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Presta R, Brunetti E, Salone B, Schiara LAM, Villosio C, Staiani M, Lucchese F, Isaia G, Marinello R, Bo M. Short-term mortality and associated factors among older hospitalized patients: A narrative retrospective analysis of end-of-life care in an acute geriatric unit. Geriatr Nurs 2024; 60:225-230. [PMID: 39293198 DOI: 10.1016/j.gerinurse.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 08/05/2024] [Accepted: 09/01/2024] [Indexed: 09/20/2024]
Abstract
OBJECTIVES To explore short-term mortality and its predictors among older patients hospitalized in a acute geriatric ward (AGW) in Northwestern Italy. DESIGN Retrospective observational single-center cohort study. MATERIAL AND METHODS Patients consecutively admitted for any reason between June 2021 and May 2022 were included in the analysis. Along with sociodemographic, clinical, and functional variables, prognosis estimation (Palliative Prognostic Index; PPI) at the time of admission was registered. Short-term all-cause mortality (in-hospital and within 3 months of discharge) was the primary outcome. RESULTS About one-third of the total sample died in the short-term (32.4 %). Along with PPI score (OR 1.115, 95 %CI 1.034-1.202), short-term mortality was independently associated with functional dependency (OR 1.278, 95 %CI 1.170-1.395). CONCLUSIONS The high short-term mortality in our sample should call for the inclusion of palliative prognostic tools within the in-hospital comprehensive geriatric assessment to better recognize and appropriately manage older patients at the end of life.
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Affiliation(s)
- Roberto Presta
- Division of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Enrico Brunetti
- Division of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza University Hospital, Turin, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Bianca Salone
- Division of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Laura Anna Maria Schiara
- Division of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Cristina Villosio
- Division of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Martina Staiani
- Division of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Francesca Lucchese
- Division of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Gianluca Isaia
- Division of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Renata Marinello
- Division of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza University Hospital, Turin, Italy; Hospital at Home Service, Division of Geriatrics, Department of General and Specialistic Medicine, Città della Salute e della Scienza University Hospital, Turin, Italy
| | - Mario Bo
- Division of Geriatrics, Department of Medical Sciences, University of Turin, Città della Salute e della Scienza University Hospital, Turin, Italy
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Martin-Khan MG, Gray LC, Brand C, Wright O, Pachana NA, Byrne GJ, Chatfield MD, Jones R, Morris J, Travers C, Tropea J, Xiong B. Patient outcome quality indicators for older persons in acute care: original development data using interRAI AC-CGA. BMC Geriatr 2024; 24:527. [PMID: 38886640 PMCID: PMC11184687 DOI: 10.1186/s12877-024-04980-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 04/16/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND A range of strategies are available that can improve the outcomes of older persons particularly in relation to basic activities of daily living during and after an acute care (AC) episode. This paper outlines the original development of outcome-oriented quality indicators (QIs) in relation to common geriatric syndromes and function for the care of the frail aged hospitalized in acute general medical wards. METHODS Design QIs were developed using evidence from literature, expert opinion, field study data and a formal voting process. A systematic literature review of literature identified existing QIs (there were no outcome QIs) and evidence of interventions that improve older persons' outcomes in AC. Preliminary indicators were developed by two expert panels following consideration of the evidence. After analysis of the data from field testing (indicator prevalence, variability across sites), panel meetings refined the QIs prior to a formal voting process. SETTING Data was collected in nine Australian general medical wards. PARTICIPANTS Patients aged 70 years and over, consented within 24 h of admission to the AC ward. MEASUREMENTS The interRAI Acute Care - Comprehensive Geriatric Assessment (interRAI AC-CGA) was administered at admission and discharge; a daily risk assessment in hospital; 28-day phone follow-up and chart audit. RESULTS Ten outcome QIs were established which focused on common geriatric syndromes and function for the care of the frail aged hospitalized in acute general medical wards. CONCLUSION Ten outcome QIs were developed. These QIs can be used to identify areas where specific action will lead to improvements in the quality of care delivered to older persons in hospital.
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Affiliation(s)
- Melinda G Martin-Khan
- Centre for Health Services Research, The University of Queensland, Building 33, Princess Alexandra Hospital, 34 Cornwall St, Brisbane, QLD, 4102, Australia
- Department of Health and Life Sciences, University of Exeter, Exeter, UK
| | - Leonard C Gray
- Centre for Health Services Research, The University of Queensland, Building 33, Princess Alexandra Hospital, 34 Cornwall St, Brisbane, QLD, 4102, Australia.
