A randomized clinical trial of outpatient geriatric evaluation and management.
OBJECTIVE
To measure the effects of outpatient geriatric evaluation and management (GEM) on high-risk older persons' functional ability and use of health services.


METHODS
Randomized clinical trial.


METHODS
Ambulatory clinic in a community hospital.


METHODS
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).


METHODS
Comprehensive assessment followed by interdisciplinary primary care.


METHODS
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.


CONCLUSIONS
Targeted outpatient GEM slows functional decline.
Boult
C
C
Department of Family Practice and Community Health, University of Minnesota School of Public Health, Minneapolis, USA.
Boult
L B
LB
Morishita
L
L
Dowd
B
B
Kane
R L
RL
Urdangarin
C F
CF
D000368:Aged; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010045:Outpatients; D010348:Patient Care Team