scholarly journals Deficits in hospital care among clinically vulnerable children aged 0 to 4 years during the COVID-19 pandemic

2021 ◽  
Author(s):  
David Etoori ◽  
Katie Harron ◽  
Louise Mc Grath-Lone ◽  
Maximiliane Verfeurden ◽  
Ruth Gilbert ◽  
...  
Keyword(s):  
Hospital Care ◽  
Low Birthweight ◽  
Hospital Admissions ◽  
Chronic Health Condition ◽  
Health Condition ◽  
Older Children ◽  
Vulnerable Children ◽  
Hospital Administrative ◽  
Unplanned Hospital Admissions ◽  
Unplanned Admissions

Objective: To quantify deficits in hospital care for clinically vulnerable children during the COVID-19 pandemic. Design: Birth cohort in Hospital Episode Statistics (HES). Setting: NHS hospitals in England. Study population: All children aged <5 years with a birth recorded in hospital administrative data (January 2010 to March 2021). Main exposure: Clinical vulnerability defined by a chronic health condition, preterm birth (<37 weeks gestation) or low birthweight (<2500g). Main outcomes: Deficits in care defined by predicted rates for 2020, estimated from 2015-2019, minus observed rates per 1000 child years during the pandemic (March 2020-2021). Results: Of 3,813,465 children, 17.7% (1 in 6) were clinically vulnerable (9.5% born preterm or low birthweight, 10.3% had a chronic condition). Deficits in hospital care during the pandemic were much higher for clinically vulnerable children than peers: respectively, outpatient attendances (314 versus 73 per 1000 child years), planned admissions (55 versus 10), and unplanned admissions (105 versus 79). Clinically vulnerable children accounted for 50.1% of the deficit in outpatient attendances, 55.0% in planned admissions, and 32.8% in unplanned hospital admissions. During the pandemic, weekly rates of planned care returned to pre-pandemic levels for infants with chronic conditions but not older children. Deficits in care differed by ethnic group and level of deprivation. Virtual outpatient attendances increased from 3.2% to 24.8% during the pandemic. Conclusion: 1 in 6 clinically vulnerable children accounted for one-third to one half of the deficit in hospital care during the pandemic.

scholarly journals HOSPITAL CARE USE IN OLDER ADULTS: THE ROLE OF PSYCHOLOGICAL AND SOCIAL FACTORS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S739-S740
Author(s):  
Viviane Straatmann ◽  
Serhiy Dekhtyar ◽  
Bettina Meinow ◽  
Laura Fratiglioni ◽  
Amaia Calderon-Larranaga
Keyword(s):  
Hospital Care ◽  
Hospital Admissions ◽  
Well Being ◽  
National Study ◽  
Healthcare Use ◽  
Swedish Population ◽  
Psychological Well Being ◽  
Unplanned Hospital Admissions ◽  
Adjusted Model

Abstract Although older people’s health status is the main determinant of healthcare use, there has been little research on how psychosocial factors relate to healthcare utilization. We explored the extent to which psychological and social aspects predict the use of hospital care in an older Swedish population. 2867 people ≥60 years from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K) were followed from baseline (2001-2004) for four years. We created standardized indexes of psychological well-being, and social well-being. Binomial negative mixed models were used to estimate the association of psychological and social indexes with hospital care use (i.e. unplanned hospital admissions [UHA], 30-day readmissions [30DR] and length of stay [LOS]). Individuals with a psychological well-being score above the median had less UHA (IRR 0.43, 95%CI 0.20-0.93) and lower LOS (IRR 0.18, 95% 0.06-0.58), even after full adjustment. High levels of social well-being were also protective for UHA and LOS in the minimally adjusted model, but not after adjusting by life style and personally traits. Relative to individuals with poor well-being on both indexes, those with rich psychological and poor social well-being had reduced hospital care use (IRR 0.44 95%CI 0.24-0.84; IRR 0.23, 95%CI 0.08-0.67, respectively), and even further in those with rich psychological and social well-being (IRR 0.33 95%CI 0.14-0.75; IRR 0.10, 95% 0.02-0.45, respectively). No statistically significant association was found with 30DR. Provided the importance of psychosocial aspects in predicting UHA and LOS, targeting the former could be a strategy for reducing healthcare use and, eventually, costs.

