TY - JOUR
TI - A multi-centre European study of factors affecting the discharge
destination of older people admitted to hospital: analysis of
in-hospital data from the ACMEplus project
AU - Campbell, SE
AU - Seymour, DG
AU - Primrose, WR
AU - Lynch, JE
AU - Dunstan,
AU - E
AU - Espallargues, M
AU - Lamura, G
AU - Lawson, P
AU - Philp, I and
AU - Mestheneos, E
AU - Politynska, B
AU - Raiha, I
AU - ACMEplus Project Team
JO - Age and Ageing
PY - 2005
VL - 34
TODO - 5
SP - 467-475
PB - Oxford University Press
SN - 0002-0729, 1468-2834
TODO - 10.1093/ageing/afi141
TODO - activities of daily living; aged; 80 and over; hospitals; outcome
assessment (health care); risk-adjustment; elderly
TODO - Objectives: to examine the relationship between seven predictor
variables (recorded on Day 3 of hospital admission) and discharge
destination in non-elective medical patients aged 65+ years.
Design: prospective cohort.
Setting: eight centres in six European countries.
Predictor variables: age, gender, living alone, physical function (three
categories based on Barthel Index), cognition (Katzman’s
orientation-memory-concentration test), main body system affected (based
on International Classification of Diseases), number of geriatric giants
(GGs) involved in the referral (a GG being a problem with falling,
mobility, continence or cognition).
Main outcome measures: discharge destination (by Day 90) in three
categories: ‘HOMESAME’ (return to previous residence), ‘INSTIN90’
(discharge to alternative residence or still in hospital at 90 days),
‘DEADINHO’ (death in hospital),
Results: in 1,626 patients, discharge destination was HOMESAME in
84.7%, DEADINHO in 8.9% and INSTIN90 in 6.4%. Mean duration of stay
was 17.7 days, median 12. Univariate analyses showed a statistically
significant relationship between all seven predictor variables and
discharge destination. Physical function was the best single predictor
with a sevenfold difference in adverse outcome rates between the best
and worst categories. On multiple logistic regression, significant
predictor variables were as follows. (i) For DEADINHO: physical
function, cognition, gender; (ii) for INSTIN90: physical function,
living alone, GGs, age, gender. Multiple linear regression identified
physical function, GGs and living alone as predictors of log, length of
stay.
Conclusion: case-mix systems to compare risk-adjusted hospital outcome
in older medical patients need to incorporate information about physical
function, cognition and presenting problems in addition to diagnosis.
ER -