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Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study) : A Randomized Controlled Trial

Ekdahl, Anne W LU ; Wirehn, Ann-Britt; Alwin, Jenny; Jaarsma, Tiny; Unosson, Mitra; Husberg, Magnus; Eckerblad, Jeanette; Milberg, Anna; Krevers, Barbro and Carlsson, Per (2015) In Journal of the American Medical Directors Association 16(6). p.497-503
Abstract

OBJECTIVES: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care.

DESIGN: Assessor-blinded, single-center randomized controlled trial.

SETTING: AGU in an acute hospital in southeastern Sweden.

PARTICIPANTS: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years.

INTERVENTION: Participants in the IG received CGA-based care at... (More)

OBJECTIVES: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care.

DESIGN: Assessor-blinded, single-center randomized controlled trial.

SETTING: AGU in an acute hospital in southeastern Sweden.

PARTICIPANTS: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years.

INTERVENTION: Participants in the IG received CGA-based care at the AGU in addition to usual care.

OUTCOME MEASURES: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant' sense of security in care, and health-related quality of life (HRQoL).

RESULTS: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371 £ (39,947 £) and 30,490 £ (31,568 £; P = .432).

CONCLUSIONS AND RELEVANCE: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people.

TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01446757.

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keywords
Aged, Aged, 80 and over, Ambulatory Care, Cause of Death, Cost-Benefit Analysis, Female, Geriatric Assessment, Health Services Research, Hospitalization, Humans, Interviews as Topic, Male, Patient Care Team, Quality of Life, Single-Blind Method, Sweden, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
in
Journal of the American Medical Directors Association
volume
16
issue
6
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:84929961545
ISSN
1525-8610
DOI
10.1016/j.jamda.2015.01.074
language
English
LU publication?
no
id
8e89297f-3798-4c2c-942e-25ea9c6806d4
date added to LUP
2017-05-19 11:31:11
date last changed
2017-08-20 05:11:27
@article{8e89297f-3798-4c2c-942e-25ea9c6806d4,
  abstract     = {<p>OBJECTIVES: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care.</p><p>DESIGN: Assessor-blinded, single-center randomized controlled trial.</p><p>SETTING: AGU in an acute hospital in southeastern Sweden.</p><p>PARTICIPANTS: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years.</p><p>INTERVENTION: Participants in the IG received CGA-based care at the AGU in addition to usual care.</p><p>OUTCOME MEASURES: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant' sense of security in care, and health-related quality of life (HRQoL).</p><p>RESULTS: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371 £ (39,947 £) and 30,490 £ (31,568 £; P = .432).</p><p>CONCLUSIONS AND RELEVANCE: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people.</p><p>TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01446757.</p>},
  author       = {Ekdahl, Anne W and Wirehn, Ann-Britt and Alwin, Jenny and Jaarsma, Tiny and Unosson, Mitra and Husberg, Magnus and Eckerblad, Jeanette and Milberg, Anna and Krevers, Barbro and Carlsson, Per},
  issn         = {1525-8610},
  keyword      = {Aged,Aged, 80 and over,Ambulatory Care,Cause of Death,Cost-Benefit Analysis,Female,Geriatric Assessment,Health Services Research,Hospitalization,Humans,Interviews as Topic,Male,Patient Care Team,Quality of Life,Single-Blind Method,Sweden,Journal Article,Randomized Controlled Trial,Research Support, Non-U.S. Gov't},
  language     = {eng},
  month        = {06},
  number       = {6},
  pages        = {497--503},
  publisher    = {Elsevier},
  series       = {Journal of the American Medical Directors Association},
  title        = {Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study) : A Randomized Controlled Trial},
  url          = {http://dx.doi.org/10.1016/j.jamda.2015.01.074},
  volume       = {16},
  year         = {2015},
}