Acute hospital use, nursing home placement, and mortality in a frail community-dwelling cohort managed with Primary Integrated Interdisciplinary Elder Care at Home

J Am Geriatr Soc. 2012 Jul;60(7):1340-6. doi: 10.1111/j.1532-5415.2012.03965.x. Epub 2012 Jun 13.


Objectives: To evaluate the effect of medical Primary Integrated Interdisciplinary Elder Care at Home (PIECH) on acute hospital use and mortality in a frail elderly population.

Design: Comparison of acute hospital care use for the year before entering the practice (pre-entry) with the most-recent 12-month period (May 1, 2010-April 30, 2011, postentry) for active and discharged patients.

Setting: Community.

Participants: All 248 frail elderly adults enrolled in the practice for at least 12 months who were living in the community and not in nursing homes in Victoria, British Columbia.

Intervention: Primary geriatric care provided by a physician, nurse, and physiotherapist in participants' homes.

Measurements: Acute hospital admissions, emergency department (ED) contacts that did not lead to admission, reason for leaving practice, and site of death.

Results: There was a 39.7% (116 vs 70; P = .004) reduction in hospital admissions, 37.6% (1,700 vs 1,061; P = .04) reduction in hospital days, and 20% (120 vs 95; P = .20) reduction in ED contacts after entering the practice. Fifty participants were discharged from the practice, 64% (n = 32) of whom died, 20% (n = 10) moved, and 16% (n = 8) were admitted to nursing homes. Fifteen (46.9%) deaths occurred at home.

Conclusion: Primary Integrated Interdisciplinary Elder Care at Home may reduce acute hospital admissions and facilitate home deaths.

MeSH terms

  • Aged, 80 and over
  • British Columbia
  • Cause of Death
  • Chi-Square Distribution
  • Delivery of Health Care, Integrated / organization & administration*
  • Demography
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Frail Elderly*
  • Geriatric Assessment
  • Health Services for the Aged / organization & administration*
  • Home Care Services / organization & administration*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Male
  • Mortality / trends*
  • Nursing Homes / statistics & numerical data*
  • Regression Analysis