Unplanned admissions and readmissions in older people: a review of recent evidence on identifying and managing high-risk individuals

2014 ◽  
Vol 24 (3) ◽  
pp. 228-237 ◽  
Author(s):  
Bronagh Walsh
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Older People ◽  
Hospital Admissions ◽  
Unplanned Admission ◽  
Policy And Practice ◽  
Admission Rates ◽  
Poor Outcomes ◽  
Unplanned Hospital Admissions ◽  
Unplanned Admissions

SummaryRising unplanned hospital admissions are a problem in ageing populations worldwide. These admissions are associated with poor outcomes for older people, contribute to rising health care costs and impede the provision of planned care. Policy and practice in recent years has focused on identification of those at risk of unplanned admission and early intervention via a range of admission avoidance services. Despite this, unplanned admissions in older people continue to rise, and managing demand for unplanned care remains a priority. Questions remain about the risk factors for unplanned admission and the best approaches to identifying and intervening with those at risk. This review explores recent evidence on admission rates, risk factors for unplanned admission in older people, identification of those at highest risk and interventions to avert unplanned admission.

WED 240 An audit of unplanned admissions in myasthenia gravis patients

2018 ◽  
Vol 89 (10) ◽  
pp. A34.4-A35
Author(s):  
Talaei M ◽  
Burke G
Keyword(s):  
Muscular Dystrophy ◽  
Myasthenia Gravis ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Fragility Fractures ◽  
Hospital Database ◽  
Southampton General Hospital ◽  
Unplanned Hospital Admissions ◽  
Unplanned Admissions ◽  
Bone Protection

BackgroundUnplanned admissions of neuromuscular patients adversely affect patients and NHS. Muscular dystrophy UK designed an audit of unplanned admissions of neuromuscular patients in 2012 and 2017.AimWe aimed to compare unplanned admissions amongst myasthenia gravis (MG) patients, in two different hospitals in Wessex, Southampton general hospital (SGH) and Queen Alexandra service (QAH).MethodsData was collected from patients attending neurology clinics in conjunction with hospital database.Results240 adult patients were included in the audit. 60 unplanned hospital admissions were identified, but only 22 (37%) were judged to be potentially avoidable. 8 admissions were due to myasthenia relapse, 8 occurred in patients with severe myasthenia on dual immunosuppression. 9 admissions were due to pneumonia in elderly patients with multiple comorbidities but well controlled myasthenia. 2 admissions were anxiety related and 3 were due to falls and fracture despite appropriate bone protection.ConclusionOur preventable admission rate for MG patients is less compared to MDUK data (37% vs 68.7% and 59.4% in 2012 and 2017). Pneumonia is common in elderly myasthenic patients who have other comorbidities. Fragility fractures can occur despite bone protection and falls advice is necessary during consultation.

scholarly journals Validity of a tool designed to assess the preventability of potentially preventable hospitalizations for chronic conditions

2019 ◽  
Vol 37 (3) ◽  
pp. 390-394
Author(s):  
Jennifer J Johnston ◽  
Jo M Longman ◽  
Dan P Ewald ◽  
Margaret I Rolfe ◽  
Sergio Diez Alvarez ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Hospital Admissions ◽  
Assessment Tool ◽  
Expert Panel ◽  
Community Dwelling ◽  
Chronic Obstructive ◽  
Preventable Hospitalizations ◽  
Potentially Preventable Hospitalizations ◽  
Unplanned Hospital Admissions ◽  
Unplanned Admissions

Abstract Background Potentially preventable hospitalizations (PPH) are defined as unplanned hospital admissions which could potentially have been prevented with the provision of effective, timely outpatient care. To better understand and ultimately reduce rates of PPH, a means of identifying those which are actually preventable is required. The Preventability Assessment Tool (PAT) was designed for use by hospital clinicians to assess the preventability of unplanned admissions for chronic conditions. Objective The present study examined the ability of the PAT to distinguish between those unplanned admissions which are preventable and those which are not, compared to the assessments of an Expert Panel. Methods Data were collected between November 2014 and June 2017 at three hospitals in NSW, Australia. Participants were community-dwelling patients with unplanned hospital admissions for congestive heart failure, chronic obstructive pulmonary disease, diabetes complications or angina pectoris. A nurse and a doctor caring for the patient made assessments of the preventability of the admission using the PAT. Expert Panels made assessments of the preventability of each admission based on a comprehensive case report and consensus process. Results There was little concordance between the hospital doctors and nurses regarding the preventability of admissions, nor between the assessments of the Expert Panel and the hospital nurse or the Expert Panel and the hospital doctor. Conclusions The PAT demonstrated poor concurrent validity and is not a valid tool for assessing the preventability of unplanned hospital admissions. The use of Expert Panels provides a more rigorous approach to assessing the preventability of such admissions.

