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Research

Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation

Adrian Baker, Paul Leak, Lewis D Ritchie, Amanda J Lee and Shona Fielding
British Journal of General Practice 2012; 62 (595): e113-e120. DOI: https://doi.org/10.3399/bjgp12X625175
Adrian Baker
Roles: GP, Lodgehill Clinic, Nairn
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Paul Leak
Roles: integrated resourcing lead
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Lewis D Ritchie
Roles: James Mackenzie Professor of General Practice
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Amanda J Lee
Roles: professor in medical statistics
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Shona Fielding
Roles: lecturer in medical statistics
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Article Figures & Data

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    Figure 1

    Overview of study results.

  • Appendix 2
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    Appendix 2

    Receiver operator characteristic (ROC) curve for the Nairn Case Finder.

Tables

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    Table 1

    Characteristics of the anticipatory care plan (ACP) and control cohorts

    CharacteristicACP patients (n = 96)Controls (n = 96)P-value
    Male, n (%)34 (35.4)40 (41.7)0.345a
    Age in years, mean (SD)80.6 (9.3)79.5 (11.6)0.352b
    Risk score
     Maximum71.871.8–
     Minimum2.22.2–
     Median (IQR)34.3 (24.5 to 41.8)36.7(24.6 to 44.1)
    • ↵a McNemar test.

    • ↵b Paired t-test. IQR = interquartile range. SD = standard deviation.

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    Table 2

    Hospitalisation data for survivors

    AdmissionsOccupied bed daysCost, £
    Total, nMedian (IQR)RateTotal, nMedian (IQR)RateTotal, nMedian (IQR)Rate
    ACP patients (n = 80)
    Pre870.5 (0–2)1.09981.60.17 (0–12.75)12.27333 020101 (0–4879)4162.75
    Post500 (0–1)0.63471.60 (0 –3.92)5.9171 0760 (0–1879)2138.45
    Difference−370 (−0–1)−0.46−5100 (0 –3.92)−6.38−161 9440 (−3261–0)−2024.3
    Within-group P-value0.0020.0200.029
    Controls (n = 81)
    Pre800 (0–2)0.991284.90 (0–7)15.86418 3350 (0–2579)5164
    Post610 (0–1)0.751122.30 (0–4.5)13.86368 1730 (0–1731)4545.35
    Difference−190 (−1–0)−0.23−162.60 (0–2.67)−2.01−50 1620 (−1327–0)−619.28
    Within-group P-value0.0870.1880.221
    Between-group P-value0.5380.4140.538
    • ACP = anticipatory care plan. IQR = interquartile range.

    • View popup
    Table 3

    Results of nested mixed-effects models for individual lengths of stay for survivors

    Total admissionsPre-post95% CIP-value
    ACP patients: district general hospital713.57−2.78 to 9.900.27
    ACP patients: community64−1.76−6.28 to 2.730.43
    Controls: district general hospital64−1.82−8.95 to 5.300.61
    Controls: community711.25−17.0 to 19.50.89
    • ACP = anticipatory care plan.

    • View popup
    Table 4

    Details on transfers and admissions for survivors

    Admitted patients, n (%)Total admissionsNumber of transfersTransfers as % of admissions
    ACP patients (n = 80)
     Pre-intervention40 (50.0)8766.9
     Post-intervention26 (32.5)501020.0
    Controls (n = 81)
     Pre-intervention38 (46.9)801113.8
     Post-intervention26 (32.1)611219.7
    • ACP = anticipatory care plan.

    • View popup
    Table 5

    Hospitalisation data for decedents in the 3 months before death

    AdmissionsOccupied bed daysCost, £
    Total, nMedian (IQR)RateTotal, nMedian (IQR)RateTotal, nMedian (IQR)Rate
    ACP patients (n = 16)140 (0–2)0.881341.67 (0–20)8.3845 75890 (0–6610)2859.9
    Controls (n = 15)241 (0–3)1.6307.9910 (0.33–6)20.5104 0513540 (131–11 626)6936.7
    Between-group P-value0.0630.0450.036
    • ACP = anticipatory care plan. IQR = interquartile range.

    • View popup
    Table 6

    Results of nested mixed-effects models for decedents’ individual lengths of stay in last 3 months of life

    Difference in length of stay
    Total admissionsControl ACP patients95% CIP-value
    Community223.25 days−7.41 to 13.90.52
    District general hospital186.86 days−17.2 to 31.00.55
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British Journal of General Practice: 62 (595)
British Journal of General Practice
Vol. 62, Issue 595
February 2012
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Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation
Adrian Baker, Paul Leak, Lewis D Ritchie, Amanda J Lee, Shona Fielding
British Journal of General Practice 2012; 62 (595): e113-e120. DOI: 10.3399/bjgp12X625175

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Anticipatory care planning and integration: a primary care pilot study aimed at reducing unplanned hospitalisation
Adrian Baker, Paul Leak, Lewis D Ritchie, Amanda J Lee, Shona Fielding
British Journal of General Practice 2012; 62 (595): e113-e120. DOI: 10.3399/bjgp12X625175
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    • INTRODUCTION
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Keywords

  • admission
  • advance care planning
  • end-of-life care
  • general practice
  • patient readmission

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