Control in the Hospital by Extensive Clinical rules for Unplanned hospitalizations in older Patients (CHECkUP); study design of a multicentre randomized study

Abstract Background Due to ageing of the population the incidence of multimorbidity and polypharmacy is rising. Polypharmacy is a risk factor for medication-related (re)admission and therefore places a significant burden on the healthcare system. The reported incidence of medication-related (re)admissions varies widely due to the lack of a clear definition. Some medications are known to increase the risk for medication-related admission and are therefore published in the triggerlist of the Dutch guideline for Polypharmacy in older patients. Different interventions to support medication optimization have been studied to reduce medication-related (re)admissions. However, the optimal template of medication optimization is still unknown, which contributes to the large heterogeneity of their effect on hospital readmissions. Therefore, we implemented a clinical decision support system (CDSS) to optimize medication lists and investigate whether continuous use of a CDSS reduces the number of hospital readmissions in older patients, who previously have had an unplanned probably medication-related hospitalization. Methods The CHECkUP study is a multicentre randomized study in older (≥60 years) patients with an unplanned hospitalization, polypharmacy (≥5 medications) and using at least two medications from the triggerlist, from Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. Patients will be randomized. The intervention consists of continuous (weekly) use of a CDSS, which generates a Medication Optimization Profile, which will be sent to the patient’s general practitioner and pharmacist. The control group will receive standard care. The primary outcome is hospital readmission within 1 year after study inclusion. Secondary outcomes are one-year mortality, number of emergency department visits, nursing home admissions, time to hospital readmissions and we will evaluate the quality of life and socio-economic status. Discussion This study is expected to add evidence on the knowledge of medication optimization and whether use of a continuous CDSS ameliorates the risk of adverse outcomes in older patients, already at an increased risk of medication-related (re)admission. To our knowledge, this is the first large study, providing one-year follow-up data and reporting not only on quality of care indicators, but also on quality-of-life. Trial registration The trial was registered in the Netherlands Trial Register on October 14, 2018, identifier: NL7449 (NTR7691). https://www.trialregister.nl/trial/7449.

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FRAIL OLDER PATIENTS HAVE A GREATER IMPROVEMENT IN PHYSICAL QUALITY OF LIFE THAN ROBUST PATIENTS AT ONE YEAR FOLLOWING INVASIVE TREATMENT FOR NON-ST ELEVATION ACUTE CORONARY SYNDROME

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)34483-2 ◽

2017 ◽

Vol 69 (11) ◽

pp. 1094

Author(s):

Vijayalakshmi Kunadian ◽

Hannah Sinclair ◽

Jonathan Batty ◽

Sophie Z. Gu ◽

Benjamin Beska ◽

...

Keyword(s):

Quality Of Life ◽

Acute Coronary Syndrome ◽

Older Patients ◽

Invasive Treatment ◽

Physical Quality ◽

Coronary Syndrome ◽

St Elevation ◽

Elevation Acute Coronary Syndrome ◽

One Year

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54 Frail older patients have a greater improvement in physical quality of life than robust patients at one year following invasive treatment for non-st elevation acute coronary syndrome

Heart ◽

10.1136/heartjnl-2017-311726.53 ◽

2017 ◽

Vol 103 (Suppl 5) ◽

pp. A42-A43 ◽

Cited By ~ 1

Author(s):

Hannah Sinclair ◽

Sophie Zhaotao Gu ◽

Jonathan Batty ◽

Benjamin Beska ◽

Murugapathy Verrasamy ◽

...

