Association of social isolation with health status among community-dwelling Chinese older adults living with homecare services: a cross-sectional survey in Hong Kong

BackgroundDefined as having few social relationships or infrequent social contact with family, friends, and the community, social isolation is a public health crisis. We aimed to evaluate the prevalence of social isolation and explore the association between social isolation and health status among community-dwelling Chinese Older Adults living with homecare services.MethodsThis is a cross-sectional survey with a structured questionnaire conducted among older adults aged ≥60 in the Central Kowloon District of Hong Kong during 2017–2018. Social isolation was assessed by the Lubben Social Network Scale-6 and a score less than 12 was defined as socially isolated. Six aspects of health status including fall risk, cognitive function, depression, activities of daily living (ADL), instrumental activities of daily living (IADL), and functional mobility were measured by standardized instruments. Multi-criteria decision analysis (MCDA) was applied to estimate an index to represent the overall health status of the respondents. Multivariate logistic/linear regression models were applied to examine the associations between social isolation and health status after adjusting the sociodemographic characteristics.ResultsAmong the 1,616 participants included in this analysis, the mean age was 80.9 years, 66.3% were female and 41.4% were identified as socially isolated. Compared with the non-isolated group, the socially isolated group had higher proportions of males, divorced or unmarried, ever smoking and drinking, living alone, and living in public housing without religion. After adjusting for confounders, the odds ratios (OR) comparing the socially isolated vs. non-isolated groups were 2.52 (95%CI: 1.79, 3.56) for high fall risk, 1.51 (1.17, 1.94) for cognitive impairment, and 1.78 (1.31, 2.43) for depression. The socially isolated group increased the odds of abnormal ADL, IADL, and functional mobility by 105–150%, and decreased the overall health score by 5.30 (3.42, 7.18).ConclusionWe demonstrated the association of social isolation with poorer physical function and mental health and overall health status among the community-dwelling Chinese older adults living with homecare services. These findings provided new knowledge about the association of social isolation with both physical and mental function for daily living even for those receiving an integrated homecare service in the community. It implies that an unmet healthcare need existed when comparing the service scope of the current homecare services in the community. It also highlighted the need for targeted prevention and intervention initiatives among community-dwelling old adults to alleviate social isolation for better health and good functioning in the community

Measuring the impact of chronic conditions and associated multimorbidity on health-related quality of life in the general population in Hong Kong SAR, China: A cross-sectional study.

ObjectivesThe aims of this study were to 1) evaluate the impact of eight common chronic conditions and multimorbidity on preference-based health-related quality of life (HRQoL), and 2) estimate the minimally important difference (MID) in the general population of Hong Kong (HK).DesignData were analyzed using secondary data analysis based on a cross-sectional, population-based validation study of HK's general population.ParticipantsA representative sample was recruited across eighteen geographical districts in HK, and 1,014 HK Chinese residents aged 18 years and older participated in the survey. The prevalence of chronic conditions among the respondents was 30.3%.InterventionsThe HRQoL was assessed using the locally validated version of EQ-5D-5L. The five-dimension descriptive system, and the utility scores of EQ-5D-5L were used as the dependent variable in the study. Eight common chronic conditions, multimorbidity, and demographic characteristics were defined as predictors in the analysis. Chi-squared test, analysis of variance (ANOVA), logistic regression, and Tobit regression models were used to analyze the data. A simulation-based approach was used to calculate the MID based on instrument-defined single level transitions.ResultsThe findings indicated that respondents with physical disabilities were more likely to report problems on all five dimensions of the EQ-5D-5L than those with other chronic conditions. In addition, respondents with multiple chronic conditions were more likely to report health problems and lower utility scores of EQ-5D-5L. The mean of MID estimates among the respondents in HK was 0.093 (standard deviation = 0.001), which is higher than in other Asian countries.ConclusionsThe findings suggest that having more chronic conditions is strongly associated with a lower HRQoL. Healthcare reforms to address foreseeable challenges arising as more patients live with chronic conditions and multimorbidity could improve the HRQoL of HK citizens

