Use Of Acute Hospital Services Research Articles

Patterns of acute hospital and specialist palliative care use among people with non-curative upper gastrointestinal cancer

PurposeUpper gastrointestinal (GI) cancers contribute to 16.7% of UK cancer deaths. These patients make high use of acute hospital services, but detail about palliative care use is lacking. We aimed to determine the patterns of use of acute hospital and hospital specialist palliative care services in patients with advanced non-curative upper GI cancer.MethodsWe conducted a service evaluation of hospital use and palliative care for all patients with non-curative upper GI cancer seen in one large hospital, using routinely collected data (2019–2022). We report and characterise hospital admissions and palliative care within the study time period, using descriptive statistics, and multivariable Poisson regression to estimate the unadjusted and adjusted incidence rate ratio of hospital admissions.ResultsThe total with non-curative upper GI cancer was 960. 86.7% had at least one hospital admission, with 1239 admissions in total. Patients had a higher risk of admission to hospital if: aged ≤ 65 (IRR for 66–75 years 0.71, IRR 76–85 years 0.68; IRR > 85 years 0.53; p < 0.05), or lived in an area of lower socioeconomic status (IMD Deciles 1–5) (IRR 0.90; p < 0.05). Over the 4-year period, the rate of re-admission was higher in patients not referred to palliative care (rate 0.52 readmissions/patient versus rate 1.47 readmissions/patient).ConclusionPeople with advanced non-curative gastrointestinal cancer have frequent hospital admissions, especially if younger or from areas of lower socioeconomic status. There is clear association between specialist palliative care referral and reduced risk of hospitalisation. This evidence supports referral to specialist palliative care.

The effect of palliative outpatient units on resource use for cancer patients in Finland

Background As cancer incidences are increasing, the means to provide effective palliative care (PC) are called for. There is evidence, that PC may prevent futile treatment at the end of life (EOL) thus implicating that PC decreases resource use at the EOL, however, the effects of outpatient PC units remain largely unknown. We surveyed the national use of Finnish tertiary care PC units and their effects on resource use at the EOL in real-life environments. Patients and Methods Cancer patients treated in the departments of Oncology at all five Finnish university hospitals in 2013 and deceased by 31 December 2014 were identified; of the 6010 patients 2007 were randomly selected for the study cohort. The oncologic therapies received and the resource usage of emergency services and hospital wards were collected from the hospitals’ medical records. Results A PC unit was visited by 37% of the patients a median 112 days before death. A decision to terminate all life-prolonging cancer treatments was more often made for patients visiting the PC unit (90% vs. 66%, respectively). A visit to a PC unit was associated with significantly fewer visits to emergency departments (ED) and hospitalization during the last 90 days of life; the mean difference in ED visits decreased by 0.48 (SD 0.33 − 0.62, p < 0.001), and the mean inpatient days by 7.1 (SD 5.93 − 8.25, p < 0.001). A PC visit unit was independently associated with decreased acute hospital resource use during the last 30 and 90 days before death in multivariable analyses. Conclusion Cancer patients’ contact with a PC unit was significantly associated with the reduced use of acute hospital services at the EOL, however; only one-third of the patients visited a PC unit. Thus, systematic PC unit referral practices for patients with advanced cancer are called for.

Impact of specialized obesity management services on the reduction in the use of acute hospital services.

Severe obesity affects 4% of Australians and is associated with increased use of healthcare services and higher healthcare costs. This study evaluates the effect of attending a public tertiary obesity service on acute hospital use. This record-linkage study included people aged ≥16 years with severe obesity who attended the Nepean Blue Mountains Family Metabolic Health Service (FMHS), New South Wales, Australia between January 2017, and September 2021. Emergency department (ED) presentations and acute hospital admissions and respective costs in the 1-year and 3-years pre-and-post first FMHS attendance were compared, overall and for adequate attendance (≥5 visits). A total of 640 patients (74% female, 50% <45 years) attended the FMHS, totalling 15 303 occasions of service, average 24 per person. There was a 31.0% and 17.6% reduction in acute admissions and ED presentations, respectively, translating into 34.0% and 23.4% decrease in costs. Adequate engagement was associated with a 48% decreased risk of acute admission (odds ratio 0.52; 95% confidence interval 0.29-0.94). Over 3-years, there was a 19.8% and 20.7% reduction in acute hospital admissions and ED presentations, respectively. Findings indicate that tertiary obesity services reduce acute hospital use. Improved access to specialized obesity management may offload hospitals and contribute to acute healthcare cost avoidance.

Effects of a nursing home telehealth program on spending and utilization for Medicare residents.

