A controlled trial of outpatient geriatric evaluation and management

Abstract

Objective: To evaluate the effects of targeted outpatient geriatric evaluation and management (GEM).

Design: Controlled clinical trial. Elderly persons were identified as being at high risk for hospital admission on the basis of their responses to a short, mailed, self-administered questionnaire. The high-risk elders who chose to participate in the GEM program were compared to those who continued to receive usual care.

Setting: Outpatient GEM clinic at an urban university hospital.

Subjects: Elderly Medicaid recipients whose probability of repeated hospital admission (Pra) within 4 years was calculated as 40% or greater (Pra > or = 0.40).

Main outcome measures: Mortality, use of institutional services, satisfaction.

Results: Of the 1210 persons who were sent questionnaires, 624 responded (response rate = 51.6%), of whom 154 (24.7%) were deemed to be a high risk for hospitalization. Of these, 43 received GEM (experimental subjects); 111 received usual care (controls). At baseline, the experimental and control groups' demographic and health-related characteristics did not differ significantly. The average experimental subject was 76.5 years old, had 9.6 significant medical problems, and took 6.7 significant long-term prescription medications. During the program's first 17 months of follow-up, the experimental subjects had lower annual rates of mortality (2.9% vs 19.2%, P = 0.03) and emergency room use (0.6 vs 1.0 visits, P = 0.01) than did the controls. The experimental subjects also tended to use nursing homes, but not hospitals, at a lower rate than the controls. All of the experimental subjects rated the program as either excellent (81.0%) or good (19.0%); 100% said they would recommend it to others. Their established primary physicians rated the GEM services as appropriate and helpful.

Conclusion: Targeted outpatient GEM was associated with reduced mortality, reduced use of emergency rooms, and a trend toward reduced use of nursing homes.