Effects of the Program of All-Inclusive Care for the Elderly on Hospital Use

Meret-Hanke, Louise

doi:10.1093/geront/gnr040

Cited by 49 publications

(42 citation statements)

References 20 publications

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“…This finding is supported by previous work through the Program of All-Inclusive Care for the Elderly (PACE) model 33. PACE is an integrated care model working across acute and primary care focusing on care coordination, early intervention, and support for patients and caregivers within the community, reporting a reduction in hospital bed days used 20. Therefore, this study suggests that a CVW model of care using an integrated approach results in better outcomes for frail older persons whether living alone or with a caregiver.…”

Section: Discussionsupporting

confidence: 75%

“…The majority of referrals to the CVW were due to functional or clinical decline precipitated by either cognitive or physical deterioration impacting on activities of daily living as well as increasing need in social supports 18–20. From a national and international viewpoint, functional decline with risks of hospital admission is grouped under the umbrella term of frailty 5,21–23.…”

Section: Functional Decline and Increasing Social Supportsmentioning

confidence: 99%

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A community virtual ward model to support older persons with complex health care and social care needs

Lewis¹,

Moore²,

Doyle³

et al. 2017

CIA

104

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BackgroundGlobally the older population is increasing rapidly. As a result there is an increase in frail older persons living within the community, with increased risks of a hospital admission and higher mortality and morbidity rates. Due to complexity of care, health care professionals face challenges in providing effective case management and avoiding unplanned admissions to hospital. A community virtual ward (CVW) model was developed to assist health care professionals to support older persons at home during periods of illness and/or functional decline.MethodsA quantitative observational study was conducted to examine if a CVW model of care reduced unplanned hospital admissions and emergency department (ED) presentations in 54 patients over a 12-month period. The sign-rank test examined matched data on bed days, ED presentations, and unplanned hospital admissions pre- and post-CVW implementation. Other risk factors for admission to hospital were examined using the Mann–Whitney test pre-and post-CVW admission, including falls, living alone, and cognition. Correlations between hospital admission avoidances and unplanned hospital admissions and ED presentations were tested using Spearman’s ρ test.ResultsThere was a reduction in ED presentations post-CVW admission (P<0.001), and median unscheduled admissions were reduced (P=0.001). Those living alone had a lower number of ED presentations (median 0.5, interquartile range 0–1) prior to admission in comparison to those living with a caregiver, with no differences observed during admission to CVW. For those who experienced a fall during CVW admission, the odds ratio (OR) of requiring long-term care doubled for each extra fall (OR =2.24, 95% CI 1.11 to 4.52, P=0.025). Reduced cognition was associated with an increased risk of ED presentations (ρ=0.292, P<0.05) but not associated with increased risks of unplanned hospital admissions (ρ=0.09, P=0.546). There were no significant correlations seen between admission avoidance and the number of unplanned hospital admissions or ED presentations.ConclusionThrough an integrated approach to care, a CVW model in the care of older persons can reduce ED presentations and unplanned hospital admissions.

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Section: Discussionsupporting

confidence: 75%

Section: Functional Decline and Increasing Social Supportsmentioning

confidence: 99%

A community virtual ward model to support older persons with complex health care and social care needs

Lewis¹,

Moore²,

Doyle³

et al. 2017

CIA

104

View full text Add to dashboard Cite

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“…This study corroborates previous research suggesting that many hospitalizations for older adults may be preventable . Most participants used only the GDH facility, even in the presence of an acute event.…”

Section: Discussionmentioning

confidence: 81%

The Geriatric Day Hospital: Preliminary Data on an Innovative Model of Care in Brazil for Older Adults at Risk of Hospitalization

Aliberti

Suemoto

Fortes-Filho

et al. 2016

J American Geriatrics Society

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Older adults have a greater risk of experiencing functional decline and iatrogenic complications during hospitalization than younger individuals. Geriatric day hospitals (GDHs) have been implemented mainly for rehabilitation. The goal of the current study was to expand the GDH spectrum of care to prevent hospital admissions in this population. This study details an innovative model of GDH care that offers short-term, nonrehabilitative treatment to older adults who have experienced an acute event, those with a decompensated chronic disease, or those in need of a minor procedure that would be unattainable in a regular outpatient setting. During the 6-hour visits made weekly for up to 2 months, participants receive integrated evaluations of their various health domains, education, and rapid access to examinations and procedures based on a multidisciplinary approach. In the first 6 years, 2,322 individuals attended the GDH. The analysis of a representative sample (n = 645) revealed that 81% were treated in the GDH without the need for another type of hospital care. This percentage was high for the different reasons for referral (infection, 71%; delirium, 73%; decompensated chronic disease, 81%). Between baseline and discharge, participants maintained their functional status, and their self-reported health improved. This study represents the first step in describing the role of the GDH as a possible alternative to emergency department use or hospitalization for older adults. Future studies are needed to determine the optimal individual for this model of care and to ensure its cost-effectiveness.

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“…Propensity matching is a technique to remove much of the bias associated with research studies for which randomization is not feasible, such as observational studies [14, 15]. It has been previously used to compare genders [16], populations that did or did not receive treatment [17–19], those with or without access to resources or specialist care [20–22], and a variety of other clinical variables. For each participant ( i ), a propensity score was computed by constructing a multiple logistic regression model with the equation e(x i ) = Pr(D i = 1|X i = x i ), where e i is the propensity score, D i is an indicator for study partner type, and the x i are a set of covariates.…”

Section: Methodsmentioning

confidence: 99%

Does Study Partner Type Impact the Rate of Alzheimer's Disease Progression?

Grill

Zhou

Karlawish

et al. 2013

JAD

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Most patients with Alzheimer’s disease (AD) do not have a spouse. Despite this, the majority of AD research participants enroll with a spouse study partner. It remains unclear if differences between AD patients who do and do not have a spouse may bias study results. In this study, we examined whether AD patients with different study partner types (spouse vs adult child) demonstrate different rates of disease progression over two years on three outcome measures commonly used in AD research, including clinical trials. We used data from the National Alzheimer’s Coordinating Center Uniform Data Set to examine disease progression in participants age 55–90 with probable AD dementia. We examined disease progression as measured by the Clinical Dementia Rating Scale-Sum of the Boxes score, the Mini Mental Status Examination, and the Functional Assessment Questionnaire. Analyses were performed on data for all available eligible participants from the NACC UDS and after performing a propensity-matching model to better account for inherent differences between the populations of interest. Propensity matching was successful only when models did not include age and gender. For both propensity-matched analyses and those of all available data, we did not observe any differences between the study partner populations for any outcome measure. These results suggest that, if investigators can improve in recruiting AD patients with adult child caregivers to research, the implications to study results may be minimal.

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Effects of the Program of All-Inclusive Care for the Elderly on Hospital Use

Cited by 49 publications

References 20 publications

A community virtual ward model to support older persons with complex health care and social care needs

A community virtual ward model to support older persons with complex health care and social care needs

The Geriatric Day Hospital: Preliminary Data on an Innovative Model of Care in Brazil for Older Adults at Risk of Hospitalization

Does Study Partner Type Impact the Rate of Alzheimer's Disease Progression?

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