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Hunold KM, Caterino JM, Carpenter CR, Mion LC, Southerland LT. Geriatric screening in the emergency department increases consultations to geriatric medicine and physical and occupational therapy: A pre/post cohort study. Acad Emerg Med 2024. [PMID: 38873870 DOI: 10.1111/acem.14964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/07/2024] [Accepted: 05/23/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND The Geriatric Emergency Department (ED) Guidelines recommend screening older patients for need for evaluation by geriatric medicine, physical therapy (PT), and occupational therapy (OT), but explicit evidence that geriatric screening changes care compared to physician gestalt is lacking. We assessed changes in multidisciplinary consultation after implementation of standardized geriatric screening in the ED. METHODS Retrospective single-site observational cohort of older adult ED patients from 2019 to 2023 with three time periods: (1) preimplementation, (2) implementation of geriatric screening, and (3) postimplementation. Geriatric, PT, and OT consultations/referrals were available during all time periods. Descriptive analysis was stratified by disposition: discharged, observation and discharged, observation and hospital admission, and hospital admission. The independent variable was completion of three geriatric screening tools by ED nurses. The dependent variable was consultation and/or referral to geriatrics, PT, and OT. Secondary outcomes were disposition, ED revisits, and 30-day rehospitalizations. RESULTS There were 57,775 qualifying ED visits of patients age ≥ 65 years during the time periods: implementation increased geriatric screening from 0.5% to 63.2%; postimplementation, discharge patients who received screening had more consultations/referrals to geriatrics (1.5% vs. 0.4%), PT (7.9% vs. 1.9%), and OT (6.5% vs. 1.2%) compared to unscreened patients. Patients observed and then discharged had more consultations/referrals to geriatrics (15.1% vs. 11.3%), PT (74.1% vs. 64.5%), and OT (65.7% vs. 56.5%). Admitted patients had no change in consultation rates. Geriatric screening was not associated with a change in 7-day ED revisits for discharged patients but was associated with decreased revisits for patients discharged from observation (11.6% vs. 42.9%, p < 0.001). CONCLUSION Geriatric screening was associated with increased consultations/referrals to geriatrics, PT, and OT in the ED and ED observation unit. This suggests that geriatric screening changes ED care for older adults.
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Affiliation(s)
- Katherine M Hunold
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
| | | | - Lorraine C Mion
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Lauren T Southerland
- Department of Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
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2
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Kuntz AA, Stumm EK, Anderson TC, Ibarra SJ, Markart MR, Haske-Palomino M. Use of a nursing-led geriatrics consult service to deliver age-friendly care. Geriatr Nurs 2023; 50:58-64. [PMID: 36641857 DOI: 10.1016/j.gerinurse.2022.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 12/15/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023]
Abstract
The Elder Veteran Program (EVP) is a nursing-led approach to deliver inpatient consultative geriatrics care at our academic Midwestern Veterans Hospital. From April to December of 2021, EVP modified its workflow using a Plan-Do-Study-Act approach to include previously under-addressed components of the IHI's "4M's" of Age-Friendly Care (Medication, Mobility, Mentation, and What Matters), with three months of retrospective data review as a Plan phase, three months of monthly Do and Study phases, and a three month Act phase to analyze post-intervention care. We found improvements in frequency of documentation of Medication, Mentation, and What Matters in EVP notes, and maintenance of Mobility documentation. Next steps include translating these documentation and workflow changes into other relevant outcome measures and outreach to other departments. Overall, our project demonstrates a novel way to integrate these Pillars into a hospital system, by leveraging an existing nursing-led geriatric consult service focused on prevention and education.
