Risk factors for hospital readmissions in elderly patients: a systematic review.

Population ageing is associated with an increase in hospital admissions. Defining the factors that affect the risk of hospital readmission could identify individuals at high risk and enable targeted interventions to be designed. This aim of this study was to identify the risk factors for hospital readmission in elderly people. A systematic review of the literature published in English or Spanish was performed by electronically searching EMBASE, MEDLINE, CINAHL, SCI and SSCI. Some keywords were aged, elder, readmission, risk, etc. Selection criteria were: prospective cohort studies with suitable statistical analysis such as logistic regression, that explored the relationship between the risk of readmission with clinical, socio-demographic or other factors in elderly patients (aged at least 75 years) admitted to hospital. Studies that fulfilled these criteria were reviewed and data were extracted by two reviewers. We assessed the methodological quality of the studies and prepared a narrative synthesis. We included 12 studies: 11 were selected from 1392 articles identified from the electronic search and one additional reference was selected by manual review. Socio-demographic factors were only explanatory in a few models, while prior admissions and duration of hospital stay were frequently relevant factors in others. Morbidity and functional disability were the most common risk factors. The results demonstrate the need for increased vigilance of elderly patients who are admitted to hospital with specific characteristics that include previous hospital admissions, duration of hospital stay, morbidity and functional disability.

[Routine preoperative screening of asymptomatic patients: beliefs and attitudes of anesthesiologists in the Canary Islands, Spain]. / Pruebas preoperatorias rutinarias en población asintomática: opiniones y actitudes de los profesionales en Canarias.

OBJECTIVES: To identify factors that explain anesthesiologists' inappropriate use of preoperative tests in asymptomatic patients scheduled for elective surgery. MATERIAL AND METHODS: A validated questionnaire was sent to anesthesiologists at university hospitals in the Canary Islands. Information about preoperative testing patterns and reasons for selecting tests was gathered. RESULTS: The questionnaire was self-administered by 66 anesthesiologists (68% of the total). Scientific knowledge was not the reason why most respondents ordered preoperative tests in asymptomatic individuals. That was the opinion of 95% of anesthesiologists for chest x-rays, 82% for electrocardiograms, and 68% for laboratory tests. Clinical history and a medical examination gave sufficient information for selecting patients in need of specific tests in the opinion of 77.19% of the respondents. Half did not agree that routine electrocardiograms and laboratory tests should be abandoned. The justification for these tests was coverage of medical malpractice liability for 68.42%. Most considered that the need to order preoperative tests in asymptomatic patients increased after age 40. CONCLUSIONS: Although anesthesiologists admit that their request for preoperative tests in asymptomatic individuals is not supported by scientific evidence, the quest for safety and legal protection from the consequences of potential adverse consequences of providing anesthesia affects the selection of preoperative tests for asymptomatic patients.

Pruebas preoperatorias rutinarias en población asintomática: opiniones y actitudes de los profesionales en Canarias / Routine preoperative screening of asymptomatic patients: beliefs and attitudes of anesthesiologists in the Canary Islands, Spain

OBJETIVO: Identificar algunas razones que contribuyen a explicar el uso inapropiado, por parte de los anestesiólogos, de las pruebas preoperatorias en población asintomática que va a ser sometida a cirugía electiva. MATERIAL Y MÉTODO: Un cuestionario validado fue enviado a los anestesiólogos de los hospitales universitarios de Canarias. Se recogió información sobre el patrón de uso y sobre las razones que justifican la selección de pruebas preoperatorias. RESULTADOS: El cuestionario fue autocumplimentado por 66 anestesiólogos (68% del total). Para la mayoría, el conocimiento científico disponible no avala la realización de pruebas preoperatorias en personas asintomáticas. Ésta era la opinión del 95% de los anestesiólogos para la radiografía de tórax; del 82% para el ECG y del 68% para las pruebas de laboratorio. Para el 77,19% de los participantes, la historia clínica y el examen médico suministran suficiente información para seleccionar los pacientes que precisen pruebas específicas. El 50% no está de acuerdo en abandonar la solicitud rutinaria del ECG y de las pruebas de laboratorio. Para el 68,42%, la solicitud de estas pruebas se justifica para cubrir la responsabilidad médico/legal. La mayoría consideran que a partir de los 40 años de edad aumenta la necesidad de realizar pruebas preoperatorias en población asintomática. CONCLUSIONES: Si bien la mayoría de anestesiólogos admiten que la solicitud de pruebas preoperatorias en población asintomática no está respaldada por el conocimiento científico, la búsqueda de seguridad y protección legal frente a las consecuencias adversas potenciales del acto anestésico condiciona la toma de decisiones en la selección de pruebas preoperatorias en población asintomática

