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O-085
Are we failing to identify patients at high risk of predictable
readmission to hospital?
R. Cowan
1
, A. Blundell
1
, A. Ali
1
.
1
Health Care of Older People, Nottingham
University Hospitals NHS Trust, United Kingdom
Introduction:
The United Kingdom
’
s National Tariff Payment System
describes the 30 day readmission rule in which commissioners set a
threshold above which payment for emergency readmissions is not
reimbursed. Reasons for hospital readmission are complex and
multifactorial, with little evidence to support cost-effective ways of
preventing readmissions.
Methods:
A prospective audit of emergency readmissions within 28
days from an admission under our department was carried out. Data
were collected for 122 readmission episodes to analyse the events of
the initial admission and reasons for readmission to hospital.
Results:
17% of patients had concerns raised by the multidisciplinary
team (MDT) at the initial admission as to how they would manage
at home; readmission was triggered by the patient, a relative or carer
in over 80% of this group. 36% of readmissions were after discharge
with increased social support in the community; most of these were
discharged to a new address (care home or rehabilitation facility) and
the remainder to their own homes with an increased care package.
The main reason for readmission was patients/relatives not coping
after discharge.
Key conclusions:
Whenwe discharge patients with concerns raised by
the MDT as to how they will manage in the community this
“
trial of
discharge
”
is a risk for readmission. Patients and carers are vulnerable
due to reduction in functional ability after an inpatient stay, and the
capacity and capability of community health and social care teams is
insufficient to mitigate risk. Subsequent readmissions are predictable,
but not avoidable without available alternatives.
O-086
The healthcare costs associated with transitions in functional
disability in community-dwelling older persons: a prospective
cohort study
M. van Rijn
1,2
, J. Suijker
3
, A. Kruithof
1
, J. Bosmans
4
, E. Moll van
Charante
3
, S. de Rooij
1,5
, B. Buurman
1,2
.
1
Department of Internal
Medicine, Section of Geriatric Medicine, Academic Medical Center,
2
ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of
Applied Sciences,
3
Department of General Medicine, Academic Medical
Centre,
4
Department of Health Sciences and the EMGO Institute for Health
and Care Research, Faculty of Earth and Life Sciences, VU University,
Amsterdam,
5
University Center for Geriatric Medicine, University Medical
Center Groningen, The Netherlands
Introduction:
This study aims to determine the association between
healthcare costs and transitions in functional disability in community
dwelling older persons in the Netherlands.
Methods:
Participants (N = 6,679) were community dwelling older
persons aged 70 years and older registered at participating GP
practices. Based on the difference in KATZ ADL index scores between
baseline and 12 months follow up, four categories of functional
disability were created: (1) stable independence (2) stable with
limitation(s) (3) functional improvement (4) functional decline. Data
on hospital admissions and GP care were used to calculate healthcare
costs. Multiple linear regression was used to model the association
between functional disability states and healthcare costs.
Results:
At baseline, the mean age of participants was 77.5 (SD 5.8)
years and 55.7% were female. Mean total healthcare costs in stable
independent older people were EUR 2,908.8 (95% CI 1,718.9
–
4,098.7)
and EUR 6,494.8 (95% CI 3,828.6
–
9,161.0) in older people with stable
limitations. Older people with functional improvement have mean
healthcare costs of EUR 11,426.6 (95% CI 59,489.9
–
15,363.3) and mean
healthcare cost in older people with functional decline are EUR
13,567.2 (95% CI 9,770.1
–
17,364.3).
Conclusion:
Older persons with functional decline or improvement
during one year follow up have higher total healthcare costs compared
to stable independent older persons. It is therefore important to
prevent older persons from functional decline and keep them on a
stable functional level without (many) limitations.
O-087
Understanding different approaches to orthopaedic-geriatric
collaboration: using the National Hip Fracture Database (NHFD) to
develop a system of classification
C. Boulton, V. Burgon, A. Johansen, F. Martin, J. Neuburger, S. Rao,
R. Wakeman, H. Wilson.
National Hip Fracture Database, Falls and
Fragility Fractures Audit Programme, Royal College of Physicians, London,
United Kingdom
Introduction:
In recent years increased orthogeriatric collaboration
has transformed hip fracture care in the UK, with hospitals developing
approaches that reflect historical considerations and the enthusiasms
of local clinicians.
Methods:
In 2015 the National Hip Fracture Database (NHFD)
questioned all 177 hospitals which admit patients with hip fracture
in England, Wales and Northern Ireland
–
to define the nature and
intensity of orthogeriatric input and inform the development of a
classification system.
Results:
All units replied. Six models were identified. Most units
described one of two models; 75 (42%) reporting
“
routine orthoger-
iatric review
”
and 78 (44%)
“
shared care
”
. Seven (4%) admitted patients
directly under a geriatrician. Nine (5%) routinely transferred patients
to geriatricians post-op. One unit has all care by a hip fracture specialist
surgeon. Seven (4%) retain a
“
traditional model
”
with orthogeriatric
review on request. This dominance of
“
routine orthogeriatric review
”
and
“
shared care
”
was seen within Wales and Northern Ireland, with
these models in ten out of thirteen and all four hospitals respectively.
Performance measures were poorer in units with a
“
traditional
model
”
, which tended to be smaller. Only 63.9% of their patients
received surgery by the next day, cf. >70% in units with integrated
models of orthogeriatric care.
Conclusions:
Comparison of performance and outcomes of different
approaches requires clarity over the model of the service in each unit.
We are using these results to develop a classification that distinguishes
between pre-/peri-operative care and post-operative elements of care
to support comparisons of services across different countries.
Late Breaking Abstracts
–
Oral presentations
LB-2
Effects of SMS-guided outdoor walking and strength training after
acute stroke
–
a pilot study
B. Vahlberg
1
, T. Cederholm
2
.
1
Department of Neuroscience,
Physiotherapy,
2
Department of Public Health and Caring Sciences, Clinical
Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
Introduction:
The level of physical activity in community-living
individuals after stroke is low and known to decrease with age. The
study aimed to achieve the recommended level of physical activity,
i.e. at least 150 minutes/week, and to evaluate the effect of an outdoor
walking program together with a functional strength exercise in
individuals with acute stroke. The training was guided by daily mobile
phone text messages (SMS).
Methods:
In this experimental pilot study with pre- and post
assessments 16 individuals participated (age >18 y, mean 64±13
years, 50% male) with verified acute stroke and sufficient walking
capacity, i.e. able to perform the 6-Minutes Walk Test, (6MWT), motor
function (Modified Rankin Scale, MRS
≤
3), cognition (Montreal
Assessment Scale, MoCA > 22 points) and with access to a mobile
phone. Participants completed a 12-week outdoor walking program
together with one strength exercise (chair-rising) that was gra-
dually increased in frequency and intensity. Instructions were
delivered daily to their own mobile phone.
Oral presentations / European Geriatric Medicine 7S1 (2016) S1
–
S27
S25