Development of a senior-specific, citizen-oriented healthcare service system in South Korea based on the Canadian 48/6 model of care

Kim, Yoon‐Sook; Lee, Jongmin; Moon, Yeonsil; Kim, Hee Joung; Shin, Jin Young; Park, Jaemin; Uhm, Kyeong Eun; Kim, Kyoung Jin; Yoo, Jung A.; Oh, Yun Kyoung; Byeon, Pilsuk; Lee, Kun Sei; Han, Seol-Heui; Choi, Jaekyung

doi:10.1186/s12877-019-1397-3

Cited by 9 publications

(14 citation statements)

References 59 publications

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“…The Korean Framework for Senior-Friendly Hospitals 6 ) was developed with reference to the Taiwanese 7 ) and Canadian 8 ) systems and was first implemented to address the need for healthcare assessment tools for older Korean inpatients in our acute-care hospital in 2016. Since May 2016, geriatric syndrome screening for care (GSC) has been performed for all older inpatients aged 65 years or older both at admission and before discharge.…”

Section: Introductionmentioning

confidence: 99%

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Importance of Geriatric Syndrome Screening within 48 Hours of Hospitalization for Identifying Readmission Risk: A Retrospective Study in an Acute-Care Hospital

Shin

Han

Choi

et al. 2020

Ann Geriatr Med Res

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Background Given the association between geriatric syndrome and hospital readmission, we evaluated the suitability of geriatric syndrome screening for care (GSC) in identifying readmission risk and suggested the appropriate time for GSC. Methods GSC considering cognitive impairment, depression, polypharmacy (five or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence was performed among 2,663 general ward inpatients aged 65 years or older within 48 hours after admission and again before discharge between November 2016 and October 2017. From each patient, fall events, pressure ulcers, potentially inappropriate medication use, and delirium were assessed at admission. Patients were divided into two groups on the basis of readmission within 1 year after the first admission. According to the screening period (at admission and before discharge) and in-hospital decline, we applied receiver operating characteristic curve analysis to compare the prevalence of clinical concerns between the readmission and no-readmission groups. We also used multiple logistic regression analysis to evaluate the risk of readmission according to the presence of geriatric syndrome and clinical outcomes. Results The 782 readmitted patients (29.4%) showed a higher rate of poor GSC than those who were not readmitted. Polypharmacy at admission was significantly correlated with readmission risk (area under the receiver operating characteristic curve=0.602). Fall events (odds ratio [OR]=4.36; 95% confidence interval [CI], 2.36–8.05), urinary incontinence (OR=4.21; 95% CI, 3.28–5.39), and depressive mood (OR=3.88; 95% CI, 2.69–5.59) at admission were risk factors for readmission. Conclusion Geriatric syndromes assessed by GSC at admission was associated with an increased risk of readmission.

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Section: Introductionmentioning

confidence: 99%

“…Although readmission risk assessment throughout older patients’ hospitalization is important, 6 - 8 ) continuous evaluation of patients in busy in-patient units can be cumbersome. Unfortunately, exactly when it is appropriate to assess the risk of readmission remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Importance of Geriatric Syndrome Screening within 48 Hours of Hospitalization for Identifying Readmission Risk: A Retrospective Study in an Acute-Care Hospital

Shin

Han

Choi

et al. 2020

Ann Geriatr Med Res

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“…The GSC-10 are as follows: cognitive impairment, delirium, depression, polypharmacy (more than 5 medications), functional immobility, dysphagia, malnutrition, pain, urinary, and fecal incontinence, which were developed from the literature review, benchmarking, focus group interviews, and expert consultation. 14 The GSC-10 was based on proven associations with readmission for older inpatients and mobility decline. 16 17 Patients with problematic issues are referred to a multidisciplinary team that performs a comprehensive consultation.…”

Section: Methodsmentioning

confidence: 99%

“…A senior-specific, citizen-oriented healthcare service system was first implemented in our acute care hospital in 2017. 14 The older inpatients were connected to a public health center for continued care at home after discharge. We have signed an agreement with the Gwangjin-gu Public Health Center (Seoul, Korea) for transitional care of older adult patients who have been discharged from our hospital.…”

