Key result
Prior hospitalization in Parkinson's disease linked to ~67% greater risk of subsequent hospital encounters.
Why the study?
Patients with Parkinson disease are at high risk of hospital encounters with increasing morbidity and mortality, but rates and associated factors over time are not well defined.
What are the rates and factors associated with hospitalization and rehospitalization in patients with Parkinson disease?
Cohort (n=7,507)
Yes
What are the rates and factors associated with hospitalization and rehospitalization in patients with Parkinson disease?
Hazard Ratio: 1.67 (95% CI 1.48–1.89)
p-value: p=<0.0001
Hospitalization and re-hospitalization are common in Parkinson disease patients, with prior hospitalization strongly predicting future hospital encounters.
Prior hospitalization may flag PD patients for closer monitoring; extends rehospitalization predictor data but leaves open need for interventional trials.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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Shahgholi et al. (2017) conducted a cohort in Parkinson disease (n=7,507). History of hospital encounter prior to baseline vs. No history of hospital encounter prior to baseline was evaluated on Time to hospital encounter after the baseline visit (HR 1.67, 95% CI 1.48-1.89, p=<0.0001). A history of hospitalization prior to baseline in patients with Parkinson's disease significantly increased the risk of subsequent hospital encounters during follow-up (HR 1.67).
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