Higher Risk Of Hospital Admission Research Articles

Telehealthcare for asthma.

Healthcare systems internationally need to consider new models of care to cater for the increasing numbers of people with asthma. Telehealthcare interventions are increasingly being seen by policymakers as a potential means of delivering asthma care. We defined telehealthcare as being healthcare delivered from a distance, facilitated electronically and involving the exchange of information through the personalised interaction between a healthcare professional using their skills and judgement and the patient providing information. To assess the effectiveness of telehealthcare interventions in people with asthma. We searched in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, and PsycINFO; this was supplemented by handsearching of respiratory journals. We also searched registers of ongoing and unpublished trials. We selected completed randomised controlled trials of telehealthcare initiatives aiming to improve asthma care. Two review authors independently appraised studies for inclusion and extracted data and performed meta-analyses. We analysed dichotomous variables to produce an odds ratio (OR) and continuous variables to produce a mean difference. We included 21 trials in this review. The 21 included studies investigated a range of technologies aiming to support the provision of care from a distance. These included: telephone (n = 9); video-conferencing (n = 2); Internet (n = 2); other networked communications (n = 6); text Short Messaging Service (n = 1); or a combination of text and Internet (n = 1). Meta-analysis showed that these interventions did not result in clinically important improvements in asthma quality of life (minimum clinically important difference = 0.5): mean difference in Juniper's Asthma Quality of Life Questionnaire (AQLQ) 0.08 (95% CI 0.01 to 0.16). Telehealthcare for asthma resulted in a non-significant increase in the odds of emergency department visits over a 12-month period: OR 1.16 (95% CI 0.52 to 2.58). There was, however, a significant reduction in hospitalisations over a 12-month period: OR 0.21 (95% CI 0.07 to 0.61), the effect being most marked in people with more severe asthma managed predominantly in secondary care settings. Telehealthcare interventions are unlikely to result in clinically relevant improvements in health outcomes in those with relatively mild asthma, but they may have a role in those with more severe disease who are at high risk of hospital admission. Further trials evaluating the effectiveness and cost-effectiveness of a range of telehealthcare interventions are needed.

A pilot study of identification and case management of high-risk COPD patients in a general practice

A variety of individual therapeutic interventions have been shown to reduce hospital admissions and improve quality of life in patients with chronic obstructive pulmonary disease (COPD). However, there is a paucity of data of looking at the effect of case management in primary care (i.e. using an integrated care approach) of people at higher risk of mortality from COPD. To examine the effect of case management in primary care of patients with COPD at high risk of hospital admission, identified using a novel multidimensional index of disease severity (DOSE index). Observational pilot study in a single general practice. High-risk patients were identified using the DOSE index and case managed using an IT system according to British National Guidelines over a 6-month period. Eleven patients entered and completed the study. There was no improvement in health status, but there was a non-significant reduction in total hospital admissions (three versus zero) and total bed days (16 versus 0) compared to the same reference period in the previous year. There was an increase in self-management knowledge. Case management of high-risk patients in primary care may reduce hospital admissions. This needs to be tested in a randomized controlled trial.

Prevention of adverse health trajectories in a vulnerable elderly population through nurse home visits: a randomized controlled trial [ISRCTN05358495

Can indicative prevention of home-visiting nurses be effective when targeted at a frail senior population using multidimensional geriatric assessments and personalized care plans? We performed an individually randomized controlled trial in 33 blinded primary care practices over 18 months. The 651 participants were aged 75 years or older, lived at home, and were frail but neither terminally ill nor demented. A score in the lowest quartile on at least two of six self-reported functional health domains (COOP-WONCA charts), defined frail health. We compared usual care with proactive home visits by trained community nurses. The nurses (a) assessed the care needs with a multidimensional computerized geriatric instrument, which enabled direct identification of health risks; (b) determined care priorities together with the person; (c) designed and executed individually tailored interventions; and (d) monitored participants by telephone and on average three home visits. Primary outcome measures were functional health and instrumental activities of daily living disability. Secondary outcomes were acute hospital admittance (time until), institutionalization, and mortality. We found no significant differences between intervention and usual care group on any of the outcome measures. Predefined subgroup analyses revealed a higher risk of hospital admission for persons with poor health in the intervention group. We could not demonstrate preventive effects of home visits by nurses in vulnerable older persons. Hospital admissions increased in the frailest group. The search for effective interventions for vulnerable persons requires further investigation. Future efforts may focus on improved integrated approaches.

