title: The geriatric floating interdisciplinary transition team.
abstract: Older adults often receive suboptimal care during hospitalizations and transitions to postacute settings. Inpatient geriatric services have been shown to increase care quality but have not improved patient outcomes consistently. Acute Care for the Elderly units improve patient outcomes but are resource intensive. Transitional care has been shown to reduce hospital readmissions and healthcare costs. This article describes the Geriatric Floating Interdisciplinary Transition Team (Geri-FITT), a model that combines the strengths of inpatient geriatric evaluation and comanagement and transitional care models by creating an inpatient comanagement service that also delivers transitional care. The Geri-FITT model is designed to improve the hospital care of older adults and their transitions to postacute settings. In Geri-FITT, a geriatrician-geriatric nurse practitioner team assesses patients, comanages geriatric syndromes, provides staff education, encourages patient self-management, communicates with primary care providers, and follows up with patients soon after discharge. This pilot cohort study of Geri-FITT included hospitalized patients aged 70 and older on four general medicine services (two Geri-FITT, two usual care) at an academic medical center (N=717). The study assessed the effect of Geri-FITT on patients' care transition quality (Care Transitions Measure) and their satisfaction with hospital care (four questions). The results indicate that Geri-FITT is associated with slightly higher, though not statistically significantly so, quality care transitions and greater patient satisfaction with inpatient care. Geri-FITT may be a feasible approach to enhancing inpatient management and transitional care for older adults. Further study of its effect on these and other outcomes in other healthcare settings seems warranted.
authors.affiliation: Division of Geriatric Medicine and Gerontology, Department of Medicine, School of Medicine, Johns Hopkins University, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA. aarbaje@jhmi.edu
authors.forename: Alicia I
authors.initials: AI
authors.lastname: Arbaje
authors.forename: David D
authors.initials: DD
authors.lastname: Maron
authors.forename: Qilu
authors.initials: Q
authors.lastname: Yu
authors.forename: V Inez
authors.initials: VI
authors.lastname: Wendel
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tanner
authors.forename: Chad
authors.initials: C
authors.lastname: Boult
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Eubank
authors.forename: Samuel C
authors.initials: SC
authors.lastname: Durso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005260:Female; D006284:Health Plan Implementation; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D016014:Linear Models; D008297:Male; D017146:Models, Organizational; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge; D017060:Patient Satisfaction; D010865:Pilot Projects; D014481:United States