Bringing Geriatricians to the Front Lines: Evaluation of a Quality Improvement Intervention in Primary Care

Abstract

Background: Frail elders often receive low-quality primary care, yet the optimal role of geriatricians in primary care settings remains uncertain. We evaluated the health utilization impacts of an innovative intervention emphasizing chronic disease self-management and physical activity promotion among frail elders in primary care.Methods: The intervention was implemented within two primary care practices at a single clinic serving a large population of frail elders enrolled in a western Washington health plan. Subjects included older patients (age >65 years) with disproportionate baseline outpatient service use who attended two on-site visits with a geriatrician during which each received comprehensive assessment and a problemsolving intervention to enhance chronic disease self-management and promote physical activity (N ‫؍‬ 146). Our evaluation had a retrospective matched cohort design. Controls receiving primary care at other health plan clinics were matched 3:1 to intervention subjects by sex and a propensity score (N ‫؍‬ 437), which was computed using demographic, clinical, and health care utilization factors that were predictive of attending the intervention. Among intervention subjects and controls following the intervention, we compared relative rates of hospitalization, outpatient and specialty visits, nursing home admission, mortality, and prescription of selected high-risk medications, as well as total health care costs.Results: From March 2002 to November 2003, the geriatrician evaluated 146 of 725 elderly subjects (20%) in the two primary care practices. During a mean follow-up of 1.3 years, intervention subjects had a reduced rate of hospitalization relative to matched controls (incidence rate ratio 0.57; 95% CI: 0.37 to 0.86; P < .01). Intervention and control subjects did not have significantly different rates of specialty visits, outpatient visits, nursing home admission, mortality, or high-risk prescriptions. Relative to matched controls during follow-up, total health care costs were 26.3% lower among intervention subjects (95% CI: 1.3%, 44.9%; P ‫؍‬ .04).Conclusions: Outpatient geriatric interventions emphasizing collaboration between geriatricians and primary care physicians, chronic disease self-management, and physical activity may reduce hospitalization risk and total health care costs among vulnerable elders. (J Am Board Fam Med 2006;19: 331-9.)

Is Geriatric Care Associated with Less Emergency Department Use?

“…Increased provision of collaborative care could allow the existing supply of geriatricians to reach a larger number of individuals. J Am Geriatr Soc 61: [4][5][6][7][8][9][10][11]2013.…”

Confronting The Growing Burden Of Chronic Disease: Can The U.S. Health Care Workforce Do The Job?

“…18 Adding geriatricians to primary care reduces hospitalizations and total health care costs. 19 Public health personnel are important additions to the multidisciplinary team. Public health interventions for primary prevention of chronic illness have been highly effective in tobacco control.…”

Benefits of active participation of family physicians in geriatric consultations

“…16,19,[21][22][23][24] In contrast, other studies have shown that geriatric assessment was ineffective in preserving or improving the functional, 15,16,19,25,26 mental 16,25,26 and affective 26 status, as well as social activity, 26 quality of life, 26 prevention of emergency room visits, 21 hospitalizations, 15,16,18,26,27 institutionalization 10,18,21,24,25 and mortality. 9,10,14,15,18,19,21,[25][26][27] At least in part, the success of geriatric assessment depends on the maximum implementation of the recommendations resulting from this assessment by family doctors. 11,28,29 It has been found that the degree of implementation of these recommendations is far from satisfactory, ranging from 49% to 79%.…”