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A Randomized, Controlled Trial of Comprehensive Geriatric Assessment and Multidisciplinary Intervention After Discharge of Elderly from the Emergency Department—The DEED II Study

Authors

  • Gideon A. Caplan MBBS, FRACP,

    1. From the *Post Acute Care ServicesEmergency Department, Prince of Wales Hospital, Randwick, New South Wales, AustraliaSchool of Public Health and Community Medicine§Faculty of Medicine, University of New South Wales, Kensington New South Wales, Australia.
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  • Anthony J. Williams RN,

    1. From the *Post Acute Care ServicesEmergency Department, Prince of Wales Hospital, Randwick, New South Wales, AustraliaSchool of Public Health and Community Medicine§Faculty of Medicine, University of New South Wales, Kensington New South Wales, Australia.
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  • Barbra Daly RN,

    1. From the *Post Acute Care ServicesEmergency Department, Prince of Wales Hospital, Randwick, New South Wales, AustraliaSchool of Public Health and Community Medicine§Faculty of Medicine, University of New South Wales, Kensington New South Wales, Australia.
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  • Ken Abraham MBBS, FACEM

    1. From the *Post Acute Care ServicesEmergency Department, Prince of Wales Hospital, Randwick, New South Wales, AustraliaSchool of Public Health and Community Medicine§Faculty of Medicine, University of New South Wales, Kensington New South Wales, Australia.
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  • This study was supported by the National Demonstration Hospitals Program of the Commonwealth Department of Health and Aged Care. Presented in part at the 2000 Annual Scientific Meeting of the American Geriatrics Society/American Federation for Aging Research, Nashville, Tennessee, May 17–21, 2000.

Address correspondence to Dr. Gideon Caplan, Director, Post Acute Care Services, Prince of Wales Hospital, Randwick NSW 2031, Australia. E-mail: g.caplan@unsw.edu.au

Abstract

Objectives: To study the effects of comprehensive geriatric assessment (CGA) and multidisciplinary intervention on elderly patients sent home from the emergency department (ED).

Design: Prospective, randomized, controlled trial with 18 months of follow-up.

Setting: Large medical school–affiliated public hospital in an urban setting in Sydney, Australia.

Participants: A total of 739 patients aged 75 and older discharged home from the ED were randomized into two groups.

Intervention: Patients randomized to the treatment group underwent initial CGA and were followed at home for up to 28 days by a hospital-based multidisciplinary outreach team. The team implemented or coordinated recommendations. The control group received usual care.

Measurements: The primary outcome measure was all admissions, to the hospital within 30 days of the initial ED visit. Secondary outcome measures were elective and emergency admissions, and nursing home admissions and mortality. Additional outcomes included physical function (Barthel Index (total possible score=20) and instrumental activities of daily living (/12) and cognitive function (mental status questionnaire (/10)).

Results: Intervention patients had a lower rate of all admissions to the hospital during the first 30 days after the initial ED visit (16.5% vs 22.2%; P=.048), a lower rate of emergency admissions during the 18-month follow-up (44.4% vs 54.3%; P=.007), and longer time to first emergency admission (382 vs 348 days; P=.011). There was no difference in admission to nursing homes or mortality. Patients randomized to the intervention group maintained a greater degree of physical and mental function (Barthel Index change from baseline at 6 months: −0.25 vs −0.75; P<.001; mental status questionnaire change from baseline at 12 months: −0.21 vs −0.64; P<.001).

Conclusion: CGA and multidisciplinary intervention can improve health outcomes of older people at risk of deteriorating health and admission to hospital. Patients aged 75 and older should be referred for CGA after an ED visit.

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