Abstract
BackgroundEvidence regarding outcomes in the Geriatric Day Hospital (GDH) model of care has been largely inconclusive, possibly due to measurement issues. This prospective cohort study aims to determine whether treatment in a GDH could improve individualized outcome measures using goal attainment scaling (GAS) and whether improvements are maintained 6-months post-discharge.MethodsA total of 469 outpatients admitted to a Canadian Geriatric Day Hospital, between December 2008 and June 2011, were included in the analysis (81.1 ± 6.7 years, 66.3% females); a smaller cohort of 121 patients received a follow-up phone call 6 months following discharge. Baseline, discharge and 6 month post-discharge observer-rated measures of mobility, cognition, and function were completed using GAS. Traditional psychometric measures were also captured.ResultsThe mean number of goals set was 1.6 (SD 0.8) and patients set goals in the following domains: 88% mobility or falls reduction; 18% optimization of home supports; 17% medication optimization;12% cognition; 8% increasing social engagement; and 5% optimization of function. Total GAS was the most responsive measure to change with 86% of patients improving at discharge; mobility goals were the most likely to be achieved. Six-month GAS scores remained significantly higher than GAS scores on admission. Those who had more goals were more likely to improve during GDH admission (OR 1.49, CI 1.02-2.19) but this association was not seen 6 months after discharge.ConclusionsThis study demonstrated short- and long-term effectiveness of GDH in helping patients achieve individualized outcome measures using GAS.
Highlights
Evidence regarding outcomes in the Geriatric Day Hospital (GDH) model of care has been largely inconclusive, possibly due to measurement issues
We investigated whether achievement of the goals of the patients who attend the GDH was a function of the goals themselves, the patient’s frailty, or other factors
Patients were referred by general practitioners (47%), geriatricians (33%), other specialists (10%), emergency department (6%) and community sources (4%)
Summary
Evidence regarding outcomes in the Geriatric Day Hospital (GDH) model of care has been largely inconclusive, possibly due to measurement issues. Geriatric Day Hospitals (GDH) were developed in the United Kingdom in the late 1950s to help bridge the gap between inpatient and community care for older adults [1]. Many traditional, standardized psychometric measures have shown responsiveness in day hospital populations; [5, 9] these measures tend to de-emphasize clinical judgment in favour of maximizing reliability, which may limit validity [8]. Their limitations include: choice of instrument complicating comparisons of effectiveness between programs; responses not being
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