Correction: Machine Learning Model for Predicting Mortality Risk in Patients With Complex Chronic Conditions: Retrospective Analysis.

[This corrects the article DOI: 10.2196/52782.].

Evaluating Person-Centred Integrated Care to People with Complex Chronic Conditions: Early Implementation Results of the ProPCC Programme.

Introduction: The evaluation of integrated care programmes for high-need high-cost older people is a challenge. We aim to share the early implementation results of the ProPCC programme in the North-Barcelona metropolitan area, in Catalonia, Spain. Methods: We analysed the intervention with retrospective data from May 2018 to December 2021 by describing the cohort complexity and by showing its 6-months pre-post impact on time spent at home and resources used: primary care visits, emergency department visits, hospital admissions and hospital stay. Findings: 264 cases were included (91% at home; 9% in nursing homes). 6-month pre vs. 6-months post results were (mean, p-value): primary care visits 8.2 vs. 11.5 (p < 0.05); emergency department visits 1.4 vs. 0.9 (p < 0.05); hospital admissions 0.7 vs. 0.5 (p < 0.05); hospital stay 12.8 vs. 7.9 days (p < 0.05). Time spent at home was 169.2 vs.174.2 days (p < 0.05). Conclusion: Early implementation of the ProPCC programme results in an increase in time spent at home (up to 3%) and significant reductions in emergency department attendance (-37.2%) and hospital stays (-38.3%). The increased use of primary care resources is compensated by the hospital resources savings, with a result in the average total cost of -46.3%.

Machine Learning Model for Predicting Mortality Risk in Patients With Complex Chronic Conditions: Retrospective Analysis.

Background: The health care system is undergoing a shift toward a more patient-centered approach for individuals with chronic and complex conditions, which presents a series of challenges, such as predicting hospital needs and optimizing resources. At the same time, the exponential increase in health data availability has made it possible to apply advanced statistics and artificial intelligence techniques to develop decision-support systems and improve resource planning, diagnosis, and patient screening. These methods are key to automating the analysis of large volumes of medical data and reducing professional workloads. Objective: This article aims to present a machine learning model and a case study in a cohort of patients with highly complex conditions. The object was to predict mortality within the following 4 years and early mortality over 6 months following diagnosis. The method used easily accessible variables and health care resource utilization information. Methods: A classification algorithm was selected among 6 models implemented and evaluated using a stratified cross-validation strategy with k=10 and a 70/30 train-test split. The evaluation metrics used included accuracy, recall, precision, F1-score, and area under the receiver operating characteristic (AUROC) curve. Results: The model predicted patient death with an 87% accuracy, recall of 87%, precision of 82%, F1-score of 84%, and area under the curve (AUC) of 0.88 using the best model, the Extreme Gradient Boosting (XGBoost) classifier. The results were worse when predicting premature deaths (following 6 months) with an 83% accuracy (recall=55%, precision=64% F1-score=57%, and AUC=0.88) using the Gradient Boosting (GRBoost) classifier. Conclusions: This study showcases encouraging outcomes in forecasting mortality among patients with intricate and persistent health conditions. The employed variables are conveniently accessible, and the incorporation of health care resource utilization information of the patient, which has not been employed by current state-of-the-art approaches, displays promising predictive power. The proposed prediction model is designed to efficiently identify cases that need customized care and proactively anticipate the demand for critical resources by health care providers.

The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents.

BACKGROUND: Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality. METHODS: We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death. RESULTS: A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). CONCLUSIONS: Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

Designing a Person-Centred Integrated Care Programme for People with Complex Chronic Conditions: A Case Study from Catalonia.

