Emergency hospital admissions for illdefined conditions amongst older people

1
Emergency hospital admissions for ill-defined
conditions amongst older people

• B Walsh, VA Lattimer, HC Roberts, PG Nicholls

BMW 16.9.08
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Background

• Ill-defined conditions (R chapter of the ICD-10)
• Ill-defined conditions incidence known to rise
  with age
• Incidence rising in UK and internationally
• Recent increases exceed that expected from
  demographic change and general growth in
  admissions

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Background

• Policy emphasis on admission avoidance
• Organisational factors may influence admission
  rates
• Need to understand drivers of these admissions

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Study aims

• To use routine admission data in order to
• Describe the patient characteristics
• Describe the admission characteristics
• Explore factors predicting admission

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Methods

• Retrospective observational study
• Data from patient administration system
• Emergency admissions to medicine and geriatrics
• All people aged 65 and over
• 12 month period (2002)
• 6760 admissions
• Comparison by diagnostic group (ill-defined vs
  other)

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Patient characteristics
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Patient characteristics
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Admission features
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Patient outcomes
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Patient Outcomes
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Predictive factors

• Risk of receiving an ill-defined diagnosis is
  reduced by
• Admission to geriatric rather than general
  medicine
• Admission from institutional rather than
  community residence
• Admission via GP rather than AE

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Summary

• No difference in age or gender
• More likely to be admitted
• via AE
• via medicine
• from non-institutional setting
• Organisational factors are important predictors
• Shorter length of stay
• Lower mortality

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References

• DH. 2001. National Service Framework for Older
  People. London DH
• Thomas M. 2008. Are we counting the right thing?
  Age Ageing 37 360-361
• Walsh B, Roberts H, Hopkinson J. 2007. Emergency
  hospital admissions of ill-defined conditions
  amongst older people a review of the literature.
  International Journal of Older People Nursing 2
  270-277
• Walsh B, Roberts HC, Nicholls PG, Lattimer VA.
  2008. Trends in hospital inpatient episodes for
  signs, symptoms and ill-defined conditions
  observational study of older peoples hospital
  admissions in England, 1995-2003. Age Ageing
  37455-478
• Wanless D, Appleby J, Harrison A, Patel D. 2007.
  Our Future Health Secured? A review of NHS
  spending and performance. London Kings Fund