The effects of shared situational awareness on functional and hospital outcomes of hospitalized older adults with heart failure

Abstract

Joo H Lee,1 Sun J Kim,2,3 Julia Lam,4 Sulgi Kim,5 Shunichi Nakagawa,6 Ji W Yoo7,8 1Department of Media and Communication, Hanyang University College of Social Sciences, Seoul, Korea; 2Department of Public Health, 3Institute of Health Services Research, Yonsei University College of Medicine, Seoul, Korea; 4University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 5Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA; 6Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA; 7Center for Senior Health and Longevity, Aurora Health Care, 8Department of Medicine, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA Background: Functional decline of hospitalized older adults is common and triggers health care expenditures. Physical therapy can retard the functional decline that occurs during hospitalization. This study aims to examine whether shared situational awareness (SSA) intervention may enhance the benefits of physical therapy for hospitalized older persons with a common diagnosis, heart failure. Method: An SSA intervention that involved daily multidisciplinary meetings was applied to the care of functionally declining older adults admitted to the medicine floor for heart failure. Covariates were matched between the intervention group (n=473) and control group (n=475). Both intervention and control groups received physical therapy for ≥0.5 hours per day. The following three outcomes were compared between groups: 1) disability, 2) transition to skilled nursing facility (SNF, post-acute care setting), and 3) 30-day readmission rate. Results: Disability was lower in the intervention group (28%) than in the control group (37%) (relative risk [RR] =0.74; 95% confidence interval [CI], 0.35–0.97; P=0.026), and transition to SNF was lower in the intervention group (22%) than in the control group (30%) (RR =0.77; 95% CI, 0.39–0.98; P=0.032). The 30-day readmission rate did not significantly differ between the two groups. Conclusion: SSA intervention enhanced the benefits of physical therapy for functionally declining older adults. When applied to older adults with heart failure in the form of daily multidisciplinary meetings, SSA intervention improved functional outcomes and reduced transfer to SNFs after hospitalization.Keywords: functionally impaired elderly, hospital communication system, hospital readmission, shared decision making, skilled nursing facility