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Specialized geriatric units save hospitals money

Wednesday June 13, 2012
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Creating specialized hospital units for elderly people with acute medical illness could reduce national healthcare costs by as much $6 billion a year, according to a study.

Researchers with the University of California, San Francisco, assessed a program called "Acute Care for Elders," which offers individualized care for older patients in specially designed hospital units. It is being piloted in 200 hospitals nationwide, serving an estimated 100,000 patients annually.

"The Medicare proportion of the healthcare budget is going up faster than anything else, and the cost of hospital stays is one of the fastest-growing components of that care," Seth Landefeld, MD, the study’s senior author and chief of the UCSF Division of Geriatrics, said in a news release. "This was really an opportunity to look at how you can deliver higher-value care while maintaining or improving quality and reducing cost."

In their research, published in the June issue of Health Affairs, Landefeld and his colleagues conducted a randomized controlled study of 1,632 elderly patients seen either in the Acute Care for Elders (ACE) program or a traditional inpatient hospital setting between August 1993 and May 1997. They found that the average length-of-stay was shorter for patients in the ACE program, 6.7 days versus 7.3 days. They also found that patients in the program incurred lower hospital costs, $9,477 versus $10,451, for a savings of $974 per patient.

Nationally, Landefeld said, these numbers could translate to a 1% saving of all Medicare expenditures, or $6 billion a year.

"What’s encouraging about this is the outcomes were identical in both groups, so we were able to save money while maintaining the quality of care," said Deborah Barnes, PhD, MPH, the study’s first author and an associate professor of psychiatry and of epidemiology and biostatistics at UCSF.

"So despite being released about half a day earlier, patients had similar levels of function at discharge, and also the readmission rates were identical in two groups over three months."

The ACE program works by creating an interdisciplinary team environment that specializes in the care of older patients. Team members may include geriatricians, APRNs, social workers, pharmacists and physical therapists

Nurses’ levels of independence and accountability are increased in the model, according to the study. The number of clinical staff per patient is similar to traditional units, but patients are assessed daily by the team for issues such as mental status changes, mobility, nutrition and pain.

"You’re not asking people to do a lot of extra work," Landefeld said. "You’re just asking them to do their work differently."

The researchers said barriers to the implementation of ACE on a larger scale include the need for clinicians to change ingrained work cultures and adjust schedules to meet and talk about the patients.

"What we found was that ACE decreased miscommunication, and it decreased the number of pages nurses had to make to doctors," Landefeld said. "Having people work together actually saved people time and reduced work down the line."

ACE may not be ideal for all hospital environments, Landefeld noted. A small hospital in a rural environment may not benefit, but the researchers said most medium to large hospitals with at least 100 beds would qualify.

"You’re saving about five times as much as you’re putting into many of the physical changes you’re making in the unit," Landefeld said. "It’s like an ICU in terms of the quality of care, but it’s not an ICU in terms of new expensive technology."

Still, said Barnes, "creating an ACE unit requires an upfront investment, and in order to make that happen you need people to believe. Our study gives people really solid data to try to encourage them along this pathway, to help them believe that if they make that upfront investment, it will work."

To read the study abstract and access the study via subscription or purchase, visit http://bit.ly/JWac6U.

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