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. 2024 Nov 5;24(1):914.
doi: 10.1186/s12877-024-05490-4.

The mobile seniors' clinic - an innovative transition of care for frail older adults

Valérie Boucher  1 , Eva-Marie Jouhair  2   3 , Marie-Josée Sirois  1   4 , Luc Tailleur  4   5 , Philippe Voyer  4 , Éric Mercier  1   4   6 , Anik Giguère  4   6   7 , Clermont E Dionne  1   4   6   7 , France Légaré  4   6 , Clémence Dallaire  4   6 , Stéphane Bergeron  1 , Pierre-Hugues Carmichael  1   7 , Marcel Emond  8   9   10   11
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The mobile seniors' clinic - an innovative transition of care for frail older adults

Valérie Boucher et al. BMC Geriatr. .

Abstract

Background: This study aims to evaluate the impact of Quebec's first hospital-at-home-inspired mobile Seniors' Clinic, the "Clinique des Ainés (CDA)", on frail older adults' returns to the Emergency Department (ED), mortality, and hospital Length Of Stay (LOS) and rehospitalizations.

Methods: Design: Quasi-experimental pre-post implementation cohort study.

Population: Patients aged ≥ 75 years admitted to the short-term geriatric unit after an ED consultation (control) or included by the CDA (intervention).

Outcomes: return to ED (RtoED), mortality, ED & hospital LOS, and rehospitalizations.

Statistical analyses: Multivariable regression modelling.

Results: Overall, 891 patients were included. At the intervention site (CDA) (n = 437), RtoED were similar at 30 (17.5% & 19.5%, p = 0.58), 90 (34.4% & 37.3%, p = 0.46) and 180 days (47.2% & 54.0%, p = 0.07) in the pre and post-implementation phases. No mortality differences were found. The hospitalization LOS was significantly shorter (28.26 and 14.22 days, p < 0.01). At 90 days, rehospitalization LOS was decreased by 8.51 days (p = 0.02) and by 6.48 days at 180 days (p = 0.03). Compared to the control site (n = 454) in the post-implementation phase, RtoED was 54% at the intervention site compared to 44.1% (p = 0.02) at 180 days. The CDA had a lower adjusted probability of mortality at 90 days compared to the control site (4.8% VS 11.7%, p = 0.03). No rehospitalization LOS differences were noted.

Conclusions: The Clinique des Ainés showed effectiveness in caring for frail older patients in their homes by decreasing their hospital LOS by half and 90 days mortality risk. It was a safe care trajectory without a clinically significant increase in ED returns or mortality.

Keywords: Aged; Emergency department; Hospital-at-home; Older adults.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Intervention site (CDA): reasons for emergency department returns. CDA: Clinique des aînés
Fig. 2
Fig. 2
Control site: reasons for emergency department returns
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