Acute care for elders units produced shorter hospital stays at lower cost while maintaining patients' functional status

Health Affairs

Volumn 31, Issue 6, 2012, Pages 1227-1236

  Barnes, Deborah E ^a   Palmer, Robert M ^b   Kresevic, Denise M ^c   Fortinsky, Richard H ^d   Kowal, Jerome ^e   Chren, Mary Margaret ^a   Landefeld, C Seth ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

^b EASTERN VIRGINIA MEDICAL SCHOOL   (United States)

^c LOUIS STOKES CLEVELAND VA MEDICAL CENTER   (United States)

^d UNIVERSITY OF CONNECTICUT SCHOOL OF MEDICINE   (United States)

^e CASE WESTERN RESERVE UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AGED; ARTICLE; CLINICAL PRACTICE; CONTROLLED STUDY; COST CONTROL; EMERGENCY CARE; FEMALE; FUNCTIONAL STATUS; GERIATRIC CARE; GERIATRIC PATIENT; HEALTH CARE COST; HEALTH CARE QUALITY; HOSPITAL BED UTILIZATION; HOSPITAL COST; HOSPITAL READMISSION; HOSPITALIZATION; HUMAN; LENGTH OF STAY; MALE; PATIENT CARE; RANDOMIZED CONTROLLED TRIAL;

ACTIVITIES OF DAILY LIVING; ACUTE DISEASE; AGED; AGED, 80 AND OVER; COSTS AND COST ANALYSIS; FEMALE; HEALTH SERVICES FOR THE AGED; HOSPITAL DEPARTMENTS; HUMANS; LENGTH OF STAY; MALE;

EID: 84862907013     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2012.0142     Document Type: Article

References (34)

