previous 6 months were malnourished (medium+high risk using ‘MUST’). About three quarters of hospital admissions and about a third of care home admissions came from their own homes with a malnutrition prevalence of 24% in each case. Outpatient studies using ‘MUST’ showed that 16–20% patients were malnourished and these were associated with more hospital admissions and longer length of stay. In sheltered housing, 10–14% of the tenants were found to be malnourished, with an overall estimated absolute prevalence of malnutrition which exceeded that in hospitals. In all cases, the majority of subjects were at high risk of malnutrition. These studies have helped establish the magnitude of the malnutrition problem in the UK and identified the need for integrated strategies between and within care settings. While hospitals provide a good opportunity to identify malnourished patients among more than 10 million patients admitted there annually and the five- to six-fold greater number attending outpatient departments, commissioners and providers of healthcare services should be aware that much of the malnutrition present in the UK originates in the community before admission to hospitals or care homes or attendance at outpatient clinics.

PP34  Collecting experience-based expertise when planning prehospital care research: a stakeholder event about evaluating paramedics working in care homes

2020 ◽  
Vol 37 (10) ◽  
pp. e16.2-e16
Author(s):  
Bridie Evans ◽  
Mark Kingston ◽  
Alison Porter ◽  
Leigh Keen ◽  
Lesley Griffiths ◽  
...  
Keyword(s):  
Hospital Admissions ◽  
Prehospital Care ◽  
Care Home ◽  
Healthcare Services ◽  
Family Satisfaction ◽  
Care Homes ◽  
Research Development ◽  
Multiple Perspectives ◽  
Care Research ◽  
Wide Range

BackgroundDue to medical advances, the population of care homes is becoming increasingly frail, often with co-morbidities. Recent innovations have seen paramedics take on non-emergency roles within or supporting care homes. This workforce innovation requires urgent evaluation, taking account of the multiple perspectives at stake. Research is more relevant, feasible and accountable if those who commission, deliver and use healthcare services are able to input their professional and personal insights.MethodWe conducted a stakeholder event as part of research development work for paramedics working in care homes (PERCH: Preliminary Exploration of paramedic Roles in Care Homes). We invited representatives from care homes, including Enabling Research in Care Homes (ENRICH) network members, ambulance services, primary and secondary care, patient/resident and public members, and the research community. To inform discussion, we presented examples of paramedics working in care homes. We then facilitated small-group discussions about how to evaluate such innovations and recorded views on sticky notes and flipcharts.Results23 people attended the event. Clarity of roles and communication processes were considered important to implement the pilot project. Attendees agreed that research outcome measures should include changes in avoidable hospital admissions, emergency department attendances and 999 calls plus staff, patient and family satisfaction. They identified some potential benefits to ambulance services and general practice, such as time saved for other patients, but believed these could be difficult to measure.DiscussionGaining the insights of a wide range of stakeholders prior to research being designed is an important, but under-utilised approach in research development. People who deliver and receive community-based care have insight derived from personal and professional experience which complements research expertise. Research in care home settings is challenging, and insights from stakeholders were significant in the development of a research proposal about the role of paramedics in care homes (PERCH study). We submitted this to the Health and Care Research Wales Research for Public and Patient Benefit funding scheme in 2019.

scholarly journals Reducing urinary tract infections in care homes by improving hydration

2019 ◽  
Vol 8 (3) ◽  
pp. e000563 ◽  
Author(s):  
Katie Lean ◽  
Rasanat Fatima Nawaz ◽  
Sundus Jawad ◽  
Charles Vincent
Keyword(s):  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Hospital Admissions ◽  
Low Cost ◽  
Care Home ◽  
Kidney Injury ◽  
Care Staff ◽  
Care Homes ◽  
Raising Awareness ◽  
Tract Infections

Dehydration may increase the risk of urinary tract infections (UTIs), which can lead to confusion, falls, acute kidney injury and hospital admission. We aimed to reduce the number of UTIs in care home residents which require admission to hospital. The principal intervention was the introduction of seven structured drink rounds every day accompanied by staff training and raising awareness. UTIs requiring antibiotics reduced by 58% and UTIs requiring hospital admissions reduced by 36%, when averaged across the four care homes. Care home residents benefited from greater fluid intake, which in turn may have reduced infection. Structured drink rounds were a low-cost intervention for preventing UTIs and implemented easily by care staff.

