Comprehensive Geriatric Assessment and Transitional Care in Acutely Hospitalized Patients: The Transitional Care Bridge Randomized Clinical Trial
IMPORTANCE: Older adults acutely hospitalized are at risk of disability. Trials on comprehensive geriatric assessment (CGA) and transitional care present inconsistent results. OBJECTIVE: To test whether an intervention of systematic CGA, followed by the transitional care bridge program, improved act...
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| Veröffentlicht in: | JAMA internal medicine 2016-03, Vol.176 (3), p.302-309 |
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| creator | Buurman, Bianca M Parlevliet, Juliette L Allore, Heather G Blok, Willem van Deelen, Bob A. J Moll van Charante, Eric P de Haan, Rob J de Rooij, Sophia E |
| description | IMPORTANCE: Older adults acutely hospitalized are at risk of disability. Trials on comprehensive geriatric assessment (CGA) and transitional care present inconsistent results. OBJECTIVE: To test whether an intervention of systematic CGA, followed by the transitional care bridge program, improved activities of daily living (ADLs) compared with systematic CGA alone. DESIGN, SETTING, AND PARTICIPANTS: This study was a double-blind, multicenter, randomized clinical trial conducted at 3 hospitals with affiliated home care organizations in the Netherlands between September 1, 2010, and March 1, 2014. In total, 1070 consecutive patients were eligible, 674 (63.0%) of whom enrolled. They were 65 years or older, acutely hospitalized to a medical ward for at least 48 hours with an Identification of Seniors at Risk–Hospitalized Patients score of 2 or higher, and randomized using permuted blocks stratified by study site and Mini-Mental State Examination score ( |
| doi_str_mv | 10.1001/jamainternmed.2015.8042 |
| format | Article |
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J ; Moll van Charante, Eric P ; de Haan, Rob J ; de Rooij, Sophia E</creator><creatorcontrib>Buurman, Bianca M ; Parlevliet, Juliette L ; Allore, Heather G ; Blok, Willem ; van Deelen, Bob A. J ; Moll van Charante, Eric P ; de Haan, Rob J ; de Rooij, Sophia E</creatorcontrib><description>IMPORTANCE: Older adults acutely hospitalized are at risk of disability. Trials on comprehensive geriatric assessment (CGA) and transitional care present inconsistent results. OBJECTIVE: To test whether an intervention of systematic CGA, followed by the transitional care bridge program, improved activities of daily living (ADLs) compared with systematic CGA alone. DESIGN, SETTING, AND PARTICIPANTS: This study was a double-blind, multicenter, randomized clinical trial conducted at 3 hospitals with affiliated home care organizations in the Netherlands between September 1, 2010, and March 1, 2014. In total, 1070 consecutive patients were eligible, 674 (63.0%) of whom enrolled. They were 65 years or older, acutely hospitalized to a medical ward for at least 48 hours with an Identification of Seniors at Risk–Hospitalized Patients score of 2 or higher, and randomized using permuted blocks stratified by study site and Mini-Mental State Examination score (<24 vs ≥24). The dates of the analysis were June 1, 2014, to November 15, 2014. INTERVENTIONS: The transitional care bridge program intervention was started during hospitalization by a visit from a community care registered nurse (CCRN) and continued after discharge with home visits at 2 days and at 2, 6, 12, and 24 weeks. The CCRNs applied the CGA care and treatment plan. MAIN OUTCOMES AND MEASURES: The main outcome was the Katz Index of ADL at 6 months compared with 2 weeks before admission. Secondary outcomes were mortality, cognitive functioning, time to hospital readmission, and the time to discharge from a nursing home. RESULTS: