Multilevel Comparisons of Hospital Discharge among Older Adults with a Fall‐Related Hospitalization

Towne, Samuel D.; Fair, Kayla; Smith, Matthew Lee; Dowdy, Diane; Ahn, SangNam; Nwaiwu, Obioma; Ory, Marcia G.

doi:10.1111/1475-6773.12763

Cited by 6 publications

(3 citation statements)

References 14 publications

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“…Although not all falls lead to significant injury and related hospitalization, those that do can be costly [5]. Further, even among community-dwelling adults, discharge after fall-related hospitalization can lead to additional care needs in institutionalized settings [6]. Fall-related incidence and related consequences are anticipated to rise as the older adult population, who are at a greater risk of falling, is growing.…”

Section: Introductionmentioning

confidence: 99%

Delivery of Fall Prevention Interventions for At-Risk Older Adults in Rural Areas: Findings from a National Dissemination

Smith

Towne

Herrera-Venson

et al. 2018

IJERPH

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Falls incidence rates and associated injuries are projected to increase among rural-dwelling older adults, which highlights the need for effective interventions to prevent falls and manage fall-related risks. The purpose of this descriptive study was to identify the geospatial dissemination of eight evidence-based fall prevention programs (e.g., A Matter of Balance, Stepping On, Tai Chi, Otago Exercise Program) across the United States (U.S.) in terms of participants enrolled, workshops delivered, and geospatial reach. These dissemination characteristics were compared across three rurality designations (i.e., metro areas; non-metro areas adjacent to metro areas; and, non-metro areas not adjacent to metro areas). Data were analyzed from a national repository of 39 Administration for Community Living (ACL) grantees from 2014–2017 (spanning 22 states). Descriptive statistics were used to assess program reach, delivery-site type, and completion rate by rurality. Geographic information systems (GIS) geospatially represented the collective reach of the eight interventions. Of the 45,812 participants who attended a fall prevention program, 12.7% attended workshops in non-metro adjacent areas and 6.6% attended workshops in non-metro non-adjacent areas. Of the 3755 workshops delivered (in over 550 unique counties), most were delivered in senior centers (26%), residential facilities (20%), healthcare organizations (13%), and faith-based organizations (9%). On average, the workshop attendance/retention rates were consistent across rurality (~70%). Findings highlight the need to diversify the delivery infrastructure for fall prevention programs to adequately serve older adults in rural areas. Ongoing efforts are needed to offer sustainable technical assistance and to develop scalable clinical-community referral systems to increase fall prevention program participation among rural-dwelling older adults.

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Section: Introductionmentioning

confidence: 99%

Delivery of Fall Prevention Interventions for At-Risk Older Adults in Rural Areas: Findings from a National Dissemination

Smith

Towne

Herrera-Venson

et al. 2018

IJERPH

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“…Fifth, hospitalization is inevitable when older adults have serious fall-related injuries like fractures. Hospital stays, especially those involving surgeries, are, however, likely to contribute to further deterioration of overall health and mental health, leading to discharge with home healthcare or to institutional settings [29]. As discussed, fall injuries are a leading cause of hospital readmission especially when older adults have cognitive impairment and are discharged home or to home healthecare [12].…”

Section: Discussionmentioning

confidence: 99%

Fall-related emergency department visits and hospitalizations among community-dwelling older adults: examination of health problems and injury characteristics

Choi

DiNitto

et al. 2019

BMC Geriatr

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BackgroundFall injuries and related healthcare use among older adults are increasing in the United States. This study examined chronic illnesses, sensory and memory problems, and injury characteristics that were associated with ED visits and hospitalizations among older adults who received medical attention for fall injuries within a 91-day reference period.MethodsData were from the publicly available 2013–2017 US National Health Interview Survey files (unweighted N = 1840 respondents aged > 60 years with fall injuries). We first described socioeconomic, health/mental health, healthcare utilization, and injury characteristics among three groups: those who neither visited an ED nor were hospitalized for their fall injury, those who visited an ED only, and those who were hospitalized. Then, using multinomial logistic regression analysis, we examined associations of healthcare utilization (ED visit only and hospitalization vs. no ED visit/hospitalization) with chronic illnesses, other health problems, and injury characteristics, controlling for socioeconomic factors.ResultsOf older adults who received medical attention for fall injuries, a little more than one-third had an ED visit only and a little less than a fifth had an overnight hospital stay. Multivariable analysis showed that lung disease and memory problems were associated with higher risk of ED visit only; hip and head injuries, facial injuries, and broken bones/fractures (from any type of injury) were more likely to result in hospitalization than other injuries. Fall injuries sustained inside the home, falls from loss of balance/dizziness, and living alone were also more likely to result in hospitalization.ConclusionsThese healthcare utilization findings indicate the significant toll that fall injuries exact on older adults and healthcare systems. Fall prevention should target risk factors that are specific to serious injuries requiring costly care. Strategies for implementing scalable, adaptable, and measurable fall prevention models by primary care and emergency medical service providers and ED staff are needed.

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“…A recent study analyzed physician search patterns in the EMR and uncovered considerable variation in information-seeking behavior [5]. In general, hierarchical modeling has been applied in various clinical settings to account for physician-related variability where the data has a hierarchical structure and can be grouped by a variety of factors such as country, state, or hospital site [26, 27, 28, 29, 30, 31, 32].…”

Section: Introductionmentioning

confidence: 99%

Modeling physician variability to prioritize relevant medical record information

Tajgardoon

Cooper

King

et al. 2020

Preprint

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Objective Patient information can be retrieved more efficiently in electronic medical record (EMR) systems by using machine learning models that predict which information a physician will seek in a clinical context. However, information-seeking behavior varies across EMR users. To explicitly account for this variability, we derived hierarchical models and compared their performance to non-hierarchical models in identifying relevant patient information in intensive care unit (ICU) cases. Materials and Methods Critical care physicians reviewed ICU patient cases and selected data items relevant for presenting at morning rounds. Using patient EMR data as predictors, we derived hierarchical logistic regression (HLR) and standard logistic regression (LR) models to predict their relevance. Results In 73 pairs of HLR and LR models, the HLR models achieved an area under the ROC curve of 0.81, 95% CI [0.80, 0.82], which was statistically significantly higher than that of LR models (0.75, 95% CI [0.74-0.76]). Further, the HLR models achieved statistically significantly lower expected calibration error (0.07, 95% CI [0.06-0.08]) than LR models (0.16, 95% CI [0.14-0.17]). Discussion The physician reviewers demonstrated variability in selecting relevant data. Our results show that HLR models perform significantly better than LR models with respect to both discrimination and calibration. This is likely due to explicitly modeling physician-related variability. Conclusion Hierarchical models can yield better performance when there is physician-related variability as in the case of identifying relevant information in the EMR.

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Multilevel Comparisons of Hospital Discharge among Older Adults with a Fall‐Related Hospitalization

Abstract: Understanding risk factors for costly discharges to institutional settings enables targeted fall-prevention interventions with identification of at-risk groups and allows for identifying policy-related factors associated with discharge status.

Cited by 6 publications

References 14 publications

Delivery of Fall Prevention Interventions for At-Risk Older Adults in Rural Areas: Findings from a National Dissemination

Delivery of Fall Prevention Interventions for At-Risk Older Adults in Rural Areas: Findings from a National Dissemination

Fall-related emergency department visits and hospitalizations among community-dwelling older adults: examination of health problems and injury characteristics

Modeling physician variability to prioritize relevant medical record information

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