OBJECTIVES: To identify factors that explain anesthesiologists' inappropriate use of preoperative tests in asymptomatic patients scheduled for elective surgery. MATERIAL AND METHODS: A validated questionnaire was sent to anesthesiologists at university hospitals in the Canary Islands. Information about preoperative testing patterns and reasons for selecting tests was gathered. RESULTS: The questionnaire was self-administered by 66 anesthesiologists (68% of the total). Scientific know-ledge was not the reason why most respondents ordered preoperative tests in asymptomatic individuals. That was the opinion of 95% of anesthesiologists for chest x-rays, 82% for electrocardiograms, and 68% for laboratory tests. Clinical history and a medical examination gave sufficient information for selecting patients in need of specific tests in the opinion of 77.19% of the respondents. Half did not agree that routine electrocardiograms and laboratory tests should be abandoned. The justification for these tests was coverage of medical mal-practice liability for 68.42%. Most considered that the need to order preoperative tests in asymptomatic patients increased after age 40. CONCLUSIONS: Although anesthesiologists admit that their request for preoperative tests in asymptomatic individuals is not supported by scientific evidence, the quest for safety and legal protection from the consequences of potential adverse consequences of providing anesthesia affects the selection of preoperative tests for asymptomatic patients

[Socio-economic costs of mental health in the Canary Islands, Spain, in 2002]. / Costes socioeconómicos de las enfermedades mentales en las Islas Canarias en 2002.

OBJECTIVE: To evaluate the economic impact in terms of direct and indirect costs of the mental health in Canary Islands (Spain) in 2002. DESIGN: The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence cost, i.e., the costs produced in 2002. The human capital theory approach has been used. SETTING: Canary Islands, Spain, including primary health care and inpatient care. PARTICIPANTS: Mental health patients. MAIN MEASUREMENTS: Direct health costs (inpatients, ambulatory care, primary health care, and drugs). Indirect costs (premature death, short-term illness, and permanent disability). RESULTS: The total costs of mental health were 189.59 million euros. The direct health costs were 81.67 million euros, constituting 43% of the total costs and 5.2% of the total public health care budget in this region. The indirect costs of mental health were 107.92 million euros, representing 57% of the total costs. CONCLUSIONS: Although this study adopts a conservative approach, the high socio-economic cost of the mental health helps us to define better the dimension of the problem to establish priorities besides opening a way towards cost-effectiveness studies that allow a more transparent debate on this topic.

Costes socioeconómicos de las enfermedades mentales en las Islas Canarias en 2002 / Socio-economic costs of mental health in the Canary Islands, Spain, in 2002

Objetivo. Evaluar el impacto económico, en términos de costes directos e indirectos, de las enfermedades mentales en Canarias durante el año 2002.Diseño. El enfoque que se ha utilizado es el método del coste de la enfermedad. Los costes directos e indirectos se han estimado utilizando los costes de la prevalencia, es decir, los costes que se originan durante el año 2002. Se ha utilizado el enfoque de la teoría del capital humano. Emplazamiento. Comunidad Autónoma Canaria, incluyendo atención primaria y atención especializada. Participantes. Pacientes con enfermedades mentales. Mediciones principales. Costes directos sanitarios (costes de las hospitalizaciones, consultas externas, atención primaria y fármacos). Costes indirectos (mortalidad anticipada, incapacidad temporal e incapacidad permanente).Resultados. Los costes totales de las enfermedades mentales ascendieron a 189,59 millones de euros. Los costes directos sanitarios fueron de 81,67 millones de euros, el 43 por ciento de los costes totales y el 5,2 por ciento del gasto sanitario público en esta autonomía. Los costes indirectos ascendieron a 107,92 millones de euros, el 57 por ciento del total. Conclusiones. A pesar de haberse adoptado un enfoque conservador, el elevado coste socioeconómico de las enfermedades mentales nos ayuda a definir mejor la dimensión del problema para establecer prioridades, además de iniciar un camino hacia estudios de coste-efectividad que permitan un debate más transparente sobre esta cuestión (AU)

[Socioeconomic costs of cardiovascular disease and cancer in the Canary Islands (Spain) in 1998]. / Los costes socioeconómicos de las enfermedades cardiovasculares y del cáncer en las Islas Canarias en 1998.

