Older adults admitted to the hospital for acute medical problems are at risk for adverse events both during and after the hospitalization. Possible events include pressure ulcers, falls, hospital-acquired infections, functional decline, institutionalization, and readmission following discharge.
Healthcare reform efforts include incentives and penalties for hospital systems to reduce complications related to care for this population. One model of care is the Mobile Acute Care of the Elderly (MACE) service. Using the MACE model, specialized care provided by an interdisciplinary team is delivered to hospitalized older adults to improve patient outcomes.
MACE team members are geriatricians, social workers, and clinical nurse specialists who focus on reducing the risks associated with hospitalization of older adults, improving the coordination of care with outpatient clinicians, discharge planning, and patient and caregiver education. Researchers recently conducted an evaluation of the MACE service at the Mount Sinai Hospital, an urban tertiary -care teaching hospital in New York City.
The evaluation, conducted from November 12, 2008, through August 10, 2011, was designed to compare the impact of the MACE service to the general medical service (usual care). Results of the evaluation were reported in JAMA Internal Medicine [2013;173(11):990-996].
Patients included in the evaluation were ³75 years of age and admitted due to an acute illness to either the MACE service or usual care. Individuals in the 2 groups were matched for age, diagnosis, and ability to ambulate independently. The primary outcome measures were incidence of adverse events (falls, pressure ulcers, use of restraints, and catheter-associated urinary tract infections), length of stay, readmission within 30 days of discharge, 30-day functional status, and patient satisfaction during care transitions (measured with the 3-Item Care Transition Measure).
Drawing from a pool of 233 patients from the MACE service and 267 from the usual care group, inclusion and exclusion criteria yielded a final matching cohort of 173 patients in each group. Patients in the MACE cohort had a mean age of 85.2 years, 76.3% were female, and 55.5% were white; these characteristics were similar to those in the usual care group (mean age, 84.7 years, 72.8% female, and 48.0% white). There was no difference between the groups in the likelihood of being a Medicaid beneficiary.
Patients in the MACE group were slightly more ill on admission compared with the usual care group and only 31.8% in each group were able to ambulate independently at baseline. Patients in the MACE group had a higher prevalence of dementia (45.1% vs 34.1%; P=.001) or delirium at admission (22.5% vs 10.4%; P=.001), and were taking more prescribed medications at baseline (mean, 10.0 vs 8.0; P<.001).
Following adjustment for confounders, patients in the MACE group were less likely to experience adverse events compared with those in the usual care group: 9.5% versus 17.0% (adjusted odds ratio, 0.11; 95% confidence interval, 0.01-0.88; P=.02). Hospital stays were also shorter in the MACE group compared with the usual care group: 4.6 days versus 6.8 days (P=.001).
Likelihood of readmission within 30 days of discharge was similar in the 2 groups, and functional status at 30 days following discharge was also similar between the groups. Finally, patient satisfaction with care measured with Hospital Consumer Assessment of Healthcare Providers and Systems Survey data did not differ significantly between the groups. However, when measured using the 3-Item Care Transition Measure, satisfaction in the MACE group was 7.4 points higher than in the usual care group (P=.001).
In summary, the researchers commented, “Admission to the MACE service was associated with lower rates of adverse events, shorter hospital stays, and better satisfaction. This model has the potential to improve care outcomes among hospitalized older adults.”