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，可能与负面健康结果有关。计划外30天的再次住院是患者结局不佳的一个指标，导致医疗成本增加，最近被医疗保险支付咨询委员会列为医院质量差的标志。识别再次住院的高风险患者将有助于将有限的出院计划资源集中到那些受益最大的人身上，并为医疗保健系统提供一个相当大的节省成本的机会。老年人意外再次住院的风险更高，但到目前为止，很少有研究检查这一人群中抑郁症状和再次住院之间的关系。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，我们将在65岁及以上的成年人中调查抑郁症状和计划外30天再次住院之间的独立联系。此外，我们还将研究抑郁症状可能导致这些患者重新入院的机制。这项提案的具体目标是确定一组65岁及以上社区居住的成年人中抑郁症状与计划外30天再次住院之间的关联，这些人已被送往一家大型城市三级保健医院，并确定不遵守出院指示与这一人群中抑郁症状和再次住院之间的关联。为了实现这些目标，我们将对720名65岁及以上社区居住的成年人进行前瞻性队列研究，这些成年人已被马里兰大学医学中心的普通内科和外科服务接纳。抑郁症状将在基线时使用GDS-15进行测量，参与者将在出院后接受跟踪，以确定再次住院事件的发生率以及使用调查方法遵守出院指示的情况。这项前瞻性队列研究将具体：1)确定抑郁症状与30天再入院之间的联系，2)使用专门为这项研究创建的仪器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联系，4)确定不遵守出院指示与30天再入院之间的联系。这项研究是新颖的，因为它旨在解决老年人的分诊和入院筛查程序，以及更好地从患者行为而不是社会或医学角度阐明再次住院的机制。这项研究的公共卫生影响在于潜在的开发和评估旨在通过识别和治疗住院老年人的抑郁和抑郁症状来减少再次住院的干预措施，此外还提供关于再次住院的可能机制的信息。 与公共卫生相关：再次住院是一种常见但可能可以避免的医疗结果，与相当大的医疗成本相关。抑郁症状与负面的健康结果相关，并可能导致重新入院的人数增加。这项研究的潜在总体影响可能是改变老年人的筛查程序，以及通过早期识别和治疗这些人的抑郁症来减少再次住院。

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.