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Elderly care program could save $6B in healthcare costs

Creating specialized hospital units for elderly people with acute medical illness could reduce national healthcare costs by as much as $6 billion a year, according to a recent study by University of California, San Francisco (UCSF) researchers. 

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The researchers assessed a program called "Acute Care for Elders," or ACE, that offers individualized care for older patients in specially-designed hospital units. The program is being piloted in 200 hospitals nationwide, serving an estimated 100,000 patients annually.

In their study, published in the June issue of Health Affairs, researchers conducted a randomized controlled study of 1,632 elderly patients seen either in the ACE program or a traditional inpatient hospital setting between August 1993 and May 1997. They found that the average length-of-stay was shorter for patients in the ACE program by a measure of 6.7 days versus 7.3 days. They also found that patients in the ACE program incurred lower hospital costs: $9,477 versus $10,451, or a savings of $974 per patient. Nationally, these numbers could translate to a one percent saving – $6 billion – of all Medicare expenditures per year.

"The Medicare proportion of the healthcare budget is going up faster than anything else, and the cost of hospital stays is one of the fastest growing components of that care," said senior author Seth Landefeld, chief of the UCSF geriatrics division, in a press release. "This was really an opportunity to look at how you can deliver higher value care while maintaining or improving quality and reducing cost."

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Landefeld and his colleagues say minor changes in the current healthcare model can yield significant results. Leaving patients in their hospital beds, for example, or constantly interrupting them in the middle of the night for disruptive evaluations, can lead to longer recovery time and longer hospital stays, he said.

"What's encouraging about this is the outcomes were identical in both groups. So we were able to save money while maintaining the quality of care," said one author of the study, Deborah Barnes, an associate professor of psychiatry and epidemiology and biostatistics at UCSF, in a press release. "So despite being released about half a day earlier, patients had similar levels of function at discharge, and also the readmission rates were identical in two groups over three months."

The ACE program works by creating an interdisciplinary team environment that specializes in the care of older patients. The number of clinical staff per patient is similar to traditional units, but patients are assessed daily by the team, and the level of independence and accountability of the nurses is increased.

"Part of what ACE does is improve communication and decrease work. And that's a strategy that's generally popular with lots of folks involved," Landefeld said in the press release. "You're not asking people to do a lot of extra work. You're just asking them to do their work differently."

The researchers say barriers to ACE being implemented on a larger scale include the ability for clinicians to change ingrained work cultures and adjust schedules to meet and talk about the patients.

ACE may not be ideal for all hospital environments, Landefeld noted. A small hospital in a rural environment may not benefit, but researchers say most medium to large hospitals with at least 100 beds would qualify.

The study also showed that the ACE program did not increase hospital readmission rates. Landefeld and his colleagues believe ACE can help hospitals lower costs while preserving quality of care for hospitalized elderly patients.

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