Patients with parkinsonism (PwP), including the most common cause, Parkinson’s disease (PD), are more likely than individuals of the same age without PD to be admitted to hospital. If people with PD are admitted, they tend to have a higher mortality risk, stay in hospital for longer than people without PD and the hospital stay is more expensive on average. After a stay in hospital, PwP may not be able to move around and do daily activities as well as before and sometimes they may develop a complication, such as becoming confused. These issues mean that it is important, if possible, to avoid the need for PwP to go into hospital and to minimise length of stay. To do this, it helps to know which factors suggest that someone with PD is at higher or lower risk of admission, so that we can target interventions to those at highest risk. For some conditions we may be able to treat people at home, rather than in hospital, if we can detect early warning signs and take action before they become more unwell. It is also important to find out whether there are things we can do, for example changing medication, in order to reduce the risk of a PwP being admitted to hospital. We plan to use the information from this study to help us design and test out a new approach to caring for PwP and supporting their caregivers.
People with parkinsonism (PwP) are more likely than controls to be admitted to hospital and these admissions are longer and more costly on average, with higher inpatient mortality. PwP may suffer a deterioration in motor symptoms following hospitalisation. Amongst the general population, admissions for so-called ‘ambulatory care sensitive conditions’ are considered potentially avoidable. Amongst PwP attending non-UK international centres of excellence, presence of a deep brain stimulator, motor fluctuation and higher number of comorbidities were associated with unplanned hospital use. Risk of readmission was associated with comorbidity count and caregiver strain.
This study aims to describe the rates of, and reasons for, admission amongst PwP and identify the risk and predictors for unplanned admission. Mixed effects Poisson regression will be used to establish predictors of hospitalisation using demographic and clinical characteristics. For admitted patients, we will describe the predictors of outcomes, including length of stay (LOS), mortality and, for admissions associated with pregnancy, the outcomes in the offspring. For the subgroup of PwP with a co-resident partner, we will investigate the association between caregiver health and risk of admission for PwP. We will also compare admission risk in PwP and controls without parkinsonism to look for an interaction between parkinsonism and morbidity. A case-control design will be used to explore events, such as prior GP contacts, in PwP admitted, compared to those not admitted.
These findings will inform a multicomponent intervention aiming to target PwP at greatest risk of negative outcomes, particularly hospitalisation. Identifying the predictors of admission in PwP will provide the empirical basis to risk stratify participants into a trial and target the intervention appropriately. Identifying high risk time windows for a potentially avoidable admission, along with modifiable risk factors, will allow us to intervene to address these to reduce admission risk or, if unavoidable, reduce LOS.
Emergency department attendance and/or unplanned hospital admission (all cause, as well as those for ambulatory care sensitive conditions); length of stay; mortality; outcomes of offspring of PwP, where admission is related to pregnancy including gestational age, pregnancy outcome, mode of delivery, birth weight of the baby, Apgar scores at 1 and 5 minutes, muscle tone at 6 weeks, and other markers of neurological function (such as hearing and vision), developmental growth parameters.
We wish to include a number of additional pregnancy data to those already listed above, these are:
Hospital admission during pregnancy
Obstetric complications
Gestational age at delivery
Spontaneous birth / induction of labour or elective caesarean section (c/s)
Neonate admitted to SCBU / NICU and if so, length of stay
Total postnatal stay in hospital for mother and baby
Offspring outcome (sex, birth weight, Apgar scores, other developmental growth parameters (if available)
Known teratogens
Relevant comorbidities in the mother
Emily Henderson - Chief Investigator - University of Bristol
Emma Tenison - Corresponding Applicant - University of Bristol
Anita McGrogan - Collaborator - University of Bristol
Carmen Brack - Collaborator - University of Bristol
Chris Metcalfe - Collaborator - University of Bristol
Chris Salisbury - Collaborator - University of Bristol
Katie Naylor - Collaborator - University of Bristol
Kritika Jain - Collaborator - University of Bristol
Md Khadimul Anam Mazhar - Collaborator - University of Bristol
Mícheál Ó Breasail - Collaborator - University of Bristol
Rachael Harrison - Collaborator - University of Bristol
Yoav Ben-Shlomo - Collaborator - University of Bristol
Anita McGrogan - Collaborator - University of Bath
Kritika Jain - Collaborator - University of Bristol
Peter Tammes - Collaborator - University of Bristol
2011 Rural-Urban Classification at LSOA level;CPRD Mother-Baby Link;HES Accident and Emergency;HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Pregnancy Register