RESUMEN
Hospitalized older people are at risk of poor functioning after hospital discharge. We aimed to relate formal and informal care costs to level of risk for low functioning of hospitalized older people up to one year after admission. We studied 460 patients 65 years or older who were admitted to a 450-bed hospital in the Netherlands between June 2010 and October 2010. Participants were classified into five risk groups at hospital admission using the Identification Seniors At Risk-Hospitalized Patients (ISAR-HP). Patients were interviewed at hospital admission and at three and twelve months after admission using validated questionnaires to measure health care utilization. Informal caregivers were interviewed by mailed paper questionnaires at the same time as patients. We estimated costs per unit from hospital information systems and nationally representative research. Mean healthcare costs were 30k euro per person per year, with one third for initial hospital stay (9,8k), one third for formal healthcare costs between hospital discharge and twelve month follow up (10,3k), and one third for informal healthcare costs between hospital discharge and twelve month follow up (9,5k). Informal and formal healthcare costs were almost double for people with the highest risk score compared to people not at risk (p<0.001). Older patients with high risk scores at hospital admission have substantially higher formal and informal care costs in the year after initial hospital admission than people with low risk scores. This implies that substantial investments may be made in preventive interventions for at-risk hospitalized older people.
Asunto(s)
Cuidadores/economía , Costos de la Atención en Salud/estadística & datos numéricos , Hospitalización/economía , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Tiempo de Internación/economía , Masculino , Países Bajos , Alta del Paciente , Estudios Prospectivos , Medición de Riesgo , Encuestas y CuestionariosRESUMEN
BACKGROUND: hospitalised older people are at risk for poor functioning after hospital discharge. We aimed to validate the predictive ability of the Identification Seniors At Risk-Hospitalized Patients (ISAR-HP) screening questionnaire to identify older patients at risk for functional dependence by comparing groups with different ISAR-HP scores on cognitive and physical functioning, mortality, health-related quality of life (HRQoL) and loneliness. DESIGN: a longitudinal prospective cohort study. SETTING: a 450-bed hospital in the Netherlands. SUBJECTS: four hundred and sixty patients 65 years or older admitted between June 2010 and October 2010. METHODS: participants were classified into five risk groups at hospital admission using the ISAR-HP. We interviewed patients at hospital admission and at 3 and 12 months after admission using validated questionnaires to score HRQoL, physical functioning, cognitive functioning and loneliness. Differences in survival were quantified by a concordance statistic (c). RESULTS: cognitive functioning, physical functioning, loneliness and HRQoL differed significantly between groups during the 1-year follow-up after hospital admission (all comparisons P < 0.05), with high-risk groups having lower scores than low-risk groups for functioning and loneliness, although not always for HRQoL. The lowest risk group (ISAR-HP = 0) scored consistently higher on functioning and HRQoL than all other groups. Mortality differed significantly between groups (P < 0.001, c = 0.67). CONCLUSIONS: the ISAR-HP can readily distinguish well-functioning older patients from patients with low functioning and low HRQoL after hospital admission. The ISAR-HP may hence assist in selecting patients who may benefit from individually tailored reactivation treatment that is provided next to treatment of their medical condition.
Asunto(s)
Envejecimiento , Evaluación Geriátrica , Admisión del Paciente , Alta del Paciente , Encuestas y Cuestionarios , Factores de Edad , Anciano , Anciano de 80 o más Años , Envejecimiento/psicología , Cognición , Femenino , Capacidad de Camas en Hospitales , Humanos , Soledad , Estudios Longitudinales , Masculino , Países Bajos , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Análisis de Supervivencia , Factores de TiempoRESUMEN
BACKGROUND: Hospital related functional decline in older patients is an underestimated problem. Thirty-five procent of 70-year old patients experience functional decline during hospital admission in comparison with pre-illness baseline. This percentage increases considerably with age. METHODS/DESIGN: To address this issue, the Vlietland Ziekenhuis in The Netherlands has implemented an innovative program (PReCaP), aimed at reducing hospital related functional decline among elderly patients by offering interventions that are multidisciplinary, integrated and goal-oriented at the physical, social, and psychological domains of functional decline. DISCUSSION: This paper presents a detailed description of the intervention, which incorporates five distinctive elements: (1) Early identification of elderly patients with a high risk of functional decline, and if necessary followed by the start of the reactivation treatment within 48 h after hospital admission; (2) Intensive follow-up treatment for a selected patient group at the Prevention and Reactivation Centre (PRC); (3) Availability of multidisciplinary geriatric expertise; (4) Provision of support and consultation of relevant professionals to informal caregivers; (5) Intensive follow-up throughout the entire chain of care by a casemanager with geriatric expertise. Outcome and process evaluations are ongoing and results will be published in a series of future papers. TRIAL REGISTRATION: The Netherlands National Trial Register: NTR2317.
Asunto(s)
Prestación Integrada de Atención de Salud/métodos , Evaluación Geriátrica/métodos , Hospitalización , Grupo de Atención al Paciente , Medicina Preventiva/métodos , Recuperación de la Función/fisiología , Actividades Cotidianas/psicología , Anciano , Anciano de 80 o más Años , Prestación Integrada de Atención de Salud/tendencias , Estudios de Seguimiento , Hospitalización/tendencias , Humanos , Países Bajos/epidemiología , Pruebas Neuropsicológicas , Grupo de Atención al Paciente/tendencias , Proyectos Piloto , Medicina Preventiva/tendenciasRESUMEN
BACKGROUND: Elderly persons admitted to the hospital are at risk for hospital related functional loss. This evaluation aims to compare the effects of different levels of (integrated) health intervention care programs on preventing hospital related functional loss among elderly patients by comparing a new intervention program to two usual care programs. METHODS/DESIGN: This study will include an effect, process and cost evaluation using a mixed methods design of quantitative and qualitative methods. Three hospitals in The Netherlands with different levels of integrated geriatric health care will be evaluated using a quasi-experimental study design. Data collection on outcomes will take place through a prospective cohort study, which will incorporate a nested randomised controlled trial to evaluate the effects of a stay at the centre for prevention and reactivation for patients with complex problems. The study population will consist of elderly persons (65 years or older) at risk for functional loss who are admitted to one of the three hospitals. Data is prospectively collected at time of hospital admission (T0), three months (T1), and twelve months (T2) after hospital admission. Patient and informal caregiver outcomes (e.g. health related quality of life, activities of daily living, burden of care, (re-) admission in hospital or nursing homes, mortality) as well as process measures (e.g. the cooperation and collaboration of multidisciplinary teams, patient and informal caregiver satisfaction with care) will be measured. A qualitative analysis will determine the fidelity of intervention implementation as well as provide further context and explanation for quantitative outcomes. Finally, costs will be determined from a societal viewpoint to allow for cost effectiveness calculations. DISCUSSION: It is anticipated that higher levels of integrated hospital health care for at risk elderly will result in prevention of loss of functioning and loss of quality of life after hospital discharge as well as in lower burden of care and higher quality of life for informal caregivers. Ultimately, the results of this study may contribute to the implementation of a national integrated health care program to prevent hospital related functional loss among elderly patients. TRIAL REGISTRATION: The Netherlands National Trial Register: NTR2317.