Noor Heim1, Herbert Rolden2, Esther M van Fenema3, Annelies W E Weverling-Rijnsburger4, Jolien P Tuijl5, Peter Jue6, Anna M Oleksik1, Anton J M de Craen1, Simon P Mooijaart1, Gerard Jan Blauw7, Rudi G J Westendorp8, Roos C van der Mast3, Irma E C van Everdinck9. 1. Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands. 2. Institute for Health Sciences, Radboudumc, Nijmegen, Netherlands. 3. Department of Psychiatry, Leiden University Medical Center, Leiden, Netherlands. 4. Department of Geriatrics, Diaconessenhuis Leiden, Leiden, Netherlands. 5. Department of Geriatrics, Bronovo Hospital, The Hague, Netherlands. 6. Department of Geriatric Medicine, Rijnland Hospital, Leiderdorp, Netherlands. 7. Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands Department of Geriatrics, Bronovo Hospital, The Hague, Netherlands. 8. Department of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, Netherlands Department of Public Health and Center of Healthy Ageing, University of Copenhagen, Copenhagen, Denmark. 9. Directorate Medical Affairs, Leiden University Medical Center, Leiden, Netherlands.
Abstract
BACKGROUND: fragmented healthcare systems are poorly suited to treat the increasing number of older patients with multimorbidity. OBJECTIVE: to report on the development, implementation and evaluation of a regional transitional care programme, aimed at improving the recovery rate of frail hospitalised older patients. METHODS: the programme was drafted in co-creation with organisations representing older adults, care providers and knowledge institutes. Conducting an action research project, the incidence of adverse outcomes within 3 months after hospital admission, and long-term care expenses (LTCE) were compared between samples in 2010-11 (pre-programme) and 2012-13 (post-programme) in frail and non-frail patients. Hospitalised patients aged ≥70 years were included in four hospitals in the targeted region. RESULTS: developed innovations addressed (i) improved risk management; (ii) delivery of integrated, function-oriented care; (iii) specific geriatric interventions; and (iv) optimisation of transfers. The incidence of adverse outcomes was compared in 813 and 904 included patients respectively in the two samples. In frail patients, the incidence of adverse outcomes decreased from 49.2% (149/303) in the pre-programme sample to 35.5% (130/366) in the post-programme sample. The risk ratio (RR), adjusted for heterogeneity between hospitals, was 0.72 (95% CI: 0.60-0.87). In non-frail patients the incidence of adverse outcomes remained unchanged (RR: 1.02, 95% CI: 0.76-1.36). LTCE were similar in the two samples. CONCLUSIONS: by involving stakeholders in designing and developing the transitional care programme, commitment of healthcare providers was secured. Feasible innovations in integrated transitional care for frail older patients after hospitalisation were sustainably implemented from within healthcare organisations.
BACKGROUND: fragmented healthcare systems are poorly suited to treat the increasing number of older patients with multimorbidity. OBJECTIVE: to report on the development, implementation and evaluation of a regional transitional care programme, aimed at improving the recovery rate of frail hospitalised older patients. METHODS: the programme was drafted in co-creation with organisations representing older adults, care providers and knowledge institutes. Conducting an action research project, the incidence of adverse outcomes within 3 months after hospital admission, and long-term care expenses (LTCE) were compared between samples in 2010-11 (pre-programme) and 2012-13 (post-programme) in frail and non-frail patients. Hospitalised patients aged ≥70 years were included in four hospitals in the targeted region. RESULTS: developed innovations addressed (i) improved risk management; (ii) delivery of integrated, function-oriented care; (iii) specific geriatric interventions; and (iv) optimisation of transfers. The incidence of adverse outcomes was compared in 813 and 904 included patients respectively in the two samples. In frail patients, the incidence of adverse outcomes decreased from 49.2% (149/303) in the pre-programme sample to 35.5% (130/366) in the post-programme sample. The risk ratio (RR), adjusted for heterogeneity between hospitals, was 0.72 (95% CI: 0.60-0.87). In non-frail patients the incidence of adverse outcomes remained unchanged (RR: 1.02, 95% CI: 0.76-1.36). LTCE were similar in the two samples. CONCLUSIONS: by involving stakeholders in designing and developing the transitional care programme, commitment of healthcare providers was secured. Feasible innovations in integrated transitional care for frail older patients after hospitalisation were sustainably implemented from within healthcare organisations.
Authors: Malcolm B Doupe; Jennifer E Enns; Sara Kreindler; Thekla Brunkert; Dan Chateau; Paul Beaudin; Gayle Halas; Alan Katz; Tara Stewart Journal: Int J Integr Care Date: 2022-03-28 Impact factor: 5.120
Authors: Marta Marsilio; Floriana Fusco; Eleonora Gheduzzi; Chiara Guglielmetti Journal: Int J Environ Res Public Health Date: 2021-03-24 Impact factor: 3.390