results for ‘ evaluation of the pilot projects geriatric day hospitals 2007’ university hospital...

Results for ‘ Evaluation of the pilot projects Geriatric Day Hospitals 2007’

University Hospital GentUniversity Hospital Liège

Project financed by the FOD

Participants

Coordination Nele Van Den Noortgate – UZ Gent

Geriatricians Jean Petermans – CHU Liège Anja Velghe – UZ Gent

Visitors of GDH Anne Rigot and Chantal Laroche – CHU Liège Vicky Van Der Kelen – UZ Gent

Statistician Daniel Gillain

Evaluation Project Geriatric Day Hospitals 2007

1/ Day Hospitals started in 2007 and those not participating at the registration in 2006

Registration comparable with 2006 (some modifications)

2/ Day Hospitals participating in 2006 for the registration of patients and hospital

Follow up study

Contence

Registration Objectives – methodology Results Discussion

Follow up Objectives – methodology Results Discussion

Registration: objectives

Describe and evaluate the characteristics and activities of the GDH

Describe the patients profile visiting the GDH

Describe the delivered activities, care and the personal means necessary

Registration: Methodology

Methodology cf 2006 Visitation of existing GDH

By evaluation project members Electronic questionnaire

Structure/architectonic / technical means/ indications/ transportation facilities/ discharge planning

Registration of visiting patients By pilot project GDH Electronic questionnaire

Socio-demographic data/ Origin/ Referring person/ Reason admission/ Medical problem/ co-morbidity/ activities/ discharge planning

Registration: Results

Pooling of the results 2006-2007

64 GDH started and asked for participation 11 GDH non responders Response Rate: 83% cf 89% in 2006

Registration of 3 509 patients 53 patients not admitted Analyse of 3 456 patients

Registration: characteristics of GDH

• Length of services in month by the moment of registration of data

Frequency Percent

< 1 jaar 32 66.7

1 - 5 jaren 7 14.6

> 5 jaren 9 18.8

Total 48 100

Missing 5 9.4

Total 53 100

Registration: characteristics of GDH

Number of new patients admitted/day in GDH during the study period (3 month)

N Mean SD Min. Max.

< 1 y 32 0.74 0.47 0.17 1.72

1 - 5 y 7 1.69 1.50 0.18 4.70

> 5 y 9 1.20 1.20 0.15 3.20

Total 48 0.96 0.90 0.15 4.70

Statistical difference between the one year group and the 1-5 year group

Registration: Transport facilities for the patient Transport is present in 38.6% of patients (cf

41.7% in 2007)

65.2% of the patients has to pay for the transport

65.5% of the GDH without transport facilities declare that the absence of the patient has influences on the admission rates

Registration: Patient Profile

Median age 80y (26-104y)