Twins born following assisted reproductive technology: perinatal outcome and admission to hospital

Compared with spontaneously conceived (SC) singletons, adverse perinatal outcome, neonatal intensive care unit (NICU) admission and hospital admission in infancy are more common in those born following Assisted Reproductive Technology (ART). Similar comparisons for twins have shown conflicting results. We investigated perinatal outcome and hospital admission during the first 3 years of life for all twin children born in Western Australia between 1994 and 2000 [700 ART, 4097 SC]. ART twins had a greater risk of adverse perinatal outcome including preterm birth, low birthweight and death compared with SC twins of unlike-sex. In their first year of life, ART twins had a longer birth admission; were 60% more likely to be admitted to a NICU; and had a higher risk of hospital admission. The increased risk of hospital admission continued in the second and third year but was not statistically significant in the third year. Couples undertaking ART should be aware that in addition to the known increased perinatal risks associated with a twin birth, ART twins are more likely than SC twins to be admitted to a NICU and hospitalized in the first 3 years of life.

High outpatient pain intensity scores predict impending hospital admissions in a comprehensive cancer center

20525 Background: This retrospective review was designed to determine if high pain intensity scores (PIS) can be used to identify outpatients at high risk for hospital admission. Methods: Categorical PIS (0–10) are obtained with each outpatient visit at the Johns Hopkins Comprehensive Cancer Center and stored in an electronic database. PIS from all outpatient medical and radiation oncology encounters from January 1, 2004 to December 31, 2006 were merged with an inpatient database to screen for admissions that occurred within 30 days of the outpatient encounter. Descriptive statistics were used to summarize age, gender, diagnosis and admissions. PIS were categorized as 0–3, 4- 6, and 7–10. Odds ratios (OR) for hospital admission were calculated using logistic regression and two-sided p values are reported. Results: 119,069 outpatient visits were assessed with 116,713 (98%) being evaluable encounters. 5183 (4.4%) encounters had PIS of 7–10 and 29% of these were associated with hospital admission within 30 d...

Pergolide Associated Cardiac Valvulopathy Based on Ontario Administrative Data

Pergolide is an ergot derived dopamine agonist that is widely used for the treatment of Parkinson's disease. Studies have found an association between pergolide and valvular heart abnormalities although there is still much to be learned about the clinical significance of the valvular changes, who is at risk, and whether there is duration of exposure effect. To assess the long term risk of hospital admissions for valvular heart disease (VHD) or congestive heart failure (CHF, a clinically overt outcome of VHD) in new users of pergolide compared to new users of levodopa. The secondary objective was to assess whether there are any characteristics that can predict who is at higher risk of developing this outcome. Retrospective, population-based cohort study. Ontario, Canada. Ontario residents aged 66 and older, newly started on treatment with either pergolide or levodopa. Admission to hospital with the most responsible diagnosis of congestive heart failure or valvular heart disease. The risk for admission for valvular heart disease or congestive heart failure were higher in those with 1-4 years exposure to pergolide compared with no exposure to pergolide (VHD: hazard ratio 2.4, p = 0.04; CHF: hazard ratio 1.6, p = 0.02). No such pattern was found with exposure to levodopa. Our study demonstrates that treatment with pergolide is associated with a higher risk of hospital admission for valvular heart disease or congestive heart failure and that this risk is greater in those with 1-4 years exposure than in those with less exposure. We did not find an increased risk beyond four years.

