Impact of an inpatient geriatric consultative service on outcomes for cognitively impaired patients

BACKGROUND: Impact of geriatric consultative services (GCS) on hospital readmission and mortality outcomes for cognitively impaired (CI) patients is not known. OBJECTIVE: Evaluate impact of GCS on hospital readmission and mortality among CI inpatients. DESIGN: Secondary data analysis of a prospective trial of a computerized decision support system between July 1, 2006 and May 30, 2008. SETTING: Study conducted at Eskenazi hospital, Indianapolis, Indiana, a 340-bed, public hospital with over 2300 yearly admissions of patients ages 65 years or older. PATIENTS: There were 415 inpatients aged 65 years and older with CI enrolled from July 2006 to March 2008. MEASUREMENTS: Thirty-day and 1-year mortality and hospital readmission following the index admission. Cox proportional hazard models were used to determine the association between receiving GCS, readmission, or mortality while adjusting for demographics, discharge destination, delirium, Charlson Comorbidity Index, and prior hospitalizations. The propensity score method was used to adjust for the nonrandom assignment of GCS. RESULTS: Patients receiving GCS were older (79 years old, 8.1 standard deviation [SD] vs 76 years old, 7.8 SD; P<0.001) with higher incidence of delirium (49% vs 29%; P<0.001). No significant differences were found between the groups for hospital readmission (hazard ratio [HR]=1.19; 95% confidence interval=0.89-1.59) and mortality at 12 months of index admission (HR=0.91; 95% confidence interval=0.59-1.40). However, a significant increase in readmissions was observed for the GCS group (HR=1.75; 95% confidence interval=1.06-2.88) at 30 days postdischarge. CONCLUSION: One-year postdischarge outcomes of CI patients who received GCS were not different from patients who did not receive the service. New models of care are needed to improve postdischarge readmission and mortality among hospitalized patients with CI.