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Acute admissions to a community hospital - health consequences: a randomized controlled trial in Hallingdal, Norway.

https://arctichealth.org/en/permalink/ahliterature267407
Source
BMC Fam Pract. 2014;15:198
Publication Type
Article
Date
2014
Author
Øystein Lappegard
Per Hjortdahl
Source
BMC Fam Pract. 2014;15:198
Date
2014
Language
English
Publication Type
Article
Keywords
Acute Disease
Aged
Aged, 80 and over
Female
Home Nursing - utilization
Hospitalization
Hospitals, Community
Hospitals, General
Humans
Length of Stay
Longitudinal Studies
Male
Middle Aged
Norway
Nursing Homes - utilization
Patient Outcome Assessment
Patient Readmission - statistics & numerical data
Abstract
Health care professionals in several countries are searching for alternatives to acute hospitalization. In Hallingdal, Norway, selected acute patients are admitted to a community hospital. The aim of this study was to analyse whether acute admission to a community hospital as an alternative to a general hospital had any positive or negative health consequences for the patients.
Patients intended for acute admission to the local community hospital were asked to join a randomized controlled trial. One group of the enrolled patients was admitted as planned (group 1, n = 33), while another group was admitted to the general hospital (group 2, n = 27). Health outcomes were measured by the Nottingham Extended Activity of Daily Living Questionnaire and by collection of data concerning specialist and community health care services in a follow-up year.
After one year, no statistical significant differences in the level of daily function was found between group 1 (admissions to the community hospital) and group 2 (admissions to the general hospital). Group 1 had recorded fewer in-patient days at hospitals and nursing homes, as well as lower use of home nursing, than group 2. For outpatient referrals, the trend was the opposite. However, the differences between the two groups were not at a 5% level of statistical significance.
No statistical significant differences at a 5% level were found related to health consequences between the two randomized groups. The study however, indicates a consistent trend of health benefits rather than risk from acute admissions to a community hospital, as compared to the general hospital. Emergency admission and treatment at a lower-level facility than the hospital thus appears to be a feasible solution for a selected group of patients.
ClinicalTrials.gov NCT01069107 . Registered 2 April 2010.
Notes
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Cites: Scand J Prim Health Care. 1995 Dec;13(4):250-68693208
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Cites: J Am Geriatr Soc. 2007 Dec;55(12):1995-200217979957
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Cites: BMC Fam Pract. 2013;14:8723800090
Cites: Lancet. 2013 Dec 21;382(9910):2069-7624054816
Cites: Soc Sci Med. 2014 Oct;119:27-3525137645
Cites: Aust N Z J Med. 2000 Apr;30(2):252-6010833119
Cites: Transplant Proc. 2009 Nov;41(9):3693-619917369
Cites: Fam Pract. 2004 Apr;21(2):173-915020387
Cites: Br J Gen Pract. 2001 Feb;51(463):95-10011217640
PubMed ID
25491726 View in PubMed
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Acute hospital use, nursing home placement, and mortality in a frail community-dwelling cohort managed with Primary Integrated Interdisciplinary Elder Care at Home.

https://arctichealth.org/en/permalink/ahliterature123476
Source
J Am Geriatr Soc. 2012 Jul;60(7):1340-6
Publication Type
Article
Date
Jul-2012
Author
Ted Rosenberg
Author Affiliation
Department of Family Medicine, University of British Columbia and Island Medical Program, University of Victoria, Victoria, British Columbia, Canada. trosenberg@gem-health.com
Source
J Am Geriatr Soc. 2012 Jul;60(7):1340-6
Date
Jul-2012
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
British Columbia
Cause of Death
Chi-Square Distribution
Delivery of Health Care, Integrated - organization & administration
Demography
Emergency Service, Hospital - utilization
Female
Frail Elderly
Geriatric Assessment
Health Services for the Aged - organization & administration
Home Care Services - organization & administration
Hospitalization - statistics & numerical data
Humans
Male
Mortality - trends
Nursing Homes - utilization
Regression Analysis
Abstract
To evaluate the effect of medical Primary Integrated Interdisciplinary Elder Care at Home (PIECH) on acute hospital use and mortality in a frail elderly population.
Comparison of acute hospital care use for the year before entering the practice (pre-entry) with the most-recent 12-month period (May 1, 2010-April 30, 2011, postentry) for active and discharged patients.
Community.
All 248 frail elderly adults enrolled in the practice for at least 12 months who were living in the community and not in nursing homes in Victoria, British Columbia.
Primary geriatric care provided by a physician, nurse, and physiotherapist in participants' homes.
Acute hospital admissions, emergency department (ED) contacts that did not lead to admission, reason for leaving practice, and site of death.
There was a 39.7% (116 vs 70; P = .004) reduction in hospital admissions, 37.6% (1,700 vs 1,061; P = .04) reduction in hospital days, and 20% (120 vs 95; P = .20) reduction in ED contacts after entering the practice. Fifty participants were discharged from the practice, 64% (n = 32) of whom died, 20% (n = 10) moved, and 16% (n = 8) were admitted to nursing homes. Fifteen (46.9%) deaths occurred at home.
Primary Integrated Interdisciplinary Elder Care at Home may reduce acute hospital admissions and facilitate home deaths.
PubMed ID
22694020 View in PubMed
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[Apoplexy units--reduced mortality, need for nursing homes, length of stay and cost savings]

