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Are we failing to identify patients at high risk of predictable

readmission to hospital?

R. Cowan


, A. Blundell


, A. Ali




Health Care of Older People, Nottingham

University Hospitals NHS Trust, United Kingdom


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.


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.


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


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.


The healthcare costs associated with transitions in functional

disability in community-dwelling older persons: a prospective

cohort study

M. van Rijn


, J. Suijker


, A. Kruithof


, J. Bosmans


, E. Moll van



, S. de Rooij


, B. Buurman




Department of Internal

Medicine, Section of Geriatric Medicine, Academic Medical Center,


ACHIEVE Centre of Expertise, Faculty of Health, Amsterdam University of

Applied Sciences,


Department of General Medicine, Academic Medical



Department of Health Sciences and the EMGO Institute for Health

and Care Research, Faculty of Earth and Life Sciences, VU University,



University Center for Geriatric Medicine, University Medical

Center Groningen, The Netherlands


This study aims to determine the association between

healthcare costs and transitions in functional disability in community

dwelling older persons in the Netherlands.


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.


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


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



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.


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


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.


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.


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


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



, 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.


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


Effects of SMS-guided outdoor walking and strength training after

acute stroke

a pilot study

B. Vahlberg


, T. Cederholm




Department of Neuroscience,



Department of Public Health and Caring Sciences, Clinical

Nutrition and Metabolism, Uppsala University, Uppsala, Sweden


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).


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