Over 85s at high risk of hospital admission with head injuries

Over 85s at high risk of hospital admission with head injuries

Isolated systolic hypertension in a cohort of type 2 diabetic patients

Previous studies of the adverse effects of isolated and borderline isolated systolic hypertension excluded or under-represented type 2 diabetic patients. The aim of this study was to evaluate the prevalence and role of isolated and borderline isolated systolic hypertension in a cohort of 3892 type 2 diabetic patients. The hypertensive patients were classified as treated (n= 1806; 46.4%), untreated diastolic hypertension (n=407; 10.4%), untreated isolated systolic hypertension (n=166; 4.3%) and untreated borderline isolated systolic hypertension (n=625; 16%). A Cox proportional hazard model including several confounders showed that the patients with untreated isolated systolic hypertension were at significantly higher risk of hospital admissions due to cerebrovascular diseases than the normotensive and untreated diastolic hypertensive patients (HR=2.05; 95% CI: 1.2-3.4 and HR=1.97; 95%CI: 1.1-3.5, respectively). In the same model, borderline isolated systolic hypertension significantly correlated with admissions for cerebrovascular diseases in comparison with normotensive patients (HR=1.73; 95% CI: 1.2-2.6). This is the first report concerning the prevalence of isolated and borderline isolated systolic hypertension in a large cohort of type 2 diabetic patients. The results are in line with population-based estimates. Our data show that isolated systolic hypertension is an independent predictor of hospital admissions due to cerebrovascular diseases.

Impact of severe disease caused by respiratory syncytial virus in children living in developed countries.

Among industrialized nations, the rate of rehospitalization in the United States for respiratory syncytial virus (RSV) is approximately 30 per 1000, exceptions being noted for American Indians and Alaskan natives, two ethnic groups who tend toward higher rates of RSV hospitalization. In distinction Japan reports an admission rate of 60 per 1000 for RSV disease. Yet Japan ranks considerably lower than many of its western counterparts in premature births. Whether an RSV subtype, a new viral genotype or some other unifying characteristic exists that might explain the severity of adenovirus, parainfluenza and RSV infections in this region of Asia remains to be determined. Outcomes trials in the United States, Canada, United Kingdom, Denmark and Japan all identified crowding and exposure to tobacco smoke as significant and independent risk factors for disease severity of RSV. The epidemiology of RSV is largely consistent throughout Europe, with peak outbreaks occurring in December and January. In Europe RSV accounts for 42 to 45% of hospital admissions for lower respiratory tract infections in children younger than 2 years of age, and inpatient populations tend to be younger and to experience greater disease severity. For RSV bronchiolitis lengths of stay in European hospitals range from a low of 4 days to a high of 10 days. The Infección Respiratoria Infantil por Virus Respiratorio Sincitial Study Group in Spain conducted 2 prospective observational studies in 14 and 26 neonatal units, respectively, on nonprophylaxed neonates to determine hospitalization rates for respiratory syncytial viral illness during 2 consecutive RSV seasons. Throughout each respiratory season the study group followed premature infants of < or =32 weeks gestational age at birth, representing an annual birth cohort of approximately 100 000 infants. A total of 584 infants who were < or =32 weeks gestational age in the first season and 999 in the second season were followed at monthly intervals. The nonprophylaxed hospitalized group was compared with the nonprophylaxed, nonhospitalized group, and presumptive risk factors were determined for rehospitalization among premature infants. These independent variables, similar for both years, were identified as low gestational age, underlying chronic lung disease, living with school age siblings, exposure to tobacco smoke and a chronologic age of < 3 months at the onset of the RSV season.Stable, yet high rates of admission for RSV illness in Spain were observed in this premature group of < or =32 weeks gestational age: 13.4% for 1999; and 13.1% for the year 2000. Of those hospitalized during the 2 years of the study, 18 and 25%, respectively, were admitted to the intensive care unit. With the exception of higher rates of family allergy, multiple deliveries and a lower rate of neonatal morbidity, prognostic variables for high risk of hospital admission in the year 2000 compared with those of the 1999 sample. Findings from this comprehensive, prospective study served as the basis for the development of standards for the prevention of respiratory syncytial virus infection by the Spanish Society of Neonatology.

