US EPA

3241840 

Journal Article 

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 

Counsell, SR; Holder, CM; Liebenauer, LL; Palmer, RM; Fortinsky, RH; Kresevic, DM; Quinn, LM; Allen, KR; Covinsky, KE; Landefeld, CS 

2000 

1 

Journal of the American Geriatrics Society
ISSN: 0002-8614
EISSN: 1532-5415 

48 

12 

1572-1581 

WOS:000167371200005 

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. SETTING: Community teaching hospital. PATIENTS: A total of 1531 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 rehabilitation; 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%; r = .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. 

aged; hospital outcomes; functional decline; institutionalization; quality of care