PHP12: ACUTE CARE ELDERLY UNITS: THEIR PREVALENCE, CHARACTERISTICS AND DETERMINANTS

Abstract

BACKGROUND: The acutely ill hospitalized elderly patients face the risk of functional decline and poor quality care. To improve the outcomes of hospitalization, various intervention models have been used. However, the contributors to the functional loss and quality of care are interrelated and warrant a multidimensional intervention. The Acute Care for Elders (ACE) unit is a one such promising model of care for elderly to minimize adverse outcomes of hospitalization. OBJECTIVE: To analyze the determinants, prevalence and characteristics of ACE units. METHODS: We surveyed all established Geriatric Medicine Divisions (n = 100) across US to determine presence of ACE unit. Data on demographics, resource, structure, administration, and patient care was obtained via a questionnaire. Hospital data regarding number of beds, revenue, number of medicare inpatients, and average length of stay was obtained from Annual Survey data of the American Hospital Association. Descriptive analysis and step-wise logistic regression were used to analyze the characteristics and determinants of ACE units. RESULTS: Of the 82 responding geriatric divisions, 15 had an active ACE unit. Average daily census on ACE units ranged from 5 to 25, average length of stay was 5.2 days and the average nurse to patient ratio was 1:6. Community dwelling was the most common pre-admission living setting. Two most common admitting diagnoses were congestive heart failure and pneumonia. T-test showed significant difference (<.05) between hospitals with ACE unit and hospitals without, with respect to number of beds and total revenue. The step-wise logistic regression indicated that total hospital revenue was the only significant factor in determining the presence of an ACE unit. CONCLUSIONS: Thus, application of the ACE unit model remains modest given the paucity of information regarding its long and short-term benefits and cost-effectiveness. Further research in this direction can facilitate informed policy decisions.