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Cost Analysis of the Geriatric Resources for Assessment and Care of Elders Care Management Intervention
Author(s) -
Counsell Steven R.,
Callahan Christopher M.,
Tu Wanzhu,
Stump Timothy E.,
Arling Gregory W.
Publication year - 2009
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 - 10.1111/j.1532-5415.2009.02383.x
Subject(s) - medicine , geriatric care , geriatrics , gerontology , intervention (counseling) , nursing , family medicine , intensive care medicine , psychiatry
OBJECTIVES: To provide, from the healthcare delivery system perspective, a cost analysis of the Geriatric Resources for Assessment and Care of Elders (GRACE) intervention, which is effective in improving quality of care and outcomes. DESIGN: Randomized controlled trial with physicians as the unit of randomization. SETTING: Community‐based primary care health centers. PARTICIPANTS: Nine hundred fifty‐one low‐income seniors aged 65 and older; 474 participated in the intervention and 477 in usual care. INTERVENTION: Home‐based care management for 2 years by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocols for common geriatric conditions. MEASUREMENTS: Chronic and preventive care costs, acute care costs, and total costs in the full sample (n=951) and predefined high‐risk (n=226) and low‐risk (n=725) groups. RESULTS: Mean 2‐year total costs for intervention patients were not significantly different from those for usual care patients in the full sample ($14,348 vs $11,834; P =.20) and high‐risk group ($17,713 vs $18,776; P =.38). In the high‐risk group, increases in chronic and preventive care costs were offset by reductions in acute care costs, and the intervention was cost saving during the postintervention, or third, year ($5,088 vs $6,575; P <.001). Mean 2‐year total costs were higher in the low‐risk group ($13,307 vs $9,654; P =.01). CONCLUSION: In patients at high risk of hospitalization, the GRACE intervention is cost neutral from the healthcare delivery system perspective. A cost‐effectiveness analysis is needed to guide decisions about implementation in low‐risk patients.