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Affiliation(s)
- Aaron A Kuntz
- Advanced Geriatrics Fellow, Geriatrics Research, Education, and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
| | - Eleanore K Stumm
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Tess C Anderson
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | | | - Megan R Markart
- William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Maureen Haske-Palomino
- Clinical Nurse Advisor for Geriatrics and Extended Care, Office of Nursing Services, William S. Middleton Memorial Veterans Hospital, Madison, WI, USA
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3
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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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4
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Oldham MA, Chahal K, Lee HB. A systematic review of proactive psychiatric consultation on hospital length of stay. Gen Hosp Psychiatry 2019; 60:120-126. [PMID: 31404826 DOI: 10.1016/j.genhosppsych.2019.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 07/25/2019] [Accepted: 08/01/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Roughly half of general hospital patients may have a psychiatric issue that impacts care, yet most of these are not recognized during hospital admission. Proactive mental health screening offers an opportunity for timely identification and clinical attention to improve outcomes. METHOD We conducted a PRISMA systematic review of Pubmed, Embase, PsycINFO, and Cochrane Library for proactive models of psychiatric consultation to reduce hospital length of stay (LOS) in adult inpatients. For each study, we evaluated the level of evidence and defined the study sample, means of group allocation, screening process, interventions, and outcomes. RESULTS Of the 12 included studies, the 8 whose screening was informed by clinicians with mental health care expertise or whose providers were integrated with primary services reported a reduction in LOS. Two of these also reported favorable cost-benefit analyses. All positive studies represent versions of either psychiatrists embedded within medical or surgical settings or a multidisciplinary team-based model. CONCLUSIONS Proactive CL psychiatry with clinically-informed screening and integrated care delivery appear to reduce LOS. Further studies are needed to explore a broader range of outcomes, hospital populations beyond hospital medicine, and additional benefits of proactive integrated mental health care in the general hospital.
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Affiliation(s)
- Mark A Oldham
- University of Rochester Medical Center, 300 Crittenden Blvd, Box PSYCH, Rochester, NY 14642, United States of America.
| | - Khushminder Chahal
- University of Rochester Medical Center, 300 Crittenden Blvd, Box PSYCH, Rochester, NY 14642, United States of America
| | - Hochang B Lee
- University of Rochester Medical Center, 300 Crittenden Blvd, Box PSYCH, Rochester, NY 14642, United States of America
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5
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Saha S, DiRusso SM, Welle S, Lieberman B, Sender J, Shabsigh R, Baltazar GA. Integration of Geriatrician Consultation for Trauma Admissions May Benefit Patient Outcomes. Gerontol Geriatr Med 2019; 5:2333721419858735. [PMID: 31259206 PMCID: PMC6589989 DOI: 10.1177/2333721419858735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/30/2019] [Accepted: 05/31/2019] [Indexed: 11/16/2022] Open
Abstract
Objective: Geriatric admissions to trauma centers have increased, and in 2013, our center integrated geriatrician consultation with the management of admitted patients. Our goal is to describe our experience with increasing geriatric fall volume to help inform organized geriatric trauma programs. Method: We retrospectively analyzed admitted trauma patients ≥65 years old, suffering falls from January 1, 2006, to December 31, 2017. We examined descriptive statistics and changes in outcomes after integration. Results: A total of 1,335 geriatric trauma patients were admitted, of which 1,054 (79%) had suffered falls. Falls increased disproportionately (+280%) compared with other mechanisms of injury (+97%). After 2013, patient discharge disposition to skilled nursing facility decreased significantly (–67%, p < .001), with a concomitant increase in safe discharges home with outpatient services. Regression analysis revealed association between integration of geriatrician consultation and outcomes. Discussion: Geriatrician consultation is associated with optimized discharge disposition of trauma patients. We recommend geriatrician consultation for all geriatric trauma activations.
