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A special care unit dedicated to care of older patients improves both outcomes and satisfaction ratings, according to researchers at Summa Health System in Akron, OH.
The study conducted at Summa tested a multi-component intervention, called Acute Care for Elders (ACE). The trial included 1,531 patients age 70 or older currently living at home who were admitted to the hospital for an acute medical illness between November 1994 and May 1997. The ACE unit included a specially designed environment with carpeting and a home-like atmosphere. The unit team consists of the patient’s nurse, a geriatric clinical nurse specialist, geriatrician, social worker, dietician, physical therapist, occupational therapist, pharmacist, and home care nurse. Features of the multi-component ACE intervention include:
• nursing care plans for prevention of disability and rehabilitation;
• early planning for patient discharge;
• review of medical care to prevent complications such as adverse drug reactions.
Patients were randomly assigned to admission to either the ACE unit or a standard room. Findings include:
• Self-reported measures of function did not differ at discharge between the intervention (ACE) group and the usual care group.
• The composite outcome of activities of daily living decline from baseline to nursing home placement was less frequent, at 34% in the ACE group compared to 40% in the usual care group.
• There were no significant differences in costs, hospital length of stay, home health visits, or readmissions in the two groups.
• Physical therapy consults were obtained for 42% of the ACE group compared to 36% of the usual care group.
• Restraints were applied to 2% of the ACE patients compared to 6% of the usual care patients.
• Satisfaction with care was higher for the ACE group than for the usual care group. This higher satisfaction rate was recorded in patients, caregivers, providers, and nurses working with the patients.
"It appears that the ACE model helps older patients remain independent and avoid nursing home placement during the year following hospitalization," says lead author Steven R. Counsell, MD, with Summa Health. "These improvements were accomplished without increasing hospital length of stay or costs."
[See: Counsell SR, Holder CM, Liebenauer LL, et al. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: A randomized controlled trial of acute care for elders (ACE) in a community hospital. J Am Ger Soc 2000; 48(12):1572-1581.]