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A Randomized Clinical Trial of Outpatient Geriatric Evaluation and Management
Author(s) -
Boult Chad,
Boult Lisa B.,
Morishita Lynne,
Dowd Bryan,
Kane Robert L.,
Urdangarin Cristina F.
Publication year - 2001
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1046/j.1532-5415.2001.49076.x
Subject(s) - medicine , randomized controlled trial , odds ratio , confidence interval , ambulatory , randomization , geriatrics , health care , depression (economics) , population , clinical trial , ambulatory care , activities of daily living , gerontology , physical therapy , emergency medicine , psychiatry , environmental health , economics , macroeconomics , economic growth
OBJECTIVES: To measure the effects of outpatient geriatric evaluation and management (GEM) on high‐risk older persons' functional ability and use of health services. DESIGN: Randomized clinical trial. SETTING: Ambulatory clinic in a community hospital. PARTICIPANTS: A population‐based sample of community‐dwelling Medicare beneficiaries age 70 and older who were at high risk for hospital admission in the future (N = 568). INTERVENTION: Comprehensive assessment followed by interdisciplinary primary care. MEASUREMENTS: Functional ability, restricted activity days, bed disability days, depressive symptoms, mortality, Medicare payments, and use of health services. Interviewers were blinded to participants' group status. RESULTS: Intention‐to‐treat analysis showed that the experimental participants were significantly less likely than the controls to lose functional ability (adjusted odds ratio (aOR) = 0.67, 95% confidence interval (CI) = 0.47–0.99), to experience increased health‐related restrictions in their daily activities (aOR = 0.60, 95% CI = 0.37–0.96), to have possible depression (aOR = 0.44, 95% CI = 0.20–0.94), or to use home healthcare services (aOR = 0.60, 95% CI = 0.37–0.92) during the 12 to 18 months after randomization. Mortality, use of most health services, and total Medicare payments did not differ significantly between the two groups. The intervention cost $1,350 per person. CONCLUSION: Targeted outpatient GEM slows functional decline.