Estimation of minimally important difference of the EQ-5D-5L utility scores among patients with either hypertension or diabetes or both: a cross-sectional study in Hong Kong

Objective To estimate and report the minimally important difference (MID) of the EuroQol five-dimensional five-level questionnaire (EQ-5D-5L) using the Hong Kong (HK) utility score among patients with either hypertension or diabetes or both.Design Data were analysed using secondary data analysis based on a cross-sectional study assessing patients’ experiences in HK.Setting A representative sample was recruited from 26 specialist outpatient clinics in HK.Participants We analysed data from 2231 and 662 patients who reported having hypertension or diabetes alone, respectively, and 874 patients had these two diseases.Intervention An instrument-defined approach was applied to estimate MID stratified according to sex and age for the three subpopulations.Results The overall MID (oMID) estimates were 0.089, 0.086 and 0.089 for patients with hypertension or diabetes alone and with these two diseases, respectively. The adjusted MID (aMID) estimate was smaller than the oMID, and the improved MID was larger than the deteriorated MID. Women had larger oMID but smaller aMID than men. Younger respondents had larger aMID than older respondents. Effect sizes ranged from 0.30 to 0.503, which fit our preset criteria.Conclusion Four types of MID of the EQ-5D utility score for patients with hypertension or diabetes alone and with these two diseases were reported. Variations in the MID estimates should be further explored in other populations or using different statistical methods

Relationship between patient experience and hospital readmission: system-level survey with deterministic data linkage method

Abstract Background Linkage of public healthcare data provides powerful resources for studying from a comprehensive view of quality of care than information for a single administrative database. It is believed that positive patient experiences reflect good quality of health care and may reduce patient readmission. This study aimed to determine the relationship between patient experience and hospital readmission at a system level by linking anonymous experience survey data with de-identified longitudinal hospital administrative admissions data. Methods Data were obtained by linking two datasets with anonymised individual-level records from seven largest-scale acute public hospitals over seven geographical clusters in Hong Kong. Selected records in the two datasets involving patient experience survey (PES) (2013 survey dataset) and healthcare utilization (admissions dataset) were used. Following data cleaning and standardization, a deterministic data linkage algorithm was used to identify pairs of records uniquely matched for a list of identifiers (10 selected variables) between two datasets. If patient’s record from the survey dataset matched with the hospitalization records in the admissions dataset, they were included in the subsequent analyses. Bivariate analyses and multivariable logistic regression models were performed to evaluate the associations between hospital readmission in the next calendar month and patient experience. Results The overall matching rate was 62.1% (1746/2811) for PES participants aged 45 or above from the survey dataset. The average score for overall inpatient experience was 8.10 (SD = 1.53). There was no significant difference between matched patients and unmatched patients in terms of their score for the perception of overall quality of care received during hospitalization (X 2 = 6.931, p-value = 0.14) and score for overall inpatient experience (X 2 = 7.853, p-value = 0.25). In the multivariable model, readmission through the outpatient department (planned admission) in the next calendar month was significantly associated with a higher score given to the overall quality of care received (adjusted OR = 1.54, 95%CI = 1.09–2.17), while such association was absent for readmission through Accident and Emergency department (adjusted OR = 0.75, 95%CI = 0.50–1.12). Conclusions This study demonstrated the feasibility of routine record linkage, with the limited intrusion of patients’ confidentiality, for evaluating health care quality. It also highlights the significant association between readmission through planned readmission and a higher score for overall quality of care received. A possible explanation might be the perceived better co-ordination between outpatient departments and inpatient service and the well-informed discharge plan given to this group of patients

Preference of Older Adults for Flexibility in Service and Providers in Community-Based Social Care: A Discrete Choice Experiment

