Primary studies included in this systematic review

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Primary study

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Delivering effective primary care to older adults: A randomized, controlled trial of the senior resource team at group health cooperative.

Journal Journal of the American Geriatrics Society
Year 2007
Links Pubmed DOI

This article is included in 7 Systematic reviews Systematic reviews (7 references)

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OBJECTIVES: To assess the effect of a team of geriatrics specialists on the practice style of primary care providers (PCPs) and the functioning of their patients aged 75 and older. DESIGN: Randomized, controlled trial. SETTING: Two primary care clinics in the Seattle, Washington, area. Participants: Thirty-one PCPs and 874 patients aged 75 and older. Intervention: An interdisciplinary team of geriatrics specialists worked with patients and providers to enhance the geriatric focus of care. Measurements: Main outcomes were a practice style reflecting a geriatric orientation and patient scores on the physical and affect subscales of the Arthritis Impact Measurement Scale 2--Short Form. Secondary outcomes were hospitalizations, incident disability in activities of daily living (ADLs), and PCP perceptions of the intervention. Death rates were also assessed. RESULTS: Intervention providers screened significantly more for geriatric syndromes at 12 months, but this finding did not persist at 24 months. There were no significant differences in adequate hypertension control or high-risk prescribing at 12 or 24 months of follow-up. There were no significant differences in patient functioning or significant differences in hospitalization rates at either time point. Meaningful differences were observed in ADL disability at 12 but not 24 months. PCPs viewed the intervention favorably. Seventy-eight participants died over the 24 months of follow-up; the proportion dying was higher in the intervention group (11.4% in intervention group vs 7.1% of controls, P = .03). CONCLUSION: The addition of an interdisciplinary geriatric team was acceptable to PCPs and had some effect on care of geriatric conditions but little effect on patient function or the use of inpatient care and was associated with greater mortality. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Primary study

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Controlled trial of multidisciplinary care teams for acutely ill medical inpatients: enhanced multidisciplinary care.

Authors Mudge A , Laracy S , Richter K , Denaro C
Journal Internal medicine journal
Year 2006
Links Pubmed DOI

This article is included in 7 Systematic reviews Systematic reviews (7 references) 1 Broad synthesis Broad syntheses (1 reference)

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BACKGROUND: Acute hospital general medicine services care for ageing complex patients, using the skills of a range of health-care providers. Evidence suggests that comprehensive early assessment and discharge planning may improve efficiency and outcomes of care in older medical patients. AIM: To enhance assessment, communication, care and discharge planning by restructuring consistent, patient-centred multidisciplinary teams in a general medicine service. METHODS: Prospective controlled trial enrolling 1538 consecutive medical inpatients. Intervention units with additional allied health staff formed consistent multidisciplinary teams aligned with inpatient admitting units rather than wards; implemented improved communication processes for early information collection and sharing between disciplines; and specified shared explicit discharge goals. Control units continued traditional, referral-based multidisciplinary models with existing staffing levels. RESULTS: Access to allied health services was significantly enhanced. There was a trend to reduced index length of stay in the intervention units (7.3 days vs 7.8 days in control units, P = 0.18), with no change in 6-month readmissions. In-hospital mortality was reduced from 6.4 to 3.9% (P = 0.03); less patients experienced functional decline in hospital (P = 0.04) and patients' ratings of health status improved (P = 0.02). Additional staffing costs were balanced by potential bed-day savings. CONCLUSION: This model of enhanced multidisciplinary inpatient care has provided sustainable efficiency gains for the hospital and improved patient outcomes.

Primary study

Unclassified

Effect of a nurse team coordinator on outcomes for hospitalized medicine patients.

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Journal The American journal of medicine
Year 2005
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This article is included in 7 Systematic reviews Systematic reviews (7 references)

