Geriatric co-management and interdisciplinary transitional care reduced hospital readmissions in frail older patients in Argentina: results from a randomized controlled trial

Schapira, Marcelo; Outumuro, María Belén; Giber, Fabiana; Pino, Cláudia Amigo; Mattiussi, Mercedes; Montero‐Odasso, Manuel; Boietti, Bruno; Saimovici, Javier; Gallo, Cristian; Hornstein, Lucila; Pollán, Javier; Garfi, Leonardo; Osman, Abdelhady; Perman, Gastón

doi:10.1007/s40520-021-01893-0

Cited by 13 publications

(11 citation statements)

References 32 publications

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“…The review by Fox and colleagues [42] showed that the cost of care in an acute geriatric unit was significantly lower than those of the usual care [42], and two studies concluded there was a reduction in the costs associated with the CGA for many of the hospital-based services analysed [43,44]. A recent RCT of geriatric co-management combined with an interdisciplinary transitional care intervention for frail older patients who had unplanned admissions to internal medicine services in Argentina showed a reduction in 30-day hospital readmissions and emergency department (ED) visits 6 months after discharge in the intervention arm [45]. The cost-effectiveness analysis of the Elder-Friendly Approaches to the Surgical Environment (EASE) Intervention for the emergency abdominal surgical care of older adults [46] conducted by Hofmeister and colleagues suggested that the EASE intervention was associated with a reduction in costs and no change in Quality-Adjusted Life Years (QALYs) [47].…”

Section: Proponents Target Population Recommendationsmentioning

confidence: 99%

“…Out of the 37 eligible studies, two studies were not included due to the characteristics of interventions [52,53], two studies were not included because it was not possible to identify the percentage of cancer patients [45,54], two studies were excluded because the number of cancer patients included was very low [46,55] and another two studies were excluded due to nonexplicit criteria for patient inclusion concerning age [56] or the inclusion of patients of all ages [57]. In the end, 29 studies were identified for the review: 24 retrieved from the databases and five from citation searching or the manual search.…”

Section: Identification Of Relevant Studiesmentioning

confidence: 99%

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Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

Zuccarino

Monacelli

Antognoli

et al. 2022

Cancers

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The Comprehensive Geriatric Assessment (CGA) and the corresponding geriatric interventions are beneficial for community-dwelling older persons in terms of reduced mortality, disability, institutionalisation and healthcare utilisation. However, the value of CGA in the management of older cancer patients both in terms of clinical outcomes and in cost-effectiveness remains to be fully established, and CGA is still far from being routinely implemented in geriatric oncology. This narrative review aims to analyse the available evidence on the cost-effectiveness of CGA adopted in geriatric oncology, identify the relevant parameters used in the literature and provide recommendations for future research. The review was conducted using the PubMed and Cochrane databases, covering published studies without selection by the publication year. The extracted data were categorised according to the study design, participants and measures of cost-effectiveness, and the results are summarised to state the levels of evidence. The review conforms to the SANRA guidelines for quality assessment. Twenty-nine studies out of the thirty-seven assessed for eligibility met the inclusion criteria. Although there is a large heterogeneity, the overall evidence is consistent with the measurable benefits of CGA in terms of reducing the in-hospital length of stay and treatment toxicity, leaning toward a positive cost-effectiveness of the interventions and supporting CGA implementation in geriatric oncology clinical practice. More research employing full economic evaluations is needed to confirm this evidence and should focus on CGA implications both from patient-centred and healthcare system perspectives.

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Section: Proponents Target Population Recommendationsmentioning

confidence: 99%

Section: Identification Of Relevant Studiesmentioning

confidence: 99%

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

Zuccarino

Monacelli

Antognoli

et al. 2022

Cancers

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“…(4,5) Ao analisar a fragilidade dos serviços prestados aos idosos na Redes de Atenção à Saúde (RAS), observa-se: descontinuidade do cuidado, ausência de referência e contrarreferência, onerosas internações hospitalares e constantes visitas ao pronto atendimento. (6) Entender o contexto das hospitalizações de idosos através do gerenciamento clínico, planejamento de alta e provisão de recursos na residência, pode evitar readmissões hospitalares, as quais geram ônus ao sistema de saúde e desconforto para o paciente e seus familiares. (6) Observa-se que o tema da Transição do Cuidado (TC) pode contribuir e complementar essa discussão, uma vez que nas últimas décadas tem se mostrado como resposta à crescente prevalência de doenças crônicas, ao envelhecimento populacional, à redução do tempo de permanência hospitalar e efetivação de um sistema de saúde mais integrado.…”

