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）：抑郁症状在老年人中普遍存在，并且可能与负面的健康结果相关。计划外 30 天再入院是患者治疗效果不佳的一个指标，会导致医疗费用增加，并且最近已被医疗保险支付咨询委员会列为医院质量差的标志。识别出再入院高风险的患者将有助于将有限的出院计划资源分配给受益最大的患者，并为医疗保健系统提供大量节省成本的机会。老年人意外再入院的风险较高，但迄今为止，很少有研究探讨该人群抑郁症状与再入院之间的关联。这些研究主要集中于患有特定疾病的患者或检查了不同的结果。相比之下，我们将调查 65 岁及以上成年人的抑郁症状与 30 天计划外再入院之间的独立关联。此外，我们还将研究抑郁症状可能导致该患者群体再次入院的机制。该提案的具体目标是确定一组 65 岁及以上社区居民的抑郁症状与计划外 30 天再入院之间的关系，这些成年人曾住进大型城市三级护理医院，并且确定该人群中不遵守出院指示与抑郁症状和再入院之间的关联。为了实现这些目标，我们将对 720 名 65 岁及以上入住马里兰大学医学中心普通医疗和外科服务的社区居民进行前瞻性队列研究。将在基线时使用 GDS-15 测量抑郁症状，并在出院后对参与者进行跟踪，以确定再入院事件的发生率以及使用调查方法遵守出院指示的情况。这项前瞻性队列研究将具体：1) 确定抑郁症状与 30 天再入院之间的关联，2) 使用专门为本研究创建的仪器测量不遵守出院指示的情况，3) 确定抑郁症状与非住院治疗之间的关联。 -遵守出院指示，4) 确定不遵守出院指示与 30 天再次入院之间的关联。这项研究的新颖之处在于，它旨在解决老年人的分诊和入院筛查程序，并从患者行为而不是社会或医学角度更好地阐明重新入院的机制。这项研究对公共卫生的影响在于，除了提供有关重新入院可能机制的信息外，还可以通过识别和治疗住院老年人的抑郁症和抑郁症状来开发和评估旨在减少重新入院的干预措施。 公共卫生相关性：再入院是一种常见但可能可以避免的医疗结果，与相当大的医疗费用相关。抑郁症状与负面健康结果相关，并可能导致再入院率增加。这项研究的潜在总体影响可能是老年人筛查程序的改变，以及通过早期识别和治疗这些人的抑郁症来减少再入院率。

项目成果

Against professional advice: treatment attrition among pregnant methamphetamine users.

反对专业建议：怀孕的甲基苯丙胺使用者的治疗流失。

• 发表时间: 2011
• 作者: Lindsay, Brianna;Albrecht, Jennifer;Terplan, Mishka
• 通讯作者: Terplan, Mishka