Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care.

DESIGN: Assessor-blinded, single-center randomized controlled trial.

SETTING: AGU in an acute hospital in southeastern Sweden.

PARTICIPANTS: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years.

INTERVENTION: Participants in the IG received CGA-based care at the AGU in addition to usual care.

OUTCOME MEASURES: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant' sense of security in care, and health-related quality of life (HRQoL).

RESULTS: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371 £ (39,947 £) and 30,490 £ (31,568 £; P = .432).

CONCLUSIONS AND RELEVANCE: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people.

TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01446757.

Details

Authors
  • Anne W Ekdahl
  • Ann-Britt Wirehn
  • Jenny Alwin
  • Tiny Jaarsma
  • Mitra Unosson
  • Magnus Husberg
  • Jeanette Eckerblad
  • Anna Milberg
  • Barbro Krevers
  • Per Carlsson
External organisations
  • Karolinska Institutet
  • Linköping University
Research areas and keywords

Keywords

  • Aged, Aged, 80 and over, Ambulatory Care, Cause of Death, Cost-Benefit Analysis, Female, Geriatric Assessment, Health Services Research, Hospitalization, Humans, Interviews as Topic, Male, Patient Care Team, Quality of Life, Single-Blind Method, Sweden, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
Original languageEnglish
Pages (from-to)497-503
Number of pages7
JournalJournal of the American Medical Directors Association
Volume16
Issue number6
Publication statusPublished - 2015 Jun 1
Publication categoryResearch
Peer-reviewedYes
Externally publishedYes