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Affiliation(s)
- Sumit Saha
- City University of New York, New York City, NY, USA
| | - Stephen M DiRusso
- City University of New York, New York City, NY, USA.,SBH Health System, Bronx, NY, USA
| | | | | | - Joel Sender
- City University of New York, New York City, NY, USA.,SBH Health System, Bronx, NY, USA
| | - Ridwan Shabsigh
- City University of New York, New York City, NY, USA.,SBH Health System, Bronx, NY, USA.,Cornell University, New York, NY, USA
| | - Gerard A Baltazar
- City University of New York, New York City, NY, USA.,SBH Health System, Bronx, NY, USA.,New York Institute of Technology, Old Westbury, NY, USA.,New York University Winthrop Hospital, Mineola, NY, USA
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6
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Schubert CC, Parks R, Coffing JM, Daggy J, Slaven JE, Weiner M. Lessons and Outcomes of Mobile Acute Care for Elders Consultation in a Veterans Affairs Medical Center. J Am Geriatr Soc 2018; 67:818-824. [PMID: 30575012 DOI: 10.1111/jgs.15730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Describe the implementation and effects of Mobile Acute Care for Elders (MACE) consultation at a Veterans Affairs Medical Center (VAMC). DESIGN Retrospective cohort analysis. INTERVENTION Veterans aged 65 or older who were admitted to the medicine service between October 1, 2012, and September 30, 2014, were screened for geriatric syndromes via review of medical records within 48 hours of admission. If the screen was positive, the MACE team offered the admitting team a same-day consultation involving comprehensive geriatric assessment and ongoing collaboration with the admitting team and supportive services to implement patient-centric recommendations for geriatric syndromes. RESULTS Veterans seen by MACE (n = 421) were compared with those with positive screens but without consultation (n = 372). The two groups did not significantly differ in age, comorbidity, sex, or race. All outcomes (30-day readmission, 30-day mortality, readmission costs) were in the expected direction for patients receiving MACE but did not reach statistical significance. Patients receiving MACE had lower odds of 30-day readmission (11.9% vs 14.8%; odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.54-1.25; p = .360) and 30-day mortality (5.5% vs 8.6%; OR = 0.64; CI = 0.36-1.12; p = .115), and they had lower 30-day readmission costs (MACE $15,502; CI = $12,242-$19,631; comparison = $18,335; CI = $14,641-$22,962; p = .316) than those who did not receive MACE after adjusting for age and Charlson Comorbidity Index. CONCLUSION Our MACE consultation model for older veterans with geriatric syndromes leverages the limited supply of clinicians with expertise in geriatrics. Although not statistically significant in this study of 793 subjects, MACE patients had lower odds of 30-day readmission and mortality, and lower readmission costs. J Am Geriatr Soc 67:818-824, 2019.
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Affiliation(s)
- Cathy C Schubert
- Indiana University School of Medicine, Indianapolis, Indiana.,Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Rebecca Parks
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana
| | - Jessica M Coffing
- Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, Indiana
| | - Joanne Daggy
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - James E Slaven
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Michael Weiner
- Indiana University School of Medicine, Indianapolis, Indiana.,Richard L. Roudebush VA Medical Center, Indianapolis, Indiana.,Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416, Indianapolis, Indiana.,Regenstrief Institute, Inc., Indianapolis, Indiana
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7
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Korc-Grodzicki B, Tew W, Hurria A, Yulico H, Lichtman S, Hamlin P, Bosl G. Development of a Geriatric Service in a Cancer Center: Lessons Learned. J Oncol Pract 2018; 13:107-112. [PMID: 28972835 DOI: 10.1200/jop.2016.017590] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Beatriz Korc-Grodzicki
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - William Tew
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Arti Hurria
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Heidi Yulico
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Stuart Lichtman
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Paul Hamlin
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
| | - George Bosl
- Memorial Sloan Kettering Cancer Center, New York, NY; and City of Hope Comprehensive Cancer Center, Duarte, CA
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8
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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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9
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Bernstein JM, Graven P, Drago K, Dobbertin K, Eckstrom E. Higher Quality, Lower Cost with an Innovative Geriatrics Consultation Service. J Am Geriatr Soc 2018; 66:1790-1795. [PMID: 30094830 DOI: 10.1111/jgs.15473] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 03/27/2018] [Accepted: 05/11/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To design a value-driven, interprofessional inpatient geriatric consultation program coordinated with systems-level changes and studied outcomes and costs. DESIGN Propensity-matched case-control study of older adults hospitalized at an academic medical center (AMC) who did or did not receive geriatric consultation. SETTING Single tertiary-care AMC in Portland, Oregon. PARTICIPANTS Adults aged 70 and older who received an inpatient geriatric consultation (n=464) and propensity-matched controls admitted before development of the consultation program (n=2,381). Pre- and postintervention controls were also incorporated into cost difference-in-difference analyses. MEASUREMENTS Daily charges, total charges, length of stay (LOS), 30-day readmission, intensive care unit (ICU) days, Foley catheter days, total medication doses per day, high-risk medication doses per day, advance directive and Physician Orders for Life Sustaining Treatment (POLST) documentation, restraint orders, discharge to home, and mortality. RESULTS On average, individuals who received a geriatric consultation had $611 lower charges per day than those without a consultation (p=.02). They spent on average 0.36 fewer days in the ICU (p<.001). They were less likely to have restraint orders (20.0% vs 27.9%, p<0.001), more likely to have a POLST (58.2% vs 44.6%, p<.001), and more likely to be discharged to home (33.4% vs 28.2%, p=.03). They received fewer doses of antipsychotics, benzodiazepines, and antiemetics (10, 5, and 7 fewer doses per 100 patient-days, respectively) and had lower in-hospital mortality (2.4% vs 4%, p=.01). There was no difference in hospital LOS or 30-day readmission. CONCLUSION Our consultation program resulted in significant reductions in daily charges, ICU days, potentially inappropriate medication use, and use of physical restraints and increased end-of-life planning. This model has potential for dissemination to other institutions operating in resource-scarce, value-driven settings.
