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Min L, Saul D, Firn J, Chang R, Wiggins J, Khateeb R. Interprofessional geriatric and palliative care intervention associated with fewer hospital days. J Am Geriatr Soc 2022; 70:398-407. [PMID: 34752635 PMCID: PMC10708622 DOI: 10.1111/jgs.17545] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/03/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND With increasing complexity of our aging inpatient population, we implemented an interprofessional geriatric and palliative care intervention on a hospitalist service. This study aimed to measure the intervention's impact on length of stay (LOS), 30-day readmission, and the daily intensity of inpatient services utilization. METHODS Using a nonrandomized controlled intervention at a 1000-bed U.S. academic quaternary medical center, we studied 13,941 individuals admitted to a general medicine hospitalist service (of which 5644 were age > =65 years); 1483 were on intervention teams (576 age > =65 years), 5413 concurrent controls, and 7045 historical controls. On 2 of 11 hospitalist teams, a geriatrician, palliative care physician and social worker attended multidisciplinary discharge rounds twice weekly, to recommend inpatient geriatric or palliative care consult (GPCC), postacute nursing or home care, versus postdischarge outpatient consultation. We measured the difference in improvement over time between intervention and control team patients for the following: (1) LOS adjusted for case-mix index, (2) 30-day readmissions, and (3) intensity of hospital service utilization (mean services provided per patient per day). RESULTS Adjusted LOS (in hospital days) was decreased by 0.36 days (p = 0.039) for the 1483 patients in the intervention teams, with greater LOS reduction of 0.55 days per admission (p = 0.022) on average among the subset of 576 older patient admissions. Readmissions were unchanged (-1.17%, p = 0.48 for all patients; 1.91%, p = 0.46 for older patients). However, the daily relative value unit (RVU) utilization was modestly increased for both the overall and older subgroup, 0.35 RVUs (p = 0.041) and 0.74 RVUs (p < 0.001) per patient-day on average across the intervention teams, respectively. CONCLUSION An interprofessional intervention of geriatric and palliative care consultation in collaboration with a hospitalist service may reduce LOS, especially for geriatric patients, without an increase in readmissions. This model may have broader implications for hospital care and should be further studied.
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Affiliation(s)
- Lillian Min
- University of Michigan Medical School, Division of Geriatric and Palliative Care, Department of Internal Medicine, Ann Arbor, Michigan
- Ann Arbor VA Healthcare Center, Geriatric Research Education and Clinical Center (GRECC), Ann Arbor, Michigan
- Ann Arbor VA Healthcare Center, Center for Clinical Management Research, Ann Arbor, Michigan
- University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor, Michigan
| | - D’Anna Saul
- University of Michigan Medical School, Division of Geriatric and Palliative Care, Department of Internal Medicine, Ann Arbor, Michigan
- University of Michigan Medical School, Division of Hospital Medicine, Department of Internal Medicine, Ann Arbor, Michigan
- University of Michigan Medical School, Division of Hospital Medicine, Department of Pediatrics, Ann Arbor, Michigan
| | - Janice Firn
- University of Michigan Institute of Healthcare Policy and Innovation, Ann Arbor, Michigan
- University of Michigan Medical School, Department of Learning Health Sciences, Ann Arbor, Michigan
- University of Michigan Medical School, Center for Bioethics and Social Sciences in Medicine (CBSSM), Ann Arbor, Michigan
| | - Robert Chang
- University of Michigan Medical School, Division of Hospital Medicine, Department of Internal Medicine, Ann Arbor, Michigan
| | - Jocelyn Wiggins
- University of Michigan Medical School, Division of Geriatric and Palliative Care, Department of Internal Medicine, Ann Arbor, Michigan
| | - Rafina Khateeb
- University of Michigan Medical School, Division of Geriatric and Palliative Care, Department of Internal Medicine, Ann Arbor, Michigan
- University of Michigan Medical School, Division of Hospital Medicine, Department of Internal Medicine, Ann Arbor, Michigan
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Sunkara PR, Lippert WC, Rosenthal GE, Hiestand BC, Blalock J, Huang CC. Implementing a Second-Level Observation Unit at a Large Academic Medical Center. South Med J 2021; 114:322-325. [PMID: 33942120 DOI: 10.14423/smj.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Supplemental digital content is available in the text.
