Predicting risk of hospital and emergency department use for home care elderly persons through a secondary analysis of cross-national data.
Predicting risk of hospital and emergency department use for home care elderly persons through a secondary analysis of cross-national data.
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DOI：
10.1186/s12913-014-0519-z
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发表时间：
2014-11-14
影响因子：
2.8
通讯作者：
Goldman B
中科院分区：
文献类型：
--
作者：
Morris JN;Howard EP;Steel K;Schreiber R;Fries BE;Lipsitz LA;Goldman B
老年人仍然是使用率最高的群体，他们会计划外去急诊室和住院。许多人已经考虑过是什么导致了如此高的利用率，并且提供的答案取决于所使用的数据集中可用的独立测量。该项目旨在进一步了解老年人急诊就诊和入住急症护理医院的原因。对 60 岁或以上社区居住老年人的跨国样本数据进行了二次分析，其中大多数人接受了当地家庭护理计划的服务。本研究中使用的评估工具是 interRAI HC（家庭护理），旨在用于评估老年家庭护理接受者。研究的模型规范阶段确定了基线自变量，这些变量可以预测或不能预测住院和急诊室使用的后续指标。接下来使用逐步逻辑回归来确定最能识别随后进入医院或就诊急诊室的老年人的特征。使用 interRAI 家庭护理措施从最终多元逻辑方程生成的项目构成了 interRAI 医院急诊风险指数。临床并发症、疾病诊断和专门治疗三个关键领域的独立测量与随后的住院或急诊室使用有关。在 18 种具有较高、有意义的比值比的临床并发症指标中，有肺炎、尿路感染、发烧、胸痛、腹泻、意外体重减轻、各种皮肤状况以及受试者自我报告的健康状况不佳。与医院/急诊室使用有有意义关系的疾病诊断包括冠状动脉疾病、充血性心力衰竭、癌症、肺气肿和肾衰竭。比值比最高的专门治疗是输血、静脉输液、伤口治疗、放射和透析。阿尔茨海默病和日托这两项措施似乎对住院/急诊室使用具有保护作用，且比值比较低。对利用率最高的老年人的“可预防”住院和再住院检查是在确保最高护理质量和控制成本的框架下进行的。 interRAI 住院-ED 风险指数提供了一种有效的方法来预测社区居住老年人的住院利用率。
Older adults remain the highest utilization group with unplanned visits to emergency departments and hospital admissions. Many have considered what leads to this high utilization and the answers provided have depended upon the independent measures available in the datasets used. This project was designed to further understanding of the reasons for older adult ED visits and admissions to acute care hospitals. A secondary analysis of data from a cross-national sample of community residing elderly, 60 years of age or older, and most of whom received services from a local home-care program was conducted. The assessment instrument used in this study is the interRAI HC (home care), designed for use in assessing elderly home care recipients. The model specification stage of the study identified the baseline independent variables that do and do not predict the follow-up measure of hospitalization and ED use. Stepwise logistic regression was used next to identify characteristics that best identified elders who subsequently entered a hospital or visited an ED. The items generated from the final multivariate logistic equation using the interRAI home care measures comprise the interRAI Hospital-ED Risk Index. Independent measures in three key domains of clinical complications, disease diagnoses and specialized treatments were related to subsequent hospitalization or ED use. Among the eighteen clinical complication measures with higher, meaningful odds ratios are pneumonia, urinary tract infection, fever, chest pain, diarrhea, unintended weight loss, a variety of skin conditions, and subject self-reported poor health. Disease diagnoses with a meaningful relationship with hospital/ED use include coronary artery disease, congestive heart failure, cancer, emphysema and renal failure. Specialized treatments with the highest odds ratios were blood transfusion, IV infusion, wound treatment, radiation and dialysis. Two measures, Alzheimer’s disease and day care appear to have a protective effect for hospitalization/ED use with lower odds ratios. Examination into “preventable” hospitalizations and re-hospitalizations for older adults who have the highest rates of utilization are occurring beneath an umbrella of assuring the highest quality of care and controlling costs. The interRAI Hospitalization-ED Risk Index offers an effective approach to predicting hospitalization utilization among community dwelling older adults.
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影响因子：
39.2
作者：
Kaboli, Peter J.;Go, Jorge T.;Vaughan-Sarrazin, Mary
通讯作者：
Vaughan-Sarrazin, Mary
影响因子：
4.9
作者：
Fan, Lin;Shah, Manish N.;Friedman, Bruce
通讯作者：
Friedman, Bruce
DOI：
10.1111/j.1532-5415.2007.01446.x
发表时间：
2007-12-01
影响因子：
6.3
作者：
Mazzaglia, Giampiero;Roti, Lorenzo;Di Bari, Mauro
通讯作者：
Di Bari, Mauro
影响因子：
4.8
作者：
Krumholz, HM;Chen, YT;Horwitz, RI
通讯作者：
Horwitz, RI
影响因子：
2.8
作者：
Albert, Steven M.;Colombi, Alberto;Hanlon, Joseph
通讯作者：
Hanlon, Joseph