Björkstedt Eeva, Voutilainen Ari, Hyttinen-Huotari Virva, Jyrkkä Johanna, Mäntyselkä Pekka, Lönnroos Eija
Wellbeing Services County of South Savo, Savonlinna Social and Health Centre, Mikkeli, Finland; Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
Institute of Public Health and Clinical Nutrition, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
J Am Med Dir Assoc. 2025 Jan;26(1):105308. doi: 10.1016/j.jamda.2024.105308. Epub 2024 Oct 18.
To examine factors, diagnoses, and costs associated with emergency department (ED) visits among home care clients.
A prospective 1-year follow-up study.
More information is needed regarding the reasons and costs associated with ED visits by home care clients. Participants were persons aged ≥65 years living in Eastern Finland and receiving regular home care services (n = 293).
Data collection included clients' demographics, health status (Charlson Comorbidity Index), medication use, assessments of physical (Timed Up and Go) and cognitive functioning (Mini-Mental State Examination), Basic and Instrumental Activities of Daily Living, mood (Geriatric Depression Scale, GDS-15) and health-related quality of life [HRQoL, EuroQol (EQ-5D-3 L)]. Logistic regression and univariate analyses of variance were conducted. The costs (total and per person-year) of ED visits were calculated.
The number of ED visits was 775 during the follow-up (mean 350 days). The likelihood of ED visits was reduced by better HRQoL and increased by a higher GDS-15 score, longer TUG times, and a history of heart failure and decreased glomerular infiltration. The most common primary diagnoses for ED visits were heart failure (8.4%), atrial fibrillation (4.0%), respiratory infection (4.0%), and cystitis (3.5%). The total costs of all ED visits during the follow-up were 251,247 € and internal medicine and surgery accounted for 142,726 € and 89,212 € of the cost, respectively. The costs per person-year were 981 €.
HRQoL, depressive symptoms, mobility, and heart and renal failure were associated with the number of ED visits. The most common reasons for ED visits were chronic heart conditions and infectious diseases and the highest costs were incurred by internal medicine treatment. With advanced care planning and active symptom screening and cooperation of home care nurses and physicians, some of the ED visits, for example due to heart failure, might be preventable.
研究居家护理患者急诊科就诊的相关因素、诊断及费用。
一项前瞻性1年随访研究。
关于居家护理患者急诊科就诊的原因和费用，需要更多信息。参与者为居住在芬兰东部、年龄≥65岁且接受定期居家护理服务的人群（n = 293）。
数据收集包括患者的人口统计学信息、健康状况（查尔森合并症指数）、用药情况、身体功能评估（计时起立行走测试）和认知功能评估（简易精神状态检查表）、日常生活基本活动和工具性活动、情绪（老年抑郁量表，GDS-15）以及健康相关生活质量[HRQoL，欧洲五维度健康量表（EQ-5D-3L）]。进行了逻辑回归和单因素方差分析。计算了急诊科就诊的费用（总计及每人每年）。
随访期间急诊科就诊次数为775次（平均350天）。HRQoL越好，急诊科就诊的可能性越低；GDS-15评分越高、计时起立行走测试时间越长、有心力衰竭病史以及肾小球滤过率降低，则急诊科就诊的可能性越高。急诊科就诊最常见的主要诊断为心力衰竭（8.4%）、心房颤动（4.0%）、呼吸道感染（4.0%）和膀胱炎（3.5%）。随访期间所有急诊科就诊的总费用为251,247欧元，内科和外科费用分别占142,726欧元和89,212欧元。每人每年的费用为981欧元。
HRQoL、抑郁症状、活动能力以及心脏和肾衰竭与急诊科就诊次数相关。急诊科就诊最常见的原因是慢性心脏疾病和传染病，内科治疗费用最高。通过提前护理规划、积极的症状筛查以及居家护理护士和医生的合作，一些急诊科就诊，例如因心力衰竭导致的就诊，可能是可以预防的。
