Abstract
BackgroundPatients with Parkinson disease (PD) are at high risk of hospital encounters with increasing morbidity and mortality. This study aimed to determine the rate of hospital encounters in a cohort followed over 5 years and to identify associated factors.MethodsWe queried the data from the International Multicenter National Parkinson Foundation Quality Improvement study. Multivariate logistic regression with backward selection was performed to identify factors associated with hospital encounter prior to baseline visit. Kaplan-Meier estimates were obtained and Cox regression performed on time to hospital encounter after the baseline visit.ResultsOf the 7,507 PD patients (mean age 66.5±9.9 years and disease duration 8.9±6.4 years at baseline visit), 1919 (25.6%) had a history of a hospital encounter prior to their baseline visit. Significant factors associated with a history of a hospital encounter prior to baseline included race (white race: OR 0.49), utilization of physical therapy (OR 1.47), history of deep brain stimulation (OR 1.87), number of comorbidities (OR 1.30), caregiver strain (OR 1.17 per standard deviation), and the standardized Timed Up and Go Test (OR 1.21). Patients with a history of hospitalization prior to the baseline were more likely to have a re-hospitalization (HR1.67, P<0.0001) compared to those without a prior hospitalization. In addition, the time to hospital encounter from baseline was significantly associated with age and number of medications. In patients with a history of hospitalization prior to the baseline visit, time to a second hospital encounter was significantly associated with caregiver strain and number of comorbidities.ConclusionHospitalization and re-hospitalization were common in this cohort of people with PD. Our results suggest addressing caregiver burden, simplifying medications, and emphasizing primary and multidisciplinary care for comorbidities are potential avenues to explore for reducing hospitalization rates.
Highlights
Patients with Parkinson’s disease (PD) are reported to have 1.44 times more hospital admissions when compared to age and sex-matched peers, [1, 2] and these admissions are associated with prolonged length-of-stay and increased morbidity and mortality [3,4,5]
Significant factors associated with a history of a hospital encounter prior to baseline included race, utilization of physical therapy, history of deep brain stimulation, number of comorbidities, caregiver strain, and the standardized Timed Up and Go Test
Our results suggest addressing caregiver burden, simplifying medications, and emphasizing primary and multidisciplinary care for comorbidities are potential avenues to explore for reducing hospitalization rates
Summary
Patients with Parkinson’s disease (PD) are reported to have 1.44 times more hospital admissions when compared to age and sex-matched peers, [1, 2] and these admissions are associated with prolonged length-of-stay and increased morbidity and mortality [3,4,5]. In a prior analysis using the National Parkinson Foundation Quality Improvement Initiative (NPF-QII), hospital encounters were shown to occur in approximately 30% of patients with PD who were followed prospectively for two years [8]. The aim of the current study was to evaluate hospital encounters using a five-year follow-up period. We aimed to identify factors associated with hospital encounters. Patients with Parkinson disease (PD) are at high risk of hospital encounters with increasing morbidity and mortality. This study aimed to determine the rate of hospital encounters in a cohort followed over 5 years and to identify associated factors
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