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PURPOSE: Several randomized trials have found that discharge planning improves outcomes for hospitalized patients. We do not know if adding a clinical nurse specialist (CNS) to physician teams in hospitals that already have discharge planning services makes a difference. METHODS: In 2 teaching hospitals, patients were randomly assigned to regular hospital care or care with a clinical nurse specialist. The clinical nurse specialist facilitated hospital care by retrieving preadmission information, arranging in-hospital consultations and investigations, organizing postdischarge follow-up visits, and checking up on patients postdischarge with a telephone call. In-hospital outcomes included mortality and length of stay. Postdischarge outcomes included time to readmission or death, patient satisfaction, and the risk of adverse event. Adverse events were poor outcomes due to medical care rather than the natural history of disease. RESULTS: A total of 620 sequential patients were randomized (CNS n = 307, control n = 313), of which 361 were followed after discharge from hospital (CNS n = 175, control n = 186). The groups were similar for the probability of in-hospital death (CNS 9.3% vs control 9.7%) or being discharged to the community (58.0% vs 60.0%). The groups did not differ for postdischarge outcomes including readmission or death (21.6% vs 15.6%; P = 0.16) or risk of adverse event (23.6% vs 22.8%). Mean [SD] patient ratings of overall quality of care on a scale of 10 was higher in the clinical nurse specialist group (8.2 [2.2] vs 7.6 [2.4]; P = 0.052). CONCLUSION: The addition of a clinical nurse specialist to a medical team improved patient satisfaction but did not impact hospital efficiency or patient safety.

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Dey P

This thread includes 2 references

Primary study

Unclassified

Prospective, randomized, controlled, single-blind trial of the costs and consequences of systematic nutrition team follow-up over 12 mo after percutaneous endoscopic gastrostomy.

Journal Nutrition (Burbank, Los Angeles County, Calif.)
Year 2005
Links Pubmed DOI

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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OBJECTIVES: We assessed the economic and clinical implications of systematic long-term nutrition team follow-up of patients after percutaneous endoscopic gastrostomy. METHODS: We designed a prospective, randomized, controlled, single-blind trial in a large district hospital and its catchment area. All adult patients referred for a gastrostomy were eligible and randomized into two groups. The intervention group had regular follow-up by the nutrition team (weekly in hospital, monthly after discharge) with appropriate support and advice for patient, carer, and primary care professionals. The control group had no specific nutrition team input (as is often current practice). Endpoints to the study were 12 mo, elective removal of tube, or death. The primary outcome was total health care costs. Secondary outcomes were complications, length of stay, readmissions, nutritional status, and quality of life. RESULTS: One hundred twelve patients were recruited. Eleven died before the start of the trial, leaving 47 in the intervention group and 54 in the control group. They were well matched for age, sex, and underlying diagnosis. Overall, the health care costs were 13,330 sterlings per patient in the intervention group compared with 16,858 pound sterlings in the control group (two-tailed, P = 0.27), a saving of 21% per patient. The intervention group had shorter lengths of stay, fewer and briefer readmissions, earlier removal of gastrostomy (where appropriate), shorter duration of feeding, and less demand for general practitioners and district nurse inputs. Nutritional status and quality of life were similar. CONCLUSIONS: Regular systematic nutrition team follow-up for gastrostomy-fed patients does not increase costs and may improve quality of care.

Primary study

Unclassified

Patients with severe stroke benefit most by interdisciplinary rehabilitation team approach.

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Journal Cerebrovascular diseases (Basel, Switzerland)
Year 2005
Links Pubmed Health Technology Assessment (HTA) DOI crd.york.ac.uk

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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BACKGROUND: We evaluated the efficacy of a regular interdisciplinary stroke team approach on rehabilitation outcome. METHODS: We compared a stroke rehabilitation unit (SRU) with regular interdisciplinary stroke team conferences with general rehabilitation ward (GRW) without such conferences in the same rehabilitation hospital. One hundred and seventy-eight patients within 3 months after stroke were allocated to SRU or GRW, based on bed availability. Main outcome measures were the Functional Independence Measure, Stroke Impairment Assessment Set, length of hospital stay, discharge disposition and cost of hospitalization. RESULTS: The interval between stroke onset and admission to our hospital was significantly longer in the SRU (n = 91) group compared with the GRW group (n = 87, p < 0.05). Although comparable numbers of patients were discharged home (74.7% in the SRU vs. 71.3% in the GRW), significantly more patients (p < 0.0001) with severe disability were discharged home in the SRU group (47.4%) compared with the GRW group (0%). There were no significant differences in the increase in Functional Independence Measure score, Stroke Impairment Assessment Set score,length of hospital stay, or cost. CONCLUSION: Patients with severe stroke appeared to benefit most from regular interdisciplinary stroke team conferences in the SRU and had an improved discharge disposition.

Primary study

Unclassified

Effects on processes and costs of care associated with the addition of an internist to an inpatient psychiatry team.

