April 23, 2013

ACE Unit reduces costs, readmissions for seniors

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It costs less to care for a geriatric patient hospitalized in a specialized Acute Care for Elders (ACE) unit than it does for patients hospitalized in a more usual care setting, according to new research from the University of Alabama at Birmingham. In findings published online in JAMA Internal Medicine April 22, 2013, UAB investigators also showed that readmission rates within 30 days for patients in the ACE unit were significantly lower than for patients receiving usual care.

An ACE unit uses an interdisciplinary team approach to care for geriatric patients, with increased recognition and management of geriatric issues. While the concept is more than twenty years old, there are only about 100 ACE units in the United States.  The UAB ACE unit was established at UAB Highlands Hospital in 2008.

Looking at an administrative data base of patients age 70 and older hospitalized at UAB in 2010, the researchers identified 818 patients who spent their entire hospitalization under the care of hospitalists at either UAB’s ACE Unit (428) or a usual care unit (390). On average, the ACE unit saw a variable direct cost savings of $371 per patient over the usual care patient group, a potential savings of $148,000 for every 400 patients.  Additionally, readmission rates for ACE unit patients was 7.9 percent, compared to 12.8 percent for usual care patients.

“The patients were evenly matched in terms of age, gender, comorbidities, length of stay and staff-to-patient ratio, even down to using the same physicians from UAB’s hospitalist service,” said Kellie Flood, M.D., the medical director of the UAB ACE unit and first author of the study. “This is the first study that shows in a head-to-head comparison that the ACE unit concept provides evidence-based geriatric care at reduced cost.”

A hallmark of the ACE unit concept is a daily team meeting, which links a geriatrician and nurse coordinator in geriatrics to the patient’s own nurse and attending physician. Health care professionals from every field that may have a role in treatment are represented, including physical and occupational therapists, dietitians, pharmacists, social workers, chaplains and volunteers.

Geriatric patients being admitted for an acute illness often have co-existing conditions such as memory loss, functional decline and depression. They may be on multiple medications. These can adversely impact their hospitalization if not recognized and addressed. The daily team meetings help to increase recognition and lead to appropriate care.

“This is what health care reform is all about,” said Flood. “In a changing health care environment with an increasingly aging population, how do we deliver high quality care at less cost?  This study confirms that the ACE unit concept does that.”

Flood says this study, along with previous research that showed ACE units improve functional abilities in hospitalized geriatric patients while reducing length of stay and long-term care placement, validates the ACE unit concept. She said the next step is to better disseminate the ACE unit concept to hospitals across the country.

“This is a win-win,” she said.  “It’s a win for the health care system with reduced costs and lowered readmission rates, and a win for the patient with better care.”