First Steps in Building ACME — an Admission Case-Mix System for the Elderly

Abstract

In the United Kingdom, specialists in Geriatric Medicine usually have a major role in treating acute medical problems of elderly people, in addition to running rehabilitation services and continuing care. The proportion of the different types of patients varies widely from service to service, however, making it difficult for clinicians to compare their performance with that of colleagues. Existing casemix measurement systems are usually designed to deal with a more homogeneous patient group (e.g. rehabilitation, long-stay care) and/or are too detailed for day-to-day use. We describe our attempts to devise a simple casemix system which would be of practical day-to-day use for individual specialists in Geriatric Medicine. We have classified patients according to (1) the acuteness and potential for recovery of their presenting illness and (2) their functional status (based on simple measures of mobility and cognitive impairment). These factors have been incorporated into a three-point score, CMIX, which was capable of explaining 19.5% of the variability in duration of stay in a prospective study of 400 new admissions in two centres. In contrast, age and sex explained only 1% of variability in these patients. The pattern of patient outcome also differed significantly between the three CMIX categories. We also propose a simple graphical method of classifying outcome which should prove useful for audit purposes even when our casemix system is not employed.

The Determinants of Successful In-Hospital Rehabilitation in People Aged 90 Years and Older

“…The failure of presenting illness to emerge as a predictive factor in our study, contrary to findings from previous studies [12,13] may represent the complexity of patients in this older age group. The very elderly are increasingly likely to be frail with complicated problems making co-morbidity, mobility and functional issues of greater significance in determining the success of rehabilitation than treatment of their main presenting illness.…”

“…This result differs from studies of all age elderly, in which a higher level of cognitive function was associated with improved outcomes of rehabilitation including a shorter length of stay [12,13] . It is possible that our finding reflects an early decision by the multidisciplinary team that, within the very elderly population, those with cognitive impairment will not respond well to rehabilitation and will need a higher level of care.…”

“…Similarly, defining factors that may predict successful rehabilitation is problematic. Previous studies of elderly hospital inpatients have identified a number of factors that may be used and include functional status [11,12] , presenting illness [12,13] , extent of co-morbidities [11] , younger age [14] , cognition [12,14] , social support [14] and nutritional status [15] .…”

Comorbidity and social factors predicted hospitalization in frail elderly patients

“…Some studies [1][2][3][4][5] underline that the severity of disease together with the burden of comorbidity are the strongest predictors of hospitalization. On the other hand, some authors [6][7][8] have reported that functional disability, cognitive impairment, and social factors may affect the rate of hospitalization, beyond the specific medical conditions.…”

Grupos de utilizacion de recursos en unidades de agudos y media estancia de servicios de geriatria

“…Aunque inicialmente diseñados para unidades de baja complejidad (Nursing Homes), en los últimos años han demostrado también su utilidad a nivel hospitalario. De entre los sistemas disponibles, Admission Case Mix for the Elderly (ACME) 24 , Grupos Relacionados con la Función (FIM-FRGs) 25 , PLAISIR 26 , los que más se han acercado por el momento a estas exigencias son los Grupos de Utilización de Recursos (RUG) [27][28][29][30] , que en sus diferentes y cada vez más sofisticadas versiones incluyen variables tanto clí-nicas como funcionales, así como la posible necesidad de tratamientos especiales (como el tratamiento funcional).…”