Mobile Geriatric Service Reduced Length of Stay

CHICAGO — A novel mobile service that provides acute care for the elderly reduced hospital length of stay and costs with no change in in-hospital mortality or readmission rates when compared with more traditional services in a retrospective study.

Traditional acute care for the elderly (ACE) units, which have been shown to improve functional outcomes without increased costs or changes in length of stay, are limited to caring for patients in a fixed hospital unit, geriatrician Dr. Jeffrey Farber noted at the annual meeting of the American Geriatrics Society.

In contrast, a mobile acute care for the elderly (MACE) service follows patients no matter where they are in the hospital. The multidisciplinary MACE team includes a geriatrics attending and a geriatrics fellow, a social worker, and a nurse coordinator. The service focuses on early discharge from units when indicated, shares information collected via postdischarge telephone calls with outpatient physicians, and enters that follow-up information into the patient's electronic medical record.

The retrospective study at Mount Sinai Medical Center, New York, compared outcomes of patients on the MACE service with matched control patients admitted to general medical services and with patients admitted to an ACE unit during the prior year. Three-fourths of the patients were women; their mean age was 82 years in the ACE unit, 83 years on the MACE service, and 81 years among the controls. All patients had an average comorbidity score of 3 using the Elixhauser method, with hypertension being the most common condition (range 53%-60%), followed by congestive heart failure (22%-27%) and diabetes (22%-29%).

For 543 patients on the MACE service, the mean length of stay (5.9 days) was significantly lower than in 450 patients admitted to the ACE unit (8.3 days), said Dr. Farber, director of Mount Sinai's acute care for the elderly service.

Total costs were significantly lower with MACE ($10,518) than in the ACE unit ($14,164), as were direct costs ($4,882 vs. $6,367) and pharmaceutical costs ($631 vs. $961).

Comparing MACE with ACE, rates were similar for in-hospital mortality (4.4% vs. 4.9%), 7-day readmission (3.9% vs. 4.9%), and 30-day readmission (20.6% vs. 20.9%), he said.

Similar results were observed when 516 patients on the MACE service were compared with 3,168 propensity-score matched controls who received traditional care via general medical services. Patients on MACE had significantly lower mean length of stay (5.8 vs. 6.8 days) and total costs ($10,346 vs. $14,145) versus controls. Rates were similar for in-hospital mortality (4.5% vs. 5.0%), 7-day readmission (3.9% vs. 5.6%), and 30-day readmission (20.9% vs. 19.6%).

“We don't know which of the components of this model are driving these results,” Dr. Farber said.

The focus on early discharge and early family meetings involving the MACE social worker and nurse coordinator may be driving the reduced length of stay, while reduced costs might be related to the more geriatric hospitalist nature of the service delivered by fewer physicians.

Because a MACE service does not require structural changes to a hospital or additional beds, there is the potential for wider adoption of such a service than a traditional ACE unit, Dr. Farber said.

Dr. Farber reported that he is supported by an academic career award from the Health Resources and Services Administration. The authors reported no conflicts of interest or study funding.

CHICAGO — A novel mobile service that provides acute care for the elderly reduced hospital length of stay and costs with no change in in-hospital mortality or readmission rates when compared with more traditional services in a retrospective study.

Traditional acute care for the elderly (ACE) units, which have been shown to improve functional outcomes without increased costs or changes in length of stay, are limited to caring for patients in a fixed hospital unit, geriatrician Dr. Jeffrey Farber noted at the annual meeting of the American Geriatrics Society.

In contrast, a mobile acute care for the elderly (MACE) service follows patients no matter where they are in the hospital. The multidisciplinary MACE team includes a geriatrics attending and a geriatrics fellow, a social worker, and a nurse coordinator. The service focuses on early discharge from units when indicated, shares information collected via postdischarge telephone calls with outpatient physicians, and enters that follow-up information into the patient's electronic medical record.

The retrospective study at Mount Sinai Medical Center, New York, compared outcomes of patients on the MACE service with matched control patients admitted to general medical services and with patients admitted to an ACE unit during the prior year. Three-fourths of the patients were women; their mean age was 82 years in the ACE unit, 83 years on the MACE service, and 81 years among the controls. All patients had an average comorbidity score of 3 using the Elixhauser method, with hypertension being the most common condition (range 53%-60%), followed by congestive heart failure (22%-27%) and diabetes (22%-29%).

For 543 patients on the MACE service, the mean length of stay (5.9 days) was significantly lower than in 450 patients admitted to the ACE unit (8.3 days), said Dr. Farber, director of Mount Sinai's acute care for the elderly service.

