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BMC Medicine
Published in: BMC Medicine 1/2013

Open Access 01-12-2013 | Research article

Impact of geriatric consultation teams on clinical outcome in acute hospitals: a systematic review and meta-analysis

Authors: Mieke Deschodt, Johan Flamaing, Patrick Haentjens, Steven Boonen, Koen Milisen

Published in: BMC Medicine | Issue 1/2013

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Abstract

Background

Comprehensive geriatric assessment for older patients admitted to dedicated wards has proven to be beneficial, but the impact of comprehensive geriatric assessment delivered by mobile inpatient geriatric consultation teams remains unclear. This review and meta-analysis aims to determine the impact of inpatient geriatric consultation teams on clinical outcomes of interest in older adults.

Methods

An electronic search of Medline, CINAHL, EMBASE, Web of Science and Invert for English, French and Dutch articles was performed from inception to June 2012. Three independent reviewers selected prospective cohort studies assessing functional status, readmission rate, mortality or length of stay in adults aged 60 years or older. Twelve studies evaluating 4,546 participants in six countries were identified. Methodological quality of the included studies was assessed with the Methodological Index for Non-Randomized Studies.

Results

The individual studies show that an inpatient geriatric consultation team intervention has favorable effects on functional status, readmission and mortality rate. None of the studies found an effect on the length of the hospital stay. The meta-analysis found a beneficial effect of the intervention with regard to mortality rate at 6 months (relative risk 0.66; 95% confidence interval 0.52 to 0.85) and 8 months (relative risk 0.51; confidence interval 0.31 to 0.85) after hospital discharge.

