Post-acute care program for frail geriatric patients associated with better post-discharge outcomes

1. Frail, elderly patients participating in a post-acute care (PAC) program for more than 2 weeks following hospitalization have decreased ER visits, readmissions, and mortality rates at 90 days, compared to those not participating in a PAC program.

Evidence Rating Level: 2 (Good)

Following a period of hospitalization, elderly adults with frailty are more vulnerable than those without frailty, with 20-35% of frail individuals over 70 becoming disabled within 1 month post-hospitalization. To address this, a model of care has been developed known as post-acute care (PAC), which can be hospital or home-based, to facilitate recovery after an acute illness. PAC for frail, elderly adults is a unique model in Taiwan, and so this multi-centre non-randomized trial aimed to compare the outcomes of patients who did and didn’t go through a PAC program. The study enrolled patients from 5 hospitals in Taiwan, with mild to severe frailty on the Clinical Frailty Scale (CFS). Patients were given the choice to participate in a PAC program or not, and patients who chose PAC were divided into home-based (HPAC) or inpatient-based (IPAC) programs, based on a number of factors. Patients were also matched by age, gender, and disability severity across groups. The PAC program involved a comprehensive geriatric assessment (CGA) and a multidisciplinary team providing physical, nutritional, psychosocial, and medical rehabilitation. The outcomes measured include ER visits at 90 days, readmissions, and mortality. In total, 254 patients were enrolled, 205 in the PAC group and 49 in the control, with the average duration of PAC being 14.4±5.6 days. The results showed that patients in the PAC group had lower ER visits at 90 days (p = 0.031), lower mortality rates at 90 days (5.9% vs 16.3%, p = 0.014). As well, duration of PAC for more than 2 weeks was an independent protective factor for 90-day ER visits (odds ratio 0.21, 95% CI 0.10-0.43, p = 0.024), readmissions (OR 0.30, 95% CI 0.16-0.56, p < 0.001), and mortality (OR 0.20, 95% CI 0.04-0.87, p = 0.032). Overall, this study showed that for frail, elderly patients, participation in a PAC program for more than 2 weeks following hospitalization is associated with decreased ER visits, readmissions, and mortality at 90 days. 

Click to read the study in PLOSONE

Image: PD

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