IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal study
Abstract Background Frailty interventions such as Comprehensive Geriatric Assessment (CGA) can provide significant benefits for older adults living with frailty. However, incorporating such proactive interventions into primary care remains a challenge. We developed an IT-assisted CGA (i-CGA) process...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Geriatrics |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12877-024-04824-6 |
| _version_ | 1797247012790337536 |
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| author | David Attwood Jim Vafidis James Boorer Scarlett Long Wendy Ellis Michelle Earley Jillian Denovan Gerard ’t Hart Maria Williams Nicholas Burdett Melissa Lemon Suzy Hope |
| author_facet | David Attwood Jim Vafidis James Boorer Scarlett Long Wendy Ellis Michelle Earley Jillian Denovan Gerard ’t Hart Maria Williams Nicholas Burdett Melissa Lemon Suzy Hope |
| author_sort | David Attwood |
| collection | DOAJ |
| description | Abstract Background Frailty interventions such as Comprehensive Geriatric Assessment (CGA) can provide significant benefits for older adults living with frailty. However, incorporating such proactive interventions into primary care remains a challenge. We developed an IT-assisted CGA (i-CGA) process, which includes advance care planning (ACP). We assessed if, in older care home residents, particularly those with severe frailty, i-CGA could improve access to advance care planning discussions and reduce unplanned hospitalisations. Method As a quality improvement project we progressively incorporated our i-CGA process into routine primary care for older care home residents, and used a quasi-experimental approach to assess its interim impact. Residents were assessed for frailty by General Practitioners. Proactive i-CGAs were completed, including consideration of traditional CGA domains, deprescribing and ACP discussions. Interim analysis was conducted at 1 year: documented completion, preferences and adherence to ACPs, unplanned hospital admissions, and mortality rates were compared for i-CGA and control (usual care) groups, 1-year post-i-CGA or post-frailty diagnosis respectively. Documented ACP preferences and place of death were compared using the Chi-Square Test. Unplanned hospital admissions and bed days were analysed using the Mann-Whitney U test. Survival was estimated using Kaplan-Meier survival curves. Results At one year, the i-CGA group comprised 196 residents (severe frailty 111, 57%); the control group 100 (severe frailty 56, 56%). ACP was documented in 100% of the i-CGA group, vs. 72% of control group, p < 0.0001. 85% (94/111) of severely frail i-CGA residents preferred not to be hospitalised if they became acutely unwell. For those with severe frailty, mean unplanned admissions in the control (usual care) group increased from 0.87 (95% confidence interval ± 0.25) per person year alive to 2.05 ± 1.37, while in the i-CGA group they fell from 0.86 ± 0.24 to 0.68 ± 0.37, p = 0.22. Preferred place of death was largely adhered to in both groups, where documented. Of those with severe frailty, 55% (62/111) of the i-CGA group died, vs. 77% (43/56) of the control group, p = 0.0013. Conclusions Proactive, community-based i-CGA can improve documentation of care home residents’ ACP preferences, and may reduce unplanned hospital admissions. In severely frail residents, a mortality reduction was seen in those who received an i-CGA. |
| first_indexed | 2024-04-24T19:51:56Z |
| format | Article |
| id | doaj.art-a1e3dda0c22e4fcd891a78b57a0e1754 |
| institution | Directory Open Access Journal |
| issn | 1471-2318 |
| language | English |
| last_indexed | 2024-04-24T19:51:56Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Geriatrics |
| spelling | doaj.art-a1e3dda0c22e4fcd891a78b57a0e17542024-03-24T12:33:06ZengBMCBMC Geriatrics1471-23182024-03-0124111010.1186/s12877-024-04824-6IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal studyDavid Attwood0Jim Vafidis1James Boorer2Scarlett Long3Wendy Ellis4Michelle Earley5Jillian Denovan6Gerard ’t Hart7Maria Williams8Nicholas Burdett9Melissa Lemon10Suzy Hope11Pathfields Medical GroupUniversity of the West of EnglandPathfields Medical GroupUniversity of ExeterPathfields Medical GroupPathfields Medical GroupPathfields Medical GroupPathfields Medical GroupPathfields Medical GroupPathfields Medical GroupPathfields Medical GroupUniversity of ExeterAbstract Background Frailty interventions such as Comprehensive Geriatric Assessment (CGA) can provide significant benefits for older adults living with frailty. However, incorporating such proactive interventions into primary care remains a challenge. We developed an IT-assisted CGA (i-CGA) process, which includes advance care planning (ACP). We assessed if, in older care home residents, particularly those with severe frailty, i-CGA could improve access to advance care planning discussions and reduce unplanned hospitalisations. Method As a quality improvement project we progressively incorporated our i-CGA process into routine primary care for older care home residents, and used a quasi-experimental approach to assess its interim impact. Residents were assessed for frailty by General Practitioners. Proactive i-CGAs were completed, including consideration of traditional CGA domains, deprescribing and ACP discussions. Interim analysis was conducted at 1 year: documented completion, preferences and adherence to ACPs, unplanned hospital admissions, and mortality rates were compared for i-CGA and control (usual care) groups, 1-year post-i-CGA or post-frailty diagnosis respectively. Documented ACP preferences and place of death were compared using the Chi-Square Test. Unplanned hospital admissions and bed days were analysed using the Mann-Whitney U test. Survival was estimated using Kaplan-Meier survival curves. Results At one year, the i-CGA group comprised 196 residents (severe frailty 111, 57%); the control group 100 (severe frailty 56, 56%). ACP was documented in 100% of the i-CGA group, vs. 72% of control group, p < 0.0001. 85% (94/111) of severely frail i-CGA residents preferred not to be hospitalised if they became acutely unwell. For those with severe frailty, mean unplanned admissions in the control (usual care) group increased from 0.87 (95% confidence interval ± 0.25) per person year alive to 2.05 ± 1.37, while in the i-CGA group they fell from 0.86 ± 0.24 to 0.68 ± 0.37, p = 0.22. Preferred place of death was largely adhered to in both groups, where documented. Of those with severe frailty, 55% (62/111) of the i-CGA group died, vs. 77% (43/56) of the control group, p = 0.0013. Conclusions Proactive, community-based i-CGA can improve documentation of care home residents’ ACP preferences, and may reduce unplanned hospital admissions. In severely frail residents, a mortality reduction was seen in those who received an i-CGA.https://doi.org/10.1186/s12877-024-04824-6Advanced care planningFrailtyCare homesPrimary careGeriatric assessment |
| spellingShingle | David Attwood Jim Vafidis James Boorer Scarlett Long Wendy Ellis Michelle Earley Jillian Denovan Gerard ’t Hart Maria Williams Nicholas Burdett Melissa Lemon Suzy Hope IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal study BMC Geriatrics Advanced care planning Frailty Care homes Primary care Geriatric assessment |
| title | IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal study |
| title_full | IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal study |
| title_fullStr | IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal study |
| title_full_unstemmed | IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal study |
| title_short | IT-assisted comprehensive geriatric assessment for residents in care homes: quasi-experimental longitudinal study |
| title_sort | it assisted comprehensive geriatric assessment for residents in care homes quasi experimental longitudinal study |
| topic | Advanced care planning Frailty Care homes Primary care Geriatric assessment |
| url | https://doi.org/10.1186/s12877-024-04824-6 |
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