The Role of an Acute Care for the Elderly Unit in Achieving Hospital Quality Indicators While Caring for Frail Hospitalized Elders

Abstract

Acute Care for the Elderly (ACE) units have successfully decreased length of stay, hospital costs, and readmission rates. Furthermore, patients return home with increased functional capacity and improved satisfaction with their hospital stay. The ACE unit concept was geared toward patients returning to independent living, but the average hospitalized geriatric patient is increasingly more frail, vulnerable, and dependent. The purpose of this study is 2-fold: (1) to determine if the ACE unit continues to offer the same benefit to the frail, often bedbound elderly, and (2) to determine if such a unit is able to maintain standard hospital quality indicators. A total of 1096 cases discharged from the Memorial-Hermann ACE unit between July 2008 and June 2010 were compared to a sample of 383 patients with similar illness severity who were discharged between July 2007 and June 2008. Metrics measured include: average length of stay (ALOS), case mix index (CMI), case mix adjusted average length of stay (CMI adj ALOS), average direct costs per case, and readmission rate. Patient satisfaction was measured using Hospital Consumer Assessment of Healthcare Providers and Systems and Press-Ganey surveys; quality and safety data were provided by Memorial-Hermann's Quality and Safety Department. The ACE unit resulted in a statistically significant decrease in ALOS and CMI adj LOS with a simultaneous increase in Health Care Financing Administration CMI, indicating that the unit was serving a sicker, more frail population. The readmission rate was 11.95%. The decrease in length of stay, readmission rate, and direct cost translates into a decrease in cost per case. Furthermore, the ACE unit successfully met hospital quality indicators.

Impact of Hospital Variables on Case Mix Index as a Marker of Disease Severity

“…For example, Ahmed et al 24 recently reported that implementing a new Acute Care for the Elderly unit resulted in shorter lengths of stay when adjusted for by CMI for elderly patients at their hospital. Furthermore, the CMI of the elderly patients cared for increased after implementing the unit, indicating that sicker patients were being referred to the unit than had been cared for before the unit's existence.…”

Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction

“…7 , 8 These patients are particularly susceptible to functional declines and increases in frailty. 9 ACE units have been shown to improve outcomes, decrease length of stay, 10 and reduce costs, 11 even while serving a more frail population. The five common ACE unit characteristics include a focus on early rehabilitation and discharge planning, geriatric-based medical review, patient-centered care, and a hospital environment designed to promote functional independence.…”

Acute Care for Elders (ACE) Team Model of Care: A Clinical Overview

“…In addition to the use of post-acute care facilities as summarized above, fifteen of the unit-based studies reported healthcare utilization (length of stay, readmissions, costs) either as primary or secondary outcome [6,7,8,10,11,12,13,14,15,16,18,19,20,21,22]. Ten of these demonstrated either significant reduction or trends toward reduced length of stay (LOS) and/or costs.…”