Improving functional outcomes in older patients : lessons from an acute care for elders unit.
Hospitalization often marks the beginning, and may be partially responsible for, a downward trajectory characterized by declining function, worsening quality of life, placement in a long term care facility, and death.
At the University Hospitals of Cleveland, an Acute Care for Elders (ACE) unit that reengineered the process of caring for older patients (>=70 years of age) to improve functional outcomes was established in September 1990.
Description of intervention
The general principles of ACE included an approach to care guided by the biopsychosocial model and recognition of the importance of fitting the hospital environment to the patient's needs.
The design of the intervention was consistent with principles of comprehensive geriatric assessment and continuous quality improvement.
Care, which focused on maintaining function, was directed by an interdisciplinary team that considered the patient's needs both at home and in the hospital.
The major components of the ACE Unit intervention included patient-centered nursing care (daily assessment of functional needs by nursing, nursing-based protocols to improve outcomes, daily rounds by a multidisciplinary team), a prepared environment, planning for discharge, and medical care review.
In a randomized trial comparing ACE with usual care, patients receiving ACE had improved functional ouotcomes at discharge.
The costs to the hospital for ACE unit care were less than for usual care. (...)
Mots-clés Pascal : Vieillard, Adulte, Age, Population, Démographie, Temps séjour, Gestion hospitalière, Hospitalisation, Hôpital, Soin, Etats Unis, Amérique du Nord, Amérique, Monde, Société, Sociologie, Evaluation, Méthodologie, Nursing, Classe âge, Indicateur, Organisation hospitalière, Aspect politique, Géographie, Qualité vie, Mode de vie
Mots-clés Pascal anglais : Elderly, Adult, Age, Population, Demography, Residence time, Hospital management, Hospitalization, Hospital, Care, United States, North America, America, World, Society, Sociology, Evaluation, Methodology, Nursing, Age distribution, Indicator, Hospital organization, Political aspect, Geography, Quality of life, Life habit
Notice produite par :
ORS Auvergne - Observatoire Régional de la Santé d'Auvergne
Code Inist : 002B30A11. Création : 21/07/1998.