title: Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial.
abstract: OBJECTIVE
  To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care.
  
  
  METHODS
  Assessor-blinded, single-center randomized controlled trial.
  
  
  METHODS
  AGU in an acute hospital in southeastern Sweden.
  
  
  METHODS
  Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years.
  
  
  METHODS
  Participants in the IG received CGA-based care at the AGU in addition to usual care.
  
  
  METHODS
  The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant' sense of security in care, and health-related quality of life (HRQoL).
  
  
  RESULTS
  Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371 £ (39,947 £) and 30,490 £ (31,568 £; P = .432).
  
  
  CONCLUSIONS
  This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people.
  
  
  BACKGROUND
  clinicaltrials.gov identifier: NCT01446757.
authors.affiliation: Department of Geriatric Medicine and Department of Social and Welfare Studies, Linköping University, Linköping, Sweden; Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden. Electronic address: anne.ekdahl@ki.se.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Ekdahl
authors.affiliation: Local Health Care Research and Development Unit, County Council in Östergötland, Linköping University, Linköping, Sweden.
authors.forename: Ann-Britt
authors.initials: AB
authors.lastname: Wirehn
authors.affiliation: Division of Health Care Analysis, Department of Medical and Health Sciences, Faculty of Health Sciences, Linkoping University, Linköping, Sweden.
authors.forename: Jenny
authors.initials: J
authors.lastname: Alwin
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Mitra
authors.initials: M
authors.lastname: Unosson
authors.affiliation: Division of Health Care Analysis, Department of Medical and Health Sciences, Faculty of Health Sciences, Linkoping University, Linköping, Sweden.
authors.forename: Magnus
authors.initials: M
authors.lastname: Husberg
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Eckerblad
authors.affiliation: Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; Department of Advanced Home Care and Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
authors.forename: Anna
authors.initials: A
authors.lastname: Milberg
authors.affiliation: Division of Health Care Analysis, Department of Medical and Health Sciences, Faculty of Health Sciences, Linkoping University, Linköping, Sweden.
authors.forename: Barbro
authors.initials: B
authors.lastname: Krevers
authors.affiliation: Division of Health Care Analysis, Department of Medical and Health Sciences, Faculty of Health Sciences, Linkoping University, Linköping, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Carlsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000458:organization & administration*; D002423:Cause of Death; D003362:Cost-Benefit Analysis; D005260:Female; D015577:Geriatric Assessment; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D011788:Quality of Life; D016037:Single-Blind Method; D013548:Sweden / Q000453:epidemiology
keywords: Comprehensive geriatric assessment; ambulatory geriatric care; costs; hospitalization; multimorbidity; randomized controlled trial; security