| | - Caroline Brand
- Department of Clinical Epidemiology, Biostatistics and Health Services Research, Melbourne Health, The University of Melbourne and The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
- Centre for Research Excellence in Patient Safety (CREPS), Monash University, Melbourne, VIC, Australia
| | - Olivia Wright
- Nutrition and Dietetics, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Gerard J Byrne
- Mayne Academy of Psychiatry, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Mental Health Service, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Mark D Chatfield
- Centre for Health Services Research, The University of Queensland, Building 33, Princess Alexandra Hospital, 34 Cornwall St, Brisbane, QLD, 4102, Australia
| | - Richard Jones
- The Warren Alpert Medical School, Brown University, Boston, MA, USA
- Institute of Ageing Research, Boston, MA, USA
| | - John Morris
- Institute of Ageing Research, Boston, MA, USA
| | - Catherine Travers
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Joanne Tropea
- Department of Medicine, University of Melbourne, Parkville, VIC, Australia
- Department of Aged Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Beibei Xiong
- Centre for Health Services Research, The University of Queensland, Building 33, Princess Alexandra Hospital, 34 Cornwall St, Brisbane, QLD, 4102, Australia
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Knight T, Kamwa V, Atkin C, Green C, Ragunathan J, Lasserson D, Sapey E. Acute care models for older people living with frailty: a systematic review and taxonomy. BMC Geriatr 2023; 23:809. [PMID: 38053044 PMCID: PMC10699071 DOI: 10.1186/s12877-023-04373-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 10/03/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The need to improve the acute care pathway to meet the care needs of older people living with frailty is a strategic priority for many healthcare systems. The optimal care model for this patient group is unclear. METHODS A systematic review was conducted to derive a taxonomy of acute care models for older people with acute medical illness and describe the outcomes used to assess their effectiveness. Care models providing time-limited episodes of care (up to 14 days) within 48 h of presentation to patients over the age of 65 with acute medical illness were included. Care models based in hospital and community settings were eligible. Searches were undertaken in Medline, Embase, CINAHL and Cochrane databases. Interventions were described and classified in detail using a modified version of the TIDIeR checklist for complex interventions. Outcomes were described and classified using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy. Risk of bias was assessed using RoB2 and ROBINS-I. RESULTS The inclusion criteria were met by 103 articles. Four classes of acute care model were identified, acute-bed based care, hospital at home, emergency department in-reach and care home models. The field is dominated by small single centre randomised and non-randomised studies. Most studies were judged to be at risk of bias. A range of outcome measures were reported with little consistency between studies. Evidence of effectiveness was limited. CONCLUSION Acute care models for older people living with frailty are heterogenous. The clinical effectiveness of these models cannot be conclusively established from the available evidence. TRIAL REGISTRATION PROSPERO registration (CRD42021279131).
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Affiliation(s)
- Thomas Knight
- Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Vicky Kamwa
- Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
| | - Catherine Atkin
- Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
| | - Catherine Green
- Department of Geriatric Medicine, Whiston Hospital, Mersey and West Lancashire Teaching Hospital NHS Trust, Prescot, L35 5DR, UK
| | - Janahan Ragunathan
- Department of Geriatric Medicine, Royal Bolton NHS Foundation Trust, Bolton, BL4 0JR, UK
| | - Daniel Lasserson
- Warwick Medical School, Professor of Acute and Ambulatory Care, University of Warwick, Coventry, CV4 7AL, UK
| | - Elizabeth Sapey
- Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK
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Havaei F, Kobekyaa F, Ma A, MacPhee M, Zhang W, Kaulius M, Ahmadi B, Boamah S, Easterbrook A, Salmon A. A Mixed Methods Study to Implement the Synergy Tool and Evaluate Its Impact on Long-Term Care Residents. Healthcare (Basel) 2023; 11:2187. [PMID: 37570427 PMCID: PMC10418466 DOI: 10.3390/healthcare11152187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND There are ongoing workforce challenges with the delivery of long-term care (LTC), such as staffing decisions based on arbitrary standards. The Synergy tool, a resident-centered approach to staffing, provides objective, real-time acuity and dependency scores (Synergy scores) for residents. The purpose of this study was to implement and evaluate the impact of the Synergy tool on LTC delivery. METHODS A longitudinal mixed methods study took place within two publicly funded LTC homes in British Columbia, Canada. Quantitative data included weekly Synergy scores for residents (24 weeks), monthly aggregated resident falls data (18 months) and a six-month economic evaluation. Qualitative data were gathered from family caregivers and thematically analyzed. RESULTS Quantitative findings from Synergy scores revealed considerable variability for resident acuity/dependency needs within and across units; and falls decreased during implementation. The six-month economic evaluation demonstrated some cost savings by comparing Synergy tool training and implementation costs with savings from resident fall rate reductions. Qualitative analyses yielded three positive impact themes (improved care delivery, better communication, and improved resident-family-staff relationships), and two negative structural themes (language barrier and staff shortages). CONCLUSIONS The Synergy tool provides useful data for enhancing a 'fit' between resident needs and available staff.
