Comprehensive geriatric assessment in a day hospital.

OBJECTIVE

To assess the effectiveness of comprehensive geriatric assessment conducted in day hospitals.

DESIGN

Retrospective cohort comparison study with restricted inclusionary criteria and adjustment for baseline characteristics.

SETTING

A hospital-based geriatric day hospital and geriatric clinic sites (both in the university and in the community).

PATIENTS

Four hundred sixty-eight patients referred for comprehensive geriatric assessment during a 12-month period.

INTERVENTION

Comprehensive geriatric assessment in a geriatric day hospital compared with assessment received in clinic sites without a day hospital.

MAIN OUTCOME MEASURES

Services received in the first 2 weeks; hospitalization, emergency room visits, placement, death, and change in selected health status measures. Follow-up data was obtained from medical records, a telephone survey, and death certificates.

RESULTS

Except in the case of rehabilitative services, day hospital patients were more likely to receive interdisciplinary services. The population seen in the day hospital was more functionally impaired and had significantly more dementia and depression. After adjusting for subjects' baseline characteristics and limiting the analyses to subjects meeting specific inclusionary criteria, the day hospital had no significant effect on mortality, use of emergency or hospital services, placement, or change on selected measures of health status. For example, compared with the clinic patients, receiving care in the day hospital was associated with an adjusted odds ratio of 1.01 (95% confidence interval: 0.53, 1.91) of being at a higher level of care at 6 months. The results were not sensitive to the choice of inclusionary criteria.

CONCLUSION

Given their cost and uncertain effectiveness, day hospitals need additional evaluation before their further diffusion occurs.