scholarly journals Intercycle Unplanned Hospital Admissions Due to Cisplatin-based Chemotherapy Regimen-induced Adverse Reactions: A Retrospective Analysis

2019 ◽  
Vol 14 (3) ◽  
pp. 182-191
Author(s):  
Heber Rew Bright ◽  
Sujith J. Chandy ◽  
Raju Titus Chacko ◽  
Selvamani Backianathan
Keyword(s):  
Adverse Reactions ◽  
Hospital Admissions ◽  
Chemotherapy Regimen ◽  
Hospital Readmissions ◽  
High Dose ◽  
Unplanned Admission ◽  
Chemotherapy Agent ◽  
Number Of Patients ◽  
Unplanned Hospital Admissions ◽  
Unplanned Admissions

Background: Cisplatin is a commonly used chemotherapy agent known to induce serious adverse reactions that may require hospital readmission. We aimed to analyze the extent and factors associated with unplanned hospital admissions due to cisplatin-based chemotherapy regimen-induced adverse reactions. Methods: Retrospective review of medical records of those patients who received at least one cycle of chemotherapy with cisplatin-based regimen during a six-month period from March to August 2017. Results: Of the 458 patients who received cisplatin during the study period, 142 patients did not meet inclusion criteria. The remaining 316 patients had a total of 770 episodes of primary admissions for chemotherapy administration. Overall, 187 episodes (24%) of intercycle unplanned hospital admission were recorded of which a major proportion (n=178; 23%) was due to chemotherapy-induced adverse reactions. Underweight patients had higher odds of unplanned admission (OR 1.77, 95% confidence interval [CI] 1.11 to 1.77). Significantly, more number of patients with cancers of head and neck and cancers of musculoskeletal were readmitted (p<0.001). Compared to high-dose cisplatin, low- and intermediate-dose cisplatin had lesser odds of unplanned admission (OR 0.52 and 0.77; 95% CI, 0.31 to 0.88 and 0.41 to 1.45, respectively). Patients without concomitant radiotherapy, drug-drug interaction and initial chemotherapy cycles had lesser odds of unplanned admission (OR 0.38, 0.50 and 0.52; 95% CI, 0.26 to 0.55, 0.25 to 0.99 and 0.32 to 0.84 respectively). Unplanned admissions were mainly due to blood-related (31%) and gastrointestinal (19%) adverse reactions. Among chemotherapy regimens, cisplatin monotherapy (34%) and cisplatin with doxorubicin (20%) regimens resulted in a major proportion of unplanned admissions. Conclusion: These findings highlight risk factors that help identify high-risk patients and suggest that therapy modifications may reduce hospital readmissions due to cisplatin-based chemotherapy-induced adverse reactions.

scholarly journals Reducing emergency hospital admissions: a population health complex intervention of an enhanced model of primary care and compassionate communities

2018 ◽  
Vol 68 (676) ◽  
pp. e803-e810 ◽  
Author(s):  
Julian Abel ◽  
Helen Kingston ◽  
Andrew Scally ◽  
Jenny Hartnoll ◽  
Gareth Hannam ◽  
...  
Keyword(s):  
Primary Care ◽  
Population Health ◽  
Complex Intervention ◽  
Hospital Admissions ◽  
Health Improvement ◽  
Social Approach ◽  
Emergency Admissions ◽  
Unplanned Hospital Admissions ◽  
Unplanned Admissions ◽  
The Impact

BackgroundReducing emergency admissions to hospital has been a cornerstone of healthcare policy. Little evidence exists to show that systematic interventions across a population have achieved this aim. The authors report the impact of a complex intervention over a 44-month period in Frome, Somerset, on unplanned admissions to hospital.AimTo evaluate a population health complex intervention of an enhanced model of primary care and compassionate communities on population health improvement and reduction of emergency admissions to hospital.Design and settingA cohort retrospective study of a complex intervention on all emergency admissions in Frome Medical Practice, Somerset, compared with the remainder of Somerset, from April 2013 to December 2017.MethodPatients were identified using broad criteria, including anyone giving cause for concern. Patient-centred goal setting and care planning combined with a compassionate community social approach was implemented broadly across the population of Frome.ResultsThere was a progressive reduction, by 7.9 cases per quarter (95% confidence interval [CI] = 2.8 to 13.1, P = 0.006), in unplanned hospital admissions across the whole population of Frome during the study period from April 2013 to December 2017, a decrease of 14.0%. At the same time, there was a 28.5% increase in admissions per quarter within Somerset, with a rise in the number of unplanned admissions of 236 per quarter (95% CI = 152 to 320, P<0.001).ConclusionThe complex intervention in Frome was associated with highly significant reductions in unplanned admissions to hospital, with a decrease in healthcare costs across the whole population of Frome.

