A Randomized Trial of Care in a Hospital Medical Unit Especially Designed to Improve the Functional Outcomes of Acutely Ill Older Patients

Landefeld, C. Seth; Palmer, Robert M.; Kresevic, Denise; Fortinsky, Richard H.; Kowal, Jerome

doi:10.1056/nejm199505183322006

Cited by 723 publications

(699 citation statements)

References 41 publications

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“…The FDP geriatrics content and design model were developed as follows: reviewing existing published geriatrics curricular materials, 5,6,8,18 including high-risk areas of geriatric hospital care; [19][20][21][22] drawing from the experience of the inpatient geriatric evaluation and treatment units; [23][24][25] and reviewing the Joint Commission mandates 26 that have a particular impact on the care of the older hospitalized patients (eg, high-risk medications, medication reconciliation, restraint use, and transitions of care). Final curricular materials were approved by consensus of the University of Chicago geriatrics/hospitalist core CHAMP faculty.…”

Section: Geriatrics Contentmentioning

confidence: 99%

The Curriculum for the Hospitalized Aging Medical Patient program: A collaborative faculty development program for hospitalists, general internists, and geriatricians

Podrazik

Levine

Smith

et al. 2008

Journal of Hospital Medicine

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BACKGROUND:The University of Chicago Curriculum for the Hospitalized Aging Medical Patient (CHAMP) faculty development program (FDP) is targeted at hospitalists and other internists who teach residents and students in the hospital setting. The aim of CHAMP is to increase the quantity and quality of teaching of geriatric medicine pertinent to the inpatient setting.METHODS:Hospitalist and general internist faculty members who attend on the University of Chicago Medicine teaching service were invited to participate. The CHAMP FDP consisted of twelve 4‐hour sessions. Two hours of each session covered inpatient geriatrics content, and 2 hours addressed improving clinical teaching (both general teaching skills and challenges specific to the inpatient wards) and teaching the Accreditation Council for Graduate Medical Education core competencies with geriatrics content. The evaluation included a self‐report survey of the impact on the graduates' teaching and clinical practice.RESULTS:The FDP was piloted in early 2004 with a core group of geriatrics and hospitalist faculty. Three subsequent cohorts totaling 29 hospitalist and general internal medicine faculty members completed the FDP by the fall of 2006. Faculty participants evaluated the program positively, and significant improvements in knowledge, attitudes to geriatrics, and perceived behavior in teaching and practicing geriatrics skills were found.CONCLUSIONS:The integration of teaching techniques and geriatrics content was enthusiastically accepted by University of Chicago hospitalists and general internists who teach residents and medical students in the inpatient setting. The program has potential for widespread suitability to all teaching faculty who care for the older hospitalized patient. Journal of Hospital Medicine 2008. © 2008 Society of Hospital Medicine.

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Section: Geriatrics Contentmentioning

confidence: 99%

The Curriculum for the Hospitalized Aging Medical Patient program: A collaborative faculty development program for hospitalists, general internists, and geriatricians

Podrazik

Levine

Smith

et al. 2008

Journal of Hospital Medicine

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“…[10][11][12][13][14][15][16] Understanding the prevalence of and the risk factors for HAD in persons as young as 55 is important, as hospitals could target areas of high prevalence for interventions to reduce functional decline in older adults, thus benefitting a greater number of people at risk. 1,[17][18][19] In order to understand the prevalence of HAD in a safety-net setting, we describe HAD in a cohort of racially and ethnically diverse adults aged 55 and older who were hospitalized at an urban safety-net facility. We describe disability at baseline, admission, and 30 days post-discharge.…”

