Counsell SR, Holder CM, Liebenauer LL, Palmer RM, Fortinsky RH, Kresevic DM, Quinn LM, Allen KR, Covinsky KE, Landefeld CS.
Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients:
a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc 2000;48(12):1572-1581.
BACKGROUND: Older persons frequently experience a decline in function following an acute medical illness and hospitalization.
OBJECTIVE: To test the hypothesis that a multicomponent intervention, called Acute Care for Elders (ACE), will improve functional outcomes
and the process of care in hospitalized older patients.
DESIGN: Randomized controlled trial.
PATIENTS: A total of 1,531 community-dwelling patients, aged 70 or older, admitted for an acute medical illness between November 1994 and
May 1997.
INTERVENTION: ACE includes a specially designed environment (with, for example, carpeting and uncluttered hallways); patient-centered
care, including nursing care plans for prevention of disability and rehabiliation; planning for patient discharge to home; and
review of medical care to prevent iatrogenic illness.
MEASUREMENTS: The main outcome was change in the number of independent activities of daily living (ADL) from 2 weeks before admission
(baseline) to discharge. Secondary outcomes included resource use, implementation of orders to promote function, and patient and provider
satisfaction.
RESULTS: Self-reported measures of function did not differ at discharge between the intervention and usual care groups by intention-to-treat
analysis. The composite outcome of ADL decline from baseline or nursing home placement was less frequent in the intervention group at
discharge (34% vs. 40%; P = .027) and during the year following hospitalization (P = .022). There were no significant group differences in
hospital length of stay and costs, home healthcare visits, or readmissions. Nursing care plans to promote independent function were more
often implemented in the intervention group (79% vs 50%; P = .001), physical therapy consults were obtained more frequently
(42% vs 36%; P = .027), and restraints were applied to fewer patients (2% vs 6%; P = .001). Satisfaction with care was higher for the
intervention group than the usual care group among patients, caregivers, physicians, and nurses (P < .05).
CONCLUSIONS: ACE in a community hospital improved the process of care and patient and provider satisfaction without increasing hospital
length of stay or costs. A lower frequency of the composite outcome ADL decline or nursing home placement may indicate potentially
beneficial effects on patient outcomes.
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