Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care

Mudge, Alison; Laracy, Sue; Richter, Kimber P.; Denaro, Charles

doi:10.1111/j.1445-5994.2006.01135.x

Cited by 58 publications

(53 citation statements)

References 19 publications

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“…Hospital-based PT was associated with reductions in early hospital readmission rate. Although several previous studies have confirmed functional responses to hospital-based PT [13][14][15]19], these were limited to stroke and hip fracture patients. Our study contributes to the literature by providing evidence that PT reduces progressive functional decline, even in common acute illness (pneumonia).…”

Section: Discussionmentioning

confidence: 98%

“…To reduce or delay functional decline during or after hospitalization, physical therapy (PT) has been utilized as an independent rehabilitation measure and a component of multidisciplinary care [14][15][16]. PT to restore functional reserve has been applied to certain acute illness, such as stroke and hip fracture, with excellent rehabilitation potential in both acute and post-acute hospital settings [13,14].…”

Section: Aging and Disease • Volume 6 Number 3 June 2015 175mentioning

confidence: 99%

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Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and DecliningPhysical Function

Kim¹,

Lee²,

Han³

et al. 2015

Aging and disease

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To examine whether hospital-based physical therapy is associated with functional changes and early hospital readmission among hospitalized older adults with community-acquired pneumonia and declining physical function. Study design was a retrospective observation study. Participants were community-dwelling older adults admitted to medicine floor for community-acquired pneumonia (n = 1,058). Their physical function using Katz activities of daily living (ADL) Index declined between hospital admission and 48 hours since hospital admission (Katz ADL Index 6→5). The intervention group was those receiving physical therapy for ≥ 0.5 hour/day. Outcomes were Katz ADL Index at hospital discharge and all-cause 30-day hospital readmission rate. The intervention and control groups did not differ in the Katz ADL Index at hospital discharge (p = 0.11). All-cause 30-day hospital readmission rate was lower in the intervention than in control groups (OR = 0.65, p = 0.02). Hospital-based physical therapy has the benefits toward reducing 30-day hospital readmission rate of acutely ill older adults with community-acquired pneumonia and declining physical function.Key words: hospitalization, patient outcome assessment, physical therapy, pneumonia Functional decline in older adults is common and occurs in up to one-third of recently hospitalized older adults [1]. The hospital environment accelerates the reduction of functional reserve implicated factors include forced immobilization, disorientation due to unfamiliar hospital environments, and frequent orders not to eat by mouth [2][3][4][5][6]. In fact, hospitalized older adults spend more than 70% of their time lying in bed due to acute medical conditions, despite having the ability to walk [4].Functional decline during or after hospitalization is associated with adverse health outcomes, prolonged hospital stays due to more frequent occurrences of hospital complications, such as delirium; and more frequent episodes of early hospital readmissions and even higher long-term mortality rate [7][8][9][10][11][12].

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Section: Discussionmentioning

confidence: 98%

Section: Aging and Disease • Volume 6 Number 3 June 2015 175mentioning

confidence: 99%

Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and DecliningPhysical Function

Kim¹,

Lee²,

Han³

et al. 2015

Aging and disease

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“…A 1993 meta-analysis reported that inpatient CGA and GEM significantly improve patients' survival (after 6 months) and functional autonomy (after 12 months). [126][127][128][129][130][131][132][133] DISCUSSION This report and its Web supplement constitute a catalog of the positive studies of 15 successful care models for older Americans with chronic conditions. Each of these models provides comprehensive health care for older patients and was deemed successful, because at least one high-quality study reported that at least one version of the model is capable of improving the quality, outcomes, or efficiency of care (compared with ''usual care'').…”

Section: Interdisciplinary Primary Carementioning

confidence: 96%

Successful Models of Comprehensive Care for Older Adults with Chronic Conditions: Evidence for the Institute of Medicine's “Retooling for an Aging America” Report

