Acute Hospital Use, Nursing Home Placement, and Mortality in a Frail Community‐Dwelling Cohort Managed with Primary Integrated Interdisciplinary Elder Care at Home

Rosenberg, Ted

doi:10.1111/j.1532-5415.2012.03965.x

Cited by 55 publications

(83 citation statements)

References 39 publications

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“…These interventions, with similarly long durations of no less than 7 months, also featured multiple key elements. Five of them were multidisciplinary-based,8 10 15 17 21 four conducted screening and assessment,9 10 15 21 four had care management,8–10 21 three involved follow up visits,9 17 21 three integrated social care,8 15 21 two linked to primary care,15 17 and one performed discharge planning 21. Only one RCT, studying telemonitoring within home for symptom assessment and treatment initiation, reported an increase in ED attendances, but also failed to demonstrate significance 13…”

Section: Resultsmentioning

confidence: 99%

Interventions targeting the elderly population to reduce emergency department utilisation: a literature review

Fan

Lukin

Zhao³

et al. 2014

Emerg Med J

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The investigated interventions have mixed effectiveness. Our findings suggest the hospital-based interventions have relatively poorer effects, and should be better connected to the community-based strategies. Interventions seem to achieve the most success with integration of multi-layered elements, especially when incorporating key elements such as a nurse-led multidisciplinary team, integrated social care, and strong linkages to the longer-term primary and community care. Notwithstanding limitations in generalising the findings, this review builds on the growing body of evidence in this particular area.

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Section: Resultsmentioning

confidence: 99%

Interventions targeting the elderly population to reduce emergency department utilisation: a literature review

Fan

Lukin

Zhao³

et al. 2014

Emerg Med J

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“…[4,20] The findings concerning the effect of intermediate care interventions are ambiguous. Whereas two British studies failed to detect a reduction in acute admissions or fewer (re-) admissions to hospital or other institutions, [1,2,13] other studies have found significantly fewer acute admissions, reduced admission length and reduced cost after intermediate care interventions [7,8] and better cost efficiency when compared to standard treatment. [9] Others, however, were unable to detect significant differences in the total cost for intermediate care and hospitalization.…”

Section: Discussionmentioning

confidence: 97%

“…[5] Despite this definition, the concept covers a wide range of interventions and target groups; [4] the effects of intermediate care intervention are thus difficult to measure and the results ambiguous. While some studies have reported substantial challenges in the implementation process, [6] others have found significant decreases, not only in admission rates, costs and admission lengths, [7][8][9] but also in readmission rates. [10] A number of other studies, despite findings of increased costs, [11,12] report no significant impact on admission [1,2,13] and readmission rates.…”

Section: Introductionmentioning

confidence: 99%

Inappropriate admissions or inadequate discharges of frail elderly: Competing program theories and implementation challenges in an intermediate care intervention

Nørgaard

Skjøt‐Arkil²,

Nissen³

et al. 2017

JNEP

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Intermediate care interventions are increasingly being implemented in the health services to avoid hospitalizing elderly frail patients with complex medical issues, often referred to as inappropriate or unwarranted admissions. This paper presents a theory-based stakeholder evaluation of an intervention involving hospitals, community care and general practitioners (GPs) in a Danish region with the overall objective to reduce the number of (inappropriate) hospital admissions for the frail elderly of 65 years or older. In a controlled study design elderly acutely ill patients were randomized to care and treatment either by a district nursing team or in an emergency department (ED) -both interventions with a 48-hour time limit. The district nursing teams were given access to various telemedicine solutions. In the programme theory analysis the stakeholders' normative theories, situation theories and causal theories were studied. Competing programme theories and barriers and facilitators were identified. Data were collected in interviews with stakeholders (managers, nurses, hospital physicians and GPs) and from the literature. The intervention included a regional hospital, four municipalities and 166 GPs servicing a mixed urban and rural region in Denmark. Four district nursing teams, eight GPs, three hospital physicians and two project managers were interviewed between January and March 2015. The stakeholder's programme theories were both concordant and competing; the GPs in particular were sceptical of the purported objective of reducing the number of inappropriate hospital admissions; they would rather see a reduction in the number of inappropriate hospital discharges. Our results indicate a compromised implementation process.

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“…The fee-for-service payment system rewards providers for the quantity, rather than the quality, of services provided. Until recently there has been no incentive for providers and hospitals to offer anything other than episodic, crisis driven, procedurally biased care, even for conditions where continuous, proactive team management of the underlying chronic disorder would reduce or prevent crisis admissions (Goeree et al, 2013, Takeda et al, 2012, Rosenberg, 2012.…”

Section: Introductionmentioning

confidence: 99%

What makes a difference to patients?

Johnston

2013

International Review of Psychiatry

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To make a difference to patients who increasingly suffer multiple chronic conditions, in a healthcare system that is capable of providing excellent care but is often ineffective and at cross-purposes in its application, means being prepared to take a different approach not only to the delivery of patient care, but to the education of physicians and other healthcare professionals. The model we must now practice and teach is one that emphasizes collaboration and prevention, quality and efficiency. Changes in practice recommended by the 2001 US Institute of Medicine report are being implemented system-wide, following the enactment of the US Patient Protection and Affordable Care Act. This paper discusses the evolving needs of patients with chronic psychiatric illness, and the psychiatrist's role in a rapidly changing healthcare landscape as a care provider, an interdisciplinary role model, and educator. In an aging population in which multi-morbidity is the norm, episodic, crisis-driven care is prohibitively expensive and does not serve patients well. Yet we still teach that model of care. The medications we prescribe for psychiatric illness, particularly antipsychotics, can cause and/or aggravate some of the commonest chronic medical illnesses; psychiatric educators must address the management of these complications. The management of chronic psychiatric illness in multi-morbid patients demands that we practice and teach a 'whole patient' approach to care, preferably delivered as part of a patient-centred team. The Affordable Care Act has mandated and created opportunities for new models designed to facilitate this, and a paradigm shift is needed in medical education. Clinicians must become adept at identifying underlying and contributing factors and collaborating with the patient, other providers, and the patient's family and significant others. Psychiatric formulation and patient care rely on these principles; we must now teach their application to other specialties, disciplines and professions.

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Acute Hospital Use, Nursing Home Placement, and Mortality in a Frail Community‐Dwelling Cohort Managed with Primary Integrated Interdisciplinary Elder Care at Home

Abstract: Primary Integrated Interdisciplinary Elder Care at Home may reduce acute hospital admissions and facilitate home deaths.

Cited by 55 publications

References 39 publications

Interventions targeting the elderly population to reduce emergency department utilisation: a literature review

Interventions targeting the elderly population to reduce emergency department utilisation: a literature review

Inappropriate admissions or inadequate discharges of frail elderly: Competing program theories and implementation challenges in an intermediate care intervention

What makes a difference to patients?

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