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Table 2 Data outcomes

From: Multidisciplinary residential home intervention to improve outcomes for frail residents

 

Cycle 1

Cycle 2

 

Care Home 1

Care Home 2

Care Home 3

Presenting complaints

Stealing other residents’ food in context of dementia

Worsened cough and breathlessness

Cognitive decline and refusal of medications including warfarin

Aggression and paranoia

Breathlessness and ankle swelling

Weight loss, day time drowsiness

Uncommunicative, decline in mobility, decline in oral intake

Pain and poor mobility

Falls

Sleeping in chair, leg pain and swelling

Anxiety, agitation

Recurrent UTI, generally unwell and has been in bed for a no. of weeks

Rash, hallucinations and delusions

Weight loss

Difficulty breathing

Challenging behaviour

Swollen legs

Refusing medication

General decline possible depression

Reduced oral intake

Reduced mobility

Low mood, insomnia

Slowing and movement disorder

Falls

Depression in context of dementia

New patient needing CGA

Loose stool, anaemia

Number of GCA reviews held

9

4

21

Mean change in number of medications (range)

−1.4

(−3 to + 1)

−0.3

(− 1 to 0)

−2.1

(− 18 to + 1)

Change in BPSD (staff report)

3/3 improved

1/4 improved

3/4 no different

Data not collected in this cycle

Change in BPSD (family report)

3/3 improved

2/4 improved

2/4 no different

Data not collected in this cycle

Number of reviews attended by relatives

(% of total participating residents)

1

(11.1%)

0

(0%)

1

(4.8%)

Number of residents with ACP initiated or reviewed

(% of total participating residents)

7

(77.8%)

3

(75%)

16

(76.2%)

Number of DNAR forms completed or reviewed pre- and post- MDT (% of total participating residents)

6 newly initiated

(66.7%)

2 newly initiated

(50.0%)

Pre-MDT = 4 (19%)

Post-MDT = 19 (90.5%)

Number of patients with Coordinate My Care record created (% of total participating residents)

0

(0%)

0

(0%)

8

(38.1%)

Project period (months)

7

3

10

Actual number of admissions to hospital during the project period in intervention residents (no. per month)

1 (0.16)

0 (0.0)

0 (0.0)

Number of admissions among participating residents in 12 months prior to reviews (mean per person over 12 months)

Data not collected in this cycle

Data not collected in this cycle

25 (1.19)

Number of admissions among participating residents in 12 months post review (mean per person over 12 months)

Data not collected in this cycle

Data not collected in this cycle

6 (0.29)

Reduction of admissions among participating residents over 1 year (mean per person over 12 months)

Data not collected in this cycle

Data not collected in this cycle

19 (0.9)

Costs of hospital admissions for the whole care home

Data not collected in this cycle

Data not collected in this cycle

12 months prior to intervention

£55,678

During year of intervention

£49,653

Number of educational sessions

5

2

9

Topics of half hour educational sessions

Polypharmacy and medication errors

Challenging behaviour in dementia

Nutrition Pain in dementia

Difficult ACP discussions

Dementia pre-diagnosis counselling

Cardiovascular complications in geriatrics

Skin care in the older patient

Advance care planning

Nutrition and weight loss

Morbidity and mortality meeting

End of life in the care home

Old age psychiatry

Behavioural symptom management

Rationalisation of medications

Communication between primary and secondary care