To assess the effects of eLongTermCare (eLTC), a telehealth program implemented by an integrated health system in 45 nursing homes across the Midwest, on the use of acute hospital services and total expenditures for Medicare residents. Minimum Data Set, Medicare fee-for-service claims, and enrollment data from 2013 to 2018. We used a longitudinal difference-in-differences design to estimate the changes in outcomes for treatment beneficiaries before and after participating in the eLTC program, relative to changes for the matched comparison beneficiaries over the same period. We measured outcomes over a 24-month follow-up period, including total Medicare spending, emergency department (ED) visits, hospitalizations, and the likelihood of readmission. Using administrative data, we identified treatment beneficiaries who stayed at participating nursing facilities during the program period and matched comparison beneficiaries with similar baseline characteristics from non-participating facilities in the same geographic locations. For long-term care residents, the eLTC program led to an estimated reduction of 73 ED visits per 1000 beneficiaries (p < 0.01, 8.6% effect) over the two-year follow-up period. The estimated effects for this group were concentrated among beneficiaries who entered the nursing home after program startup, with sizable reductions in hospitalizations, ED visits, and spending. For skilled care residents, the program was associated with an estimated reduction of 85 ED visits per 1000 beneficiaries (p=0.03, 9.7% effect), but had no discernible effect on their hospitalizations or total Medicare spending. Telehealth can be a valuable tool for nursing homes to enhance care coordination and provide timely access to care, leading to lower spending for nursing home residents. Future research needs to explore payment methods that encourage telehealth expansion in nursing homes.

Physical multimorbidity, mental health and unplanned admissions from 2008 to 2018 in Abruzzo region

Abstract Background Multimorbidity is defined as the presence of more than one long-term disorder and it is associated with increased use of health services. Socioeconomic deprivation and mental health conditions may lead to undesirable additional unplanned admission to hospital (urgent or emergency admission). This study examines the association among unplanned admission, multimorbidity, mental health and socioeconomic deprivation for both preventable and not preventable hospitalization. Methods We conducted a retrospective analysis of hospital discharge records between 2008 and 2018 in Abruzzo, an Italian region. Multilevel logistic regression models were implemented for both preventable and not preventable unplanned admissions. We set as levels the district of residence and Local Health Authority. As independent variables we used the Italian Deprivation Index of the district of residence to mitigate socioeconomic inequalities, unweighted count of physical health conditions (0, 1, 2, 3, ≥4), the presence of a diagnosis of mental health condition. All the models were also adjusted for age and gender. Results We selected 2,017,720 non preventable admissions, 836,808 (41.45%) of which unplanned, and 152,938 preventable admissions, 107,336 (70.18%) of which unplanned. Both unplanned and potentially unplanned admissions were associated with increasing physical multimorbidity (for ≥4 v. 0 condition, OR 4.85; CI95% 4.26-5.53 for unplanned admission and OR 1.42; CI95% 1.11-1.83 for preventable unplanned admission) and with mental health conditions (OR 1.66; CI95% 1.57-1.75 for unplanned admission and OR 1.18; CI95% 1.00-1.38 for preventable unplanned admission). Conclusions Co-occurrence of physical multimorbidity and mental health condition was associated either with unplanned admission or unplanned preventable admission. Primary care interventions targeting multimorbidity are necessary to reduce the hospital service burden. Key messages Physical multimorbidity substantially affects the use of acute hospital services. Primary care interventions targeting multimorbidity are necessary to reduce the hospital service burden.

Beyond forest plots: clinical gestalt and its influence on COPD telemonitoring studies and outcomes review

BackgroundChronic obstructive pulmonary disease (COPD) is a progressive chronic condition. Improvements in therapies have resulted in better patient outcomes. The use of technology such as telemonitoring as an additional intervention...

How much do we know about the use of acute hospital services by Nursing Home residents?

How much do we know about the use of acute hospital services by Nursing Home residents?

Integrated Care Facilitation Model Reduces Use of Hospital Resources by Patients with Pediatric Asthma

This evaluation assessed a model of care for pediatric asthma patients that aimed to promote health and reduce their preventable and avoidable use of acute hospital services. Pediatric asthma patients (n=223) were allocated care facilitators who provided assistance in the promotion of carer/self-management, education and linkage to an integrated healthcare system, comprising of acute and community-based healthcare providers. Patients' use of acute hospital services (emergency department [ED] presentations, admissions, and bed-days) pre- and postrecruitment were compared using Wilcoxon signed rank tests. The pediatric asthma care givers quality of life questionnaire' was used to assess changes in health and quality of life. The patients displayed a 57% reduction in ED presentations, 74% in admissions, and a 71% reduction in bed-days. Whereas a comparator group displayed 27%, 32%, and 14% increases, respectively. Patients also reported significant improvements in quality of life domains of activity limitation (+5.6, p<.001) and emotional function (+9.1, p<.001). The reduction in the use of hospital services was attributed to the aversion of preventable presentations and admissions, via the enhancement of carer/self-management and access to community health services. These outcomes were supported by indicators of improved patient health and quality of life, and comments by the participant's carers.

