title: A controlled trial of inpatient and outpatient geriatric evaluation and management.
abstract: BACKGROUND
  Over the past 20 years, both inpatient units and outpatient clinics have developed programs for geriatric evaluation and management. However, the effects of these interventions on survival and functional status remain uncertain.
  
  
  METHODS
  We conducted a randomized trial involving frail patients 65 years of age or older who were hospitalized at 11 Veterans Affairs medical centers. After their condition had been stabilized, patients were randomly assigned, according to a two-by-two factorial design, to receive either care in an inpatient geriatric unit or usual inpatient care, followed by either care at an outpatient geriatric clinic or usual outpatient care. The interventions involved teams that provided geriatric assessment and management according to Veterans Affairs standards and published guidelines. The primary outcomes were survival and health-related quality of life, measured with the use of the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), one year after randomization. Secondary outcomes were the ability to perform activities of daily living, physical performance, utilization of health services, and costs.
  
  
  RESULTS
  A total of 1388 patients were enrolled and followed. Neither the inpatient nor the outpatient intervention had a significant effect on mortality (21 percent at one year overall), nor were there any synergistic effects between the two interventions. At discharge, patients assigned to the inpatient geriatric units had significantly greater improvements in the scores for four of the eight SF-36 subscales, activities of daily living, and physical performance than did those assigned to usual inpatient care. At one year, patients assigned to the outpatient geriatric clinics had better scores on the SF-36 mental health subscale, even after adjustment for the score at discharge, than those assigned to usual outpatient care. Total costs at one year were similar for the intervention and usual-care groups.
  
  
  CONCLUSIONS
  In this controlled trial, care provided in inpatient geriatric units and outpatient geriatric clinics had no significant effects on survival. There were significant reductions in functional decline with inpatient geriatric evaluation and management and improvements in mental health with outpatient geriatric evaluation and management, with no increase in costs.
authors.affiliation: Veterans Affairs Medical Center, Durham, NC 27705, USA.
authors.forename: Harvey Jay
authors.initials: HJ
authors.lastname: Cohen
authors.forename: John R
authors.initials: JR
authors.lastname: Feussner
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Molly
authors.initials: M
authors.lastname: Carnes
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Hamdy
authors.forename: Frank
authors.initials: F
authors.lastname: Hsieh
authors.forename: Ciaran
authors.initials: C
authors.lastname: Phibbs
authors.forename: Donald
authors.initials: D
authors.lastname: Courtney
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Lyles
authors.forename: Conrad
authors.initials: C
authors.lastname: May
authors.forename: Cynthia
authors.initials: C
authors.lastname: McMurtry
authors.forename: Leslye
authors.initials: L
authors.lastname: Pennypacker
authors.forename: David M
authors.initials: DM
authors.lastname: Smith
authors.forename: Nina
authors.initials: N
authors.lastname: Ainslie
authors.forename: Thomas
authors.initials: T
authors.lastname: Hornick
authors.forename: Kayla
authors.initials: K
authors.lastname: Brodkin
authors.forename: Philip
authors.initials: P
authors.lastname: Lavori
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000553:Ambulatory Care / Q000379:methods; D000704:Analysis of Variance; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D005853:Geriatrics / Q000379:methods*; D006299:Health Services for the Aged / Q000458:organization & administration; D006760:Hospitalization; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008603:Mental Health; D010044:Outpatient Clinics, Hospital; D010348:Patient Care Team; D016016:Proportional Hazards Models; D016019:Survival Analysis; D014481:United States