https://arctichealth.org/en/permalink/ahliterature48270
Source
Ugeskr Laeger. 1996 Aug 26;158(35):4894-7
Publication Type
Article
Date
Aug-26-1996
Author
H S Jørgensen
H. Nakayama
H O Raaschou
K J Larsen
P. Hübbe
T S Olsen
Author Affiliation
Bispebjerg Hospital, København, neurologisk afdeling.
Source
Ugeskr Laeger. 1996 Aug 26;158(35):4894-7
Date
Aug-26-1996
Language
Danish
Publication Type
Article
Keywords
Cerebrovascular Disorders - mortality - rehabilitation - therapy
Cost Savings
Denmark
English Abstract
Hospital Units - economics - organization & administration
Humans
Nursing Homes - utilization
Prospective Studies
Research Support, Non-U.S. Gov't
Abstract
Treatment of stroke patients on specialised stroke units has become more frequent, yet the effect of this treatment has not been determined. In this prospective, community-based study of 1241 unselected acute stroke patients we compared outcome between patients geographically randomised to treatment on a stroke unit or a general neurological/medical ward, from the time of acute admission to the end of rehabilitation. Baseline characteristics were comparable between the two treatment groups regarding age, sex, marital status, prestroke residence, and stroke severity. The patients treated on the stroke unit had higher comorbidity with regard to hypertension and diabetes. Multivariate linear and logistic regression analyses were applied to estimate the independent influence of stroke unit treatment on outcome. Stroke unit treatment significantly reduced in-hospital mortality (OR 0.50), case-fatality rate (OR 0.45), 6-month mortality (OR 0.57), 1-year mortality (0.59, and discharge rate to a nursing home (OR 0.61). The relative chance of being discharged to own home was almost doubled (OR 1.9), and the length of hospital stay reduced by 30% in patients treated on the stroke unit, P
Notes
Comment In: Ugeskr Laeger. 1997 Apr 21;159(17):2570-19182390
Comment In: Ugeskr Laeger. 1997 Feb 10;159(7):965-69054092
PubMed ID
8801694 View in PubMed
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Are there gender differences in functional outcome after stroke?