OBJECTIVE: To evaluate the economic impact in terms of direct and indirect costs of the cardiovascular disease and cancer in the Canary Islands in 1998. METHODS: The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence costs, i.e., the costs produced in 1998. Direct costs were divided into hospitalization costs, outpatient costs, primary health care costs, and drug costs while indirect costs were obtained through transformation of physical units into monetary units using the approach of human capital theory and the friction cost method. RESULTS: The total costs of cardiovascular disease and cancer were 246.11 and 193.72 million euros respectively. The direct costs of the two diseases were 134.44 and 58.04 million euros respectively, representing 55% and 30% of total costs and 16% of total health care expenditure in this region. The indirect costs of these two diseases were 111.68 and 135.68 million euros respectively, representing 45% and 70% of total costs. Use of the friction cost method revealed that indirect costs decreased by 88% for cardiovascular disease and those for cancer decreased by 77%. CONCLUSIONS: Although this study adopts a conservative approach by omitting costs associated with pain and suffering, permanent disability, and those of at-home care provided by the family, the annual socioeconomic cost of cardiovascular disease and cancer in the Canary Islands was high, amounting to 440 million euros.

Los costes socioeconómicos de las enfermedades cardiovasculares y del cáncer en las Islas Canarias en 1998 / Socioeconomic costs of cardiovascular disease and cancer in the Canary Islands [Spain] in 1998

Objetivo: Evaluar el impacto económico, en términos de costes directos e indirectos, de las enfermedades cardiovasculares y del cáncer, en Canarias, durante el año 1998.Métodos: El enfoque que se ha utilizado es el método del coste de la enfermedad. Los costes directos e indirectos se han estimado utilizando los costes de la prevalencia, es decir, los costes que se produjeron durante el año 1998. Los costes directos se han desglosado en costes de las hospitalizaciones, consultas externas, atención primaria y fármacos. Los indirectos se han obtenido a partir de unidades físicas mediante su transformación en unidades monetarias utilizando el enfoque de la teoría del capital humano y el método del período de fricción. Resultados: Los costes totales de las enfermedades cardiovasculares y del cáncer ascendieron a 246,11 y 193,72 millones de euros, respectivamente, utilizando el método del capital humano. Los costes directos atribuibles a las mismas fueron de 134,44 y 58,04 millones de euros, respectivamente, representando el 55 y 30 por ciento de los costes totales y el 16 por ciento del gasto total sanitario en esta región. Los costes indirectos de estas dos enfermedades ascendieron a 111,68 y 135,68 millones de euros, respectivamente, representando el 45 y 70 por ciento del total. Utilizando el método del período de fricción, los costes indirectos se redujeron en un 88 por ciento para enfermedades cardiovasculares y en un 77 por ciento en el cáncer. Conclusiones: A pesar de haberse adoptado un enfoque conservador, dado que en este estudio no se incluyen los costes asociados con el dolor y el sufrimiento, la invalidez permanente y la atención en el hogar por parte de los familiares, el elevado coste socioeconómico anual de las enfermedades cardiovasculares y del cáncer en Canarias alcanzó los 440 millones de euros (AU)

Objective: To evaluate the economic impact in terms of direct and indirect costs of the cardiovascular disease and cancer in the Canary Islands in 1998. Methods: The cost-of-illness method was used. Direct and indirect costs were estimated using prevalence costs, i.e., the costs produced in 1998. Direct costs were divided into hospitalization costs, outpatient costs, primary health care costs, and drug costs while indirect costs were obtained through transformation of physical units into monetary units using the approach of human capital theory and the friction cost method. Results: The total costs of cardiovascular disease and cancer were 246.11 and 193.72 million euros respectively. The direct costs of the two diseases were 134.44 and 58.04 million euros respectively, representing 55% and 30% of total costs and 16% of total health care expenditure in this region. The indirect costs of these two diseases were 111.68 and 135.68 million euros respectively, representing 45% and 70% of total costs. Use of the friction cost method revealed that indirect costs decreased by 88% for cardiovascular disease and those for cancer decreased by 77%. Conclusions: Although this study adopts a conservative approach by omitting costs associated with pain and suffering, permanent disability, and those of at-home care provided by the family, the annual socioeconomic cost of cardiovascular disease and cancer in the Canary Islands was high, amounting to 440 million euros (AU)

