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Results for ‘ Evaluation of the pilot projects Geriatric Day Hospitals 2007’ University Hospital Gent University Hospital Liège Project financed by the.

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Presentation on theme: "Results for ‘ Evaluation of the pilot projects Geriatric Day Hospitals 2007’ University Hospital Gent University Hospital Liège Project financed by the."— Presentation transcript:

1 Results for ‘ Evaluation of the pilot projects Geriatric Day Hospitals 2007’ University Hospital Gent University Hospital Liège Project financed by the FOD

2 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

3 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

4 Contence Registration Objectives – methodology Results Discussion Follow up Objectives – methodology Results Discussion

5 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

6 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

7 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

8 Registration: characteristics of GDH Length of services in month by the moment of registration of data FrequencyPercent < 1 jaar3266.7 1 - 5 jaren714.6 > 5 jaren918.8 Total48100 Missing59.4 Total53100

9 Registration: characteristics of GDH Number of new patients admitted/day in GDH during the study period (3 month) NMeanSDMin.Max. < 1 y320.740.470.171.72 1 - 5 y71.691.500.184.70 > 5 y91.20 0.153.20 Total480.960.900.154.70 Statistical difference between the one year group and the 1-5 year group

10 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

11 Registration: Patient Profile Median age 80y (26-104y) 25% less than 75y Man/vrouw: 36/64

12 Registration: Patient Profile

13 Place of staying of the patient by admission FrequencyPercent2006 OnbekendInconnu120.36 HuisMaison250576.0276.7 FamilieFamille892.702.7 ServiceflatRésidence service762.312.8 ROB/RVTMRPA / MRS54716.6015.70 PVTMSP 70.21 KortverblijfCentres de courts séjours70.21 AndereAutre521.572.1 Total3295100

14 Registration: Patient Profile FrequencyPercent Lager onderwijsPrimaires60331.1 Lager middelbaar onderwijsSecondaires inférieures71536.9 Hoger middelbaar onderwijsSecondaires supérieures36819.0 Hoger onderwijs korte typeHautes études type court1065.5 Hoger onderwijs lange typeHautes études type long442.3 UniversiteitUniversité1005.2 Total1936100

15 Registration: Patient Profile Caregivers FrequencyPercent2006 Zonder enige hulpSans aucune aide48923.221.8 Met hulp van familieAide de la famille59128.025.3 Met professionele hulpAide professionnelle28113.319.3 Familie + professioneleFamille + professionnelle74935.531.7 Total2110100

16 Registration: Patient Profile FrequencyPercent A209388.9% B24010.2% C210.9% Total2354100 Missing110231.9% Total3456

17 Registration: Patient Profile Referring persons FrequencyPercent2006 Behandelend artsMédecin286092.385.0 FamilieFamille1284.13.2 ROB/RVTMRPA / MRS371.21.1 Eigen intiatiefPropre initiative742.42.2 Total3099100 FrequencyPercent2006 HuisartsMédecin traitant109140.240.1 ZiekenhuisartsMédecin de l'hôpital162059.859.9 Total2711100

18 Registration: Patient Profile Opname via recent verblijf Admission via un séjour récent FrequencyPercent2006 Ja/oui85231.025.3 Nee/non189369.074.7 AfdelingUnitéFrequencyPercent2006 GeriatrieGériatrie61475.163.4 InterneMédecine11213.719.8 ChirurgischeChirurgie8210.016.2 Sp 101.20.6 Total818100 96.8%

19 Registration: Activities Urgent problem for admission FrequencyPercent2006 OnbekendInconnu301.11.4 JaOui2378.66.4 NeeNon247990.392.2

20 Registration: Activities 20062007 Diagnostisch85,0%84.3% Geriatrisch syndroom56,7%56.4% Geheugen39,6%37.4% Depressie9,2%8.6% Val-mobiliteit23,3%23.3% Andere22,2%27.1% Specifiek medisch probleem48,9%47%

21 Registration: Activities 20062007 Revalidatie4,5%6.05% Therapeutisch18,2%16.64% bloedtransfusie 18,2% Medicatie infuus 52,0% Wondevaluatie 9,9%

22 Registration: Activities

23 TotN % 2006 Functionele evaluatieEvaluation fonctionnelle34561522 44.0447.60 Evaluatie geheugenproblematiekEvaluation de la mémoire34561453 42.0443.55 Evaluatie gemoedsstemmingEvaluation de l'humeur3456796 23.0323.38 Evaluatie mobilliteitsproblemen/valrisico Evaluation de la mobilité et des risques de chute 3456657 19.0118.30 Evaluatie rijvaardigheidEvaluation de l'aptitude à conduire345618 0.520.48 Evaluatie nutritieEvaluation de la nutrition3456423 12.2411.27 Evaluatie pijnEvaluation de la douleur3456461 13.346.95 Evaluatie frailtyEvaluation de la fragilité3456121 3.503.65 Evaluatie visusEvaluation de la vision3456157 4.545.64 Evaluatie gehoorEvaluation de l'audition345640 1.161.07

24 Registration: Activities

25 Registration: Personal Means Diagnostic activities TotN% 2006 GeriaterGériatre3456222364.362.1 Arts specialistMédecin spécialiste3456181352.558.7 VerpleegkundigeInfirmière3456241669.971.5 KinesitherapeutKinésithérapeute345650914.712.3 ErgotherapeutErgothérapeute345680923.418.7 PsycholoogPsychologue345671120.620 LogopedistLogopède3456611.81.4 OntslagmanagerRéférant hospitalier34561293.75 Sociaal vpkInfirmière sociale345636210.512.2 DiëtisteDiététicien3456631.81.6 AndereAutre34562557.4

