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

Fan, Lijun; Lukin, Bill; Zhao, Jingzhou; Sun, Jiandong; Hou, Xiang-Yu

doi:10.1136/emermed-2014-203770

Cited by 28 publications

(25 citation statements)

References 42 publications

(109 reference statements)

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“…Then, we evaluated the factors associated with URV risk for non-admitted patients and hospitalized patients by using simple variables at the disposal of the emergency care provider. Two models for predicting risk of readmission after hospital discharge using easily available clinical and administrative data have been previously proposed [ 24 – 26 ], but only half of all discharged patients eventually readmitted were correctly identified [ 22 , 31 , 32 ]. The value of carrying out a geriatric clinical assessment (GCA) and various geriatric scores has been suggested; however most authors agree that this geriatric expertise takes too much time to be performed routinely in ED [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…All elderly patients seen in the ED were included. Even if +65 years old is currently accepted as elderly people by WHO, previous studies on interventions targeting the elderly population to reduce ED utilization in developed countries have been included patients aged greater than 55, 60, 65, 70 and 75 years old [ 22 ]. As 75 years old is the currently accepted value in France to define geriatrics patients, elderly population was defined as patients aged 75-years and over.…”

Section: Methodsmentioning

confidence: 99%

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Unscheduled-Return-Visits after an Emergency Department (ED) Attendance and Clinical Link between Both Visits in Patients Aged 75 Years and Over: A Prospective Observational Study

et al. 2015

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BackgroundPredictors of unscheduled return visits (URV), best time-frame to evaluate URV rate and clinical relationship between both visits have not yet been determined for the elderly following an ED visit.MethodsWe conducted a prospective-observational study including 11,521 patients aged ≥75-years and discharged from ED (5,368 patients (53.5%)) or hospitalized after ED visit (6,153 patients). Logistic Regression and time-to-failure analyses including Cox proportional model were performed.ResultsMean time to URV was 17 days; 72-hour, 30-day and 90-day URV rates were 1.8%, 6.1% and 10% respectively. Multivariate analysis indicates that care-pathway and final disposition decisions were significantly associated with a 30-day URV. Thus, we evaluated predictors of 30-day URV rates among non-admitted and hospitalized patient groups. By using the Cox model we found that, for non-admitted patients, triage acuity and diagnostic category and, for hospitalized patients, that visit time (day, night) and diagnostic categories were significant predictors (p<0.001). For URV, we found that 25% were due to closely related-clinical conditions. Time lapses between both visits constituted the strongest predictor of closely related-clinical conditions.ConclusionOur study shows that a decision of non-admission in emergency departments is linked with an accrued risk of URV, and that some diagnostic categories are also related for non-admitted and hospitalized subjects alike. Our study also demonstrates that the best time frame to evaluate the URV rate after an ED visit is 30 days, because this is the time period during which most URVs and cases with close clinical relationships between two visits are concentrated. Our results suggest that URV can be used as an indicator or quality.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Unscheduled-Return-Visits after an Emergency Department (ED) Attendance and Clinical Link between Both Visits in Patients Aged 75 Years and Over: A Prospective Observational Study

et al. 2015

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“…These approaches encompass measures to improve the availability of primary or community care so that patients otherwise require hospital transfers could be alternatively cared at their residencies or in the community, and measures of fast tracking and early discharge planning for patients visiting hospitals so that they could depart from the ED or hospital at an earliest time. A large literature has been establishing the possibility of such measures toward reductions in hospital attendances and decrease in length of hospital stays [ 28 , 29 ], both of which would bring about savings in acute hospital service utilisation and thus related costs. Associated savings in hospital care service utilisation are considered as a fundamental driver of the cost-saving potential of such programs; and by this means, hospital resources can be more appropriately and efficiently used by other people in needs.…”

Section: Discussionmentioning

confidence: 99%

Cost analysis of improving emergency care for aged care residents under a Hospital in the Nursing Home program in Australia