Empowerment of control and choice of the service users in health and social care has been incorporated into service provision in various countries. This study aimed to elicit the preference of community-based long-term care (LTC) service users on levels of flexibility in service provision. A discrete choice experiment was performed among older community care service users to measure their preference for attributes of LTC services identified from a prior qualitative study. Each participant was asked to make choices in six choice tasks with two alternatives of hypothetical LTC services that were generated from the attributes. A generalized multinomial logistic model was applied to determine the relative importance and willingness to pay for the attributes. It found that the participants preferred multiple flexible providers, determining services by themselves, meeting case managers every month and social workers as sources of information on service provision. Significant preference heterogeneity was found for flexibility in providers and flexibility in services between those with and without activity of daily living impairment. The findings highlighted the preference of older adults for greater flexibility in LTC, while they rely heavily on social workers in decision making. The enhancement of flexibility in LTC should be supported by policies that allow the older service users to make decisions based on their own preferences or communication with social workers instead of determining the services and providers for them. Options should be offered to users to decide their preferred level of flexibility to better reflect their divided preferences

Validation of the accident and emergency experience questionnaire: a cross-sectional survey

Abstract Background Patient feedback is an important way for healthcare providers to understand patient experience and improve the quality of care effectively and facilitate patient-centered care in the healthcare system. This study aimed to suggest a validated instrument by evaluating the psychometric properties of the Accident and Emergency Experience Questionnaire (AEEQ) for measuring patient experience in the accident and emergency department (AED) service among the adult Chinese population. Methods Attendances aged 18 or above from all public hospitals with AEDs during 16–30 June 2016 were targeted and a cross-sectional telephone survey was conducted using AEEQ. Preliminary AEEQ consisted of 92 items, including 53 core evaluative items and 19 informative items, and the other 20 items covered socio-demographics, self-perceived health status, and free open-ended comments on AED service. Psychometric properties of the evaluative items were evaluated for practicability, content and structure validity, internal consistency, and test-retest reliability in this study. Results A total of 512 patients were recruited with a response rate of 54% and a mean age of 53.2 years old. The exploratory factor analysis suggested removing 7 items due to weak factor loadings and high cross-loading and then leaving 46 items grouped into 5 dimensions, which were care and treatment (14 items), environment and facilities (16 items), information on medication and danger signals (5 items), clinical investigation (3 items), and overall impression (8 items) to represent patient experience on AED service. The internal consistency and test-retest reliability were high with Cronbach’s alpha coefficient and Spearman’s correlation coefficient of the suggested scale of 0.845 and 0.838, respectively. Conclusion The AEEQ is a valid and reliable instrument to evaluate the AED service which helps to build the engagement platform for promoting patient-centered care between patients and frontline healthcare professionals and improving healthcare quality in the future

Association between Information Dissemination and Compliance with Preventive Measures during the Coronavirus Disease Pandemic in Hong Kong Working Population: Cross-Sectional Survey

Background: To fight the Coronavirus disease (COVID-19) pandemic, it is important for the population to keep abreast of COVID-19 updates and comply with the suggested preventive measures. Understanding the influence of popular dissemination channels under the surge of an ‘infodemic’ is crucial, as the population may receive conflicting information from various sources. Objective: This study aimed to examine the association between information source usage and COVID-19-preventive measures compliance. Methods: An online cross-sectional study was conducted in February 2020. Four COVID-19-preventive strategies, including ‘hand hygiene’, ‘mask wearing’, ‘household hygiene’, and ‘social distancing’, were studied with respect to their usage from three common health information sources and three dissemination channels. Logistic regressions were modelled to study the odds ratio of the preventive behavior compliance in terms of information source usage. Results: A total of 1048 respondents completed the survey and the sample demonstrated high compliance in hand hygiene (81.4%) and mask wearing (93.5%), but lower compliance in household hygiene (22.4%) and social distancing (65.7%). Females and chronic diseases patients were found more likely to adopt COVID-19-preventive measures. Participants recorded highest usage in social media (80.1%) among information sources and respondents with frequent social media use had improved compliances in the preventive behaviors studied. Conclusions: The study presented evidence to demonstrate the effectiveness of social media in disseminating information related to complying COVID-19-preventive behaviors. The impact of social media in spreading COVID-19 information should be recognized, despite the concerns regarding misinformation. With disciplined use, social media may help to halt the spread of COVID-19 and other communicable diseases by encouraging community participation