Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients

A randomized controlled trial of acute care for elders (ACE) in a community hospital

Steven Counsell, Carolyn M. Holder, Laura L. Liebenauer, Robert M. Palmer, Richard H. Fortinsky, Denise M. Kresevic, Linda M. Quinn, Kyle R. Allen, Kenneth E. Covinsky, C. Seth Landefeld

Research output: Contribution to journalArticle

247 Citations (Scopus)

Abstract

Background: Older persons frequently experience a decline in function following an acute medical illness and hospitalization. Objective: To test the hypothesis that a multicomponent intervention, called Acute Care for Elders (ACE), will improve functional outcomes and the process of care in hospitalized older patients. Design: Randomized controlled trial. Setting: Community teaching hospital. Patients: A total of 1531 community-dwelling patients, aged 70 or older, admitted for an acute medical illness between November 1994 and May 1997. Intervention: ACE includes a specially designed environment (with, for example, carpeting and uncluttered hallways); patient-centered care, including nursing care plans for prevention of disability and rehabilitation; planning for patient discharge to home; and review of medical care to prevent iatrogenic illness. Measurements: The main outcome was change in the number of independent activities of daily living (ADL) from 2 weeks before admission (baseline) to discharge. Secondary outcomes included resource use, implementation of orders to promote function, and patient and provider satisfaction. Results: Self-reported measures of function did not differ at discharge between the intervention and usual care groups by intention-to-treat analysis. The composite outcome of ADL decline from baseline or nursing home placement was less frequent in the intervention group at discharge (34% vs 40%; P =.027) and during the year following hospitalization (P =.022). There were no significant group differences in hospital length of stay and costs, home healthcare visits, or readmissions. Nursing care plans to promote independent function were more often implemented in the intervention group (79% vs 50%; P =.001), physical therapy consults were obtained more frequently (42% vs 36%; P =.027), and restraints were applied to fewer patients (2% vs 6%; P =.001). Satisfaction with care was higher for the intervention group than the usual care group among patients, caregivers, physicians, and nurses (P <.05). Conclusions: ACE in a community hospital improved the process of care and patient and provider satisfaction without increasing hospital length of stay or costs. A lower frequency of the composite outcome ADL decline or nursing home placement may indicate potentially beneficial effects on patient outcomes.

Original languageEnglish
Pages (from-to)1572-1581
Number of pages10
JournalJournal of the American Geriatrics Society
Volume48
Issue number12
DOIs
StatePublished - 2000

Fingerprint

Community Hospital
Randomized Controlled Trials
Length of Stay
Activities of Daily Living
Patient Care Planning
Hospital Costs
Nursing Homes
Patient Satisfaction
Hospitalization
Independent Living
Patient-Centered Care
House Calls
Intention to Treat Analysis
Patient Discharge
Teaching Hospitals
Caregivers
Rehabilitation
Nurses
Delivery of Health Care
Physicians

Keywords

  • aged
  • functional decline
  • hospital outcomes
  • institutionalization
  • quality of care

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients : A randomized controlled trial of acute care for elders (ACE) in a community hospital. / Counsell, Steven; Holder, Carolyn M.; Liebenauer, Laura L.; Palmer, Robert M.; Fortinsky, Richard H.; Kresevic, Denise M.; Quinn, Linda M.; Allen, Kyle R.; Covinsky, Kenneth E.; Landefeld, C. Seth.

In: Journal of the American Geriatrics Society, Vol. 48, No. 12, 2000, p. 1572-1581.

Research output: Contribution to journalArticle

Counsell, Steven ; Holder, Carolyn M. ; Liebenauer, Laura L. ; Palmer, Robert M. ; Fortinsky, Richard H. ; Kresevic, Denise M. ; Quinn, Linda M. ; Allen, Kyle R. ; Covinsky, Kenneth E. ; Landefeld, C. Seth. / Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients : A randomized controlled trial of acute care for elders (ACE) in a community hospital. In: Journal of the American Geriatrics Society. 2000 ; Vol. 48, No. 12. pp. 1572-1581.
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abstract = "Background: Older persons frequently experience a decline in function following an acute medical illness and hospitalization. Objective: To test the hypothesis that a multicomponent intervention, called Acute Care for Elders (ACE), will improve functional outcomes and the process of care in hospitalized older patients. Design: Randomized controlled trial. Setting: Community teaching hospital. Patients: A total of 1531 community-dwelling patients, aged 70 or older, admitted for an acute medical illness between November 1994 and May 1997. Intervention: ACE includes a specially designed environment (with, for example, carpeting and uncluttered hallways); patient-centered care, including nursing care plans for prevention of disability and rehabilitation; planning for patient discharge to home; and review of medical care to prevent iatrogenic illness. Measurements: The main outcome was change in the number of independent activities of daily living (ADL) from 2 weeks before admission (baseline) to discharge. Secondary outcomes included resource use, implementation of orders to promote function, and patient and provider satisfaction. Results: Self-reported measures of function did not differ at discharge between the intervention and usual care groups by intention-to-treat analysis. The composite outcome of ADL decline from baseline or nursing home placement was less frequent in the intervention group at discharge (34{\%} vs 40{\%}; P =.027) and during the year following hospitalization (P =.022). There were no significant group differences in hospital length of stay and costs, home healthcare visits, or readmissions. Nursing care plans to promote independent function were more often implemented in the intervention group (79{\%} vs 50{\%}; P =.001), physical therapy consults were obtained more frequently (42{\%} vs 36{\%}; P =.027), and restraints were applied to fewer patients (2{\%} vs 6{\%}; P =.001). Satisfaction with care was higher for the intervention group than the usual care group among patients, caregivers, physicians, and nurses (P <.05). Conclusions: ACE in a community hospital improved the process of care and patient and provider satisfaction without increasing hospital length of stay or costs. A lower frequency of the composite outcome ADL decline or nursing home placement may indicate potentially beneficial effects on patient outcomes.",
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