title: Identification and team-based interprofessional management of hospitalized vulnerable older adults.
abstract: BACKGROUND
  Extended hospital stays and complications are common among older adults and may lead to morbidity and loss of independence. Specialized geriatric units have been shown to improve outcomes but, with the growing numbers of older adults, may be difficult to scale to meet needs.
  
  
  OBJECTIVE
  The purpose was to evaluate a quality improvement initiative that redesigned unit-based workflow and trained interprofessional teams on general medical/surgical units to create care plans for vulnerable older adults using principles of comprehensive geriatric assessment and team management.
  
  
  METHODS
  The evaluation included a cluster randomized controlled trial of 10 medical/surgical units and intention-to-treat analysis of all patients meeting risk screening criteria.
  
  
  RESULTS
  N = 1,384, median age = 80.9 years, and 53.5% female. Mean difference in observed vs. expected length of stay was 1.03 days shorter (p = .006); incidence of complications (odds ratio [OR] = 0.45; 95% confidence interval [CI] = 0.21-0.98) and transfer to intensive care (OR = 0.45; 95% CI = 0.25-0.79) lower among patients admitted to intervention units; incidence of discharge to institutional care was higher (OR = 1.43; 95% CI = 1.06-1.93). Mortality during hospitalization (OR = 0.64; 95% CI = 0.37-1.11) did not differ between groups.
  
  
  CONCLUSIONS
  Reorganizing general medical/surgical units to provide team-based interprofessional care can improve outcomes among hospitalized older adults.
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Jeff Edward
authors.initials: JE
authors.lastname: Borenstein
authors.affiliation: Department of Nursing, Cedars-Sinai Medical Center, Los Angeles, CA. Electronic address: harriet.aronow@cshs.org.
authors.forename: Harriet Udin
authors.initials: HU
authors.lastname: Aronow
authors.affiliation: Department of Nursing, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Linda Burnes
authors.initials: LB
authors.lastname: Bolton
authors.affiliation: Department of Nursing, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Mariane Ivy
authors.initials: MI
authors.lastname: Dimalanta
authors.affiliation: Department of Case Management, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Chan
authors.affiliation: Department of Pharmacy Services, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Katherine
authors.initials: K
authors.lastname: Palmer
authors.affiliation: Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Bradley
authors.initials: B
authors.lastname: Rosen
authors.affiliation: Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
authors.forename: Glenn David
authors.initials: GD
authors.lastname: Braunstein
mesh_terms: D000046:Academic Medical Centers; D000369:Aged, 80 and over; D057286:Electronic Health Records; D005260:Female; D015577:Geriatric Assessment; D017052:Hospital Mortality; D006757:Hospital Units; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D015141:Los Angeles; D008297:Male; D010347:Patient Care Planning; D010348:Patient Care Team / Q000458:organization & administration*; D010351:Patient Discharge; D010360:Patient Transfer / Q000706:statistics & numerical data; D058996:Quality Improvement; D035862:Vulnerable Populations
keywords: Cluster randomized trial; Comprehensive geriatric assessment; Interprofessional team care; Older adult inpatients; Program evaluation