[Cost analysis and potential savings related to the use of preoperative tests in the hospitals of the Canary Islands [Spain]]. / Análisis de costes y ahorros potenciales relacionados con la utilización de pruebas preoperatorias en los hospitales de Canarias.

OBJECTIVE: To estimate the potential cost savings that might take place in the Canary Islands Health Service (CHS) through the appropriate scientific use of preoperative tests, using information obtained from five public university hospitals. METHODS: A questionnaire was completed by 55 anesthesiologists, representing 60% of the total in the CHS. The questionnaire paid special attention to the most frequently used preoperative tests: chest radiograph, electrocardiogram, laboratory tests, and spirometry. The mean unit costs for the various preoperative tests were obtained from the two hospitals participating in the study. To calculate the potential cost savings derived from the appropriate use of preoperative tests, several scenarios were considered. These were characterized by different hypotheses or degrees of fulfillment of a protocol based on scientific knowledge and considered as the gold standard. RESULTS: In the ideal scenario in which the recommended scientific protocol was fulfilled in 100% of the 16 179 patients with an American Society of Anesthesiologists (ASA) grade of I-II, the economic impact would be notable, since it would free sensitive resources that could be used for other health programs. These figures could amount to approximately 1.02 million euros, without considering the cost of preoperative hospital stay. This figure could increase by up to approximately 2.13 million euros if one day of preoperative hospital stay were included and by up to 3.24 million euros if two days of preoperative hospital stay were included. CONCLUSIONS: The recent literature review and the results of the questionnaire applied in the CHS indicate that preoperative tests are of greatest benefit to patients and to society if their use is guided by scientific knowledge. In addition, resources can be freed by better selection and utilization of preoperative tests.

Análisis de costes y ahorros potenciales relacionadoscon la utilización de pruebas preoperatorias en los hospitalesde Canarias / Cost analysis and potential savings related to the use of preoperative tests in the hospitals of the Canary Islands [Spain]

Objetivos: Estimar el ahorro potencial que podría tener lugar en el Servicio Canario de Salud (SCS), a partir de una utilización apropiada científica de las pruebas preoperatorias, haciendo uso de la información obtenida de los 5 hospitales universitarios de la red pública. Métodos: Un total de 55 anestesiólogos (60 por ciento) del SCS cumplimentaron un cuestionario. En éste se prestó especial atención a las pruebas preoperatorias más frecuentemente utilizadas, como la radiografía de tórax, el electrocardiograma, las pruebas de laboratorio y la espirometría. Los costes unitarios medios para las diferentes pruebas preoperatorias se obtuvieron de 2 hospitales participantes en el estudio. Para calcular los ahorros potenciales derivados del uso apropiado de las pruebas preoperatorias se han considerado varios escenarios caracterizados por diferentes hipótesis o grados de cumplimiento de un protocolo basado en el conocimiento científico, considerado como parámetro de referencia. Resultados: En el caso ideal de que se cumpliera el protocolo científico recomendado en el 100 por ciento de los 16.179 pacientes considerados ASA I y II, la repercusión económica sería notable, pues supondría una liberación de recursos sensible que podría ser utilizada para otros programas de salud. Estas cifras podrían alcanzar aproximadamente los 1,02 millones de euros, sin considerar el coste de la estancia preoperatoria. Esta cifra podría incrementarse hasta, aproximadamente, los 2,13 millones de euros si incluimos un día de estancia preoperatoria, y hasta los 3,24 millones de euros incluyendo 2 días de estancia preoperatoria. Conclusiones: La revisión reciente de la literatura científica y los resultados proporcionados por el cuestionario aplicado en el SCS indican que las pruebas preoperatorias alcanzan los mayores beneficios para los pacientes y para la sociedad si se guían por el conocimiento científico. Es posible, además, liberar recursos a partir de una mejor selección y utilización de las pruebas preoperatorias (AU)