scholarly journals Challenges of using asthma admission rates as a measure of primary care quality in children: An international comparison

2021 ◽  
pp. 135581962110127
Author(s):  
Irina Lut ◽  
Kate Lewis ◽  
Linda Wijlaars ◽  
Ruth Gilbert ◽  
Tiffany Fitzpatrick ◽  
...  
Keyword(s):  
Primary Care ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Underlying Disease ◽  
Primary Diagnosis ◽  
Care Quality ◽  
Attendance Rates ◽  
Admission Rates ◽  
Primary Care Quality ◽  
Hospital Administrative

Objectives To demonstrate the challenges of interpreting cross-country comparisons of paediatric asthma hospital admission rates as an indicator of primary care quality. Methods We used hospital administrative data from >10 million children aged 6–15 years, resident in Austria, England, Finland, Iceland, Ontario (Canada), Sweden or Victoria (Australia) between 2008 and 2015. Asthma hospital admission and emergency department (ED) attendance rates were compared between countries using Poisson regression models, adjusted for age and sex. Results Hospital admission rates for asthma per 1000 child-years varied eight-fold across jurisdictions. Admission rates were 3.5 times higher when admissions with asthma recorded as any diagnosis were considered, compared with admissions with asthma as the primary diagnosis. Iceland had the lowest asthma admission rates; however, when ED attendance rates were considered, Sweden had the lowest rate of asthma hospital contacts. Conclusions The large variations in childhood hospital admission rates for asthma based on the whole child population reflect differing definitions, admission thresholds and underlying disease prevalence rather than primary care quality. Asthma hospital admissions among children diagnosed with asthma is a more meaningful indicator for inter-country comparisons of primary care quality.

scholarly journals Longitudinal rates of hospital adverse events that contributed to death in Norway and Sweden from 2013 to 2018

2021 ◽  
pp. 251604352110261
Author(s):  
Ellen Tveter Deilkås ◽  
Marion Haugen ◽  
Madeleine Borgstedt Risberg ◽  
Hanne Narbuvold ◽  
Øystein Flesland ◽  
...  
Keyword(s):  
Adverse Events ◽  
Acute Care ◽  
Medical Records ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Demographic Characteristics ◽  
Mutual Learning ◽  
Time Period ◽  
Relevant Context ◽  
Linear Trends

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.

scholarly journals Reducing unscheduled hospital care for adults with diabetes following a hypoglycaemic event: which community-based interventions are most effective? A systematic review

2021 ◽  
Author(s):  
Aoife Watson ◽  
Donna McConnell ◽  
Vivien Coates
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Integrated Care ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Community Based Interventions ◽  
Community Based ◽  
Integrated Care Pathways ◽  
Effective Community ◽  
Balance Of Care

Abstract Aim To determine which community-based interventions are most effective at reducing unscheduled hospital care for hypoglycaemic events in adults with diabetes. Methods Medline Ovid, CINAHL Plus and ProQuest Health and Medical Collection were searched using both key search terms and medical subject heading terms (MeSH) to identify potentially relevant studies. Eligible studies were those that involved a community-based intervention to reduce unscheduled admissions in adults with diabetes. Papers were initially screened by the primary researcher and then a secondary reviewer. Relevant data were then extracted from papers that met the inclusion criteria. Results The search produced 2226 results, with 1360 duplicates. Of the remaining 866 papers, 198 were deemed appropriate based on titles, 90 were excluded following abstract review. A total of 108 full papers were screened with 19 full papers included in the review. The sample size of the 19 papers ranged from n = 25 to n = 104,000. The average ages within the studies ranged from 41 to 74 years with females comprising 57% of the participants. The following community-based interventions were identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine, education, integrated care pathways, enhanced primary care and care management teams. Conclusions This systematic review shows that a range of community-based interventions, requiring different levels of infrastructure, are effective in reducing unscheduled hospital care for hypoglycaemia in people with diabetes. Investment in effective community-based interventions such as integrated care and patient education must be a priority to shift the balance of care from secondary to primary care, thereby reducing hospital admissions.

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