Emergency Department Use by Community-Dwelling Individuals With Dementia in the United States: An Integrative Review
Tóm tắt
As part of the National Plan to Address Alzheimer's Disease, reducing potentially avoidable emergency department (ED) use by individuals with dementia has been identified as a component of enhancing the quality and efficiency of care for this population. To help inform the development of interventions to achieve this goal, an integrative review was conducted to: (a) compare rates and reasons for ED visits by community-dwelling individuals with and without dementia, considering also the effect of dementia subtype and severity; and (b) identify other risk factors for increased ED use among community-dwelling individuals with dementia. Nineteen articles met inclusion criteria. Individuals with dementia had higher rates of ED visits compared to those without dementia, although differences were attenuated in the last year of life. Increased symptoms and disability were associated with increased rates of ED visits, whereas resources that enabled effective management of increased need decreased rates. Gerontological nurses across settings are on the frontlines of preventing potentially avoidable ED visits by community-dwelling individuals with dementia through patient and family education and leadership in the development of new models of care. [
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Tài liệu tham khảo
Andersen R.M. (1968). Behavioral model of families' use of health service. Chicago, IL: University of Chicago Center for Health Administration Studies.
Andersen R.M., Davidson P.L. (2007). Improving access to care in America: Individual and contextual indicators. In , Andersen R.M., Thomas T.H., Kominski G.F. (Eds.), Changing the U.S. health care system: Key issues in health services policy and management (3rd ed.). San Francisco, CA: John Wiley & Sons.
Fillit H., Hill J.W., Futterman R. (2002). Health care utilization and costs of Alzheimer's disease: The role of co-morbid conditions, disease stage, and pharmacotherapy. Family Medicine, 34, 528–535.
Medicare Payment Advisory Committee. (2014). Measuring quality of care in Medicare: Feasibility of measuring population-based outcomes: Potentially preventable admissions and emergency department visits . Retrieved from http://www.medpac.gov/docs/default-source/reports/chapter-3-online-only-appendixes-measuring-quality-of-care-in-medicare-june-2014-report-.pdf?sfvrsn=0
U.S. Department of Health and Human Services. (2014). National plan to address Alzheimer's disease: 2014 update . Retrieved from https://aspe.hhs.gov/national-plan-address-alzheimer%E2%80%99s-disease-2014-update
Viswanathan M., Berkman N.D., Dryden D.M., Hartling L. (2013). Assessing risk of bias and confounding in observational studies of interventions or exposures: Further development of the RTI Item Bank. Rockville, MD: Agency for Healthcare Research and Quality.