Objective: To estimate the potential cost savings that might take place in the Canary Islands Health Service (CHS) through the appropriate scientific use of preoperative tests, using information obtained from five public university hospitals. Methods: A questionnaire was completed by 55 anesthesiologists, representing 60% of the total in the CHS. The questionnaire paid special attention to the most frequently used preoperative tests: chest radiograph, electrocardiogram, laboratory tests, and spirometry. The mean unit costs for the various preoperative tests were obtained from the two hospitals participating in the study. To calculate the potential cost savings derived from the appropriate use of preoperative tests, several scenarios were considered. These were characterized by different hypotheses or degrees of fulfillment of a protocol based on scientific knowledge and considered as the gold standard. Results: In the ideal scenario in which the recommended scientific protocol was fulfilled in 100% of the 16 179 patients with an American Society of Anesthesiologists (ASA) grade of I-II, the economic impact would be notable, since it would free sensitive resources that could be used for other health programs. These figures could amount to approximately 1.02 million euros, without considering the cost of preoperative hospital stay. This figure could increase by up to approximately 2.13 million euros if one day of preoperative hospital stay were included and by up to 3.24 million euros if two days of preoperative hospital stay were included. Conclusions: The recent literature review and the results of the questionnaire applied in the CHS indicate that preoperative tests are of greatest benefit to patients and to society if their use is guided by scientific knowledge. In addition, resources can be freed by better selection and utilization of preoperative tests (AU)

[The social and economic cost of diabetes mellitus]. / Los costes socioeconómicos de la diabetes mellitus.

OBJECTIVE: To evaluate the economic impact in terms of the direct costs (health care costs) and the indirect costs (effects on production caused by mortality and morbidity) of diabetes mellitus (DM) in the Canary Islands (Spain) during 1998. DESIGN: The approach used was to study the cost of the disease through looking only at people in the productive sphere (human capital). Direct and indirect costs were calculated by using costs of prevalence, i.e. the costs caused during 1998. SETTING: Direct costs were broken down into hospital care, primary care, out-patient consultations, drugs and further tests; indirect costs, into premature mortality and time off work. Measurements and main results. The total cost of DM amounted to 6468.76 million pesetas (38.88 millio ), or the equivalent of 126 168 pesetas (758.28 ) a year for each known diabetic patient. Total direct cost of DM was 4011.51 million pesetas (24.11 million ), which amounts to 2.13% of health expenditure in the Canaries; or the equivalent of 78 240 pesetas (470.23 ) a year for each known diabetic patient. Direct cost of health care was 62% of the total cost. Total indirect cost was 2457.25 million pesetas (14.77 million ), 38% of the total cost. CONCLUSIONS: Despite the conservatism of the approach, in that the study omitted costs linked to pain and suffering, permanent disability or home care by family members, the high social and economic cost of DM patients calls for cost-effectiveness studies that would permit a more transparent debate on this question.

Los costes socioeconómicos de la diabetes mellitus / The social and economic costs of diabetes mellitus

Objetivo. Evaluar el impacto económico en términos de costes directos (costes de la asistencia sanitaria) y costes indirectos (efectos sobre la producción provocados por la mortalidad y morbilidad) de la diabetes mellitus (DM) en Canarias durante el año 1998.Diseño. El enfoque que se ha utilizado es el método del coste de la enfermedad, considerando a las personas únicamente en una esfera productiva (capital humano). Los costes directos e indirectos se han estimado utilizando los costes de la prevalencia, es decir, los costes que se producen durante el año 1998.Emplazamiento. Los costes directos se han desglosado en asistencia hospitalaria, atención primaria, consultas externas, fármacos y pruebas complementarias; los costes indirectos en mortalidad anticipada y bajas laborales. Mediciones y resultados principales. El coste total de la DM ascendió a 6.468,76 millones de pesetas (38,88 millones de e) o el equivalente a 126.168 pesetas (758,28 e) anuales por cada paciente diabético conocido. El coste directo total atribuible a la DM fue de 4.011,51 millones de pesetas (24,11 millones de e), lo que supone el 2,13 por ciento del gasto sanitario en Canarias, o el equivalente a 78.240 pesetas (470,23 e) anuales por cada paciente diabético conocido. El coste directo de la asistencia sanitaria constituyó un 62 por ciento del coste total. El coste indirecto total fue de 2.457,25 millones de pesetas (14,77 millones de e), lo que constituye un 38 por ciento del coste total. Conclusiones. A pesar de haberse adoptado un enfoque conservador, dado que el estudio no incluye los costes asociados con el dolor y sufrimiento, invalidez permanente y la atención en el hogar por parte de los familiares, el elevado coste socioeconómico de los pacientes con DM abre un camino hacia estudios coste-efectividad que permitan un debate más transparente sobre este tema (AU)