A geriatric evaluation and management programme prevented functional decline and reduced depression in high risk older adults

Boult C, Boult LB, Morishita L , et al. A randomized clinical trial of outpatient geriatric evaluation and management. J Am Geriatr Soc2001 Apr; 49 : 351 –9 [OpenUrl][1][CrossRef][2][PubMed][3][Web of...

An outpatient geriatric evaluation and management programme was more effective than usual care in preventing functional decline in high risk older adults

Boult C, Boult LB, Morishita L, et al. A randomized clinical trial of outpatient geriatric evaluation and management. J Am Geriatr Soc2001 Apr; 49 : 351 –9 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4]...

Proximity to coke works and hospital admissions for respiratory and cardiovascular disease in England and Wales

BACKGROUNDThe incidence of hospital admissions for respiratory and cardiovascular diseases in areas close to operating coke works in England and Wales was investigated.METHODSA small area study using distance from source...

Test‐Retest Reliability of a Questionnaire That Identifies Elders at Risk for Hospital Admission

To determine the test-retest reliability of a questionnaire designed to measure elderly persons' probability of repeated admission (P(ra)) to a hospital within 4 years. Participants received the test questionnaire by mail; respondents to the test questionnaire received the retest questionnaire 3 weeks later. Elderly (65+) community-dwelling enrollees in the Medical Assistance (Medicaid) program of Ramsey County, MN (n = 192). The correlation (r) between the P(ra) values computed from the test-retest correlations (k) of the questionnaire's individual items were also measured. The response rate was 63% (121/192) for the test questionnaire and 69% (84/121) for the retest questionnaire. The test and retest values of P(ra) computed from responses to the questionnaires were highly correlated (r = 0.78, P < 0.0001). For the individual questionnaire items, the range of k values was 0.50-1.00 (P < 0.0001 for all items). Slightly higher values of r and k were obtained when the respondents were women and when the same person (either proxy or self) completed both questionnaires. Age was not consistently related to reliability. the test-retest reliability of individual items and of the computed P(ra) was high, suggesting that responses by elderly persons to mailed questionnaires pertaining to health status are stable over brief periods of time. The resulting P(ra) values may be useful in identifying elders at high risk for hospital admission.

A Controlled Trial of Outpatient Geriatric Evaluation and Management

To evaluate the effects of targeted outpatient geriatric evaluation and management (GEM). Controlled clinical trial. Elderly persons were identified as being at high risk for hospital admission on the basis of their responses to a short, mailed, self-administered questionnaire. The high-risk elders who chose to participate in the GEM program were compared to those who continued to receive usual care. Outpatient GEM clinic at an urban university hospital. Elderly Medicaid recipients whose probability of repeated hospital admission (Pra) within 4 years was calculated as 40% or greater (Pra > or = 0.40). Mortality, use of institutional services, satisfaction. Of the 1210 persons who were sent questionnaires, 624 responded (response rate = 51.6%), of whom 154 (24.7%) were deemed to be a high risk for hospitalization. Of these, 43 received GEM (experimental subjects); 111 received usual care (controls). At baseline, the experimental and control groups' demographic and health-related characteristics did not differ significantly. The average experimental subject was 76.5 years old, had 9.6 significant medical problems, and took 6.7 significant long-term prescription medications. During the program's first 17 months of follow-up, the experimental subjects had lower annual rates of mortality (2.9% vs 19.2%, P = 0.03) and emergency room use (0.6 vs 1.0 visits, P = 0.01) than did the controls. The experimental subjects also tended to use nursing homes, but not hospitals, at a lower rate than the controls. All of the experimental subjects rated the program as either excellent (81.0%) or good (19.0%); 100% said they would recommend it to others. Their established primary physicians rated the GEM services as appropriate and helpful. Targeted outpatient GEM was associated with reduced mortality, reduced use of emergency rooms, and a trend toward reduced use of nursing homes.