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Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial
- Source :
- Journal of the American Medical Directors Association. 16(6):497-503
- Publication Year :
- 2015
- Publisher :
- Elsevier BV, 2015.
-
Abstract
- Objectives: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care. Design: Assessor-blinded, single-center randomized controlled trial. Setting: AGU in an acute hospital in southeastern Sweden. Participants: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n ¼ 208) or control group (CG; n ¼ 174). Mean age (SD) was 82.5 (4.9) years. Intervention: Participants in the IG received CGA-based care at the AGU in addition to usual care. Outcome measures: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant’ sense of security in care, and health-related quality of life (HRQoL). Results: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P ¼.035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988e2.310; P ¼.057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371£ (39,947£) and 30,490£ (31,568£; P ¼ .432). Conclusions and relevance: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people. Trial Registration: clinicaltrials.gov identifier: NCT01446757. 2015 AMDA e The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
- Subjects :
- Male
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
Pediatrics
medicine.medical_specialty
endocrine system
multimorbidity
Cost-Benefit Analysis
ambulatory geriatric care
Psychological intervention
Nursing(all)
costs
security
Comprehensive geriatric assessment
law.invention
Interviews as Topic
Quality of life (healthcare)
Ambulatory care
Randomized controlled trial
law
Cause of Death
Ambulatory Care
Medicine
Humans
Single-Blind Method
Geriatric Assessment
General Nursing
Aged
Aged, 80 and over
Patient Care Team
Sweden
Medicine(all)
business.industry
Public health
Health Policy
Hazard ratio
Health services research
General Medicine
Health Care Service and Management, Health Policy and Services and Health Economy
Hospitalization
randomized controlled trial
Ambulatory
Emergency medicine
Quality of Life
hospitalization
Female
Health Services Research
Geriatrics and Gerontology
business
Subjects
Details
- ISSN :
- 15258610
- Volume :
- 16
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- Journal of the American Medical Directors Association
- Accession number :
- edsair.doi.dedup.....6d46ca6716ecca445240a46572cbdc4c
- Full Text :
- https://doi.org/10.1016/j.jamda.2015.01.074