File Name: probability random variables and random processes shayk .zip
February , Volume Number 2 , page 91 - [Free]. Join NursingCenter to get uninterrupted access to this Article. What are the main risk factors for acute care hospital readmission within one month of discharge in people aged 60 years or older from western countries? Background : In most western countries the population is aging. Both the number of older persons is increasing as well as the complexity of their health needs. In addition, advances in medical science have enabled more active treatment for people with multiple co-morbidities and patients in health care, on average, need more intensive management.
Limiting rising costs and increasing 'efficiency' is a leading policy goal in all health care systems and health units, including hospitals. Different initiatives have been undertaken to limit costs, including reducing the average length of hospital stay and decreasing the number of beds in hospitals.
Hospital readmission, defined as a return to hospital shortly after discharge from a recent hospital stay, 3 , 4 has been reported over a considerable period of time, 5 , 6 as a common negative health outcome from hospitalization of older persons. Readmission rates are used as indicators of quality of hospital care. Hospital readmission is emotionally upsetting for many older persons and an unnecessary burden of illness, leading to anxiety and distress.
The literature relating to hospital readmissions identifies a subset of patients who may be categorized as 'risk-patients'. Cheek refers to different categories of being old; 1 'young-old', 'old-old' or 'oldest-old', in the range of people known as older. According to the WHO, in most developed countries the chronological age of 65 years is accepted as a definition of becoming an 'older person' - equivalent to retirement age.
In this systematic review the term 'risk' refers to the probability of a deleterious or adverse outcome during everyday life, or an exposure to a risk factor. This suggests that a varying range of hospital readmissions in different settings 13 and populations 21 may have been avoidable and could have been prevented. Other risk factors that have been highlighted are discharge and health care system related factors such as length of stay and the number of previous hospitalizations. The evidence base identified by the initial literature review comprised a range of study designs, data sources, patient populations, settings and age groups.
It also showed a lack of consistency of study objectives, definitions and outcome measures. The evidence base identified by the initial literature review revealed no systematic review dealing with the same topic. The proposed systematic review is motivated firstly by the absence of a systematic review on the topic within the last three years. Secondly, by the importance of hospital administrators and policy having access to the best available evidence on risk factors for hospital readmissions in older persons, in order to design effective strategies to reduce readmissions.
This systematic review will consider studies that include participants of both sexes, aged 60 years or older from western countries, who have been admitted to hospital as an in-patient, discharged to their homes or to residential care facilities and readmitted to an acute care hospital within one month. One month is defined as a period ranking between immediate after discharge until days after discharge.. The phenomenon of interest in this review is the risk factors for hospital readmission within one month of discharge in western countries.
The primary outcome of interest is readmission of older persons to an acute care hospital within one month of discharge from a former hospital admission. Studies that do not report on the outcome of interest as a primary or secondary outcome and at a time interval within one month will be excluded. Subgroup analyses will be conducted for studies investigating hospital readmission within shorter time intervals than one month.
This review will consider analytical and descriptive epidemiological study designs including prospective and retrospective cohort studies, case control studies, case series, individual case reports and cross sectional studies that evaluate risk factors for hospital readmission for inclusion.
Cohort studies nested in experimental studies and studies that identify, describe and evaluate the explanatory or predictive value of risk factors for hospital readmission within one month will be included. Studies will only be included if they present results based on measures of risk such as frequencies, rates, medians, percentiles or relative measures such as relative risk RR , odds ratios OR or area under ROC curve AUC.
Results from experimental studies randomized and non-randomized controlled trials, quasi-experimental studies or validation of screening tools and diagnostic studies are outside the scope of this review and will be excluded. A three-step search strategy will be utilized in this review. An initial limited search of PubMed and CINAHL will be undertaken, followed by analysis of the text words contained in the title and abstract and of the index terms used to describe the article.
A second search using all identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles will be searched for additional studies. Studies published in the English, German, French, Swedish, Norwegian and Danish languages will be considered for inclusion in this systematic review. Databases will be searched from January 1, to December 31, The search terms and the PICOS Population, Intervention, Comparator, Outcome, Study types 22 have been discussed and specified in collaboration between the primary and secondary reviewers and in discussion with a research librarian, aiming to identify the maximum of articles possible.
Conducting an online search of unpublished studies in MedNar, Google Scholar and relevant homepages. To manage the references Ref Works will be used. Records will be retrieved and added to the library by the primary reviewer. All decisions about rejecting or obtaining documents will be recorded by the same person. The primary reviewer will be responsible for the library of references.
To be able to replicate the search process all searches, all decisions and steps will be documented based on PRISMA statement guidelines. Any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer.
Data will be extracted from papers included in the review using the standardized data extraction tool from JBI-MAStARI Appendix II in combination with a self-developed data extraction tool which has been recently validated in a review by the authors of the present review and was adapted to the needs of the present review.
The data extraction process will be done independently by two reviewers and any disagreements that arise between the reviewers will be resolved through discussion, or with a third reviewer. In the case of missing information or unclear data, the author of primary studies will be contacted. All results will be subject to double data entry. A Random effects model will be used and heterogeneity will be assessed statistically using the standard chi-square.
Where statistical pooling is not possible, the findings will be presented in narrative form including tables and figures to aid in data presentation where appropriate. Medical Library Aalborg University Hospital for the advice on the systematic search strategy. External funding is received from The A. Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.
BMJ ; e [Context Link]. Cheek J. A potent mix: older people, transitions, practice development and research. Res Nurs ; 15 2 : Hospital readmission in general medicine patients: a prediction model. J Gen Intern Med ; 25 3 : Readmission risk factors after hospital discharge among the elderly. Popul Health Manag ; 15 6 : Predictors of hospital readmission. A Meta-Analysis. Eval Health Prof ; 14 3 : Tierney AJ, Worth A. Review: Readmission of Elderly Patients to Hospital.
Age Ageing; 24 2 : ACME plus project. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing ; 33 2 : Dobrzanska L, Newell R. Readmissions: A primary care examination of reasons for readmission of older people and possible readmission risk factors.
J Clin Nurs ; 15 5 : Incidence and main factors associated with early unplanned hospital readmission among French medical inpatients aged 75 and over admitted through emergency units.
Age Ageing ; 37 4 : Risk factors for hospital readmissions in elderly patients: a systematic review. QJM ; Carroll A, Dowling M.
Discharge planning: communication, education and patient participation. BJN ; 6 4 : A qualitative meta-synthesis of patients' experiences of intra- and inter-hospital transitions. J Adv Nurs ; 69 8 : Scott I. Preventing the rebound: improving care transition in hospital discharge processes.
Aus Health Rev ; 34 4 : Validation of the potentially avoidable hospital readmission rate as a routine indicator of the quality of hospital care. Med Care ; 44 11 : The Danish Health and Medicines Authority. Readmission of elderly in Denmark in Proc Bayl Univ Med Cent ; 21 4 : World Health Organization. Health statistics and health information systems.
Link available 11 23 Frailty syndrome: a transitional state in a dynamic process. Gerontology ; 55 5 : Polypharmacy in elderly patients. Am J Geriatr Pharmac ; 5 4 :
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February , Volume Number 2 , page 91 - [Free]. Join NursingCenter to get uninterrupted access to this Article. What are the main risk factors for acute care hospital readmission within one month of discharge in people aged 60 years or older from western countries? Background : In most western countries the population is aging. Both the number of older persons is increasing as well as the complexity of their health needs.
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