Comparison of evidence-based interventions on outcomes of hospitalized, cognitively impaired older adults
Open accessAbstract
AIM: This article reports the effects of three evidence-based interventions of varying intensity, each designed to improve outcomes of hospitalized cognitively impaired older adults. MATERIALS & METHODS: In this comparative effectiveness study, 202 older adults with cognitive impairment (assessed within 24 h of index hospitalization) were enrolled at one of three hospitals within an academic health system. Each hospital was randomly assigned one of the following interventions: Augmented Standard Care (ASC; lower dose: n = 65), Resource Nurse Care (RNC; medium dose: n = 71) or the Transitional Care Model (TCM; higher dose: n = 66). Since randomization at the patient level was not feasible due to potential contamination, generalized boosted modeling that estimated multigroup propensity score weights was used to balance baseline patient characteristics between groups. Analyses compared the three groups on time with first rehospitalization or death, the number and days of all-cause rehospitalizations per patient and functional status through 6-month postindex hospitalization. RESULTS: In total, 25% of the ASC group were rehospitalized or died by day 33 compared with day 58 for the RNC group versus day 83 for the TCM group. The largest differences between the three groups on time to rehospitalization or death were observed early in the Kaplan-Meier curve (at 30 days: ASC = 22% vs RNC = 19% vs TCM = 9%). The TCM group also demonstrated lower mean rehospitalization rates per patient compared with the RNC (p < 0.001) and ASC groups (p = 0.06) at 30 days. At 90-day postindex hospitalization, the TCM group continued to demonstrate lower mean rehospitalization rates per patient only when compared with the ASC group (p = 0.02). No significant group differences in functional status were observed. CONCLUSION: Findings suggest that the TCM intervention, compared with interventions of lower intensity, has the potential to decrease costly resource use outcomes in the immediate postindex hospitalization period among cognitively impaired older adults.
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- Authors
- Naylor, M. D., Hirschman, K. B., Hanlon, A. L., Bowles, K. H., Bradway, C., McCauley, K. M., & Pauly, M. V.
- Affiliations
- University of Pennsylvania (US)
- Corresponding author
- Naylor, Mary D
- ORCID
- Venue
- Journal of Comparative Effectiveness Research
- Publisher
- Becaris Publishing Limited
- Published
- 2014-05
- Volume
- 3
- Issue
- 3
- Pages
- 245-257
- ISSN
- 2042-6305 (ISSN-L)
- 2042-6313
- PMC
- PMC4171127
- OpenAlex
- W2083604329
- Cited by
- 91
- References
- 62
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 3 · 2023: 8 · 2022: 8 · 2021: 9 · 2020: 10 · 2019: 9 · 2018: 8 · 2017: 8 · 2016: 11 · 2015: 3 · 2014: 2
- FWCI
- 6.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Comparative Effectiveness Research (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (R01AG023116)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Keywords
- cognitive impairment, older adults, hospitalized patients, Transitional Care Model, hospital readmission, mortality, functional status, comparative effectiveness, post-acute care
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cognition Disorders, Continuity of Patient Care, Female, Hospitalization, Humans, Male, Middle Aged, Patient Readmission, Treatment Outcome, Caregivers, Evidence-Based Medicine, Comparative Effectiveness Research
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