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Text
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<a href="http://doi.org/10.1111/j.1532-5415.2000.tb03866.x" target="_blank" rel="noreferrer noopener">http://doi.org/10.1111/j.1532-5415.2000.tb03866.x</a>
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Pages
1572-1581
Issue
12
Volume
48
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Title
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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
Publisher
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Journal of the American Geriatrics Society
Date
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2000
2000-12
Subject
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depression; illness; program; Geriatrics & Gerontology; consultation; institutionalization; functional decline; aged; medical unit; comprehensive geriatric assessment; decline; hospital outcomes; quality of care
Creator
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Counsell S R; Holder C M; Liebenauer L; Palmer R M; Fortinsky R H; Kresevic D M; Quinn L M; Allen K R; Covinsky K E; Landefeld C S
Description
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BACKGROUND: Older persons frequently experience a decline in function following an acute medical illness and hospitalization. OBJECTIVE: To test the hypothesis that a multicomponent intervention, called Acute Care for Elders (ACE), will improve functional outcomes and the process of care in hospitalized older patients. DESIGN: Randomized controlled trial. SETTING: Community teaching hospital. PATIENTS: A total of 1531 community-dwelling patients, aged 70 or older, admitted for an acute medical illness between November 1994 and May 1997. INTERVENTION: ACE includes a specially designed environment (with, for example, carpeting and uncluttered hallways); patient-centered care, including nursing care plans for prevention of disability and rehabilitation; planning for patient discharge to home; and review of medical care to prevent iatrogenic illness. MEASUREMENTS: The main outcome was change in the number of independent activities of daily living (ADL) from 2 weeks before admission (baseline) to discharge. Secondary outcomes included resource use, implementation of orders to promote function, and patient and provider satisfaction. RESULTS: Self-reported measures of function did not differ at discharge between the intervention and usual care groups by intention-to-treat analysis. The composite outcome of ADL decline from baseline or nursing home placement was less frequent in the intervention group at discharge (34% vs 40%; P =.027) and during the year following hospitalization (P = .022). There were no significant group differences in hospital length of stay and costs, home healthcare visits, or readmissions. Nursing care plans to promote independent function were more often implemented in the intervention group (79% vs 50%; P = .001), physical therapy consults were obtained more frequently (42% vs 36%; P = .027), and restraints were applied to fewer patients (2% vs 6%; r = .001). Satisfaction with care was higher for the intervention group than the usual care group among patients, caregivers, physicians, and nurses (P <.05). CONCLUSIONS: ACE in a community hospital improved the process of care and patient and provider satisfaction without increasing hospital length of stay or costs. A lower frequency of the composite outcome ADL decline or nursing home placement may indicate potentially beneficial effects on patient outcomes.
Identifier
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<a href="http://doi.org/10.1111/j.1532-5415.2000.tb03866.x" target="_blank" rel="noreferrer noopener">10.1111/j.1532-5415.2000.tb03866.x</a>
Format
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Journal Article or Conference Abstract Publication
2000
Aged
Allen K R
comprehensive geriatric assessment
consultation
Counsell S R
Covinsky K E
decline
Department of Family & Community Medicine
Depression
Fortinsky R H
functional decline
Geriatrics & Gerontology
Holder C M
hospital outcomes
illness
institutionalization
Journal Article or Conference Abstract Publication
Journal of the American Geriatrics Society
Kresevic D M
Landefeld C S
Liebenauer L
medical unit
NEOMED College of Medicine
Palmer R M
program
Quality of care
Quinn L M