Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-24T00:05:21.643Z Has data issue: false hasContentIssue false
  • English
  • Français

Unplanned admissions and readmissions in older people: a review of recent evidence on identifying and managing high-risk individuals

Published online by Cambridge University Press:  10 July 2014

Bronagh Walsh
Bronagh Walsh*
Affiliation:
Centre for Innovation and Leadership in Health Sciences, University of Southampton, UK
*
Address for correspondence: Dr Bronagh Walsh, Centre for Innovation and Leadership in Health Sciences, Faculty of Health Sciences, Building 45, Room 2014, University of Southampton, Highfield, Southampton. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Rising unplanned hospital admissions are a problem in ageing populations worldwide. These admissions are associated with poor outcomes for older people, contribute to rising health care costs and impede the provision of planned care. Policy and practice in recent years has focused on identification of those at risk of unplanned admission and early intervention via a range of admission avoidance services. Despite this, unplanned admissions in older people continue to rise, and managing demand for unplanned care remains a priority. Questions remain about the risk factors for unplanned admission and the best approaches to identifying and intervening with those at risk. This review explores recent evidence on admission rates, risk factors for unplanned admission in older people, identification of those at highest risk and interventions to avert unplanned admission.

Keywords

older peopleadmissionreadmissionrisk stratificationadmission avoidance
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 24 , Issue 3 , August 2014 , pp. 228 - 237
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1Imison, C, Poteliakhoff, E, Thompson, J. Older People and Emergency Bed Use. Exploring Variation. London, King's Fund; 2012.Google Scholar
2White, C. Hospital admissions rise by 6% in England. BMJ 2010; 340: 456.Google Scholar
3Robinson, P. Are hospital admissions out of control? See: www.chks.co.uk; 2010.Google Scholar
4Blunt, I, Bardsley, M, Dixon, J. Trends in Emergency Admissions in England 2004–2009. The Nuffield Trust; 2010.Google Scholar
5Comptroller and Auditor General. Emergency Admissions to Hospital: Managing the Demand. London, The Stationery Office; 2013.Google Scholar
6Urgent and Emergency Care Review Team. High quality care for all, now and for future generations: transforming urgent and emergency care services in England – Urgent and Emergency Care Review End of Phase I Report. NHS England; 2013. See: www.nhs.uk/NHSEngland/keogh-review/Documents/UECR.Ph1ReportGoogle Scholar
7Purdy, S.Avoiding Hospital Admissions. What does the Research say? London, King's Fund; 2010.Google Scholar
8Hawkes, N. Hospitals pay penalties of £1.2bn for ‘too many’ admissions and ‘too early’ discharges. BMJ 2014; 348: 1653.Google Scholar
9Ham, C.Reducing Unplanned Hospital Admissions: what does the literature tell us? Birmingham, Health Services Management Centre; 2006.Google Scholar
10Inouye, SK, Zhang, Y, Jones, RN, Shi, P, Cupples, LA, Calderon, HN, Marcantonio, ER. Risk factors for hospitalization among community-dwelling primary care older patients: development and validation of a predictive model. Med Care 2008; 46: 726–31.Google Scholar
11Lopez-Aguila, S, Contel, JC, Farre, J, Campuzano, JL, Rajmil, L. Predictive model for emergency hospital admission and 6-month readmission. Am J Managed Care 2011; 17: e348–57.Google Scholar
12Donnan, PT, Dorward, DW, Mutch, B, Morris, AD. Development and validation of model for predicting emergency admissions over the next year (PEONY): a UK historical cohort study. Arch Int Med 2008; 168: 1416–22.Google Scholar
