Designing a Value-Based Care Delivery Model for Complex Older Adults Based on Geriatric and Palliative Care Principles (FR461B)

Abstract

•Identify patient characteristics in the older adult population, which have a high likelihood of association with poor patient outcomes and high health care utilization.•Identify triggers for predicting a decline in the aging and serious illness trajectories so geriatric and palliative care principles can be integrated upstream in the care continuum. Complex older adult population is a segment we often refer to as ‘high utilizers’ and most ‘at-risk’ of sub-optimal care. This segment may benefit most from upstream integration of geriatric and palliative care principles in the care plan. Our biggest challenge may be early identification of this cohort, at the onset of decline in health status. Identify patient characteristics and triggers in the older adult population, which have a high likelihood of association with poor patient outcomes and high health care utilization. As part of assessing senior care needs at Stanford Hospital, we piloted a new consult service “ACE – Acute Care for Elders”. We created a simple inpatient consult trigger – “Age 75 years and older with evidence of recent decline in health state”. A comprehensive assessment was done which included elements of a palliative care consult and a comprehensive geriatric assessment. From January 1st to June 30th, 2016, eighty-four patients were seen. The mean age was 85 years with evidence of serious illness in 68%, functional impairment (dependence in two or more ADLs) in 87%, and cognitive impairment in 73% at baseline. During hospital stay, 56% had evidence of delirium, 46% had physical symptom burden, 35% had psycho-social distress. 60% had two or more hospital or ED visits in the prior six months and 40% had been readmitted within 30 days. 7% passed away during hospital stay and 10% were discharged with hospice. We may be able to identify this cohort early by using markers of frailty (dependence of ADLs, cognitive impairment) and utilization (ED visits).