Impact of an Inpatient Geriatric Consultative Service on Outcomes for Cognitively Impaired Patients

Abstract

Background

Impact of geriatric consultative services (GCS) on hospital readmission and mortality outcomes for cognitively impaired (CI) patients is not known. Objective

Evaluate impact of GCS on hospital readmission and mortality among CI inpatients. Design

Secondary data-analysis of a prospective trial of a computerized decision support system between July 1, 2006, and May 30, 2008. Setting

Study conducted at XXXXX hospital, a 340-bed, public hospital with over 2,300 yearly admissions of 65 or older. Patients

415 inpatients aged 65 and older with CI were enrolled from July 2006 to March 2008. Measurements

30 day and one year mortality and hospital readmission following the index admission. Cox’s proportional hazard models were used to determine the association between receiving GCS, re-admission or mortality while adjusting for demographics, discharge destination, delirium, Charlson Comorbidity Index, and prior hospitalizations. The propensity score method was used to adjust for the non-random assignment of GCS. Results

Patients receiving GCS were older (79; 8.1 SD vs 76; 7.8 SD; p<.001 with higher incidence of delirium (49% vs. 29%; p<.001)). No significant differences were found between the groups for hospital readmission (Hazard Ratio (HR)=1.19; 95% CI = 0.89, 1.59) and mortality at 12 months of index admission (HR=.91 ; 95% CI = 0.59, 1.40). However, a significant increase in readmissions was observed for the GCS group (HR=1.75; 95% CI = 1.06–2.88) at 30 days post-discharge. Conclusion

One year post-discharge outcomes of CI patients that received GCS were not different from patients who did not receive the service. New models of care are needed to improve post-discharge readmission and mortality among hospitalized patients with CI.