25% less than 75y

Man/vrouw: 36/64

age12010080604020

Fre

qu

en

cy

800

600

400

200

0

Mean =79,41Std. Dev. =7,452

N =3.346


Place of staying of the patient by admission

Frequency Percent 2006

Onbekend Inconnu 12 0.36

Huis Maison 2505 76.02 76.7

Familie Famille 89 2.70 2.7

Serviceflat Résidence service 76 2.31 2.8

ROB/RVT MRPA / MRS 547 16.60 15.70

PVT MSP 7 0.21

Kortverblijf Centres de courts séjours 7 0.21

Andere Autre 52 1.57 2.1

Total 3295 100


Frequency Percent

Lager onderwijs Primaires 603 31.1

Lager middelbaar onderwijs Secondaires inférieures 715 36.9

Hoger middelbaar onderwijs Secondaires supérieures 368 19.0

Hoger onderwijs korte type Hautes études type court 106 5.5

Hoger onderwijs lange type Hautes études type long 44 2.3

Universiteit Université 100 5.2

Total 1936 100


Caregivers


Zonder enige hulp Sans aucune aide 489 23.2 21.8

Met hulp van familie Aide de la famille 591 28.0 25.3

Met professionele hulp Aide professionnelle 281 13.3 19.3

Familie + professionele Famille + professionnelle 749 35.5 31.7

Total 2110 100


Frequency Percent

A 2093 88.9%

B 240 10.2%

C 21 0.9%

Total 2354 100

Missing 1102 31.9%

Total 3456


Referring persons


Behandelend arts Médecin 2860 92.3 85.0


ROB/RVT MRPA / MRS 37 1.2 1.1

Eigen intiatief Propre initiative 74 2.4 2.2

Total 3099 100


Huisarts Médecin traitant 1091 40.2 40.1

Ziekenhuisarts Médecin de l'hôpital 1620 59.8 59.9

Total 2711 100


Opname via recent verblijf

Admission via un séjour récent


Ja/oui 852 31.0 25.3

Nee/non 1893 69.0 74.7

Afdeling Unité Frequency Percent 2006

Geriatrie Gériatrie 614 75.1 63.4

Interne Médecine 112 13.7 19.8

Chirurgische Chirurgie 82 10.0 16.2

Sp Sp 10 1.2 0.6

Total 818 100

96.8%

Registration: Activities

Urgent problem for admission


Onbekend Inconnu 30 1.1 1.4

Ja Oui 237 8.6 6.4

Nee Non 2479 90.3 92.2


2006 2007

Diagnostisch 85,0% 84.3%

Geriatrisch syndroom 56,7% 56.4%

Geheugen 39,6% 37.4%

Depressie 9,2% 8.6%

Val-mobiliteit 23,3% 23.3%

Andere 22,2% 27.1%

Specifiek medisch probleem 48,9% 47%


2006 2007

Revalidatie 4,5% 6.05%

Therapeutisch 18,2% 16.64%

bloedtransfusie 18,2%

Medicatie infuus 52,0%

Wondevaluatie 9,9%

Tot N % % 2006

Functionele evaluatie Evaluation fonctionnelle 3456 1522 44.04 47.60

Evaluatie geheugenproblematiek Evaluation de la mémoire 3456 1453 42.04 43.55

Evaluatie gemoedsstemming Evaluation de l'humeur 3456 796 23.03 23.38

Evaluatie mobilliteitsproblemen/valrisico

Evaluation de la mobilité et des risques de chute

3456 657 19.01 18.30

Evaluatie rijvaardigheid Evaluation de l'aptitude à conduire 3456 18 0.52 0.48

Evaluatie nutritie Evaluation de la nutrition 3456 423 12.24 11.27

Evaluatie pijn Evaluation de la douleur 3456 461 13.34 6.95

Evaluatie frailty Evaluation de la fragilité 3456 121 3.50 3.65

Evaluatie visus Evaluation de la vision 3456 157 4.54 5.64

Evaluatie gehoor Evaluation de l'audition 3456 40 1.16 1.07

Registration: Personal Means

Diagnostic activities Tot N % % 2006

Geriater Gériatre 3456 2223 64.3 62.1

Arts specialist Médecin spécialiste 3456 1813 52.5 58.7

Verpleegkundige Infirmière 3456 2416 69.9 71.5

Kinesitherapeut Kinésithérapeute 3456 509 14.7 12.3

Ergotherapeut Ergothérapeute 3456 809 23.4 18.7

Psycholoog Psychologue 3456 711 20.6 20

Logopedist Logopède 3456 61 1.8 1.4

Ontslagmanager Référant hospitalier 3456 129 3.7 5

Sociaal vpk Infirmière sociale 3456 362 10.5 12.2

Diëtiste Diététicien 3456 63 1.8 1.6

Andere Autre 3456 255 7.4

Registration: discharge

N%

2006%

2007

Huis Maison 2211 63.98 77.5

ROB / RVT MRPA / MRS 445 12.88 15.6

PVT MSP 5 0.14 0.17

Serviceflat Résidence service 51 1.48 1.78

Kortverblijf Court séjour 11 0.32 0.38


Gehospitaliseerd Hospitalisation 105 3.04 3.7

Overlijden Décès 5 0.14 0.17

Total 2852 82.5 100

Missing 604 17.5

Total 3456 100

Follow up Study: Methodology

Follow up of the patients one year after registration in the previous study Electronic questionnaire

Follow up; Profile of patients; Advices by discharge; follow up of advices during the last year

Registered by nurses of GDH treating the older person

Follow up study: Results

Response rate: GDH

Results for 32/45 GDH (71%) 11 Non Responders 2 with < 5% of pts

Patients Including Non Responders

Results for 1269 patients/2706 patients included in 2006 (46.9%)

Excluding Non Responders Results for 1265 patients/2063 patients included in

2006 (61%)


Frequency Percent

No FU 844 66.5

FU 425 33.5

Total 1269 100

Percent

Same problem 357 89.5

Different problem 42 10.5

Total 399 100

Missing 26 0.06

No significant difference in age/sex between patients in FU and without FU


No FU FU Total

Dead Count 170 10 180

% in row 94.44 5.56 100

% in column 27.29 3.07 18.97

Alive Count 453 316 769

% in row 58.91 41.09 100

% in column 72.71 96.93 81.03

Total Count 623 326 949

% in row 65.65 34.35 100

% in column 100 100 100

Χ² test=81.7; p<0.0001; missing value = 320Mortality rate in community for people aged 75+: 9.1%