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Affiliation(s)
- Padageshwar R Sunkara
- From the Departments of Internal Medicine and Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William C Lippert
- From the Departments of Internal Medicine and Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Gary E Rosenthal
- From the Departments of Internal Medicine and Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Brian C Hiestand
- From the Departments of Internal Medicine and Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - John Blalock
- From the Departments of Internal Medicine and Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Chi C Huang
- From the Departments of Internal Medicine and Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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Pomare C, Long JC, Churruca K, Ellis LA, Braithwaite J. Interprofessional collaboration in hospitals: a critical, broad-based review of the literature. J Interprof Care 2020; 34:509-519. [PMID: 31928245 DOI: 10.1080/13561820.2019.1702515] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Interprofessional collaboration (IPC) is a common term applied in the healthcare literature, with suggestions it contributes to improved quality and safety of patient care across the globe. Despite worldwide implementation of models of IPC, past systematic or meta-reviews on this topic have concluded that the evidence is mixed. However, these reviews are yet to adequately consider the qualitative and mixed-methods literature on this topic. In this critical review, we synthesize the outcomes and key findings of IPC in hospitals, taking a broader approach by including diverse study designs. A total of 4,776 abstracts were screened from three major databases (Medline, CINAHL, Embase). Thirty-four studies fulfilled inclusion criteria. Although outcomes and key findings (e.g., staff turnover, error rates) were mostly positive, there were inconsistencies in the results. The included studies reflected a variety of study designs and different methodological approaches. Overall, our review revealed moderate evidence that IPC can positively influence patient, staff and organizational factors in hospitals, and that inconsistent findings may be due to variation in context (e.g., the cohort of patients). Recommendations from the review are to incorporate qualitative- and mixed-methods approaches to studying IPC in healthcare and tailor evaluations of IPC outcomes specific to the context.
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Affiliation(s)
- Chiara Pomare
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University , Sydney, Australia
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Sunkara PR, Islam T, Bose A, Rosenthal GE, Chevli P, Jogu H, TK LA, Huang CC, Chaudhary D, Beekman D, Dutta A, Menon S, Speiser JL. Impact of structured interdisciplinary bedside rounding on patient outcomes at a large academic health centre. BMJ Qual Saf 2019; 29:569-575. [DOI: 10.1136/bmjqs-2019-009936] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/03/2019] [Accepted: 11/18/2019] [Indexed: 11/04/2022]
Abstract
BackgroundEffective communication between healthcare providers and patients and their family members is an integral part of daily care and discharge planning for hospitalised patients. Several studies suggest that team-based care is associated with improved length of stay (LOS), but the data on readmissions are conflicting. Our study evaluated the impact of structured interdisciplinary bedside rounding (SIBR) on outcomes related to readmissions and LOS.MethodsThe SIBR team consisted of a physician and/or advanced practice provider, bedside nurse, pharmacist, social worker and bridge nurse navigator. Outcomes were compared in patients admitted to a hospital medicine unit using SIBR (n=1451) and a similar control unit (n=770) during the period of October 2016 to September 2017. Multivariable negative binomial regression analysis was used to compare LOS and logistic regression analysis was used to calculate 30-day and 7-day readmission in patients admitted to SIBR and control units, adjusting for covariates.ResultsPatients admitted to SIBR and control units were generally similar (p≥0.05) with respect to demographic and clinical characteristics. Unadjusted readmission rates in SIBR patients were lower than in control patients at both 30 days (16.6% vs 20.3%, p=0.03) and 7 days (6.3% vs 9.0%, p=0.02) after discharge, while LOS was similar. After adjusting for covariates, SIBR was not significantly related to the odds of 30-day readmission (OR 0.81, p=0.07) but was lower for 7-day readmission (OR 0.70, p=0.03); LOS was similar in both groups (p=0.58).ConclusionSIBR did not reduce LOS and 30-day readmissions but had a significant impact on 7-day readmissions.
