Interprofessional geriatric and palliative care intervention associated with fewer hospital days

Abstract

Background: With increasing complexity of our aging inpatient population, we implemented an interprofessional geriatric and palliative care intervention on a hospitalist service. This study aimed to measure the intervention's impact on length of stay (LOS), 30-day readmission, and the daily intensity of inpatient services utilization. Methods: Using a nonrandomized controlled intervention at a 1000-bed U.S. academic quaternary medical center, we studied 13,941 individuals admitted to a general medicine hospitalist service (of which 5644 were age > =65 years); 1483 were on intervention teams (576 age > =65 years), 5413 concurrent controls, and 7045 historical controls. On 2 of 11 hospitalist teams, a geriatrician, palliative care physician and social worker attended multidisciplinary discharge rounds twice weekly, to recommend inpatient geriatric or palliative care consult (GPCC), postacute nursing or home care, versus postdischarge outpatient consultation. We measured the difference in improvement over time between intervention and control team patients for the following: (1) LOS adjusted for case-mix index, (2) 30-day readmissions, and (3) intensity of hospital service utilization (mean services provided per patient per day). Results: Adjusted LOS (in hospital days) was decreased by 0.36 days (p = 0.039) for the 1483 patients in the intervention teams, with greater LOS reduction of 0.55 days per admission (p = 0.022) on average among the subset of 576 older patient admissions. Readmissions were unchanged (À1.17%, p = 0.48 for all This research was presented as an abstract at the 2019 American Geriatric Society Annual Scientific Meeting.See related editorial by Zaldy S. Tan in this issue.

Palliative care in geriatric: a systematic review

“…Apesar da abordagem em CP ser indicada desde o diagnóstico de uma doença ameaçadora da vida, a decisão de quando indicar e implementar cuidados exclusivamente paliativos aos pacientes idosos é uma questão complexa. Mesmo que um em cada quatro idosos gravemente enfermos, internados em alas geriátricas seja encaminhado para cuidados paliativos, não existe uma concordância sobre a melhor forma de se avaliar e comunicar o prognóstico em populações geriátricas (Min et al, 2022;Chávarri-Guerra et al, 2021). Arcanjo et al (2018) ressaltam ainda que a maioria dos familiares e cuidadores é quem solicita os cuidados paliativos aos pacientes idosos.…”

“…Portanto, agir nessa perspectiva aproxima-se das formulações teóricas, em que as pessoas idosas apresentam diversas dificuldades, como o controle da dor e de outros sintomas, os quais podem ser de dimensão física, emocional, espiritual. E, nesse agir, possibilita reciprocidade, enriquecimento mútuo, com tendência à horizontalização das relações de poder entre os profissionais envolvidos, possibilitando a troca de afetos e, saberes entre as áreas de conhecimento (Min et al, 2022). Sun et al (2020) afirmam ainda que com a pandemia da COVID-19, foi necessário que os profissionais de saúde optassem por não iniciar ou continuar terapias de sustentação da vida, dada a alta proporção de pacientes idosos com anormalidades metabólicas na internação hospitalar.…”

“…Diante do exposto, pacientes geriátricos possuem necessidades únicas que se diferenciam dos adultos mais jovens, portanto, suas necessidades de cuidados paliativos também devem ser diferentes. Os cuidados paliativos são adequados para qualquer paciente geriátrico com doença grave, independentemente do prognóstico ou proximidade com o fim da vida, assim sendo, as equipes interdisciplinares podem fornecer uma ampla variedade de serviços para atender às necessidades desse paciente (Min et al, 2022;Chávarri-Guerra et al, 2021).…”

There's no place like home

“…As mentioned above, if we look at financing mechanism for the care of frail older adults in the United States, there is more fragmentation inherent in financing. 2 Acute hospital care is covered through the Medicare program. However, aftercare remains problematic.…”

Containing the hospital days for older patients in the era of value‐based care

“…8 In this issue of JAGS, Min and colleagues describe the impact of a non-randomized controlled study of an interprofessional geriatric and palliative care intervention on length of stay, 30-day readmission, and inpatient services utilization at a large, academic medical center. 9 The intervention consisted of the attendance of a geriatrician, palliative care physician, and social worker in twice-weekly multidisciplinary discharge rounds, with informal recommendations for identified geriatric or palliative care issues made to the hospitalist team. The investigators found that compared to control teams, patients cared for by the intervention hospitalist group had a 0.36 days shorter length of stay with no change in readmission rates but with a modest increase in overall relative value unit utilization.…”