• Mortality Rate one year after visit GDH


Significant more FU in pts with GS than in those without GS

GS NO FU FU Total

No Count 631 125 756

% in row 83.47 16.53 100

% in column 74.76 29.41 59.57

Yes Count 213 300 513

% in row 41.52 58.48 100

% in column 25.24 70.59 40.43


% in row 66.51 33.49 100

% in column 100 100 100

² test = 241.4 ; p < 0.0001


No influence of GDH on the current place of stay

Idem as in 2006 No FU FU Total

Non Count 75 39 114

% in row 65.79 34.21 100

% in column 11.72 9.38 10.80

Yes Count 565 377 942

% in row 59.98 40.02 100

% in column 88.28 90.63 89.20


% in row 60.61 39.39 100

% in column 100 100 100

² test = 1.4 ; N.S ; missing value = 213


Freq %

Huis Le patient vit dans sa maison 5 4.5

Familie Le patient vit avec en famille 4 3.6

ServiceflatLe patient vit dans une résidence

service7 6.3

Rustoorden voor bejaarden (ROB) / Rust- en verzorgingstehuizen (RVT)

Maison de repos (MR) / maison de repos et de soins (MRS)

91 82.0

Psychiatrische verzorgingstehuizen (PVT)Maisons de soins psychiatriques

(MSP)2 1.8

Kortverblijf Centre de jour 2 1.8

Totaal Total 111 100

If place of stay has changed, it mostly changed for an admission in a nursing home (82%)

Missing value = 3


There were few changes in family situation (only in 6.3%). However there seems to be an association between changes in family situation and being in follow up in GDH (² test = 7.3 ; p < 0.007; missing value=230)

Idem compared to 2006 No FU FU Total

No Count 29 36 65

% in row 44.62 55.38 100

% in column 4.62 8.76 6.26

Yes Count 599 375 974

% in row 61.50 38.50 100

% in column 95.38 91.24 93.74


% in row 60.44 39.56 100

% in column 100 100 100


In case of changes in family situation, patients most often lose their partner or changed to live together with other people

Freq %

Alleenstaand Le patient vit seul 27 46.6%

Samenwonend met nieuwe partnerLe patient vit en couple avec un

nouveau partenaire2 3.4%

Samenwonend met kinderen Le patient vit avec ses enfants 6 10.3%

Samenwonend met anderen (geen kinderen/echtgenoot)

Le patient vit avec des personnes étrangères à la famille

23 39.7%

Totaal Total 58 100%


Professional help and caregivers changed in 27% of the patients. There was no correlation between being in FU and changes in help

No FU FU Total

Changed Count 145 111 256

% in row 56.64 43.36 100

% in column 25.22 29.76 27.00

Idem Count 430 262 692

% in row 62.14 37.86 100

% in column 74.78 70.24 73.00


% in row 60.65 39.35 100

% in column 100 100 100

(² test = 2.4 ; p = 0.124; missing value: 321)


Changes in care were most frequently an enlargement of the professional care (71.4%) and caregivers (47.8%)

Professionele thuishulp

Aide professionnelle à domicile Freq %

Idem als 2006 Idem qu'en 2006 33 15.0%

Afgebouwd Terminée 30 13.6%

Uitgebreid Elargie 157 71.4%


Mantelzorg Aide non professionnelle Freq %

Idem als 2006 Idem qu'en 2006 70 38.5%

Afgebouwd Terminée 25 13.7%

Uitgebreid Elargie 87 47.8%



Hospitalisation In 66.7% of the population visiting the GDH In 40% associated with the reason of visit in GDH No correlation was found with the rate of hospitalization, the

mean length of stay and the presence of FU on the GDH.

Correlation with visit GDH Freq %

Ja Oui 139 39.49%

Neen Non 197 55.97%

Ik weet het niet Inconnu 16 4.55%

Total 352 100

Missing 917 72.26%

Total 1269 100

Advice for medication intake 69.3% of the population

Followed in 95.6% If not (4.4% of cases):

48.3% on own initiative; 51.7% advice of GP 96.7% started at home 49% has FU in GDH vs only 18.3% of those

without advice (² test = 86.7 ; p < 0.0001 )


