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.
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.


METHODS
Randomized controlled trial.


METHODS
Community teaching hospital.


METHODS
A total of 1,531 community-dwelling patients, aged 70 or older, admitted for an acute medical illness between November 1994 and May 1997.


METHODS
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.


METHODS
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.
Counsell
S R
SR
ACE Clinical Research Office, Summa Health System, Akron, Ohio, USA.
Holder
C M
CM
Liebenauer
L L
LL
Palmer
R M
RM
Fortinsky
R H
RH
Kresevic
D M
DM
Quinn
L M
LM
Allen
K R
KR
Covinsky
K E
KE
Landefeld
C S
CS
D000203:Activities of Daily Living; D000208:Acute Disease / Q000628:therapy*; D000368:Aged / Q000523:psychology; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment; D005853:Geriatrics / Q000592:standards*; D006272:Health Facility Environment; D006764:Hospitals, Community / Q000592:standards* / Q000706:statistics & numerical data; D016304:Hospitals, Private / Q000592:standards; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D008297:Male; D009820:Ohio; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration*; D010347:Patient Care Planning / Q000458:organization & administration*; D010351:Patient Discharge; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000458:organization & administration*; D015397:Program Evaluation; D017749:Total Quality Management / Q000458:organization & administration