THE EFFECTIVENESS AND EFFICIENCY OF OUTPATIENT GERIATRIC EVALUATION AND MANAGEMENT

OBJECTIVES: To compare the effectiveness of geriatric evaluation and m anagement (CEM) with usual primary care (UPC). DESIGN: A 2x3 randomize d controlled group design. SETTING: A 450-bed Department of Veterans A ffairs Medical Center (VAMC) that provides general medical and surgica l care to eligible veterans. PARTICIPANTS: One-hundred sixty male subj ects (mean age = 72 years), who were above average users of VAMC outpa tient clinics and who had at least two Activity of Daily Living (ADL) or Instrumental Activity of Daily Living (IADL) impairments, were assi gned to GEM (n = 80) or UPC (n = 80). MEASUREMENTS: Data were collecte d about patients' (1) health and functional status, (2) psychosocial w ell-being, (3) quality of health and social care, (4) health care util ization, and (5) health care costs. Data were obtained before randomiz ation, and again at 8 and 16 months. RESULTS: The results indicated th at GEM was more effective than UPC in improving some aspects of the qu ality of health and social care and in increasing patient satisfaction with care. GEM also reduced emergency room use, and showed a trend to ward decreasing acute admissions. It was not effective, however, in im proving patients' psychosocial well-being. Except for a short-term sur vival advantage, it was also not effective in preventing deterioration in their health and functional status. Further, GEM did not reduce ov erall utilization of outpatient or inpatient services, and it signific antly increased total outpatient health care costs. CONCLUSIONS: Outpa tient GEM improves patient satisfaction and some aspects of the qualit y of care patients' receive but does not reduce the cost of outpatient or inpatient care. Longer-term follow-up studies are needed to determ ine whether reductions in emergency room use and inpatient admissions persist over time and result in reductions in the overall cost of care .