A controlled trial of outpatient geriatric evaluation and management.
OBJECTIVE
To evaluate the effects of targeted outpatient geriatric evaluation and management (GEM).


METHODS
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.


METHODS
Outpatient GEM clinic at an urban university hospital.


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


METHODS
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.


CONCLUSIONS
Targeted outpatient GEM was associated with reduced mortality, reduced use of emergency rooms, and a trend toward reduced use of nursing homes.
Boult
C
C
Dept. of Family Practice and Community Health, University of Minnesota Medical School, Minneapolis 55414-3034.
Boult
L
L
Murphy
C
C
Ebbitt
B
B
Luptak
M
M
Kane
R L
RL
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D002986:Clinical Trials as Topic; D005260:Female; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000706:statistics & numerical data; D006304:Health Status; D006760:Hospitalization; D006801:Humans; D008297:Male; D009026:Mortality; D017060:Patient Satisfaction; D012307:Risk Factors; D011795:Surveys and Questionnaires