Improving hospital outcomes in patients admitted from residential aged care: results from a controlled trial.

BACKGROUND

residents of aged care are old, frail and frequently require hospital management of intercurrent illness, but hospital outcomes are poor.

OBJECTIVE

to identify the impact of an interdisciplinary care model on medical inpatients admitted from residential aged care (RAC).

DESIGN

pre-planned subgroup analysis of controlled trial.

SETTING

general medical units of a teaching hospital in Brisbane, Australia.

SUBJECTS

consecutive patients aged over 65 admitted from RAC (n = 189) or the community (n = 815).

METHODS

all admitted general medical patients were allocated by existing cyclical roster to control (usual care) or intervention units (interdisciplinary care consisting of improved allied health staffing, consistent teams, daily team meetings and early discharge planning). Patient characteristics and outcomes of care were compared between RAC and community subgroups. In the RAC subgroup, outcomes were compared between the control and intervention groups.

RESULTS

patients admitted from RAC had much higher in-hospital mortality (13 versus 6%) and 6-month mortality (35 versus 17%) than those from community. RAC residents receiving the intervention had a significant reduction in in-hospital mortality (4 versus 22% P < 0.001) sustained at 6 months (28 versus 44% P = 0.02).

CONCLUSIONS

poor hospital outcomes for RAC residents may reflect prevailing models of inpatient care.