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Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England
OBJECTIVE: Older people and people with complex needs often require both health and social care services, but there is limited insight into individual journeys across these services. To help inform joint health and social care planning, we aimed to assess the relationship between hospital admissions...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9511602/ https://www.ncbi.nlm.nih.gov/pubmed/36109027 http://dx.doi.org/10.1136/bmjopen-2022-061875 |
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author | Grimm, Fiona Lewer, Dan Craig, John Rogans-Watson, Rafi Shand, Jenny |
author_facet | Grimm, Fiona Lewer, Dan Craig, John Rogans-Watson, Rafi Shand, Jenny |
author_sort | Grimm, Fiona |
collection | PubMed |
description | OBJECTIVE: Older people and people with complex needs often require both health and social care services, but there is limited insight into individual journeys across these services. To help inform joint health and social care planning, we aimed to assess the relationship between hospital admissions and domiciliary care receipt. DESIGN: Retrospective cohort study, using linked data on primary care activity, hospital admissions and social care records. SETTING: London Borough of Barking and Dagenham, England. PARTICIPANTS: Adults aged 19 and over who lived in the area on 1 April 2018 and who were registered at a general practice in East London between 1 April 2018 and 31 March 2020 (n=140 987). OUTCOME MEASURES: The outcome was initiation of domiciliary care. We estimated the rate of hospital-associated care package initiation, and of care packages unrelated to hospital admission. We also described the characteristics of hospital admissions that preceded domiciliary care, including primary diagnosis codes. RESULTS: 2041/140 987 (1.4%) participants had a domiciliary care package during a median follow-up of 1.87 years. 32.6% of packages were initiated during a hospital stay or within 7 days of discharge. The rate of new domiciliary care packages was 120 times greater (95% CI 110 to 130) during or after a hospital stay than at other times, and this association was present for all age groups. Primary admission reasons accounting for the largest number of domiciliary care packages were hip fracture, pneumonia, stroke, urinary tract infection, septicaemia and exacerbations of long-term conditions (chronic obstructive pulmonary disease and heart failure). Admission reasons with the greatest likelihood of a subsequent domiciliary care package were fractures and strokes. CONCLUSION: Hospitals are a major referral route into domiciliary care. While patients admitted due to new and acute illnesses account for many domiciliary care packages, exacerbations of long-term conditions and age-related and frailty-related conditions are also important drivers. |
format | Online Article Text |
id | pubmed-9511602 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-95116022022-09-27 Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England Grimm, Fiona Lewer, Dan Craig, John Rogans-Watson, Rafi Shand, Jenny BMJ Open Health Services Research OBJECTIVE: Older people and people with complex needs often require both health and social care services, but there is limited insight into individual journeys across these services. To help inform joint health and social care planning, we aimed to assess the relationship between hospital admissions and domiciliary care receipt. DESIGN: Retrospective cohort study, using linked data on primary care activity, hospital admissions and social care records. SETTING: London Borough of Barking and Dagenham, England. PARTICIPANTS: Adults aged 19 and over who lived in the area on 1 April 2018 and who were registered at a general practice in East London between 1 April 2018 and 31 March 2020 (n=140 987). OUTCOME MEASURES: The outcome was initiation of domiciliary care. We estimated the rate of hospital-associated care package initiation, and of care packages unrelated to hospital admission. We also described the characteristics of hospital admissions that preceded domiciliary care, including primary diagnosis codes. RESULTS: 2041/140 987 (1.4%) participants had a domiciliary care package during a median follow-up of 1.87 years. 32.6% of packages were initiated during a hospital stay or within 7 days of discharge. The rate of new domiciliary care packages was 120 times greater (95% CI 110 to 130) during or after a hospital stay than at other times, and this association was present for all age groups. Primary admission reasons accounting for the largest number of domiciliary care packages were hip fracture, pneumonia, stroke, urinary tract infection, septicaemia and exacerbations of long-term conditions (chronic obstructive pulmonary disease and heart failure). Admission reasons with the greatest likelihood of a subsequent domiciliary care package were fractures and strokes. CONCLUSION: Hospitals are a major referral route into domiciliary care. While patients admitted due to new and acute illnesses account for many domiciliary care packages, exacerbations of long-term conditions and age-related and frailty-related conditions are also important drivers. BMJ Publishing Group 2022-09-07 /pmc/articles/PMC9511602/ /pubmed/36109027 http://dx.doi.org/10.1136/bmjopen-2022-061875 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Health Services Research Grimm, Fiona Lewer, Dan Craig, John Rogans-Watson, Rafi Shand, Jenny Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England |
title | Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England |
title_full | Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England |
title_fullStr | Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England |
title_full_unstemmed | Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England |
title_short | Conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in East London, England |
title_sort | conditions associated with the initiation of domiciliary care following a hospital admission: a cohort study in east london, england |
topic | Health Services Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9511602/ https://www.ncbi.nlm.nih.gov/pubmed/36109027 http://dx.doi.org/10.1136/bmjopen-2022-061875 |
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