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Mobile Acute Care for Elders (MACE) Consultation Lowers Readmission and Mortality Rates


BACKGROUND:
When hospitalized, older Veterans can have underlying geriatric syndromes including depression, memory issues, difficulty walking, polypharmacy, and poor social support that are challenging to recognize during the complexity of acute illness. These syndromes can lead to complications such as delirium, falls, and functional decline, which in turn may lead to increased morbidity, mortality, readmission, longer hospital stays, decreased quality of life, and increased costs. Mobile Acute Care for Elders (MACE) has emerged as a way to provide dedicated geriatric care designed to prevent these complications, without the need for a physical inpatient unit. Between October 2012 and September 2014, records of Veterans admitted to the Indianapolis VA Medical Center who were age 65 and older were screened within 48 hours of admission for geriatric syndromes. For positive screens, admitting staff was offered MACE consultation and ongoing collaboration with a geriatrician and gerontological nurse practitioner. When the consult was accepted, admitting and MACE staff designed a geriatric plan of care to treat acute illness and mitigate functional decline. Of the 793 records that screened positive, 421 Veterans were seen by MACE, while 372 were not seen (comprising the comparison group), due to admitting team declination of consultation, or lack of MACE availability.

FINDINGS:

  • Although no results were statistically significant, Veterans receiving MACE had lower odds of 30-day readmission than those not receiving MACE (12% vs.15%).
  • Veterans receiving MACE had lower odds of 30-day mortality than those not receiving MACE (6% vs.9%).
  • The group of Veterans receiving MACE had lower median costs for 30-day readmission than the group not receiving MACE ($16,000 vs. $18,000).

IMPLICATIONS:

  • The MACE consultation model for older Veterans with geriatric syndromes leverages the limited supply of clinicians with geriatrics expertise. It has the potential to improve care of older Veterans while achieving cost savings to the health system.

LIMITATIONS:

  • The MACE and comparison groups may have had unmeasured differences that could have affected results.
  • Sample sizes were smaller than needed to detect statistically significant outcomes.
  • Subjects were predominantly male, and the study was performed at an academic medical center in an urban setting, possibly limiting generalizability to all VA medical centers or all older Veterans.

AUTHOR/FUNDING INFORMATION:
This study was supported in part by HSR&D. Ms. Coffing and Dr. Weiner are part of HSR&D's Center for Health Information and Communication, Indianapolis, IN.


PubMed Logo Schubert CC, Parks R, Coffing J, Daggy J, Slaven J, Weiner M. Lessons and Outcomes of Mobile Acute Care for Elders Consultation in a Veterans Affairs Medical Center Journal of the American Geriatrics Society. December 21, 2018;epub ahead of print.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.