A randomized clinical trial of outpatient geriatric evaluation and management

J Am Geriatr Soc. 2001 Apr;49(4):351-9. doi: 10.1046/j.1532-5415.2001.49076.x.

Abstract

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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • Female
  • Geriatric Assessment*
  • Humans
  • Male
  • Outcome and Process Assessment, Health Care
  • Outpatients
  • Patient Care Team