Effect of an Inpatient Geriatric Consultation Team on Functional Outcome, Mortality, Institutionalization, and Readmission Rate in Older Adults with Hip Fracture: A Controlled Trial

Deschodt, Mieke; Braes, Tom; Broos, Paul; Sermon, An; Boonen, Steven; Flamaing, Johan; Milisen, Koen

doi:10.1111/j.1532-5415.2011.03488.x

Cited by 84 publications

(111 citation statements)

References 29 publications

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“…Other researchers recommend providing discharged patients with a personal health record to help guide outpatient providers (Koehler et al, 2009), giving patients specific instructions about medicines and their health records, following through with home visits, and improving coordination of services and information flow between providers in hospitals and in the community, especially those providers who are in long term services (Deschodt et al, 2011;Dombrowski, Yoos, Neufeld, & Tarshish, 2012;Hansen, Young, Hinami, Leung, & Williams, 2011;Phillips, Wright, Kern, et al, 2004). However, even when a multidisciplinary team approach is employed, lack of communication within the team can lead to poor discharge outcomes (Bauer, Fitzgerald, Haesler, & Manfrin, 2009).…”

Section: Downloaded By [Chulalongkorn University] At 13:02 03 Januarymentioning

confidence: 95%

Hospital to Community Transitions for Adults: Discharge Planners and Community Service Providers’ Perspectives

Chapin

Chandran

Sergeant

et al. 2014

Social Work in Health Care

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Discharges from the hospital to community-based settings are more difficult for older adults when there is lack of communication, resource sharing, and viable partnerships among service providers in these settings. The researchers captured the perspectives of three different groups of participants from hospitals, independent living centers, and Area Agencies on Aging, which has rarely been done in studies on discharge planning. Findings include identification of barriers in the assessment and referral process (e.g., timing of discharge, inattention to client goals, lack of communication and partnerships between hospital discharge planners and community providers), and strategies for overcoming these barriers. Implications are discussed including potential for Medicaid and Medicare cost reductions due to fewer re-hospitalizations.

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Section: Downloaded By [Chulalongkorn University] At 13:02 03 Januarymentioning

confidence: 95%

Hospital to Community Transitions for Adults: Discharge Planners and Community Service Providers’ Perspectives

Chapin

Chandran

Sergeant

et al. 2014

Social Work in Health Care

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“…12,69,78,80,81,83,87,90-93,95-97,100-103,105-111,114,115,117-124, 130-133,135-140,143,144,146-149,151-158,160-162,167,169,184,192,195,199-201 Sixty-five of these studies reported physical or physiological outcomes, 12,69,78,80,81,83,87,[90][91][92][93]95,97,100,102,103,[105][106][107][108][109][110][111]114,115,[117][118][119][120][121][122][123][124][130][131][132][133][135][136][137][138][139][140]143,144,[146][147][148][149][151][152][153][154][155]…”

Section: Summary Of Outcomesmentioning

confidence: 99%

“…81,97,101,103,112,120,125,128,131,133,135,143,[145][146][147]149,151,152,154,160,161,179,188,195,200,201 Ten of these studies compared some form of community (own home or care home) rehabilitation with hospital-based rehabilitation, 101,103,125,128,131,133,135,143,145,160 with one comparing hospital plus home rehabilitation with hospital rehabilitation only. 133 Eight studies 97,112,120,146,149,151,152,200 compared hospital-based rehabilitation with usual care, no post-discharge care or rehabilitation in nursing facilities.…”

Section: Place Of Rehabilitationmentioning

confidence: 99%

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Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Williams

