Geriatric Re-Admission Rates Can be Minimized, Finds BUMC Study
Despite their greater frailty, patients cared for in an interdisciplinary geriatrics practice at Boston Medical Center (BMC) were no more likely to be re-hospitalized than adults receiving “usual care” according to researchers from Boston University School of Medicine (BUSM) and Boston University School of Public Health. The findings, which appeared in the American Journal of Medical Quality, demonstrate that it is possible to achieve re-hospitalization rates comparable to those of younger and healthier older adults using current care delivery models.
According to the authors, BU Geriatric Services uses specific practices to reduce re-hospitalizations including: case management and care coordination led by advanced practice nurses; discharge communication (documented in the electronic health records and sent to the primary care team) between the inpatient geriatric service attending physician and the primary care team on the day of discharge and attending physician review of medication reconciliation performed by house staff at discharge.
“The odds of re-hospitalization among older, sicker geriatric patients cared for at BMC which uses a multidisciplinary, team-based, integrated geriatric practice model, were no different when compared with older adults cared for in a general medical services who tended to be younger and healthier,” explained lead author Daniel Oates, MD, MSc, an assistant professor of medicine at BUSM and a geriatrician at BMC. “In fact, this was the case even though 71 percent of BU Geriatrics’ patients admitted to the inpatient geriatrics service came from home care or nursing home programs and were significantly more likely to have a diagnosis of dementia, depression or weight loss; a history of delirium; or a pressure ulcer,” he added. Additionally, BU Geriatrics’ patients were more likely to be discharged to a skilled nursing facility (43 percent for geriatric patients vs 17 percent for general medical patients) or home with services from a certified home health agency (26 percent for geriatric patients vs 16 percent for general medical patients), which are further indicators of the illness severity and complexity of the geriatric patients.
Oates added, “BU Geriatric Services is a “working model” of geriatric care, not a costly “add on” to what is already in place. This study demonstrates that it is possible to limit re-hospitalizations within current care delivery models.”