The effectiveness and efficiency of outpatient geriatric evaluation and management (GEM) was compared with usual outpatient primary care (UPC). One hundred sixty frail elderly outpatients were assigned randomly to GEM or UPC and assessed at baseline and at 8 months on measures of (1) health and functional status, (2) psychosocial well-being, (3) quality of health and social care, (4) use of inpatient and outpatient services, and (5) cost of care. The results indicate that GEM was significantly more effective than UPC in reducing mortality, increasing patient satisfaction, and improving the quality of health and social care. However, it was not effective in reducing health care use or the cost of care.

The effectiveness and efficiency of outpatient geriatric evaluation and management (GEM) was compared to usual outpatient primary care (UPC). Although GEM had no overall impact on health care utilization or cost of care for the entire study period, significant reductions were found during the sixteen- to twenty-four-month study period, suggesting a possible investment effect. In the first eight months of the study, GEM patients incurred 34.8% more in health care costs than UPC patients, but in the final eight months of the study the cost of care for UPC patients exceeded that for GEM patients by 37.8%.

Outpatient GEM improves patient satisfaction and some aspects of the quality of care patients' receive but does not reduce the cost of outpatient or inpatient care. Longer-term follow-up studies are needed to determine whether reductions in emergency room use and inpatient admissions persist over time and result in reductions in the overall cost of care.

A strategic partnership between a nursing care coordination telephone support program and a home healthcare agency was evaluated. The study was supported by the Centers for Medicare and Medicaid. According to the results, the partnership was a clinically effective service that proved satisfactory to family caregivers, improved the use of community services, and reduced inpatient use and costs without affecting mortality.

Reports in the end-of-life literature reveal that patients and health care professionals, including social workers, nurses, and physicians, avoid discussions about preparation for such care. End-of-life care discussion barriers include, but are not limited to, professionals feeling unprepared to have the discussions and patients' lack of readiness to discuss planning for this care. Another barrier is the lack of a structured framework to initiate these discussions, especially with clients with advanced illnesses who may not acknowledge that they are at high risk for needing end-of-life care in the future. In a controlled trial of an Advanced Illness Coordinated Care Program, social workers initiated end-of-life planning discussions using the Stages of Change model (SOC). This article describes how the social workers introduced end-of-life planning discussions using the SOC conceptual structure to illustrate the application of a conceptual framework for professionals working with advanced illness populations.