INTRODUCTION: The prevalence of people with complex chronic conditions is increasing. This population's high social and health needs require person-centred integrated approaches to care. METHODS: To collect data about experiences with the health system and identify priorities for care, we conducted 2 focus groups and 15 semi-structured interviews involving patients with multimorbidity and advanced conditions, caregivers, and representatives of patients' associations. To design the programme, we combined this information with evidence-based recommendations from local healthcare and social care professionals. RESULTS: Patients' and caregivers' main priorities were to ensure (a) comprehension of information provided by healthcare professionals; (b) coordination between patients, caregivers, and professionals; (c) access to social services; (d) support to caregivers in managing situations; (e) perceived support throughout the healthcare process; (f) home care, when available; and (d) a patient-centred approach. These dimensions were included in 37 of 63 clinical actions of the programme to cover the whole care trajectory: identifying high needs, defining, and providing care plans, managing crises, and providing transitional care and end-of-life care. CONCLUSION: We developed an evidence-based integrated care programme tailored to high-need patients combining input from patients, caregivers, and healthcare and social care professionals.

Severe Hypoalbuminemia at Admission Is Strongly Associated with Worse Prognosis in Older Adults with SARS-CoV-2 Infection.

Serum albumin levels have been associated with prognosis in several conditions among older adults. The aim of this study is to assess the prognostic value in mortality of serum albumin in older adults with SARS-CoV-2 infection. METHODS: Cohort observational study with consecutive older-adults (≥65 years old), with confirmed SARS-CoV-2 infection admitted to a university hospital between March-May 2020. A logistic regression model was fitted to assess the impact of albumin levels on in-hospital mortality adjusted by potential confounders. RESULTS: Among a total of 840 patients admitted to the hospital, 405 (48%) were older adults with a total of 92 deaths (23%) among them. Those who died were older, had more comorbidities, higher inflammation status and lower levels of serum albumin at admission [3.10 g/dL (0.51) vs. 3.45 g/dL (0.45); p < 0.01. Serum albumin levels at admission were negatively correlated with inflammatory markers such as C-Reactive protein (Pearson Coeff -0.4634; p < 0.001) or IL-6 (Pearson's Coeff -0.244; p = 0.006) at admission but also to other clinical outcomes such time to clinical stability (Pearson's Coeff -0.259; p < 0.001). Severe hypoalbuminemia associated with increased risk of mortality was defined as ≤3 g/dL at admission according to the AUC/ROC analysis (0.72 95% CI 0.63-0.81) In a multivariate logistic regression model adjusting by age, inflammation, comorbidities and severity at admission severe hypoalbuminemia was a strong predictor of in-hospital mortality (OR 2.18 95% CI 1.03-4.62; p = 0.039). CONCLUSION: Severe hypoalbuminemia with ≤3 g/dL is an independent risk factor for mortality among older adults with SARS-CoV-2 infection. There is a consistent correlation between albumin levels and inflammatory biomarkers. Further studies are needed to determine whether the supplementation of albumin as coadjuvant treatment will have a positive impact on the prognosis of this infection.

Assessment of Arrow-of-Time Metrics for the Characterization of Underwater Explosions.

Anthropogenic impulsive sound sources with high intensity are a threat to marine life and it is crucial to keep them under control to preserve the biodiversity of marine ecosystems. Underwater explosions are one of the representatives of these impulsive sound sources, and existing detection techniques are generally based on monitoring the pressure level as well as some frequency-related features. In this paper, we propose a complementary approach to the underwater explosion detection problem through assessing the arrow of time. The arrow of time of the pressure waves coming from underwater explosions conveys information about the complex characteristics of the nonlinear physical processes taking place as a consequence of the explosion to some extent. We present a thorough review of the characterization of arrows of time in time-series, and then provide specific details regarding their applications in passive acoustic monitoring. Visibility graph-based metrics, specifically the direct horizontal visibility graph of the instantaneous phase, have the best performance when assessing the arrow of time in real explosions compared to similar acoustic events of different kinds. The proposed technique has been validated in both simulations and real underwater explosions.

Prevalence and Prognostic Value of Myocardial Injury in the Initial Presentation of SARS-CoV-2 Infection among Older Adults.

