Replicating the Hospital Elder Life Program in a Community Hospital and Demonstrating Effectiveness Using Quality Improvement Methodology

Authors

  • Fred H. Rubin MD,

    1. From the *Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of MedicineInformatics and Quality Improvement, University of Pittsburgh Medical Center, Presbyterian Shadyside, Pittsburgh, Pennsylvania§Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsInstitute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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  • Jennifer T. Williams BS,

    1. From the *Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of MedicineInformatics and Quality Improvement, University of Pittsburgh Medical Center, Presbyterian Shadyside, Pittsburgh, Pennsylvania§Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsInstitute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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  • Dianne A. Lescisin MHPE,

    1. From the *Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of MedicineInformatics and Quality Improvement, University of Pittsburgh Medical Center, Presbyterian Shadyside, Pittsburgh, Pennsylvania§Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsInstitute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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  • William J. Mook MS,

    1. From the *Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of MedicineInformatics and Quality Improvement, University of Pittsburgh Medical Center, Presbyterian Shadyside, Pittsburgh, Pennsylvania§Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsInstitute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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  • Shuja Hassan MD,

    1. From the *Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of MedicineInformatics and Quality Improvement, University of Pittsburgh Medical Center, Presbyterian Shadyside, Pittsburgh, Pennsylvania§Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsInstitute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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  • Sharon K. Inouye MD, MPH

    1. From the *Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of MedicineInformatics and Quality Improvement, University of Pittsburgh Medical Center, Presbyterian Shadyside, Pittsburgh, Pennsylvania§Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsInstitute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts
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Address correspondence to Fred H. Rubin, MD, Department of Medicine, UPMC Shadyside, 5230 Centre Avenue, Pittsburgh, PA 15232. E-mail: Rubinfh@upmc.edu

Abstract

OBJECTIVES: To evaluate a replication of the Hospital Elder Life Program (HELP), a quality-improvement model, in a community hospital without a research infrastructure, using administrative data.

DESIGN: A pretest/posttest quality-improvement study.

SETTING: A 500-bed community teaching hospital in western Pennsylvania.

PARTICIPANTS: Four thousand seven hundred sixty-three hospitalized patients aged 70 and older admitted to one nursing unit over 3.5 years.

INTERVENTION: Application of the HELP multicomponent intervention targeting patients at risk for delirium.

MEASUREMENTS: A proxy measure for delirium was developed using administrative data to calculate delirium rate and differences in variable costs of care and length of stay for patients before and after the intervention. Similar calculations were used in delirious patients for variable costs and length of stay before and after the intervention. Satisfaction surveys were administered to nursing staff and patient families before and after the intervention.

RESULTS: The intervention reduced the absolute rate of delirium according to proxy report 14.4% from baseline, which represented a relative reduction in risk of 35.3% (P=.002). Total costs on this 40-bed nursing unit were reduced $626,261 over 6 months. Satisfaction of nursing staff and families was high in the intervention group. In addition, the intervention showed sustained benefits over time and remains funded by the hospital.

CONCLUSION: HELP can be successfully replicated in a community hospital, yielding clinical and financial benefits.

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