Clare Lewis RGN, BSc Hons, MSc Nursing, PhD candidate School of Nursing & Midwifery Royal College of Surgeons Ireland (RCSI)
Clare has been working in the area of advanced practice in both primary and secondary care settings for over 20 years working in both England & Ireland in the area of chronic disease management and older persons care. Clare was accredited as one of the first Advanced Nurse Practitioners in chronic disease management within Ireland and developed the first outpatient ambulatory inotropic outpatient service for patients awaiting a heart transplant or as destination therapy. Given previous expertise within the area of older persons care working as a nurse practitioner within the community, Clare developed and set up a clinical case management service for older persons with complex health and social care needs, supporting older people to remain at home. Over the last 3 years, Clare has been working with the School of Nursing and Midwifery RCSI and Nursing and Midwifery Planning and Development Unit within the Health Service Executive to develop Ireland’s first Community Virtual Ward (CVW) to assist health care practitioners with appropriate risk stratification, decision making, timely service mobilisation and periods of monitoring through a model of case management. This model of care has been recognised at national level within Ireland receiving an excellence award for innovation. Clare is her final year of doctoral research with the RCSI examining risk prediction and adverse outcomes through the CVW to assist health care practitioners in the management of complex care within the community to support older persons at home.
Predictors of adverse outcomes and factors associated with a risk-stratification community virtual ward model for older persons with complex health and social care needs.
Population ageing is occurring rapidly worldwide, particularly in more developed countries (Rachel., 2017). As a result, a greater proportion of frail older adults are expected to be living in the community at increased risk of emergency department (ED) presentation and hospital admission (Kelly et al., 2017). While risk-stratification is useful in allocating limited resources, few instruments or models are available to support healthcare professionals to manage the complex health and social care needs of these patients (O’Caoimh et al., 2015). The recent introduction of a Community Virtual Ward (CVW) for older persons with complex healthcare needs, reduced ED presentations and unplanned hospital admissions (Lewis et al., 2017). Given this, we examined predictors of adverse healthcare outcomes and factors associated with the risk-stratification model used with the CVW model in a single centre in Ireland.
A quasi-experimental longitudinal study including retrospective and prospective data was conducted. A Markov model informed the study design. Cox proportional regression analysis will be used to examine significance of time to event. To examine relationships between risk scores, transient states and adverse outcomes, univariate, multivariate and multinomial regression analysis models will be employed.
In total 88 community-dwellers, mean age (+/- standard deviation) of 83.30 +/-6.306 years were included. These were mostly classed as severely frail on the Rockwood Clinical Frailty Scale (mean 6.89/9 +/- 0.651) and highly dependent by the Barthel Index (2.68/20 +/- 0.796). Results (available December 2017) will examine if there is a relationship between risk scores, events and associated interventions by health care professionals in predicting and mitigating risk of adverse events. This will include the relationship between risk scores and the number of overall events and health status in determining when a patient can move to a lower level of risk and measurement of frailty as an indicator of outcomes overtime.
The CVW provides a framework for case management within the community to support older people at home. This model has the potential to evolve to identify stability, risk profiles and the appropriateness of care for frail older adults with complex healthcare needs.