Fan

Lukin

Zhao³

et al. 2018

PLoS ONE

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BackgroundThis study aims to examine the costs associated with a Hospital in the Nursing Home (HiNH) program in Queensland Australia directed at patients from residential aged care facilities (RACFs) with emergency care needs.MethodsA cost analysis was undertaken comparing the costs under the HiNH program and the current practice, in parallel with a pre-post controlled study design. The study was conducted in two Queensland public hospitals: the Royal Brisbane and Women’s Hospital (intervention hospital) and the Logan Hospital (control hospital). Main outcome measures were the associated incremental costs or savings concerning the HiNH program provision and the acute hospital care utilisation over one year after intervention.ResultsThe initial deterministic analysis calculated the total induced mean costs associated with providing the HiNH program over one year as AU$488,116, and the total induced savings relating to acute hospital care service utilisation of AU$8,659,788. The total net costs to the health service providers were thus calculated at -AU$8,171,671 per annum. Results from the probabilistic sensitivity analysis (based on 10,000 simulations) showed the mean and median annual net costs associated with the HiNH program implementation were -AU$8,444,512 and–AU$8,202,676, and a standard deviation of 2,955,346. There was 95% certainty that the values of net costs would fall within the range from -AU$15,018,055 to -AU$3,358,820.ConclusionsThe costs relating to implementing the HiNH program appear to be much less than the savings in terms of associated decreases in acute hospital service utilisation. The HiNH service model is likely to have the cost-saving potential while improving the emergency care provision for RACF residents.

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“…Reviews of ED interventions were organised into four evidence clusters: discharge intervention reviews (11,15,18,19,21), staff-focused reviews (13,14,17,20,23), population focused reviews (22,24), and intervention component reviews (12,16,24). Only 5 of the 15 reviews reported interventions delivered wholly within the ED -the remainder were continued into other settings.…”

Section: Intervention Classificationmentioning

confidence: 99%

Improving outcomes for older people in the emergency department: a review of reviews

et al. 2020

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BackgroundThere has been a recognised trend of increasing use of emergency and urgent care and emergency departments (EDs) by older people, which is marked by a substantial evidence base reporting interventions for this population and guidance from key organisations. Despite this, outcomes for this population remain suboptimal. A plethora of reviews in this area provides challenges for clinicians and commissioners in determining which interventions and models of care best meet people’s needs. The aim of this review was to identify effective ED interventions which have been reported for older people, and to provide a clear summary of the myriad reviews and numerous intervention types in this area.MethodsA review of reviews, reporting interventions for older people, either initiated or wholly delivered within the ED.ResultsA total of 15 review articles describing 83 primary studies met our content and reporting standards criteria. The majority (n=13) were systematic reviews (four using meta-analysis.) Across the reviews, 26 different outcomes were reported with inconsistency. Follow-up duration varied within and across the reviews. Based on how authors had reported results, evidence clusters were developed: (1) staff-focused reviews, (2) discharge intervention reviews, (3) population-focused reviews and (4) intervention component reviews.ConclusionsThe evidence base describing interventions is weak due to inconsistent reporting, differing emphasis placed on the key characteristics of primary studies (staff, location and outcome) by review authors and varying quality of reviews. No individual interventions have been found to be more promising, but interventions initiated in the ED and continued into other settings have tended to result in more favourable patient and health service outcomes. Despite many interventions reported within the reviews being holistic and patient focused, outcomes measured were largely service focused.PROSPERO registration numberPROSPERO CRD42018111461.

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

Cited by 28 publications

References 42 publications

Unscheduled-Return-Visits after an Emergency Department (ED) Attendance and Clinical Link between Both Visits in Patients Aged 75 Years and Over: A Prospective Observational Study

Unscheduled-Return-Visits after an Emergency Department (ED) Attendance and Clinical Link between Both Visits in Patients Aged 75 Years and Over: A Prospective Observational Study

Cost analysis of improving emergency care for aged care residents under a Hospital in the Nursing Home program in Australia

Improving outcomes for older people in the emergency department: a review of reviews

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