title: Impact of an inpatient geriatric consultative service on outcomes for cognitively impaired patients.
abstract: BACKGROUND
  Impact of geriatric consultative services (GCS) on hospital readmission and mortality outcomes for cognitively impaired (CI) patients is not known.
  
  
  OBJECTIVE
  Evaluate impact of GCS on hospital readmission and mortality among CI inpatients.
  
  
  METHODS
  Secondary data analysis of a prospective trial of a computerized decision support system between July 1, 2006 and May 30, 2008.
  
  
  METHODS
  Study conducted at Eskenazi hospital, Indianapolis, Indiana, a 340-bed, public hospital with over 2300 yearly admissions of patients ages 65 years or older.
  
  
  METHODS
  There were 415 inpatients aged 65 years and older with CI enrolled from July 2006 to March 2008.
  
  
  METHODS
  Thirty-day and 1-year mortality and hospital readmission following the index admission. Cox proportional hazard models were used to determine the association between receiving GCS, readmission, or mortality while adjusting for demographics, discharge destination, delirium, Charlson Comorbidity Index, and prior hospitalizations. The propensity score method was used to adjust for the nonrandom assignment of GCS.
  
  
  RESULTS
  Patients receiving GCS were older (79 years old, 8.1 standard deviation [SD] vs 76 years old, 7.8 SD; P < 0.001) with higher incidence of delirium (49% vs 29%; P < 0.001). No significant differences were found between the groups for hospital readmission (hazard ratio [HR] = 1.19; 95% confidence interval = 0.89-1.59) and mortality at 12 months of index admission (HR = 0.91; 95% confidence interval = 0.59-1.40). However, a significant increase in readmissions was observed for the GCS group (HR = 1.75; 95% confidence interval = 1.06-2.88) at 30 days postdischarge.
  
  
  CONCLUSIONS
  One-year postdischarge outcomes of CI patients who received GCS were not different from patients who did not receive the service. New models of care are needed to improve postdischarge readmission and mortality among hospitalized patients with CI.
authors: Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
authors: Arif
authors: A
authors: Nazir
authors: Babar
authors: B
authors: Khan
authors: Steven
authors: S
authors: Counsell
authors: Macey
authors: M
authors: Henderson
authors: Sujuan
authors: S
authors: Gao
authors: Malaz
authors: M
authors: Boustani
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000628:therapy*; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007297:Inpatients; D008297:Male; D009026:Mortality; D010346:Patient Care Management / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D010359:Patient Readmission / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors
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