Conclusions

Inpatient geriatric consultation team interventions have a significant impact on mortality rate at 6 and 8 months postdischarge, but have no significant impact on functional status, readmission or length of stay. The reason for the lack of effect on these latter outcomes may be due to insufficient statistical power or the insensitivity of the measuring method for, for example, functional status. The questions of to whom IGCT intervention should be targeted and what can be achieved remain unanswered and require further research.
Trial registration: CRD42011001420 (http://​www.​crd.​york.​ac.​uk/​PROSPERO)
Appendix
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Literature
1.
Ellis G, Whitehead MA, O'Neill D, Langhorne P, Robinson D: Comprehensive geriatric assessment for older adults admitted to hospital. Cochrane Database Syst Rev. 2011, 7: CD006211.PubMed
2.
Rubenstein LZ, Stuck AE, Siu AL, Wieland D: Impacts of geriatric evaluation and management programs on defined outcomes: overview of the evidence. J Am Geriatr Soc. 1991, 39: 8S-18S.CrossRefPubMed
3.
Palmer RM, Landefeld CS, Kresevic D, Kowal J: A medical unit for the acute care of the elderly. J Am Geriatr Soc. 1994, 42: 545-52.CrossRefPubMed
4.
Bakker FC, Robben SH, Olde Rikkert MG: Effects of hospital-wide interventions to improve care for frail older inpatients: a systematic review. BMJ Qual Saf. 2011, 20: 680-691. 10.1136/bmjqs.2010.047183.CrossRefPubMed
5.
Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM: Inpatient rehabilitation specifically designed for geriatric patients: systematic review and meta-analysis of randomised controlled trials. BMJ. 2010, 340: c1718-10.1136/bmj.c1718.CrossRefPubMedPubMedCentral
6.
Baztan JJ, Suarez-Garcia FM, Lopez-Arrieta J, Rodriguez-Manas L, Rodriguez-Artalejo F: Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis. BMJ. 2009, 338.
7.
Ellis G, Langhorne P: Comprehensive geriatric assessment for older hospital patients. Br Med Bull. 2004, 71: 45-59. 10.1093/bmb/ldh033.CrossRefPubMed
8.
Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ: Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993, 342: 1032-1036. 10.1016/0140-6736(93)92884-V.CrossRefPubMed
9.
Van Craen K, Braes T, Wellens N, Denhaerynck K, Flamaing J, Moons P, Boonen S, Gosset C, Petermans J, Milisen K: The effectiveness of inpatient geriatric evaluation and management units: a systematic review and meta-analysis. J Am Geriatr Soc. 2010, 58: 83-92. 10.1111/j.1532-5415.2009.02621.x.CrossRefPubMed
10.
Campion EW, Jette A, Berkman B: An interdisciplinary geriatric consultation service: a controlled trial. J Am Geriatr Soc. 1983, 31: 792-96.CrossRefPubMed
11.
Winograd CH, Stearns C: Inpatient geriatric consultation. Challenges and benefits. J Am Geriatr Soc. 1990, 38: 926-932.CrossRefPubMed
12.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008, 337: a1655-10.1136/bmj.a1655.CrossRefPubMedPubMedCentral
13.
English M, Schellenberg J, Todd J: Assessing health system interventions: key points when considering the value of randomization. Bull World Health Organ. 2011, 89: 907-912. 10.2471/BLT.11.089524.CrossRefPubMedPubMedCentral
14.
Shrier I, Boivin JF, Steele RJ, Platt RW, Furlan A, Kakuma R, Brophy J, Rossignol M: Should meta-analyses of interventions include observational studies in addition to randomized controlled trials? A critical examination of underlying principles. Am J Epidemiol. 2007, 166: 1203-1209. 10.1093/aje/kwm189.CrossRefPubMed
15.
Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J: Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg. 2003, 73: 712-716. 10.1046/j.1445-2197.2003.02748.x.CrossRefPubMed
16.
DerSimonian R, Laird N: Meta-analysis in clinical trials. Control Clin Trials. 1986, 7: 177-188. 10.1016/0197-2456(86)90046-2.CrossRefPubMed
17.
Duval S, Tweedie R: Trim and fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000, 56: 455-463. 10.1111/j.0006-341X.2000.00455.x.CrossRefPubMed
18.
Moher D, Liberati A, Tetzlaff J, Altman DG: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009, 151: 264-269.CrossRefPubMed
19.
Deschodt M, Braes T, Broos P, Sermon A, Boonen S, Flamaing J, Milisen K: Effect of an inpatient geriatric consultation team on functional outcome, mortality, institutionalization, and readmission rate in older adults with hip fracture: a controlled trial. J Am Geriatr Soc. 2011, 59: 1299-1308. 10.1111/j.1532-5415.2011.03488.x.CrossRefPubMed
20.
Gayton D, Wood-Dauphinee S, de Lorimer M, Tousignant P, Hanley J: Trial of a geriatric consultation team in an acute care hospital. J Am Geriatr Soc. 1987, 35: 726-736.CrossRefPubMed
21.
Hogan DB, Fox RA, Badley BW, Mann OE: Effect of a geriatric consultation service on management of patients in an acute care hospital. CMAJ. 1987, 136: 713-717.PubMedPubMedCentral
22.
Hogan DB, Fox RA: A prospective controlled trial of a geriatric consultation team in an acute-care hospital. Age Ageing. 1990, 19: 107-113. 10.1093/ageing/19.2.107.CrossRefPubMed
