Anne W Ekdahl1, Ann-Britt Wirehn2, Jenny Alwin3, Tiny Jaarsma4, Mitra Unosson4, Magnus Husberg3, Jeanette Eckerblad4, Anna Milberg5, Barbro Krevers3, Per Carlsson3. 1. Department of Geriatric Medicine and Department of Social and Welfare Studies, Linköping University, Linköping, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden. Electronic address: anne.ekdahl@ki.se. 2. Local Health Care Research and Development Unit, County Council in Östergötland, Linköping University, Linköping, Sweden. 3. Division of Health Care Analysis, Department of Medical and Health Sciences, Faculty of Health Sciences, Linkoping University, Linköping, Sweden. 4. Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden. 5. Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Advanced Home Care and Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
Abstract
OBJECTIVES: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care. DESIGN: Assessor-blinded, single-center randomized controlled trial. SETTING: AGU in an acute hospital in southeastern Sweden. PARTICIPANTS: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years. INTERVENTION: Participants in the IG received CGA-based care at the AGU in addition to usual care. OUTCOME MEASURES: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant' sense of security in care, and health-related quality of life (HRQoL). RESULTS: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371 £ (39,947 £) and 30,490 £ (31,568 £; P = .432). CONCLUSIONS AND RELEVANCE: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01446757.
RCT Entities:
OBJECTIVES: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care. DESIGN: Assessor-blinded, single-center randomized controlled trial. SETTING: AGU in an acute hospital in southeastern Sweden. PARTICIPANTS: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years. INTERVENTION: Participants in the IG received CGA-based care at the AGU in addition to usual care. OUTCOME MEASURES: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant' sense of security in care, and health-related quality of life (HRQoL). RESULTS: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371 £ (39,947 £) and 30,490 £ (31,568 £; P = .432). CONCLUSIONS AND RELEVANCE: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01446757.
Authors: Martina Lundqvist; Jenny Alwin; Martin Henriksson; Magnus Husberg; Per Carlsson; Anne W Ekdahl Journal: BMC Geriatr Date: 2018-01-31 Impact factor: 3.921