title: Operational and quality outcomes of a mobile acute care for the elderly service.
abstract: BACKGROUND
  The traditional acute care for the elderly (ACE) unit has demonstrated improved functional outcomes without increased costs or changes in length of stay (LOS). It is, however, limited in scope to patients cared for on a fixed geographical unit.
  
  
  OBJECTIVE
  To compare operational and quality outcomes for patients cared for on a mobile ACE (MACE) service to those cared for on a unit-based ACE service and matched controls on other general medical services.
  
  
  METHODS
  Retrospective cohort study with propensity-score matching.
  
  
  METHODS
  An urban academic medical center.
  
  
  METHODS
  A total of 8094 hospitalized adults >64 years old admitted to an ACE, MACE, and general medical services from July 2006 to June 2009.
  
  
  METHODS
  An interdisciplinary MACE service com- posed of a geriatrician-hospitalist, fellow, nurse coordinator, and social worker.
  
  
  METHODS
  LOS, total cost, 7- and 30-day readmission rates, and in-hospital mortality.
  
  
  RESULTS
  Mean LOS and total cost were significantly lower for patients in the MACE service compared with the ACE unit service (5.8 vs 7.9 days, P < 0.001, and $10,315 vs $13,187, P = 0.002) and compared with propensity-score matched controls during the second year of operation (5.6 vs 7.2 days, P < 0.001, and $10,693 vs $15,636, P < 0.001). In-hospital mortality and 7- and 30-day readmission rates were similar in all groups.
  
  
  CONCLUSIONS
  A mobile ACE service may result in reduced LOS and lower costs with no change in in-hospital mortality or 7- or 30-day readmission rates when compared with standard medical service and a traditional unit-based ACE service.
authors.affiliation: Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York 10029-6574, USA. jeffrey.farber@mssm.edu
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Farber
authors.forename: Beartriz
authors.initials: B
authors.lastname: Korc-Grodzicki
authors.forename: Qingling
authors.initials: Q
authors.lastname: Du
authors.forename: Rosanne M
authors.initials: RM
authors.lastname: Leipzig
authors.forename: Albert L
authors.initials: AL
authors.lastname: Siu
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D005260:Female; D005851:Geriatric Nursing / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D008297:Male; D008952:Mobile Health Units / Q000191:economics / Q000458:organization & administration* / Q000592:standards*; D057216:Propensity Score; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies