Journal Article

Hospitalization and rehospitalization in Parkinson disease patients: Data from the National Parkinson Foundation Centers of Excellence

Okun, Michael S., Pei, Qinglin, Schmidt, Peter, Martinez-Ramirez, Daniel, Hassan, Anhar, Shahgholi, Leili, Wu, Samuel S., De Jesus, Sol, Armstrong, Melissa J.

2017

نظرة عامة

Patients with Parkinson disease (PD) are at high risk of hospital encounters with increasing morbidity and mortality. This study aimed to determine the rate of hospital encounters in a cohort followed over 5 years and to identify associated factors. We queried the data from the International Multicenter National Parkinson Foundation Quality Improvement study. Multivariate logistic regression with backward selection was performed to identify factors associated with hospital encounter prior to baseline visit. Kaplan-Meier estimates were obtained and Cox regression performed on time to hospital encounter after the baseline visit. Of the 7,507 PD patients (mean age 66.5±9.9 years and disease duration 8.9±6.4 years at baseline visit), 1919 (25.6%) had a history of a hospital encounter prior to their baseline visit. Significant factors associated with a history of a hospital encounter prior to baseline included race (white race: OR 0.49), utilization of physical therapy (OR 1.47), history of deep brain stimulation (OR 1.87), number of comorbidities (OR 1.30), caregiver strain (OR 1.17 per standard deviation), and the standardized Timed Up and Go Test (OR 1.21). Patients with a history of hospitalization prior to the baseline were more likely to have a re-hospitalization (HR1.67, P<0.0001) compared to those without a prior hospitalization. In addition, the time to hospital encounter from baseline was significantly associated with age and number of medications. In patients with a history of hospitalization prior to the baseline visit, time to a second hospital encounter was significantly associated with caregiver strain and number of comorbidities. Hospitalization and re-hospitalization were common in this cohort of people with PD. Our results suggest addressing caregiver burden, simplifying medications, and emphasizing primary and multidisciplinary care for comorbidities are potential avenues to explore for reducing hospitalization rates.

• الناشر: Public Library of Science,Public Library of Science (PLoS)
• موضوع: Age / Aged / Arthritis / Brain / Burnout, Professional - psychology / Caregivers / Caregivers - psychology / Comorbidity / Comorbidity - trends / Continental Population Groups / Data collection / Deep brain stimulation / Deep Brain Stimulation - statistics & numerical data / Diabetes / Emergency medical care / Female / Foundations / Health aspects / Hospitalization / Hospitalization - statistics & numerical data / Hospitals / Humans / Identification methods / Logistic Models / Male / Medicine and Health Sciences / Middle Aged / Morbidity / Mortality / Movement disorders / Neurodegenerative diseases / Neurology / Parkinson disease / Parkinson Disease - ethnology / Parkinson Disease - physiopathology / Parkinson Disease - therapy / Parkinson's disease / Patients / People and Places / Physical Therapy Modalities - statistics & numerical data / Prospective Studies / Quality control / Quality of life / Questionnaires / Race / Simplification / Society / Stimulation / Surveys and Questionnaires / Therapy