Acute Hospital Use, Nursing Home Placement, and Mortality in a Frail Community-Dwelling Cohort Managed with Primary Integrated Interdisciplinary Elder Care at Home.
Rosenberg, Ted MD, MSc 1
Journal of the American Geriatrics Society.
60(7):1340-1346, July 2012.
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OBJECTIVES: To evaluate the effect of medical Primary Integrated Interdisciplinary Elder Care at Home (PIECH) on acute hospital use and mortality in a frail elderly population.
DESIGN: Comparison of acute hospital care use for the year before entering the practice (pre-entry) with the most-recent 12-month period (May 1, 2010-April 30, 2011, postentry) for active and discharged patients.
PARTICIPANTS: All 248 frail elderly adults enrolled in the practice for at least 12 months who were living in the community and not in nursing homes in Victoria, British Columbia.
INTERVENTION: Primary geriatric care provided by a physician, nurse, and physiotherapist in participants' homes.
MEASUREMENTS: Acute hospital admissions, emergency department (ED) contacts that did not lead to admission, reason for leaving practice, and site of death.
RESULTS: There was a 39.7% (116 vs 70; P = .004) reduction in hospital admissions, 37.6% (1,700 vs 1,061; P = .04) reduction in hospital days, and 20% (120 vs 95; P = .20) reduction in ED contacts after entering the practice. Fifty participants were discharged from the practice, 64% (n = 32) of whom died, 20% (n = 10) moved, and 16% (n = 8) were admitted to nursing homes. Fifteen (46.9%) deaths occurred at home.
CONCLUSION: Primary Integrated Interdisciplinary Elder Care at Home may reduce acute hospital admissions and facilitate home deaths.
(C) 2012 by the American Geriatrics Society