Depressive symptoms and 30-day unplanned hospital readmission in older adults

描述（由申请人提供）：抑郁症状在老年人中普遍存在，可能与负面的健康结果有关。计划外30天再入院是患者预后不良的一个指标，导致医疗费用增加，最近被医疗保险支付咨询委员会列为医院质量差的标志。识别高风险再入院患者将有助于将有限的出院计划资源用于受益最大的患者，并为医疗保健系统节省大量成本提供了机会。老年人计划外再入院的风险更高，但迄今为止，很少有研究探讨抑郁症状与这一人群再入院之间的关系。这些研究主要集中在患有特定疾病的患者身上，或者检查了不同的结果。相反，我们将调查65岁及以上的成年人抑郁症状和计划外30天再入院之间的独立关联。此外，我们还将研究抑郁症状可能导致该患者人群再次入院的机制。该提案的具体目标是确定65岁及以上社区居民成年人队列中抑郁症状与计划外30天再入院之间的相关性，这些成年人已入住大型城市三级护理医院，并确定不遵守出院指示与该人群中抑郁症状和再入院之间的相关性。为了实现这些目标，我们将对720名65岁及以上的社区居住成年人进行前瞻性队列研究，这些人已被马里兰州大学医学中心的普通内科和外科服务所录取。基线时将使用GDS-15测量抑郁症状，出院后将对受试者进行随访，以确定再入院事件的发生率以及使用调查方法遵守出院指示。本前瞻性队列研究将具体：1）确定抑郁症状与30天再入院之间的关联，2）使用专门为此研究创建的工具测量不遵守出院指示的情况，3）确定抑郁症状与不遵守出院指示之间的关联，以及4）确定不遵守出院指示与30-白天再入院这项研究是新颖的，因为它的目的是解决分流和老年人的入院筛查程序，以及更好地阐明从病人的行为，而不是社会或医学的角度再入院的机制。本研究的公共卫生影响在于潜在的发展和评估干预措施，旨在减少住院老年人的抑郁症和抑郁症状的识别和治疗，除了提供信息的可能机制，再入院。 公共卫生相关性：再入院是一种常见但可能可以避免的医疗保健结果，与相当大的医疗保健费用相关。抑郁症状与负面的健康结果有关，并可能导致更多的再入院。这项研究的潜在总体影响可能是老年人筛查程序的变化，以及通过早期识别和治疗这些人的抑郁症减少再入院。

DESCRIPTION (provided by applicant): Depressive symptoms are prevalent in older adults and may be associated with negative health outcomes. Unplanned 30-day hospital readmission is an indicator of poor patient outcomes, leads to increased healthcare costs, and has recently been targeted by the Medicare Payment Advisory Commission as a marker of poor hospital quality. The identification of patients at high risk of hospital readmission will facilitate targetng of limited discharge planning resources to those who will benefit the most and represents an opportunity for considerable cost savings to the healthcare system. Older adults are at higher risk of unplanned hospital readmission, but to date, few studies have examined the association between depressive symptoms and hospital readmission in this population. These studies have focused primarily on patients with specific illnesses or have examined different outcomes. In contrast, we will investigate the independent association between depressive symptoms and unplanned 30-day hospital readmission in adults aged 65 and older. Further, we will also examine a mechanism by which depressive symptoms may lead to hospital readmission in this patient population. The specific goals of this proposal are to determine the association between depressive symptoms and unplanned 30-day hospital readmission in a cohort of community-dwelling adults aged 65 and older, who have been admitted to a large, urban, tertiary-care hospital, and to determine the association between non- adherence to discharge instructions and both depressive symptoms and hospital readmission in this population. To achieve these objectives, we will conduct a prospective cohort study of 720 community-dwelling adults aged 65 and older who have been admitted to general medical and surgical services of the University of Maryland Medical Center . Depressive symptoms will be measured with the GDS-15 at baseline, and participants will be followed post-hospital discharge to ascertain incidence of readmission events as well as adherence to discharge instructions using survey methodology. This prospective cohort study will specifically: 1) determine the association between depressive symptoms and 30-day hospital readmission, 2) measure non-adherence to discharge instructions using an instrument created specifically for this study, 3) determine the association between depressive symptoms and non-adherence to discharge instructions and 4) determine the association between non-adherence to discharge instructions and 30-day hospital readmission. This study is novel in that it aims to address triage and admission screening procedures for older adults as well as to better elucidate the mechanisms underlying hospital readmission from a patient behavior, rather than a social or medical perspective. The public health impact of this study lies in the potential development and evaluation of interventions designed to reduce hospital readmissions by the identification and treatment of depression and depressive symptoms in the hospitalized elderly, in addition to providing information on a possible mechanism of hospital readmission. PUBLIC HEALTH RELEVANCE: Hospital readmission is a common but potentially avoidable healthcare outcome associated with considerable healthcare costs. Depressive symptoms are associated with negative health outcomes and may lead to increased hospital readmissions. The potential overall impact of this study could be changes in screening procedures for older adults as well as reductions in hospital readmission by early identification and treatment of depression in these individuals.