Myocardial involvement during SARS-CoV-2 infection has been reported in many prior publications. We aim to study the prevalence and the clinical implications of acute myocardial injury (MIN) during SARS-CoV-2 infection, particularly in older patients. The method includes a longitudinal observational study with all consecutive adult patients admitted to a COVID-19 unit between March-April 2020. Those aged ≥65 were considered as older adult group. MIN was defined as at least 1 high-sensitive troponin (hs-TnT) concentration above the 99th percentile upper reference limit with different sex-cutoff. Results. Among the 634 patients admitted during the period of observation, 365 (58%) had evidence of MIN, and, of them, 224 (61%) were older adults. Among older adults, MIN was associated with longer time to recovery compared to those without MIN (13 days (IQR 6-21) versus 9 days (IQR 5-17); p < 0.001, respectively. In-hospital mortality was significantly higher in older adults with MIN at admission versus those without it (71 (31%) versus 11 (12%); p < 0.001). In a logistic regression model adjusting by age, sex, severity, and Charlson Comorbidity Index, the OR for in-hospital mortality was 2.1 (95% CI: 1.02-4.42; p = 0.043) among those older adults with MIN at admission. Older adults with acute myocardial injury had greater time to clinical recovery, as well as higher odds of in-hospital mortality.

Drug exposure may have a substantial influence on COVID-19 prognosis among residents of long-term care facilities: an exploratory analysis.

OBJECTIVES: To explore the association between drug exposure and SARS-CoV-2 prognosis among elderly people living in long-term care facilities (LTC) DESIGN: We carried out a cross-sectional study among old people living in LTC that had a proven SARS-CoV-2 infection, including socio-demographic data, comorbidities and drug intake at the moment of the diagnosis. The study was focused on ACE2 inhibitors, ARA-II blockers, inhaled bronchodilators, oral corticoids, platelet antiaggregants, oral anti-coagulants, statins and Vitamin D. RESULTS: 1 306 individuals were included, with a mean age of 86.7 years, and 72.3% were females. The case fatality rate was 24.4%. Among the studied exposures platelet antiaggregants were the most prevalent (24.7%). After adjusting for propensity score, the intake of inhaled corticoids (OR 0.73; p=0.03) and statins (OR 0.65; p=0.03) were found to be protective factors of death, whereas ACE2 inhibitor showed an almost significant association (OR 0.73, p=0.07). CONCLUSIONS: Considering the high prevalence of drug intake among elderly people, drug exposure may be an important Covid-19 disease modifier in LTC residents and should be considered when exploring prognostic risk factors associated to Covid-19.

A retrospective cohort study of risk factors for mortality among nursing homes exposed to COVID-19 in Spain.

Long-term care (LTC) facilities have shown remarkably high mortality rates during the coronavirus disease 2019 (COVID-19) outbreak in many countries1, and different risk factors for mortality have been identified in this setting2-5. Using facilities as the unit of analysis, we investigated multiple variables covering facility characteristics and socioeconomic characteristics of the geographic location to identify risk factors for excess mortality from a comprehensive perspective. Furthermore, we used a clustering approach to detect patterns in datasets and generate hypotheses regarding potential relationships between types of nursing homes and mortality trends. Our retrospective analysis included 167 nursing homes providing LTC to 8,716 residents during the COVID-19 outbreak in Catalonia (northeast Spain). According to multiple regression analysis, COVID-19-related and overall mortality at the facility level were significantly associated with a higher percentage of patients with complex diseases, lower scores on pandemic preparedness measures and higher population incidence of COVID-19 in the surrounding population. When grouping nursing homes into eight clusters based on common features, we found higher mortality rates in four clusters, mainly characterized by a higher proportion of residents with complex chronic conditions or advanced diseases, lower scores on pandemic preparedness, being located in rural areas and larger capacity, respectively.

New Insights into the Design and Application of a Passive Acoustic Monitoring System for the Assessment of the Good Environmental Status in Spanish Marine Waters.