26 Registration: discharge N % 2006 % 2007 HuisMaison221163.9877.5 ROB / RVTMRPA / MRS44512.8815.6 PVTMSP50.140.17 ServiceflatRésidence service511.481.78 KortverblijfCourt séjour110.320.38 FamilieFamille190.550.67 GehospitaliseerdHospitalisation1053.043.7 OverlijdenDécès50.140.17 Total285282.5100 Missing60417.5 Total3456100

27 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

28 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%)

29 Follow up study: Results FrequencyPercent No FU84466.5 FU42533.5 Total1269100 Percent Same problem35789.5 Different problem4210.5 Total399100 Missing260.06 No significant difference in age/sex between patients in FU and without FU

30 Follow up study: Results No FUFUTotal DeadCount17010180 % in row94.445.56100 % in column27.293.0718.97 AliveCount453316769 % in row58.9141.09100 % in column72.7196.9381.03 TotalCount623326949 % in row65.6534.35100 % in column100 Χ² test=81.7; p<0.0001; missing value = 320 Mortality rate in community for people aged 75+: 9.1% Mortality Rate one year after visit GDH

31 Follow up study: Results Significant more FU in pts with GS than in those without GS GS NO FUFUTotal NoCount631125756 % in row83.4716.53100 % in column74.7629.4159.57 YesCount213300513 % in row41.5258.48100 % in column25.2470.5940.43 TotalCount8444251269 % in row66.5133.49100 % in column100  ² test = 241.4 ; p < 0.0001

32 Follow up study: Results No influence of GDH on the current place of stay Idem as in 2006No FUFUTotal NonCount7539114 % in row65.7934.21100 % in column11.729.3810.80 YesCount565377942 % in row59.9840.02100 % in column88.2890.6389.20 TotalCount6404161056 % in row60.6139.39100 % in column100  ² test = 1.4 ; N.S ; missing value = 213

33 Follow up study: Results Freq% HuisLe patient vit dans sa maison54.5 FamilieLe patient vit avec en famille43.6 Serviceflat Le patient vit dans une résidence service 76.3 Rustoorden voor bejaarden (ROB) / Rust- en verzorgingstehuizen (RVT) Maison de repos (MR) / maison de repos et de soins (MRS) 9182.0 Psychiatrische verzorgingstehuizen (PVT) Maisons de soins psychiatriques (MSP) 21.8 KortverblijfCentre de jour21.8 TotaalTotal111100 If place of stay has changed, it mostly changed for an admission in a nursing home (82%) Missing value = 3

34 Follow up study: Results 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 2006No FUFUTotal NoCount293665 % in row44.6255.38100 % in column4.628.766.26 YesCount599375974 % in row61.5038.50100 % in column95.3891.2493.74 TotalCount6284111039 % in row60.4439.56100 % in column100

35 Follow up study: Results In case of changes in family situation, patients most often lose their partner or changed to live together with other people Freq% AlleenstaandLe patient vit seul2746.6% Samenwonend met nieuwe partner Le patient vit en couple avec un nouveau partenaire 23.4% Samenwonend met kinderenLe patient vit avec ses enfants610.3% Samenwonend met anderen (geen kinderen/echtgenoot) Le patient vit avec des personnes étrangères à la famille 2339.7% TotaalTotal58100%

36 Follow up study: Results Professional help and caregivers changed in 27% of the patients. There was no correlation between being in FU and changes in help No FUFUTotal ChangedCount145111256 % in row56.6443.36100 % in column25.2229.7627.00 IdemCount430262692 % in row62.1437.86100 % in column74.7870.2473.00 TotalCount575373948 % in row60.6539.35100 % in column100 (  ² test = 2.4 ; p = 0.124; missing value: 321)

37 Follow up study: Results Changes in care were most frequently an enlargement of the professional care (71.4%) and caregivers (47.8%) Professionele thuishulp Aide professionnelle à domicileFreq% Idem als 2006Idem qu'en 20063315.0% AfgebouwdTerminée3013.6% UitgebreidElargie157 71.4% TotaalTotal220100% MantelzorgAide non professionnelleFreq% Idem als 2006Idem qu'en 20067038.5% AfgebouwdTerminée2513.7% UitgebreidElargie87 47.8% TotaalTotal182100%

38 Follow up study: Results 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% JaOui13939.49% NeenNon19755.97% Ik weet het nietInconnu164.55% Total352100 Missing91772.26% Total1269100

39 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 ) Follow up study: Results

40 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 Follow up study: Results

41 Freq% Op zelfde niveau als bij stop van de therapie Au même niveau que lors de l'arrêt de la kinésithérapie 2329.5 Beter dan bij stop van de therapie Mieux que lors de l'arrêt de la kinésithérapie 2126.9 Slechter dan bij stop van de therapie Moins bon que lors de l'arrêt de la kinésithérapie 2329.5 Ik weet het nietJe ne sais pas1114.1 TotaalTotal78100

42 Follow up study: Results GDH and his value in the treatment of the older person Geen FUFUTotal Positive value Count346205551 % in row62.7937.21100 % in column73.1584.0276.85 No value at all Count31637 % in row83.7816.22100 % in column6.552.465.16 No idea Count9633129 % in row74.4225.58100 % in column20.3013.5217.99 Total Count473244717 (  ² test = 11.81 ; p = 0.0027; significant correlation between follow up and positive value of GDH)

43 Profile of the GDH Admission Heterogeneity between different GDH Personal Means Activities and advices Outcome parameters Discussion

44 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%)

45 Registration: Discussion (2) 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?

46 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

47 Registration: discussion (3) 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

48 Registration: discussion (4) 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 …

49 Registration: discussion (5) 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 …

50 Registration: Discussion (5) 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

51 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

52 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


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