title: Evaluating Outcomes from an Integrated Health Service for Older Patients.
abstract: BACKGROUND
  Hospital-associated disability is the loss of the ability to complete one activity of daily living (ADL), with this decline occurring between the onset of acute illness and discharge from the hospital. Approximately 30% of patients who are >70 years old and admitted to hospitals are discharged with an ADL disability. Comprehensive geriatric assessment (CGA) models use a multidimensional, interdisciplinary process of diagnosis and treatment with the goal of improving outcomes and decreasing lengths of stay.
  
  
  METHODS
  A retrospective clinical audit of Ipswich Hospital's medical records included patients for random selection who were >75 years of age and had an acute admission to the Older Person Evaluation Review and Assessment (OPERA) or general medicine (GM) service from July 2012 to December 2012. Data were collected for the entire admission period on length of stay, comorbidities, allied health visits, functional ability, and delirium and dementia at admission.
  
  
  RESULTS
  Of the 267 patients evaluated, 133 were admitted to the OPERA service, and 134 were admitted to the GM service. Patients admitted to the OPERA service were significantly more ill than patients admitted to the GM service as measured by the Charlson Comorbidity Index scores (6.53 ± 1.83 vs 6.02 ± 1.96, respectively, P=0.02), Katz Index of Independence in ADL scores (3.77 ± 2.22 vs 4.72 ± 2.00, respectively, P<0.001), presence of delirium at admission (28% vs 15%, respectively, P=0.02), and presence of dementia at admission (42% vs 21%, respectively, P=0.002). However, patients in both groups had a mean acute length of stay of 4 days (P=0.33), the readmission rate was <20% for both groups (P=0.33), and the mortality rate for each group was similar (3%).
  
  
  CONCLUSIONS
  By showing that patients admitted to the OPERA service were more ill than patients admitted to the GM service but health outcomes were maintained, researchers hope to justify the need for such CGA models. Additional goals include garnering support for the maintenance and growth of CGA models; decreasing mortality, cost, and readmission rates; and improving the quality of life for older patients.
authors.affiliation: The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Kyle D
authors.initials: KD
authors.lastname: Severinsen
authors.affiliation: The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Anne
authors.initials: A
authors.lastname: Tufton
authors.affiliation: The University of Queensland School of Medicine, Brisbane, Queensland, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Hannan
authors.affiliation: Department of Biostatistics and Epidemiology, Medical College of Georgia, Georgia Regents University, Augusta, GA.
authors.forename: Jessica S
authors.initials: JS
authors.lastname: Schwind
authors.affiliation: Department of Infection Prevention and Control, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Dana
authors.initials: D
authors.lastname: Schmucker
authors.affiliation: Department of Geriatrics, Ipswich Hospital, Ipswich, Queensland, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Cutler
keywords: Aged; frail elderly; geriatric assessment; geriatrics; health services for the aged