Long-Term Effects of Outpatient Geriatric Evaluation and Management on Health Care Utilization, Cost, and Survival

Abstract

Purpose: The long-term effectiveness and efficiency of an outpatient geriatric evaluation and management (GEM) program was compared to usual primary care (UPC). Design and Method: A randomized controlled group design was used. Health care utilization, cost of care, and survival were assessed during a 48-month period among a sample of 160 male veterans age 55 and over who were above-average users of outpatient services. Results: The results indicate that GEM patients incurred significantly lower overall health care costs than UPC patients by 24 months and that cost savings plateaued during the 24- to 48-month period. Cost savings were due primarily to fewer hospital days of care. No significant differences were found in survival. Implications: Results of this follow-up study suggest that outpatient GEMoffers a specialized health delivery option for frail older persons that may reduce costs over the long term without having a negative impact on survival rates.

Integrated Primary Care and Social Work: A Systematic Review

“…Six studies were located in public-health community clinics (Béland et al, 2006;Counsell et al, 2007;Ell et al, 2010;Kwong, Chung, Cheal, Chou, & Chen, 2013;Roy-Byrne et al, 2014;Safren, O'Cleirigh, Skeer, Elsesser, & Mayer, 2013), and four studies were located in academic health care systems (Counsell et al, 2007;Huffman et al, 2014;Ross, Roberts, Campbell, Solomon, & Brouhard, 2004). The remaining studies were conducted in assisted-living settings (Bellantonio et al, 2008;Boult et al, 2001), a detoxification unit (Samet et al, 2003), Veterans Administration medical centers (Engelhardt, Toseland, Gao, & Banks, 2006), a community hospital (Leung et al, 2004), and OB/GYN clinics (Grote et al, 2015;.…”

“…In 15 studies, the majority of participants were 45 years or older. Reflecting the growth of integrated care in aging services, nine studies focused on older adults (Béland et al, 2006;Bellantonio et al, 2008;Boult et al, 2000Boult et al, , 2001Counsell et al, 2007;Engelhardt et al, 2006;Fortinsky et al, 2009;Leung et al, 2004;Sommers et al, 2000). Two studies focused on parents of children (Farmer et al, 2011;Ross et al, 2004), and one study focused primarily on adolescents (Richardson et al, 2014).…”

A Scoping Review of Contemporary Social Work Practice With Veterans

“…In a trial of mind–body bridging for sleep and Gulf War Illness–related conditions provided by social workers, those veterans who received the intervention reported an improvement in sleep, pain, and co-occurring conditions (Nakamura, Lipschitz, Landward, Kuhn, & West, 2011). Finally, geriatric evaluation and management programs, which include a social worker by design, are superior to usual primary care for older veterans (Engelhardt, Toseland, Gao, & Banks, 2006).…”

“…The literature did cite specific situations where social work services provided a direct benefit. These included cost savings (Engelhardt et al, 2006) and improved outcomes for veterans (Bielaszka-DuVernay et al, 2011, Pearlman et al, 2005). This finding is vital when considering current discussions of privatizing VA care.…”

Determining Possible Professionals and Respective Roles and Responsibilities for a Model Comprehensive Elder Abuse Intervention: A Delphi Consensus Survey

“…These professionals were categorized on the Delphi Round 1 survey as hospital-based core team: emergency physician, geriatrician, Geriatric Emergency Management (GEM) social worker, and social worker/counsellor; emergency services sector: police officer and paramedic; legal sector: Crown prosecutor, victim support worker (court), lawyer, public guardian and trustee, parole officer, and coroner; and community sector: community health worker, financial worker, dentist, caregiver advocate, spiritual advisor, and respite care worker. GEM professionals have specialized training in geriatric issues in acute care (e.g., cognitive status, safety, functional status, and self-care) so that they can rapidly assess frail, at-risk seniors and improve follow-up with appropriate services in the community [ 35 , 36 ] and community health workers deliver home and community health care and connect patients to other services in the community [ 37 ]. Each professional was rated on a five point Likert scale (1 = strongly disagree, 2 = somewhat disagree, 3 = neutral, 4 = somewhat agree, 5 = strongly agree) for their importance to the comprehensive hospital-based elder abuse intervention.…”