Convention Hall A May 14, 2019 invited abstract
Masterclass 13:15 - 14:29

Transferring Patients from Hospital to Community

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M2.1a Ortho-Geriatrics - from Hospital to Community.pdf

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M2.1b Ortho-Geriatrics - from Hospital to Community.pdf

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M2.2 When Frailty Meets Chronic Diseases in Old Age, What Should We Do?.pdf

M2.3 Redesigning Care for Patients at Increased Risk of Hospitalisation

Ortho-Geriatrics - from Hospital to Community
13:20 - 13:40
Presented by : Dr. Sheung Wai Law
The main goal of management for Geriatric fragility fractures is to achieve an optimal functional state with maximal independence in community. This cannot be achieved without a care pathway with Ortho-geriatric collaboration and community partnership. A clinical pathway management with medical-social collaboration for fragility fracture provides a cross-sector platform for healthcare and social professionals from different disciplines to organize their rehabilitation and support services in a coherent and consistent manner. Patient with fragility fractures discharged from Hospital will be referred to community partner with mutually-agreed assessment tools and training protocols, offering the best chance for successful outcomes in a cost-effective way. A seamless integration of medical, rehabilitation and social supports in a cross-sector clinical pathway. Lifestyle adjustment, social and community reintegration, and competence building of both patients and their caregivers optimize independence. In long run, it enhances the overall effectiveness of the local hospital and rehabilitation systems and facilitates aging in place.
Ortho-Geriatrics - from Hospital to Community
13:20 - 13:40
Presented by : Dr. Patrick Chiu

Geriatric hip fracture contributes significant morbidity and mortality to older people. The number of fragility hip fracture is expected to increase exponentially over the next 30 years as a result of increased life expectancy and population growth. Older adults with fragility fractures tend to have frailty and multiple comorbidities. Treatment is not only focusing on the orthopaedic problem, but also the geriatric issues associated with the fracture. To improve treatment outcomes, multidisciplinary treatment approaches with involvement of different healthcare professionals in the care pathway has been implemented. In this talk, the role of geriatrician, in particular, the comprehensive geriatric assessment (CGA) of patients with fragility fractures will be highlighted. CGA is a multidimensional and interdisciplinary process that seeks to determine the medical problems, functional and mental capacity, nutritional status and social situation of older patients in order to develop a coordinated and integrated care plan for treatment and long-term follow-up. In patients with fragility hip fracture, CGA and management emphasizes on collateral history, assessment of co-morbidities, medication review, optimization of medical conditions, peri-operative care and discharge planning. Furthermore, the importance of continuity of care when discharged from hospital, namely community rehabilitation, fall prevention, bone health, secondary prevention of fractures and follow-up, will also be emphasized.

When Frailty Meets Chronic Diseases in Old Age, What Should We Do?
13:40 - 14:00
Presented by : Dr. Tung Wai Au Yeung
With ageing of the society, chronic diseases management has become a priority among various public health issues. Moreover, ageing is also associated with frailty, which can alter the treatment goal and method of chronic disease management. In this talk, I am going to give a brief introduction about age-associated frailty syndrome and then how it can and should re-orientate our treatment goals and strategy in chronic disease management. I shall use diabetes in old age as a prototype of age-associated frailty syndrome and present an update perspective about management of frailty in older patients with diabetes mellitus. In addition, the importance of nutrition, resistive exercise and muscle strength preservation will be discussed in the prevention and intervention of frailty.
Redesigning Care for Patients at Increased Risk of Hospitalisation
14:00 - 14:20
Presented by : Dr. Andrew SCHRAM

Coordination of inpatient and outpatient care is an important challenge in improving population health, but evidence examining the effectiveness of existing care coordination programs is mixed. To address this need, the Comprehensive Care Physician (CCP) Program at The University of Chicago provides patients at increased risk of hospitalization the opportunity to receive inpatient and outpatient care from the same physician. We compared patient satisfaction, self-related health general and mental health status, and self–reported hospitalization rates of patients randomly assigned to the CCP program vs. standard care (SC) in which patients receive inpatient care from hospitalists and outpatient care from a primary care physician who does not care for them in the hospital. 

Two-thousand Medicare patients with at least 1 hospitalization in the past year or in the emergency department at the time of recruitment were randomly assigned in equal proportions to CCP or SC between November 2012 and June 2016. Patients were surveyed every 3 months by telephone for a minimum of 1 year and maximum of 5 years to assess patient experience with their primary physician, general and mental health status, and hospitalization rate. Longitudinal outcomes were analyzed using mixed-effect regression models. 

At baseline, mean age was 63 years, 62% were female, 88% were black, and 45% were eligible for both Medicare and Medicaid. There were no statistically significant differences in demographic or health measures between CCP and SC patients at baseline. Follow-up rates to 1 year were 95% for CCP and 85% for SC. Mean patient satisfaction ratings of their physicians were 0.27 points higher for CCP vs. SC patients (p0. 0001, 95% CI:[0.16, 0.37]), corresponding to the difference between the 80th percentile and 95th percentile in such scores nationally. Mean self-rated health status measured from 1 (poor) to 5 (excellent), was not significantly different for CCP vs. SC for general health (DCCP-SC=-0. 001, p=0. 9701, 95%CI: [-0.06, 0.06]), but were 0.11 higher for CCP compared to SC mental health (p=0. 0033 95% CI: [0.03, 018]). Using a zero-inflated Poisson mixed-model, the rate of hospitalization was 22% lower and statistically significant (p=0.030, event rate ratio 0.78, 95% CI: [0.62, 0.98]) for CCP compared to the SC at the first 3-month follow-up wave and remained at least 15% below SC and statistically significant up to the minimum 1 year follow-up.

These findings suggest that the CCP model may improve patient experience and health status while substantially reducing utilization for patients at increased risk of hospitalization.


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