Evaluation of the Mobile Acute Care of the Elderly (MACE) Service

Hung, William; Ross, Joseph S.; Farber, Jeffrey; Siu, Albert L.

doi:10.1001/jamainternmed.2013.478

Cited by 67 publications

(41 citation statements)

References 22 publications

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“…There is a dearth of formal geriatric expertise in hospitals across the country, and inpatient teams frequently fail to recognize and manage geriatric syndromes, address goals of care, safely reduce medication burden, or assess risks for hospital‐associated disability and delirium . Varying models of inpatient geriatric care, including Acute Care for Elders (ACE) units, orthogeriatric units, and primary geriatric services, have been found to have lower rates of delirium and functional decline, shorter hospital length of stay (LOS), fewer discharges to nursing homes, and lower costs, but many hospitals lack resources for dedicated geriatric units and teams. The effects of traditional geriatric consultation services on outcomes and costs have been mixed .…”

mentioning

confidence: 99%

Higher Quality, Lower Cost with an Innovative Geriatrics Consultation Service

Bernstein

Graven

Drago

et al. 2018

J American Geriatrics Society

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mentioning

confidence: 99%

Higher Quality, Lower Cost with an Innovative Geriatrics Consultation Service

Bernstein

Graven

Drago

et al. 2018

J American Geriatrics Society

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“…MACE maintains the traditional ACE characteristics of interdisciplinary patient‐centered care, medical review, early discharge planning, and early rehabilitation but forgoes the prepared environment of a physical unit. In these previous studies, MACE was associated with lower rates of geriatric complications, shorter inpatient length of stay, and lower hospital costs …”

Section: Results Of Non–unit‐based Geriatric Consultation Trialsmentioning

confidence: 84%

“…Because of these barriers, in recent years work has been emerging around mobile ACE (MACE), either as a consultation in collaboration with the admitting service or with MACE as the admitting service for the older patient. MACE maintains the traditional ACE characteristics of interdisciplinary patient‐centered care, medical review, early discharge planning, and early rehabilitation but forgoes the prepared environment of a physical unit.…”

Section: Results Of Non–unit‐based Geriatric Consultation Trialsmentioning

confidence: 99%

Lessons and Outcomes of Mobile Acute Care for Elders Consultation in a Veterans Affairs Medical Center

Schubert

Parks

Coffing

et al. 2018

J American Geriatrics Society

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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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“…Hung et al describe a Mobile Acute Care for Elders (MACE) service utilizing a mobile interdisciplinary team that seeks to decrease the hazards of hospitalization, facilitate transitions of care, and provide patient and family education. MACE service patients were less likely to experience adverse events, had shorter length of stay (LOS), and rated the quality of their care transition higher than matched general medicine patients [ 41 ]. Other studies have produced mixed results.…”

Section: Ace/mobile Acementioning

confidence: 99%