Passive acoustic monitoring systems allow for non-invasive monitoring of underwater species and anthropogenic noise. One of these systems has been developed keeping in mind the need to create a user-friendly tool to obtain the ambient noise indicators, while at the same time providing a powerful tool for marine scientists and biologists to progress in studying the effect of human activities on species and ecosystems. The device is based on a low-power processor with ad-hoc electronics, ensuring that the system has efficient energy management, and that the storage capacity is large enough to allow deployments for long periods. An application is presented using data from an acoustic campaign done in 2018 at El Gorguel (Cartagena, Spain). The results show a good agreement between theoretical maps created using AIS data and the ambient noise level indicators measured in the frequency bands of 63 Hz and 125 Hz specified in the directive 11 of the EU Marine Strategy Framework Directive. Using a 2D representation, these ambient noise indicators have enabled repetitive events and daily variations in boat traffic to be identified. The ship noise registered can also be used to track ships by using the acoustic signatures of the engine propellers' noise.

Hospitalización Domiciliaria Integral para la atención a pacientes mayores con procesos agudos discapacitantes: factores predictivos de éxito terapéutico / Hospital-at-home Integrated Care Programme tailored to older patients with disabling acute processes: identification of prognostic factors

Introducción: Diversos autores han demostrado la eficacia de diferentes estrategias de hospitalización a domicilio en pacientes mayores. En estos procesos la identificación de factores pronósticos es imprescindible para una adecuada selección de candidatos. Material y métodos: Se analizó una cohorte de pacientes mayores atendidos en régimen de Hospitalización Domiciliaria Integral por descompensaciones de procesos médicos, ortopédicos o cerebrovasculares con deterioro funcional asociado durante 5años en una organización sanitaria integral. Se analizaron resultados al alta: resolución sanitaria (alta a atención primaria), recuperación favorable (ganancia funcional relativa ≥35%) y la combinación de estas dos variables. Por modelo multivariable de regresión logística se analizó la asociación entre las variables clínicas obtenidas de la valoración geriátrica integral efectuada al ingreso con resultados al alta favorables. Resultados: Se incluyeron 484 pacientes, con edad 84,4 (6,7), género femenino 69%, Barthel basal 74,2 (22,6), cuidador principal familiar-privado/residencia 82/18% y procedencia unidades de hospitalización/urgencias-comunidad 55/45%. Los resultados por procesos (médico/ortopédico/ictus) fueron: resolución sanitaria 71,7/87,5/77,6%; recuperación favorable 72,1/84,9/73,5%; resolución sanitaria con recuperación favorable 67,1/81,6/67,3%. Se asociaron con resolución sanitaria y recuperación funcional favorable (OR [IC95%])-: el ingreso por proceso ortopédico (2,00 [1,22-3,29]), presentar una puntuación en índice de Barthel al ingreso >40 puntos (2,00 [1,18-3,38]) y la ausencia de úlceras por presión al ingreso (2,80 [1,68-4,65]). Conclusiones: Los pacientes con diagnóstico ortopédico, los que tienen una discapacidad no grave al ingreso y los que no presentan úlceras por presión al ingreso pudieron presentar mejores resultados de resolución sanitaria con recuperación favorable. Sufrir deterioro cognitivo o delirium, o estar institucionalizado, no se relacionaron con resultados menos favorables

Introduction: Several authors have demonstrated the efficacy of different hospital-at-home strategies in older patients. The identification of prognostic factors is key for improving the targeting process of candidates. Methods: We performed an analysis of a cohort of older patients attended due to disabling health crises (medical, orthopaedics, or stroke) by a hospital-at-home scheme developed in an integrated care institution over a 5-year period. Main outcomes were: health crisis resolution (discharge to Primary Care); functional resolution (relative functional gain ≥35%), and their combined variable. A logistic regression analysis was performed, including clinical variables from Comprehensive Geriatric Assessment at admission to detect factors related to favourable outcomes. Results: A total of 484 patients were included. The main characteristics were: age 84.4 (6.7), female gender 69%, baseline Barthel score 74.2 (22.6), family-private caregiver/nursing home 82%/18%, referral from hospital wards/emergency department-community in 55%/45%. The main results (for selected processes medical/orthopaedics/stroke) were: health crisis resolution 71.7/87.5/77.6%; functional resolution 72.1/84.9/73.5%; favourable crisis resolution (health crisis resolution with functional resolution) 67.1/81.6/67.3%. Favourable crisis resolution was associated with [OR (95%CI)]: orthopaedic as main diagnosis [2.00 (1.22-3.29)], Barthel score at admission higher than 40 points [2.00 (1.18-3.38)], and the absence of pressure ulcers at admission [2.80 (1.68-4.65)]. Conclusions: Patients presenting with an orthopaedic diagnosis, not having severe disability at admission, and not having pressure ulcers at admission could obtain better results on favourable crisis resolution. Suffering cognitive impairment or delirium, or being institutionalised, was not found related with less favourable results