Integrated care facilitation for older patients with complex health care needs reduces hospital demand

The evaluation of a new model of care for older people with complex health care needs that aimed to reduce their use of acute hospital services. Older people (over 55 years) with complex health care needs, who had made three or more presentations to a hospital emergency department (ED) in the previous 12 months, or who were identified by community health care agencies as being at risk of making frequent ED presentations, were recruited to the project. The participants were allocated a "care facilitator" who provided assistance in identifying and accessing required health care services, as well as education in aspects of self management. Data for the patients who had been participants on the project for a minimum of 90 days (n=231) were analysed for their use of acute hospital services (ED presentations, admissions and hospital bed-days) for the period 12-months pre-recruitment and post-recruitment. A similar analysis on the use of hospital services was conducted on the data of patients who were eligible and who had been offered participation, but who had declined (comparator group; n=85). Post recruitment, the recruited patients displayed a 20.8% reduction in ED presentations, a 27.9% reduction in hospital admissions, and a 19.2% reduction in bed-days. By comparison, the patients who declined recruitment displayed a 5.2% increase in ED presentations, a 4.4% reduction in hospital admissions, and a 15.3% increase in inpatient bed-days over a similar timeframe. A model of care that facilitates access to community health services and provides coordination between existing services reduces hospital demand.

Obesity and use of acute hospital services in participants of the Renfrew/Paisley study

Because overweight and obesity are associated with comorbidities, increasing levels of overweight and obesity may impact on hospital use. Body mass index (BMI) in middle age was related to acute hospital use in 7036 men and 8327 women from the Renfrew/Paisley prospective cohort study in Scotland. Participants in this general population study were examined between 1972 and 1976 when aged 45-64 years. Acute hospital admissions and bed days per 1000 person-years were calculated by the World Health Organization BMI categories in the follow-up period to 31 March 2004. Underweight and normal weight men had lower-than-expected admission rates, and overweight and obese men had higher-than-expected admission rates. Obese men had higher-than-expected bed day rates. For women, there was a U-shaped relationship with admission rate, with normal weight women having the lowest admission rate and underweight and obese women having similar high rates. Underweight and obese women had higher-than-expected bed day rates. Participants who were obese in midlife had more-than-expected acute hospital admissions and in particular more bed days. With levels of obesity increasing since this study was started in the 1970s, if these patterns persist, there may be increasing demand on health service resources.

Discharging older people from hospital to home: what do we know?

Aims and objectives. The aim of this literature review was to examine empirical research to date on hospital discharge and illuminate areas in need of further exploration. Background. Discharging older people from hospital has long been associated with difficulties and complications. With a steady increase in the ageing population in Ireland and their use of acute hospital services, the successful management of hospital discharge is now a central concern to health service management. Methods. Using a seven-step approach by Stolz et al. [Scandinavian Journal of Caring Sciences (2004) Vol. 18, 111-119] a keyword database search was conducted which revealed 44 studies that matched the author's inclusion criteria. Results. These studies uncover aspects of the discharge process that are in need of further research, and particularly suggest more rigour in the measurement of hospital discharge outcomes. Relevance to clinical practice. This review focuses on a very important clinical issue given the predicted increase in the use of acute services by older people and the known vulnerabilities of the interface between hospital and community settings.

Coping and health service utilisation in a UK study of paediatric sickle cell pain

Aims: To assess sickle cell pain and coping in children and to examine the relation between these factors and the utilisation of health services. Methods: Cross sectional study involving 67...

Getting more for their dollar: a comparison of the NHS with California's Kaiser Permanente.

Objective: To compare the costs and performance of the NHS with those of an integrated system for financing and delivery health services (Kaiser Permanente) in California.Methods: The adjusted costs of...

The use of acute hospital services by elderly residents of nursing and residential care homes.

