Reducing hospital costs for the geriatric patient admitted from the emergency department: a randomized trial.
OBJECTIVE
To test the impact of a geriatric evaluation and management model on the costs of acute hospital management of emergently admitted older adults.


METHODS
Randomized controlled trial. Patients were followed in the acute hospital from admission through discharge. Results based on both univariate and multiple regression analyses.


METHODS
Private, nonprofit, academic medical center in a densely populated urban area.


METHODS
Adults 70 years of age and older admitted from the Emergency Department to the medicine service (non-ICU admission) who did not have an internist on staff at the admitting hospital. Of 141 randomized patients, 111 (78.7%) met eligibility criteria.


METHODS
Assignment of a geriatrician and a social worker as the primary managing team during the hospital stay.


METHODS
Length of stay, total cost of acute hospital care, cost of laboratory, pharmacy, and rehabilitation services.


RESULTS
Patients in the intervention group had 2.1 fewer days of hospitalization, but this shorter length of stay was not statistically significant (P = 0.108). There were no differences in mortality or discharge disposition. In risk-adjusted, multiple regression analysis the intervention group had a statistically significant lower predicted total cost per patient than the usual care group (-$2,544, P = 0.029); assignment to the intervention group was associated with a lower predicted cost per patient for laboratory (including cardiology graphics) services (P = 0.007) and pharmacy costs (P = 0.047).


CONCLUSIONS
When controlled for important predictors of expected resource use, care provided by a geriatric management team resulted in a significant reduction in the cost of hospitalization. A reduction in the cost of laboratory, cardiographic, and pharmacy services is consistent with the team's philosophy of defining the services needed based on goals related to functional outcomes.
Naughton
B J
BJ
Department of Medicine, Northwestern University, Chicago, IL.
Moran
M B
MB
Feinglass
J
J
Falconer
J
J
Williams
M E
ME
D000046:Academic Medical Centers / Q000191:economics*; D000368:Aged; D000369:Aged, 80 and over; D003363:Cost Control; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D005853:Geriatrics / Q000191:economics* / Q000458:organization & administration; D017721:Hospital Costs; D006786:Hospitals, Urban / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D017146:Models, Organizational; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration; D012044:Regression Analysis; D014481:United States