The study cohort comprised 674 participants. Their mean age was 80 years, 42.1% (n = 284) were male, and 39.2% (n = 264) were cognitively impaired at admission. Intent-to-treat analysis found no differences in the mean Katz Index of ADL at 6 months between the intervention arm (mean, 2.0; 95% CI, 1.8-2.2) and the CGA-only arm (mean, 1.9; 95% CI, 1.7-2.2). For secondary outcomes, there were 85 deaths (25.2%) in the intervention arm and 104 deaths (30.9%) in the CGA-only arm, resulting in a lower risk on the time to death within 6 months after hospital admission (hazard ratio, 0.75; 95% CI, 0.56-0.99; P = .045; number needed to treat to prevent 1 death, 16). No other secondary outcome was significant. CONCLUSIONS AND RELEVANCE: A systematic CGA, followed by the transitional care bridge program, showed no effect on ADL functioning in acutely hospitalized older patients. TRIAL REGISTRATION: Netherlands Trial Registry: NTR2384</description><identifier>ISSN: 2168-6106</identifier><identifier>EISSN: 2168-6114</identifier><identifier>DOI: 10.1001/jamainternmed.2015.8042</identifier><identifier>PMID: 26882111</identifier><language>eng</language><publisher>United States: American Medical Association</publisher><subject>Activities of Daily Living ; Aged ; Aged, 80 and over ; Cognition ; Double-Blind Method ; Female ; Geriatric Assessment ; Home Care Services ; Homes for the Aged ; Humans ; Male ; Mortality ; Netherlands ; Nursing Homes ; Patient Care Planning ; Patient Discharge ; Patient Readmission - statistics & numerical data ; Patient Selection ; Program Evaluation ; Proportional Hazards Models ; Risk Assessment ; Risk Factors ; Time Factors ; Transitional Care</subject><ispartof>JAMA internal medicine, 2016-03, Vol.176 (3), p.302-309</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://jamanetwork.com/journals/jamainternalmedicine/articlepdf/10.1001/jamainternmed.2015.8042$$EPDF$$P50$$Gama$$H</linktopdf><linktohtml>$$Uhttps://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/jamainternmed.2015.8042$$EHTML$$P50$$Gama$$H</linktohtml><link.rule.ids>64,314,776,780,3327,27901,27902,76458,76461</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26882111$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Buurman, Bianca M</creatorcontrib><creatorcontrib>Parlevliet, Juliette L</creatorcontrib><creatorcontrib>Allore, Heather G</creatorcontrib><creatorcontrib>Blok, Willem</creatorcontrib><creatorcontrib>van Deelen, Bob A. J</creatorcontrib><creatorcontrib>Moll van Charante, Eric P</creatorcontrib><creatorcontrib>de Haan, Rob J</creatorcontrib><creatorcontrib>de Rooij, Sophia E</creatorcontrib><title>Comprehensive Geriatric Assessment and Transitional Care in Acutely Hospitalized Patients: The Transitional Care Bridge Randomized Clinical Trial</title><title>JAMA internal medicine</title><addtitle>JAMA Intern Med</addtitle><description>IMPORTANCE: Older adults acutely hospitalized are at risk of disability. Trials on comprehensive geriatric assessment (CGA) and transitional care present inconsistent results. OBJECTIVE: To test whether an intervention of systematic CGA, followed by the transitional care bridge program, improved activities of daily living (ADLs) compared with systematic CGA alone. DESIGN, SETTING, AND PARTICIPANTS: This study was a double-blind, multicenter, randomized clinical trial conducted at 3 hospitals with affiliated home care organizations in the Netherlands between September 1, 2010, and March 1, 2014. In total, 1070 consecutive patients were eligible, 674 (63.0%) of whom enrolled. They were 65 years or older, acutely hospitalized to a medical ward for at least 48 hours with an Identification of Seniors at Risk–Hospitalized Patients score of 2 or higher, and randomized using permuted blocks stratified by