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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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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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Ellis G, Gardner M, Tsiachristas A, Langhorne P, Burke O, Harwood RH, Conroy SP, Kircher T, Somme D, Saltvedt I, Wald H, O'Neill D, Robinson D, Shepperd S. Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev 2017; 9:CD006211. [PMID: 28898390 PMCID: PMC6484374 DOI: 10.1002/14651858.cd006211.pub3] [Citation(s) in RCA: 348] [Impact Index Per Article: 49.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Comprehensive geriatric assessment (CGA) is a multi-dimensional, multi-disciplinary diagnostic and therapeutic process conducted to determine the medical, mental, and functional problems of older people with frailty so that a co-ordinated and integrated plan for treatment and follow-up can be developed. This is an update of a previously published Cochrane review. OBJECTIVES We sought to critically appraise and summarise current evidence on the effectiveness and resource use of CGA for older adults admitted to hospital, and to use these data to estimate its cost-effectiveness. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, three other databases, and two trials registers on 5 October 2016; we also checked reference lists and contacted study authors. SELECTION CRITERIA We included randomised trials that compared inpatient CGA (delivered on geriatric wards or by mobile teams) versus usual care on a general medical ward or on a ward for older people, usually admitted to hospital for acute care or for inpatient rehabilitation after an acute admission. DATA COLLECTION AND ANALYSIS We followed standard methodological procedures expected by Cochrane and Effective Practice and Organisation of Care (EPOC). We used the GRADE approach to assess the certainty of evidence for the most important outcomes. For this update, we requested individual patient data (IPD) from trialists, and we conducted a survey of trialists to obtain details of delivery of CGA. We calculated risk ratios (RRs), mean differences (MDs), or standardised mean differences (SMDs), and combined data using fixed-effect meta-analysis. We estimated cost-effectiveness by comparing inpatient CGA versus hospital admission without CGA in terms of cost per quality-adjusted life year (QALY) gained, cost per life year (LY) gained, and cost per life year living at home (LYLAH) gained. MAIN RESULTS We included 29 trials recruiting 13,766 participants across nine, mostly high-income countries. CGA increases the likelihood that patients will be alive and in their own homes at 3 to 12 months' follow-up (risk ratio (RR) 1.06, 95% confidence interval (CI) 1.01 to 1.10; 16 trials, 6799 participants; high-certainty evidence), results in little or no difference in mortality at 3 to 12 months' follow-up (RR 1.00, 95% CI 0.93 to 1.07; 21 trials, 10,023 participants; high-certainty evidence), decreases the likelihood that patients will be admitted to a nursing home at 3 to 12 months follow-up (RR 0.80, 95% CI 0.72 to 0.89; 14 trials, 6285 participants; high-certainty evidence) and results in little or no difference in dependence (RR 0.97, 95% CI 0.89 to 1.04; 14 trials, 6551 participants; high-certainty evidence). CGA may make little or no difference to cognitive function (SMD ranged from -0.22 to 0.35 (5 trials, 3534 participants; low-certainty evidence)). Mean length of stay ranged from 1.63 days to 40.7 days in the intervention group, and ranged from 1.8 days to 42.8 days in the comparison group. Healthcare costs per participant in the CGA group were on average GBP 234 (95% CI GBP -144 to GBP 605) higher than in the usual care group (17 trials, 5303 participants; low-certainty evidence). CGA may lead to a slight increase in QALYs of 0.012 (95% CI -0.024 to 0.048) at GBP 19,802 per QALY gained (3 trials; low-certainty evidence), a slight increase in LYs of 0.037 (95% CI 0.001 to 0.073), at GBP 6305 per LY gained (4 trials; low-certainty evidence), and a slight increase in LYLAH of 0.019 (95% CI -0.019 to 0.155) at GBP 12,568 per LYLAH gained (2 trials; low-certainty evidence). The probability that CGA would be cost-effective at a GBP 20,000 ceiling ratio for QALY, LY, and LYLAH was 0.50, 0.89, and 0.47, respectively (17 trials, 5303 participants; low-certainty evidence). AUTHORS' CONCLUSIONS Older patients are more likely to be alive and in their own homes at follow-up if they received CGA on admission to hospital. We are uncertain whether data show a difference in effect between wards and teams, as this analysis was underpowered. CGA may lead to a small increase in costs, and evidence for cost-effectiveness is of low-certainty due to imprecision and inconsistency among studies. Further research that reports cost estimates that are setting-specific across different sectors of care are required.
