Higher Quality, Lower Cost with an Innovative Geriatrics Consultation Service

Objectives: To design a value-driven, interprofessional inpatient geriatric consultation program coordinated with systems-level changes and studied outcomes and costs.

Design: Propensity-matched case-control study of older adults hospitalized at an academic medical center (AMC) who did or did not receive geriatric consultation.

Setting: Single tertiary-care AMC in Portland, Oregon.

Participants: Adults aged 70 and older who received an inpatient geriatric consultation (n=464) and propensity-matched controls admitted before development of the consultation program (n=2,381). Pre- and postintervention controls were also incorporated into cost difference-in-difference analyses.

Measurements: Daily charges, total charges, length of stay (LOS), 30-day readmission, intensive care unit (ICU) days, Foley catheter days, total medication doses per day, high-risk medication doses per day, advance directive and Physician Orders for Life Sustaining Treatment (POLST) documentation, restraint orders, discharge to home, and mortality.

Results: On average, individuals who received a geriatric consultation had $611 lower charges per day than those without a consultation (p=.02). They spent on average 0.36 fewer days in the ICU (p<.001). They were less likely to have restraint orders (20.0% vs 27.9%, p<0.001), more likely to have a POLST (58.2% vs 44.6%, p<.001), and more likely to be discharged to home (33.4% vs 28.2%, p=.03). They received fewer doses of antipsychotics, benzodiazepines, and antiemetics (10, 5, and 7 fewer doses per 100 patient-days, respectively) and had lower in-hospital mortality (2.4% vs 4%, p=.01). There was no difference in hospital LOS or 30-day readmission.

Conclusion: Our consultation program resulted in significant reductions in daily charges, ICU days, potentially inappropriate medication use, and use of physical restraints and increased end-of-life planning. This model has potential for dissemination to other institutions operating in resource-scarce, value-driven settings.