A randomized, controlled trial of comprehensive geriatric assessment and multidisciplinary intervention after discharge of elderly from the emergency department--the DEED II study.
OBJECTIVE
To study the effects of comprehensive geriatric assessment (CGA) and multidisciplinary intervention on elderly patients sent home from the emergency department (ED).


METHODS
Prospective, randomized, controlled trial with 18 months of follow-up.


METHODS
Large medical school-affiliated public hospital in an urban setting in Sydney, Australia.


METHODS
A total of 739 patients aged 75 and older discharged home from the ED were randomized into two groups.


METHODS
Patients randomized to the treatment group underwent initial CGA and were followed at home for up to 28 days by a hospital-based multidisciplinary outreach team. The team implemented or coordinated recommendations. The control group received usual care.


METHODS
The primary outcome measure was all admissions, to the hospital within 30 days of the initial ED visit. Secondary outcome measures were elective and emergency admissions, and nursing home admissions and mortality. Additional outcomes included physical function (Barthel Index (total possible score=20) and instrumental activities of daily living (/12) and cognitive function (mental status questionnaire (/10)).


RESULTS
Intervention patients had a lower rate of all admissions to the hospital during the first 30 days after the initial ED visit (16.5% vs 22.2%; P=.048), a lower rate of emergency admissions during the 18-month follow-up (44.4% vs 54.3%; P=.007), and longer time to first emergency admission (382 vs 348 days; P=.011). There was no difference in admission to nursing homes or mortality. Patients randomized to the intervention group maintained a greater degree of physical and mental function (Barthel Index change from baseline at 6 months: -0.25 vs -0.75; P<.001; mental status questionnaire change from baseline at 12 months: -0.21 vs -0.64; P<.001).


CONCLUSIONS
CGA and multidisciplinary intervention can improve health outcomes of older people at risk of deteriorating health and admission to hospital. Patients aged 75 and older should be referred for CGA after an ED visit.
Caplan
Gideon A
GA
Post Acute Care Services, Prince of Wales Hospital, Randwick, New South Wales, Australia. g.caplan@unsw.edu.au
Williams
Anthony J
AJ
Daly
Barbra
B
Abraham
Ken
K
D000203:Activities of Daily Living; D000359:Aftercare / Q000458:organization & administration*; D000368:Aged; D000369:Aged, 80 and over; D003159:Community-Institutional Relations; D003191:Comprehensive Health Care / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006302:Health Services Research; D006299:Health Services for the Aged / Q000458:organization & administration*; D018575:Home Care Services, Hospital-Based / Q000458:organization & administration; D006779:Hospitals, Public; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data; D015397:Program Evaluation; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014193:Trauma Centers