Are frail elderly patients treated in a CGA unit more satisfied with their hospital care than those treated in conventional acute medical care?

Niklas Ekerstad,1,2 Göran Östberg,3 Maria Johansson,3 Björn W Karlson3,4 1Department of Cardiology, NU (NÄL-Uddevalla) Hospital Group, Trollhättan-Uddevalla-Vänersborg, 2Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Linköping, 3Division of Internal and Acute Medicine, NU Hospital Group, Trollhättan-Uddevalla-Vänersborg, 4Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden Objectives: Our aim was to study whether the acute care of frail elderly patients directly admitted to a comprehensive geriatric assessment (CGA) unit is superior to the care in a conventional acute medical care unit in terms of patient satisfaction.Design: TREEE (Is the TReatment of frail Elderly patients Effective in an Elderly care unit?) is a clinical, prospective, controlled, one-center intervention trial comparing acute treatment in CGA units and in conventional wards.Setting: This study was conducted in the NÄL-Uddevalla county hospital in western Sweden.Participants: In this follow-up to the TREEE study, 229 frail patients, aged ≥75 years, in need of acute in-hospital treatment, were eligible. Of these patients, 139 patients were included in the analysis, 72 allocated to the CGA unit group and 67 to the conventional care group. Mean age was 85 years and 65% were female.Intervention: Direct admittance to an acute elderly care unit with structured, systematic interdisciplinary CGA-based care, compared to conventional acute medical care via the emergency room.Measurements: The primary outcome was the satisfaction reported by the patients shortly after discharge from hospital. A four-item confidential questionnaire was used. Responses were given on a 4-graded scale.Results: The response rate was 61%. In unadjusted analyses, significantly more patients in the intervention group responded positively to the following three questions about the hospitalization: “Did you get the nursing from the ward staff that you needed?” (p=0.003), “Are you satisfied with the information you received on your diseases and medication?” (p=0.016), and “Are you satisfied with the planning before discharge from the hospital?” (p=0.032). After adjusted analyses by multiple regression, a significant difference in favor of the intervention remained for the first question (p=0.027).Conclusion: Acute care in a CGA unit with direct admission was associated with higher levels of patient satisfaction compared with conventional acute care via the emergency room. Keywords: frailty, elderly, comprehensive geriatric assessment, acute care, patient satisfaction, direct admissio