Total costs were significantly lower with MACE ($10,518) than in the ACE unit ($14,164), as were direct costs ($4,882 vs. $6,367) and pharmaceutical costs ($631 vs. $961).

Comparing MACE with ACE, rates were similar for in-hospital mortality (4.4% vs. 4.9%), 7-day readmission (3.9% vs. 4.9%), and 30-day readmission (20.6% vs. 20.9%), he said.

Similar results were observed when 516 patients on the MACE service were compared with 3,168 propensity-score matched controls who received traditional care via general medical services. Patients on MACE had significantly lower mean length of stay (5.8 vs. 6.8 days) and total costs ($10,346 vs. $14,145) versus controls. Rates were similar for in-hospital mortality (4.5% vs. 5.0%), 7-day readmission (3.9% vs. 5.6%), and 30-day readmission (20.9% vs. 19.6%).

“We don't know which of the components of this model are driving these results,” Dr. Farber said.

The focus on early discharge and early family meetings involving the MACE social worker and nurse coordinator may be driving the reduced length of stay, while reduced costs might be related to the more geriatric hospitalist nature of the service delivered by fewer physicians.

Because a MACE service does not require structural changes to a hospital or additional beds, there is the potential for wider adoption of such a service than a traditional ACE unit, Dr. Farber said.

Dr. Farber reported that he is supported by an academic career award from the Health Resources and Services Administration. The authors reported no conflicts of interest or study funding.

CHICAGO — A novel mobile service that provides acute care for the elderly reduced hospital length of stay and costs with no change in in-hospital mortality or readmission rates when compared with more traditional services in a retrospective study.

Traditional acute care for the elderly (ACE) units, which have been shown to improve functional outcomes without increased costs or changes in length of stay, are limited to caring for patients in a fixed hospital unit, geriatrician Dr. Jeffrey Farber noted at the annual meeting of the American Geriatrics Society.

In contrast, a mobile acute care for the elderly (MACE) service follows patients no matter where they are in the hospital. The multidisciplinary MACE team includes a geriatrics attending and a geriatrics fellow, a social worker, and a nurse coordinator. The service focuses on early discharge from units when indicated, shares information collected via postdischarge telephone calls with outpatient physicians, and enters that follow-up information into the patient's electronic medical record.

The retrospective study at Mount Sinai Medical Center, New York, compared outcomes of patients on the MACE service with matched control patients admitted to general medical services and with patients admitted to an ACE unit during the prior year. Three-fourths of the patients were women; their mean age was 82 years in the ACE unit, 83 years on the MACE service, and 81 years among the controls. All patients had an average comorbidity score of 3 using the Elixhauser method, with hypertension being the most common condition (range 53%-60%), followed by congestive heart failure (22%-27%) and diabetes (22%-29%).

For 543 patients on the MACE service, the mean length of stay (5.9 days) was significantly lower than in 450 patients admitted to the ACE unit (8.3 days), said Dr. Farber, director of Mount Sinai's acute care for the elderly service.

Total costs were significantly lower with MACE ($10,518) than in the ACE unit ($14,164), as were direct costs ($4,882 vs. $6,367) and pharmaceutical costs ($631 vs. $961).

Comparing MACE with ACE, rates were similar for in-hospital mortality (4.4% vs. 4.9%), 7-day readmission (3.9% vs. 4.9%), and 30-day readmission (20.6% vs. 20.9%), he said.

Similar results were observed when 516 patients on the MACE service were compared with 3,168 propensity-score matched controls who received traditional care via general medical services. Patients on MACE had significantly lower mean length of stay (5.8 vs. 6.8 days) and total costs ($10,346 vs. $14,145) versus controls. Rates were similar for in-hospital mortality (4.5% vs. 5.0%), 7-day readmission (3.9% vs. 5.6%), and 30-day readmission (20.9% vs. 19.6%).

“We don't know which of the components of this model are driving these results,” Dr. Farber said.

The focus on early discharge and early family meetings involving the MACE social worker and nurse coordinator may be driving the reduced length of stay, while reduced costs might be related to the more geriatric hospitalist nature of the service delivered by fewer physicians.

Because a MACE service does not require structural changes to a hospital or additional beds, there is the potential for wider adoption of such a service than a traditional ACE unit, Dr. Farber said.

Dr. Farber reported that he is supported by an academic career award from the Health Resources and Services Administration. The authors reported no conflicts of interest or study funding.