35 Enhanced Service Through An Integrated New Model of Care in A Buckinghamshire Care Home

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i9-i10
Author(s):  
U Okoli ◽  
S Chimhau ◽  
B Nagyova ◽  
A Sahni ◽  
S Amin ◽  
...  
Keyword(s):  
Best Practice ◽  
Adverse Drug Events ◽  
Hospital Admissions ◽  
Care Home ◽  
Cost Savings ◽  
Care Homes ◽  
Multiple Chronic Conditions ◽  
Model Of Care ◽  
Nice Guideline ◽  
Care Plans

Abstract Introduction Care home residents often have multiple, chronic conditions and are receiving complex treatment regimes. Polypharmacy and medication errors are common. The frequency and quality of medication reviews is variable with limited general practice (GP) capacity to carry out comprehensive reviews. The initiative used a care home pharmacist, technician, geriatrician and GPs to tackle these issues on an individual and care home level. The objective being to ensure the safe and effective use of medicines for all care home residents. NICE guideline [NG56] recommends reducing pharmacological treatment burden for adults with multimorbidity at risk of adverse drug events such as unplanned hospital admissions. A study by Dilles et al1 found adverse drug reactions in 60% of residents. Methods A new interdisciplinary model of care was delivered in a 120 bedded Buckinghamshire care home. Clinical Commissioning Group pharmacist, general practitioners and pharmacy technician reviewed medication for all residents. The most complex individuals were reviewed by the geriatrician and if needed by other multidisciplinary team members specialist. Results Overall 115 medications were stopped for 109 residents, with 31 interventions to reduce falls risk and 19 interventions on medication at high risk2 of causing admission. Total cost savings on medicines optimisation, medicines waste and non-elective admission prevented was £35,211. Residents’ care plans were updated to reflect best practice standards. Conclusions Future direction of this project focuses on system wide improvements to promote interdisciplinary healthcare professionals work in care homes. The success of this integrated model of care has enabled recurrent funding of pharmacist by the local county council and an additional 42 geriatrician sessions into Buckinghamshire care homes. References 1. Dilles T, Vander Stichele R, Van Bortel L, Elseviers M. Journal of American Medical Directors Association 2013; 14: 371–6. 2. Pirmohamed M, et al. Br Med J 2004; 329: 15–9 61.

scholarly journals Clinical Characteristics and Risk Factors for Adverse Outcomes of Influenza Infections in Hematopoietic Stem Cell Transplant Recipients

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 22-22
Author(s):  
Brian J. Chernak ◽  
Emily Coskun ◽  
Nina Orfali ◽  
Yuqing Qiu ◽  
Rosemary Soave ◽  
...  
Keyword(s):  
Risk Factors ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplant ◽  
Stem Cell Transplant ◽  
Vaccination Status ◽  
Adverse Outcomes ◽  
Positive Test ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Graft Versus Host

Background: As one of the most prevalent pathogens in the environment, influenza affects millions of patients annually and contributed to tens of thousands of deaths in the United States during 2018-2019 alone. Immune deficiency is one of the most significant risk factors for adverse outcomes in adults with influenza, and similarly infectious complications are one of the most common causes of death in hematopoietic stem cell transplant (HSCT) recipients. However, data on outcomes or risk factors for progression in influenza infections specifically in HSCT recipients are limited. Methods: We reviewed patient demographics, oncology and transplant history from HSCT recipients with polymerase chain reaction (PCR)-confirmed influenza over 5 influenza seasons (from 2013-2014 through 2018-2019). Influenza subtype (A H1, H3, and B), laboratory studies at diagnosis, treatments, vaccination status, and outcomes for each influenza infection were recorded and analyzed. Results: A total of 143 infection events were collected and analyzed for symptoms and outcomes. Influenza infections of each subtype occurred in each season, although a different strain predominated each season. The most common symptoms at presentation were cough (65.3%) and fever (55.2%). Symptoms at presentation and outcomes were not significantly different amongst Influenza type A H1, A H3 and type B infections (p>0.05). In total, 22 (15.4%) infections presented as lower respiratory tract infections (LRTIs) and 7 additional infections progressed to LRTIs (all LRTI: 29; 20.1%). 63 (44.1%) infected patients required hospital admission, 15 (10.5%) required transfer to the intensive care unit (ICU) and 8 (5.6%) were intubated. 6 patients (4.2%) died by 30 days after the initial positive test, and 23 (16.1%) died by 180 days. LRTI was significantly associated with hospital admission (p<0.001), transfer to the ICU (p<0.001), intubation (p=0.005), and 30-day mortality (p=0.016); it was not significantly associated with 180-day mortality (0.357). The chronic use of steroids within the past 30 days prior to the initial positive test was significantly associated with risk of presenting with a LRTI (p=0.009), all LRTI (p=0.017), admission (p=0.010), and both 30-day (p=0.027) and 180-day mortality (p=0.016). It was not significantly associated with transfer to the ICU (p>0.05) or intubation (p>0.05). No other factors were significantly associated with LRTI, including vaccination status or treatment with antivirals (p>0.05). Logistic regression analysis of selected factors found that patients receiving steroids were significantly associated with LRTI (OR 2.58: 95% CI 1.00-6.63; p=0.047) (Table 1). There was, however, no statistically significant association detected between active graft-versus-host disease and LRTI (OR 1.25: 95% CI 0.35-4.06; p=0.721). We also found that treatment with oseltamivir within 2 days of symptom onset was not significantly associated with LRTI (OR 1.42: 95% CI 0.59-3.49; p=0.431). Persistent shedding (positive tests longer than 21 days from initial positive test) was also not associated with adverse outcomes (p>0.05). Conclusion: This study suggests that the use of chronic steroids in treatment for graft-versus-host disease in HSCT patients may increase the risk for adverse outcomes in influenza infections. Disclosures No relevant conflicts of interest to declare.

