title: The effects of interdisciplinary outpatient geriatrics on the use, costs and quality of health services in the fee-for-service environment.
abstract: OBJECTIVE
  To evaluate the effect of interdisciplinary outpatient geriatrics on the use, cost, and quality of health services in a fee-for-service (FFS) environment of two networks of primary care clinics operated by a not-for-profit provider organization in Dallas County, Texas.
  
  
  METHODS
  The Senior Health Network (SHN) provides interdisciplinary primary care to patients aged 55 years or older; the Health Texas Provider Network (HTPN) provides "usual" primary care to patients of all ages. We conducted a two-year retrospective cohort study of 13,098 fee-for-service Medicare beneficiaries who had 2+ visits to one of the networks in 2000. In the SHN, interdisciplinary teams supplemented primary care with social services, specialized clinics, and health education. We compared the use, cost and quality of health services, as reflected by paid Medicare claims, provided to eligible patients in the SHN vs the HTPN.
  
  
  RESULTS
  Medicare payments for hospital, skilled nursing facility, and home health care services were lower for SHN patients than HTPN patients (-32.7%, -19.8%, and -23.8%, respectively, p<or=0.05). SHN patients had a lower likelihood of admission to hospitals for treatment of five "ambulatory care sensitive conditions" (aOR 0.69, 95% CI 0.58- 0.81), and they were less likely to receive several preventive services. Total Medicare payments for the two cohorts did not differ significantly.
  
  
  CONCLUSIONS
  Interdisciplinary outpatient geriatric care in a FFS setting has the potential to avert hospital admissions for ambulatory care sensitive conditions and to reduce Medicare payments for hospital, skilled nursing facility, and home health care services.
authors.affiliation: Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. jfamadas@jhsph.edu
authors.forename: Joanna Case
authors.initials: JC
authors.lastname: Famadas
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Frick
authors.forename: Ziad R
authors.initials: ZR
authors.lastname: Haydar
authors.forename: David
authors.initials: D
authors.lastname: Nicewander
authors.forename: David
authors.initials: D
authors.lastname: Ballard
authors.forename: Chad
authors.initials: C
authors.lastname: Boult
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data*; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D018588:Fee-for-Service Plans / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data*; D018574:Home Care Agencies / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data; D010348:Patient Care Team / Q000191:economics* / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000191:economics / Q000706:statistics & numerical data; D013781:Texas / Q000453:epidemiology; D014481:United States / Q000453:epidemiology