Roberts

Din

et al. 2017

Health Technol Assess

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BackgroundProximal femoral fracture is a major health problem in old age, with annual UK health and social care costs of £2.3B. Rehabilitation has the potential to maximise functional recovery and maintain independent living, but evidence of clinical effectiveness and cost-effectiveness is lacking.ObjectivesTo develop an enhanced community-based rehabilitation package following surgical treatment for proximal femoral fracture and to assess acceptability and feasibility for a future definitive randomised controlled trial (RCT) and economic evaluation.DesignPhase I – realist review, survey and focus groups to develop the rehabilitation package. Phase II – parallel-group, randomised (using a dynamic adaptive algorithm) feasibility study with focus groups and an anonymised cohort study.SettingRecruitment was from orthopaedic wards of three acute hospitals in the Betsi Cadwaladr University Health Board, North Wales. The intervention was delivered in the community following hospital discharge.ParticipantsOlder adults (aged ≥ 65 years) who had received surgical treatment for hip fracture, lived independently prior to fracture, had mental capacity (assessed by the clinical team) and received rehabilitation in the North Wales area.InterventionsParticipants received usual care (control) or usual care plus an enhanced rehabilitation package (intervention). Usual care was variable and consisted of multidisciplinary rehabilitation delivered by the acute hospital, community hospital and community services depending on need and availability. The intervention was designed to enhance rehabilitation by improving patients’ self-efficacy and increasing the amount and quality of patients’ practice of physical exercise and activities of daily living. It consisted of a patient-held information workbook, a goal-setting diary and six additional therapy sessions.Main outcome measuresThe primary outcome measure was the Barthel Activities of Daily Living (BADL) index. The secondary outcome measures included the Nottingham Extended Activities of Daily Living (NEADL) scale, EuroQol-5 Dimensions, ICEpop CAPability measure for Older people, General Self-Efficacy Scale, Falls Efficacy Scale – International (FES-I), Self-Efficacy for Exercise scale, Hospital Anxiety and Depression Scale (HADS) and service use measures. Outcome measures were assessed at baseline and at 3-month follow-up by blinded researchers.ResultsSixty-two participants were recruited (23% of those who were eligible), 61 were randomised (control,n = 32; intervention,n = 29) and 49 (79%) were followed up at 3 months. Compared with the cohort study, a younger, healthier subpopulation was recruited. There were minimal differences in most outcomes between the two groups, including the BADL index, with an adjusted mean difference of 0.5 (Cohen’sd = 0.29). The intervention group showed a medium-sized improvement on the NEADL scale relative to the control group, with an adjusted mean difference between groups of 3.0 (Cohen’sd = 0.63). There was a trend for greater improvement in FES-I and HADS in the intervention group, but with small effect sizes, with an adjusted mean difference of 4.2 (Cohen’sd = 0.31) and 1.3 (Cohen’sd = 0.20), respectively. The cost of delivering the intervention was £231 per patient. There was a possible small relative increase in quality-adjusted life-years in the intervention group. No serious adverse events relating to the intervention were reported.ConclusionsTrial methods were feasible in terms of eligibility, recruitment and retention, although recruitment was challenging. The NEADL scale was more responsive than the BADL index, suggesting that the intervention could enable participants to regain better levels of independence compared with usual care. This should be tested in a definitive Phase III RCT. There were two main limitations of the study: the feasibility study lacked power to test for differences between the groups and a ceiling effect was observed in the primary measure.Trial registrationCurrent Controlled Trials ISRCTN22464643.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 44. See the NIHR Journals Library for further project information.

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“…14,15 Some studies have shown that CGA incorporated into preoperative assessment may positively predict postoperative outcomes 32-38 with only one exception. 39 Interestingly, it has been proposed a pre-operative algorithm by using geriatric assessment markers. Several markers (i.e., Mini-Cog ≤3, albumin ≤33 g/L, ≥1 fall in past 6 months and haematocrit <35%, dependence ≥1 activity of daily living, comorbidity by using Charlson index M A N U S C R I P T…”

Section: Discussionmentioning

confidence: 99%

Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study

Abete

Cherubini

Bari

et al. 2016

The American Journal of Surgery

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Effect of an Inpatient Geriatric Consultation Team on Functional Outcome, Mortality, Institutionalization, and Readmission Rate in Older Adults with Hip Fracture: A Controlled Trial

Cited by 84 publications

References 29 publications

Hospital to Community Transitions for Adults: Discharge Planners and Community Service Providers’ Perspectives

Hospital to Community Transitions for Adults: Discharge Planners and Community Service Providers’ Perspectives

Developing a multidisciplinary rehabilitation package following hip fracture and testing in a randomised feasibility study: Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)

Does comprehensive geriatric assessment improve the estimate of surgical risk in elderly patients? An Italian multicenter observational study

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