scholarly journals Risk factors for hospital readmission in older adults within 30 days of discharge – a comparative retrospective study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Maria Glans ◽  
Annika Kragh Ekstam ◽  
Ulf Jakobsson ◽  
Åsa Bondesson ◽  
Patrik Midlöv
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Retrospective Study ◽  
Home Care ◽  
Hospital Readmission ◽  
Patient Characteristics ◽  
Transition Of Care ◽  
Discharge Transition ◽  
Surgical Unit

Abstract Background The area of hospital readmission in older adults within 30 days of discharge is extensively researched but few studies look at the whole process. In this study we investigated risk factors related, not only to patient characteristics prior to and events during initial hospitalisation, but also to the processes of discharge, transition of care and follow-up. We aimed to identify patients at most risk of being readmitted as well as processes in greatest need of improvement, the goal being to find tools to help reduce early readmissions in this population. Methods This comparative retrospective study included 720 patients in total. Medical records were reviewed and variables concerning patient characteristics prior to and events during initial hospital stay, as well as those related to the processes of discharge, transition of care and follow-up, were collected in a standardised manner. Either a Student’s t-test, χ2-test or Fishers’ exact test was used for comparisons between groups. A multiple logistic regression analysis was conducted to identify variables associated with readmission. Results The final model showed increased odds of readmission in patients with a higher Charlson Co-morbidity Index (OR 1.12, p-value 0.002), excessive polypharmacy (OR 1.66, p-value 0.007) and living in the community with home care (OR 1.61, p-value 0.025). The odds of being readmitted within 30 days increased if the length of stay was 5 days or longer (OR 1.72, p-value 0.005) as well as if being discharged on a Friday (OR 1.88, p-value 0.003) or from a surgical unit (OR 2.09, p-value 0.001). Conclusion Patients of poor health, using 10 medications or more regularly and living in the community with home care, are at greater risk of being readmitted to hospital within 30 days of discharge. Readmissions occur more often after being discharged on a Friday or from a surgical unit. Our findings indicate patients at most risk of being readmitted as well as discharging routines in most need of improvement thus laying the ground for further studies as well as targeted actions to take in order to reduce hospital readmissions within 30 days in this population.

Hospital readmission risks in older adults following inpatient subacute care: A six-month follow-up study

2018 ◽  
Vol 77 ◽  
pp. 142-149 ◽  
Author(s):  
Den-Ching A. Lee ◽  
Cylie Williams ◽  
Aislinn F. Lalor ◽  
Ted Brown ◽  
Terry P. Haines
Keyword(s):  
Older Adults ◽  
Hospital Readmission ◽  
Subacute Care ◽  
Follow Up Study

Abstract WMP95: A Transition of Care Program to Reduce Stroke Related Hospital Readmissions

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Heather Khan ◽  
Hebah M Hefzy
Keyword(s):  
Risk Factors ◽  
Readmission Rate ◽  
Stroke Risk ◽  
Community Hospital ◽  
Hospital Readmissions ◽  
Care Program ◽  
Transition Of Care ◽  
Stroke Risk Factors ◽  
Risk Patients

Introduction: Readmission to the hospital after discharge following a stroke or TIA remains a nation-wide problem. While the CMS national benchmark was approximately 12% in 2015, our hospital Medicare stroke readmission rate rose from approximately 12% at the end of 2014 to 28.6% in February 2015. Our goal was a reduction in stroke readmission rates to below the national benchmark of 12% by December 2015. Hypothesis: We hypothesized that implementing a transition of care program at our 200 bed community hospital would reduce hospital stroke-related readmissions. Methods: In March 2015, a random sample of forty stroke/TIA patients that were discharged home between December of 2014 and February of 2015 were interviewed. The patients were asked about barriers to discharge, what could have improved the discharge experience, and what problems they encountered that could have resulted in a readmission. Based on their answers, risk factors were identified using an inverse Pareto graph and a transition of care program was implemented which included the following work flow: 1) daily rounding to query patients regarding insight into stroke risk factors, environmental concerns, and social impacts to discharge in the stroke unit by the stroke coordinator (a registered nurse); 2) a discharge telephone call within two business days to high risk patients identified during rounds focusing on review of the discharge summary, re-education regarding stroke risk factors, and ensuring that follow-up appointments were in place; 3) an outpatient follow-up appointment with a board certified vascular neurologist within two weeks of discharge. Results: Our transition of care program resulted in an improvement of 82.5%, with a Medicare stroke re-admission rate of 5% in December 2015. As of May 2016, our year-to-date hospital stroke readmission rate is 8.1%, while the current CMS national average is 12.7%. Conclusions: A transition of care program is implementable in a community hospital setting, and results in reduced stroke-related hospital readmissions. Its success emphasizes the importance of identifying high risk patients and assessing individual drivers of readmission risk.

