Mobile Geriatric Teams: A Cost-effective Way of Improving Patient Safety and Reducing Traditional Healthcare Utilization Among the Frail Elderly?

Method The current study was conducted through a randomized control trial (RCT), upon approval from the Regional Ethical Committee in Linköping, Dnr 2014/371-31. The study context was an MGT, initiated in 2013 and originated from a hospital serving approximately 149,000 inhabitants in Southern Sweden.

Participants The inclusion criteria for this trial were the "frail elderly" defined as: community-dwelling persons aged > 75 years, having more than three chronic diagnoses and prescribed six or more pharmaceutical drugs for continuous use and with at least three hospital stays (> 24 hours in hospital) during the last six months. Since these criteria were broad in order to capture relevant individuals, but also likely to generate persons of no relevance to the MGT intervention, identification of the study sample was conducted in three steps, in turn, repeated in three waves.

In the first step, a nurse with special training in identifying populations by filtered searches in digital patient records identified 449 individuals in an initial search (March 2015). Another 75 individuals were identified in a second search wave (May 2015) and another 157 individuals in a third search wave (September 2015).

In the second step, a nurse with geriatric competence checked the patient records of all individuals. Deceased persons or persons who had moved to a nursing home since the initial search were excluded. Patients with repeated hospital admissions due to surgery (without multi-morbidity) or patients admitted for palliative care were also excluded from the sample. Thirdly and finally for all waves, a nurse with clinical experience of MGT re-evaluated each of the previous searches in order to exclude individuals that the MGT would not consider for inclusion, since they were likely to not benefit from the MGT measures.

The final recruitment of participants from the above-described filtering resulted in 66 potential participants from the first search, 34 from the second search and 41 from the third search. These were randomized, as shown in Figure 2, to an intervention group and a control group, comprising 31 participants each and an administrative control group, not contacted or followed in the present trial. The initial intention was only to observe the administrative control group data from health and social care registers, but for (the purpose of) the present study this was never done.