[Preoperative testing routines for healthy, asymptomatic patients in the Canary Islands (Spain)]. / Patrón de utilización de pruebas preoperatorias en una población sana y asintomática en Canarias.

OBJECTIVES: To analyze patterns of routine testing before elective/scheduled surgery in healthy/asymptomatic patients classified as ASA I or II according to the American Society of Anesthesiologists. MATERIAL AND METHOD: A questionnaire on the organization of preoperative testing was completed by anesthesiologists at five public hospitals in the Canary Islands. The questionnaire emphasized the most commonly ordered screening procedures, such as chest X-rays, electrocardiograms, laboratory tests and spirometry. RESULTS: Red cell counts were most frequently requested (for 86% of the patients), followed by platelet counts (80%) and blood chemistry (75%) and coagulation studies (72%). Least requested were urine tests and spirometry. The frequencies of electrocardiogram and chest X-ray requests fell between the two extremes, with patient age and the presence of certain indications seeming to affect whether those tests would be ordered or not. The need for such screening was perceived to increase for patients over 40 years of age. The ordering of preoperative tests varied from hospital to hospital and among anesthesiologists at a single site in spite of established protocols. CONCLUSIONS: Hospitals and individual anesthesiologists differ considerably in how they request preoperative tests. The variations can not be explained solely by differing patient needs given that respondents were contemplating only healthy/asymptomatic individuals undergoing relatively simple procedures.

Patrón de utilización de pruebas preoperatorias en una población sana y asintomática en Canarias / Preoperative testing routines for healthy, asymptomatic patients in the Canary Islands (Spain)

OBJETIVO. Evaluar los patrones de uso de las pruebas preoperatorias rutinarias en cirugía electiva y programada a pacientes sanos y asintomáticos, considerados ASA I y II por la Sociedad Americana de Anestesiólogos. MATERIAL Y MÉTODO. Un cuestionario fue cumplimentado por los anestesiólogos de los 5 hospitales públicos de Canarias para conocer cómo se organiza la selección de pruebas preoperatorias. En el cuestionario se prestó especial atención a las pruebas preoperatorias más frecuentemente utilizadas, como la radiografía de tórax, el electrocardiograma, las pruebas de laboratorio y la espirometría. RESULTADOS. De los resultados del cuestionario se desprende que la hematimetría es la determinación que con más frecuencia se efectúa (86 por ciento de los pacientes), seguida por el recuento de plaquetas (80 por ciento), la bioquímica sanguínea (75 por ciento) y el estudio de coagulación (72 por ciento). En el extremo opuesto se sitúa el estudio de orina seguido de la espirometría. La frecuencia intermedia de utilización corresponde al electrocardiograma y a la radiología de tórax, si bien la realización de estas dos pruebas parece estar condicionada por la edad de los pacientes y la concurrencia de indicaciones especiales. El límite de edad a partir del cual se considera que aumenta la necesidad de estas pruebas es situado en los 40 años. Se describen variaciones en la realización de pruebas preoperatorias, tanto entre los anestesiólogos de diferentes hospitales como dentro de cada centro hospitalario, a pesar de la existencia de protocolos en cada uno de ellos. CONCLUSIONES. Existen importantes variaciones en los patrones de uso de las pruebas preoperatorias entre hospitales y entre profesionales que no pueden ser explicadas únicamente por la diferencia de necesidad entre los pacientes, dado que la información requerida afectaba a enfermos sanos y asintomáticos, en los que las intervenciones quirúrgicas previstas eran de bajo grado de complejidad (AU)