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Affiliation(s)
- Farinaz Havaei
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Francis Kobekyaa
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Andy Ma
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Maura MacPhee
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Wei Zhang
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
| | - Megan Kaulius
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Bahar Ahmadi
- School of Nursing, The University of British Columbia, Vancouver, BC V6T 2B5, Canada
| | - Sheila Boamah
- School of Nursing, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Adam Easterbrook
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
| | - Amy Salmon
- Centre for Health Evaluation & Outcome Sciences, Vancouver, BC V6Z 1Y6, Canada
- Faculty of Medicine, The University of British Columbia, Vancouver, BC V6T 1Z3, Canada
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Yuksel JM, Ulen KR, Varghese D, Noviasky J. Pharmacist Involvement in an Acute Care of the Elderly Team: Impact on Appropriate Medication Use. Sr Care Pharm 2023; 38:338-345. [PMID: 37496166 DOI: 10.4140/tcp.n.2023.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Background Currently, our institution does not have a full-time pharmacist rounding with the inpatient acute care of the elderly (ACE) team daily. We sought to evaluate the involvement of a clinical pharmacy service within the ACE team and its impact on appropriate medication use. Objective The primary outcome was the number of drug-related problems (DRPs) and potentially inappropriate medications (PIMs) detected by the pharmacist compared with no pharmacist on the ACE team. Secondary outcomes included length of stay, 30-day re-hospitalization, and accepted DRPs and PIMs recommendations made by the pharmacist. Methods This was a retrospective, single-center, cohort study. The control cohort consisted of patients seen over 3 months when no pharmacist was present. The intervention cohort comprised patients seen over 3 months when a pharmacist was present on the ACE team. Patients were excluded if there was not a documented chart note from a geriatric provider or pharmacist. Results A total of 125 patients were included in the intervention group and 106 patients in the control group. Regarding the primary outcome, the control cohort had significantly fewer identified PIMs and DRPs in comparison with the intervention cohort (P < 0.001; P < 0.01, respectively). There was no significant difference in length of stay (P = 0.317). There was a statistical difference between groups regarding 30-day readmission rates (P = 0.007). Conclusion Our study shows that the inclusion of a pharmacist on the ACE team was associated with more DRPs, and PIMs identified, creating a positive impact on patient care and 30-day readmission.
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Affiliation(s)
| | - Kelly R Ulen
- 1 Upstate Community Hospital, Syracuse, New York
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Rogers SE, Flood KL, Kuang QY, Harrison JD, Malone ML, Cremer J, Palmer RM. The current landscape of Acute Care for Elders units in the United States. J Am Geriatr Soc 2022; 70:3012-3020. [PMID: 35666631 PMCID: PMC9588489 DOI: 10.1111/jgs.17892] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The clinical benefits of Acute Care for Elders (ACE) units have been established for over 25 years. However, how widely disseminated ACE units are in the United States and the degree of fidelity to the key elements of this model of care are unknown. Our objective was to identify all existing ACE units in the United States and to obtain detailed information about variations in implementation. METHODS The strategy to identify current ACE units began with online searches and snowball sampling using contacts from professional societies and workgroups. Next, a request for information regarding the existence of ACE units was sent to the remaining US hospitals listed in a national hospital database. An online survey was sent to identified ACE unit contacts to capture information on implementation characteristics and the five key elements of ACE units. RESULTS There were 3692 hospitals in the database with responses from 2055 (56%) hospitals reporting the presence or absence of an ACE unit. We identified 68 hospitals (3.3%) with an existing or previous ACE unit. Of these 68 hospitals, 50 (74%) completed the survey and reported that 43 ACE units were currently open and 7 had been closed. Of the 43 currently open ACE units, most are affiliated with an academic hospital and there is variable implementation of each of the five key ACE elements (from 69% to 98%). CONCLUSIONS Among the 50 hospitals to complete the survey, 43 current ACE units were identified, with variable fidelity to the key elements. Estimates of prevalence of ACE units and fidelity to key elements are limited by nonresponses to the national survey request by nearly half of hospitals.
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Affiliation(s)
- Stephanie E. Rogers
- Department of Medicine, Division of Geriatrics; University of California, San Francisco, San Francisco, CA 94143
| | - Kellie L. Flood
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care; University of Alabama at Birmingham, Birmingham, AL 35294
| | - Qiao Yu Kuang
- Department of Medicine, Division of Geriatrics; University of California, San Francisco, San Francisco, CA 94143
| | - James D. Harrison
- Department of Medicine, Division of Hospital Medicine; University of California, San Francisco, San Francisco, CA 94143
| | - Michael L. Malone
- Aurora Senior Services and Aurora UW Medical Group, Advocate Aurora Health, Milwaukee, WI 53005
| | - Julia Cremer
- Department of Medicine, Division of Geriatrics; University of California, San Francisco, San Francisco, CA 94143
| | - Robert M. Palmer
- Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, VA 23501
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Cleveland J. Acute Care for Elders units: a model from the past or for the future? J Am Geriatr Soc 2022; 70:2758-2760. [PMID: 35978492 DOI: 10.1111/jgs.17994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/06/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Jo Cleveland
- Section of Geriatrics and Gerontology, Department of Internal Medicine, Wake Forest Baptist Medical Center-Geriatrics, Medical Center Blvd, Winston-Salem, North Carolina, USA
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Deschasse G, Charpentier A, Prodhomme C, Genin M, Delecluse C, Gaxatte C, Gérard C, Bukor Z, Devulde P, Couvreur LA, Bloch F, Puisieux F, Visade F, Beuscart JB. Transition to Comfort Care Only and End-of-Life Trajectories in an Acute Geriatric Unit: A Secondary Analysis of the DAMAGE Cohort. J Am Med Dir Assoc 2022; 23:1492-1498. [DOI: 10.1016/j.jamda.2022.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/11/2022] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
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McNabney MK, Green AR, Burke M, Le ST, Butler D, Chun AK, Elliott DP, Fulton AT, Hyer K, Setters B, Shega JW. Complexities of care: Common components of models of care in geriatrics. J Am Geriatr Soc 2022; 70:1960-1972. [PMID: 35485287 PMCID: PMC9540486 DOI: 10.1111/jgs.17811] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 12/29/2022]
Abstract
As people age, they are more likely to have an increasing number of medical diagnoses and medications, as well as healthcare providers who care for those conditions. Health professionals caring for older adults understand that medical issues are not the sole factors in the phenomenon of this “care complexity.” Socioeconomic, cognitive, functional, and organizational factors play a significant role. Care complexity also affects family caregivers, providers, and healthcare systems and therefore society at large. The American Geriatrics Society (AGS) created a work group to review care to identify the most common components of existing healthcare models that address care complexity in older adults. This article, a product of that work group, defines care complexity in older adults, reviews healthcare models and those most common components within them and identifies potential gaps that require attention to reduce the burden of care complexity in older adults.
