Evaluation of a hospitalist-run acute care for the elderly service
| Autor: | Jean Youngwerth, Ethan Cumbler, Heidi L. Wald, Jeannette Guerrasio, Jeffrey J. Glasheen |
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| Rok vydání: | 2011 |
| Předmět: |
Male
medicine.medical_specialty Resuscitation Critical Care Leadership and Management Health Services for the Aged MEDLINE Assessment and Diagnosis law.invention Randomized controlled trial law Acute care medicine Humans Care Planning Aged Retrospective Studies Geriatrics Aged 80 and over Academic Medical Centers Medical Audit business.industry Health Policy Retrospective cohort study General Medicine Hospital medicine Hospitalists Emergency medicine Delirium Fundamentals and skills Female medicine.symptom business |
| Zdroj: | Journal of hospital medicine. 6(6) |
| ISSN: | 1553-5606 |
| Popis: | BACKGROUND: Comprehensive care for frail older inpatients may improve selected outcomes and reduce harm. OBJECTIVE: To evaluate a Hospitalist-run Acute Care for the Elderly (Hospitalist-ACE) service. DESIGN: Quasi-randomized, controlled trial. SETTING: Urban academic medical center. PATIENTS: Medical inpatients age ≥70 years. INTERVENTION: Hospitalist-ACE service components: 1) selected hospitalist attendings; 2) daily interdisciplinary rounds; 3) standardized geriatric assessment; 4) clinical focus on mitigating harm and discharge planning; 5) novel inpatient geriatrics curriculum. MEASURES: The primary outcome was recognition of abnormal functional status by the primary medical team. Secondary outcomes included: recognition of abnormal cognitive status and delirium by the primary medical team; use of physical restraints and sleep aids; documentation of code status; hospital charges, length of stay, readmission rates, discharge location, and falls. RESULTS: One hundred twenty-two Hospitalist-ACE patients were compared to 95 usual care patients. Hospitalist-ACE patients had significantly greater recognition of abnormal functional status (65% vs 32%, P < 0.0001), and abnormal cognitive status (57% vs 36%, P = 0.02), and greater use of “Do Not Attempt Resuscitation” orders (39% vs 26%, P = 0.04). There were no differences in use of physical restraints, or sleep aids, falls, or discharge location. Hospitalist-ACE patients and usual care patients had similar mean lengths of stay in days (3.4 ± 2.7 vs 3.1 ± 2.7, P = 0.52), mean charges ($24,617 ± $15,828 vs $21,488 ± $13,407, P = 0.12), and 30-day readmission rates (12% vs 10%, P = 0.50). CONCLUSIONS: A Hospitalist-ACE service may improve care processes without significantly increasing resource consumption. No impact on key clinical outcomes was observed. Journal of Hospital Medicine 2011;6:313–321. © 2011 Society of Hospital Medicine |
| Databáze: | OpenAIRE |
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