title: The CareWell in Hospital program to improve the quality of care for frail elderly inpatients: results of a before-after study with focus on surgical patients.
abstract: BACKGROUND
  The objective of this study was to evaluate implementation of an innovative intervention designed to prevent complications and stimulate early rehabilitation among frail elderly inpatients.
  
  
  METHODS
  The program was implemented in April 2011. A mixed-methods process evaluation and before-after study were performed. Primary effect outcomes included incidence of hospital-acquired delirium, cognitive decline, and decline in activities of daily living (ADL) during hospital stay. Secondary endpoints included ADL performance 3 months postdischarge, readmission, and caregiver burden.
  
  
  RESULTS
  One hundred ninety-one preintervention and 195 postintervention patients aged 70 years or older were included. Overall, no significant differences in primary endpoints were found. Mean ADL between discharge and follow-up improved (3.2 vs 5.7, P = .058). Caregivers rated burden of care lower at 3 months postdischarge (.5 vs -.6, P = .049).
  
  
  CONCLUSIONS
  The CareWell in Hospital program was implemented satisfactorily. Although the low baseline delirium incidence (11%), higher comorbidity, and an increasing learning curve during a restricted implementation period potentially influenced the overall effects, this integrated care program may have beneficial effects on outcomes among frail elderly surgical patients.
authors.affiliation: Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: Franka.Bakker@Radboudumc.nl.
authors.forename: Franka C
authors.initials: FC
authors.lastname: Bakker
authors.affiliation: Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Anke
authors.initials: A
authors.lastname: Persoon
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Sebastian J H
authors.initials: SJH
authors.lastname: Bredie
authors.affiliation: Department of Pulmonary Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Jolanda
authors.initials: J
authors.lastname: van Haren-Willems
authors.affiliation: Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Leferink
authors.affiliation: Department of Cardio-Thoracic Surgery, -Heart Center, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Luc
authors.initials: L
authors.lastname: Noyez
authors.affiliation: Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Schoon
authors.affiliation: Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Marcel G M
authors.initials: MGM
authors.lastname: Olde Rikkert
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology / Q000517:prevention & control; D065187:Controlled Before-After Studies; D003693:Delirium / Q000209:etiology / Q000517:prevention & control; D005260:Female; D016330:Frail Elderly; D006748:Hospital Departments; D006760:Hospitalization; D006785:Hospitals, University; D006801:Humans; D008297:Male; D009426:Netherlands; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control*; D015397:Program Evaluation; D013514:Surgical Procedures, Operative / Q000534:rehabilitation*
keywords: Delirium; Frailty; Functional decline; Hospital Elder Life Program; Implementation; Surgery