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Affiliation(s)
| | - Ariel R Green
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Meg Burke
- Geriatric Medicine Associates, Westminster, Colorado, USA
| | - Stephanie T Le
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dawn Butler
- Indiana University, Indianapolis, Indiana, USA
| | - Audrey K Chun
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Kathryn Hyer
- University of South Florida, Tampa, Florida, USA
| | | | - Joseph W Shega
- University of Central Florida, Gotha, Florida, USA.,VITAS Healthcare, Gotha, Florida, USA
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Ribbink ME, Gual N, MacNeil-Vroomen JL, Ars Ricart J, Buurman BM, Inzitari M. Two European Examples of Acute Geriatric Units Located Outside of a General Hospital for Older Adults With Exacerbated Chronic Conditions. J Am Med Dir Assoc 2021; 22:1228-1234. [PMID: 33524341 DOI: 10.1016/j.jamda.2020.12.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Throughout Europe, the number of older adults requiring acute hospitalization is increasing. Admission to an acute geriatric unit outside of a general hospital could be an alternative. In this model of acute medical care, comprehensive geriatric assessment and rehabilitation are provided to selected older patients. This study aims to compare patients' diagnoses, characteristics, and outcomes of 2 European sites where this care occurs. DESIGN Exploratory cohort study. SETTING AND PARTICIPANTS Subacute Care Unit (SCU), introduced in 2012 in Barcelona, Spain, and the Acute Geriatric Community Hospital (AGCH), introduced in 2018 in Amsterdam, the Netherlands. The main admission criteria for older patients were acute events or exacerbations of chronic conditions, hemodynamic stability on admission, and no requirement for complex diagnostics. MEASURES We compared setting, characteristics, and outcomes between patients admitted to the 2 units. RESULTS Data from 909 patients admitted to SCU and 174 to AGCH were available. Patients were admitted from the emergency department or from home. The mean age was 85.8 years [standard deviation (SD) = 6.7] at SCU and 81.9 years (SD = 8.5) (P < .001) at AGCH. At SCU, patients were more often delirious (38.7% vs 22.4%, P < .001) on admission. At both units, infection was the main admission diagnosis. Other diagnoses included heart failure or chronic obstructive pulmonary disease. Five percent or less of patients were readmitted to general hospitals. Average length of stay was 8.8 (SD = 4.4) days (SCU) and 9.9 (SD = 7.5) days (AGCH). CONCLUSIONS AND IMPLICATIONS These acute geriatric units are quite similar and both provide an alternative to admission to a general hospital. We encourage the comparison of these units to other examples in Europe and suggest multicentric studies comparing their performance to usual hospital care.