Section: Introductionunclassified

Transição do cuidado de pessoas idosas do hospital para casa

Tomazela¹,

Valente²,

Lima³

et al. 2023

Acta Paulista De Enfermagem

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Conflitos de interesse: nada a declarar.Resumo Objetivo: Analisar a qualidade da Transição do Cuidado de idosos que receberam alta do hospital para casa. Métodos: Estudo observacional transversal, realizado com 156 idosos, após internação em hospital público, localizado no município de Piracicaba, estado de São Paulo. Os dados foram coletados em prontuário eletrônico do paciente e por ligações telefônicas com idosos, seus familiares e/ou cuidadores, até quatro semanas após alta hospitalar. Foram utilizados questionário com dados sociodemográficos e instrumento Care Transitions Measure, versão validada para o Brasil. Resultados: A duração média da última internação foi de 8,27 dias causada, majoritariamente (72,44 %) por COVID-19 e 75% dos idosos apresentaram entre 1 e 3 comorbidades, sendo a hipertensão arterial sistêmica (57,7%) a mais frequente. A média de escore do CTM 15 -Brasil foi 68,6. O Fator 1 -Preparação para o autogerenciamento obteve o maior escore (70,5) e o Fator 4 -Plano de Cuidados, o menor (59,14). Houve correlação positiva entre os 4 fatores do Care Transitions Measure, também entre estes fatores e do número de medicamentos utilizados para tratamento dos idosos, de acordo com a Classificação Anatômica Terapêutica Química.Conclusão: Evidenciou-se a qualidade da Transição do Cuidado no hospital, próxima do valor considerado satisfatório, sendo dois dos quatro fatores com pontuação maior que 70; entretanto há necessidade de adoção de estratégias para melhorar o processo de alta do hospital para casa, principalmente, no que se refere a preferências asseguradas e plano de cuidado dos idosos.

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“…TC has been proved to improve the prognosis of patients with chronic diseases [ 8 , 9 ]. Moreover, TC can reduce medical costs by lowering emergency attendance rates and readmission rate [ 10 ]. An investigation indicated that nurses-led TC shows a positive impact on blood glucose control and treatment compliance, and lowers medical cost for diabetic patients after discharge [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Questionnaire Survey-Based Quantitative Assessment of the Impact of Transitional Care on Self-Management of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Mao

2021

Computational and Mathematical Methods in Medicine

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Background and Objective. Chronic obstructive pulmonary disease (COPD) features high morbidity. Different nursing interventions can relieve patient’s burden. This investigation quantitatively assessed the impact of transitional care (TC) on self-management of patients with acute exacerbation of COPD based on a questionnaire survey. Methods. Clinical information of 78 COPD patients treated with TC (intervention group) or routine care (control group) in Shanghai Pulmonary Hospital during March 2019 and August 2020 was gathered. Patients were followed up for 3 months after discharge. The intervention group ( n = 39 ) was subjected to a TC plan for 3 months to help patients and their family caregivers for self-management of COPD. TC was provided by specially trained nurses, and patients were supported by standardized tools. Nursing measures in the control group ( n = 79 ) included transitional support for 30 d after hospital discharge. In this way, patients were guaranteed to follow discharge plans and transit to outpatient nursing. Patient’s anxiety and depression symptoms, sleep quality, survival quality, mobility, and life quality at admission and after 3 months of discharge were assessed by Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Quality of Life Scale Abbreviated Version, Activity of Daily Life Scale, St. George’s Respiratory Questionnaire, and COPD Assessment Test. Results. Except for anxiety and depression, patient’s sleep quality, survival quality, mobility, and life quality in two groups were significantly improved. Moreover, average change of total CAT score during 3 months of intervention was -5.44, while that in the control group was -1.74 ( p = 0.011 ). Improvement of survival quality of patients in the intervention group ( p = 0.001 ) was markedly greater than that in the control group ( p = 0.016 ). Conclusion. Altogether, TC based on quantification by questionnaire survey is beneficial to COPD patient’s life quality and self-management.

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Geriatric co-management and interdisciplinary transitional care reduced hospital readmissions in frail older patients in Argentina: results from a randomized controlled trial

Cited by 13 publications

References 32 publications

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

Exploring Cost-Effectiveness of the Comprehensive Geriatric Assessment in Geriatric Oncology: A Narrative Review

Transição do cuidado de pessoas idosas do hospital para casa

Questionnaire Survey-Based Quantitative Assessment of the Impact of Transitional Care on Self-Management of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

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