Reduced emergency room and hospital utilization in persons with multiple chronic conditions and disability receiving home-based primary care

Schamess, Andrew; Foraker, Randi E.; Kretovics, Matthew; Barnes, Kelli D.; Beatty, Stuart J.; Bose‐Brill, Seuli; Tayal, Neeraj

doi:10.1016/j.dhjo.2016.10.004

Cited by 25 publications

(30 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…An acute‐on‐chronic health condition differs from ongoing health needs as it is an acute onset of a chronic condition, also known as an acute exacerbation. Evidence surrounding HNHC patients demonstrates that acute‐on‐chronic health conditions are the major drivers of health services use, and thus, start the cause‐and‐effect system of the feedback loop 24 . HNHC patients often experience acute exacerbations as a result of inadequate disease management, social stressors (e.g., isolation or lack of housing), or poor care coordination 1,25 .…”

Section: Resultsmentioning

confidence: 99%

High‐need high‐cost patients: A Concept Analysis

Bilazarian

2020

Nursing Forum

View full text Add to dashboard Cite

High‐need high‐cost (HNHC) patients are variously defined in the literature as the small subset of the population who account for the majority of US health care costs. Lack of consensus on the defining attributes of HNHC patients has challenged the effectiveness of interventions aimed to improve disease management and reduce costs. Guided by the Walker and Avant method of concept analysis, a literature review of 2 databases (PubMed and CINAHL) was conducted. Three main subgroups of HNHC patients were identified: adults with multiple chronic conditions and functional disability, the frail elderly, and patients under 65 years old with a disability or behavioral health condition. HNHC patients are categorized by a feedback loop of acute‐on‐chronic health conditions, preventable health service utilization, and fragmented care. Antecedents that predispose becoming a HNHC patient include challenges accessing timely care, low socioeconomic status, unmet support, and social factors such as isolation and inadequate.

show abstract

Section: Resultsmentioning

confidence: 99%

High‐need high‐cost patients: A Concept Analysis

Bilazarian

2020

Nursing Forum

View full text Add to dashboard Cite

show abstract

“…Moreover, variables related to community health services, such as home healthcare, were not considered. If home healthcare can contribute to improving older adults’ health management, this clientele is considered at higher risk of ED visits, related to their higher multimorbidity level [42, 43].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with frequent use of emergency-department services in a geriatric population: a systematic review

et al. 2019

View full text Add to dashboard Cite

Background Frequent geriatric users of emergency departments (EDs) constitute a small group of individuals accounting for a disproportionately high number of ED visits. In addition to overcrowding, this situation might result in a less appropriate response to health needs and negative health impacts. Geriatric patients turn to EDs for a variety of reasons. A better understanding of the variables associated with frequent ED use will help implement interventions best suited for their needs . Objective This review aimed at identifying variables associated with frequent ED use by older adults. Methods For this systematic review, we searched Medline, CINAHL, Healthstar, and PsyINFO (before June 2018). Articles written in English or French meeting these criteria were included: targeting a population aged 65 years or older, reporting on frequent ED use, using an observational study design and multivariate regression analysis. The search was supplemented by manually examining the reference lists of relevant studies. Independent reviewers identified articles for inclusion, extracted data, and assessed quality with the JBI Critical Appraisal Checklist for Studies Reporting Prevalence . A narrative synthesis was done to combine the study results. A sensitivity analysis was performed to evaluate the effect of removing the studies not meeting the quality criteria. Results Out of 5096 references, 8 met our inclusion criteria. A high number of past hospital and ED admissions, living in a rural area adjacent to an urban center, low income, a high number of prescribed drugs, and a history of heart disease were associated with frequent ED use among older adults. In addition, having a principal-care physician and living in a remote rural area were associated with fewer ED visits. Some variables recognized in the literature as influencing ED use among older adults received scant consideration, such as comorbidity, dementia, and considerations related to primary-care and community settings. Conclusion Further studies should bridge the gap in understanding and give a more global portrait by adding important personal variables such as dementia, organizational variables such as use of community and primary care, and contextual variables such as social and economic frailty. Electronic supplementary material The online version of this article (10.1186/s12877-019-1197-9) contains supplementary material, which is available to authorized users.

show abstract

“…Some people, such as those living in poverty, with a long-term disability, from a culturally and linguistically diverse background or located in rural and remote areas, have difficulty accessing primary care services and resources. 1–4 …”

Section: Introductionmentioning

confidence: 99%

Patient navigators facilitating access to primary care: a scoping review

et al. 2018

View full text Add to dashboard Cite

ObjectivePatient navigators are a promising mechanism to link patients with primary care. While navigators have been used in population health promotion and prevention programmes, their impact on access to primary care is not clear. The aim of this scoping review was to examine the use of patient navigators to facilitate access to primary care and how they were defined and described, their components and the extent to which they were patient centred.Setting and participantsWe used the Arksey and O’Malley scoping review method. Searches were conducted in MEDLINE, Embase, ProQuest Medical, other key databases and grey literature for studies reported in English from January 2000 to April 2016. We defined a patient navigator as a person or process creating a connection or link between a person needing primary care and a primary care provider. Our target population was people without a regular source of, affiliation or connection with primary care. Studies were included if they reported on participants who were connected to primary care by patient navigation and attended or made an appointment with a primary care provider. Data analysis involved descriptive numerical summaries and content analysis.ResultsTwenty studies were included in the final scoping review. Most studies referred to ‘patient navigator’ or ‘navigation’ as the mechanism of connection to primary care. As such, we grouped the components according to Freeman’s nine-principle framework of patient navigation. Seventeen studies included elements of patient-centred care: informed and involved patient, receptive and responsive health professionals and a coordinated, supportive healthcare environment.ConclusionsPatient navigators may assist to connect people requiring primary care to appropriate providers and extend the concept of patient-centred care across different healthcare settings. Navigation requires further study to determine impact and cost-effectiveness and explore the experience of patients and their families.

show abstract

Reduced emergency room and hospital utilization in persons with multiple chronic conditions and disability receiving home-based primary care

Cited by 25 publications

References 74 publications

High‐need high‐cost patients: A Concept Analysis

High‐need high‐cost patients: A Concept Analysis

Factors associated with frequent use of emergency-department services in a geriatric population: a systematic review

Patient navigators facilitating access to primary care: a scoping review

Contact Info

Product

Resources

About