The impact of primary care quality on inpatient length of stay for people with dementia: an analysis by discharge destination
Notice bibliographique
Résumé
Dementia is a chronic and progressive condition involving memory loss, mood swings, and difficulties in communication, mobility, reasoning and self-care. Older people with dementia occupy up a quarter of NHS hospital beds and tend to have prolonged hospital stays. Being admitted to hospital can have a significant negative impact on the person’s physical and mental health, and have an emotional impact on carers. As part of a national scheme known as the Quality and Outcomes Framework (QOF), GPs are rewarded for providing an annual review for patients with dementia. In the review, the GP checks the patient’s physical and mental health, and the support needs of the patient and carer. The GP also ensures services are coordinated across different parts of the system, e.g. that the patient is linked to community mental health services who can support them at home after a hospital stay. So does the QOF dementia review help achieve timely discharge from hospital? We used several large linked datasets to answer this question, analysing data on around 36,700 people from 2006 to 2010. The analyses took account of the influence of the GP practice with which people were registered and adjusted for other factors that might shorten or lengthen hospital stay. On average, hospital stay for people with dementia was around 18 days but was longer for those who were subsequently discharged to a care home (33 days). The QOF review had little effect on length of stay, with slightly shorter stays achieved only for individuals discharged back into the community and slightly longer stays for those who were discharged to a care home. Older people tended to be discharged from hospital more quickly than younger people, and Sunday admissions were shorter than admissions initiated on other days of the week. Unsurprisingly, people with multiple conditions had longer stays. Better availability of social care options – care home beds, or local authority intermediate care facilities – was linked to shorter hospital stays, which suggests that these sorts of services can be used instead of hospital care if they can be accessed. Another finding was that intense levels of unpaid care are associated with longer hospital stays – so it’s particularly important that GPs make sure these types of carer are well supported.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,012 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,010 |
| Bibliométrie | 0,003 | 0,005 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,003 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».