1. Creditor MC. Hazards of hospitalization of the elderly. Ann Intern Med. 1993;118(3):219-23.
2. Covinsky KE, Pierluissi E, Johnston CB. Hospitalization-associated disability: "she was probably able to ambulate, but I'm not sure." JAMA. 2011;306(16):1782-93.
3. Palmer RM, Landefeld CS, Kresevic D, Kowal J. A medical unit for the acute care of the elderly. J Am Geriatr Soc. 1994;42(5):545-52.
4. Rubenstein LZ, Stuck AE, Siu AL, Wieland D. Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence. J Am Geriatr Soc. 1991;39(9 PT 2):8S-16S.
5. Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: a metaanalysis of controlled trials. Lancet. 1993;342(8878):1032-6.
6. Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients. N Engl J Med. 1995;332(20):1338-44.
7. Counsell SR, Holder CM, Liebenauer LL, Palmer RM, Fortinsky RH, Kresevic DM, et al. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc. 2000;48(12):1572-81.
8. Covinsky KE, Palmer RM, Kresevic DM, Kahana E, Counsell SR, Fortinsky RH, et al. Improving functional outcomes in older patients: lessons from an Acute Care for Elders unit. Jt Comm J Qual Improv. 1998;24(2):63-76.
9. Landefeld CS, Palmer RM, Fortinsky RH, Kresevic DM, Kowal J. A randomized trial of Acute Care for Elders (ACE) in the current era: lower hospital costs without adverse effects on functional outcomes at discharge. J Gen Intern Med. 1998; 13(SUPPL):45.
10. Covinsky KE, King Jr JT., Quinn LM, Siddique R, Palmer R, Kresevic DM, et al. Do Acute Care for Elders units increase hospital costs? A cost analysis using the hospital perspective. J Am Geriatr Soc. 1997;45(6): 729-34.
11. Fortinsky RH, Covinsky KE, Palmer RM, Landefeld CS. Effects of functional status changes before and during hospitalization on nursing home admission of older adults. J Gerontol A Biol Sci Med Sci. 1999; 54(10):M521-6.
12. Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, et al. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA. 2001;285(23): 2987-94.
13. Chuang KH, Covinsky KE, Sands LP, Fortinsky RH, Palmer RM, Landefeld CS. Diagnosis-related group- adjusted hospital costs are higher in older medical patients with lower functional status. J Am Geriatr Soc. 2003;51(12):1729-34.
14. To access the Appendix, click on the Appendix link in the box to the right of the article online
15. Kuo YF, Sharma G, Freeman JL, Goodwin JS. Growth in the care of older patients by hospitalists in the United States. N Engl J Med. 2009;360(11):1102-12.
16. Wachter RM, Goldman L. The hospitalist movement 5 years later. JAMA. 2002;287(4):487-94.
17. Howrey BT, Kuo YF, Goodwin JS. Association of care by hospitalists on discharge destination and 30-day outcomes after acute ischemic stroke. Med Care. 2011;49(8):701-7.
18. Kuo YF, Goodwin JS. Association of hospitalist care with medical utilization after discharge: evidence of cost shift from a cohort study. Ann Intern Med. 2011;155(3):152-9.
19. Bureau of Labor Statistics. CPI inflation calculator [Internet]. Washington (DC): BLS; [cited 2012 May 15]. Available from: http://data.bls.gov/cgi-bin/cpicalc.pl
20. Center for Medicare and Medicaid Innovation. Bundled payments for care improvement [Internet]. Baltimore (MD): Innovation Center; [last updated 2012 May 10; cited 2012 May 15]. Available from: http:// innovation.cms.gov/initiatives/ bundled-payments/index.html
21. Baztán JJ, Suárez-Garcia FM, López-Arrieta J, Rodriguez-Mañas L, Rodriguez-Artalejo F. Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ. 2009;338:b50.
22. Ellis G, Whitehead MA, Robinson D, O'Neill D, Langhorne P. Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials. BMJ. 2011;343:d6553.
23. Jayadevappa R, Bloom BS, Raziano DB, Lavizzo-Mourey R. Dissemination and characteristics of Acute Care for Elders (ACE) units in the United States. Int J Technol Assess Health Care. 2003;19(1):220-7.
24. National Research Council. Retooling for an aging America: building the health care workforce. Washington (DC): National Academies Press; 2008.
25. Bardach SH, Rowles GD. Geriatric education in the health professions: are we making progress? Gerontologist. 2012 Mar 6. [Epub ahead of print].
26. Nurses Improving Care for Healthsystem Elders. Knowledge center [Internet]. New York (NY): NICHE; [cited 2012 May 15]. Available from: http://nicheprogram.org/ knowledge_center
27. Farber JI, Korc-Grodzicki B, Du Q, Leipzig RM, Siu AL. Operational and quality outcomes of a mobile acute care for the elderly service. J Hosp Med. 2011;6(6):358-63.
28. Malone ML, Vollbrecht M, Stephenson J, Burke L, Pagel P, Goodwin JS. Acute Care for Elders (ACE) tracker and e-Geriatrician: methods to disseminate ACE concePTs to hospitals with no geriatricians on staff. J Am Geriatr Soc. 2010;58(1):161-7.
29. Siu AL, Spragens LH, Inouye SK, Morrison RS, Leff B. The ironic business case for chronic care in the acute care setting. Health Aff (Millwood). 2009;28(1):113-25.
30. Shepperd S, Doll H, Angus RM, Clarke MJ, Iliffe S, Kalra L, et al. Avoiding hospital admission through provision of hospital care at home: a systematic review and metaanalysis of individual patient data. CMAJ. 2009;180(2):175-82.
31. Rubin FH, Neal K, Fenlon K, Hassan S, Inouye SK. Sustainability and scalability of the hospital elder life program at a community hospital. J Am Geriatr Soc. 2011;59(2):359-65.
32. Morrison RS, Dietrich J, Ladwig S, Quill T, Sacco J, Tangeman J, et al. Palliative care consultation teams cut hospital costs for Medicaid beneficiaries. Health Aff (Millwood).2011;30(3):454-63.
33. Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166(17):1822-8.
34. Sood N, Huckfeldt PJ, Escarce JJ, Grabowski DC, Newhouse JP. Medicare's bundled payment pilot for acute and postacute care: analysis and recommendations on where to begin. Health Aff (Millwood). 2011;30(9):1708-17.