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

Background

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 NCT3662945.

Keywords:

• frail elderly
• healthcare utilization
• mobile geriatric team
• patient safety
• quality of life

Acknowledgments

Financial support for this study was provided by Futurum – the Academy for Healthcare, Region County council Jönköping, Sweden. We are especially grateful to RN Monica Gladh, RN Patricia Herkel, Physician Daniel Gustafsson and their coworkers in the MGT team, RN Gunnar Albinsson and last but not least, the study participants.

Abbreviations

ADL, Activities of Daily Living; CGA, Comprehensive Geriatric Assessment; CHF, Chronic Heart Failure; DiD, Difference in Difference; EMR, Emergency Room Visits; HRQoL, Health-related quality of life; MGT, Mobile Geriatric Team; MMSE, Mini Mental State Examination; RCT, Randomized Controlled Study; WMW, Wilcoxon-Mann-Whitney.

Disclosure

The authors report no conflicts of interest in this work.