Different ways to present clinical cases in a classroom: video projection versus live representation of a simulated clinical scene with actors.

BACKGROUND: Use of the video digital format in the classroom is a common way to present clinical cases to stimulate discussion and increase learning. A simulated live performance with actors, also in the classroom, could be an alternative way to present cases that may be more attractive to arouse students' interest and attention. The aim of the present study was to compare the learning process between a group of students who saw a clinical case as a simulated live scene in the classroom and others seeing the same clinical case projected by video. METHOD: One hundred and thirty-one students (69 from physiotherapy and 62 from medicine) attended an interactive seminar on delirium in older people. Each group was subdivided into two groups: one saw the clinical case as a theatrical performance in the classroom (scene group; n = 68), while the other saw the same case projected on video (video group; n = 63). Before and after attending the seminar, students answered a questionnaire [four questions on theoretical knowledge of delirium (score 0-7) and two on subjective learning perception (linear scale: 0-10) (score 0-20)]. At the end, a further question was included on the usefulness of the scene or a video in the learning process (linear scale: 0-10). RESULTS: Students in both groups (live scene and video) significantly improved in all questionnaire scores after the seminar (p = 0.001) with a large Effect Size (ES > 0.80). Students of the scene group obtained higher scores on theoretical delirium knowledge [6.41 ± 0.73 vs 5.93 ± 1.31 (p = 0.05)], subjective learning perception questions (what they thought they knew about delirium) (16.28 ± 3.51 versus 15.92 ± 2.47 (p = 0.072)], and the overall questionnaire (22.45 ± 4.15 versus 21.48 ± 2.94 (p = 0.027)] than the video group. Students of the scene group opined that live scene was very useful for learning with a mean score of 9.04 ± 1.16 (range 0-10), and opinion in the student's video group scored 8.21 ± 1.22 (p = 0.001). CONCLUSIONS: All students improved significantly their knowledge but those who saw the theatrical performance obtained slightly better results, which suggest that this form of clinical case presentation in the classroom may be an alternative at least as effective as traditional video projections.

[Hospital-at-home Integrated Care Programme tailored to older patients with disabling acute processes: identification of prognostic factors]. / Hospitalización Domiciliaria Integral para la atención a pacientes mayores con procesos agudos discapacitantes: factores predictivos de éxito terapéutico.

INTRODUCTION: Several authors have demonstrated the efficacy of different hospital-at-home strategies in older patients. The identification of prognostic factors is key for improving the targeting process of candidates. METHODS: We performed an analysis of a cohort of older patients attended due to disabling health crises (medical, orthopaedics, or stroke) by a hospital-at-home scheme developed in an integrated care institution over a 5-year period. Main outcomes were: health crisis resolution (discharge to Primary Care); functional resolution (relative functional gain ≥35%), and their combined variable. A logistic regression analysis was performed, including clinical variables from Comprehensive Geriatric Assessment at admission to detect factors related to favourable outcomes. RESULTS: A total of 484 patients were included. The main characteristics were: age 84.4 (6.7), female gender 69%, baseline Barthel score 74.2 (22.6), family-private caregiver/nursing home 82%/18%, referral from hospital wards/emergency department-community in 55%/45%. The main results (for selected processes medical/orthopaedics/stroke) were: health crisis resolution 71.7/87.5/77.6%; functional resolution 72.1/84.9/73.5%; favourable crisis resolution (health crisis resolution with functional resolution) 67.1/81.6/67.3%. Favourable crisis resolution was associated with [OR (95%CI)]: orthopaedic as main diagnosis [2.00 (1.22-3.29)], Barthel score at admission higher than 40 points [2.00 (1.18-3.38)], and the absence of pressure ulcers at admission [2.80 (1.68-4.65)]. CONCLUSIONS: Patients presenting with an orthopaedic diagnosis, not having severe disability at admission, and not having pressure ulcers at admission could obtain better results on favourable crisis resolution. Suffering cognitive impairment or delirium, or being institutionalised, was not found related with less favourable results.

