Association between the level of municipality healthcare services and outcome among acutely older patients in the emergency department

a Danish population-based cohort study

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Abstract

OBJECTIVES: This study aims to describe the association between use of municipality healthcare services before an emergency department (ED) contact and mortality, hospital reattendance and institutionalisation.

DESIGN: Population-based prospective cohort study.

SETTING: ED of a large university hospital.

PARTICIPANTS: All medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014).

PRIMARY AND SECONDARY OUTCOME MEASURES: Patients were categorised as independent of home care, dependent of home care or in residential care depending on municipality healthcare before ED contact. Patients were followed 360 days after discharge. Outcomes were postdischarge mortality, hospital reattendance and institutionalisation.

RESULTS: A total of 3775 patients were included (55% women), aged (median (IQR) 78 years (71-85)). At baseline, 48.9% were independent, 34.9% received home care and 16.2% were in residential care. Receiving home care or being in residential care was a strong predictor of mortality, hospital reattendance and institutionalisation. Among patients who were independent, 64.3% continued being independent up to 360 days after discharge. Even among patients ≥85 years, 35.4% lived independently in their own house 1 year after ED contact.

CONCLUSION: Prehospital information on municipality healthcare is closely related to patient outcome in older ED patients. It might have the potential to be used in risk stratification and planning of needs of older acute medical patients attending the ED.

Original languageEnglish
Article numbere026881
JournalBMJ Open
Volume9
Issue number4
Number of pages11
ISSN2044-6055
DOIs
Publication statusPublished - 24. Apr 2019

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Hospital Emergency Service
Cohort Studies
Delivery of Health Care
Home Care Services
Population
Hospital Mortality
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • cohort study
  • emergency department
  • institutionalisation
  • mortality
  • older patients
  • re-hospitalisation

Cite this

@article{2e270e1fff3447d39f1ef4bc3815abc5,
title = "Association between the level of municipality healthcare services and outcome among acutely older patients in the emergency department: a Danish population-based cohort study",
abstract = "OBJECTIVES: This study aims to describe the association between use of municipality healthcare services before an emergency department (ED) contact and mortality, hospital reattendance and institutionalisation.DESIGN: Population-based prospective cohort study.SETTING: ED of a large university hospital.PARTICIPANTS: All medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014).PRIMARY AND SECONDARY OUTCOME MEASURES: Patients were categorised as independent of home care, dependent of home care or in residential care depending on municipality healthcare before ED contact. Patients were followed 360 days after discharge. Outcomes were postdischarge mortality, hospital reattendance and institutionalisation.RESULTS: A total of 3775 patients were included (55{\%} women), aged (median (IQR) 78 years (71-85)). At baseline, 48.9{\%} were independent, 34.9{\%} received home care and 16.2{\%} were in residential care. Receiving home care or being in residential care was a strong predictor of mortality, hospital reattendance and institutionalisation. Among patients who were independent, 64.3{\%} continued being independent up to 360 days after discharge. Even among patients ≥85 years, 35.4{\%} lived independently in their own house 1 year after ED contact.CONCLUSION: Prehospital information on municipality healthcare is closely related to patient outcome in older ED patients. It might have the potential to be used in risk stratification and planning of needs of older acute medical patients attending the ED.",
keywords = "cohort study, emergency department, institutionalisation, mortality, older patients, re-hospitalisation",
author = "Anette Tanderup and Jesper Ryg and Jens-Ulrik Rosholm and Lassen, {Annmarie Touborg}",
note = "{\circledC} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",
year = "2019",
month = "4",
day = "24",
doi = "10.1136/bmjopen-2018-026881",
language = "English",
volume = "9",
journal = "B M J Open",
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TY - JOUR

T1 - Association between the level of municipality healthcare services and outcome among acutely older patients in the emergency department

T2 - a Danish population-based cohort study

AU - Tanderup, Anette

AU - Ryg, Jesper

AU - Rosholm, Jens-Ulrik

AU - Lassen, Annmarie Touborg

N1 - © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/4/24

Y1 - 2019/4/24

N2 - OBJECTIVES: This study aims to describe the association between use of municipality healthcare services before an emergency department (ED) contact and mortality, hospital reattendance and institutionalisation.DESIGN: Population-based prospective cohort study.SETTING: ED of a large university hospital.PARTICIPANTS: All medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014).PRIMARY AND SECONDARY OUTCOME MEASURES: Patients were categorised as independent of home care, dependent of home care or in residential care depending on municipality healthcare before ED contact. Patients were followed 360 days after discharge. Outcomes were postdischarge mortality, hospital reattendance and institutionalisation.RESULTS: A total of 3775 patients were included (55% women), aged (median (IQR) 78 years (71-85)). At baseline, 48.9% were independent, 34.9% received home care and 16.2% were in residential care. Receiving home care or being in residential care was a strong predictor of mortality, hospital reattendance and institutionalisation. Among patients who were independent, 64.3% continued being independent up to 360 days after discharge. Even among patients ≥85 years, 35.4% lived independently in their own house 1 year after ED contact.CONCLUSION: Prehospital information on municipality healthcare is closely related to patient outcome in older ED patients. It might have the potential to be used in risk stratification and planning of needs of older acute medical patients attending the ED.

AB - OBJECTIVES: This study aims to describe the association between use of municipality healthcare services before an emergency department (ED) contact and mortality, hospital reattendance and institutionalisation.DESIGN: Population-based prospective cohort study.SETTING: ED of a large university hospital.PARTICIPANTS: All medical patients ≥65 years of age from a single municipality with a first attendance to the ED during a 1-year period (November 2013 to November 2014).PRIMARY AND SECONDARY OUTCOME MEASURES: Patients were categorised as independent of home care, dependent of home care or in residential care depending on municipality healthcare before ED contact. Patients were followed 360 days after discharge. Outcomes were postdischarge mortality, hospital reattendance and institutionalisation.RESULTS: A total of 3775 patients were included (55% women), aged (median (IQR) 78 years (71-85)). At baseline, 48.9% were independent, 34.9% received home care and 16.2% were in residential care. Receiving home care or being in residential care was a strong predictor of mortality, hospital reattendance and institutionalisation. Among patients who were independent, 64.3% continued being independent up to 360 days after discharge. Even among patients ≥85 years, 35.4% lived independently in their own house 1 year after ED contact.CONCLUSION: Prehospital information on municipality healthcare is closely related to patient outcome in older ED patients. It might have the potential to be used in risk stratification and planning of needs of older acute medical patients attending the ED.

KW - cohort study

KW - emergency department

KW - institutionalisation

KW - mortality

KW - older patients

KW - re-hospitalisation

U2 - 10.1136/bmjopen-2018-026881

DO - 10.1136/bmjopen-2018-026881

M3 - Journal article

VL - 9

JO - B M J Open

JF - B M J Open

SN - 2044-6055

IS - 4

M1 - e026881

ER -