Identification and team-based interprofessional management of hospitalized vulnerable older adults

Jeff Edward Borenstein; Harriet Udin Aronow; Linda Burnes Bolton; Mariane Ivy Dimalanta; Ellen Chan; Katherine Palmer; Xiao Zhang; Bradley Rosen; Glenn David Braunstein

doi:10.1016/j.outlook.2015.11.014

Identification and team-based interprofessional management of hospitalized vulnerable older adults

Nurs Outlook. 2016 Mar-Apr;64(2):137-145. doi: 10.1016/j.outlook.2015.11.014. Epub 2015 Nov 22.

Authors

Jeff Edward Borenstein¹, Harriet Udin Aronow², Linda Burnes Bolton³, Mariane Ivy Dimalanta³, Ellen Chan⁴, Katherine Palmer⁵, Xiao Zhang⁶, Bradley Rosen¹, Glenn David Braunstein¹

Affiliations

¹ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
² Department of Nursing, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: harriet.aronow@cshs.org.
³ Department of Nursing, Cedars-Sinai Medical Center, Los Angeles, CA.
⁴ Department of Case Management, Cedars-Sinai Medical Center, Los Angeles, CA.
⁵ Department of Pharmacy Services, Cedars-Sinai Medical Center, Los Angeles, CA.
⁶ Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.

PMID: 26833250
DOI: 10.1016/j.outlook.2015.11.014

Abstract

Background: Extended hospital stays and complications are common among older adults and may lead to morbidity and loss of independence. Specialized geriatric units have been shown to improve outcomes but, with the growing numbers of older adults, may be difficult to scale to meet needs.

Purpose: The purpose was to evaluate a quality improvement initiative that redesigned unit-based workflow and trained interprofessional teams on general medical/surgical units to create care plans for vulnerable older adults using principles of comprehensive geriatric assessment and team management.

Method: The evaluation included a cluster randomized controlled trial of 10 medical/surgical units and intention-to-treat analysis of all patients meeting risk screening criteria.

Results: N = 1,384, median age = 80.9 years, and 53.5% female. Mean difference in observed vs. expected length of stay was 1.03 days shorter (p = .006); incidence of complications (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.21-0.98) and transfer to intensive care (OR = 0.45; 95% CI = 0.25-0.79) lower among patients admitted to intervention units; incidence of discharge to institutional care was higher (OR = 1.43; 95% CI = 1.06-1.93). Mortality during hospitalization (OR = 0.64; 95% CI = 0.37-1.11) did not differ between groups.

Conclusion: Reorganizing general medical/surgical units to provide team-based interprofessional care can improve outcomes among hospitalized older adults.

Keywords: Cluster randomized trial; Comprehensive geriatric assessment; Interprofessional team care; Older adult inpatients; Program evaluation.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Academic Medical Centers
Aged, 80 and over
Electronic Health Records
Female
Geriatric Assessment*
Hospital Mortality
Hospital Units
Hospitalization*
Humans
Intensive Care Units / statistics & numerical data
Length of Stay / statistics & numerical data
Linear Models
Los Angeles
Male
Patient Care Planning*
Patient Care Team / organization & administration*
Patient Discharge
Patient Transfer / statistics & numerical data
Quality Improvement
Vulnerable Populations