title: Cost analysis of the Geriatric Resources for Assessment and Care of Elders care management intervention.
abstract: OBJECTIVE
  To provide, from the healthcare delivery system perspective, a cost analysis of the Geriatric Resources for Assessment and Care of Elders (GRACE) intervention, which is effective in improving quality of care and outcomes.
  
  
  METHODS
  Randomized controlled trial with physicians as the unit of randomization.
  
  
  METHODS
  Community-based primary care health centers.
  
  
  METHODS
  Nine hundred fifty-one low-income seniors aged 65 and older; 474 participated in the intervention and 477 in usual care.
  
  
  METHODS
  Home-based care management for 2 years by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocols for common geriatric conditions.
  
  
  METHODS
  Chronic and preventive care costs, acute care costs, and total costs in the full sample (n5951) and predefined high-risk (n5226) and low-risk (n5725) groups.
  
  
  RESULTS
  Mean 2-year total costs for intervention patients were not significantly different from those for usual care patients in the full sample ($14,348 vs $11,834; P=.20) and high-risk group ($17,713 vs $18,776; P=.38). In the high-risk group, increases in chronic and preventive care costs were offset by reductions in acute care costs, and the intervention was cost saving during the postintervention, or third, year ($5,088 vs $6,575; P<.001). Mean 2- year total costs were higher in the low-risk group ($13,307 vs $9,654; P=.01).
  
  
  CONCLUSIONS
  In patients at high risk of hospitalization, the GRACE intervention is cost neutral from the healthcare delivery system perspective. A cost-effectiveness analysis is needed to guide decisions about implementation in low-risk patients.
authors.affiliation: Center for Aging Research, School of Medicine, Indiana University, Indianapolis, Indiana 46202, USA. scounsel@iupui.edu
authors.forename: Steven R
authors.initials: SR
authors.lastname: Counsell
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Callahan
authors.forename: Wanzhu
authors.initials: W
authors.lastname: Tu
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Stump
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Arling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003365:Costs and Cost Analysis; D019468:Disease Management; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007196:Indiana; D008297:Male; D017146:Models, Organizational; D020380:Needs Assessment; D010348:Patient Care Team / Q000191:economics*; D011203:Poverty; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration; D017064:Process Assessment, Health Care
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