Developing and evaluating a complex Geriatric CO-mAnagement program for Cardiology patients admitted to the Hospital (G-COACH)

Purpose: To develop and evaluate a geriatric co-management program for frail patients admitted to the hospital with acute cardiovascular disease. Methods: First, a meta-analysis was performed. Second, quality indicators were developed in an international Delphi study. Third, a prediction model was developed in a cohort study to identify patients at risk for in-hospital functional decline. Fourth, local context factors and care gaps were identified. Fifth, a geriatric co-management program was developed using data from steps 1 – 4 and engaging stakeholders in consensus development meetings. Sixth, the program was piloted, implemented and evaluated in a quasi-experimental before-and-after study with process evaluation. Results: The meta-analysis identified less complications and functional decline and a shorter length of stay favoring co-management. The Delphi study found consensus on 31 quality indicators. The prediction model included mobility, cognition, depressive symptoms, nutritional status and use of restraints to adequately predict functional decline (AUC = 0.77) with good calibration. The program consists of three intervention groups. Patients at low risk for functional decline receive standard care. Patients at high risk for functional decline are co-managed by a geriatric nurse focusing on early rehabilitation and discharge planning by coaching the staff of cardiology. Patients who developed geriatric complications are co-managed by a geriatrician. Pilot findings demonstrate improved detection of geriatric needs leading to proactive care planning of patients’ functional and social needs. Conclusion: This stakeholder-based quality improvement project uses iterative evaluations and adaptations to move from a theoretical model to prove of concept to preparing for large-scale implementation.status: publishe