Serum albumin is a strong predictor of sepsis outcome in elderly patients.

The incidence of sepsis is disproportionately higher in elderly adults, and age is an independent predictor of mortality. Retrospective analysis was conducted among patients admitted to the emergency department in a tertiary teaching hospital from January 2016 to June 2017. To study the prognosis determinants of sepsis among elderly patients attended in the emergency room of a tertiary care hospital. As secondary objectives, we aimed to describe the causes of sepsis, the general outcome, and the general characteristics of these patients. Two hundred thirty-five episodes data of patients admitted throughout the 15-month study period who were diagnosed with sepsis, severe sepsis or septic shock, were included. Throughout the study cohort, 51 patients (21.7%) fulfilled the criteria of severe sepsis or septic shock. All-cause mortality was 11 patients (4.7%) on day 14 and 27 (11.5%) on day 30. Prognosis factors associated with 30-day mortality were the following: albumin level < 2.6 g/dl (first quartile of the overall population), odds ratio (OR 3.26, 95% CI 12-9.41; p = 0.029), Charlson comorbidity index (OR 1.23, 95% CI 1.04-1.45; p = 0.012), C-reactive protein on admission (OR 1.04, 95% CI 0.99-1.08; p = 0.062), and non-adequacy of the initial antimicrobial therapy (OR 3.3, 95% CI 1.06-10.4; p = 0.039). Among elderly patients with sepsis, strong predictors of mortality such as albumin could be considered as part of prognosis and future potential interventions. Adequacy of antimicrobial therapy at admission must be one of the objectives in the treatment of sepsis, also in the elderly, since it is an independent predictor of mortality.

Valor pronóstico de los instrumentos de evaluación de enfermedad avanzada y de final de vida en ancianos ingresados en un centro sociosanitario / Prognostic value of assessment tools on elderly patients with chronic advanced disease and end of life, admitted to an intermediate care centre

Objetivo. Aplicar 3instrumentos de evaluación de enfermedad avanzada en ancianos ingresados en un centro sociosanitario y evaluar su relación con la mortalidad. Métodos. Se aplicaron los instrumentos NECPAL, índice PROFUND e índice de comorbilidad de Charlson a 87 pacientes. Resultados. El instrumento NECPAL identificó a 31 pacientes (35,6%) en situación de necesidad de atención paliativa; según el índice PROFUND, 45 (54,7%) tenían riesgo alto/muy alto de mortalidad (≥7 puntos) y según el índice de Charlson, 31 (35,6%) tenían carga de morbilidad alta (≥4 puntos). Pacientes NECPAL positivos: el 80,5% tenían puntuación ≥7 en índice PROFUND y 48,3% un Charlson ≥ 4; dichas proporciones fueron 34,4 y 28,5% en los NECPAL negativos (p<0,001 y p≤0,06, respectivamente). Correlaciones entre los 3instrumentos: cuantitativas (Spearman): número de respuestas NECPAL con PROFUND (r=0,57; p<0,001); con Charlson (r=0,214; p=0,047) y entre PROFUND y Charlson (r=0,157; p=0,148). Cualitativas (kappa) NECPAL (positivo/negativo) con PROFUND (corte 6/7) (0,40; p<0,001), con Charlson (corte 3/4) (0,19; p=0,080) y entre PROFUND y Charlson (0,08; p=0,399). Predicción de mortalidad (área bajo la curva): NECPAL 3 meses 0,81 (IC: 0,62-1,00); 6 meses 0,71 (IC: 0,53-0,89) y 12 meses 0,67 (IC: 0,52-0,82). PROFUND 3 meses 0,71 (IC: 0,50-0,91); 6 meses 0,73 (IC: 0,58-0,87) y 12 meses 0,69 (IC: 0,57-0,81). Charlson 3 meses 0,72 (IC: 0,52-0,91); 6 meses 0,62 (IC: 0,45-0,80) y 12 meses 0,64 (IC: 0,50-0,78). Conclusiones. Los 3instrumentos se relacionaron de forma significativa con una mayor mortalidad. La concordancia entre los resultados de los distintos instrumentos fue baja (AU)

