Reducing the burden of morbidity and medical utilization of older patients by outpatient geriatric services: implications to primary health-care settings.
OBJECTIVE
That geriatric evaluation and management (GEM) is associated with better quality of care for elderly patients has been reported by previous studies, but evidence supporting that GEM can reduce the burden of morbidity (BOM) was lacking. The aim of this study was to evaluate the benefits of outpatient GEM on reducing BOM and medical utilization in Taiwan.


METHODS
Data of this retrospective case-control study were obtained from the 2004-2006 Taiwan National Health Insurance Research Database (NHIRD). Patients who attended the outpatient GEM program for over 6 months in a tertiary medical center in 2005 were enrolled as the case group, and a 1:5 age and gender-matched control group was formed by randomly-selected patients from the same medical center for comparisons. BOM was obtained by applying the Adjusted Clinical Group (ACG) program, and medical utilization variables were totalled for each patient from the NHIRD. Patients were further reassigned to two morbidity categories, the low (resource utilization bands ≤ 3) and high (resource utilization bands > 3) morbidity category, according to their degree of morbidity before statistical analyses.


RESULTS
Data of 4254 elderly patients (709 cases, 3545 controls) were included in the study. BOM and medical utilization were increased in both groups in both morbidity categories during the study period. However, the growth of BOM, total medical expenditure, number of emergency department visit, and days and expenditure of hospitalization were significantly reduced in the case than the control group in the low morbidity category, not the high morbidity category.


CONCLUSIONS
Outpatient GEM could effectively reduce growth of BOM and medical utilization for relatively healthy elderly patients in Taiwan where elderly patients have relatively free access to general and specialty care. The results of this study implied the potential benefits of systematically implementing GEM in primary health-care settings to improve the quality of care and slow down the growth of BOM for elderly patients.
Department of Medical Affairs and Planning, National Yang Ming University, Taipei, Taiwan.
Ping
P
Tao
Ming-Hsien
MH
Lin
Li-Ning
LN
Peng
Wui-Chiang
WC
Lee
Fang-Yue
FY
Lin
Chen-Hsen
CH
Lee
Ching-Wen
CW
Chien
Vivien
V
Shen
Liang-Kung
LK
Chen
D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D005260:Female; D005853:Geriatrics; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D009017:Morbidity; D016012:Poisson Distribution; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013624:Taiwan