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Affiliation(s)
- Graham Ellis
- Monklands HospitalMedicine for the ElderlyMonkscourt AvenueAirdrieUKML6 0JS
| | - Mike Gardner
- University of OxfordNuffield Department of Population HealthRichard Doll Building, Old Road CampusOxfordUKOX3 7LF
| | - Apostolos Tsiachristas
- University of OxfordNuffield Department of Population HealthRichard Doll Building, Old Road CampusOxfordUKOX3 7LF
| | - Peter Langhorne
- ICAMS, University of GlasgowAcademic Section of Geriatric MedicineLevel 2, New Lister BuildingGlasgow Royal InfirmaryGlasgowUKG31 2ER
| | - Orlaith Burke
- University of OxfordNuffield Department of Population HealthRichard Doll Building, Old Road CampusOxfordUKOX3 7LF
| | - Rowan H Harwood
- Queen's Medical Centre, Nottingham University Hospitals NHS TrustHealth Care of Older PeopleNottinghamUKNG7 2UH
| | - Simon P Conroy
- University of LeicesterDepartment of Health SciencesLeicesterUKLE1 5WW
| | - Tilo Kircher
- Philipps‐Universität Marburg ‐ UKGMKlinik für Psychiatrie und PsychotherapieRudolf‐Bultmann‐Straße 8MarburgGermanyD‐35039
| | - Dominique Somme
- Hôpital PontchaillouFaculté de Médecine, Université de Rennes 1, Service de
Gériatrie CHU de Rennes, Centre de Recherche sur l'Action Politique en
Europe2 rue Henri Le GuillouxRennesFrance35033
| | - Ingvild Saltvedt
- Norwegian University of Science and Technology (NTNU)Department of Neuromedicine and Movement ScienceTrondheimNorway
| | - Heidi Wald
- University of Colorado School of MedicineDivision of Health Care Policy and Research, Department of MedicineHCPR, Campus Box F480, Suite 400 13199 E. Montview BlvdAuroraUSA
| | - Desmond O'Neill
- Trinity CollegeCentre for Ageing, Neuroscience and the HumanitiesTrinity Centre for Health Sciences, Tallaght HospitalDublinIreland24
| | - David Robinson
- St James’s HospitalMedicine for the ElderlyDublinIrelandDublin 8
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRichard Doll Building, Old Road CampusOxfordUKOX3 7LF
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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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Bhamidipati VS, Elliott DJ, Justice EM, Belleh E, Sonnad SS, Robinson EJ. Structure and outcomes of interdisciplinary rounds in hospitalized medicine patients: A systematic review and suggested taxonomy. J Hosp Med 2016; 11:513-23. [PMID: 26991337 DOI: 10.1002/jhm.2575] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 12/14/2015] [Accepted: 12/22/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Interdisciplinary rounds (IDR) have been described to improve outcomes. However, there is limited understanding of optimal IDR design. PURPOSE To systematically review published reports of IDR to catalog types of IDR and outcomes, and assess the influence of IDR design on outcomes. DATA SOURCES Ovid MEDLINE, Ovid MEDLINE In-Process & Other Non-Indexed Citations, Journals Ovid, Cumulative Index to Nursing and Allied Health Literature (EBSCOhost), and PubMed from 1990 through December 2014, and hand searching of article bibliographies. STUDY SELECTION Experimental, quasiexperimental, and observation studies in English-language literature where physicians rounded with another healthcare professional in inpatient medicine units. DATA EXTRACTION Studies were abstracted for study setting and characteristics, and design and outcomes of IDR. DATA SYNTHESIS Twenty-two studies were included in the qualitative analysis. Many were of low to medium quality with few high-quality studies. There