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Affiliation(s)
- Juliana M Bernstein
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon
| | - Peter Graven
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon
| | - Kathleen Drago
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon
| | - Konrad Dobbertin
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon
| | - Elizabeth Eckstrom
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, Oregon
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Sinvani L, Carney M, Kozikowski A, Smilios C, Patel V, Qiu G, Zhang M, Babalola O, Kandov Y, Rosenberg D, Wolf-Klein G, Pekmezaris R. The role of geriatrician-hospitalists in the care of older adults: A retrospective cohort study. Arch Gerontol Geriatr 2018; 77:31-37. [PMID: 29631172 DOI: 10.1016/j.archger.2018.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 12/22/2017] [Accepted: 03/02/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Medicare patients account for over 50% of hospital days at a cost of over $1 trillion per year. Yet, hospitalization of older adults often results in poor outcomes. We evaluated the role of geriatrician-hospitalists in the care of older adults. Materials and methods A retrospective cohort study was conducted in a 764-bed tertiary care hospital with patients 65 and older admitted to medicine. Geriatrician-hospitalists care was compared to usual care by non-geriatrician hospitalists (staff and non-staff). Outcome measures included length of stay (LOS) and 30-day readmissions. Process measures included geriatric-focused care practices, such as early mobilization, safety precautions, delirium management, use of potentially inappropriate medications and documentation of advanced directives as well as discharge disposition. RESULTS Of the 10,529 patients, 2949 (28.0%) were cared for by staff hospitalists, 7181 (68.2%) by non-staff hospitalists and 399 (3.79%) by geriatrician-hospitalists. Patients cared for by geriatrician-hospitalists were significantly older with more comorbidities than those admitted to staff and non-staff hospitalists (average age: 86.3, 79.7, and 80.3, respectively, p < 0.0001; Charlson Comorbidity Index: 7.46, 7.01, and 7.17, respectively, p = 0.0005). Multivariate analysis showed no difference in LOS, 30-day readmissions, and discharge disposition. In terms of care practices, significant differences were found for the following: time to PT (p < 0.0001), duration of indwelling bladder catheters (p = 0.018), documentation of Do-Not-Resuscitate (p < 0.0001), benzodiazepine use (p < 0.0001) and anticholinergics (p = 0.0029), respectively. CONCLUSIONS As the population continues to age at unprecedented rates and hospitals struggle to meet the demands and expectations, geriatrician-hospitalists may improve care practices important for older adult care management.