Keyword(s):

Quality Of Life ◽

Acute Coronary Syndrome ◽

Older Patients ◽

Invasive Treatment ◽

Physical Quality ◽

Coronary Syndrome ◽

St Elevation ◽

Elevation Acute Coronary Syndrome ◽

One Year

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Pharmacist-Led Model to Reduce Hospital Readmissions in Medically Complex Children

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-21.4.346 ◽

2016 ◽

Vol 21 (4) ◽

pp. 346-352 ◽

Cited By ~ 1

Author(s):

Alison M. DaCosta ◽

Courtney B. Sweet ◽

Lisa R. Garavaglia ◽

Francis L. Casey ◽

Jeffrey D. Lancaster

Keyword(s):

Quality Of Life ◽

Health Care ◽

Health Care Utilization ◽

Hospital Admissions ◽

Hospital Readmissions ◽

Emergency Department Visits ◽

Care Utilization ◽

Satisfaction With Care ◽

Pedsql 4.0

OBJECTIVES: This pilot study investigated the feasibility and effect on health care utilization of medically complex children participating in a pharmacist-led model for care coordination. Quality of life and satisfaction with care were secondarily assessed for each patient. METHODS: Four medically complex children were enrolled and contacted by the pharmacist weekly for 5 consecutive months. Time for each encounter with a patient was collected. Each patient's hospital admissions, days of stay, emergency department visits, and clinic visits were recorded. At enrollment and at the end of the study, each caregiver completed the PedsQL 4.0 questionnaire to evaluate the child's quality of life and the Patient Assessment of Care for Chronic Conditions questionnaire to assess satisfaction with care. Patients aged 5 years and older completed an age-appropriate version of the PedsQL 4.0 as well. RESULTS: The pharmacist spent on average 60 to 80 minutes per patient per week. Hospital admissions and days of stay decreased for 3 patients and increased for 1 patient during this study. Quality of life increased for 2 patients and decreased for 2 patients and satisfaction with care increased for all 4 caregivers. CONCLUSIONS: This model was feasible for a pharmacist to coordinate and required frequent physician involvement. Health care utilization varied between patients, but overall decreased for the 4 patients pooled. Changes in quality of life varied and may be attributed to using a survey that was not specific to medically complex children. Overall, caregivers were highly satisfied with this service and the health care their child received.

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Abstract 44: Quality of Life for Younger Patients Following Lacunar Stroke: A Secondary Analysis of SPS-3

Stroke ◽

10.1161/str.51.suppl_1.44 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Adam H de Havenon ◽

Ka-Ho Wong ◽

Kirby Taylor ◽

Michael Dela Cruz ◽

Theodore Rock ◽

...

Keyword(s):

Quality Of Life ◽

Older Patients ◽

Secondary Analysis ◽

Lacunar Stroke ◽

Linear Regression Models ◽

Stroke Patients ◽

Younger Patients ◽

Student’S T ◽

One Year

Background: The long-term quality of life (QoL) effects of stroke on younger patients has not been adequately compared to older stroke patients. Methods: We included patients from the Secondary Prevention of Small Subcortical Strokes (SPS3) trial, who had a lacunar stroke within the last 6 months. We divided the cohort into younger patients aged <55 years versus older patients aged ≥55. The primary outcome was a 12 domain stroke specific QoL scale (ss-QoL), measured at one year from enrollment. The ss-QoL scores range from 0-5, with higher scores indicating better QoL. We fit linear regression models to the 12 domains and their mean, and adjusted for 90-day mRS, gender, white race, history of MI, diabetes, HTN, COPD, and level of education. After identifying domains of interest, we examined specific questions within domains to compare the mean score on individual questions using Student’s t-test. Results: We included 2,542 patients with a mean (SD) age of 62.8 (10.7) and 64% were male. Younger stroke patients comprised 26.5% (673/2,542) of the cohort and had a mean (SD) ss-QoL score of 4.18 (0.75) compared to 4.24 (0.69) of the older patients, a difference which was significant in the adjusted model (p=0.015). Younger stroke patients had significantly lower scores on the following individual ss-QoL domains compared to older stroke patients: language, thinking, personality, mood, family roles, and energy (Table 1). The three questions that younger stroke patients had the most difference with older patients were “in the past week I was discouraged about my future” (young vs old, 3.7 vs 4.0, p<0.001), “…had little confidence in myself” (4.0 vs 4.3, p<0.001), and “…was irritable” (3.7 vs 3.9, p<0.001). Conclusion: After lacunar stroke, compared to older patients, younger patients score worse on stroke specific quality of life at 1-1.5 years after stroke, particularly in domains related to mood. This under-appreciated impact of stroke in the young warrants additional research.

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