TY - JOUR
T1 - Comprehensive geriatric assessment and transitional care in acutely hospitalized patients
T2 - the transitional care bridge randomized clinical trial
AU - Buurman, Bianca M.
AU - Parlevliet, Juliette L.
AU - Allore, Heather G.
AU - Blok, Willem
AU - van Deelen, Bob A.J.
AU - Moll van Charante, Eric P.
AU - de Haan, Rob J.
AU - de Rooij, Sophia E.
PY - 2016/3
Y1 - 2016/3
N2 - IMPORTANCE: Older adults acutely hospitalized are at risk of disability. Trials on comprehensive geriatric assessment (CGA) and transitional care present inconsistent results.OBJECTIVE: To test whether an intervention of systematic CGA, followed by the transitional care bridge program, improved activities of daily living (ADLs) compared with systematic CGA alone.DESIGN, SETTING, AND PARTICIPANTS: This study was a double-blind, multicenter, randomized clinical trial conducted at 3 hospitals with affiliated home care organizations in the Netherlands between September 1, 2010, and March 1, 2014. In total, 1070 consecutive patients were eligible, 674 (63.0%) of whom enrolled. They were 65 years or older, acutely hospitalized to a medical ward for at least 48 hours with an Identification of Seniors at Risk-Hospitalized Patients score of 2 or higher, and randomized using permuted blocks stratified by study site and Mini-Mental State Examination score (<24 vs ≥24). The dates of the analysis were June 1, 2014, to November 15, 2014.INTERVENTIONS: The transitional care bridge program intervention was started during hospitalization by a visit from a community care registered nurse (CCRN) and continued after discharge with home visits at 2 days and at 2, 6, 12, and 24 weeks. The CCRNs applied the CGA care and treatment plan.MAIN OUTCOMES AND MEASURES: The main outcome was the Katz Index of ADL at 6 months compared with 2 weeks before admission. Secondary outcomes were mortality, cognitive functioning, time to hospital readmission, and the time to discharge from a nursing home.RESULTS: The study cohort comprised 674 participants. Their mean age was 80 years, 42.1% (n = 284) were male, and 39.2% (n = 264) were cognitively impaired at admission. Intent-to-treat analysis found no differences in the mean Katz Index of ADL at 6 months between the intervention arm (mean, 2.0; 95% CI, 1.8-2.2) and the CGA-only arm (mean, 1.9; 95% CI, 1.7-2.2). For secondary outcomes, there were 85 deaths (25.2%) in the intervention arm and 104 deaths (30.9%) in the CGA-only arm, resulting in a lower risk on the time to death within 6 months after hospital admission (hazard ratio, 0.75; 95% CI, 0.56-0.99; P = .045; number needed to treat to prevent 1 death, 16). No other secondary outcome was significant.CONCLUSIONS AND RELEVANCE: A systematic CGA, followed by the transitional care bridge program, showed no effect on ADL functioning in acutely hospitalized older patients.TRIAL REGISTRATION: Netherlands Trial Registry: NTR2384.
AB - IMPORTANCE: Older adults acutely hospitalized are at risk of disability. Trials on comprehensive geriatric assessment (CGA) and transitional care present inconsistent results.OBJECTIVE: To test whether an intervention of systematic CGA, followed by the transitional care bridge program, improved activities of daily living (ADLs) compared with systematic CGA alone.DESIGN, SETTING, AND PARTICIPANTS: This study was a double-blind, multicenter, randomized clinical trial conducted at 3 hospitals with affiliated home care organizations in the Netherlands between September 1, 2010, and March 1, 2014. In total, 1070 consecutive patients were eligible, 674 (63.0%) of whom enrolled. They were 65 years or older, acutely hospitalized to a medical ward for at least 48 hours with an Identification of Seniors at Risk-Hospitalized Patients score of 2 or higher, and randomized using permuted blocks stratified by study site and Mini-Mental State Examination score (<24 vs ≥24). The dates of the analysis were June 1, 2014, to November 15, 2014.INTERVENTIONS: The transitional care bridge program intervention was started during hospitalization by a visit from a community care registered nurse (CCRN) and continued after discharge with home visits at 2 days and at 2, 6, 12, and 24 weeks. The CCRNs applied the CGA care and treatment plan.MAIN OUTCOMES AND MEASURES: The main outcome was the Katz Index of ADL at 6 months compared with 2 weeks before admission. Secondary outcomes were mortality, cognitive functioning, time to hospital readmission, and the time to discharge from a nursing home.RESULTS: The study cohort comprised 674 participants. Their mean age was 80 years, 42.1% (n = 284) were male, and 39.2% (n = 264) were cognitively impaired at admission. Intent-to-treat analysis found no differences in the mean Katz Index of ADL at 6 months between the intervention arm (mean, 2.0; 95% CI, 1.8-2.2) and the CGA-only arm (mean, 1.9; 95% CI, 1.7-2.2). For secondary outcomes, there were 85 deaths (25.2%) in the intervention arm and 104 deaths (30.9%) in the CGA-only arm, resulting in a lower risk on the time to death within 6 months after hospital admission (hazard ratio, 0.75; 95% CI, 0.56-0.99; P = .045; number needed to treat to prevent 1 death, 16). No other secondary outcome was significant.CONCLUSIONS AND RELEVANCE: A systematic CGA, followed by the transitional care bridge program, showed no effect on ADL functioning in acutely hospitalized older patients.TRIAL REGISTRATION: Netherlands Trial Registry: NTR2384.
KW - Activities of Daily Living
KW - Aged
KW - Aged, 80 and over
KW - Cognition
KW - Double-Blind Method
KW - Female
KW - Geriatric Assessment
KW - Home Care Services
KW - Homes for the Aged
KW - Humans
KW - Male
KW - Mortality
KW - Netherlands
KW - Nursing Homes
KW - Patient Care Planning
KW - Patient Discharge
KW - Patient Readmission
KW - Patient Selection
KW - Program Evaluation
KW - Proportional Hazards Models
KW - Risk Assessment
KW - Risk Factors
KW - Time Factors
KW - Transitional Care
KW - Comparative Study
KW - Journal Article
KW - Multicenter Study
KW - Randomized Controlled Trial
KW - Research Support, Non-U.S. Gov't
U2 - 10.1001/jamainternmed.2015.8042
DO - 10.1001/jamainternmed.2015.8042
M3 - Article
C2 - 26882111
VL - 176
SP - 302
EP - 309
JO - JAMA internal medicine
JF - JAMA internal medicine
SN - 2168-6106
IS - 3
ER -