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Affiliation(s)
- Liron Sinvani
- Department of Medicine, Division of Hospital Medicine, Northwell Health, 600 Community Drive, Manhasset, NY 11030, USA
| | - Maria Carney
- Department of Medicine, Division of Geriatric & Palliative Medicine, Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA
| | - Andrzej Kozikowski
- Division of Health Services Research, Department of Medicine, Center for Health Innovations and Outcomes Research, Northwell Health, 600 Community Drive, Manhasset, NY 11030, USA
| | - Christopher Smilios
- Division of Health Services Research, Department of Medicine, Center for Health Innovations and Outcomes Research, Northwell Health, 600 Community Drive, Manhasset, NY 11030, USA
| | - Vidhi Patel
- Division of Health Services Research, Department of Medicine, Center for Health Innovations and Outcomes Research, Northwell Health, 600 Community Drive, Manhasset, NY 11030, USA.
| | - Guang Qiu
- Division of Health Services Research, Department of Medicine, Center for Health Innovations and Outcomes Research, Northwell Health, 600 Community Drive, Manhasset, NY 11030, USA
| | - Meng Zhang
- The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY, USA
| | - Olawumi Babalola
- Department of Medicine, Division of Hospital Medicine, Northwell Health, 600 Community Drive, Manhasset, NY 11030, USA
| | - Yakov Kandov
- Department of Medicine, Division of Hospital Medicine, Northwell Health, 600 Community Drive, Manhasset, NY 11030, USA
| | - David Rosenberg
- Department of Medicine, Division of Hospital Medicine, Northwell Health, 600 Community Drive, Manhasset, NY 11030, USA
| | - Gisele Wolf-Klein
- Department of Medicine, Division of Geriatric & Palliative Medicine, Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA
| | - Renee Pekmezaris
- Division of Health Services Research, Department of Medicine, Center for Health Innovations and Outcomes Research, Northwell Health, 600 Community Drive, Manhasset, NY 11030, USA
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11
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Van Grootven B, McNicoll L, Mendelson DA, Friedman SM, Fagard K, Milisen K, Flamaing J, Deschodt M. Quality indicators for in-hospital geriatric co-management programmes: a systematic literature review and international Delphi study. BMJ Open 2018; 8:e020617. [PMID: 29549210 PMCID: PMC5857708 DOI: 10.1136/bmjopen-2017-020617] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/18/2018] [Accepted: 02/08/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To find consensus on appropriate and feasible structure, process and outcome indicators for the evaluation of in-hospital geriatric co-management programmes. DESIGN An international two-round Delphi study based on a systematic literature review (searching databases, reference lists, prospective citations and trial registers). SETTING Western Europe and the USA. PARTICIPANTS Thirty-three people with at least 2 years of clinical experience in geriatric co-management were recruited. Twenty-eight experts (16 from the USA and 12 from Europe) participated in both Delphi rounds (85% response rate). MEASURES Participants rated the indicators on a nine-point scale for their (1) appropriateness and (2) feasibility to use the indicator for the evaluation of geriatric co-management programmes. Indicators were considered appropriate and feasible based on a median score of seven or higher. Consensus was based on the level of agreement using the RAND/UCLA Appropriateness Method. RESULTS In the first round containing 37 indicators, there was consensus on 14 indicators. In the second round containing 44 indicators, there was consensus on 31 indicators (structure=8, process=7, outcome=16). Experts indicated that co-management should start within 24 hours of hospital admission using defined criteria for selecting appropriate patients. Programmes should focus on the prevention and management of geriatric syndromes and complications. Key areas for comprehensive geriatric assessment included cognition/delirium, functionality/mobility, falls, pain, medication and pressure ulcers. Key outcomes for evaluating the programme included length of stay, time to surgery and the incidence of complications. CONCLUSION The indicators can be used to assess the performance of geriatric co-management programmes and identify areas for improvement. Furthermore, the indicators can be used to monitor the implementation and effect of these programmes.
