title: Evaluation of a hospitalist-run acute care for the elderly service.
abstract: BACKGROUND
  Comprehensive care for frail older inpatients may improve selected outcomes and reduce harm.
  
  
  OBJECTIVE
  To evaluate a Hospitalist-run Acute Care for the Elderly (Hospitalist-ACE) service.
  
  
  METHODS
  Quasi-randomized, controlled trial.
  
  
  METHODS
  Urban academic medical center.
  
  
  METHODS
  Medical inpatients age ≥70 years.
  
  
  METHODS
  Hospitalist-ACE service components: 1) selected hospitalist attendings; 2) daily interdisciplinary rounds; 3) standardized geriatric assessment; 4) clinical focus on mitigating harm and discharge planning; 5) novel inpatient geriatrics curriculum.
  
  
  METHODS
  The primary outcome was recognition of abnormal functional status by the primary medical team. Secondary outcomes included: recognition of abnormal cognitive status and delirium by the primary medical team; use of physical restraints and sleep aids; documentation of code status; hospital charges, length of stay, readmission rates, discharge location, and falls.
  
  
  RESULTS
  One hundred twenty-two Hospitalist-ACE patients were compared to 95 usual care patients. Hospitalist-ACE patients had significantly greater recognition of abnormal functional status (65% vs 32%, P < 0.0001), and abnormal cognitive status (57% vs 36%, P = 0.02), and greater use of "Do Not Attempt Resuscitation" orders (39% vs 26%, P = 0.04). There were no differences in use of physical restraints, or sleep aids, falls, or discharge location. Hospitalist-ACE patients and usual care patients had similar mean lengths of stay in days (3.4 ± 2.7 vs 3.1 ± 2.7, P = 0.52), mean charges ($24,617 ± $15,828 vs $21,488 ± $13,407, P = 0.12), and 30-day readmission rates (12% vs 10%, P = 0.50).
  
  
  CONCLUSIONS
  A Hospitalist-ACE service may improve care processes without significantly increasing resource consumption. No impact on key clinical outcomes was observed.
authors.affiliation: Division of Health Care Policy Research, University of Colorado Denver School of Medicine, Aurora, Colorado, USA. heidi.wald@ucdenver.edu
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Wald
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Glasheen
authors.forename: Jeannette
authors.initials: J
authors.lastname: Guerrasio
authors.forename: Jean M
authors.initials: JM
authors.lastname: Youngwerth
authors.forename: Ethan Ulysses
authors.initials: EU
authors.lastname: Cumbler
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D006299:Health Services for the Aged; D020445:Hospitalists; D006801:Humans; D008297:Male; D008485:Medical Audit; D012189:Retrospective Studies