Association between older patients receiving geriatric co-management at the emergency department and acute hospital admissions compared to usual care: an observational, controlled study.

Objectives The aim of this study is to determine if a geriatric co-management model, referred to as The Geriatric Emergency Medicine (GEM)-team, is associated with less admissions to hospital in older patients compared to the usual care without increasing the risk of mortality or 30-day ED readmissions. Design This observational, controlled study used 18-month data prospectively collected from hospital records. Inverse probability weighted, logistic and linear regression models were used for evaluation. Setting An Emergency Department at a suburban Dutch, general hospital, receiving approximately 10,000 patients aged 70 or older. Participants All patients aged 70 or older were screened according to predefined criteria. When positively screened patients were presented at the ED on weekdays between 9AM and 5PM they received geriatric co-management. Outside these hours and when capacity of the GEM-team was reached, patients received care as usual. Interventions Geriatric co-management at the ED, involves a geriatric multidisciplinary team in collaboration with the primary ED-physician who share management and responsibility for the provided medical treatment and nursing care starting directly at the primary assessment. Primary and secondary outcome measures The primary outcome was hospital admission and secondary outcomes were the composite outcome of 30-day ED readmissions and mortality. Results Patients receiving geriatric co-management (n=972) had lower odds for hospitalization after adjusting for the propensity score (odds ratio OR: 0.61, 95% confidence interval CI: 0.50-0.75) compared to the control-group (n=1355) while 30-day ED readmissions and mortality did not differ between groups (OR 0.95, 95% CI: 0.75-1.22). Conclusions Geriatric co-management at the ED is associated with decreased hospital admissions while 30-day ED readmissions or mortality was not impacted. These preliminary results contribute to the evidence that geriatric co-management may be an effective intervention for older patients with frailty at the ED.