Abtin Ijadi Maghsoodi, Jewel Barlow-Armstrong, Valery Pavlov, Paul Rouse, Cameron Graham Walker, Matthew Parsons
{"title":"What Makes Effective Acute Geriatric Care? - A mixed Methods Study From Aotearoa New Zealand","authors":"Abtin Ijadi Maghsoodi, Jewel Barlow-Armstrong, Valery Pavlov, Paul Rouse, Cameron Graham Walker, Matthew Parsons","doi":"10.1007/s12126-024-09568-7","DOIUrl":null,"url":null,"abstract":"<p> Current policies for older patients do not adequately address the barriers to effective implementation of optimal care models in New Zealand, partly due to differences in patient definitions and the in-patient pathway they should follow through hospital. This research aims to: (a) synthesise a definition of a complex older patient; (b) identify and explore primary and secondary health measures; and (c) identify the primary components of a care model suitable for a tertiary hospital in the midland region of the North Island of New Zealand.</p><p>This mixed-methods study utilised a convergence model, in which qualitative and quantitative data were investigated separately and then combined for interpretation. Semi-structured interviews (<i>n</i>=11) were analysed using a general inductive method of enquiry to develop key codes, categories and themes. Univariate data analysis was employed using six years of routinely collected data of patients admitted to the emergency department and inpatient units (<i>n</i>=261,773) of the tertiary hospital.</p><p>A definition of a complex older patient was determined that incorporates chronic conditions, comorbidities and iatrogenic complications, functional decline, activities of daily living, case fatality, mortality, hospital length of stay, hospital costs, discharge destination, hospital readmission and emergency department revisit and age – not necessarily over 65 years old. Well-performing geriatric care models were found to include patient-centred care, frequent medical review, early rehabilitation, early discharge planning, a prepared environment and multidisciplinary teams.</p><p>The findings of this New Zealand study increase understanding of acute geriatric care for complex older patients by filling a gap in policies and strategies, identifying potential components of an optimal care model and defining a complex geriatric patient.</p><p>The findings of this study present actionable opportunities for clinicians, managers, academics and policymakers to better understand a complex older patient in New Zealand, with significant relevance also for international geriatric care and to establish an effective acute geriatric care model that leads to beneficial health outcomes and provides safeguard mechanisms.</p>","PeriodicalId":51665,"journal":{"name":"Ageing International","volume":"49 3","pages":"660 - 683"},"PeriodicalIF":1.0000,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s12126-024-09568-7.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Ageing International","FirstCategoryId":"1085","ListUrlMain":"https://link.springer.com/article/10.1007/s12126-024-09568-7","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"GERONTOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Current policies for older patients do not adequately address the barriers to effective implementation of optimal care models in New Zealand, partly due to differences in patient definitions and the in-patient pathway they should follow through hospital. This research aims to: (a) synthesise a definition of a complex older patient; (b) identify and explore primary and secondary health measures; and (c) identify the primary components of a care model suitable for a tertiary hospital in the midland region of the North Island of New Zealand.
This mixed-methods study utilised a convergence model, in which qualitative and quantitative data were investigated separately and then combined for interpretation. Semi-structured interviews (n=11) were analysed using a general inductive method of enquiry to develop key codes, categories and themes. Univariate data analysis was employed using six years of routinely collected data of patients admitted to the emergency department and inpatient units (n=261,773) of the tertiary hospital.
A definition of a complex older patient was determined that incorporates chronic conditions, comorbidities and iatrogenic complications, functional decline, activities of daily living, case fatality, mortality, hospital length of stay, hospital costs, discharge destination, hospital readmission and emergency department revisit and age – not necessarily over 65 years old. Well-performing geriatric care models were found to include patient-centred care, frequent medical review, early rehabilitation, early discharge planning, a prepared environment and multidisciplinary teams.
The findings of this New Zealand study increase understanding of acute geriatric care for complex older patients by filling a gap in policies and strategies, identifying potential components of an optimal care model and defining a complex geriatric patient.
The findings of this study present actionable opportunities for clinicians, managers, academics and policymakers to better understand a complex older patient in New Zealand, with significant relevance also for international geriatric care and to establish an effective acute geriatric care model that leads to beneficial health outcomes and provides safeguard mechanisms.
期刊介绍：
As a quarterly peer-reviewed journal that has existed for over three decades, Ageing International serves all professionals who deal with complex ageing issues. The journal is dedicated to improving the life of ageing populations worldwide through providing an intellectual forum for communicating common concerns, exchanging analyses and discoveries in scientific research, crystallizing significant issues, and offering recommendations in ageing-related service delivery and policy making. Besides encouraging the submission of high-quality research and review papers, Ageing International seeks to bring together researchers, policy analysts, and service program administrators who are committed to reducing the ''implementation gap'' between good science and effective service, between evidence-based protocol and culturally suitable programs, and between unique innovative solutions and generalizable policies. For significant issues that are common across countries, Ageing International will organize special forums for scholars and investigators from different disciplines to present their regional perspectives as well as to provide more comprehensive analysis. The editors strongly believe that such discourse has the potential to foster a wide range of coordinated efforts that will lead to improvements in the quality of life of older persons worldwide. Abstracted and Indexed in:
ABI/INFORM, Academic OneFile, Academic Search, CSA/Proquest, Current Abstracts, EBSCO, Ergonomics Abstracts, Expanded Academic, Gale, Google Scholar, Health Reference Center Academic, OCLC, PsychINFO, PsyARTICLES, SCOPUS, Social Science Abstracts, and Summon by Serial Solutions.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