13Walsh, B, Roberts, HC, Nicholls, PG, Lattimer, VA. Trends in hospital inpatient episodes for signs, symptoms and ill-defined conditions: observational study of older people's hospital episodes in England, 1995–2003. Age Ageing 2008; 37: 455–478.Google Scholar
14Zerdevas, P, Dobson, C. Emergency Readmission Rates: Further Analysis. London, Department of Health; 2008.Google Scholar
15Laniece, I, Couturier, P, Drame, M, Gavazzi, G, Lehman, S, Jolly, D, Voisin, T, Lang, PO, Jovenin, N, Gauvain, JB, Novella, JL, Sain-Jean, O, Blanchard, F. Incidence and main factors associated with early unplanned hospital readmission among French medical in-patients aged 75 and over admitted through emergency units. Age Ageing 2008; 37: 416–22.CrossRefGoogle Scholar
16Hastings, SN, Oddone, EZ, Fillenbaum, G, Sloane, RJ, Schmader, KE. Frequency and predictors of adverse health outcomes in older Medicare beneficiaries discharged from the emergency department. Med Care 2008; 46: 771–77.CrossRefGoogle ScholarPubMed
17Walsh, B, Addington-Hall, J, Roberts, HC, Nicholls, PG, Corner, J. Outcomes after unplanned admission to hospital in older people: ill-defined conditions as potential indicators of the frailty trajectory. JAGS 2012; 60: 2104–9.Google Scholar
18Moons, P, De Ridder, K, Geyskens, K, Sabbe, M, Braes, T, Flamaing, J, Milisen, K. Screening for risk of readmission of patients aged 65 years and above after discharge from the emergency department: predictive value of four instruments. Eur J Emerg Med 2007; 14: 315–23.Google Scholar
19Weeks, WB, Lee, RE, Wallace, AE, West, AN, Bagian, JP. Do older rural and urban veterans experience different rates of unplanned admission to VA and non-VA hospitals? Rural Health 2009; 25: 62–69.Google Scholar
20Saver, BG, Wang, CY, Dobie, SA, Green, PK, Baldwin, LM. The central role of comorbidity in predicting ambulatory care sensitive hospitalizations. Eur J Public Health 2013; 24: 66–72.Google Scholar
21Ben-Chetrit, E, Chen-Shuali, C, Zimran, E, Munter, G, Nesher, G. A simplified tool for prediction of readmission in elderly patients hospitalized in internal medicine departments. Israeli Med Assoc J 2012; 14: 752–56.Google Scholar
22Crane, SJ, Tung, EE, Hanson, GJ, Cha, S, Chaudhry, R, Takahashi, PY. Use of an electronic administrative database to identify older community-dwelling adults at high-risk for hospitalization or emergency department visits: the elder risk assessment index. BMC Health Serv Res 2010; 10: 338.Google Scholar
23Gage, H, Ting, S, Williams, P, Drennan, V, Goodman, C, Iliffe, S, Manthorpe, J, Davies, SL, Masey, H. Nurse-led case management for community dwelling older people: an explorative study of models and costs. J Nursing Management 2013; 21: 191–201.Google Scholar
24Sargent, P, Boaden, R, Roland, M. How many patients can community matrons successfully case manage? J Nursing Management 2008; 16: 38–46Google Scholar
25Longman, JM, Rolfe, M, Passey, MD, Heathcote, KE, Ewald, DP, Dunn, T, Barclay, LM, Morgan, GG. Frequent hospital admission of older people with chronic disease: a cross-sectional survey with telephone follow-up and data linkage. BMC Health Serv Res 2012; 12: 373.CrossRefGoogle ScholarPubMed
26Salanitro, AH, Hovater, M, Hearld, KR, Roth, DL, Sawyer, P, Locher, JL, Bodner, E, Brown, CJ, Allman, RM, Ritchie, CS. Symptom burden predicts hospitalization independent of comorbidity in commnity-dwelling older adults JAGS 2012; 60: 1632–37.Google Scholar
27Press, Y, Tandeter, H, Romem, P, Hazzan, R, Farkash, M. Depressive symptomatology as a risk factor for increased health service utilization among elderly patients in primary care. Archives Gerontol Geriatrics 2011; 54: 127–130.CrossRefGoogle ScholarPubMed