Objective. To apply 3advanced chronic disease evaluation tools in elderly patients admitted to an intermediate and long-term care centre, and evaluate its relationship with mortality. Methods. The NECPAL tool, PROFUND prognostic index, and Charlson comorbidity index were applied to 87 patients. Results. The NECPAL tool identified 31 patients (35.6%) in need of palliative care, and according to the PROFUND index, 45 (54.7%) had high/very high risk of mortality (≥7 points), and according to Charlson index, 31 (35.6%) had high comorbidity (≥4 points). Of the NECPAL positive patients, 80.5% had a PROFUND index score ≥7, and 48.3% a Charlson index ≥ 4. These percentages were 34.4% and 28.5% in negative NECPAL patients (P<.001 and P≤.06, respectively). Correlations between the 3tools: quantitative (Spearman) number of responses in NECPAL with PROFUND (r=.57; P<.001); with Charlson (r=.214; P<.047) and between PROFUND and Charlson (r=.157; P=.148). Qualitative (kappa) NECPAL (positive/negative) with PROFUND (cut-off 6/7) (0.40; P<.001), and Charlson (cut-off 3/4) (0.19; P=.080) and between PROFUND and Charlson (0.08; P=.399). Mortality prediction (area under the curve): NECPAL 3 months 0.81 (95% CI: 0.62-1.00); 6 months 0.71 (95% CI: 0.53-0.89) and 12 months 0.67 (95% CI: 0.52-0.82). PROFUND 3 months 0.71 (95% CI: 0.50-0.91); 6 months 0.73 (95% CI: 0.58-0.87), and 12 months 0.69 (95% CI: 0.57-0.81). Charlson 3 months 0.72 (95% CI: 0.52-0.91); 6 months 0.62 (95% CI: 0.45-0.80), and 12 months 0.64 (95% CI: 0.50-0.78). Conclusions. The 3tools were significantly associated with high mortality. A low concordance was found between the results of the different tools (AU)

[Prognostic value of assessment tools on elderly patients with chronic advanced disease and end of life, admitted to an intermediate care centre]. / Valor pronóstico de los instrumentos de evaluación de enfermedad avanzada y de final de vida en ancianos ingresados en un centro sociosanitario.

OBJECTIVE: To apply 3advanced chronic disease evaluation tools in elderly patients admitted to an intermediate and long-term care centre, and evaluate its relationship with mortality. METHODS: The NECPAL tool, PROFUND prognostic index, and Charlson comorbidity index were applied to 87 patients. RESULTS: The NECPAL tool identified 31 patients (35.6%) in need of palliative care, and according to the PROFUND index, 45 (54.7%) had high/very high risk of mortality (≥7 points), and according to Charlson index, 31 (35.6%) had high comorbidity (≥4 points). Of the NECPAL positive patients, 80.5% had a PROFUND index score ≥7, and 48.3% a Charlson index ≥ 4. These percentages were 34.4% and 28.5% in negative NECPAL patients (P<.001 and P≤.06, respectively). Correlations between the 3tools: quantitative (Spearman) number of responses in NECPAL with PROFUND (r=.57; P<.001); with Charlson (r=.214; P<.047) and between PROFUND and Charlson (r=.157; P=.148). Qualitative (kappa) NECPAL (positive/negative) with PROFUND (cut-off 6/7) (0.40; P<.001), and Charlson (cut-off 3/4) (0.19; P=.080) and between PROFUND and Charlson (0.08; P=.399). Mortality prediction (area under the curve): NECPAL 3 months 0.81 (95% CI: 0.62-1.00); 6 months 0.71 (95% CI: 0.53-0.89) and 12 months 0.67 (95% CI: 0.52-0.82). PROFUND 3 months 0.71 (95% CI: 0.50-0.91); 6 months 0.73 (95% CI: 0.58-0.87), and 12 months 0.69 (95% CI: 0.57-0.81). Charlson 3 months 0.72 (95% CI: 0.52-0.91); 6 months 0.62 (95% CI: 0.45-0.80), and 12 months 0.64 (95% CI: 0.50-0.78). CONCLUSIONS: The 3tools were significantly associated with high mortality. A low concordance was found between the results of the different tools.

