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Association between post‐discharge secondary care and risk of repeated hospital presentation, entry into long‐term care and mortality in older people after acute hospitalization
Author(s) -
Wu Zhenqiang,
Kim Min Soo,
Broad Joanna B,
Zhang Xian,
Bloomfield Katherine,
Connolly Martin J
Publication year - 2019
Publication title -
geriatrics and gerontology international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.823
H-Index - 57
eISSN - 1447-0594
pISSN - 1444-1586
DOI - 10.1111/ggi.13766
Subject(s) - medicine , proportional hazards model , emergency department , hazard ratio , observational study , emergency medicine , geriatrics , medical record , pediatrics , confidence interval , psychiatry
Aim Hospitalizations are frequent among acutely ill older people, and might be reduced by post‐discharge secondary care (PDSC). We aimed to determine the proportion of older patients planned to receive or attending PDSC after acute hospitalization and the association with undesirable outcomes. Methods A retrospective observational study was carried out using an electronic health record system in two hospitals in New Zealand. Patients were aged ≥75 years, initially presented at an emergency department (ED) and were discharged from medical, surgical, geriatrics or orthopedics wards in three 2‐week periods. Planned PDSC at discharge, attended PDSC, ED presentation, long‐term care (LTC) admission and death in 90 days after discharge were obtained through the health record system. Proportional hazards regression assessed the associations of planned or attended PDSC with undesirable outcomes (ED presentation, LTC admission and death) within 90 days of discharge. Results Clinical records for 1085 patients were extracted, 963 were eligible. Of these, 413 (42.9%) had planned PDSC in discharge summaries, and 573 (59.5%) actually attended in 90 days. Patients planned for PDSC had a similarly adjusted hazard of ED presentation (HR 0.99, P = 0.92), LTC admission (HR 0.73, P = 0.25) and death (HR 0.80, P = 0.34) within 90 days of discharge, compared with those not planned. Similar non‐significant associations were observed between attended PDSC and undesirable outcomes. Conclusions In patients aged ≥75 years in New Zealand, we did not find “planned PDSC” at discharge or “attended PDSC” after an acute hospitalization to be associated with ED presentation, LTC admission and death within 90 days after discharge. Other potential benefits of planned or attended PDSC require further investigation. Geriatr Gerontol Int 2019; 19: 1048–1053 .