Development and implementation of an acute geriatric community clinic

Abstract

Background: As in many Western countries, there has been a 19% increase in Emergency Room (ER) visits by ≥ 65 years older adults in the Netherlands. In these vulnerable older patients outcomes following an ER visit and subsequent hospitalization are known to be poor: 30% gain new disabilities and 20% are readmitted within 30 days postdischarge, up to 15 % will die in this same period. The Acute Geriatric Community Clinic (AGCC) was designed to address geriatric symptoms, multiple chronic conditions and functional decline in older patients. These are factors frequently associated with costly hospital readmissions and institutionalization. July 2018, we opened the first Acute Geriatric Community Clinic (AGCC) in the Netherlands. The AGCC provides community based acute hospital care, thereby filling the current gap between primary and secondary care. Integrated medical and nursing care are provided to persons who have common medical problems (pneumonia, exacerbation COPD, heart failure or an urinary tract infection) and geriatric conditions (cognitive impairment, depression, functional impairment). Studies are currently set up to provide evidence for the effectiveness of the AGCC on patient outcomes. Goals of this presentation: Familiarize the audience with the concept of acute geriatric care in the community and explain how the project was funded/implemented. Help researchers pitch interventions to health insurance companies. To provide insight into development of an AGCC. Explain the target population and the patient triage for an AGCC. Discuss the study design used in evaluating the AGCC compared to regularly hospitalized patients. Speaker Sections Introduction of the AGCC (20 min) Prof. Buurman will discuss the cooperation with the various stakeholders who supported the implementation of the AGCC. The audience is invited to ask questions on the main concept of the AGCC and share their experiences with similar projects. How can an healthcare insurer be the driver of innovation in intermediate care for ageing populations? Developing this concept from a patient perspective (15 min) Rosanne van Seben will describe the process of designing the care concept of the AGCC, which was done together with patients. She will explain how a patient journey from hospital to home was the frame of reference for designing the AGCC. The audience is invited to share their comments and reflect on the concept of care of the AGCC. Finding the right patient for the AGCC (15 min) Marthe Ribbink will discuss the identification of patients who can be admitted to the AGCC. The audience is invited to share thoughts on which patients could benefit from an AGCC in their country, and what barriers could exist to safely admit patients. The clinical, economic and process evaluation of the AGCC (20 min) Assistant Professor Janet MacNeil will explain the observational, controlled design of the AGCC study. The primary outcome is readmission at 3 months compared to hospitalized matched controls. Secondary outcomes will include patient-related outcomes and a societal economic evaluation. A barriers to implementation study is also planned. Target audience: Health professionals, older adults, policy makers and researchers.

Keywords

• intermediate care
• acute geriatric care
• community care
• vulnerable populations