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Affiliation(s)
- Bastiaan Van Grootven
- Research Foundation - Flanders, Brussels, Belgium
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
| | - Lynn McNicoll
- Division of Geriatrics, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel A Mendelson
- Department of Medicine, Division of Geriatrics and Aging, University of Rochester, Rochester, New York, USA
| | - Susan M Friedman
- Department of Medicine, Division of Geriatrics and Aging, University of Rochester, Rochester, New York, USA
| | - Katleen Fagard
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Disease, Metabolism and Ageing, KU Leuven - University of Leuven, Leuven, Belgium
| | - Koen Milisen
- Department of Public Health and Primary Care, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Johan Flamaing
- Department of Geriatric Medicine, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Disease, Metabolism and Ageing, KU Leuven - University of Leuven, Leuven, Belgium
| | - Mieke Deschodt
- Department of Chronic Disease, Metabolism and Ageing, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Public Health, Institute of Nursing Science, University of Basel, Basel, Switzerland
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12
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Desan PH, Lee HB, Zimbrean P, Sledge W. New Models of Psychiatric Consultation in the General Medical Hospital: Liaison Psychiatry Is Back. Psychiatr Ann 2017. [DOI: 10.3928/00485713-20170524-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Deschodt M, Claes V, Van Grootven B, Van den Heede K, Flamaing J, Boland B, Milisen K. Structure and processes of interdisciplinary geriatric consultation teams in acute care hospitals: A scoping review. Int J Nurs Stud 2016; 55:98-114. [DOI: 10.1016/j.ijnurstu.2015.09.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/02/2015] [Accepted: 09/25/2015] [Indexed: 01/16/2023]
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Beveridge C, Knutson K, Spampinato L, Flores A, Meltzer DO, Van Cauter E, Arora VM. Daytime Physical Activity and Sleep in Hospitalized Older Adults: Association with Demographic Characteristics and Disease Severity. J Am Geriatr Soc 2015; 63:1391-400. [PMID: 26131982 DOI: 10.1111/jgs.13520] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess objectively measured daytime physical activity and sleep duration and efficiency in hospitalized older adults and explore associations with demographic characteristics and disease severity. DESIGN Prospective cohort study. SETTING University of Chicago Medical Center general medicine wards. PARTICIPANTS Community-dwelling inpatients aged 50 and older (N = 120) MEASUREMENTS: Physical activity and sleep were measured using wrist accelerometers. Information on Charlson Comorbidity Index and length of stay was collected from charts. Random-effects linear regression analysis was used to examine the association between in-hospital sleep and physical activity. RESULTS From March 2010 to May 2013, 120 participants wore wrist actigraphy monitors for at least 2 nights and 1 intervening day. Median activity level over the waking period was 77 counts/min (interquartile range 51-121 counts/min), an activity level that approximately corresponds to sitting while watching television (65 counts/min). Mean sleep duration the night before the activity interval was 289 ± 157 minutes, and mean sleep efficiency the night before the activity interval was 65.2 ± 26.9%. Mean activity counts/min were lowest for the oldest participants (oldest quartile 62, 95% confidence interval (CI) = 50-75; youngest quartile 121, 95% CI = 98-145, trend test P < .001) and those with highest Charlson Comorbidity Index (highest tertile 71, 95% CI = 60-83; lowest tertile 125, 95% CI = 104-147, trend test P = .01). Controlling for severity of illness and demographic characteristics, activity declined by 3 counts/min (95% CI = -5.65 to -0.43, P = .02) for each additional hour of inpatient sleep. CONCLUSION Older, sicker adults are less physically active during hospitalization. In contrast to studies in the community, inpatients who slept more were not more active. This may highlight that need for sleep is greater in the hospital than in the community.
