Evaluate the effect of an exercise-based model of hospital and in-home follow-up care for older people at risk of hospital readmission on emergency.

INTERVENTION

Artile 1 Comprehensive discharge follow-up in patients’ homes by GPs and district nurses of elderly patients.”

Authors:
Rytter, Lars; Jakobsen, Helle Neel; Rønholt, Finn; Hammer, Anna Viola; Andreasen, Anne Helms; Nissen, Aase; Kjellberg, Jakob
Abstract:
Objectives. Many hospital admissions are due to inappropriate medical treatment, and discharge of fragile elderly patients involves a high risk of readmission. The

present study aimed to assess whether a follow-up programme undertaken by GPs and district nurses could improve the quality of the medical treatment and reduce the

risk of readmission of elderly newly discharged patients. Design and setting . The patients were randomized to either an intervention group receiving a structured home

visit by the GP and the district nurse one week after discharge followed by two contacts after three and eight weeks, or to a control group receiving the usual care.

Patients . A total of 331 patients aged 78+ years discharged from Glostrup Hospital, Denmark, were included. Main outcome measures . Readmission rate within 26 weeks

after discharge among all randomized patients. Control of medication, evaluated 12 weeks after discharge on 293 (89%) of the patients by an interview at home and by a

questionnaire to the GP. Results . Control-group patients were more likely to be readmitted than intervention-group patients (52% v 40%; p = 0.03). In the intervention

group, the proportions of patients who used prescribed medication of which the GP was unaware (48% vs. 34%; p = 0.02) and who did not take the medication prescribed by

the GP (39% vs. 28%; p = 0.05) were smaller than in the control group. Conclusion . The intervention shows a possible framework securing the follow-up on elderly

patients after discharge by reducing the readmission risk and improving medication control.
Submitted by: Ashley Nelson

Article 2. “Fewer emergency readmissions and better quality of life for older adults at risk of hospital readmission: a randomized controlled trial to determine the

effectiveness of a 24-week exercise and telephone follow-up program.”
Authors:
Courtney M; Edwards H; Chang A; Parker A; Finlayson K; Hamilton K
Source:
Journal of the American Geriatrics Society (J AM GERIATR SOC), 2009; 57 (3): 395-402. (32 ref)
Abstract:
OBJECTIVES: To evaluate the effect of an exercise-based model of hospital and in-home follow-up care for older people at risk of hospital readmission on emergency

health service utilization and quality of life. DESIGN: Randomized controlled trial. SETTING: Tertiary metropolitan hospital in Australia. PARTICIPANTS: One hundred

twenty-eight patients (64 intervention, 64 control) with an acute medical admission, aged 65 and older and with at least one risk factor for readmission (multiple

comorbidities, impaired functionality, aged >or=75, recent multiple admissions, poor social support, history of depression). INTERVENTION: Comprehensive nursing and

physiotherapy assessment and individualized program of exercise strategies and nurse-conducted home visit and telephone follow-up commencing in the hospital and

continuing for 24 weeks after discharge. MEASUREMENTS: Emergency health service utilization (emergency hospital readmissions and visits to emergency department,

general practitioner (GP), or allied health professional) and health-related quality of life (Medical Outcomes Study 12-item Short Form Survey (SF-12v2) collected at

baseline and 4, 12, and 24 weeks after discharge. RESULTS: The intervention group required significantly fewer emergency hospital readmissions (22% of intervention

group, 47% of control group, P=.007) and emergency GP visits (25% of intervention group, 67% of control group, P<.001). The intervention group also reported

significantly greater improvements in quality of life than the control group as measured using SF-12v2 Physical Component Summary scores (F (3, 279)=30.43, P<.001) and

Mental Component Summary scores (F (3, 279)=7.20, P<.001). CONCLUSION: Early introduction of an individualized exercise program and long-term telephone follow-up may

reduce emergency health service utilization and improve quality of life of older adults at risk of hospital readmission.

Please noted the two article above is my assignment that needs intervention 1/2 a page each.


 

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