Outcomes of Care by Geriatricians and Non-geriatricians in an Academic Hospital

Frontiers in Medicine

article

Reshma Aziz Merchant¹  Vanda Wen Teng Ho¹  Matthew Zhixuan Chen¹  Beatrix Ling Ling Wong¹  Zhiying Lim¹  Yiong Huak Chan³  Natalie Ling¹  Shu Ee Ng¹  Amelia Santosa⁴  Diarmuid Murphy⁵  Anantharaman Vathsala³ 

[1] Division of Geriatric Medicine, Department of Medicine, National University Hospital;Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore;Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore;Division of Rheumatology, Department of Medicine, National University Hospital;Value Driven Outcomes Office, National University Health System;Division of Nephrology, Department of Medicine, National University Hospital

关键词: geriatric medicine;    cost;    length of stay;    readmission;    mortality;   

DOI  :  10.3389/fmed.2022.908100

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Introduction While hospitalist and internist inpatient care models dominate the landscape in many countries, geriatricians and internists are at the frontlines managing hospitalized older adults in countries such as Singapore and the United Kingdom. The primary aim of this study was to determine outcomes for older patients cared for by geriatricians compared with non-geriatrician-led care teams. Materials and Methods A retrospective cohort study of 1,486 Internal Medicine patients aged ≥75 years admitted between April and September 2021 was conducted. They were either under geriatrician or non-geriatrician (internists or specialty physicians) care. Data on demographics, primary diagnosis, comorbidities, mortality, readmission rate, Hospital Frailty Risk Score (HFRS), Age-adjusted Charlson Comorbidity Index, Length of Stay (LOS), and cost of hospital stay were obtained from the hospital database and analyzed. Results The mean age of patients was 84.0 ± 6.3 years, 860 (57.9%) females, 1,183 (79.6%) of Chinese ethnicity, and 902 (60.7%) under the care of geriatricians. Patients under geriatrician were significantly older and had a higher prevalence of frailty, dementia, and stroke, whereas patients under non-geriatrician had a higher prevalence of diabetes and hypertension. Delirium as the primary diagnosis was significantly higher among patients under geriatrician care. Geriatrician-led care model was associated with shorter LOS, lower cost, similar inpatient mortality, and 30-day readmission rates. LOS and cost were lower for patients under geriatrician care regardless of frailty status but significant only for low and intermediate frailty groups. Geriatrician-led care was associated with significantly lower extended hospital stay (OR 0.73; 95% CI 0.56–0.95) and extended cost (OR 0.69; 95% CI 0.54–0.95). Conclusion Geriatrician-led care model showed shorter LOS, lower cost, and was associated with lower odds of extended LOS and cost.

【 授权许可】

CC BY