Eeva Björkstedt, Ari Voutilainen, Virva Hyttinen-Huotari, Johanna Jyrkkä, Pekka Mäntyselkä, Eija Lönnroos
{"title":"家庭护理客户急诊就诊的预测因素、诊断和费用。","authors":"Eeva Björkstedt, Ari Voutilainen, Virva Hyttinen-Huotari, Johanna Jyrkkä, Pekka Mäntyselkä, Eija Lönnroos","doi":"10.1016/j.jamda.2024.105308","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To examine factors, diagnoses, and costs associated with emergency department (ED) visits among home care clients.</p><p><strong>Design: </strong>A prospective 1-year follow-up study.</p><p><strong>Settings and participants: </strong>More information is needed regarding the reasons and costs associated with ED visits by home care clients. Participants were persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293).</p><p><strong>Methods: </strong>Data collection included clients' demographics, health status (Charlson Comorbidity Index), medication use, assessments of physical (Timed Up and Go) and cognitive functioning (Mini-Mental State Examination), Basic and Instrumental Activities of Daily Living, mood (Geriatric Depression Scale, GDS-15) and health-related quality of life (HRQoL, EuroQol [EQ-5D-3 L]). Logistic regression and univariate analyses of variance were conducted. The costs (total and per person-year) of ED visits were calculated.</p><p><strong>Results: </strong>The number of ED visits was 775 during the follow-up (mean 350 days). The likelihood of ED visits was reduced by better HRQoL and increased by a higher GDS-15 score, longer TUG times, and a history of heart failure and decreased glomerular infiltration. The most common primary diagnoses for ED visits were heart failure (8.4%), atrial fibrillation (4.0%), respiratory infection (4.0%), and cystitis (3.5%). The total costs of all ED visits during the follow-up were 251,247 € and internal medicine and surgery accounted for 142,726 € and 89,212 € of the cost, respectively. The costs per person-year were 981 €.</p><p><strong>Conclusions and implications: </strong>HRQoL, depressive symptoms, mobility, and heart and renal failure were associated with the number of ED visits. The most common reasons for ED visits were chronic heart conditions and infectious diseases and the highest costs were incurred by internal medicine treatment. With advanced care planning and active symptom screening and cooperation of home care nurses and physicians, some of the ED visits, for example due to heart failure, might be preventable.</p>","PeriodicalId":17180,"journal":{"name":"Journal of the American Medical Directors Association","volume":null,"pages":null},"PeriodicalIF":4.2000,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictors, Diagnoses, and Costs of Emergency Department Visits Among Home Care Clients.\",\"authors\":\"Eeva Björkstedt, Ari Voutilainen, Virva Hyttinen-Huotari, Johanna Jyrkkä, Pekka Mäntyselkä, Eija Lönnroos\",\"doi\":\"10.1016/j.jamda.2024.105308\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To examine factors, diagnoses, and costs associated with emergency department (ED) visits among home care clients.</p><p><strong>Design: </strong>A prospective 1-year follow-up study.</p><p><strong>Settings and participants: </strong>More information is needed regarding the reasons and costs associated with ED visits by home care clients. Participants were persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293).</p><p><strong>Methods: </strong>Data collection included clients' demographics, health status (Charlson Comorbidity Index), medication use, assessments of physical (Timed Up and Go) and cognitive functioning (Mini-Mental State Examination), Basic and Instrumental Activities of Daily Living, mood (Geriatric Depression Scale, GDS-15) and health-related quality of life (HRQoL, EuroQol [EQ-5D-3 L]). Logistic regression and univariate analyses of variance were conducted. The costs (total and per person-year) of ED visits were calculated.</p><p><strong>Results: </strong>The number of ED visits was 775 during the follow-up (mean 350 days). The likelihood of ED visits was reduced by better HRQoL and increased by a higher GDS-15 score, longer TUG times, and a history of heart failure and decreased glomerular infiltration. The most common primary diagnoses for ED visits were heart failure (8.4%), atrial fibrillation (4.0%), respiratory infection (4.0%), and cystitis (3.5%). The total costs of all ED visits during the follow-up were 251,247 € and internal medicine and surgery accounted for 142,726 € and 89,212 € of the cost, respectively. The costs per person-year were 981 €.</p><p><strong>Conclusions and implications: </strong>HRQoL, depressive symptoms, mobility, and heart and renal failure were associated with the number of ED visits. The most common reasons for ED visits were chronic heart conditions and infectious diseases and the highest costs were incurred by internal medicine treatment. 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Predictors, Diagnoses, and Costs of Emergency Department Visits Among Home Care Clients.
Objectives: To examine factors, diagnoses, and costs associated with emergency department (ED) visits among home care clients.
Design: A prospective 1-year follow-up study.
Settings and participants: More information is needed regarding the reasons and costs associated with ED visits by home care clients. Participants were persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293).
Methods: Data collection included clients' demographics, health status (Charlson Comorbidity Index), medication use, assessments of physical (Timed Up and Go) and cognitive functioning (Mini-Mental State Examination), Basic and Instrumental Activities of Daily Living, mood (Geriatric Depression Scale, GDS-15) and health-related quality of life (HRQoL, EuroQol [EQ-5D-3 L]). Logistic regression and univariate analyses of variance were conducted. The costs (total and per person-year) of ED visits were calculated.
Results: The number of ED visits was 775 during the follow-up (mean 350 days). The likelihood of ED visits was reduced by better HRQoL and increased by a higher GDS-15 score, longer TUG times, and a history of heart failure and decreased glomerular infiltration. The most common primary diagnoses for ED visits were heart failure (8.4%), atrial fibrillation (4.0%), respiratory infection (4.0%), and cystitis (3.5%). The total costs of all ED visits during the follow-up were 251,247 € and internal medicine and surgery accounted for 142,726 € and 89,212 € of the cost, respectively. The costs per person-year were 981 €.
Conclusions and implications: HRQoL, depressive symptoms, mobility, and heart and renal failure were associated with the number of ED visits. The most common reasons for ED visits were chronic heart conditions and infectious diseases and the highest costs were incurred by internal medicine treatment. With advanced care planning and active symptom screening and cooperation of home care nurses and physicians, some of the ED visits, for example due to heart failure, might be preventable.
期刊介绍:
JAMDA, the official journal of AMDA - The Society for Post-Acute and Long-Term Care Medicine, is a leading peer-reviewed publication that offers practical information and research geared towards healthcare professionals in the post-acute and long-term care fields. It is also a valuable resource for policy-makers, organizational leaders, educators, and advocates.
The journal provides essential information for various healthcare professionals such as medical directors, attending physicians, nurses, consultant pharmacists, geriatric psychiatrists, nurse practitioners, physician assistants, physical and occupational therapists, social workers, and others involved in providing, overseeing, and promoting quality