https://arctichealth.org/en/permalink/ahliterature52697
Source
Clin Rehabil. 1997 May;11(2):171-9
Publication Type
Article
Date
May-1997
Author
T B Wyller
K M Sødring
U. Sveen
A E Ljunggren
E. Bautz-Holter
Author Affiliation
Department of Geriatric Medicine, Ullevaal University Hospital, Oslo, Norway.
Source
Clin Rehabil. 1997 May;11(2):171-9
Date
May-1997
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Aged
Aged, 80 and over
Cerebrovascular Disorders - epidemiology - rehabilitation
Cognition Disorders - epidemiology
Female
Follow-Up Studies
Humans
Logistic Models
Male
Multivariate Analysis
Norway - epidemiology
Nursing Homes - utilization
Odds Ratio
Prognosis
Psychomotor Performance
Research Support, Non-U.S. Gov't
Sex Distribution
Abstract
PURPOSE: To study gender differences in functional outcome unexpectedly observed in a follow-up study of stroke patients. DESIGN: Prospective study of hospitalized stroke patients, with evaluations in the subacute phase and after one year. SETTING: Geriatric and general medical wards, and geriatric outpatient clinic of a university hospital serving as general hospital for a defined population. SUBJECTS: All stroke patients admitted during a six-month period (n = 165) were considered for inclusion, of whom 87 could be assessed in the subacute phase and 65 after one year. MAIN OUTCOME MEASURES: Motor function assessed by the Sødring Motor Evaluation of Stroke Patients; cognitive function by the Assessment of Stroke and other Brain Damage; and activities of daily living (ADL) function by the Barthel Index. Nursing-home residency registered after one year. RESULTS: Men achieved a significantly better score than women on most of the scales used. The age-adjusted odds for a man to have a higher Barthel score than a woman was 3.1 (95% confidence interval (CI) 1.3-7.0) in the subacute phase and 3.3 (95% CI 1.2-9.0) after one year. Differences of the same magnitude were seen on the subscales of the motor and cognitive tests. The same trend was observed on all items of the Barthel Index. The males had a lower likelihood to be permanent nursing-home residents after one year, the age-adjusted odds ratio for nursing-home residency for females versus males being 6.3 (95% CI 1.2-65.3). CONCLUSION: Women seem to be functionally more impaired by stroke than men.
PubMed ID
9199870 View in PubMed
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The association between alcohol use and long-term care placement among older Canadians: a 14-year population-based study.

https://arctichealth.org/en/permalink/ahliterature106442
Source
Addict Behav. 2014 Jan;39(1):219-24
Publication Type
Article
Date
Jan-2014
Author
Mark S Kaplan
Nathalie Huguet
David Feeny
Bentson H McFarland
Raul Caetano
Julie Bernier
Norman Giesbrecht
Lisa Oliver
Pamela Ramage-Morin
Nancy A Ross
Author Affiliation
Portland State University, Portland, OR, USA. Electronic address: kaplanm@pdx.edu.
Source
Addict Behav. 2014 Jan;39(1):219-24
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Aged
Alcohol Abstinence - statistics & numerical data
Alcohol drinking - epidemiology
Alcoholism - epidemiology
Canada - epidemiology
Female
Group Homes - utilization
Homes for the Aged - utilization
Humans
Kaplan-Meier Estimate
Long-Term Care - utilization
Longitudinal Studies
Male
Middle Aged
Nursing Homes - utilization
Proportional Hazards Models
Residential Facilities - utilization
Temperance - statistics & numerical data
Abstract
Studies have shown that moderate alcohol use confers protection against some of the dominant predictors of long-term care placement, including diminished cognitive functioning, physical disability, and injury. But little is known about the association between alcohol use and the likelihood of placement in long-term care facilities. A nationally representative sample of 5404 community-dwelling Canadians ages 50 years and older at baseline (1994/95) was obtained from the longitudinal National Population Health Survey. Alcohol use categories were developed based on the quantity and frequency of use in the 12 months before the interview. Cox proportional hazards models were used to estimate the association between alcohol use at baseline and subsequent placement in long-term care facilities after adjusting for covariates measured at baseline. During the 14-year follow-up period, 14% of lifetime abstainers, 10% of former drinkers, 7% of infrequent drinkers, 4% of moderate drinkers, and 3% of heavy drinkers were placed in long-term care facilities. Furthermore, the multivariate analysis revealed that abstainers, former drinkers, and infrequent drinkers were more than twice as likely to be placed in long-term care as moderate drinkers. Moderate drinking was protective against placement in long-term care facilities even after adjusting for an array of well-known confounders. The strong protective effect of moderate alcohol use on long-term care entry is likely due to a complex mix of physical, cognitive and psychosocial health factors.
PubMed ID
24169370 View in PubMed
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[Care for the aged and current public attitude].

https://arctichealth.org/en/permalink/ahliterature241652
Source
Sykepleien. 1983 Aug 22;70(14):6-10, 21
Publication Type
Article
Date
Aug-22-1983

Care of patients with the most severe and persistent mental illness in an area without a psychiatric hospital.

