QJM Advance Access published online on January 14, 2008
QJM, doi:10.1093/qjmed/hcm136
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Measuring case-mix and outcome for older people in acute hospital care across Europe: the development and potential of the ACMEplus instrument
From the 1The Catalan Agency for Health Technology Assessment and Research, Catalan Health Service, Barcelona, Spain, 2CIBER Epidemiología y Salud Pública (CIBERESP), Spain, 3Sheffield Institute for Studies on Ageing, University of Sheffield and Northern General Hospital, Sheffield, UK, 4The University of Aberdeen, Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK, 5Department of Medicine for the Elderly, Woodend Hospital, Aberdeen, UK, 6Department of Geriatric Medicine, Granollers General Hospital, Barcelona, Spain, 7Department of Geriatric Medicine, University Hospital Birmingham NHS Trust, Birmingham, UK, 8Istituto Nazionale di Riposo e Cura Anziani (INRCA), Ancona, Italy, 9Sextant Co. Athens, Greece, 10The University of Bialystok, Bialystok, Poland and 11Health office, Turku, Finland
Address correspondence to M. Espallargues, The Catalan Agency for Health Technology Assessment and Research, Catalan Health Service, Barcelona, Spain. email: mespallargues{at}aatrm.catsalut.net
Received 6 July 2007 and in revised form 29 October 2007
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Abstract |
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Aim: To identify case-mix variables measured shortly after admission to be included in a patient classification system (ACMEplus) that best explains hospital outcome for older people in different health care systems.
Design: Observational prospective cohort study collecting patient factors (sociodemographics, functional, mental, clinical, administrative and perceived health) at different time assessments.
Methods: Multicentre study involving eight hospitals in six European countries (United Kingdom, Spain, Italy, Finland, Greece and Poland). It included consecutive patients aged 65 years or older admitted to hospital for acute medical problems. Main outcome measures: discharge status, hospital readmission, mortality and length of stay.
Results: Of the 1667 included patients (mean age = 78.1 years; male gender = 43.5%) two-third had at least one ‘Geriatric Giant’ (immobility, confusion, incontinence or falls) on admission or shortly after. The most frequently affected system was cardiovascular (29.2%) and 31% of patients declared poor or very poor health. Mean length of stay was 17.9 days, 79% of patients were discharged to their usual residence; in-hospital and 1-month follow up mortality were 7.4% and 11.6%, respectively. Physical function explained the highest variation (between 8% and 21%), followed by cognitive status and number of Geriatric Giants, for almost all outcomes except readmission.
Conclusions: Factors other than diagnosis (physical function, cognition and presenting problems) are important in predicting key outcomes of acute hospital care for older people and are consistent across countries. Their inclusion in a standardized system of measurement may be a way of improving quality and equity of medical care in older people.
*In addition to the named authors, the ACMEplus project team consists of: Cari Almazan, Cristian Balducci, Ahmed Abdel Hafiz, Anna Hernandez-Cortes, Janusz Lewko, Maria Gabriella Melchiorre, Montse Moharra, Francesca Polverini, Costis Prouskas, Ramon Pujol, Sabrina Quattrini, Tapio Rajala and Judy Triantafillou.