is no clear definition of IDR in the literature. There was wide variation in IDR design and team composition across studies. We found three different models of IDR: pharmacist focused, bedside rounding, and interdisciplinary team rounding. There are reasonable data to support an association with length of stay and staff satisfaction but little data on patient safety or satisfaction. Positive outcomes may be related to particular components of IDR design, but the relationship between design and outcomes remains unclear. CONCLUSIONS Future studies should be more deliberately designed and fully reported with careful attention to team composition and features of IDR and their impact on selected outcomes. We present a proposed IDR definition and taxonomy for future studies. Journal of Hospital Medicine 2016;11:513-523. © 2016 Society of Hospital Medicine.
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Affiliation(s)
- V Surekha Bhamidipati
- Department of Medicine, Christiana Care Health System, Wilmington, Delaware
- Value Institute, Christiana Care Health System, Wilmington, Delaware
| | - Daniel J Elliott
- Department of Medicine, Christiana Care Health System, Wilmington, Delaware
- Value Institute, Christiana Care Health System, Wilmington, Delaware
| | - Ellen M Justice
- Medical Libraries, Christiana Care Health System, Wilmington, Delaware
| | - Ene Belleh
- Medical Libraries, Christiana Care Health System, Wilmington, Delaware
| | - Seema S Sonnad
- Value Institute, Christiana Care Health System, Wilmington, Delaware
| | - Edmondo J Robinson
- Department of Medicine, Christiana Care Health System, Wilmington, Delaware
- Value Institute, Christiana Care Health System, Wilmington, Delaware
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Yoo JW, Kim SJ, Geng Y, Shin HP, Nakagawa S. Quality and innovations for caring hospitalized older persons in the unites States. Aging Dis 2014; 5:41-51. [PMID: 24490116 PMCID: PMC3901613 DOI: 10.14366/ad.2014.050041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/09/2013] [Accepted: 10/14/2013] [Indexed: 01/22/2023] Open
Abstract
Older persons are occasionally acutely ill and their hospitalizations frequently end up with complications and adverse outcomes. Medicare from U.S. federal government's payment resource for older persons is facing financial strain. Medicare highlights both cost-saving and high quality of care while older persons are hospitalized. Several health policy changes were initiated to achieve Medicare's goals. In response to Medicare's health policy changes, U.S. hospital environments have been changed and these resulted in hospital quality measurements' improvement. American seniors are facing the challenges during and around their hospital care. Several innovative measures are suggested to overcome these challenges.
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Affiliation(s)
- Ji Won Yoo
- Center for Senior Health and Longevity, Aurora Health Care, Milwaukee, WI, USA
- Department of Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Sun Jung Kim
- Department of Public Health, College of Medicine, Yonsei University Seoul, Korea
- Institute of Health Services Research, College of Medicine, Yonsei University Seoul, Korea
| | - Yan Geng
- Center for Senior Health and Longevity, Aurora Health Care, Milwaukee, WI, USA
| | - Hyun Phil Shin
- Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Shunichi Nakagawa
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY. USA
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