The impact of 'comprehensive geriatric assessment (CGA)' implementation on the effectiveness and cost (CEA) of healthcare in an acute geriatric ward.
OBJECTIVE
to investigate the cost effectiveness of CGA in an acute geriatric ward.


METHODS
a non-randomized controlled trial was carried out at Dr. Cipto Mangunkusumo General Hospital from January to December 2005. The inclusion criteria were elderly patients with geriatric syndrome. Exclusion criteria were advanced malignancy, APACHE II score > 34,in-hospital mortality in the first 24 hours, move to another ward before completing CGA management, the presence of dementia. After patients were allocated into CGA and non-CGA group, effectiveness was assessed using ADL/WHO Unescap score, days of hospitalization, proportion of re-hospitalization, survival, quality of life score (EQ5D),patients and nurses satisfaction score. Cost effectiveness analysis was done using TreeAge-Pro 2004 software program.


RESULTS
the length of hospitalization was shorter in the CGA group than in non-CGA group (10.99 [0.79] days vs.20.16 [2.62] days; p=0.00). At the end of treatment, mean of ADL score changes was significantly higher in CGA group than non-CGA group. Mean of WHO-Unescap score changes in CGA group was higher than non-CGA group (0.71[0.04]vs 0.61 [0.04]; p=0.09). EQ5D-VAS score was also higher in CGA group (0.79[0,01] vs 0.75[0.01]; p=0,01). Survival proportion in CGA group was lower than non-CGA group(80.37% vs 86.92%; p>0.05). Rehospitalization proportion was higher in non-CGA group than in CGA group (21.5%vs 11.21%; p 0.04). Patient's satisfaction level was higher in CGA group (193.38 [1.25] vs 177.47 [3.04]; p=0.00).Nurse satisfaction level was also higher in CGA group than non-CGA group but not statistically significant (225.06[7.08] vs 220.06[8.26]; p=0.65).Mean of healthcare cost in non-CGA group was higher than in CGA group (Rp. 9,746,426.00 [1,180,331] vs Rp 4,760,965.00 [338,089]). Cost effectiveness analysis indicated that CGA was superior to conventional approach because for each point score of QALD's, total cost was lower in geriatric acute care unit than in conventional ward(Rp 418,199.00 vs Rp 628,695.00). Moreover, QALD's in CGA group was better than in non-CGA group (24.1 vs 22.8; p= 0.03).


CONCLUSIONS
the CGA approach is more cost effective compared to conventional approach. Quality adjusted life days are better in CGA group than in non-CGA group although survival is not statistically different. In CGA group, length of hospitalization was shorter, functional status and patient satisfaction is better in general. Working satisfaction of nurses in CGA group was not lower than in non CGA group.
Soejono
Czeresna Heriawan
CH
Department of Internal Medicine, Faculty of Medicine University of Indonesia-dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro No. 71, Jakarta. geriatri_fkuirscm@yahoo.com
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003191:Comprehensive Health Care / Q000191:economics* / Q000379:methods; D003362:Cost-Benefit Analysis; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D015397:Program Evaluation; D019057:Quality-Adjusted Life Years; D011795:Surveys and Questionnaires; D016019:Survival Analysis