28Walsh, B, Roberts, HC, Nicholls, PG. (2011) Features and outcomes of unplanned hospital admissions of older people due to ill-defined (R-coded) conditions: retrospective analysis of hospital admissions data in England. BMC Geriatrics 2011; 11: 62.Google Scholar
29Drubbel, I, de Wit, NJ, Bleijenberg, N, Eijkemans, RJ, Schuurmans, MJ, Numans, ME. Prediction of adverse health outcomes in older people using a frailty index based on routine data. J Gerontol A 2013; 63: 301–8.Google Scholar
30Hoorgerduijn, JG, Buurman, BM, Koravaar, JC, Grobbee, DE, de Rooji, SE, Schuurmans, MJ. The prediction of functional decline in older hospitalised patients. Age Ageing 2012; 41: 381–87.Google Scholar
31Nuffield Trust. Predictive risk and health care: an overview. London. Nuffield Trust; 2011.Google Scholar
32Roland, M, Dusheiko, M, Gravelle, H, Parker, S. Follow-up of people aged 65 and over with a history of emergency admissions: analysis of routine admission data. BMJ 2005; 330: 289–92.CrossRefGoogle ScholarPubMed
33Dorr, DA, Jones, SS, Burns, L, Donnelly, SM, Brunker, CP, Wilcox, A, Clayton, PD. Use of health-related quality of life metrics to predict mortality and hospitalizations in community-dwelling seniors. JAGS 2006; 54: 667–73.Google Scholar
34Graf, CE, Gianelli, SV, Hermann, FR, Sarasim, FP, Michel, JP, Zekry, D, Chevalley, T. Identification of older patients at risk of unplanned readmission after discharge from the emergency department – comparison of two screening tools. Swiss Med Weekly 2012; 141: w13327.CrossRefGoogle Scholar
35Billings, J, Mijanovich, T, Dixon, J, Curry, N, Wennberg, D, Darin, B, Steinort, K. Case finding algorithms for patients at risk of re-hospitalisation. PARR1 and PARR2. London, King's Fund; 2006.Google Scholar
36Billings, J, Dixon, J, Mijanovich, T, Wennberg, D. Case-finding for patients at risk of readmission to hospital: development of an algorithm to identify high risk patients BMJ 2006; 330: 327–330.Google Scholar
37. Combined Model Development Team. Combined Predictive Model. Final Report. King's Fund, London; 2006.Google Scholar
38Georghiou, T, Steventon, A, Billings, J, Blunt, I, Lewis, G, Bardsley, M. Predictive risk and health care: an overview. London, Nuffield Trust; 2011.Google Scholar
39Curry, N, Billings, J, Darin, B, Dixon, J, Williams, M, Wennberg, D. Predictive Risk Project: Literature Review. London, King's Fund; 2005.Google Scholar
40Deschodt, M, Wellens, NI, Braes, T, Re Vuyst, A, Boonen, S, Flamaing, J, Moons, P, Milisen, K. Prediction of functional decline in older hospitalized patients: a comparative multi-center study of three screening tools. Ageing Clin Exp Res 2011; 23: 421–26.CrossRefGoogle Scholar
41Lee, JS, Schwindt, G, Langervin, M, Moghabghab, R, Alibhaj, SM, Kiss, A, Naglie, G. Validation of the triage risk stratification tool to identify older persons at risk for hospital admission and returning to the emergency department. JAGS 2008; 56: 2112–17.Google Scholar
42Edmans, J, Bradshaw, L, Gladman, JRF, Franklin, M, Berdunov, V, Elliott, R, Conroy, SP. The Identification of Seniors At Risk (ISAR) score to predict clinical outcomes and health service costs in older people discharged from UK acute medical units. Age Ageing 2013; 42: 747–53.Google Scholar
43Roland, M, Lewis, R, Steventon, A, Abel, G, Adams, J, Bardsley, M, Brereton, L, Chitnis, X, Conklin, A, Staetsky, L, Tunkel, S, Ling, T. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation. Int J Integrated Care 2012; 12: e130.Google Scholar
44Purdy, S, Paranjothy, S, Huntley, A, Thomas, R, Mann, M, Huws, D, Brindle, P, Elwyn, G. Interventions to reduce unplanned hospital admission: a series of systematic reviews. NHSBristol/Cardiff University/University of Bristol; 2012.Google Scholar
45Roland, M. Reducing emergency admissions: are we on the right track? BMJ 2012; 345: e6017.Google Scholar
