To identify rates of potentially preventable complications for dementia patients compared with no... more To identify rates of potentially preventable complications for dementia patients compared with non-dementia patients. Retrospective cohort design using hospital discharge data for dementia patients, case matched on sex, age, comorbidity and surgical status on a 1 : 4 ratio to non-dementia patients. Public hospital discharge data from the state of New South Wales, Australia for 2006/2007. 426 276 overnight hospital episodes for patients aged 50 and above (census sample). Rates of preventable complications, with episode-level risk adjustment for 12 complications that are known to be sensitive to nursing care. Controlling for age and comorbidities, surgical dementia patients had higher rates than non-dementia patients in seven of the 12 complications: urinary tract infections, pressure ulcers, delirium, pneumonia, physiological and metabolic derangement (all at p<0.0001), sepsis and failure to rescue (at p<0.05). Medical dementia patients also had higher rates of these complicati...
Research in Social and Administrative Pharmacy, 2015
Persons with dementia (PWD) often have complex medication regimens and are at risk of medication ... more Persons with dementia (PWD) often have complex medication regimens and are at risk of medication problems during the multiple transitions of care experienced as the condition progresses. To explore medication processes in acute care episodes and care transitions for PWD and to make recommendations to improve practice. Semi-structured interviews were conducted by two pharmacy researchers from a focused purposive sample of fifty-one participants (carers, health professionals, Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Australia staff) from urban and rural Australia. After written consent, the interviews were audio-recorded then transcribed verbatim for face-to-face interviews, or notes were taken during the interview if conducted by telephone. The transcripts were checked for accuracy by the pharmacy researchers. Thematic analysis of the data was undertaken independently by the two researchers to reduce bias and any disagreements were resolved by discussion. Themes identified were: medication reconciliation; no modified planning for care transitions; underutilization of information technology; multiple prescribers; residential aged care facilities; and medication reviews by pharmacists. Sub themes were: access to appropriate staff; identification of dementia; dose administration aids; and staff training. Medication management is sub-optimal for PWD during care transitions and may compromise safety. Suggested improvements included: increased involvement of pharmacists in care transitions; outreach or transitional health care professionals; modified planning for care transitions for individuals over 80 years; co-ordinated electronic records; structured communication; and staff training.
To identify rates of potentially preventable complications for dementia patients compared with no... more To identify rates of potentially preventable complications for dementia patients compared with non-dementia patients. Retrospective cohort design using hospital discharge data for dementia patients, case matched on sex, age, comorbidity and surgical status on a 1 : 4 ratio to non-dementia patients. Public hospital discharge data from the state of New South Wales, Australia for 2006/2007. 426 276 overnight hospital episodes for patients aged 50 and above (census sample). Rates of preventable complications, with episode-level risk adjustment for 12 complications that are known to be sensitive to nursing care. Controlling for age and comorbidities, surgical dementia patients had higher rates than non-dementia patients in seven of the 12 complications: urinary tract infections, pressure ulcers, delirium, pneumonia, physiological and metabolic derangement (all at p<0.0001), sepsis and failure to rescue (at p<0.05). Medical dementia patients also had higher rates of these complicati...
Abstract: This paper critically examines the clarity, practicality, desirability and validity of ... more Abstract: This paper critically examines the clarity, practicality, desirability and validity of the 31 outcome standards that the Commonwealth Government introduced to assess quality of care in Australian nursing homes. Key features of the Australian system in an international context are its focus on outcomes, the limited number of standards used, and the comparatively subjective nature of some standards. Directors of nursing from 410 nursing homes in the Brisbane, Sydney, Melbourne and Adelaide metropolitan areas were interviewed as part of the Nursing Home Regulation in Action Project. The overwhelming majority reported the standards as clear and desirable. In the minority of cases where problems were raised, practicability was the basis for concern. A factor analysis of the ratings given by standards monitoring teams to these 410 homes failed to demonstrate redundancy across standards or grouping of standards by objectives. Nevertheless, the standards were sufficiently highly interrelated to justify summing to produce an overall compliance score. This study shows that the 31 standards hold up well under scrutiny, both from the perspectives of key actors in the monitoring process, and from a psychometric point of view.
Background: Increased length of stay and high rates of adverse clinical events in hospitalised pa... more Background: Increased length of stay and high rates of adverse clinical events in hospitalised patients with dementia is stimulating interest and debate about which costs may be associated and potentially avoided within this population. Methods: A retrospective cohort study was designed to identify and compare estimated costs for older people in relation to hospital-acquired complications and dementia. Australia's most populous state provided a census sample of 426,276 discharged overnight public hospital episodes for patients aged 50+ in the 2006–07 financial year. Four common hospital-acquired complications (urinary tract infections, pressure areas, pneumonia, and delirium) were risk-adjusted at the episode level. Extra costs were attributed to patient length of stay above the average for each patient's Diagnosis Related Group, with separate identification of fixed and variable costs (all in Australian dollars).