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Affiliation(s)
- Marthe E Ribbink
- Amsterdam University Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Neus Gual
- RE-FIT Barcelona research group, Parc Sanitari Pere Virgili and Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Department of Medicine, Univeristat Autonoma de Barcelona, Barcelona, Spain
| | - Janet L MacNeil-Vroomen
- Amsterdam University Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Joan Ars Ricart
- RE-FIT Barcelona research group, Parc Sanitari Pere Virgili and Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Department of Medicine, Univeristat Autonoma de Barcelona, Barcelona, Spain
| | - Bianca M Buurman
- Amsterdam University Medical Center, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands; ACHIEVE - Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Marco Inzitari
- RE-FIT Barcelona research group, Parc Sanitari Pere Virgili and Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain; Department of Medicine, Univeristat Autonoma de Barcelona, Barcelona, Spain
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Prevalence of Geriatric Syndromes and the Need for Hospice Care in Older Patients of the Emergency Department: A Study in an Asian Medical Center. Emerg Med Int 2020; 2020:7174695. [PMID: 32724676 PMCID: PMC7382720 DOI: 10.1155/2020/7174695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background The prevalence of geriatric syndromes and the need for hospice care in the emergency department (ED) in Asian populations remain unclear. This study was conducted to fill the data gap. Methods Using a newly developed emergency geriatric assessment (EGA), we investigated the prevalence of geriatric syndromes and the need for hospice care in older ED patients of a tertiary medical center between September 1, 2016, and January 31, 2017. Results We recruited a total of 693 patients with a mean age of 78.0 years (standard deviation 8.2 years), comprising 46.6% of females. According to age subgroups, 37.4% of patients were aged 65-74 years, 37.4% were aged 75-84 years, and 25.2% were aged ≥85 years. The prevalence rates of geriatric syndromes were as follows: delirium (11.4%), depression (23.4%), dementia (43.1%), deterioration of activities of daily living (ADL) for <1 year (29.4%), vision impairment (22.2%), hearing impairment (23.8%), sleep disturbance (13.1%), any fall in <1 year (21.8%), polypharmacy (28.7%), pain (35.1%), pressure ulcer (5.6%), incontinence or retention (29.6%), indwelling device or physical restrain (21.6%), nutrition problem (35.7%), frequent use of medical resources (50.1%), lack of advance care planning (84.0%), caregiver problem (4.6%), socioeconomic problem (5.5%), and need for family meeting (6.2%). The need for hospice care was 11.9%. Most geriatric syndromes increased with advancing age except depression, sleep disturbance, polypharmacy, pain, nutrition problem, lack of advance care planning, caregiver problem, and socioeconomic problem. Conclusion Geriatric syndromes and the need for hospice care were common in the older ED patients. Further studies about subsequent intervention for improving geriatric care are needed.
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Khadaroo RG, Warkentin LM, Wagg AS, Padwal RS, Clement F, Wang X, Buie WD, Holroyd-Leduc J. Clinical Effectiveness of the Elder-Friendly Approaches to the Surgical Environment Initiative in Emergency General Surgery. JAMA Surg 2020; 155:e196021. [PMID: 32049271 DOI: 10.1001/jamasurg.2019.6021] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Importance Older adults, especially those with frailty, have a higher risk for complications and death after emergency surgery. Acute Care for the Elderly models have been successful in medical wards, but little evidence is available for patients in surgical wards. Objectives To develop and assess the effect of an Elder-Friendly Approaches to the Surgical Environment (EASE) model in an emergency surgical setting. Design, Setting, and Participants This prospective, nonrandomized, controlled before-and-after study included patients 65 years or older who presented to the emergency general surgery service of 2 tertiary care hospitals in Alberta, Canada. Transfers from other medical services, patients undergoing elective surgery or with trauma, and nursing home residents were excluded. Of 6795 patients screened, a total of 684 (544 in the nonintervention group and 140 in the intervention group) were included. Data were collected from April 14, 2014, to March 28, 2017, and analyzed from November 16, 2018, through May 30, 2019. Interventions Integration of a geriatric assessment team, optimization of evidence-based elder-friendly practices, promotion of patient-oriented rehabilitation, and early discharge planning. Main Outcomes and Measures Proportion of participants experiencing a major complication or death (composite) in the hospital, Comprehensive Complication Index, length of hospital stay, and proportion of participants who required an alternative level of care on discharge. Covariate-adjusted, within-site change scores were computed, and the overall between-site, preintervention-postintervention difference-in-differences (DID) were analyzed. Results A total of 684 patients were included in the analysis (mean [SD] age, 76.0 [7.6] years; 327 women [47.8%] and 357 men [52.2%]), of whom 139 (20.3%) were frail. At the intervention site, in-hospital major complications or death decreased by 19% (51 of 153 [33.3%] vs 19 of 140 [13.6%]; P < .001; DID P = .06), and mean (SE) Comprehensive Complication Index decreased by 12.2 (2.5) points (P < .001; DID P < .001). Median length of stay decreased by 3 days (10 [interquartile range (IQR), 6-17] days to 7 [IQR, 5-14] days; P = .001; DID P = .61), and fewer patients required an alternative level of care at discharge (61 of 153 [39.9%] vs 29 of 140 [20.7%]; P < .001; DID P = .11). Conclusions and Relevance To our knowledge, this is the first study to examine clinical outcomes associated with a novel elder-friendly surgical care delivery redesign. The findings suggest the clinical effectiveness of such an approach by reducing major complications or death, decreasing hospital stays, and returning patients to their home residence. Trial Registration ClinicalTrials.gov Identifier: NCT02233153.