Boult

Green

Boult

et al. 2009

J American Geriatrics Society

284

257

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The quality of chronic care in America is low, and the cost is high. To help inform efforts to overhaul the ailing U.S. healthcare system, including those related to the "medical home," models of comprehensive health care that have shown the potential to improve the quality, efficiency, or health-related outcomes of care for chronically ill older persons were identified. Using multiple indexing terms, the MEDLINE database was searched for articles published in English between January 1, 1987, and May 30, 2008, that reported statistically significant positive outcomes from high-quality research on models of comprehensive health care for older persons with chronic conditions. Each selected study addressed a model of comprehensive health care; was a meta-analysis, systematic review, or trial with an equivalent concurrent control group; included an adequate number of representative, chronically ill participants aged 65 and older; used valid measures; used reliable methods of data collection; analyzed data rigorously; and reported significantly positive effects on the quality, efficiency, or health-related outcomes of care. Of 2,714 identified articles, 123 (4.5%) met these criteria. Fifteen models have improved at least one outcome: interdisciplinary primary care (1), models that supplement primary care (8), transitional care (1), models of acute care in patients' homes (2), nurse-physician teams for residents of nursing homes (1), and models of comprehensive care in hospitals (2). Policy makers and healthcare leaders should consider including these 15 models of health care in plans to reform the U.S. healthcare system. The Centers for Medicare and Medicaid Services would need new statutory flexibility to pay for care by the nurses, social workers, pharmacists, and physicians who staff these promising models.

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“…28 Compared with usual care control medical wards, intervention wards demonstrated no difference in readmissions. Similar results were noted in a randomised trial of interdisciplinary ward rounds involving 1102 general medical patients.…”

Section: Multidisciplinary Teams and Ward Roundsmentioning

confidence: 99%

Preventing the rebound: improving care transition in hospital discharge processes

Scott

2010

Aust. Health Review

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Background. Unplanned readmissions of recently discharged patients impose a significant burden on hospitals with limited bed capacity. Deficiencies in discharge processes contribute to such readmissions, which have prompted experimentation with multiple types of peridischarge interventions.Objective. To determine the relative efficacy of peridischarge interventions categorised into two groups: (1) single component interventions (sole or predominant) implemented either before or after discharge; and (2) integrated multicomponent interventions which have pre-and postdischarge elements.Design. Systematic metareview of controlled trials. Data collection. Search of four electronic databases for controlled trials or systematic reviews of trials published between January 1990 and April 2009 that reported effects on readmissions.Data synthesis. Among single-component interventions, only four (intense self-management and transition coaching of high-risk patients and nurse home visits and telephone support of patients with heart failure) were effective in reducing readmissions. Multicomponent interventions that featured early assessment of discharge needs, enhanced patient (and caregiver) education and counselling, and early postdischarge follow-up of high-risk patients were associated with evidence of benefit, especially in populations of older patients and those with heart failure.Conclusion. Peridischarge interventions are highly heterogenous and reported outcomes show considerable variation. However, multicomponent interventions targeted at high-risk populations that include pre-and postdischarge elements seem to be more effective in reducing readmissions than most single-component interventions, which do not span the hospitalcommunity interface.What is known about this topic? Unplanned readmissions within 30 days of hospital discharge are common and may reflect deficiencies in discharge processes. Various peridischarge interventions have been evaluated, mostly single-component interventions that occur either before or after discharge, but failing to yield consistent evidence of benefit in reducing readmissions. More recent trials have assessed multicomponent interventions which involve pre-and postdischarge periods, but no formal review of such studies has been undertaken. What does this paper add? With the exception of intense self-management and transition coaching of high-risk patients, and nurse home visits and telephonic support for patients with heart failure, single-component interventions were ineffective in reducing readmissions. Multicomponent interventions demonstrated evidence of benefit in reducing readmissions by as much as 28%, with best results achieved in populations of older patients and those with heart failure. What are the implications for practitioners and managers? Hospital clinicians and managers should critically review and, where appropriate, modify their current discharge processes in accordance with these findings and negotiate the extra funding and personnel required to allow succ...

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Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care

Abstract: This model of enhanced multidisciplinary inpatient care has provided sustainable efficiency gains for the hospital and improved patient outcomes.

Cited by 58 publications

References 19 publications

Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and DecliningPhysical Function

Effects of Hospital-Based Physical Therapy on Hospital Discharge Outcomes among Hospitalized Older Adults with Community-Acquired Pneumonia and DecliningPhysical Function

Successful Models of Comprehensive Care for Older Adults with Chronic Conditions: Evidence for the Institute of Medicine's “Retooling for an Aging America” Report

Preventing the rebound: improving care transition in hospital discharge processes

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