title: The effect of geriatrics evaluation and management on nursing home use and health care costs: results from a randomized trial.
abstract: BACKGROUND
  The Geriatric Evaluation and Management study was developed to assess the impact of a comprehensive geriatric assessment service on the care of the elderly.
  
  
  OBJECTIVE
  We sought to evaluate the cost and clinical impact of inpatient units and outpatient clinics for geriatric evaluation and management.
  
  
  METHODS
  We undertook a prospective, randomized, controlled trial using a 2x2 factorial design, with 1-year follow-up.
  
  
  METHODS
  A total of 1388 participants hospitalized on either a medical or surgical ward at 11 participating Veterans Affairs medical centers were randomized to receive either inpatient geriatric unit (GEMU) or usual inpatient care (UCIP), followed by either outpatient care from a geriatric clinic (GEMC) versus usual outpatient care (UCOP).
  
  
  METHODS
  We measured health care utilization and costs.
  
  
  RESULTS
  Patients assigned to the GEMU had a significantly decreased rate of nursing home placement (odds ratio=0.65; P=0.001). Neither the GEMU nor GEMC had any statistically significant improvement effects on survival and only modest effects on health status. There were statistically insignificant mean cost savings of $1027 (P=0.29) per patient for the GEMU and $1665 (P=0.69) per patient for the GEMC.
  
  
  CONCLUSIONS
  Inpatient or outpatient geriatric evaluation and management units didn't increase the costs of care. Although there was no effect on survival and only modest effects on SF-36 scores at 1-year follow-up, there was a statistically significant reduction in nursing home admissions for patients treated in the GEMU.
authors.affiliation: Health Economics Resource Center, VA Palo Alto Health Care System, Palo Alto, and Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA. cphibbs@stanford.edu
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: Phibbs
authors.forename: Jon-Erik C
authors.initials: JE
authors.lastname: Holty
authors.forename: Mary K
authors.initials: MK
authors.lastname: Goldstein
authors.forename: Alan M
authors.initials: AM
authors.lastname: Garber
authors.forename: Yajie
authors.initials: Y
authors.lastname: Wang
authors.forename: John R
authors.initials: JR
authors.lastname: Feussner
authors.forename: Harvey J
authors.initials: HJ
authors.lastname: Cohen
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D015577:Geriatric Assessment; D017048:Health Care Costs; D006801:Humans; D009735:Nursing Homes / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs