Clinical Interventions in Aging (Nov 2019)
Mobile Geriatric Teams – A Cost-Effective Way Of Improving Patient Safety And Reducing Traditional Healthcare Utilization Among The Frail Elderly? A Randomized Controlled Trial
Abstract
Sofi Fristedt,1–3 Paul Nystedt,4 Örjan Skogar2,5 1Department of Rehabilitation and ARN-J Aging Research Network, Jönköping University, School of Health and Welfare, Jönköping, Sweden; 2Futurum - The Academy for Health and Care, Jönköping, Sweden; 3Department of Health Sciences, Lund University, Lund, Sweden; 4Jönköping Academy, Jönköping International Business School, Jönköping University, Jönköping, Sweden; 5Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Stockholm, SwedenCorrespondence: Sofi FristedtSchool of Health and Welfare, Jönköping University, Gjuterigatan 5, Jönköping SE 551 11, SwedenTel +46 36-101269Email [email protected]: Demographic changes combined with costly technological progress put a financial strain on the healthcare sector in the industrialized world. Hence, there is a constant need to develop new cost-effective treatment procedures in order to optimize the use of available resources. As a response, the concept of a Mobile Geriatric Team (MGT) has emerged not only nationally but also internationally during the last decade; however, scientific evaluation of this initiative has been very scarce. Thus, the objective of this study was to perform a mixed methods analysis, including a prospective, controlled and randomized quantitative evaluation, in combination with an interview-based qualitative assessment, to measure the effectiveness and user satisfaction of MGT.Materials and methods: Community-dwelling, frail elderly people were randomized to an intervention group (n=31, mean age 84) and a control group (n=31, mean age 86). A two-year retrospective quantitative data collection and a prospective one-year follow-up on healthcare utilization were combined with qualitative interviews. Non-parametric statistics and difference-in-difference (DiD) analyses were applied to the quantitative data. Qualitative data were analyzed using content analysis.Results: No significant group differences in healthcare utilization were found before inclusion. Post intervention, primary care contact (including MGTs) increased for the MGT group. Inpatient care decreased dramatically for both groups. Hence, the increase in primary care contact for MGT patients was not accompanied by a reduction in inpatient care compared to the control group. Utilization of non-primary care was lower (p< 0.01) post-intervention in both groups.Conclusion: There appears to be a “natural” variation in healthcare needs over time among frail elderly people. Hence, it is vital to perform open, controlled clinical studies in tandem with the implementation of new caregiving strategies. The MGT initiative was clearly appreciated but did not fully achieve the desired reduction in healthcare utilization in this study.Trial registration: Retrospectively registered 09/10/2018, ClinicalTrials.gov ID NCT03662945.Keywords: frail elderly, healthcare utilization, mobile geriatric team, patient safety, quality of life
