The influence of integrated geriatric outpatient clinics on the health care utilization of older people

Wei, Yu‐Ju; Hsieh, Ching‐Hua; Huang, Yu-Ting; Huang, Ming-Shyan; Fang, Tzu-Jung

doi:10.1186/s12877-020-01782-7

Cited by 11 publications

(14 citation statements)

References 48 publications

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“…15 Similarly, a case-control study at a single medical center in Taiwan found that patients who received care at a geriatric outpatient clinic had fewer emergency department visits and hospitalizations compared to those at a nongeriatric outpatient clinic. 17 However, these studies did not examine patterns of EOL care for persons living with dementia. We provide new evidence on the association between geriatric training and a wide range of EOL care measures for persons with dementia using a US nationally representative sample.…”

Section: Discussionmentioning

confidence: 99%

“…Among them, subspecialty training in geriatric medicine is designed to prepare physicians to meet the complex care needs of older adults, including persons with dementia at the last stage of their lives 14 . Studies have suggested that physicians with formal geriatric training provide a better quality of care for older adults for some inpatient (e.g., early physical therapy, less benzodiazepine use) and outpatient (e.g., fewer emergency department visits and hospitalizations) quality indicators 15–17 . However, little is known as to the association between physicians' geriatric training and patterns of EOL care delivered to persons with dementia.…”

Section: Introductionmentioning

confidence: 99%

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Association between physicians' geriatric training and patterns of end‐of‐life care delivered to persons with dementia

Gotanda

Zhang

Reuben

et al. 2023

J American Geriatrics Society

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BackgroundGeriatric training is designed to prepare physicians to meet the complex needs of older adults, including persons with dementia at the end‐of‐life (EOL) stage. We sought to compare patterns of EOL care delivered to persons with dementia between physicians with versus without geriatric training.MethodsWe conducted a cross‐sectional study of a 20% random sample of fee‐for‐service Medicare beneficiaries with dementia who died in 2016–2018 (n = 99,631). We attributed beneficiaries to a physician who had the largest number of primary care visits during the last 6 months of life and determined whether the physician was trained in geriatrics. Our outcome measures included: (i) advance care planning (ACP) and palliative care (e.g., ACP, hospice enrollment in the last 90 days of life), and (ii) high‐intensity EOL care (e.g., emergency department visits or hospital admissions in the last 30 days of life).ResultsBeneficiaries with dementia under the care of physicians with geriatric training had a higher proportion of ACP (adjusted proportion, 15.8% vs. 13.0%; p < 0.001 after accounting for multiple comparisons), palliative care counseling (22.4% vs. 20.9%; p = 0.01), and hospice enrollment (63.7% vs. 60.6%; p < 0.001). Geriatric training was also associated with a lower proportion of emergency department visits (55.1% vs. 59.1%; p < 0.001), hospital admissions (48.8% vs. 52.3%; p < 0.001), ICU admissions (24.9% vs. 27.4%; p < 0.001), use of mechanical ventilation (11.2% vs. 13.0%; p < 0.001), and use of cardiopulmonary resuscitation (2.1% vs. 2.4%; p = 0.03) in the last 30 days of life. There was no evidence that the placement of feeding tubes differed between the two groups.ConclusionsPhysicians' geriatric training was associated with the receipt of more ACP and palliative care and less intensive EOL care among persons with dementia. Provision of geriatric training for physicians may have the potential to improve the quality of EOL care delivered to persons with dementia.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between physicians' geriatric training and patterns of end‐of‐life care delivered to persons with dementia

Gotanda

Zhang

Reuben

et al. 2023

J American Geriatrics Society

View full text Add to dashboard Cite

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“…The MDT approach involves multiple medical professionals providing integrated medical care. Integrated healthcare, which began modestly in the 1930s, has evolved into a mature model of healthcare that is quickly becoming the standard of care in many countries (30)(31)(32).…”

Section: Discussionmentioning

confidence: 99%

Preliminary evaluation of a new initiative to centralize colorectal cancer care during the COVID-19 epidemic in Shanghai, China: a retrospective study

