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

Abstract

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.