title: The effectiveness and efficiency of outpatient geriatric evaluation and management.
abstract: OBJECTIVE
  To compare the effectiveness of geriatric evaluation and management (GEM) with usual primary care (UPC).
  
  
  METHODS
  A 2 x 3 randomized controlled group design.
  
  
  METHODS
  A 450-bed Department of Veterans Affairs Medical Center (VAMC) that provides general medical and surgical care to eligible veterans.
  
  
  METHODS
  One-hundred sixty male subjects (mean age = 72 years), who were above average users of VAMC outpatient clinics and who had at least two Activity of Daily Living (ADL) or Instrumental Activity of Daily Living (IADL) impairments, were assigned to GEM (n = 80) or UPC (n = 80).
  
  
  METHODS
  Data were collected about patients' (1) health and functional status, (2) psychosocial well-being, (3) quality of health and social care, (4) health care utilization, and (5) health care costs. Data were obtained before randomization, and again at 8 and 16 months.
  
  
  RESULTS
  The results indicated that GEM was more effective than UPC in improving some aspects of the quality of health and social care and in increasing patient satisfaction with care. GEM also reduced emergency room use, and showed a trend toward decreasing acute admissions. It was not effective, however, in improving patients' psychosocial well-being. Except for a short-term survival advantage, it was also not effective in preventing deterioration in their health and functional status. Further, GEM did not reduce overall utilization of outpatient or inpatient services, and it significantly increased total outpatient health care costs.
  
  
  CONCLUSIONS
  Outpatient GEM improves patient satisfaction and some aspects of the quality of care patients' receive but does not reduce the cost of outpatient or inpatient care. Longer-term follow-up studies are needed to determine whether reductions in emergency room use and inpatient admissions persist over time and result in reductions in the overall cost of care.
authors.affiliation: Samuel S. Stratton Department of Veterans Affairs Medical Center (VAMC), Albany, New York 12208, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Engelhardt
authors.forename: R W
authors.initials: RW
authors.lastname: Toseland
authors.forename: J C
authors.initials: JC
authors.lastname: O'Donnell
authors.forename: J T
authors.initials: JT
authors.lastname: Richie
authors.forename: D
authors.initials: D
authors.lastname: Jue
authors.forename: S
authors.initials: S
authors.lastname: Banks
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D015577:Geriatric Assessment; D005853:Geriatrics / Q000379:methods / Q000592:standards; D006302:Health Services Research; D006304:Health Status; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York; D010043:Outcome and Process Assessment, Health Care; D017060:Patient Satisfaction; D011320:Primary Health Care; D011787:Quality of Health Care / Q000191:economics