Advice for rehabilitation therapy 20.7 % of patients Followed in 85.6%

15.1% in GDH 40.4% at home 44.6% started at GDH and continued at home

Not followed in 14.4% 78.3% own initiative 21.7% initiative of GP



Freq %

Op zelfde niveau als bij stop van de therapie

Au même niveau que lors de l'arrêt de la kinésithérapie

23 29.5

Beter dan bij stop van de therapieMieux que lors de l'arrêt de la

kinésithérapie21 26.9

Slechter dan bij stop van de therapie

Moins bon que lors de l'arrêt de la kinésithérapie

23 29.5

Ik weet het niet Je ne sais pas 11 14.1

Totaal Total 78 100


GDH and his value in the treatment of the older person

Geen FU FU Total

Positive value

Count 346 205 551

% in row 62.79 37.21 100

% in column 73.15 84.02 76.85

No value at all

Count 31 6 37

% in row 83.78 16.22 100

% in column 6.55 2.46 5.16

No idea

Count 96 33 129

% in row 74.42 25.58 100

% in column 20.30 13.52 17.99


(² test = 11.81 ; p = 0.0027; significant correlation between follow up and positive value of GDH)

Profile of the GDH

Admission

Heterogeneity between different GDH

Personal Means

Activities and advices

Outcome parameters

Discussion

Registration: Discussion (1)

Profile of the patient on the GDH is Compared to the acute G ward

Younger ~ 3 yrs More often admitted from home More often discharged to home with less modification

in care giving (only in 5.2% of pts) Compared to General Population

Comparable level of education More professional caregivers – seems to be more

dependent than general population Higher mortality rate (~ 19% versus 9.1%) Higher admission rate in the acute hospital (66.7%)


Admission Often referred by physician

Only in 40% GP Geriatric Ward seems to become more and

more the provider of GDH activity Active policy for information of GP, specialist is

already organized Results from qualitative research in field of general

physicians is expected till the end of 2008 Quid for the internal and surgical specialists?

Registration: discussion (3)

Heterogeneity between different GDH Hours of Activity

Hypothesis: Efficient use of means Consequence of a shortness of geriatricians Often there is a lack in the current means of logistic

support (secretary, transport in the hospital) Available surface/rooms

Hypothesis: 22% are integrated in other day hospitals 60% are sharing rooms with others Calculations are not correct


Heterogeneity between different GDH Patient profile (probably) linked with the

performed activities (diagnostic and therapeutic)

Integration in other day hospital setting Use of GDH as medical DH for the (older) person

(fe gastro and colonoscopy …) Shortness of geriatricians to see the patient at

GDH, so referred to consulting physicians (in 1 out of 3) or seen ambulatory and only for the multidisciplinary evaluation send to the GDH with ambulatory consultation after the visit to the GDH


Personal Means The mentioned personal means are not always the

necessary means Strongly influenced by the financial means provided by

the FOD/SPF Less nurses are used (~ 1.5 FTE) More physiotherapist, occupational therapist and

psychologist are used than provided (~ 1.5 FTE) Hospitals invest in the presence of social worker, dietician,

speech therapist and administrative worker Shortness of Geriatricians

Too less financial incentives Lot of work to perform, organisation, family talk …


Performed activities at GDH are mainly diagnostic (85%)

GDH lead to the possibility of financing the often existing and necessary multidisciplinary team for an efficient memory clinic, fall clinic, assessment clinic …

Less often to no experience with rehabilitation in day hospital setting

Afraid of reaction from first level caregivers as GP, physiotherapist by starting up rehab activities

Treatments are often performed at specific day hospitals for oncology, haematology, surgical …


Advices for therapy should be given, also advices for home therapy and non pharmacological therapy Medication in 70%,

96.7% started at home FU in 95.6%, stopped in ½ on advice of GP

Rehabilitation in 20%, 40.4% started at home FU in 85%, stopped in ¾ on own initiative Positive effect in ½ (direct and afterwards)

Higher degree of satisfaction if the patient stay in FU at the GDH

Registration: Discussion

Outcome parameters: Very difficult to define

FU in GDH seems to has only a small effect on family situation but no effect on stay at home, hospitalisation, need for professional caregivers

However family are in 75% of the cases convinced of the added value. This seems to be positively correlated with FU

Longitudinal follow up of a number of elderly compared to a control population should bring an answer to these questions

Registration: recommendations

Working group consisted of Delegates from BvGG-SBGG (fe working group on

GDH) College of Geriatric Medicine Research Group

Define ‘Good Clinical Practice’ Type of patients who will benefit from GDH Activities to perform in GDH & who to differentiate

Treatments, rehabilitation Assessment tools to use in GDH Policy to recruit patients benefiting from GDH

results for ‘ evaluation of the pilot projects geriatric day hospitals 2007’ university hospital...

Documents

registration of patients

patient profileregistration

patients cf

patient profile96

patient profileplace

data registration

patients profile

moment of registration