scholarly journals The inpatient, outpatient and social care costs associated with atrial fibrillation in Scotland: a record linkage study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Giorgio Ciminata ◽  
Olivia Wu ◽  
Claudia Geue
Keyword(s):  
Economic Burden ◽  
Social Care ◽  
Hospital Admissions ◽  
Healthcare Resource ◽  
Economic Status ◽  
Care Home ◽  
Individual Level ◽  
Socio Economic Status ◽  
The Cost ◽  
Care Costs

ABSTRACTBackgroundAtrial Fibrillation (AF) is a highly debilitating condition with significant economic burden. Previous studies have estimated the cost of hospitalisations associated with AF in Scotland. However, patients with AF are often elderly with co-morbidities requiring substantial outpatient and social care. ObjectivesThis study seeks to estimate inpatient, outpatient and social care costs associated with AF in a Scottish cohort, by using individual-level linked data. MethodsThe AF cohort of 50 years and older patients, hospitalised with a known diagnosis of AF or atrial flutter between 1997 and 2014, was followed up for five years following the first AF event. Individual-level data on hospitalisation and discharge to social care home were obtained from the Scottish Morbidity Records (SMR01); whereas data on outpatient attendance were obtained from (SMR00). Death records for the same time period were extracted from National Records of Scotland (NRS). Hospital and outpatient costs associated with the corresponding data were estimated utilising the Scottish National Tariff (SNT) based on Healthcare Resource Groups (HRGs), and the Scottish Health Service Costs report, respectively. Social care costs were identified from the Care Home Census. Following data linkage, the econometric analysis was carried out using a two-part model where, the first part estimates through a probit model the probability of using a healthcare service, and the second part estimates costs conditional on having incurred positive costs. The regression model was adjusted for demographic characteristics, socio-economic status, year of admission and location. ResultsOverall, a cohort of 253,963 AF patients accounted for 2,988,607 hospital admissions and 4,452,476 outpatient attendances. The mean cost per patient was estimated to be £3,071 (95% CI 3,033-3,109). Overall, hospital admissions and outpatient visits accounted for 71.7% and 3.7% of the total cost, respectively; social care accounted for 24.6% of the total costs. The cost increased with age and females incurred higher costs than males. Significant differences were observed among the urban/rural classifications, individual health boards and the socio-economic status. ConclusionsThis study has shown the importance of taking into account healthcare resource use incurred beyond hospitalisation. In addition to inpatient costs, outpatient and social care costs contribute considerably to the overall economic burden.

scholarly journals Risk factors for unplanned hospital admission in a specialist homeless general practice population: case–control study to investigate the relationship with tri-morbidity

2020 ◽  
Vol 70 (695) ◽  
pp. e406-e411
Author(s):  
Catherine Himsworth ◽  
Priyamvada Paudyal ◽  
Christopher Sargeant
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Factor ◽  
Hospital Admission ◽  
Case Control Study ◽  
Hospital Admissions ◽  
Case Control ◽  
Homeless Population ◽  
Unplanned Hospital Admissions ◽  
Control Study

Background‘Tri-morbidity’ describes the complex comorbidity of chronic physical illness, mental illness, and alcohol and/or drug misuse within the homeless population. Poor health outcomes of homeless people are reflected by the higher rate of unplanned hospital admissions compared with the non-homeless population.AimTo identify whether tri-morbidity is a risk factor for unplanned hospital admissions in the homeless population.Design and settingA case–control study of patients who were registered with a specialist homeless GP surgery in Brighton (72 cases and 72 controls).MethodCases were defined as those who had ≥1 overnight hospital admission within a 12-month period. Controls were matched for demographics but with no hospital admission. The primary care record was analysed, and tri-morbidity entered into binomial logistic regression with admission as the dichotomous dependent variable.ResultsThe logistic regression analysis demonstrated that other enduring mental health disorders and/or personality disorder (odds ratio [OR] 3.84, 95% confidence interval [CI] = 1.56 to 9.44), alcohol use (OR 2.92, 95% CI = 1.42 to 5.98), and gastrointestinal disorder (OR 2.90, 95% CI = 1.06 to 7.98) were independent risk factors for admission. Tri-morbidity increased odds of admission by more than four-fold (OR 4.19, 95% CI = 1.90 to 9.27).ConclusionThis study shows that tri-morbidity is an important risk factor for unplanned hospital admissions among the homeless population, and provides an interesting starting point for the development of a risk stratification tool to identify those at risk of unplanned admission in this population.

Sign in / Sign up

Export Citation Format

Share Document