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Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial
Region Östergötland, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm.
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
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2015 (English)In: Journal of the American Medical Directors Association, ISSN 1538-9375, Vol. 16, no 6, 497-503 p.Article in journal (Refereed) Published
Abstract [en]

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 = 208) or control group (CG; n = 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 = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .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 = .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.

Place, publisher, year, edition, pages
Elsevier, 2015. Vol. 16, no 6, 497-503 p.
Keyword [en]
Comprehensive geriatric assessment; ambulatory geriatric care; costs; hospitalization; multimorbidity; randomized controlled trial; security
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:liu:diva-118967DOI: 10.1016/j.jamda.2015.01.074ISI: 000355134100009PubMedID: 25703450OAI: oai:DiVA.org:liu-118967DiVA: diva2:817599
Available from: 2015-06-05 Created: 2015-06-05 Last updated: 2016-04-24

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Ekdahl, Anne WWirehn, Ann-BrittAlwin, JennyJaarsma, TinyUnosson, MitraHusberg, MagnusEckerblad, JeanetteMilberg, AnnaKrevers, BarbroCarlsson, Per

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Ekdahl, Anne WWirehn, Ann-BrittAlwin, JennyJaarsma, TinyUnosson, MitraHusberg, MagnusEckerblad, JeanetteMilberg, AnnaKrevers, BarbroCarlsson, Per
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Department of Geriatric Medicine in LinköpingFaculty of Medicine and Health SciencesDivision of Health, Activity and CareDivision of Health Care AnalysisResearch & Development Unit in Local Health CareFaculty of Health SciencesDepartment of Advanced Home Care in NorrköpingCenter of Palliative Care
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