Frail patients’ hospital resource use, outcomes, and care transitions - An analysis of the English NHS
File(s)
Author(s)
Bui, Khanh
Type
Thesis or dissertation
Abstract
Background
There has been an increasing focus on developing novel frailty instruments through the use of routinely collected data in recent years for higher feasibility and cost-efficient frailty identification in the population. Following this shift, little is yet explored in literature on the impact of different components of frailty on costs, its transition patterns, and its impact on elemental health outcomes of the population.
Methodology
Three observational studies were conducted using Hospital Episode Statistics database from 2004 to 2013. Study 1 employed the generalised linear and negative binomial models to assess the impact of the different dimensions of frailty syndromes on admission costs and resource use, and the differences in cost impact between seven frailty syndromes. Study 2 employed the multistate model to examine the transition probabilities between frailty states and factors that influence a patient’s frailty state. Study 3 used bivariate probit model to assess the association between frail patients who had experienced inter-hospital transfers (IHTs) and their probability of having adverse outcomes.
Results
In Study 1, patients with frail syndromes were older, more likely to be female, living in more deprived areas, and more likely to have higher annual admission costs, more emergency hospital admissions and longer length of stay. In Study 2, frailty was found to be a dynamic process with heterogenous transition probabilities between states. Age, gender, source of admission, and deprivation index were associated with changes in the frailty states. In Study 3, IHTs were associated with lower in-hospital mortality, longer length of stay, higher probability of readmission, and higher probability of discharge to home for frail patients.
Conclusions
The findings from this thesis advocate future initiatives on programme interventions and clinical trials with a focus on the frail patient group to reduce their costs of services and prevent or diminish progression to higher stages of frailty and adverse outcomes.
There has been an increasing focus on developing novel frailty instruments through the use of routinely collected data in recent years for higher feasibility and cost-efficient frailty identification in the population. Following this shift, little is yet explored in literature on the impact of different components of frailty on costs, its transition patterns, and its impact on elemental health outcomes of the population.
Methodology
Three observational studies were conducted using Hospital Episode Statistics database from 2004 to 2013. Study 1 employed the generalised linear and negative binomial models to assess the impact of the different dimensions of frailty syndromes on admission costs and resource use, and the differences in cost impact between seven frailty syndromes. Study 2 employed the multistate model to examine the transition probabilities between frailty states and factors that influence a patient’s frailty state. Study 3 used bivariate probit model to assess the association between frail patients who had experienced inter-hospital transfers (IHTs) and their probability of having adverse outcomes.
Results
In Study 1, patients with frail syndromes were older, more likely to be female, living in more deprived areas, and more likely to have higher annual admission costs, more emergency hospital admissions and longer length of stay. In Study 2, frailty was found to be a dynamic process with heterogenous transition probabilities between states. Age, gender, source of admission, and deprivation index were associated with changes in the frailty states. In Study 3, IHTs were associated with lower in-hospital mortality, longer length of stay, higher probability of readmission, and higher probability of discharge to home for frail patients.
Conclusions
The findings from this thesis advocate future initiatives on programme interventions and clinical trials with a focus on the frail patient group to reduce their costs of services and prevent or diminish progression to higher stages of frailty and adverse outcomes.
Version
Open Access
Date Issued
2022-11
Date Awarded
2023-02
Copyright Statement
Creative Commons Attribution NonCommercial Licence
Advisor
Mossialos, Elias
Kristensen, Søren
Sponsor
National Institute for Health Research (Great Britain)
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)