study site and Mini-Mental State Examination score (<24 vs ≥24). The dates of the analysis were June 1, 2014, to November 15, 2014. INTERVENTIONS: The transitional care bridge program intervention was started during hospitalization by a visit from a community care registered nurse (CCRN) and continued after discharge with home visits at 2 days and at 2, 6, 12, and 24 weeks. The CCRNs applied the CGA care and treatment plan. MAIN OUTCOMES AND MEASURES: The main outcome was the Katz Index of ADL at 6 months compared with 2 weeks before admission. Secondary outcomes were mortality, cognitive functioning, time to hospital readmission, and the time to discharge from a nursing home. RESULTS: The study cohort comprised 674 participants. Their mean age was 80 years, 42.1% (n = 284) were male, and 39.2% (n = 264) were cognitively impaired at admission. Intent-to-treat analysis found no differences in the mean Katz Index of ADL at 6 months between the intervention arm (mean, 2.0; 95% CI, 1.8-2.2) and the CGA-only arm (mean, 1.9; 95% CI, 1.7-2.2). For secondary outcomes, there were 85 deaths (25.2%) in the intervention arm and 104 deaths (30.9%) in the CGA-only arm, resulting in a lower risk on the time to death within 6 months after hospital admission (hazard ratio, 0.75; 95% CI, 0.56-0.99; P = .045; number needed to treat to prevent 1 death, 16). No other secondary outcome was significant. CONCLUSIONS AND RELEVANCE: A systematic CGA, followed by the transitional care bridge program, showed no effect on ADL functioning in acutely hospitalized older patients. TRIAL REGISTRATION: Netherlands Trial Registry: NTR2384</description><subject>Activities of Daily Living</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cognition</subject><subject>Double-Blind Method</subject><subject>Female</subject><subject>Geriatric Assessment</subject><subject>Home Care Services</subject><subject>Homes for the Aged</subject><subject>Humans</subject><subject>Male</subject><subject>Mortality</subject><subject>Netherlands</subject><subject>Nursing Homes</subject><subject>Patient Care Planning</subject><subject>Patient Discharge</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Patient Selection</subject><subject>Program Evaluation</subject><subject>Proportional Hazards Models</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Transitional Care</subject><issn>2168-6106</issn><issn>2168-6114</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptkdFKwzAUhoMoKroX8EJz6c1mkqZN690s6gRBkXpdztIzjbTpTDJhvoVvbOamIhgCCZzv_8_FR8gJZyPOGD97gQ6MDehsh81IMJ6OcibFFtkXPMuHGedy--fPsj0y8P6FxZMzJpNkl-yJLM8F53yffJR9N3f4jNabN6TX6AwEZzQde4_ed2gDBdvQykEkgukttLQEh9RYOtaLgO2STno_NwFa844NvYdgYsqf0-oZ_8ldONM8IX2IrX33lShbY42O8youbw_Jzgxaj4PNe0Aery6rcjK8vbu-Kce3QxAqD0MNBaQJqqxQUigdb6qyqWZaombAsOBJ0wgNrCgAtJKRlnqWpDPFkkyLIjkgp-veuetfF-hD3RmvsW3BYr_wNVeKKyGzIo-oWqPa9d47nNVzZzpwy5qzeqWk_qOkXimpV0pi8nizZDFdTb5z3wIicLQGYsHvVBZRnkw-AXyulrU</recordid><startdate>20160301</startdate><enddate>20160301</enddate><creator>Buurman, Bianca M</creator><creator>Parlevliet, Juliette L</creator><creator>Allore, Heather G</creator><creator>Blok, Willem</creator><creator>van Deelen, Bob A. 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J</creatorcontrib><creatorcontrib>Moll van Charante, Eric P</creatorcontrib><creatorcontrib>de Haan, Rob J</creatorcontrib><creatorcontrib>de Rooij, Sophia E</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>JAMA internal medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Buurman, Bianca M</au><au>Parlevliet, Juliette L</au><au>Allore, Heather G</au><au>Blok, Willem</au><au>van Deelen, Bob A. J</au><au>Moll van Charante, Eric P</au><au>de Haan, Rob J</au><au>de Rooij, Sophia E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comprehensive Geriatric Assessment