Li¹,

Zeng²,

Wang³

et al. 2022

Ann Transl Med

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Background: A novel colorectal cancer center (CCC) was developed in the Shanghai Tenth People's hospital of Tongji University during the COVID-19 epidemic. In this study, we aimed to evaluate the CCC model in terms of three aspects.Methods: This retrospective study used data from the Shanghai Tenth People's hospital patient databases.The research hypothesis was that the CCC reduces preoperative waiting time (PWT), length of hospital stay (LOS), and costs of hospitalization, without reducing the quality of surgery. Thus, we compared the time, cost, and quality between March 1 to December 31, 2019, and March 1 to December 31, 2020. Descriptive and inferential analyses of patient demographic characteristics, time, postoperative outcomes, and inpatient costs were conducted.Results: A total of 965 hospitalizations for colorectal cancer (CRC) were identified-415 in 2019 and 550 in 2020. In the CCC, PWT declined by 26.2 hours (P<0.01). Patients in the CCC express group only needed to wait for 24.5 hours before undergoing surgery, with a shorter LOS than the normal group (P<0.01). None of the patients had any symptoms of COVID-19 or were high-risk COVID-19 contacts, and the incidence of immediate postoperative complications was low. The mean total inpatient cost (TIC) for all patients with CRC was 78,309.824 Chinese Yuan in 2020, which was slightly lower than that in 2019.Conclusions: This study found that the centralized management model for CRC care could help patients save the PWT, LOS and costs of hospitalization during the COVID-19 epidemic.

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“…Their expertise positions them well to assess and support the unique needs of older adults living with frailty, multimorbidity, and functional impairment 1,2 . Outcomes of outpatient geriatrician care may include reduced functional decline and reduced risk of emergency department visits, unplanned hospital admissions, and overall mortality 3–5 . Reports from the United States and the United Kingdom suggest that there were 16.3 and 13.4 geriatricians per 100,000 population (≥65), respectively, in those jurisdictions in 2018 6–8 .…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Outcomes of outpatient geriatrician care may include reduced functional decline and reduced risk of emergency department visits, unplanned hospital admissions, and overall mortality. [3][4][5] Reports from the United States and the United Kingdom suggest that there were 16.3 and 13.4 geriatricians per 100,000 population (≥65), respectively, in those jurisdictions in 2018. [6][7][8] In Ontario, there were 5.3 per 100,000 population (≥65) in the same year, or 129 geriatricians, 9,10 compared to 1196 general internal medicine physicians and 14,747 family medicine physicians provincially.…”

Section: Introductionmentioning

confidence: 99%

Determinants of access of frail, community‐residing older adults to geriatricians in Ontario

Hogeveen

Hirdes

Heckman

et al. 2023

J American Geriatrics Society

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ObjectivesLittle is known about determinants of access to community‐based geriatricians. The Geriatric 5Ms™ describe geriatricians' core competencies and inform referrals to specialists for older adults with complex needs. We explored the association of the Geriatric 5Ms™ and other characteristics with outpatient access to geriatricians by home care (HC) clients.MethodsThis was a population‐based, retrospective cohort study of frail community‐dwelling HC clients (≥60 years) with complex needs (n = 196,444). Health assessment information was linked to health services data in Ontario, Canada, 2012–2015. Multivariable generalized estimating equations were used to identify characteristics associated with geriatrician contact (≥1 visit in 90 days post‐HC admission), including derived Geriatric 5Ms™ score, and predisposing, enabling, and need factors obtained from clinical assessments.ResultsOnly 5.2% of the cohort had outpatient geriatrician contact in Ontario, Canada. Derived Geriatric 5Ms™ score was associated with higher odds of contact, but the model had modest discriminatory power (c‐statistic = 0.67). In the broader multivariable model, based on empirically included factors and adjusted for regional differences, age, worsening of decision‐making, dementia, hallucinations, Parkinsonism, osteoporosis, and caregiver distress/institutionalization risk were associated with higher odds of geriatrician contact. Female sex, difficulties accessing home, impaired locomotion, recovery potential, hemiplegia/hemiparesis, and cancer, were associated with lower odds of contact. This model had good discriminatory power (c‐statistic = 0.77).ConclusionsFew frail, community‐dwelling older adults receiving HC had any outpatient geriatrician contact. While the derived Geriatric 5Ms™ score was associated with contact, a broader empirical model performed better than the Geriatric 5Ms™ in predicting contact with an outpatient geriatrician. Contact was mainly driven by conditions common in older adults, but evidence suggests that geriatricians are not evaluating the most medically complex and unstable older adults in the community. These findings suggest a need to re‐examine the referral process for geriatricians and the allocation of limited specialized resources.

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The influence of integrated geriatric outpatient clinics on the health care utilization of older people

Cited by 11 publications

References 48 publications

Association between physicians' geriatric training and patterns of end‐of‐life care delivered to persons with dementia

Association between physicians' geriatric training and patterns of end‐of‐life care delivered to persons with dementia

Preliminary evaluation of a new initiative to centralize colorectal cancer care during the COVID-19 epidemic in Shanghai, China: a retrospective study

Determinants of access of frail, community‐residing older adults to geriatricians in Ontario

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