A new model of multidimensional discharge planning: continuity of care for frail and complex inpatients.

OBJECTIVE: Delays in patient discharge can adversely affect hospital and emergency room productivity and increase healthcare costs. The discharge should be structured from the hospital admission towards the most appropriate environment. This study aims to investigate the efficacy of the Unit, named "Continuity of Care Center" (CCC), to guarantee a safest and fastest hospital discharge in frail patients and to test the effect of our team-approach on hospital outcomes (length of stay and hospital mortality). MATERIALS AND METHODS: This is a prospective cohort study carried out in an acute care hospital with 1,558 beds and is equipped with 41 operating theaters. We collected data from October 2016 to June 2019. RESULTS: The time of patient discharge had an important reduction: 15.5±30.8 in the first 3 months vs. 11.0±20.1 in the last 3 months considered. The median of the time of discharge in all 12 months considered was 12 day. The length of stay presented an important reduction from 33.3±47.5 during the first 3 months vs. 28.8±39.5 in the last 3 months of activity of CCC; and a significant reduction of hospital deaths was recorded from 20% during the first 3 months to 14% in the last 3 months of activity of CCC. CONCLUSIONS: Results indicate a constant decrease in patient discharge time and length of hospital stay, with a consequent significant reduction of healthcare costs. According to the estimates of Italian Health Ministry concerning Latium region, every hospitalization day has a mean cost of € 674.00. Thus, the CCC activity has contributed to a reduction of approximately 12,832 days of hospitalization, in the considered period, with an estimated hospital saving of € 8,648,761.

Prevalence of cognitive and functional impairment in an elderly Puerto Rican population.

Data from the Gurabo census of the elderly, 1987-1988 (n = 1890) were analyzed to determine the prevalence rates for cognitive and functional impairment in that population. Besides socio-demographic questions, the census questionnaire included the Short Portable Mental Status Questionnaire to determine cognitive dysfunction, and the modified Katz Scale to detect functional impairment. The overall prevalence rates were 18.5% and 18.4% for cognitive and functional dysfunction respectively. After multiple logistic regression analysis, cognitive impairment was found to be associated with poor education (OR = 4.0, CI = 2.31-6.93), older age (OR = 2.67, C.I. = 2.00-3.58), functional decline (OR = 2.44, C.I. = 1.83-3.25), female sex (OR = 1.82, C.I. = 1.39-2.40) and low income (OR = 1.49, C.I. = 113-1.98). Functional impairment was found to be associated with cognitive dysfunction (OR = 2.45, C.I. = 1.84-3.27) and older age (OR = 2.08, C.I.-1.59 = 2,72). These findings suggest that a substantial proportion of the elderly in Puerto Rico may require assistance to deal with the consequences of these impairments.

The Kren-Akorore: a recently contacted indigenous tribe.

Primitive groups of people, living in complete isolation, are rarely encountered these days. In fact, the process of 'approximation', or contact, depends upon decisions made on both sides--that representing the civilized world and that representing the group called by us 'primitive'. The isolated group, however, can never perceive the tremendous risks its members will inevitably encounter one the barrier of isolation, by which they are protected, has been broken. Civilized man has the means of persuasion and attraction at his disposal and also knows the risks involved. It must therefore be his responsibility to protect and preserve the group right from the initial contact. In spite of the medical resources available, primitive man has paid heavily in human lives through contact with the civilized world. This raises two equally important question: (a) have medical resources been thoroughly applied to protect these groups? And (b) are the existing medical resources sufficient to ensure the survival of primitive man once his state of isolation has been broken? Without any definite answers to these questions, we are limited to describing our experiences with the Kren-Akorore Indians, recently contacted in Central Brazil. We also present data on the biological characteristics of these Indians, collected two years after the first contact.