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. 2022 Jun 6:9:908100.
doi: 10.3389/fmed.2022.908100. eCollection 2022.

Outcomes of Care by Geriatricians and Non-geriatricians in an Academic Hospital

Reshma Aziz Merchant  1   2 , Vanda Wen Teng Ho  1 , Matthew Zhixuan Chen  1 , Beatrix Ling Ling Wong  1 , Zhiying Lim  1 , Yiong Huak Chan  3 , Natalie Ling  1 , Shu Ee Ng  1 , Amelia Santosa  4 , Diarmuid Murphy  5 , Anantharaman Vathsala  3   6
Affiliations

Outcomes of Care by Geriatricians and Non-geriatricians in an Academic Hospital

Reshma Aziz Merchant et al. Front Med (Lausanne). .

Abstract

Introduction: While hospitalist and internist inpatient care models dominate the landscape in many countries, geriatricians and internists are at the frontlines managing hospitalized older adults in countries such as Singapore and the United Kingdom. The primary aim of this study was to determine outcomes for older patients cared for by geriatricians compared with non-geriatrician-led care teams.

Materials and methods: A retrospective cohort study of 1,486 Internal Medicine patients aged ≥75 years admitted between April and September 2021 was conducted. They were either under geriatrician or non-geriatrician (internists or specialty physicians) care. Data on demographics, primary diagnosis, comorbidities, mortality, readmission rate, Hospital Frailty Risk Score (HFRS), Age-adjusted Charlson Comorbidity Index, Length of Stay (LOS), and cost of hospital stay were obtained from the hospital database and analyzed.

Results: The mean age of patients was 84.0 ± 6.3 years, 860 (57.9%) females, 1,183 (79.6%) of Chinese ethnicity, and 902 (60.7%) under the care of geriatricians. Patients under geriatrician were significantly older and had a higher prevalence of frailty, dementia, and stroke, whereas patients under non-geriatrician had a higher prevalence of diabetes and hypertension. Delirium as the primary diagnosis was significantly higher among patients under geriatrician care. Geriatrician-led care model was associated with shorter LOS, lower cost, similar inpatient mortality, and 30-day readmission rates. LOS and cost were lower for patients under geriatrician care regardless of frailty status but significant only for low and intermediate frailty groups. Geriatrician-led care was associated with significantly lower extended hospital stay (OR 0.73; 95% CI 0.56-0.95) and extended cost (OR 0.69; 95% CI 0.54-0.95).

Conclusion: Geriatrician-led care model showed shorter LOS, lower cost, and was associated with lower odds of extended LOS and cost.

Keywords: cost; geriatric medicine; length of stay; mortality; readmission.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Median length of stay (A) and median total bill (B) by primary diagnosis and inpatient care team.
FIGURE 2
FIGURE 2
Median medications bill (A), median laboratory bill (B) and median radiology bill (C) by primary diagnosis and inpatient care team.
FIGURE 3
FIGURE 3
Median length of stay and total bill by frailty group and inpatient care team.
See this image and copyright information in PMC

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References

    1. Ruiz M, Bottle A, Long S, Aylin P. Multi-morbidity in hospitalised older patients: who are the complex elderly? PLoS One. (2016) 10:e0145372. 10.1371/journal.pone.0145372 - DOI - PMC - PubMed
    1. Marcantonio ER. Delirium in hospitalized older adults. N Engl J Med. (2017) 377:1456–66. - PMC - PubMed
    1. Chin YC, Koh GC, Tay YK, Tan CH, Merchant RA. Underdiagnosis of delirium on admission and prediction of patients who will develop delirium during their inpatient stay: a pilot study. Singapore Med J. (2016) 57:18–21. 10.11622/smedj.2016007 - DOI - PMC - PubMed
    1. Parker SG, Fadayevatan R, Lee SD. Acute hospital care for frail older people. Age Ageing. (2006) 35:551–2. - PubMed
    1. Dent E, Morley JE, Cruz-Jentoft AJ, Woodhouse L, Rodriguez-Manas L, Fried LP, et al. Physical frailty: ICFSR international clinical practice guidelines for identification and management. J Nutr Health Aging. (2019) 23:771–87. - PMC - PubMed