Potentially inappropriate medication among people with dementia in eight European countries.

Objectives: to evaluate the frequency of potentially inappropriate medication (PIM) prescription among older people with dementia (PwD) from eight countries participating in the European study 'RightTimePlaceCare', and to evaluate factors and adverse outcomes associated with PIM prescription. Methods: survey of 2,004 PwD including a baseline assessment and follow-up after 3 months. Interviewers gathered data on age, sex, prescription of medication, cognitive status, functional status, comorbidity, setting and admission to hospital, fall-related injuries and mortality in the time between baseline and follow-up. The European Union(7)-PIM list was used to evaluate PIM prescription. Multivariate regression analysis was used to investigate factors and adverse outcomes associated with PIM prescription. Results: overall, 60% of the participants had at least one PIM prescription and 26.4% at least two. The PIM therapeutic subgroups most frequently prescribed were psycholeptics (26% of all PIM prescriptions) and 'drugs for acid-related disorders' (21%). PwD who were 80 years and older, lived in institutional long-term care settings, had higher comorbidity and were more functionally impaired were at higher risk of being prescribed two PIM or more. The prescription of two or more PIM was associated with higher chance of suffering from at least one fall-related injury and at least one episode of hospitalisation in the time between baseline and follow-up. Conclusions: PIM use among PwD is frequent and is associated with institutional long-term care, age, advanced morbidity and functional impairment. It also appears to be associated with adverse outcomes. Special attention should be paid to psycholeptics and drugs for acid-related disorders.

Hospital-at-home Integrated Care Programme for the management of disabling health crises in older patients: comparison with bed-based Intermediate Care.

Objective: to analyse the clinical impact of a home-based Intermediate Care model in the Catalan health system, comparing it with usual bed-based care. Design: quasi-experimental longitudinal study. Setting: hospital Municipal de Badalona and El Carme Intermediate Care Hospital, Badalona, Catalonia, Spain. Participants: we included older patients with medical and orthopaedic disabling health crises in need of Comprehensive Geriatric Assessment (CGA) and rehabilitation. Methods: a CGA-based hospital-at-home Integrated Care Programme (acute care and rehabilitation) was compared with a propensity score matched cohort of contemporary patients attended by usual inpatient hospital care (acute care plus intermediate care hospitalisation), for the management of medical and orthopaedics processes. Main outcomes measures were: (a) Health crisis resolution (referral to primary care at the end of the intervention); (b) functional resolution: relative functional gain (functional gain/functional loss) ≥ 0.35; and (c) favourable crisis resolution (health + functional) = a + b. We compared between-groups outcomes using uni/multivariable logistic regression models. Results: clinical characteristics were similar between home-based and bed-based groups. Acute stay was shorter in home group: 6.1 (5.3-6.9) versus 11.2 (10.5-11.9) days, P < 0.001. The home-based scheme showed better results on functional resolution 79.1% (versus 75.2%), OR 1.62 (1.09-2.41) and on favourable crisis resolution 73.8% (versus 69.6%), OR 1.54 (1.06-2.22), with shorter length of intervention, with a reduction of -5.72 (-9.75 and -1.69) days. Conclusions: in our study, the extended CGA-based hospital-at-home programme was associated with shorter stay and favourable clinical outcomes. Future studies might test this intervention to the whole Catalan integrated care system.