For the 25 most common DRGs, cost saving was even greater with the use of an ACE unit, $1,693 compared with $2,138 for usual care, or $445.
Readmissions appeared to drop with ACE unit use as well. For example, while 12.8% of the patients who received usual returned to a UAB hospital within 30 days of discharge, for those patients treated in the ACE unit, the readmission rate was 7.9%.
In an accompanying editorial, Lisa Walke, MD, and Mary Tinetti, MD of the Yale University School of Medicine, wrote that the idea is great except for a significant problem:
"Currently there are not enough geriatric specialists to provide this care; all clinicians caring for older adults will need to acquire geriatric knowledge and skills."
Also, they wrote, communications systems to share information across sites of care "is lacking; efficient communication remains a challenge. Moreover, the financial incentive to create a seamless system of care does not exist."
Better utilization of electronic health records, they wrote, "should facilitate timely and effective communication among providers." They also expect that the rising number of aging baby boomers will make a difference as well.
"Possibly the most promising indications that the delivery of care to older adults will change are older adults themselves," they wrote. "Baby boomers, now starting to turn 65 years old, have redefined the norms at every stage of their lives. There is no reason to believe this will change."