The objective of this study was to compare hospitalisation rates by cause of admission, hospital death rates and length of stay for residents from nursing and residential care homes with those in the community. This is a retrospective study of acute hospital emergency admissions in one health district, Merton, Sutton and Wandsworth between April 1996 and March 1997. Data linkage and manual look up were used to derive emergency hospital admissions for residents of care homes aged 65 and over. Admission rates were calculated for cause, length of stay and hospital death for residents of care homes and in the community with relative risks. The relative risk of emergency admission from a care home compared with the community was 1.39 for all diagnoses, 2.68 for all injuries, and 3.96 for fracture of neck of femur. The relative risk of dying in hospital for care home residents was 2.58 overall, and 3.64 in the first 48 hours of a hospital stay (all P-values <0.0001). Admission rates were higher from residential than from nursing homes. There was some increase in admissions from homes during holiday periods and over Christmas. In conclusion, there are major difficulties in monitoring admissions from nursing and residential care homes due to poor quality recording and inaccuracies in NHS coding. This was compounded by an absence of data on the age and sex profile and healthcare needs of the resident population in care homes. Prospective studies are required to ascertain when admission is avoidable and when it is appropriate. The information strategy needs to ensure that routine data sources are capable of monitoring the use of hospital services by residents of care homes.

Regionalization and Hospital Utilization: Alberta 1991/2–1996/7

Background In February 1994 Alberta Health announced a three-year business plan for the radical restructuring of the health care system in Alberta. The business plan outlined large reductions in funding for acute hospital care spending and the establishment of 17 Regional Health Authorities (RHAs). Objectives The objectives of this study are to describe for the period 1991/2 to 1996/7: 1) Trends in overall acute hospital utilization by Alberta residents and residents of each of the 17 RHAs. 2) Trends in the provision of acute hospital services by each of the 17 RHAs and the Alberta Cancer Board. 3) Trends in the transfer of patients between RHAs. Results Between 1991/2 and 1996/7, the age-sex standardized separation rate, the age-sex standardized average length of stay, and age-sex standardized hospital days rate for Alberta residents fell by 25.6%, 18.7%, and 39.5% respectively. The age-standardized hospital days rate fell in all 17 RHAs. The total number of separations (Alberta residents and non-residents) from Alberta acute care facilities fell by 19.6% while the average care intensity for all separations from Alberta acute care facilities rose by 8.7%. The ratio of the highest to lowest average RHA care intensity remained between 1.7 and 1.9 during the study period. RHA self-sufficiency indices increased dramatically in one RHA and remained largely unchanged in the remaining RHAs. RHA import indices decreased for most RHAs. Conclusions Large reductions in the use of acute hospital services have occurred in Alberta during the period of major health care restructuring. Further research is needed to examine shifts in services to other sectors and to assess the impact of these reductions on patient outcomes.

Use of Hospital Services, Religious Attendance, and Religious Affiliation

We examined the relationship between religious attendance, religious affiliation, and use of acute hospital services by older medical patients. Religious affiliation (n = 542) and church attendance (n = 455) were examined in a consecutive sample of medical patients aged 60 or older admitted to Duke University Medical Center. Information on use of acute hospital services during the year before admission and length of the current hospital stay was collected. Frequency of church attendance and religious affiliation were examined as predictors of hospital service use, controlling for age, sex, race, education, social support, depressive symptoms, physical functioning, and severity of medical illness as covariates using logistic regression. Patients who attended church weekly or more often were significantly less likely in the previous year to have been admitted to the hospital, had fewer hospital admissions, and spent fewer days in the hospital than those attending less often; these associations retained their significance after controlling for covariates. Patients unaffiliated with a religious community, while not using more acute hospital services in the year before admission, had significantly longer index hospital stays than those affiliated. Unaffiliated patients spent an average of 25 days in the hospital, compared with 11 days for affiliated patients; this association strengthened when physical health and other covariates were controlled. Participation in and affiliation with a religious community is associated with lower use of hospital services by medically ill older adults, a population of high users of health care services. Possible reasons for this association and its implications are discussed.

Use of Acute Hospital Services and Mortality Among Religious and Non-Religious Copers with Medical Illness

ABSTRACT Religious coping was examined in a sample of 1011 men acutely hospitalized with medical illness (84% over age 65). Two groups of men were identified: (1) those who relied heavily upon religious beliefs and behaviors to cope with their illness (10%) and (2) those who found religion of little or no help in this regard (16%). These two groups were then followed prospectively for a mean period of 14 months (range 0 to 32 months). Data on hospitalization and survival were collected. There were no differences in length of hospitalization, frequency of hospitalization, or survival between the two groups. We conclude that short-term follow-up of hospitalized men found no differences in health-care service use or mortality between religious and non-religious copers. Whether or not the positive relationships between mental health, social support, avoidance of alcohol, and religious coping translate into lower healthcare utilization or longer survival among the medically ill requires further study.

Use of acute hospital services by homeless children

Use of acute hospital services by homeless children