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To assess the association between demographics, comorbidity, geriatric conditions, and three health-related quality of life (HRQOL) outcomes one year after acute hospitalisation in older patients.A prospective cohort study conducted between 2006 and 2009 with one-year follow-up in 11 medical wards at two university hospitals and one teaching hospital in the Netherlands. Participants were 473 patients of 65 years and older, acutely hospitalised for more than 48 hours. Demographics, Charlson Comorbidity Index (CCI), and data on 18 geriatric conditions were collected at baseline. At baseline and 12 months post-admission, the EuroQol-5D was administered. Based on a population-derived valuation (Dutch EuroQol-5D tariff), utilities (range -0.38-1.00) were determined, which were used to calculate quality-adjusted life years (QALY) over one year (max QALY score 1). The EuroQol-5D visual analogue scale (VAS) (range 0-100) was also used. Linear regression analyses were performed to explore the association between the independent variables and the three HRQOL outcomes.CCI was most consistently significantly associated with HRQOL outcomes: Beta -0.05 (95% CI -0.06--0.03) for utility, -0.04 (95% CI -0.05-0.03) for QALY, -1.03 (95% CI -2.06-0.00) for VAS, p0.001,0.001, 0.05, respectively). Baseline utility was significantly associated with one-year utility (beta 0.25, 95% CI 0.11-0.39, p0.01) and QALY (beta 0.31, 95% CI 0.17-0.45, p0.001). The number of geriatric conditions at baseline was more strongly associated with one-year utility than any individual geriatric condition.Less comorbidity, better utility and less geriatric conditions at baseline were associated with better HRQOL one year after acute hospitalisation in older patients.

Hospitalised patients are especially vulnerable in times of transitions in care. Structured discharge planning might improve patient outcomes. We implemented and assessed the effect of a multidisciplinary discharge bundle to reduce 30-day readmission.A pre-post-test design study with a follow-up of one month at four internal medicine wards in a Dutch university teaching hospital. Eligible patients were 18 years and older, acutely admitted and hospitalised for at least 48 hours. The discharge bundle consisted of (1) planning the date of discharge within 48 hours after admission, (2) a discharge checklist, (3) a personalised patient discharge letter, and (4) multidisciplinary patient education. The primary outcome measure was unplanned 30-day readmission.Participants in the post-test group (n = 204) did not have a lower rate of unplanned hospital readmission than those receiving usual care (n = 224) (12.9 vs. 13.2%, p = 0.93). The medical discharge summaries were sent to the general practitioner faster in the post-test period (median of 14 days pre-test vs. 5 days post-test, p0.001) and this group also had a trend towards a longer time to first readmission (14 vs. 10 days, p = 0.06). Patient satisfaction was high in both groups (7.5 and 7.4 points, (p = 0.49)).The comprehensive discharge bundle was not effective in reducing the rate of readmission and increasing patient satisfaction, but medical discharge summaries were sent faster to the general practitioner and a trend to a longer time to readmission was present.