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Affiliation(s)
- Rachel G Khadaroo
- Department of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada.,Department of Critical Care Medicine, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Lindsey M Warkentin
- Department of Surgery, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Adrian S Wagg
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Fiona Clement
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Xiaoming Wang
- Aberhart Centre, Research Facilitation, Alberta Health Services, Edmonton, Alberta, Canada
| | - William D Buie
- Department of Surgery, Cummings School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jayna Holroyd-Leduc
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Brennan MJ, Knee AB, Leahy EJ, Ehresman MJ, Courtney HA, Coffelt P, Stefan MS. An Acute Care for Elders Quality Improvement Program for Complex, High-Cost Patients Yields Savings for the System. J Hosp Med 2019; 14:527-533. [PMID: 31112495 PMCID: PMC6715051 DOI: 10.12788/jhm.3198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/28/2019] [Accepted: 03/05/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND Acute Care for Elders (ACE) programs improve outcomes for older adults; however, little is known about whether impact varies with comorbidity severity. OBJECTIVE To describe differences in hospital-level outcomes between ACE and routine care across various levels of comorbidity burden. DESIGN Cross-sectional quality improvement study. SETTING A 716-bed teaching hospital. PARTICIPANTS Medical inpatients aged ≥70 years hospitalized between September 2014 and August 2017. INTERVENTION ACE care, including interprofessional rounds, geriatric syndromes screening, and care protocols, in an environment prepared for elders MEASUREMENTS: Total cost, length of stay (LOS), and 30-day readmissions. We calculated median differences for cost and LOS between ACE and usual care and explored variations across the distribution of outcomes at the 25th, 50th, 75th and 90th percentiles. Results were also stratified across quartiles of the combined comorbidity score. RESULTS A total of 1,429 ACE and 10,159 non-ACE patients were included in this study. The mean age was 81 years, 57% were female, and 81% were white. ACE patients had lower costs associated with care ranging from $171 at the 25th percentile to $3,687 at the 90th percentile, as well as lower LOS ranging from 0 days at the 25th percentile to 1.9 days at the 90th percentile. After stratifying by comorbidity score, the greatest differences in outcomes were among those with higher scores. There was no difference in 30-day readmission between the groups. CONCLUSION The greatest reductions in cost and LOS were in patients with greater comorbidity scores. Risk stratification may help hospitals prioritize admissions to ACE units to maximize the impact of the more intensive intervention.
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Affiliation(s)
- Maura J Brennan
- Department of Medicine, Baystate Health, Springfield, Massachusetts
| | - Alexander B Knee
- Baystate Medical Center Office of Research, Springfield, Massachusetts
| | - Erin J Leahy
- Department of Medicine, Baystate Health, Springfield, Massachusetts
| | - Michael J Ehresman
- Clinical Financial and Decision Support, Baystate Medical Center, Springfield, Massachusetts
| | | | - Patricia Coffelt
- Department of Nursing, Baystate Medical Center, Springfield, Massachusetts
| | - Mihaela S Stefan
- Department of Medicine, Baystate Health, Springfield, Massachusetts
- Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts
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Will KK, Johnson ML, Lamb G. Team-Based Care and Patient Satisfaction in the Hospital Setting: A Systematic Review. J Patient Cent Res Rev 2019; 6:158-171. [PMID: 31414027 DOI: 10.17294/2330-0698.1695] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose Limited research examining the relationship between team-based models of care and patient satisfaction in the hospital setting is available. The purpose of this literature review was to explore this relationship as well as the relationships between team composition, team-based interventions, patient satisfaction, and other outcomes of care when measured as part of the study. Methods A systematic appraisal of research studies published through February 2017 was conducted using PubMed, Cochrane Library, CINAHL, Embase, Ovid, gray literature and Google Scholar. Inclusion criteria were 1) experimental (randomized control trials), quasi-experimental, or non-experimental (cross-sectional) study design; 2) team-based care interventions; 3) hospital setting; 4) patient satisfaction measured as an outcome; and 5) published in English. Results The literature search yielded 15,247 citations. In total, 142 articles were retrieved for full-text screening; 21 studies met inclusion criteria. Overall, 57% of the studies identified a statistically significant improvement in patient satisfaction associated with team-based care. Team-based care interventions ranged from single team activities such as multidisciplinary rounds to comprehensive team-based models of care. Patient satisfaction scores were greater with teams that had more than two professions and more comprehensive team-based models. About one-quarter of studies that measured patient satisfaction and at least one additional outcome demonstrated improvement in both. Conclusions Team-based care may positively affect patient satisfaction. Team composition and type of team intervention appears to influence the strength of the relationship. Improvements in satisfaction are not consistently accompanied by improvements in other outcomes.
