INPATIENT GERIATRIC EVALUATION AND MANAGEMENT UNITS (GEMS) IN THE VETERANS HEALTH SYSTEM - DIAMONDS IN THE ROUGH

Background, Research suggests that inpatient geriatric evaluation and management units (GEMs), which undertake interdisciplinary diagnosis t o improve the health of frail. elderly patients, are effective. The De partment of Veterans Affairs (VA) helped pioneer U.S. GEMs and mandate s that every facility shall have a GEM by 1996. We conducted a populat ion survey of VA GEMs in 1991 to assess their dissemination. Methods. Various organizational and performance characteristics of GEMs were en tered in a data base derived from a piloted questionnaire and administ rative records. Basic criteria from consensus reports were used to cla ssify and compare ''standard'' and ''nonstandard'' GEMs. The criteria covered performance of assessment, team structure, patient selection, GEM location, and treatment functions. We analyzed the effect of GEM t ype and other factors on length of stay and placement. Reasons for clo sure of GEMs inactive in 1991 were recovered, and GEMs active in 1991 but later closed are described. Results. As of 1991, 41 of 73 GEMs wer e classified as standard, and 32 nonstandard. Standard compared to non standard GEMs had shorter stays (25.4 vs 69.9 days; p <.001), higher h ome discharge rates (63.4% vs 40%; p < .001), and lower nursing home p lacement rates (19.1% vs 40.3%; p <.001). Eleven hospitals had closed their programs by 1991. By 1993, 6 additional GEMs had closed; all wer e nonstandard in 1991. Conclusions, Most VA GEMs are organized accordi ng td basic consensus standards, and appear to be discharging most pat ients back to the community after reasonably short stays. However, var ious resource constraints are common, apparently reflected in nonstand ard organization and GEM closure. Additional work is needed to monitor GEM proliferation, implementation, and performance in and out of the VA system.