Section: Introductionmentioning

confidence: 99%

The Experience of Providing Older Adult Patients with Transitional Care from an Acute Care Hospital to Home in Cooperation with a Public Health Center

et al. 2020

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Background: This study aimed to describe the experience of providing older adult patients with transitional care from an acute care hospital to home in cooperation with a public health center, in order to present the barriers to that care and suggest better organizational methods. Methods: This was a cross-sectional study to show the results of the Geriatric Screening for Care-10 (GSC-10) and outcomes of transitional care. Among 659 hospitalized patients aged 65 years or above who lived in an administrative district, forty-five subjects were enrolled between June 24, 2019 and January 23, 2020. Within 48 hours of admission, using the 10 areas of GSC-10, they were assessed for cognitive impairment, depression, polypharmacy (5 or more medications), functional mobility, dysphagia, malnutrition, pain, and incontinence, and were reassessed before discharge. The transitional care plan (containing the treatment summary, the results of the GSC-10 assessment, and the post-discharge plan) was forwarded to a representative of the public health center, who provided continued disease management and various health care services, such as chronic disease and frailty care, and physical rehabilitation. Results: Of all the participants, 64.4% had more than 1 GSC-10 concern. The most prevalent concerns were functional immobility (35.6%) and polypharmacy (22.2%). About 15.6% of the participants were readmitted to a nursing home or hospital. A total of 38 participants received the transitional care intervention. They received an average of 2.7 administered interventions. However, the rate of rejection was high (30.1%) and patients were visited an average of 16.5 days after discharge. Conclusion: Through our experience of providing transitional care from an acute care hospital to home in cooperation with a public health center, we expect that the transitional care suitable for the Korean medical situation could be established and successful.

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“…Therefore, attempts have been made to contribute to the health care of the elderly by developing an elderly-centered and citizen-centered medical service system based on the 48/6 model of care (48/6), which has already been proven to some extent. 2 …”

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confidence: 99%

Letter to the Editor: How Can the 48/6 Model of Care be Applied in Various Clinical Setting in Korea?

2020

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Korean society ages and the birth rate decreases, the country officially became an aged society at 2017, meaning that the elderly account for more than 14% of the total population. For dozens of years, the population factor has been driving growth in Korean economy, but now it has become the greatest risk for that future of health and welfare. As the amount of medical services provided to patients increases, it is expected that in the current healthcare system, where medical costs increase proportionately, the economic burden associated with medical services for the elderly increases, and thus, sustainability issues will arise. 1 Furthermore, the elderly has various social and medical needs in their daily lives, and meeting these needs is a starting point for improving the quality of life. In addition, if the healthy life expectancy of the elderly increases and reduces the duration of disease occurrence, the medical costs associated with increasing life expectancy may be reduced. Therefore, attempts have been made to contribute to the health care of the elderly by developing an elderlycentered and citizen-centered medical service system based on the 48/6 model of care (48/6), which has already been proven to some extent. 2 The 48/6 is an integrative care initiative for improving the health outcomes of hospitalized older patients. 3 However, its applicability in community-dwelling older adults as a health screening tool has not been well investigated. In the recent issue of the Journal of Korean Medical Science, Uhm et al. 4 reviewed the concept of applicability of the 48/6 as a health screening tool, and its association with mobility in community-dwelling older adults. The authors concluded that the 48/6 is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the six care areas. The authors insisted that the role of the model in screening for the health status of older adults living in the community, and in estimating mobility. However, considering the characteristics of the 48/6, it is not easy to activate the model in community. It is somewhat regrettable that this article contents are mainly about the clinical application, rather than the real value of 48/6. On this line, there are several issues need to be addressed. First, the tools applied in the study are not the full version of the 48/6, but the 10 questions, which are the short version of the 48/6, so it is appropriate to use other term, such as the Geriatric Screening for Care-10 (GCS-10) published by the authors in 2017 5 rather than the 48/6. Second, the 48/6 (or GCS-10) was originally created for the purpose of early screening of the problem within 48 hours of admission, so it should be considered whether it

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Development of a senior-specific, citizen-oriented healthcare service system in South Korea based on the Canadian 48/6 model of care

Cited by 9 publications

References 59 publications

Importance of Geriatric Syndrome Screening within 48 Hours of Hospitalization for Identifying Readmission Risk: A Retrospective Study in an Acute-Care Hospital

Importance of Geriatric Syndrome Screening within 48 Hours of Hospitalization for Identifying Readmission Risk: A Retrospective Study in an Acute-Care Hospital

The Experience of Providing Older Adult Patients with Transitional Care from an Acute Care Hospital to Home in Cooperation with a Public Health Center

Letter to the Editor: How Can the 48/6 Model of Care be Applied in Various Clinical Setting in Korea?

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