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Joan D Penrod

Publications and source records attributed to Joan D Penrod.

9 recordsLinked to original sources
PubMed2006

Early ambulation after hip fracture: effects on function and mortality.

BACKGROUND: Few studies have examined the relationship between inpatient bed rest and functional outcomes. We examined how immobility is associated with function and mortality in patients with hip fracture. METHODS: We conducted a prospective cohort study of 532 patients 50 years and older, who were treated with surgery after hip fracture in 4 hospitals in New York. We collected information from hospital visits, medical records, and interviews. "Days of immobility" was defined as days until the patient moved out of bed beyond a chair. Follow-up was obtained on function (using the Functional Independence Measure) at 2 and 6 months and on survival at 6 months. RESULTS: Patients with hip fracture experienced an average of 5.2 days of immobility. Compared with patients with a longer duration of immobility (ie, at the 90th percentile) in adjusted analyses, patients at the 10th percentile of immobility had lower 6-month mortality (-5.4%; 95% confidence interval [CI], -10.9% to -1.0%) and better Functional Independence Measure score for locomotion (0.99 points; 95% CI, 0.3 to 1.7 points, with higher values indicating better function), but there was no significant difference in locomotion by 6 months (0.58 points; 95% CI, -0.3 to 1.4 points). The adverse association of immobility was strongest in patients using personal assistance or supervision with locomotion at baseline (difference in 6-month mortality between the 90th and 10th percentile of immobility was -17.1% [P = .004] for this group and only 1.2% [P = .38] for patients independent in locomotion at baseline). CONCLUSION: In patients with hip fracture, delay in getting the patient out of bed is associated with poor function at 2 months and worsened 6-month survival.

Aged, 80 and over↗
PubMed2006

Cost and utilization outcomes of patients receiving hospital-based palliative care consultation.

OBJECTIVE: To compare per diem total direct, ancillary (laboratory and radiology) and pharmacy costs of palliative care (PC) compared to usual care (UC) patients during a terminal hospitalization; to examine the association between PC and ICU admission. DESIGN: Retrospective, observational cost analysis using a VA (payer) perspective. SETTING: Two urban VA medical centers. MEASUREMENTS: Demographic and health characteristics of 314 veterans admitted during two years were obtained from VA administrative data. Hospital costs came from the VA cost accounting system. ANALYSIS: Generalized linear models (GLM) were estimated for total direct, ancillary and pharmacy costs. Predictors included patient age, principal diagnosis, comorbidity, whether patient stay was medical or surgical, site and whether the patient was seen by the palliative care consultation team. A probit regression was used to analyze probability of ICU admission. Propensity score matching was used to improve balance in observed covariates. RESULTS: PC patients were 42 percentage points (95% CI, -56% [corrected] to -31%) less likely to be admitted to ICU. Total direct costs per day were $239 (95% CI, -387 to -122) lower and ancillary costs were $98 (95% CI, -133 to -57) lower than costs for UC patients. There was no difference in pharmacy costs. The results were similar using propensity score matching. CONCLUSION: PC was associated with significantly lower likelihood of ICU use and lower inpatient costs compared to UC. Our findings coupled with those indicating better patient and family outcomes with PC suggest both a cost and quality incentive for hospitals to develop PC programs.

Aged↗
PubMed2006

Effect of inpatient quality of care on functional outcomes in patients with hip fracture.

