Hospitalization of older persons is accompanied by a disproportionate risk of poor outcomes and adverse events such as functional decline, delirium, and falls. Several process measures potentially associated with increased quality of care for this vulnerable population exist. The Acute Care for the Elderly (ACE) service is a hybrid of a general medical service and an inpatient geriatrics unit. The ACE model includes the following components: a core group of hospitalist attendings with an interest in geriatric medicine, daily interdisciplinary rounds, a novel educational curriculum, standardized brief geriatric assessment, and a clinical focus on mitigating the hazards of hospitalization and effective care transitions. We evaluated the ACE service during its first year.
Medical inpatients greater than 70 years old were assigned to the ACE service or to usual care in a quasi‐randomized fashion based on medical record number between November 1, 2007, and April 15, 2008. Patients transferred from other hospitals or services were excluded. Study outcomes included 6 processes of care (recognition of abnormal functional status, cognitive function, or delirium; physical restraint use; sleep aid use; and documentation of code status) and 4 outcomes of care (falls, charges, length of stay, and 30‐day readmission rate). Data were obtained from chart review and administrative data queries. Process and outcome measures for ACE patients were compared to usual care patients using the Wilcoxon rank sum test for continuous variables and chi‐square tests for categorical variables.
One hundred and twenty‐two ACE patients and 95 usual‐care patients met the study entry criteria. The 2 groups were similar with respect to age (81 years), sex (55% female), and admitting diagnosis. ACE patients had significantly greater documentation and treatment of abnormal functional status (65% vs. 32%, P < 0.0001) and abnormal cognitive status (57% v. 36%, P < 0.01), including delirium (28% vs. 15%, P < 0.05). There were no differences in use of physical restraints, sleep aids, or documentation of code status, although ACE patients had a higher rate of do‐not‐resuscitate orders (41% v. 26%, P < 0.01). ACE patients and usual‐care patients were similar in mean length of stay in days (3.4 ± 2.7 vs. 3.1 ± 2.7, P = 0.52), mean charges ($24,617 ± $15,828 vs. $21,488 ± $13,407, P = 0.12), 30‐day readmission rates (12% vs. 10%, P = 0.50), and fall rates (1.6% vs. 2.1%, P = 1.00) The case mix index for ACE patients was 1.15 and that for usual‐care patients was 1.05.
Ahospitalist‐run medical service for elderly inpatients can markedly affect processes of care delivered during hospitalization without increases in resource consumption. This model of care, which could be readily exported to other settings, deserves further evaluation.
H. Wald, none; E. Cumbler, none; J. Guerrasio, none; J. Youngwerth, none; J. Glasheen, none.
To cite this abstract:Wald H, Cumbler E, Guerrasio J, Youngwerth J, Glasheen J. A Hospitalist‐Run Geriatrics Service Is Associated with Improved Processes of Care. Abstract published at Hospital Medicine 2009, May 14-17, Chicago, Ill. Abstract 101. https://www.shmabstracts.com/abstract/a-hospitalistrun-geriatrics-service-is-associated-with-improved-processes-of-care/. Accessed December 10, 2018.