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Affiliation(s)
- Claire Beveridge
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Kristen Knutson
- Department of Medicine, University of Chicago, Chicago, Illinois.,Sleep, Metabolism, and Health Center, University of Chicago, Chicago, Illinois
| | - Lisa Spampinato
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Andrea Flores
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - David O Meltzer
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Eve Van Cauter
- Department of Medicine, University of Chicago, Chicago, Illinois.,Sleep, Metabolism, and Health Center, University of Chicago, Chicago, Illinois
| | - Vineet M Arora
- Department of Medicine, University of Chicago, Chicago, Illinois.,Sleep, Metabolism, and Health Center, University of Chicago, Chicago, Illinois
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Nazir A, Khan B, Counsell S, Henderson M, Gao S, Boustani M. Impact of an inpatient geriatric consultative service on outcomes for cognitively impaired patients. J Hosp Med 2015; 10:275-80. [PMID: 25641773 PMCID: PMC4411200 DOI: 10.1002/jhm.2326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/21/2014] [Accepted: 12/07/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Impact of geriatric consultative services (GCS) on hospital readmission and mortality outcomes for cognitively impaired (CI) patients is not known. OBJECTIVE Evaluate impact of GCS on hospital readmission and mortality among CI inpatients. DESIGN Secondary data analysis of a prospective trial of a computerized decision support system between July 1, 2006 and May 30, 2008. SETTING Study conducted at Eskenazi hospital, Indianapolis, Indiana, a 340-bed, public hospital with over 2300 yearly admissions of patients ages 65 years or older. PATIENTS There were 415 inpatients aged 65 years and older with CI enrolled from July 2006 to March 2008. MEASUREMENTS Thirty-day and 1-year mortality and hospital readmission following the index admission. Cox proportional hazard models were used to determine the association between receiving GCS, readmission, or mortality while adjusting for demographics, discharge destination, delirium, Charlson Comorbidity Index, and prior hospitalizations. The propensity score method was used to adjust for the nonrandom assignment of GCS. RESULTS Patients receiving GCS were older (79 years old, 8.1 standard deviation [SD] vs 76 years old, 7.8 SD; P < 0.001) with higher incidence of delirium (49% vs 29%; P < 0.001). No significant differences were found between the groups for hospital readmission (hazard ratio [HR] = 1.19; 95% confidence interval = 0.89-1.59) and mortality at 12 months of index admission (HR = 0.91; 95% confidence interval = 0.59-1.40). However, a significant increase in readmissions was observed for the GCS group (HR = 1.75; 95% confidence interval = 1.06-2.88) at 30 days postdischarge. CONCLUSION One-year postdischarge outcomes of CI patients who received GCS were not different from patients who did not receive the service. New models of care are needed to improve postdischarge readmission and mortality among hospitalized patients with CI.
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Affiliation(s)
- Arif Nazir
- Indiana University School of Medicine, Indianapolis, Indiana
| | - Babar Khan
- Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
- Regenstrief Institute, Inc. Indianapolis, Indiana
| | - Steven Counsell
- Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
| | - Macey Henderson
- Richard M. Fairbanks School of Public Health, Indianapolis, Indiana
| | - Sujuan Gao
- Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
| | - Malaz Boustani
- Indiana University School of Medicine, Indianapolis, Indiana
- Indiana University Center for Aging Research, Indianapolis, Indiana
- Regenstrief Institute, Inc. Indianapolis, Indiana
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Ding YY, Sun Y, Tay JC, Chong WF. Short-term outcomes of seniors aged 80 years and older with acute illness: hospitalist care by geriatricians and other internists compared. J Hosp Med 2014; 9:634-9. [PMID: 25044377 DOI: 10.1002/jhm.2238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/10/2014] [Accepted: 06/28/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although acute geriatric units have improved the outcomes of hospitalized seniors, it is uncertain as to whether hospitalist care by geriatricians outside of these units confers similar benefit. OBJECTIVE To determine whether hospitalist care by geriatricians reduces short-term mortality and readmission, and length of stay (LOS) for seniors aged 80 years and older with acute medical illnesses compared with care by other internists. DESIGN Retrospective cohort study using administrative and chart review data on demographic, admission-related, and clinical information of hospital episodes. SETTING General internal medicine department of an acute-care hospital in Singapore from 2005 to 2008. PATIENTS Seniors aged 80 years and older with specific focus on 2 subgroups with premorbid functional impairment and acute geriatric syndromes. INTERVENTION Hospitalist care by geriatricians compared with care by other internists. MEASURES Hospital mortality, 30-day mortality or readmission, and LOS. RESULTS For 1944 hospital episodes (intervention: 968, control: 976), there was a nonsignificant trend toward lower hospital mortality (15.5% vs 16.9%) but not 30-day mortality or readmission, or LOS for care by geriatricians compared with care by other internists. A marginally stronger trend toward lower hospital mortality for care by geriatricians among those with acute geriatric syndromes (20.2% vs 23.1%) was observed. Similar treatment effects were found after adjustment for demographic, admission-related, and clinical factors. CONCLUSIONS For seniors aged 80 years and over with acute medical illness, hospitalist care by geriatricians did not significantly reduce short-term mortality, readmission, or LOS, compared with care by other internists.
