title: Feasibility and impact of a post-discharge geriatric evaluation and management service for patients from residential care: the Residential Care Intervention Program in the Elderly (RECIPE).
abstract: BACKGROUND
  Geriatric evaluation and management has become standard care for community dwelling older adults following an acute admission to hospital. It is unclear whether this approach is beneficial for the frailest older adults living in permanent residential care. This study was undertaken to evaluate (1) the feasibility and consumer satisfaction with a geriatrician-led supported discharge service for older adults living in residential care facilities (RCF) and (2) its impact on the uptake of Advanced Care Planning (ACP) and acute health care service utilisation.
  
  
  METHODS
  In 2002-4 a randomised controlled trial was conducted in Melbourne, Australia comparing the geriatrician-led outreach service to usual care for RCF residents. Patients were recruited during their acute hospital stay and followed up at the RCF for six months. The intervention group received a post-discharge home visit within 96 hours, at which a comprehensive geriatric assessment was performed and a care plan developed. Participants and their families were also offered further meetings to discuss ACPs and document Advanced Directives (AD). Additional reviews were made available for assessment and management of intercurrent illness within the RCF. Consumer satisfaction was surveyed using a postal questionnaire.
  
  
  RESULTS
  The study included 116 participants (57 intervention and 59 controls) with comparable baseline characteristics. The service was well received by consumers demonstrated by higher satisfaction with care in the intervention group compared to controls (95% versus 58%, p = 0.006).AD were completed by 67% of participants/proxy decision makers in the intervention group compared to 13% of RCF residents prior to service commencement. At six months there was a significant reduction in outpatient visits (intervention 21 (37%) versus controls 45 (76%), (p < 0.001), but no difference in readmissions rates (39% intervention versus 34% control, p = 0.6). There was a trend towards reduced hospital bed-day utilisation (intervention 271 versus controls 372 days).
  
  
  CONCLUSIONS
  It is feasible to provide a supported discharge service that includes geriatrician assessment and care planning within a RCF. By expanding the service there is the potential for acute health care cost savings by decreasing the demand for outpatient consultation and further reducing acute care bed-days.
authors.forename: Penelope
authors.initials: P
authors.lastname: Harvey
authors.forename: Meg
authors.initials: M
authors.lastname: Storer
authors.forename: David John
authors.initials: DJ
authors.lastname: Berlowitz
authors.forename: Bruce
authors.initials: B
authors.lastname: Jackson
authors.forename: Anastasia
authors.initials: A
authors.lastname: Hutchinson
authors.affiliation: Department of Medicine and Aged Care, Northern Health & Department of Medicine, The University of Melbourne, Melbourne, Australia. Kwang.Lim@nh.org.au.
authors.forename: Wen Kwang
authors.initials: WK
authors.lastname: Lim
mesh_terms: D032722:Advance Care Planning / Q000592:standards; D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care / Q000592:standards; D061345:Early Medical Intervention / Q000379:methods* / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000592:standards; D012112:Residential Facilities / Q000379:methods* / Q000592:standards
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Arch Gen Psychiatry. 1965 Jan;12:63-70
references.pmid: 14221692
references.citation: Int J Evid Based Healthc. 2007 Dec;5(4):450-7
references.pmid: 21631805
references.citation: BMJ. 2008 Sep 29;337:a1655
references.pmid: 18824488
references.citation: Int J Geriatr Psychiatry. 2003 Mar;18(3):244-9
references.pmid: 12642894
references.citation: Med J Aust. 2007 Jul 16;187(2):92-4
references.pmid: 17635091
references.citation: J Ambul Care Manage. 2009 Jul-Sep;32(3):216-25
references.pmid: 19542811
references.citation: Age Ageing. 2005 Mar;34(2):130-5
references.pmid: 15713856
references.citation: J Am Geriatr Soc. 2004 Jan;52(1):159-60
references.pmid: 14687333
references.citation: N Engl J Med. 2011 Sep 29;365(13):1165-7
references.pmid: 21991889
references.citation: BMC Med. 2013 Apr 24;11:111
references.pmid: 23618406
references.citation: J Am Geriatr Soc. 2001 Feb;49(2):172-8
references.pmid: 11207872
references.citation: Md State Med J. 1965 Feb;14:61-5
references.pmid: 14258950
references.citation: J Am Geriatr Soc. 2002 Apr;50(4):761-7
references.pmid: 11982681
references.citation: JAMA. 2000 Mar 15;283(11):1437-44
references.pmid: 10732933
references.citation: Health Aff (Millwood). 2010 Jan-Feb;29(1):57-64
references.pmid: 20048361
references.citation: Int J Evid Based Healthc. 2008 Jun;6(2):270-6
references.pmid: 21631824
references.citation: Aust N Z J Med. 1999 Aug;29(4):494-9
references.pmid: 10868526
references.citation: J Am Geriatr Soc. 2002 Feb;50(2):223-9
references.pmid: 12028202
references.citation: J Am Geriatr Soc. 1995 Feb;43(2):130-7
references.pmid: 7836636
references.citation: J Am Geriatr Soc. 2004 Oct;52(10):1730-6
references.pmid: 15450053
references.citation: Ann Intern Med. 1993 Feb 1;118(3):219-23
references.pmid: 8417639
references.citation: J Gen Intern Med. 2002 Aug;17(8):618-24
references.pmid: 12213143
references.citation: Age Ageing. 2004 Jul;33(4):374-8
references.pmid: 15151909
references.citation: J Am Geriatr Soc. 2002 May;50(5):829-35
references.pmid: 12028168