46Gravelle, H, Dusheiko, M, Sheaff, R, Sargent, P, Boaden, R, Pickard, S. (2007) Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data. BMJ 2007; 334: 31.Google Scholar
47Tappenden, P, Campbell, F, Rawdin, A, Wong, R, Kalita, N. The clinical and cost-effectiveness of home-based, nurse-led health promotion for older people: a systematic review. Health Technology Assessment 2012: 16, 1–72.Google Scholar
48Lewis, G, Georghiou, T, Steventon, A, Vaithianathan, R, Chitnis, X, Billings, J, Blunt, I, Wright, L, Roberts, A, Bardsley, M. Impact of ‘Virtual Wards’ on hospital use: a research study using propensity matched controls and a cost analysis. Final Report. NIHRService Delivery and Organisation Programme; 2013.Google Scholar
49Williams, V, Smith, A, Chapman, L, Oliver, D. Community matrons – an exploratory study of patients’ views and experiences. J Advanced Nursing 2011; 67: 86–93.CrossRefGoogle ScholarPubMed
50Ross, S, Curry, N, Goodwin, N. Case Management. What it is and how it can best be implemented. London, The King's Fund; 2011.Google Scholar
51Challis, D, Hughes, J, Berzins, K, Reilly, S, Abell, J, Stewart, K, Bowns, I. Implementation of case management in long-term conditions in England: survey and case studies. J Health Serv Res Policy 2011; 16: 8–13.Google Scholar
52Metzelthin, SF, van Rossum, E, de Witte, LP, Ambergen, AW, Hobma, SO, Sipers, W, Kempen GIJM, . Effectiveness of interdisciplinary primary care approach to reduce disability in community dwelling frail older people: cluster randomised controlled trial. BMJ 2013; 347: f5264.CrossRefGoogle ScholarPubMed
53Markle-Reid, M, Browne, G, Gafni, A. Nurse-led health promotion interventions improve quality of life in frail older home care clients: lessons learned from three randomized trials in Ontario, Canada. J Evaluation Clinical Practice 2011; 19: 118–131.Google Scholar
54Van Hout, HP, Jansen, AP, van Marwijk, HW, Pronk, M, Frijters, DF, Nijpels, G. Prevention of adverse health trajectories in a vulnerable elderly population through nurse home visits: a randomised controlled trial. J Gerontol A 2010; 65: 734–42.Google Scholar
55Imhof, L, Naef, R, Wallhagen, MI, Schwarz, J, Mahrer-Imhof, R. Effects of an advanced practice nurse in-home health consultation programme for community dwelling persons aged 80 and over. JAGS 2012; 60: 2223–31.Google Scholar
56Ellis, G, Whitehead, MA, Robinson, D, O’Neill, D, Langhorne, P. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ 2011; 343: d6553.Google Scholar
57Bouzon, AC, Torregrossa, PR, Larrain, MPP, Rodriguez Manas, L.Effectiveness of re-evaluation of admission of patients with poor functional status. Rev Esp Geriatr Gerontol 2010; 45: 19–21.Google Scholar
58Edmans, J, Bradshaw, L, Franklin, M, Gladman, J, Conroy, S. Specialist geriatric medical assessment for patients discharged from hospital acute assessment units: randomised controlled trial. BMJ 2013; 347: f5874.CrossRefGoogle ScholarPubMed
59Conroy, SP, Stevens, T, Parker, SG, Gladman JRF, . A systematic review of comprehensive geriatric assessment to improve outcomes for frail older people being rapidly discharged from acute hospital: ‘interface geriatrics’. Age Ageing 2011; 40: 436–43.Google Scholar
60Oliver, D, Foot, C, Humphries, R. Making our health and care systems fit for an ageing population. London, King's Fund; 2014.Google Scholar
61Ham, C, Walsh, N. Making integrated care happen at scale and pace: lessons from experience. London, King's Fund; 2013.Google Scholar
62Walsh, B, Lattimer, V, Wintrup, J, Brailsford, S. Professional perspectives on systemic barriers to admission avoidance: learning from a system dynamics study of older people's admission pathways. Int J Older People Nursing 2014; doi: 10.1111/opn.12056 (in press).Google Scholar