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Affiliation(s)
- Yew Yoong Ding
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; Health Services & Outcomes Research, National Healthcare Group, Singapore
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Quality in transitional care of the elderly: Key challenges and relevant improvement measures. Int J Integr Care 2014; 14:e013. [PMID: 24868196 PMCID: PMC4027895 DOI: 10.5334/ijic.1194] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 03/21/2014] [Accepted: 03/25/2014] [Indexed: 11/20/2022] Open
Abstract
Introduction Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures. Methodology Included in the study were elderly patients (75+) receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41) were carried out by two researchers. Results Six main challenges with belonging descriptions have been identified: (1) next of kin (bridging providers, advocacy, support, information brokering), (2) patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions), (3) health care personnel's competence (professional, system, awareness of others’ roles), (4) information exchange (oral, written, electronic), (5) context (stability, variability, change incentives, number of patient handovers) and (6) patient assessment (complex clinical picture, patient description, clinical assessment). Conclusion Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings.
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Van Blarcom JR, Srivastava R, Colling D, Maloney CG. The development and implementation of a direct admission system at a tertiary care hospital. Hosp Pediatr 2014; 4:69-77. [PMID: 24584975 DOI: 10.1542/hpeds.2013-0019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bruus I, Varik M, Aro I, Kalam-Salminen L, Routasalo P. Patient-centeredness in long-term care of older patients - a structured interview. Int J Older People Nurs 2011; 7:264-71. [DOI: 10.1111/j.1748-3743.2011.00301.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mehta KM, Pierluissi E, Boscardin WJ, Kirby KA, Walter LC, Chren MM, Palmer RM, Counsell SR, Landefeld CS. A clinical index to stratify hospitalized older adults according to risk for new-onset disability. J Am Geriatr Soc 2011; 59:1206-16. [PMID: 21649616 PMCID: PMC3839864 DOI: 10.1111/j.1532-5415.2011.03409.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Many older adults who are independent prior to hospitalization develop a new disability by hospital discharge. Early risk stratification for new-onset disability may improve care. Thus, this study's objective was to develop and validate a clinical index to determine, at admission, risk for new-onset disability among older, hospitalized adults at discharge. DESIGN Data analyses derived from two prospective studies. SETTING Two teaching hospitals in Ohio. PARTICIPANTS Eight hundred eighty-five patients aged 70 years and older were discharged from a general medical service at a tertiary care hospital (mean age 78, 59% female) and 753 patients discharged from a separate community teaching hospital (mean age 79, 63% female). All participants reported being independent in five activities of daily living (ADLs: bathing, dressing, transferring, toileting, and eating) 2 weeks before admission. MEASUREMENTS New-onset disability, defined as a new need for personal assistance in one or more ADLs at discharge in participants who were independent 2 weeks before hospital admission. RESULTS Seven independent risk factors known on admission were identified and weighted using logistic regression: age (80-89, 1 point; ≥90, 2 points); dependence in three or more instrumental ADLs at baseline (2 points); impaired mobility at baseline (unable to run, 1 point; unable to climb stairs, 2 points); dependence in ADLs at admission (2-3 ADLs, 1 point; 4-5 ADLs, 3 points); acute stroke or metastatic cancer (2 points); severe cognitive impairment (1 point); and albumin less than 3.0 g/dL (2 points). New-onset disability occurred in 6%, 13%, 18%, 34%, 35%, 45%, 50%, and 87% of participants with 0, 1, 2, 3, 4, 5, 6, and 7 or more points, respectively, in the derivation cohort (area under the receiver operating characteristic curve (AUC)=0.784), and in 8%, 10%, 27%, 38%, 44%, 45%, 58%, and 83%, respectively, in the validation cohort (AUC=0.784). The risk score also predicted (P<.001) disability severity, nursing home placement, and long-term survival. CONCLUSION This clinical index determines risk for new-onset disability in hospitalized older adults and may inform clinical care.
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Affiliation(s)
- Kala M Mehta
- Division of Geriatrics, University of California at San Francisco, San Francisco, CA 94121, USA.
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Geriatric medicine and health care system: how can they fit together? ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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