Risk of Care Home Placement following Acute Hospital Admission:Effects of a Pay-for-Performance Scheme for Dementia

IntroductionThe Quality and Outcomes Framework, or QOF, rewards primary care doctors (GPs) in the UK for providing certain types of care. Since 2006, GPs have been paid to identify patients with dementia and to conduct an annual review of their mental and physical health. During the review, the GP also assesses the carer's support needs, including impact of caring, and ensures that services are co-ordinated across care settings. In principle, this type of care should reduce the risk of admission to long-term residential care directly from an acute hospital ward, a phenomenon considered to be indicative of poor quality care. However, this potential effect has not previously been tested.MethodsUsing English data from 2006/07 to 2010/11, we ran multilevel logit models to assess the impact of the QOF review on the risk of care home placement following emergency admission to acute hospital. Emergency admissions were defined for (a) people with a primary diagnosis of dementia and (b) people with dementia admitted for treatment of an ambulatory care sensitive condition. We adjusted for a wide range of potential confounding factors.ResultsOver the study period, 19% of individuals admitted to hospital with a primary diagnosis of dementia (N = 31,120) were discharged to a care home; of those admitted for an ambulatory care sensitive condition (N = 139,267), the corresponding figure was 14%. Risk factors for subsequent care home placement included older age, female gender, vascular dementia, incontinence, fall, hip fracture, and number of comorbidities. Better performance on the QOF review was associated with a lower risk of care home placement but only when the admission was for an ambulatory care sensitive condition.ConclusionsThe QOF dementia review may help to reduce the risk of long-term care home placement following acute hospital admission.</p

Cytokine removal in human septic shock : where are we and where are we going?

Although improving, the mortality from septic shock still remains high despite increased international awareness. As a consequence, much effort has focused on alternative treatment strategies in an effort to improve outcomes. The application of blood purification therapies to improve immune homeostasis has been suggested as one such method, but these approaches, such as high-volume continuous haemofiltration or cytokine and/or endotoxin removal, have enjoyed little success to date. More recently, the use of sorbent technologies has attracted much attention. These adsorbers are highly effective at removing inflammatory mediators, in particular, cytokines, from the bloodstream. This narrative review is the executive summary of meetings held throughout the 6th International Fluid Academy Days in Antwerp, Belgium (Nov 23-25, 2017), focusing on the current understanding regarding the use of such adsorbers in humans with septic shock. We followed a modified Delphi approach involving a combination of evidence appraisal together with expert opinion in order to achieve recommendations for practice and, importantly, future research

The impact of primary care quality on inpatient length of stay for people with dementia : An analysis by discharge destination

Dementia is a chronic and progressive condition involving memory loss, mood swings, and difficulties in communication, mobility, reasoning and self-care. Older people with dementia occupy up a quarter of NHS hospital beds and tend to have prolonged hospital stays. Being admitted to hospital can have a significant negative impact on the person’s physical and mental health, and have an emotional impact on carers. As part of a national scheme known as the Quality and Outcomes Framework (QOF), GPs are rewarded for providing an annual review for patients with dementia. In the review, the GP checks the patient’s physical and mental health, and the support needs of the patient and carer. The GP also ensures services are coordinated across different parts of the system, e.g. that the patient is linked to community mental health services who can support them at home after a hospital stay. So does the QOF dementia review help achieve timely discharge from hospital? We used several large linked datasets to answer this question, analysing data on around 36,700 people from 2006 to 2010. The analyses took account of the influence of the GP practice with which people were registered and adjusted for other factors that might shorten or lengthen hospital stay. On average, hospital stay for people with dementia was around 18 days but was longer for those who were subsequently discharged to a care home (33 days). The QOF review had little effect on length of stay, with slightly shorter stays achieved only for individuals discharged back into the community and slightly longer stays for those who were discharged to a care home. Older people tended to be discharged from hospital more quickly than younger people, and Sunday admissions were shorter than admissions initiated on other days of the week. Unsurprisingly, people with multiple conditions had longer stays. Better availability of social care options – care home beds, or local authority intermediate care facilities – was linked to shorter hospital stays, which suggests that these sorts of services can be used instead of hospital care if they can be accessed. Another finding was that intense levels of unpaid care are associated with longer hospital stays – so it’s particularly important that GPs make sure these types of carer are well supported