OBJECTIVES: We sought to examine the relationship between functional outcome and process of care for patients with hip fracture. RESEARCH DESIGN AND PARTICIPANTS: We undertook a prospective cohort study in 4 hospitals of 554 patients treated with surgery for hip fracture. MEASUREMENTS: Information on patient characteristics and processes of hospital care collected from the medical record, interviews, and bedside observations. Follow-up information obtained at 6 months on function (using the Functional Independence Measure [FIM]), survival, and readmission. RESULTS: Individual processes of care were generally not associated with adjusted outcomes. A scale of 9 processes related to mobilization was associated with improved adjusted locomotion (P = 0.006), self care (P = 0.022), and transferring (P = 0.007) at 2 months, but the benefits were smaller and not significant by 6 months. These processes were not associated with mortality. The predicted value for the FIM locomotion measure (range, 2-14) at 2 months was 5.9 (95% confidence interval 5.4-6.4) for patients at the 10th percentile of performance on these processes compared with 7.1 (95% confidence interval 6.6, 7.6) at the 90th percentile. Patients who experienced no hospital complications and no readmissions retained the benefits in locomotion at 6 months. Anticoagulation processes were associated with improved transferring at 2 months (P = 0.046) but anticoagulation and other processes of care were not otherwise associated with improved function. DISCUSSION: Our findings indicate the need to attend to all steps in the care of patients with hip fracture. Additionally, functional outcomes were more sensitive markers of improved process of care, compared with 6-month mortality, in the case of hip fracture.

Aged, 80 and over↗
PubMed2004

Types and rate of implementation of palliative care team recommendations for care of hospitalized veterans.

BACKGROUND: Hospital-based interdisciplinary palliative care teams (PCTs) are increasingly being established to meet the growing demand for high quality care for patients with life-limiting illnesses in which the goal is comfort rather than cure. Two recent studies suggest that PCTs teams are highly effective in influencing care of patients within large academic medical centers. The current study examines whether the previously demonstrated success of palliative care teams within subspecialty academic health centers could be replicated in an urban Veterans Affairs medical center (VAMC). OBJECTIVE: To describe the characteristics of patients referred to, recommendations made by, and implementation rate of an interdisciplinary PCT in an urban VAMC. DESIGN: Retrospective, observational study. SETTING/SUBJECTS: One hundred patients referred by inpatient doctor to the PCT between October 1999 and March 2002 in a 214-bed VA hospital in the New York City area. MEASUREMENTS: Patient demographics, prevalence of five types of recommendations by the PCT and implementation rate by primary physician: (1) advance directives; (2) discharge planning; (3) pain management; (4) symptom management of dyspnea, delirium, constipation, nausea, anxiety, and depression; and (5) consultation orders for other services. RESULTS: The average number of recommendations per patient was 2.84 and 84.2% were implemented. The most frequent recommendations concerned discharge plans. The reasons recommendations were not implemented included: (1) patient or family refusal noted in the medical record, (2) the patient's clinical status changed, including patient death, and (3) the attending physician chose a different dose, medication, or route of administration than was recommended. CONCLUSIONS: Overall, most recommendations were implemented by the referring physicians. This finding is consistent with several prior studies demonstrating that PCTs in acute care can and do influence processes of care for hospitalized patients. Well-designed observational studies and randomized controlled trials of specific palliative care interventions and their effect on patient, family, and health care system outcomes are needed.

Academic Medical Centers↗
PubMed2004

Physical therapy and mobility 2 and 6 months after hip fracture.

OBJECTIVES: To examine the relationship between early physical therapy (PT), later therapy, and mobility 2 and 6 months after hip fracture. DESIGN: Prospective, multisite observational study. SETTING: Four hospitals in the New York City area. PARTICIPANTS: Four hundred forty-three hospitalized older patients discharged after surgery for hip fracture in 1997-98. MEASUREMENTS: Patient demographics, fracture type, comorbidities, dementia, number of new impairments at discharge, amount of PT between day of surgery and postoperative day (POD) 3, amount of therapy between POD4 and 8 weeks later, and prefracture, 2-, and 6-month mobility measured using the Functional Independence Measure. RESULTS: More PT immediately after hip fracture surgery was associated with significantly better locomotion 2 months later. Each additional session from the day of surgery through POD3 was associated with an increase of 0.4 points (P=.032) on the 14-point locomotion scale, but the positive relationship between early PT and mobility was attenuated by 6 months postfracture. There was no association between later therapy and 2- or 6-month mobility. CONCLUSION: PT immediately after hip fracture surgery is beneficial. The effects of later therapy on mobility were difficult to assess because of limitations of the data. Well-designed randomized, controlled trials of the effect of varying schedules and amounts of therapy on functional status after hip fracture would be informative.

