The mobile seniors' clinic - an innovative transition of care for frail older adults.

Autor: Boucher V; CHU de Québec-Université Laval Research Centre, 1401 18ième rue, Québec, G1J1Z4, Canada., Jouhair EM; Sorbonne Université, Paris, France.; CHU Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France., Sirois MJ; CHU de Québec-Université Laval Research Centre, 1401 18ième rue, Québec, G1J1Z4, Canada.; Faculté de médecine, Université Laval, Québec, Canada., Tailleur L; Faculté de médecine, Université Laval, Québec, Canada.; Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Québec, Canada., Voyer P; Faculté de médecine, Université Laval, Québec, Canada., Mercier É; CHU de Québec-Université Laval Research Centre, 1401 18ième rue, Québec, G1J1Z4, Canada.; Faculté de médecine, Université Laval, Québec, Canada.; VITAM- Centre de recherche en santé durable, Québec, Canada., Giguère A; Faculté de médecine, Université Laval, Québec, Canada.; VITAM- Centre de recherche en santé durable, Québec, Canada.; Centre d'excellence sur le vieillissement de Québec (CEVQ), Québec, Canada., Dionne CE; CHU de Québec-Université Laval Research Centre, 1401 18ième rue, Québec, G1J1Z4, Canada.; Faculté de médecine, Université Laval, Québec, Canada.; VITAM- Centre de recherche en santé durable, Québec, Canada.; Centre d'excellence sur le vieillissement de Québec (CEVQ), Québec, Canada., Légaré F; Faculté de médecine, Université Laval, Québec, Canada.; VITAM- Centre de recherche en santé durable, Québec, Canada., Dallaire C; Faculté de médecine, Université Laval, Québec, Canada.; VITAM- Centre de recherche en santé durable, Québec, Canada., Bergeron S; CHU de Québec-Université Laval Research Centre, 1401 18ième rue, Québec, G1J1Z4, Canada., Carmichael PH; CHU de Québec-Université Laval Research Centre, 1401 18ième rue, Québec, G1J1Z4, Canada.; Centre d'excellence sur le vieillissement de Québec (CEVQ), Québec, Canada., Emond M; CHU de Québec-Université Laval Research Centre, 1401 18ième rue, Québec, G1J1Z4, Canada. marcel.emond@fmed.ulaval.ca.; Faculté de médecine, Université Laval, Québec, Canada. marcel.emond@fmed.ulaval.ca.; VITAM- Centre de recherche en santé durable, Québec, Canada. marcel.emond@fmed.ulaval.ca.; Centre d'excellence sur le vieillissement de Québec (CEVQ), Québec, Canada. marcel.emond@fmed.ulaval.ca.
Jazyk: angličtina
Zdroj: BMC geriatrics [BMC Geriatr] 2024 Nov 05; Vol. 24 (1), pp. 914. Date of Electronic Publication: 2024 Nov 05.
DOI: 10.1186/s12877-024-05490-4
Abstrakt: Background: This study aims to evaluate the impact of Quebec's first hospital-at-home-inspired mobile Seniors' Clinic, the "Clinique des Ainés (CDA)", on frail older adults' returns to the Emergency Department (ED), mortality, and hospital Length Of Stay (LOS) and rehospitalizations.
Methods: Design: Quasi-experimental pre-post implementation cohort study.
Population: Patients aged ≥ 75 years admitted to the short-term geriatric unit after an ED consultation (control) or included by the CDA (intervention).
Outcomes: return to ED (RtoED), mortality, ED & hospital LOS, and rehospitalizations.
Statistical Analyses: Multivariable regression modelling.
Results: Overall, 891 patients were included. At the intervention site (CDA) (n = 437), RtoED were similar at 30 (17.5% & 19.5%, p = 0.58), 90 (34.4% & 37.3%, p = 0.46) and 180 days (47.2% & 54.0%, p = 0.07) in the pre and post-implementation phases. No mortality differences were found. The hospitalization LOS was significantly shorter (28.26 and 14.22 days, p < 0.01). At 90 days, rehospitalization LOS was decreased by 8.51 days (p = 0.02) and by 6.48 days at 180 days (p = 0.03). Compared to the control site (n = 454) in the post-implementation phase, RtoED was 54% at the intervention site compared to 44.1% (p = 0.02) at 180 days. The CDA had a lower adjusted probability of mortality at 90 days compared to the control site (4.8% VS 11.7%, p = 0.03). No rehospitalization LOS differences were noted.
Conclusions: The Clinique des Ainés showed effectiveness in caring for frail older patients in their homes by decreasing their hospital LOS by half and 90 days mortality risk. It was a safe care trajectory without a clinically significant increase in ED returns or mortality.
(© 2024. The Author(s).)
Databáze: MEDLINE
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