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Original Investigation
June 10, 2013

Evaluation of the Mobile Acute Care of the Elderly (MACE) Service

Author Affiliations

Author Affiliations: Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York (Drs Hung, Farber, and Siu); Health Services Research and Development Service and the Geriatrics Research Education Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York (Drs Hung and Siu); and Section of General Internal Medicine, Department of Medicine, Yale University School of Medicine and Yale–New Haven Hospital Center for Outcomes Research and Evaluation, New Haven, Connecticut (Dr Ross).

JAMA Intern Med. 2013;173(11):990-996. doi:10.1001/jamainternmed.2013.478

Importance Older adults are particularly vulnerable to adverse events during hospitalization for acute medical problems. The Mobile Acute Care of the Elderly (MACE) service is a novel model of care delivered by an interdisciplinary team, designed to deliver specialized care to hospitalized older adults to improve patient outcomes.

Objective To evaluate the impact of the MACE service when compared with general medical service (usual care).

Design Prospective, matched cohort study.

Setting The Mount Sinai Hospital, an urban tertiary acute care hospital.

Participants Patients aged 75 years or older admitted because of an acute illness to either the MACE service or usual care. Patients were matched for age, diagnosis, and ability to ambulate independently.

Exposures Admission to the MACE service when compared with admission to usual care.

Main Outcome Measures Patient outcomes included incidence of adverse events, including falls, pressure ulcers, restraint use, and catheter-associated urinary tract infections, along with length of stay, rehospitalization within 30 days, functional status at 30 days, and patient satisfaction during care transitions, measured with the 3-item Care Transition Measure.

Results A total of 173 matched pairs of patients were recruited. The mean (SD) age was 85.2 (5.3) and 84.7 (5.4) years in the MACE and usual-care groups, respectively. After adjustment for confounders, patients in the MACE group were less likely to experience adverse events (9.5% vs 17.0%; adjusted odds ratio, 0.11; 95% CI, 0.01-0.88; P = .04) and had shorter hospital stays (0.8 days, 95% CI, 0.7-0.9; P = .001) than patients receiving usual care. Patients in the MACE group were not less likely to have a lower rate of rehospitalization within 30 days than those in the usual-care group (odds ratio, 0.91; 95% CI, 0.39-2.10; P = .83). Functional status did not differ between the 2 groups. Care Transition Measure scores were 7.4 points (95% CI, 2.9-11.9; P = .001) higher in the MACE group.

Conclusions and Relevance Admission to the MACE service was associated with lower rates of adverse events, shorter hospital stays, and better satisfaction. This model has the potential to improve care outcomes among hospitalized older adults.

Trial Registration clinicaltrials.gov Identifier: NCT00927160