Potentially preventable hospitalizations-The 'pre-hospital syndrome': Retrospective observations from the MonashWatch self-reported health journey study in Victoria, Australia

Abstract

Rationale, aims, and objectives: HealthLinks: Chronic Care is a state-wide public hospital initiative designed to improve care for cohorts at-risk of potentially preventable hospitalizations at no extra cost. MonashWatch (MW) is an hospital outreach service designed to optimize admissions in an at-risk cohort. Telehealth operators make regular phone calls (≥weekly) using the Patient Journey Record System (PaJR). PaJR generates flags based on patient self-report, alerting to a risk of admission or emergency department attendance. 'Total flags' of global health represent concerns about self-reported general health, medication, and wellness. 'Red flags' represent significant disease/symptoms concerns, likely to lead to hospitalization.

Methods: A time series analysis of PaJR phone calls to MW patients with ≥1 acute non-surgical admissions in a 20-day time window (10 days pre-admission and 10 days post-discharge) between 23 December 2016 and 11 October 2017. Pettitt's hypothesis-testing homogeneity measure was deployed to analyse Victorian Admitted Episode/Emergency Minimum Datasets and PaJR data.

Findings: A MW cohort of 103 patients (mean age 74 ± 15 years; with 59% males) had 263 admissions was identified. Bed days ranged from <1 to 37.3 (mean 5.8 ± 5.8; median 4.1). The MW cohort had 7.6 calls on average in the 20-day pre- and post-hospital period. Most patients reported significantly increased flags 'pre-hospital' admission: medication issues increased on day 7.0 to 8.5; total flags day 3, worse general health days 2.5 to 1.8; and red flags of disease symptoms increased on day 1. These flags persisted following discharge.

Discussion/conclusion: This study identified a 'pre-hospital syndrome' similar to a post-hospital phase aka the well-documented 'post-hospital syndrome'. There is evidence of a 10-day 'pre-hospital' window for interventions to possibly prevent or shorten an acute admission in this MW cohort. Further validation in a larger diverse sample is needed.

Keywords: health transitions; patient journeys; post-hospital syndrome; readmission; time series.