Depressive symptoms and 30-day unplanned hospital readmission in older adults

老年人的抑郁症状和 30 天计划外再入院

• 批准号: 8261811
• 负责人: Jennifer S. Albrecht
• 金额: $ 4.13万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-30 至 2013-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8261811
• 关键词: Depressive; symptoms; 30; day; unplanned

DESCRIPTION (provided by applicant): Depressive symptoms are prevalent in older adults and may be associated with negative health outcomes. Unplanned 30-day hospital readmission is an indicator of poor patient outcomes, leads to increased healthcare costs, and has recently been targeted by the Medicare Payment Advisory Commission as a marker of poor hospital quality. The identification of patients at high risk of hospital readmission will facilitate targetng of limited discharge planning resources to those who will benefit the most and represents an opportunity for considerable cost savings to the healthcare system. Older adults are at higher risk of unplanned hospital readmission, but to date, few studies have examined the association between depressive symptoms and hospital readmission in this population. These studies have focused primarily on patients with specific illnesses or have examined different outcomes. In contrast, we will investigate the independent association between depressive symptoms and unplanned 30-day hospital readmission in adults aged 65 and older. Further, we will also examine a mechanism by which depressive symptoms may lead to hospital readmission in this patient population. The specific goals of this proposal are to determine the association between depressive symptoms and unplanned 30-day hospital readmission in a cohort of community-dwelling adults aged 65 and older, who have been admitted to a large, urban, tertiary-care hospital, and to determine the association between non- adherence to discharge instructions and both depressive symptoms and hospital readmission in this population. To achieve these objectives, we will conduct a prospective cohort study of 720 community-dwelling adults aged 65 and older who have been admitted to general medical and surgical services of the University of Maryland Medical Center . Depressive symptoms will be measured with the GDS-15 at baseline, and participants will be followed post-hospital discharge to ascertain incidence of readmission events as well as adherence to discharge instructions using survey methodology. This prospective cohort study will specifically: 1) determine the association between depressive symptoms and 30-day hospital readmission, 2) measure non-adherence to discharge instructions using an instrument created specifically for this study, 3) determine the association between depressive symptoms and non-adherence to discharge instructions and 4) determine the association between non-adherence to discharge instructions and 30-day hospital readmission. This study is novel in that it aims to address triage and admission screening procedures for older adults as well as to better elucidate the mechanisms underlying hospital readmission from a patient behavior, rather than a social or medical perspective. The public health impact of this study lies in the potential development and evaluation of interventions designed to reduce hospital readmissions by the identification and treatment of depression and depressive symptoms in the hospitalized elderly, in addition to providing information on a possible mechanism of hospital readmission. PUBLIC HEALTH RELEVANCE: Hospital readmission is a common but potentially avoidable healthcare outcome associated with considerable healthcare costs. Depressive symptoms are associated with negative health outcomes and may lead to increased hospital readmissions. The potential overall impact of this study could be changes in screening procedures for older adults as well as reductions in hospital readmission by early identification and treatment of depression in these individuals.

描述（由申请人提供）：老年人的抑郁症状普遍存在，可能与健康结果有关。计划外30天的医院再入院是患者结果不佳的指标，导致医疗保健费用增加，并且最近受到Medicare支付咨询委员会的针对性，是医院质量差的标志。识别出高度医院再入院风险的患者将有助于对那些受益最多的人的出院计划资源有限，并为医疗保健系统节省大量成本的机会。老年人面临外医院再入院的风险更高，但迄今为止，很少有研究检查抑郁症状与该人群的医院再入院之间的关联。这些研究主要集中在患有特定疾病的患者或检查不同的结果上。相比之下，我们将研究65岁及以上的成年人的抑郁症状与计划外30天的医院再入院之间的独立关联。此外，我们还将研究一种机制，通过这种机制，抑郁症状可能导致该患者人群的住院入院。该提案的具体目标是确定抑郁症状与计划外30天的医院再入院之间的关联，在一组65岁及65岁以上的社区居民中，他们已被接纳为大型，城市的第三次医院医院，并确定该人群中非依从性和抑郁症状和住院症状之间的关联。为了实现这些目标，我们将对720名65岁及65岁以上社区居民的人群进行了预期研究，他们被马里兰大学医学中心接受了一般医学和外科服务。将在基线时使用GDS-15测量抑郁症状，并将遵循院后出院，以确定再入院事件的发生率，并使用调查方法遵守解除指令。这项前瞻性队列研究将特别：1）确定抑郁症状与30天的住院入院之间的关联，2）测量使用专门为本研究创建的仪器出院指令的不遵守性，3）确定抑郁症状与不遵守指示的不遵守性与出院指导之间的关联，以及4）确定不遵守指令与30天医院的研究之间的关联。这项研究是新颖的，因为它旨在解决老年人的分类和入学筛查程序，并更好地阐明患者行为的医院再入院机制，而不是社交或医学观点。这项研究的公共卫生影响在于，除了提供有关医院再入院机制的信息外，还通过鉴定和治疗抑郁症和抑郁症状的抑郁和抑郁症状来减少医院再入院的干预措施的潜在发展和评估。 公共卫生相关性：医院再入院是一种与大量医疗保健费用相关的常见但可能避免的医疗保健结果。抑郁症状与负面的健康结局有关，可能导致医院再入院增加。这项研究的潜在总体影响可能是老年人筛查程序的变化以及通过早期鉴定和治疗这些人的抑郁症来减少医院再入院。