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Affiliation(s)
- Kristen K Will
- College of Health Solutions, Arizona State University, Phoenix, AZ
| | | | - Gerri Lamb
- Center for Advancing Interprofessional Practice, Education and Research, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
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Conroy SP, Bardsley M, Smith P, Neuburger J, Keeble E, Arora S, Kraindler J, Ariti C, Sherlaw-Johnson C, Street A, Roberts H, Kennedy S, Martin G, Phelps K, Regen E, Kocman D, McCue P, Fisher E, Parker S. Comprehensive geriatric assessment for frail older people in acute hospitals: the HoW-CGA mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07150] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BackgroundThe aim of this study was to provide high-quality evidence on delivering hospital-wide Comprehensive Geriatric Assessment (CGA).Objective(s)(1) To define CGA, its processes, outcomes and costs in the published literature, (2) to identify the processes, outcomes and costs of CGA in existing hospital settings in the UK, (3) to identify the characteristics of the recipients and beneficiaries of CGA in existing hospital settings in the UK and (4) to develop tools that will assist in the implementation of hospital-wide CGA.DesignMixed-methods study combining a mapping review, national survey, large data analysis and qualitative methods.ParticipantsPeople aged ≥ 65 years in acute hospital settings.Data sourcesLiterature review – Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE and EMBASE. Survey – acute hospital trusts. Large data analyses – (1) people aged ≥ 75 years in 2008 living in Leicester, Nottingham or Southampton (development cohort,n = 22,139); (2) older people admitted for short stay (Nottingham/Leicester,n = 825) to a geriatric ward (Southampton,n = 246) or based in the community (Newcastle,n = 754); (3) people aged ≥ 75 years admitted to acute hospitals in England in 2014–15 (validation study,n = 1,013,590). Toolkit development – multidisciplinary national stakeholder group (co-production); field-testing with cancer/surgical teams in Newcastle/Leicester.ResultsLiterature search – common outcomes included clinical, operational and destinational, but not patient-reported, outcome measures. Survey – highly variable provision of multidisciplinary assessment and care across hospitals. Quantitative analyses – in the development cohort, older people with frailty diagnoses formed a distinct group and had higher non-elective hospital use than older people without a frailty diagnosis. Patients with the highest 20% of hospital frailty risk scores had increased odds of 30-day mortality [odds ratio (OR) 1.7], long length of stay (OR 6.0) and 30-day re-admission (OR 1.5). The score had moderate agreement with the Fried and Rockwood scales. Pilot toolkit evaluation – participants across sites were still at the beginning of their work to identify patients and plan change. In particular, competing definitions of the role of geriatricians were evident.LimitationsThe survey was limited by an incomplete response rate but it still provides the largest description of acute hospital care for older people to date. The risk stratification tool is not contemporaneous, although it remains a powerful predictor of patient harms. The toolkit evaluation is still rather nascent and could have meaningfully continued for another year or more.ConclusionsCGA remains the gold standard approach to improving a range of outcomes for older people in acute hospitals. Older people at risk can be identified using routine hospital data. Toolkits aimed at enhancing the delivery of CGA by non-specialists can be useful but require prolonged geriatrician support and implementation phases. Future work could involve comparing the hospital-based frailty index with the electronic Frailty Index and further testing of the clinical toolkits in specialist services.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Simon Paul Conroy
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | | | | | | | | | | | | | | | - Andrew Street
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Helen Roberts
- Academic Geriatric Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Sheila Kennedy
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Graham Martin
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Kay Phelps
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Emma Regen
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - David Kocman
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Patricia McCue
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Stuart Parker
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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16
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Deschodt M, Boland B, Lund CM, Saks K, Velonaki VS, Samuelsson O, Kennelly S, Vassallo MA, Veninšek G, Flamaing J. Implementation of geriatric care models in Europe (imAGE.eu): a cross-sectional survey in eight countries. Eur Geriatr Med 2018; 9:771-782. [DOI: 10.1007/s41999-018-0107-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 08/30/2018] [Indexed: 11/29/2022]
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17
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Acute Care for Elders (ACE) Team Model of Care: A Clinical Overview. Geriatrics (Basel) 2018; 3:geriatrics3030050. [PMID: 31011087 PMCID: PMC6319203 DOI: 10.3390/geriatrics3030050] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022] Open
Abstract
The Institute of Medicine (IOM) Reports of To Err is Human and Crossing the Quality Chasm have called for more interprofessional and coordinated hospital care. For over 20 years, Acute Care for Elders (ACE) Units and models of care that disseminate ACE principles have demonstrated outcomes in-line with the IOM goals. The objective of this overview is to provide a concise summary of studies that describe outcomes of ACE models of care published in 1995 or later. Twenty-two studies met the inclusion. Of these, 19 studies were from ACE Units and three were evaluations of ACE Services, or teams that cared for patients on more than one hospital unit. Outcomes from these studies included increased adherence to evidence-based geriatric care processes, improved patient functional status at time of hospital discharge, and reductions in length of stay and costs in patients admitted to ACE models compared to usual care. These outcomes represent value-based care. As interprofessional team models are adopted, training in successful team functioning will also be needed.
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18
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Parker SG, McLeod A, McCue P, Phelps K, Bardsley M, Roberts HC, Conroy SP. New horizons in comprehensive geriatric assessment. Age Ageing 2017; 46:713-721. [PMID: 28874007 DOI: 10.1093/ageing/afx104] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Indexed: 12/27/2022] Open
Abstract
In this article, we discuss the emergence of new models for delivery of comprehensive geriatric assessment (CGA) in the acute hospital setting. CGA is the core technology of Geriatric Medicine and for hospital inpatients it improves key outcomes such as survival, time spent at home and institutionalisation. Traditionally It is delivered by specialised multidisciplinary teams, often in dedicated wards, but in recent years has begun to be taken up and developed quite early in the admission process (at the 'front door'), across traditional ward boundaries and in specialty settings such as surgical and pre-operative care, and oncology. We have scanned recent literature, including observational studies of service evaluations, and service descriptions presented as abstracts of conference presentations to provide an overview of an emerging landscape of innovation and development in CGA services for hospital inpatients.
