Interprofessional Intervention to Improve Geriatric Consultation Timing on an Acute Medical Service
| Autor: | Jocelyn Wiggins, Janice Firn, Robert Chang, D'Anna Saul, Lillian Min, Rafina Khateeb, Margaret R. Puelle |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Quality management Interprofessional Relations Article 03 medical and health sciences 0302 clinical medicine Primary outcome Intervention (counseling) Humans Medicine 030212 general & internal medicine Geriatric Assessment Referral and Consultation Aged Aged 80 and over Service (business) Academic Medical Centers Inpatient care business.industry Geriatric consultation 030503 health policy & services Length of Stay medicine.disease Quality Improvement Comorbidity Patient Discharge United States Confidence interval Hospitalization Hospitalists Physical therapy Female Geriatrics and Gerontology 0305 other medical science business |
| Zdroj: | J Am Geriatr Soc |
| ISSN: | 1532-5415 0002-8614 |
| DOI: | 10.1111/jgs.15582 |
| Popis: | BACKGROUND/OBJECTIVES: Geriatric consultation has been shown to benefit some types of older patients hospitalized for acute illness and injury. However, in our institution, requests for consultation are variable, resulting in some requests occurring too late in the hospital course for optimal clinical benefit. Our objective was to test if an interprofessional intervention improved the use and timing of geriatric consultation on a hospitalist service. DESIGN: Difference-in-differences (DID), which measures the difference in improvement over time between intervention and control team patients attributable to the intervention. SETTING: 1000-bed U.S. Academic Medical Center PARTICIPANTS: A total of 7038 patients aged 60 years or older admitted to a general medicine hospitalist service: n=718 on intervention teams, n=686 historical controls, n=5634 on control teams (concurrent and historic) INTERVENTION: On 2 of 11 hospitalist teams, a geriatrician attended multidisciplinary discharge rounds twice weekly. The geriatrician advised on benefit of a geriatric consult for patients older than 60. MEASUREMENTS: Primary outcome was percent of hospitalizations resulting in a geriatric consultation. Secondary outcome was time-to-geriatric consultation in days. Both outcomes were controlled for age, gender, co-morbidity, mean daily utilization, and admission in the prior 30 days. In the primary analysis, length of stay was controlled. RESULTS: The intervention increased percent of patients with a geriatric consultation (DID=increase of 2.35% absolute percentage-points, CI=+ 0.59, +4.39%) and decreased time to consult (DID=3.61 fewer days, CI=−1, −7). CONCLUSION: An interprofessional intervention that focused on hospitalist ordering practices increased utilization of appropriate geriatric consultation and decreased time to consult. This model of interprofessional effort is effective. Future adaptations are needed to target scarce geriatric resources without increasing overall utilization. |
| Databáze: | OpenAIRE |
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