Evaluating outcomes from an integrated health service for older patients

Severinsen, Kyle D., Tufton, Anne, Hannan, Emma, Schwind, Jessica S., Schmucker, Dana and Cutler, Allison (2015) Evaluating outcomes from an integrated health service for older patients. Ochsner Journal, 15 4: 423-428.

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Author Severinsen, Kyle D.
Tufton, Anne
Hannan, Emma
Schwind, Jessica S.
Schmucker, Dana
Cutler, Allison
Title Evaluating outcomes from an integrated health service for older patients
Journal name Ochsner Journal   Check publisher's open access policy
ISSN 1524-5012
Publication date 2015-12-01
Sub-type Article (original research)
Open Access Status File (Publisher version)
Volume 15
Issue 4
Start page 423
End page 428
Total pages 6
Place of publication New Orleans, United States
Publisher Ochsner Clinic
Formatted abstract
Background: Hospital-associated disability is the loss of the ability to complete one activity of daily living (ADL), with this decline occurring between the onset of acute illness and discharge from the hospital. Approximately 30% of patients who are >70 years old and admitted to hospitals are discharged with an ADL disability. Comprehensive geriatric assessment (CGA) models use a multidimensional, interdisciplinary process of diagnosis and treatment with the goal of improving outcomes and decreasing lengths of stay.

Methods:
A retrospective clinical audit of Ipswich Hospital's medical records included patients for random selection who were >75 years of age and had an acute admission to the Older Person Evaluation Review and Assessment (OPERA) or general medicine (GM) service from July 2012 to December 2012. Data were collected for the entire admission period on length of stay, comorbidities, allied health visits, functional ability, and delirium and dementia at admission.

Results: Of the 267 patients evaluated, 133 were admitted to the OPERA service, and 134 were admitted to the GM service. Patients admitted to the OPERA service were significantly more ill than patients admitted to the GM service as measured by the Charlson Comorbidity Index scores (6.53 ± 1.83 vs 6.02 ± 1.96, respectively, P=0.02), Katz Index of Independence in ADL scores (3.77 ± 2.22 vs 4.72 ± 2.00, respectively, P<0.001), presence of delirium at admission (28% vs 15%, respectively, P=0.02), and presence of dementia at admission (42% vs 21%, respectively, P=0.002). However, patients in both groups had a mean acute length of stay of 4 days (P=0.33), the readmission rate was <20% for both groups (P=0.33), and the mortality rate for each group was similar (3%).

Conclusion: By showing that patients admitted to the OPERA service were more ill than patients admitted to the GM service but health outcomes were maintained, researchers hope to justify the need for such CGA models. Additional goals include garnering support for the maintenance and growth of CGA models; decreasing mortality, cost, and readmission rates; and improving the quality of life for older patients.
Keyword Aged
Frail elderly
Geriatric assessment
Geriatrics
Health services for the aged
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Medicine Publications
 
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Created: Tue, 29 Dec 2015, 10:33:10 EST by System User on behalf of Learning and Research Services (UQ Library)