23.
Kircher TT, Wormstall H, Muller PH, Schwarzler F, Buchkremer G, Wild K, Hahn JM, Meisner C: A randomised trial of a geriatric evaluation and management consultation services in frail hospitalised patients. Age Ageing. 2007, 36: 36-42.CrossRefPubMed
24.
McVey LJ, Becker PM, Saltz CC, Feussner JR, Cohen HJ: Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial. Ann Intern Med. 1989, 110: 79-84.CrossRefPubMed
25.
Naughton BJ, Moran MB, Feinglass J, Falconer J, Williams ME: Reducing hospital costs for the geriatric-patient admitted from the emergency department - a randomized trial. J Am Geriatr Soc. 1994, 42: 1045-1049.CrossRefPubMed
26.
Reuben DB, Borok GM, Wolde-Tsadik G, Ershoff DH, Fishman LK, Ambrosini VL, Liu Y, Rubenstein LZ, Beck JC: A randomized trial of comprehensive geriatric assessment in the care of hospitalized patients. N Engl J Med. 1995, 332: 1345-1350. 10.1056/NEJM199505183322007.CrossRefPubMed
27.
Saltz CC, McVey LJ, Becker PM, Feussner JR, Cohen HJ: Impact of a geriatric consultation team on discharge placement and repeat hospitalization. Gerontologist. 1988, 28: 344-350. 10.1093/geront/28.3.344.CrossRefPubMed
28.
Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, Yang CT: A pilot investigation of the short-term effects of an interdisciplinary intervention program on elderly patients with hip fracture in Taiwan. J Am Geriatr Soc. 2005, 53: 811-818. 10.1111/j.1532-5415.2005.53253.x.CrossRefPubMed
29.
Shyu YI, Liang J, Wu CC, Su JY, Cheng HS, Chou SW, Chen MC, Yang CT: Interdisciplinary intervention for hip fracture in older Taiwanese: benefits last for 1 year. J Gerontol A Biol Sci Med Sci. 2008, 63: 92-97. 10.1093/gerona/63.1.92.CrossRefPubMed
30.
Thomas DR, Brahan R, Haywood BP: Inpatient community-based geriatric assessment reduces subsequent mortality. J Am Geriatr Soc. 1993, 41: 101-104.CrossRefPubMed
31.
Vidán M, Serra JA, Moreno C, Riquelme G, Ortiz J: Efficacy of a comprehensive geriatric intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am Geriatr Soc. 2005, 53: 1476-82. 10.1111/j.1532-5415.2005.53466.x.CrossRefPubMed
32.
Winograd CH, Gerety MB, Lai NA: A negative trial of inpatient geriatric consultation. Lessons learned and recommendations for future research. Arch Intern Med. 1993, 153: 2017-2023. 10.1001/archinte.1993.00410170101010.CrossRefPubMed
33.
Kansagara D, Englander H, Salanitro A, Kagen D, Theobald C, Freeman M, Kripalani S: Risk prediction models for hospital readmission: a systematic review. JAMA. 2011, 306: 1688-1698. 10.1001/jama.2011.1515.CrossRefPubMedPubMedCentral
34.
van Walraven C, Bennett C, Jennings A, Austin PC, Forster AJ: Proportion of hospital readmissions deemed avoidable: a systematic review. CMAJ. 2011, 183: E391-E402.CrossRefPubMedPubMedCentral
35.
Halfon P, Eggli Y, Pretre-Rohrbach I, Meylan D, Marazzi A, Burnand B: Validation of the potentially avoidable hospital readmission rate as a routine indicator of the quality of hospital care. Med Care. 2006, 44: 972-81. 10.1097/01.mlr.0000228002.43688.c2.CrossRefPubMed
36.
Allen CM, Becker PM, McVey LJ, Saltz C, Feussner JR, Cohen HJ: A randomized, controlled clinical trial of a geriatric consultation team. Compliance with recommendations. JAMA. 1986, 255: 2617-2621. 10.1001/jama.1986.03370190101032.CrossRefPubMed
37.
38.
Meldon SW, Mion LC, Palmer RM: A triage risk screening tool to predict health care outcomes in older emergency department (ED) patients. J Am Geriatr Soc. 2002, 50: S146-10.1046/j.1532-5415.2002.50020.x.CrossRef
39.
McCusker J, Bellavance F, Cardin S, Trepanier S, Verdon J, Ardman O: Detection of older people at increased risk of adverse health outcomes after an emergency visit: The ISAR screening tool. J Am Geriatr Soc. 1999, 47: 1229-1237.CrossRefPubMed
40.
Deschodt M, Wellens N, Braes T, De Vuyst A, Boonen S, Flamaing J, Moons F, Milisen K: Prediction of functional decline in older hospitalized patients: a comparative multicenter study of three screening tools. Aging Clin Expl Res. 2011, 23: 421-426.CrossRef
41.
Braes T, Flamaing J, Sterckx W, Lipkens P, Sabbe M, de Rooij SE, Schuurmans MJ, Moons F, Milisen K: Predicting the risk of functional decline in older patients admitted to the hospital: a comparison of three screening instruments. Age Ageing. 2009, 38: 600-603. 10.1093/ageing/afp097.CrossRefPubMed
42.
Deschodt M, Braes T, Flamaing J, Detroyer E, Broos P, Haentjens P, Boonen S, Milisen K: Preventing delirium in older adults with recent hip fracture through multidisciplinary geriatric consultation. J Am Geriatr Soc. 2012, 60: 733-739. 10.1111/j.1532-5415.2012.03899.x.CrossRefPubMed
Metadata
Title
Impact of geriatric consultation teams on clinical outcome in acute hospitals: a systematic review and meta-analysis
Authors
Mieke Deschodt
Johan Flamaing
Patrick Haentjens
Steven Boonen
Koen Milisen
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2013
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/1741-7015-11-48

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