title: Comparison of evidence-based interventions on outcomes of hospitalized, cognitively impaired older adults.
abstract: OBJECTIVE
  This article reports the effects of three evidence-based interventions of varying intensity, each designed to improve outcomes of hospitalized cognitively impaired older adults.
  
  
  METHODS
  In this comparative effectiveness study, 202 older adults with cognitive impairment (assessed within 24 h of index hospitalization) were enrolled at one of three hospitals within an academic health system. Each hospital was randomly assigned one of the following interventions: Augmented Standard Care (ASC; lower dose: n = 65), Resource Nurse Care (RNC; medium dose: n = 71) or the Transitional Care Model (TCM; higher dose: n = 66). Since randomization at the patient level was not feasible due to potential contamination, generalized boosted modeling that estimated multigroup propensity score weights was used to balance baseline patient characteristics between groups. Analyses compared the three groups on time with first rehospitalization or death, the number and days of all-cause rehospitalizations per patient and functional status through 6-month postindex hospitalization.
  
  
  RESULTS
  In total, 25% of the ASC group were rehospitalized or died by day 33 compared with day 58 for the RNC group versus day 83 for the TCM group. The largest differences between the three groups on time to rehospitalization or death were observed early in the Kaplan-Meier curve (at 30 days: ASC = 22% vs RNC = 19% vs TCM = 9%). The TCM group also demonstrated lower mean rehospitalization rates per patient compared with the RNC (p < 0.001) and ASC groups (p = 0.06) at 30 days. At 90-day postindex hospitalization, the TCM group continued to demonstrate lower mean rehospitalization rates per patient only when compared with the ASC group (p = 0.02). No significant group differences in functional status were observed.
  
  
  CONCLUSIONS
  Findings suggest that the TCM intervention, compared with interventions of lower intensity, has the potential to decrease costly resource use outcomes in the immediate postindex hospitalization period among cognitively impaired older adults.
authors: NewCourtland Center for Transitions & Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
authors: Mary D
authors: MD
authors: Naylor
authors: Karen B
authors: KB
authors: Hirschman
authors: Alexandra L
authors: AL
authors: Hanlon
authors: Kathryn H
authors: KH
authors: Bowles
authors: Christine
authors: C
authors: Bradway
authors: Kathleen M
authors: KM
authors: McCauley
authors: Mark V
authors: MV
authors: Pauly
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000706:statistics & numerical data; D003072:Cognition Disorders / Q000453:epidemiology / Q000451:nursing; D057186:Comparative Effectiveness Research; D003266:Continuity of Patient Care; D019317:Evidence-Based Medicine; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: cognitive impairment; functional status; rehospitalizations; transitional care