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Journal Psychiatric services (Washington, D.C.)
Year 2005
Links Pubmed Health Technology Assessment (HTA) DOI crd.york.ac.uk

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVE: This study examined the effects of collaboration between an internist and psychiatrists on the processes and cost of care among psychiatric inpatients. METHODS: A randomized controlled study was performed on the psychiatric inpatient units of an academic medical center. All inpatients who were admitted to the units between March 2001 and January 2002 were asked to participate in the study. Patients in the intervention group met with an internist who participated in their care by communicating with the patients' primary care physicians, assessing needs, updating appropriate health maintenance services, managing chronic and acute medical problems, and attending hospital work rounds. Patients in the usual-care group received usual care. The processes of care were measured by examining 17 categories that involved assessment of needs, coordination of care, and completion of health maintenance services. Resource use was measured by examining hospital charges and length of stay. RESULTS: A total of 139 adults participated in the study: 55 were in the intervention group and 84 were in the usual-care group. Patients in the intervention group showed significant improvement in 12 of the 17 categories of the processes of care. Overall, no differences were found in hospital charges or length of stay. CONCLUSIONS: Adding an internist to an inpatient psychiatric team is an effective way of improving care for this traditionally underserved population without increasing cost.

Primary study

Unclassified

Evaluation of a multiprofessional community stroke team: A randomized controlled trial.

Journal Clinical rehabilitation
Year 2004
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This article is included in 4 Systematic reviews Systematic reviews (4 references)

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The aim of this study was to evaluate a specialist multiprofessional team in a community setting. Stroke patients and their informal carers who were referred to receive rehabilitation from a community stroke team. There were no significant differences between patients who received rehabilitation from community stroke team (n = 189) and those who received routine care (n = 232) in their independence in activities of daily living, mood, quality of life or knowledge of stroke. The patients in the community stroke team group were significantly more satisfied with the emotional support they had received. Carers of patients in the community stroke team were under significantly less strain than carers in the routine care group. Carers of patients in the community stroke team group were significantly more satisfied with their knowledge of stroke and were more satisfied overall. The patients treated by the community stroke team were more satisfied with the emotional support they received and had equivalent outcomes in terms of independence in activities of daily living and mood. Their carers were under less strain and were more satisfied with their knowledge of stroke recovery, the emotional support they received and overall satisfaction with services. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Primary study

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Medical and surgical comanagement after elective hip and knee arthroplasty: a randomized, controlled trial.

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Journal Annals of internal medicine
Year 2004
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This article is included in 4 Systematic reviews Systematic reviews (4 references)

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BACKGROUND: Hospitalists are assuming an increasing role in the care of surgical patients, but the impact of this model of care on postoperative outcomes is unknown. OBJECTIVE: To determine the impact of providing a collaborative, hospitalist-led model of care on postoperative outcomes and costs among patients having hip or knee arthroplasty. DESIGN: Randomized, controlled trial. SETTING: Academic medical center. PARTICIPANTS: 526 patients having elective orthopedic surgery who are at elevated risk for postoperative morbidity. MEASUREMENTS: Length of stay, inpatient postoperative medical complications, health care provider satisfaction, and inpatient costs. INTERVENTIONS: A comanagement medical Hospitalist-Orthopedic Team compared with standard postoperative care by orthopedic surgeons with medical consultation. RESULTS: More patients in the hospitalist group were discharged from the hospital with no complications (61.6% vs. 49.8%; difference, 11.8 percentage points [95% CI, 2.8 to 20.7 percentage points]). Fewer minor complications were observed among hospitalist patients (30.2% vs. 44.3%; difference, -14.1 percentage points [CI, -22.7 to -5.3 percentage points]). Observed length of stay was not statistically different between treatment groups. However, when adjusted for discharge delays, mean length of stay for patients in the hospitalist model of care was shorter (5.1 days vs. 5.6 days; difference, -0.5 day [CI, -0.8 to -0.1 day]). Total costs did not differ between groups. Orthopedic surgeons and nurses preferred the hospitalist model. LIMITATIONS: Care providers and patients were aware of intervention assignments, and the study could not capture all costs associated with the hospitalist model. CONCLUSIONS: The comanagement medical Hospitalist-Orthopedic Team model reduced minor postoperative complication rates with no statistically significant difference in length of stay or cost. The nurses and surgeons strongly preferred the comanagement hospitalist model. Additional research on the clinical and economic impact of the hospitalist model in other surgical populations is warranted.

Publication Thread

Rabow MW

This thread includes 2 references