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Affiliation(s)
- S G Parker
- Newcastle University, Institute for Health and Society, Newcastle upon Tyne, UK
| | - A McLeod
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Newcastle upon Tyne, UK
| | - P McCue
- Newcastle University, Institute for Health and Society, Newcastle upon Tyne, UK
| | - K Phelps
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, Leicester LE1 7RH, UK
| | | | - H C Roberts
- University of Southampton, Academic Geriatric Medicine, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - S P Conroy
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, Centre for Medicine, Leicester LE1 7RH, UK
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Gausvik C, Lautar A, Miller L, Pallerla H, Schlaudecker J. Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. J Multidiscip Healthc 2015; 8:33-7. [PMID: 25609978 PMCID: PMC4298312 DOI: 10.2147/jmdh.s72623] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR) on an acute care for the elderly (ACE) unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer patient care. These results point to the interconnectedness and dual benefit to both job satisfaction and patient quality of care that can come from enhancements to team communication.
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Affiliation(s)
| | | | | | | | - Jeffrey Schlaudecker
- Division of Geriatric Medicine, University of Cincinnati, Cincinnati, OH, USA ; Geriatric Medicine Fellowship Program, University of Cincinnati/The Christ Hospital, Cincinnati, OH, USA
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20
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Long-Term Fate of Patients Discharged to Extended Care Facilities After Cardiovascular Surgery. Ann Thorac Surg 2013; 96:871-7. [DOI: 10.1016/j.athoracsur.2013.04.041] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 04/10/2013] [Accepted: 04/15/2013] [Indexed: 11/20/2022]
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21
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Mendez CM, Harrington DW, Christenson P, Spellberg B. Impact of hospital variables on case mix index as a marker of disease severity. Popul Health Manag 2013; 17:28-34. [PMID: 23965045 DOI: 10.1089/pop.2013.0002] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Case mix index (CMI) has become a standard indicator of hospital disease severity in the United States and internationally. However, CMI was designed to calculate hospital payments, not to track disease severity, and is highly dependent on documentation and coding accuracy. The authors evaluated whether CMI varied by characteristics affecting hospitals' disease severity (eg, trauma center or not). The authors also evaluated whether CMI was lower at public hospitals than private hospitals, given the diminished financial resources to support documentation enhancement at public hospitals. CMI data for a 14-year period from a large public database were analyzed longitudinally and cross-sectionally to define the impact of hospital variables on average CMI within and across hospital groups. Between 1996 and 2007, average CMI declined by 0.4% for public hospitals, while rising significantly for private for-profit (14%) and nonprofit (6%) hospitals. After the introduction of the Medicare Severity Diagnosis Related Group (MS-DRG) system in 2007, average CMI increased for all 3 hospital types but remained lowest in public vs. private for-profit or nonprofit hospitals (1.05 vs. 1.25 vs. 1.20; P<0.0001). By multivariate analysis, teaching hospitals, level 1 trauma centers, and larger hospitals had higher average CMI, consistent with a marker of disease severity, but only for private hospitals. Public hospitals had lower CMI across all subgroups. Although CMI had some characteristics of a disease severity marker, it was lower across all strata for public hospitals. Hence, caution is warranted when using CMI to adjust for disease severity across public vs. private hospitals.
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Affiliation(s)
- Carmen M Mendez
- 1 Division of General Internal Medicine, Harbor-University of California Los Angeles (UCLA) Medical Center , Los Angeles, California
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22
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Yoo JW, Seol H, Kim SJ, Yang JM, Ryu WS, Min TD, Choi JB, Kwon M, Kim S. Effects of hospitalist-directed interdisciplinary medicine floor service on hospital outcomes for seniors with acute medical illness. Geriatr Gerontol Int 2013; 14:71-7. [DOI: 10.1111/ggi.12056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Ji Won Yoo
- Department of Internal Medicine and Institute of Gerontology; University of Michigan Medical School; Ann Arbor Michigan USA
- Department of Internal Medicine; Korea University College of Medicine; Seoul Korea
| | - Haesun Seol
- Federally Qualified Health Center; VNA Health Center; Bensenville Illinois USA
| | - Sun Jung Kim
- School of Public Health; Yonsei University; Seoul Korea
| | - Janet Miyoung Yang
- Department of Internal Medicine; Saint Joseph Mercy Hospital; Ann Arbor Michigan USA
| | - Woo Sang Ryu
- Center of Clinical Research; Korea University College of Medicine; Seoul Korea
| | - Too Dae Min
- Center of Clinical Research; Korea University College of Medicine; Seoul Korea
| | - Jong Bum Choi
- Center for Clinical Research; Yonsei University College of Medicine; Seoul Korea
| | - Minkyung Kwon
- Center for Clinical Research; Yonsei University College of Medicine; Seoul Korea
| | - Sulgi Kim
- Department of Epidemiology; School of Public Health; University of Washington; Seattle Washington USA
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