How Does the Team Approach to Outpatient Geriatric Evaluation Compare with Traditional Care: A Report of a Randomized Controlled Trial

Abstract

Although team-oriented geriatric assessment clinics are growing throughout the country, little documentation exists regarding their clinical efficacy, cost-effectiveness, or impact on patient functioning and well-being. This report describes a randomized controlled clinical trial to evaluate the effectiveness of a team-oriented geriatric assessment approach compared to traditional care. One hundred-seventeen subjects 65 years of age and over, meeting eligibility criteria to target frail older persons with changing medical and social needs, were randomly assigned to receive a comprehensive geriatric assessment by a multidisciplinary team (treatment) or by one of a panel of community internists who were reimbursed according to their usual and customary fee (controls). Extensive analysis of baseline information failed to identify any significant differences between groups. Over the 1-year follow-up period, treatment participants experienced 26 hospital admissions and used 670 hospital days compared with 23 admissions and 1113 days for controls (a 39.8% difference). Annual hospital costs averaged $4297 for treatment subjects and $7018 for controls. Overall institutional costs including hospital and nursing home care revealed an average saving of $2189 per person for treatment subjects compared with controls, a 25% reduction. A small proportion of subjects accounted for this difference. No significant differences were noted in patient or caregiver satisfaction with the evaluation process, functional ability, or health status. These findings suggest that team-oriented outpatient geriatric assessment provides a promising way to deliver high-quality, satisfying care to older persons without increasing (and possibly decreasing) health care costs.

Interventions to prevent disability in frail community-dwelling older persons: an overview

“…Health education is applied in four interventions (Boult et al 2001;Gitlin et al 2006;Markle-Reid et al 2006;Melis et al 2008;Rubenstein et al 2007). A complication in drawing conclusions about elements that contributed to effectiveness is the presence of identical features in the six clinical trials that did not show any differences for disability Gagnon et al 1999;Rockwood et al 2000;Rubenstein et al 2007;Williams et al 1987). There is, however, some indication that case management, individualized treatment, multidimensional assessment, and ongoing evaluation and monitoring are relevant features in this type of CGA interventions.…”

“…Home visits (Williams et al 1987;Bernabei et al 1998;Rockwood et al 2000;Landi et al 2001;Melis et al 2008), telephone calls (Rubenstein et al 2007), or a combination of both (Melin and Bygren, 1992;Phelan et al 2004;Gitlin et al 2006;Markle-Reid et al 2006) are repeatedly used. In three studies, assessment and treatment were done in a (geriatric) clinic (Cohen et al 2002;.…”

Nurse-Physician Relationships in Hospitals: 20 000 Nurses Tell Their Story

“…23,24 Collaborative nurse-physician relationships also lead to better patient and organizational outcomes such as decreased length of stay and net reduction in treatment costs without reduction in functional levels or decrease in satisfaction among patients. 25 In addition to patient outcomes, high-quality nurse-physician relations result in increased satisfaction among nurses and physicians and increased autonomy for nurses. [9][10][11][12]26,27 …”

Effect of a Practice Guideline on the Process of Emergency Department Care of Falls in Elder Patients

“…These strategies have been successfully used by others with significant results. [32][33][34][35][36][37] …”