scholarly journals ASSOCIATED RISK FACTORS OF RESTRAINT USE IN OLDER ADULTS WITH HOME CARE

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 907-907 ◽  
Author(s):  
K. Scheepmans ◽  
B. Dierckx de Casterlé ◽  
K. Vanbrabant ◽  
L. Paquay ◽  
H. Van Gansbeke ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Home Care ◽  
Restraint Use ◽  
Associated Risk Factors

scholarly journals Multidimensional Sleep and Mortality in Older Adults: A Machine-Learning Comparison With Other Risk Factors

2019 ◽  
Vol 74 (12) ◽  
pp. 1903-1909 ◽  
Author(s):  
Meredith L Wallace ◽  
Daniel J Buysse ◽  
Susan Redline ◽  
Katie L Stone ◽  
Kristine Ensrud ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Older Adults ◽  
Cardiovascular Mortality ◽  
Predictive Ability ◽  
Future Research ◽  
Applied Machine Learning ◽  
Predictive Variables ◽  
Time In Bed

Abstract Background Sleep characteristics related to duration, timing, continuity, and sleepiness are associated with mortality in older adults, but rarely considered in health recommendations. We applied machine learning to: (i) establish the predictive ability of a multidimensional self-reported sleep domain for all-cause and cardiovascular mortality in older adults relative to other established risk factors and (ii) to identify which sleep characteristics are most predictive. Methods The analytic sample includes N = 8,668 older adults (54% female) aged 65–99 years with self-reported sleep characterization and longitudinal follow-up (≤15.5 years), aggregated from three epidemiological cohorts. We used variable importance (VIMP) metrics from a random survival forest to rank the predictive abilities of 47 measures and domains to which they belong. VIMPs > 0 indicate predictive variables/domains. Results Multidimensional sleep was a significant predictor of all-cause (VIMP [99.9% confidence interval {CI}] = 0.94 [0.60, 1.29]) and cardiovascular (1.98 [1.31, 2.64]) mortality. For all-cause mortality, it ranked below that of the sociodemographic (3.94 [3.02, 4.87]), physical health (3.79 [3.01, 4.57]), and medication (1.33 [0.94, 1.73]) domains but above that of the health behaviors domain (0.22 [0.06, 0.38]). The domains were ranked similarly for cardiovascular mortality. The most predictive individual sleep characteristics across outcomes were time in bed, hours spent napping, and wake-up time. Conclusion Multidimensional sleep is an important predictor of mortality that should be considered among other more routinely used predictors. Future research should develop tools for measuring multidimensional sleep—especially those incorporating time in bed, napping, and timing—and test mechanistic pathways through which these characteristics relate to mortality.

scholarly journals P140 Factors associated with development of NAFLD in patients with inflammatory bowel disease: a 5-year retrospective study on 225 patients

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S207-S208
Author(s):  
V Domislović ◽  
I Knežević-Štromar ◽  
M Premužić ◽  
M Brinar ◽  
D Vranešić Bender ◽  
...  
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Liver Disease ◽  
Liver Fibrosis ◽  
Obese Patients ◽  
Logrank Test ◽  
Factors Associated ◽  
Advanced Liver Fibrosis ◽  
Disease Specific