and Transitional Care in Acutely Hospitalized Patients: The Transitional Care Bridge Randomized Clinical Trial</atitle><jtitle>JAMA internal medicine</jtitle><addtitle>JAMA Intern Med</addtitle><date>2016-03-01</date><risdate>2016</risdate><volume>176</volume><issue>3</issue><spage>302</spage><epage>309</epage><pages>302-309</pages><issn>2168-6106</issn><eissn>2168-6114</eissn><abstract>IMPORTANCE: Older adults acutely hospitalized are at risk of disability. Trials on comprehensive geriatric assessment (CGA) and transitional care present inconsistent results. OBJECTIVE: To test whether an intervention of systematic CGA, followed by the transitional care bridge program, improved activities of daily living (ADLs) compared with systematic CGA alone. DESIGN, SETTING, AND PARTICIPANTS: This study was a double-blind, multicenter, randomized clinical trial conducted at 3 hospitals with affiliated home care organizations in the Netherlands between September 1, 2010, and March 1, 2014. In total, 1070 consecutive patients were eligible, 674 (63.0%) of whom enrolled. They were 65 years or older, acutely hospitalized to a medical ward for at least 48 hours with an Identification of Seniors at Risk–Hospitalized Patients score of 2 or higher, and randomized using permuted blocks stratified by study site and Mini-Mental State Examination score (<24 vs ≥24). The dates of the analysis were June 1, 2014, to November 15, 2014. INTERVENTIONS: The transitional care bridge program intervention was started during hospitalization by a visit from a community care registered nurse (CCRN) and continued after discharge with home visits at 2 days and at 2, 6, 12, and 24 weeks. The CCRNs applied the CGA care and treatment plan. MAIN OUTCOMES AND MEASURES: The main outcome was the Katz Index of ADL at 6 months compared with 2 weeks before admission. Secondary outcomes were mortality, cognitive functioning, time to hospital readmission, and the time to discharge from a nursing home. RESULTS: The study cohort comprised 674 participants. Their mean age was 80 years, 42.1% (n = 284) were male, and 39.2% (n = 264) were cognitively impaired at admission. Intent-to-treat analysis found no differences in the mean Katz Index of ADL at 6 months between the intervention arm (mean, 2.0; 95% CI, 1.8-2.2) and the CGA-only arm (mean, 1.9; 95% CI, 1.7-2.2). For secondary outcomes, there were 85 deaths (25.2%) in the intervention arm and 104 deaths (30.9%) in the CGA-only arm, resulting in a lower risk on the time to death within 6 months after hospital admission (hazard ratio, 0.75; 95% CI, 0.56-0.99; P = .045; number needed to treat to prevent 1 death, 16). No other secondary outcome was significant. CONCLUSIONS AND RELEVANCE: A systematic CGA, followed by the transitional care bridge program, showed no effect on ADL functioning in acutely hospitalized older patients. TRIAL REGISTRATION: Netherlands Trial Registry: NTR2384</abstract><cop>United States</cop><pub>American Medical Association</pub><pmid>26882111</pmid><doi>10.1001/jamainternmed.2015.8042</doi><tpages>8</tpages></addata></record> |
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| subjects | Activities of Daily Living Aged Aged, 80 and over Cognition Double-Blind Method Female Geriatric Assessment Home Care Services Homes for the Aged Humans Male Mortality Netherlands Nursing Homes Patient Care Planning Patient Discharge Patient Readmission - statistics & numerical data Patient Selection Program Evaluation Proportional Hazards Models Risk Assessment Risk Factors Time Factors Transitional Care |
| title | Comprehensive Geriatric Assessment and Transitional Care in Acutely Hospitalized Patients: The Transitional Care Bridge Randomized Clinical Trial |
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