Acute Hospital Use, Nursing Home Placement, and Mortality in a Frail Community-Dwelling Cohort Managed with Primary Integrated Interdisciplinary Elder Care at Home

Authors

  • Ted Rosenberg MD, MSc

    Corresponding author
    • Department of Family Medicine, University of British Columbia and Island Medical Program, University of Victoria, Victoria, British Columbia, Canada
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Address correspondence to Ted Rosenberg, Department of Family Medicine, University of British Columbia and Island Medical Program, University of Victoria, 996 Abbey Road, Victoria, British Columbia, Canada V8Y 1L2. E-mail: trosenberg@gem-health.com

Abstract

Objectives

To evaluate the effect of medical Primary Integrated Interdisciplinary Elder Care at Home (PIECH) on acute hospital use and mortality in a frail elderly population.

Design

Comparison of acute hospital care use for the year before entering the practice (pre-entry) with the most-recent 12-month period (May 1, 2010–April 30, 2011, postentry) for active and discharged patients.

Setting

Community.

Participants

All 248 frail elderly adults enrolled in the practice for at least 12 months who were living in the community and not in nursing homes in Victoria, British Columbia.

Intervention

Primary geriatric care provided by a physician, nurse, and physiotherapist in participants' homes.

Measurements

Acute hospital admissions, emergency department (ED) contacts that did not lead to admission, reason for leaving practice, and site of death.

Results

There was a 39.7% (116 vs 70; P = .004) reduction in hospital admissions, 37.6% (1,700 vs 1,061; P = .04) reduction in hospital days, and 20% (120 vs 95; P = .20) reduction in ED contacts after entering the practice. Fifty participants were discharged from the practice, 64% (n = 32) of whom died, 20% (n = 10) moved, and 16% (n = 8) were admitted to nursing homes. Fifteen (46.9%) deaths occurred at home.

Conclusion

Primary Integrated Interdisciplinary Elder Care at Home may reduce acute hospital admissions and facilitate home deaths.

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