https://arctichealth.org/en/permalink/ahliterature166154
Source
Psychiatr Serv. 2006 Dec;57(12):1765-70
Publication Type
Article
Date
Dec-2006
Author
Jean-François Trudel
Alain Lesage
Author Affiliation
Department of Psychiatry, Faculté de Médecine, Universitéde Sherbrooke, IUGS-Argyll, 375 Argyll, Sherbrooke, Quebec, Canada J1J 3H5. jean-francois.trudel@usherbrooke.ca
Source
Psychiatr Serv. 2006 Dec;57(12):1765-70
Date
Dec-2006
Language
English
Publication Type
Article
Keywords
Adult
Canada - epidemiology
Catchment Area (Health) - statistics & numerical data
Chronic Disease
Cohort Studies
Cross-Sectional Studies
Female
Group Homes - utilization
Health Services Accessibility
Humans
Male
Mental Disorders - diagnosis - epidemiology - nursing - psychology
Middle Aged
Needs Assessment
Nursing Homes - utilization
Psychiatric Department, Hospital - utilization
Psychiatric Status Rating Scales
Rural health services - organization & administration
Severity of Illness Index
Abstract
With standard community resources, managing some patients with long-term mental illness can prove difficult, given the high level of care required. How many beds do such patients require? The study examined the prevalence, diagnostic and behavioral characteristics, and residential arrangements of a cohort of these patients in a semirural area of Canada (population of 291,500). The area has always functioned without a psychiatric hospital.
A cross-sectional inquiry was made of all relevant institutions and residential facilities (including the local jail and shelters). Key stakeholders were interviewed and provincial databases were accessed in an effort to identify all adults aged 18 to 65 originating from the catchment area who displayed both a psychotic illness and severe behavioral disturbance necessitating ongoing close supervision. The Riverview Psychiatric Inventory was used to describe and quantify behavioral problems.
Thirty-six patients met the study criteria, for a prevalence of 12.4 per 100,000 in the general population. Most resided in a publicly funded nursing home or a well-staffed rural group home. Four (prevalence of 1.4 per 100,000) had a forensic profile, needed secure settings, and were long-term residents on acute care wards. Only one patient had transferred to a psychiatric hospital outside the catchment area.
Care for this population can be provided outside conventional psychiatric institutions but requires highly supervised long-term residential services in the range of ten to 40 per 100,000 in the population, depending on area characteristics, with urban, socially deprived areas likely having higher needs.
PubMed ID
17158492 View in PubMed
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The choice of alternatives to acute hospitalization: a descriptive study from Hallingdal, Norway.

https://arctichealth.org/en/permalink/ahliterature112775
Source
BMC Fam Pract. 2013;14(1):87
Publication Type
Article
Date
2013
Author
Oystein Lappegard
Per Hjortdahl
Author Affiliation
Department of Hallingdal Sjukestugu, Medical Clinic of Ringerike General Hospital, Vestre Viken Hospital Trust, Ål, Norway. oystein.lappegard@vestreviken.no
Source
BMC Fam Pract. 2013;14(1):87
Date
2013
Language
English
Publication Type
Article
Keywords
Acute Disease - therapy
Aged, 80 and over
Focus Groups
Health Knowledge, Attitudes, Practice
Health Services Needs and Demand - statistics & numerical data
Humans
Local Government
Norway
Nursing Homes - utilization
Patient Admission - statistics & numerical data - trends
Personnel Staffing and Scheduling
Physician Executives - psychology
Physician's Practice Patterns
Physicians, Family - psychology
Qualitative Research
Referral and Consultation - statistics & numerical data - trends
Rural Population
Socioeconomic Factors
Abstract
Hallingdal is a rural region in southern Norway. General practitioners (GPs) refer acutely somatically ill patients to any of three levels of care: municipal nursing homes, the regional community hospital or the local general hospital. The objective of this paper is to describe the patterns of referrals to the three different somatic emergency service levels in Hallingdal and to elucidate possible explanations for the differences in referrals.
Quantitative methods were used to analyse local patient statistics and qualitative methods including focus group interviews were used to explore differences in referral rates between GPs. The acute somatic admissions from the six municipalities of Hallingdal were analysed for the two-year period 2010-11 (n?=?1777). A focus group interview was held with the chief municipal medical officers of the six municipalities. The main outcome measure was the numbers of admissions to the three different levels of acute care in 2010-11. Reflections of the focus group members about the differences in admission patterns were also analysed.
Acute admissions at a level lower than the local general hospital ranged from 9% to 29% between the municipalities. Foremost among the local factors affecting the individual doctor's admission practice were the geographical distance to the different places of care and the GP's working experience in the local community.
The experience from Hallingdal demonstrates that GPs use available alternatives to hospitalization but to varying degrees. This can be explained by socio-demographic factors and factors related to the medical reasons for admission. However, there are also important local factors related to the individual GP and the structural preparedness for alternatives in the community.
Notes
Cites: Aust N Z J Med. 2000 Apr;30(2):252-6010833119
Cites: Fam Pract. 2000 Dec;17(6):462-7111120716
Cites: Lancet. 2001 Aug 11;358(9280):483-811513933
Cites: J R Soc Med. 2001 Dec;94(12):628-3111733589
Cites: Fam Pract. 2002 Dec;19(6):611-612429663
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Cites: CMAJ. 2009 Jan 20;180(2):175-8219153394
Cites: Arch Gerontol Geriatr. 2009 Dec;49 Suppl 2:S21-520005421
Cites: Qual Prim Care. 2009;17(6):423-920051193
Cites: Tidsskr Nor Laegeforen. 2011 Oct 4;131(19):1878-8121984292
Cites: Scand J Public Health. 2012 Jun;40(4):309-1522786914
Cites: Scand J Prim Health Care. 2012 Dec;30(4):241-623050793
Cites: Emerg Med J. 2013 Sep;30(9):707-1122983980
PubMed ID
23800090 View in PubMed
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Clinical milestones in Parkinson's disease: A 7-year population-based incident cohort study.