Abstract Background Patients with IBD are at higher risk for non-alcoholic fatty liver disease (NAFLD) comparing to general population. Complex pathogenesis of NAFLD in IBD may be related to disease-specific risk factors such as chronic inflammation, steroid exposure, drug induced hepatotoxicity, malnutrition and alteration of gut microbiota, which is emerging as a major factor in the pathogenesis of NAFLD. The goal of the study was to investigate factors associated with NADLF and advanced liver fibrosis (ALF) in patients with CD and UC. Methods This is a retrospective study on IBD patients without extraintestinal manifestations and known liver disease. NAFLD was defined as Hepatic Steatosis Index (HSI) ≥ 36, and ALF was defined as FIB-4 ≥ 2.67. Predictors of NAFLD development were analysed using Kaplan–Meier and Cox regression analyses. Results In this retrospective study, we have included 225 IBD patients; 72.4% (n = 163) patients with CD and 27.6% (n = 62) patients with UC (median age 41.2 yr, 53.7% males) which were observed for a median of 4.6 years. There were 63.1% (n = 142) patients with normal BMI, 27.6% (n = 62) overweight and 9.3% (n = 21) obese patients. Obese patients had the highest HIS score 43.9 ± 5.9, following with overweight 37.8 ± 5.7 and normal BMI 30 ± 4.3 kg/m2, p < 0.001. During the follow-up obese and overweight patients had higher risk of developing NAFLD comparing to patients with normal BMI (obese HR = 11.1 95% CI 4.3–28.3 and overweight HR = 5.55 95% CI 3.4–9.1, Logrank test p < 0.001) (Figure 1). Regarding FIB-4 score there, was no difference among different BMI categories (p = 0.192), and there was no difference in ALF development in the follow-up period (Logrank test p = 0.91). In Cox proportional-hazards regression significant predictors for NAFLD development were dyslipidaemia HR=2.11, 95% CI 1.2–3.7, overweight HR=6 95% CI 3.6–10, and obesity HR=13.4, 95% CI 7–35. Conclusion NAFLD is frequent comorbidity in patients with CD and UC, which can lead to development of advanced liver fibrosis. Our results show that patients with IBD have a high risk of NAFLD development, whereas the increased risk for ALF was not observed. Overweight and obese patients and those with dyslipidemia should be closer monitored due to significantly higher risk of NAFLD. This study points out the complexity disease-specific risk factors and importance of better stratifying IBD patients at risk of NAFLD and advanced liver fibrosis.

Risk factors for screw migration after triple pelvic osteotomy

2001 ◽  
Vol 37 (3) ◽  
pp. 269-273 ◽  
Author(s):  
S Simmons ◽  
AL Johnson ◽  
DJ Schaeffer
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Medical Records ◽  
Pelvic Osteotomy ◽  
Factors Associated

The objective of this retrospective study was to identify risk factors for screw migration after triple pelvic osteotomy (TPO) in clinical patients. The medical records, radiographs made immediately after surgery, and follow-up radiographs documenting a healed osteotomy were reviewed for 52 dogs treated with unilateral TPO and 38 dogs treated with bilateral TPO. Signalment, surgeon expertise, length of surgery, sequence of surgery in dogs treated bilaterally, use of ischial or ilial wires or both, screw depth in the sacrum, and screw migration were documented for each of the 128 pelvic osteotomies. Screws placed in the first and second plate hole, securing the cranial portion of the plate, loosened most frequently. Factors associated with decreased screw migration included use of an ischial hemicerclage wire and increased depth of sacral purchase with the first and second cranial screws.

Relationship Between Insomnia, Depression, and Mortality: A 12-Year Follow-Up of Older Adults in the Community

2000 ◽  
Vol 12 (3) ◽  
pp. 295-306 ◽  
Author(s):  
Lena Mallon ◽  
Jan-Erik Broman ◽  
Jerker Hetta
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Natural History ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Death Rate ◽  
Mortality Data ◽  
Total Death ◽  
History Of

The purpose of the study was to investigate the natural history of insomnia and its association with depression and mortality. In 1983, 1,870 randomly selected subjects aged 45–65 years answered a questionnaire on sleep and health. Of the 1,604 survivors in 1995, 1,244 (77.6%) answered a new questionnaire with almost identical questions. Mortality data were collected for the 266 subjects that had died during the follow-up period. Chronic insomnia was reported by 36.0% of women and 25.4% of men (χ2 = 9.7; p < .01). About 75% of subjects with insomnia at baseline continued to have insomnia at follow-up. Insomnia in women predicted subsequent depression (odds ratio [OR] = 4.1; 95% confidence interval [CI] 2.1–7.2) but was not related to mortality. In men, insomnia predicted mortality (OR = 1.7; 95% CI 1.2–2.3), but after adjustment for an array of possible risk factors, this association was no longer significant. Men with depression at baseline had an adjusted total death rate that was 1.9 times higher than in the nondepressed men (95% CI: 1.2–3.0).

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