Abstract
Objective: To determine the subsequent pattern of emergency admissions
in older people with a history of frequent emergency admissions.
Design: Analysis of routine admissions data from NHS hospitals using
hospital episode statistics (HES) in England.
Subjects: Individual patients aged greater than or equal to 65, greater
than or equal to 75, and greater than or equal to 85 who had at least
two emergency admissions in 1997-8.
Main outcome measures: Emergency admissions and bed use in this "high
risk" cohort of patients were counted for the next five years and
compared with the general population of the same age. No account was
taken of mortality as the analysis was designed to estimate the future
use of beds in this high risk cohort.
Results: Over four to five years, admission rates and bed use in the
high risk cohorts fell to the mean rate for older people. Although
patients greater than or equal to 65 with two or more such admissions
were responsible for 38% of admissions in the index year, they were
responsible for fewer than 10% of admissions' in the following year and
just over 3% five years later.
Conclusion: Patients with multiple emergency admissions are often
identified as a high risk group for subsequent admission and
substantial claims are made for interventions designed to avoid
emergency admission in such patients. Simply monitoring admission rates
cannot assess interventions designed to reduce admission among frail
older people as rates fall without any intervention. Comparison with a
matched control group is necessary. Wider benefits than reduced
admissions should be considered when introducing intensive case
management of older people.
Original language | English |
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Pages (from-to) | 289-292 |
Number of pages | 4 |
Journal | British Medical Journal |
Volume | 330 |
Issue number | 7486 |
DOIs | |
Publication status | Published - 5 Feb 2005 |
Keywords
- CONGESTIVE-HEART-FAILURE
- PRIMARY-CARE
- READMISSION
- QUALITY
- HOSPITALIZATION
- INDICATORS
- RISK