https://arctichealth.org/en/permalink/ahliterature292261
Source
Parkinsonism Relat Disord. 2017 Sep; 42:28-33
Publication Type
Journal Article
Date
Sep-2017
Author
Anders Bjornestad
Kenn Freddy Pedersen
Ole-Bjorn Tysnes
Guido Alves
Author Affiliation
The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway; Department of Neurology, Stavanger University Hospital, Stavanger, Norway; Institute of Clinical Medicine, University of Bergen, Norway. Electronic address: anders.bjornestad@outlook.com.
Source
Parkinsonism Relat Disord. 2017 Sep; 42:28-33
Date
Sep-2017
Language
English
Publication Type
Journal Article
Keywords
Accidental Falls - statistics & numerical data
Aged
Cohort Studies
Community Health Planning
Dementia - epidemiology - physiopathology
Disease Progression
Female
Hallucinations - epidemiology - physiopathology
Humans
Incidence
Male
Middle Aged
Norway - epidemiology
Nursing Homes - utilization
Parkinson Disease - epidemiology - mortality - physiopathology
Risk factors
Abstract
Clinical staging of Parkinson's disease (PD) is important for patient management and prognosis. The non-motor and functional features visual hallucinations, recurrent falls, dementia and nursing home placement are currently not included in clinical staging schemes, but have been suggested as clinical milestones with important prognostic implications in advanced PD. In this study, we sought to evaluate the potential of these four milestone events for clinical staging and prognosis during the early years of the disease.
We recruited 185 patients with incident PD and monitored prospectively every six months through seven years for emergence and consequences of four clinical milestones.
One or more milestones were reached in 53.0%. Of the patients who reached the milestones, visual hallucinations appeared after a median of 3.3 (interquartile range 1.3-4.9) years from diagnosis, recurrent falls after 3.8 (2.8-5.2) years, dementia after 4.0 (2.1-4.8) years and nursing home placement after 5.4 (3.9-6.7) years. Presence of any milestone was associated with occurrence of other milestones (relative risks 1.9-6.3; all p = 0.001). Experiencing two or more milestones increased the risk of death during the study (relative risk 2.7, p = 0.03).
In early PD, visual hallucinations, recurrent falls, dementia and nursing home placement appear closely interrelated, possibly reflecting a shared neuropathological disease stage. All events convey important and sinister information on PD status and prognosis and are relatively easily accessible during routine clinical consultations. Therefore, they appear highly useful as clinical PD milestones and could possibly be incorporated into a novel disease rating scale.
PubMed ID
28578818 View in PubMed
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63 records – page 1 of 7.