To identify rates of potentially preventable complications for dementia patients compared with no... more To identify rates of potentially preventable complications for dementia patients compared with non-dementia patients. Retrospective cohort design using hospital discharge data for dementia patients, case matched on sex, age, comorbidity and surgical status on a 1 : 4 ratio to non-dementia patients. Public hospital discharge data from the state of New South Wales, Australia for 2006/2007. 426 276 overnight hospital episodes for patients aged 50 and above (census sample). Rates of preventable complications, with episode-level risk adjustment for 12 complications that are known to be sensitive to nursing care. Controlling for age and comorbidities, surgical dementia patients had higher rates than non-dementia patients in seven of the 12 complications: urinary tract infections, pressure ulcers, delirium, pneumonia, physiological and metabolic derangement (all at p<0.0001), sepsis and failure to rescue (at p<0.05). Medical dementia patients also had higher rates of these complicati...
Research in Social and Administrative Pharmacy, 2015
Persons with dementia (PWD) often have complex medication regimens and are at risk of medication ... more Persons with dementia (PWD) often have complex medication regimens and are at risk of medication problems during the multiple transitions of care experienced as the condition progresses. To explore medication processes in acute care episodes and care transitions for PWD and to make recommendations to improve practice. Semi-structured interviews were conducted by two pharmacy researchers from a focused purposive sample of fifty-one participants (carers, health professionals, Alzheimer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Australia staff) from urban and rural Australia. After written consent, the interviews were audio-recorded then transcribed verbatim for face-to-face interviews, or notes were taken during the interview if conducted by telephone. The transcripts were checked for accuracy by the pharmacy researchers. Thematic analysis of the data was undertaken independently by the two researchers to reduce bias and any disagreements were resolved by discussion. Themes identified were: medication reconciliation; no modified planning for care transitions; underutilization of information technology; multiple prescribers; residential aged care facilities; and medication reviews by pharmacists. Sub themes were: access to appropriate staff; identification of dementia; dose administration aids; and staff training. Medication management is sub-optimal for PWD during care transitions and may compromise safety. Suggested improvements included: increased involvement of pharmacists in care transitions; outreach or transitional health care professionals; modified planning for care transitions for individuals over 80 years; co-ordinated electronic records; structured communication; and staff training.
To identify rates of potentially preventable complications for dementia patients compared with no... more To identify rates of potentially preventable complications for dementia patients compared with non-dementia patients. Retrospective cohort design using hospital discharge data for dementia patients, case matched on sex, age, comorbidity and surgical status on a 1 : 4 ratio to non-dementia patients. Public hospital discharge data from the state of New South Wales, Australia for 2006/2007. 426 276 overnight hospital episodes for patients aged 50 and above (census sample). Rates of preventable complications, with episode-level risk adjustment for 12 complications that are known to be sensitive to nursing care. Controlling for age and comorbidities, surgical dementia patients had higher rates than non-dementia patients in seven of the 12 complications: urinary tract infections, pressure ulcers, delirium, pneumonia, physiological and metabolic derangement (all at p<0.0001), sepsis and failure to rescue (at p<0.05). Medical dementia patients also had higher rates of these complicati...
Abstract: This paper critically examines the clarity, practicality, desirability and validity of ... more Abstract: This paper critically examines the clarity, practicality, desirability and validity of the 31 outcome standards that the Commonwealth Government introduced to assess quality of care in Australian nursing homes. Key features of the Australian system in an international context are its focus on outcomes, the limited number of standards used, and the comparatively subjective nature of some standards. Directors of nursing from 410 nursing homes in the Brisbane, Sydney, Melbourne and Adelaide metropolitan areas were interviewed as part of the Nursing Home Regulation in Action Project. The overwhelming majority reported the standards as clear and desirable. In the minority of cases where problems were raised, practicability was the basis for concern. A factor analysis of the ratings given by standards monitoring teams to these 410 homes failed to demonstrate redundancy across standards or grouping of standards by objectives. Nevertheless, the standards were sufficiently highly interrelated to justify summing to produce an overall compliance score. This study shows that the 31 standards hold up well under scrutiny, both from the perspectives of key actors in the monitoring process, and from a psychometric point of view.
Background: Increased length of stay and high rates of adverse clinical events in hospitalised pa... more Background: Increased length of stay and high rates of adverse clinical events in hospitalised patients with dementia is stimulating interest and debate about which costs may be associated and potentially avoided within this population. Methods: A retrospective cohort study was designed to identify and compare estimated costs for older people in relation to hospital-acquired complications and dementia. Australia's most populous state provided a census sample of 426,276 discharged overnight public hospital episodes for patients aged 50+ in the 2006–07 financial year. Four common hospital-acquired complications (urinary tract infections, pressure areas, pneumonia, and delirium) were risk-adjusted at the episode level. Extra costs were attributed to patient length of stay above the average for each patient's Diagnosis Related Group, with separate identification of fixed and variable costs (all in Australian dollars).
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