Activities of Daily Living↗
PubMed2004

Patient relocation in the 6 months after hip fracture: risk factors for fragmented care.

OBJECTIVES: To describe the incidence and patterns of patient relocation after hip fracture, identify factors associated with relocation, and examine effect of relocation on outcomes. DESIGN: Prospective cohort study. SETTING: Four hospitals in the New York metropolitan area. PARTICIPANTS: A total of 562 patients hospitalized for hip fracture discharged alive in 1997 to 1998. MEASUREMENTS: Patient characteristics and hospital course were ascertained using patient or surrogate interview, research nurse assessment, and medical record review. Patient location was ascertained at five time points using patient or surrogate interview, and hospital readmissions were identified using New York state and hospital admission databases. Mobility was measured using patient or surrogate report using the Functional Independence Measure. RESULTS: During 6 months of follow-up, the mean number of relocations per patient+/-standard deviation was 3.5+/-1.5 (range 2-10). Forty-one percent of relocations were between home and hospital, 36% between rehabilitation or nursing facility and hospital, 17% between rehabilitation or nursing facility and home, and 4% between two rehabilitation/nursing facilities. In a Poisson regression model that controlled for patient characteristics, hospital course, and length of follow-up, factors associated with relocation (P<.05) were absence of dementia, in-hospital delirium, one or more new impairments at hospital discharge, hospital discharge other than to home, and not living at home alone prefracture. Relocation was not significantly associated with immobility or mortality at 6 months (odds ratio=1.14, 95% confidence interval=0.97-1.35). CONCLUSION: Subgroups of patients with elevated risk of relocation after hip fracture may be target groups for intensive care coordination and care planning interventions.

Aged↗
PubMed2003

Hospital readmissions after hospital discharge for hip fracture: surgical and nonsurgical causes and effect on outcomes.

OBJECTIVES: To examine the causes of hospital readmission after hip fracture and the relationships between hospital readmission and 6-month physical function and mortality. DESIGN: Prospective, multisite, observational cohort study. SETTING: Four hospitals in the New York City metropolitan area. PARTICIPANTS: Five hundred sixty-two patients hospitalized for hip fracture aged 50 and older and discharged alive in 1997-1998. MEASUREMENTS: Patient demographic characteristics, type of fracture and repair, comorbid conditions, postoperative complications, do not resuscitate status, and active clinical problems at the time of hospital discharge. Prefracture and 6-month mobility were measured using the Functional Independence Measure. Hospital readmissions and International Classification of Diseases, Ninth Revision principal diagnoses were ascertained from hospital admission/discharge databases, the New York Statewide Planning and Research Cooperative System, medical record review, and patient self-report. RESULTS: Eighty-two percent of participants were women, and 93% were white. Within 6 months after hospital discharge, 178 (32%) patients were readmitted to the hospital, with 45 (8%) readmitted more than once. Forty-seven of 233 readmissions (20%) occurred within the first 2 weeks after discharge, and 80 (34%) occurred within 4 weeks. Over 6 months, 89% of readmissions were for nonsurgical problems, of which infectious (21%) and cardiac (12%) diseases were the most common. In multivariate analyses, patients who were readmitted were more likely to require total assistance with ambulation at 6 months (odds ratio (OR) = 2.7, 95% confidence interval (CI) = 1.6-4.6) and to die (OR = 4.0, 95% CI = 2.2-7.3) than those not readmitted. CONCLUSION: Hospital readmissions after hip fracture are largely due to nonsurgical illness and are associated with increased morbidity and mortality.

Aged↗