title: Is geriatric care associated with less emergency department use?
abstract: OBJECTIVE
  To determine whether community-dwelling individuals and nursing home (NH) residents treated by a geriatrician were less likely to use the emergency department (ED) than individuals treated by other physicians.
  
  
  METHODS
  Retrospective cohort study using data from a national sample of older adults with a history of cardiovascular disease.
  
  
  METHODS
  Ambulatory care or NH.
  
  
  METHODS
  Fee-for-service Medicare beneficiaries aged 66 and older diagnosed with one or more geriatric conditions from 2004 to 2007 and followed for up to 3 years.
  
  
  METHODS
  Emergency department use was measured in Medicare inpatient and outpatient claims; geriatric care was measured as geriatrician visits in ambulatory or NH settings coded in physician claims.
  
  
  RESULTS
  Multivariable analyses controlled for observed and unobserved subject characteristics that were constant during the study period. For community-dwelling participants, one or more nonhospital geriatrician visits in a 6-month period were associated with 11.3% lower ED use the following month (95% confidence interval (CI) = 7.5-15.0, N = 287,259). Participants who received primary care from geriatricians were less likely to have ED use than those who had traditional primary care. Results for participants who received consultative care from geriatricians were similar to those for participants who received primary care from geriatricians. Results for NH residents (N = 66,551) were similar to those for community-dwelling participants.
  
  
  CONCLUSIONS
  Geriatric care was associated with an estimated 108 fewer ED visits per 1,000 community-dwelling residents and 133 fewer ED visits per 1,000 NH residents per year. Geriatric consultative care in collaboration with primary care providers may be as effective in reducing ED use as geriatric primary care. Increased provision of collaborative care could allow the existing supply of geriatricians to reach a larger number of individuals.
authors.affiliation: Mathematica Policy Research, Inc., Washington, District of Columbia 20002, USA. ldarcy@mathematica-mpr.com
authors.forename: Laura P
authors.initials: LP
authors.lastname: D'Arcy
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.forename: Marisa E
authors.initials: ME
authors.lastname: Domino
authors.forename: Laura C
authors.initials: LC
authors.lastname: Hanson
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000706:statistics & numerical data*; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States