Section: Introductionmentioning

confidence: 99%

Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital

et al. 2015

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BACKGROUND:Little is known about hospitalizationassociated disability (HAD) in older adults who receive care in safety-net hospitals. OBJECTIVES: To describe HAD and to examine its association with age in adults aged 55 and older hospitalized in a safety-net hospital. DESIGN: Secondary post hoc analysis of a prospective cohort from a discharge intervention trial, the Support from Hospital to Home for Elders. SETTING: Medicine, cardiology, and neurology inpatient services of San Francisco General Hospital, a safety-net hospital. PARTICIPANTS: A total of 583 participants 55 and older who spoke English, Spanish, or Chinese. We determined the incidence of HAD 30 days post-hospitalization and ORs for HAD by age group. MEASUREMENTS: The outcome measure was death or HAD at 30 days after hospital discharge. HAD is defined as a new or additional disability in one or more activities of daily living (ADL) that is present at hospital discharge compared to baseline. Participants' functional status at baseline (2 weeks prior to admission) and 30 days postdischarge was ascertained by self-report of ADL function. RESULTS: Many participants (75.3 %) were functionally independent at baseline. By age group, HAD occurred as follows: 27.4 % in ages 55-59, 22.2 % in ages 60-64, 17.4 % in ages 65-69, 30.3 % in ages 70-79, and 61.7 % in ages 80 or older. Compared to the youngest group, only the adjusted OR for HAD in adults over 80 was significant, at 2.45 (95 % CI 1.17, 5.15). CONCLUSIONS: In adults at a safety-net hospital, HAD occurred in similar proportions among adults aged 55-59 and those aged 70-79, and was highest in the oldest adults, aged ≥ 80. In safety-net hospitals, interventions to reduce HAD among patients 70 years and older should consider expanding age criteria to adults as young as 55.

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“…[1][2][3][4][5] It is, however, limited in scope to only those patients cared for on a fixed geographical unit. This structural limitation is of increasing relevance in times of high hospital bed occupancy rates, as during such times, many appropriate older patients are admitted elsewhere.…”

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confidence: 99%

Operational and quality outcomes of a mobile acute care for the elderly service

Farber

Korc-Grodzicki

et al. 2011

Journal of Hospital Medicine

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BACKGROUND:The traditional acute care for the elderly (ACE) unit has demonstrated improved functional outcomes without increased costs or changes in length of stay (LOS). It is, however, limited in scope to patients cared for on a fixed geographical unit.OBJECTIVE:To compare operational and quality outcomes for patients cared for on a mobile ACE (MACE) service to those cared for on a unit‐based ACE service and matched controls on other general medical services.DESIGN:Retrospective cohort study with propensity‐score matching.SETTING:An urban academic medical center.PATIENTS:A total of 8094 hospitalized adults >64 years old admitted to an ACE, MACE, and general medical services from July 2006 to June 2009.INTERVENTION:An interdisciplinary MACE service com‐ posed of a geriatrician‐hospitalist, fellow, nurse coordinator, and social worker.MEASUREMENTS:LOS, total cost, 7‐ and 30‐day readmission rates, and in‐hospital mortality.RESULTS:Mean LOS and total cost were significantly lower for patients in the MACE service compared with the ACE unit service (5.8 vs 7.9 days, P < 0.001, and $10,315 vs $13,187, P = 0.002) and compared with propensity‐score matched controls during the second year of operation (5.6 vs 7.2 days, P < 0.001, and $10,693 vs $15,636, P < 0.001). In‐hospital mortality and 7‐ and 30‐day readmission rates were similar in all groups.CONCLUSIONS:A mobile ACE service may result in reduced LOS and lower costs with no change in in‐hospital mortality or 7‐ or 30‐day readmission rates when compared with standard medical service and a traditional unit‐based ACE service. Journal of Hospital Medicine 2011;6:358–363. © 2011 Society of Hospital Medicine

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A Randomized Trial of Care in a Hospital Medical Unit Especially Designed to Improve the Functional Outcomes of Acutely Ill Older Patients

Cited by 723 publications

References 41 publications

The Curriculum for the Hospitalized Aging Medical Patient program: A collaborative faculty development program for hospitalists, general internists, and geriatricians

The Curriculum for the Hospitalized Aging Medical Patient program: A collaborative faculty development program for hospitalists, general internists, and geriatricians

Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital

Operational and quality outcomes of a mobile acute care for the elderly service

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