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Dissemination of the hospital elder life program: implementation, adaptation, and successes
Sharon K Inouye1, Dorothy I Baker, Patricia Fugal
1Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02131, USA. hospitalelderlife@yale.edu
Objectives:
To describe the Hospital Elder Life Program (HELP) across dissemination sites, to detail adaptations, and to summarize advantages across sites.
Design:
Cross-sectional survey.
Setting:
HELP sites in acute care hospitals.
Participants:
Thirteen sites that enrolled 11,344 patients.
Measurements:
Seventy-five closed- and open-ended questions describing details of the HELP site, procedures, staffing, outcomes tracked, and advantages.
Results:
As of July 1, 2005, HELP had been fully implemented in 13 sites, with a median duration of 24 months (range 6.0-38.0). Although a high degree of fidelity to the original model was maintained, variations existed in staffing patterns, outcome tracking, and recommended HELP procedures. Adaptations were made across multiple domains, including enrollment criteria at 15.4% of sites, screening and assessment tools at 61.5%, and individual intervention protocols at 15.4% to 30.8%. Local circumstances drove these adaptations, with the most common reasons being lack of adequate staffing and logistical constraints. All sites conducted regular HELP staff meetings; other recommended quality assurance procedures were conducted at 46.2% to 92.3% of sites. Reported advantages of HELP included providing an educational resource at 100% of sites, improving hospital outcomes (e.g., delirium and functional decline) at 100%, providing nursing education and improving retention at 100%, enhancing patient and family satisfaction with care at 92.3%, raising visibility for geriatrics at 92.3%, and improving quality of care at 84.6%.
Conclusion:
This report describes the real-world implementation of HELP across 13 sites, documents their local adaptations and successes, and provides insight into how motivated institutions can create change to improve quality of care for older persons.
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