What do we know about patient targeting in geriatric evaluation and management (GEM) programs?

Wieland, Darryl; Rubenstein, Laurence Z.

doi:10.1007/bf03339586

Cited by 35 publications

(26 citation statements)

References 62 publications

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“…A similar percentage of eligible elders has been identi ed in a randomized, multisite Veterans Affairs clinical trial of the outcomes of GEM unit care (Cohen, 1999). Wieland & Rubenstein (1996) have documented the effects of 'targeting' patients on outcomes in a meta-analysis of randomized trials of GEM units. The impact of using one or more targeting criteria on eligibility for inclusion in studies of comprehensive geriatric assessment has been examined by Reuben et al (1992).…”

Section: Subject Selectionmentioning

confidence: 99%

Collaboration improves the quality of care: methodological challenges and evidence from US health care research

Schmitt

2001

Journal of Interprofessional Care

122

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At the present time when interprofessional collaboration in practice is reaching new levels of interest related to health care system changes in both the UK and the US, a key question being raised is: What are the outcomes and costs of interprofessional collaborative models of care? The purposes of this paper are to: (a) summarize past research efforts, primarily in the US, to examine whether interprofessional collaboration improves the outcomes of care, (b) articulate the continuing conceptual and methodological challenges associated with efforts to examine this relationship, (c) present more recent research in the US in which investigators have overcome some of the conceptual and methodological barriers to this type of research, and (d) identify gaps in knowledge and areas for future research on the relationship between collaborative models of care and care outcomes.

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Section: Subject Selectionmentioning

confidence: 99%

Collaboration improves the quality of care: methodological challenges and evidence from US health care research

Schmitt

2001

Journal of Interprofessional Care

122

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“…These criteria were designed to select patients most likely to benefit from a program of geriatric evaluation and management. [22][23][24] The Charlson comorbidity index was calculated. 25 Inpatients were considered for enrollment when the team on the geriatric evaluation and management unit decided that their condition was stable.…”

Section: Patientsmentioning

confidence: 99%

A Controlled Trial of Inpatient and Outpatient Geriatric Evaluation and Management

Cohen¹,

Feussner

Weinberger³

et al. 2002

N Engl J Med

542

450

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“…Eligible patients also had to be frail, defined as having at least two of the following characteristics: inability to perform one or more basic activities of daily living (ADLs), a stroke within the previous 3 months, a history of falls, difficulty walking, malnutrition, dementia, depression, one or more unplanned admissions in the previous 3 months, prolonged bed rest, or incontinence. These target criteria were selected to capture patients most likely to benefit from a program of GEM 17,18 . Patients were excluded if they were admitted from a nursing home, had previously been hospitalized in an inpatient GEM, were currently enrolled in another clinical trial, had a severe disabling disease or terminal condition or severe dementia, did not speak English, lacked access to a telephone for follow-up, or were unwilling or unable to return for follow-up for any reason.…”

Section: Study Populationmentioning

confidence: 99%

Geriatric Inpatient Units in the Care of Hospitalized Frail Adults with a History of Heart Failure

Gharacholou

Sloane

Cohen

et al. 2012

International Journal of Gerontology

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s u m m a r y Background: Frail hospitalized older adults are at risk for adverse outcomes. Previous studies have suggested benefits for inpatient geriatric management (GEM). We sought to determine whether hospitalized patients with a history of heart failure (HF) benefitted from inpatient GEM or not. Methods: We studied 309 inpatients previously diagnosed with HF who were participants in a randomized trial of geriatric evaluation and management (GEM) versus usual care (UC). The intervention involved multidisciplinary teams that provided comprehensive geriatric assessment. We evaluated health-related quality of life (HRQOL), basic activities of daily living (ADLs), health service utilization, and survival at discharge, 6 months, and 1 year post randomization. Results: GEM patients had higher mean change scores for physical function (unadjusted means: 0.17 vs. e4.67, p ¼ 0.046) and basic ADLs (1.25 vs. 0.67, p ¼ 0.003) at hospital discharge, which remained significant after adjusting for baseline HRQOL scores and in-hospital days. Outcomes were not significantly different at 1 year. Length of stay for GEM was greater than UC (24 days vs. 17 days, p ¼ 0.03), but total costs at 1 year were not different (p ¼ 0.9). Mortality rates at 1 year were high and similar (GEM 29.0%, UC 27.3%, p ¼ 0.73) in both the groups. Conclusion: Inpatient GEM was associated with better maintenance of physical function and basic ADLs at hospital discharge; however, no differences in HRQOL or survival were observed between GEM and UC at 1 year post randomization. Restructuring inpatient care models to incorporate inpatient GEM principles may be one method to optimize health-care delivery.

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What do we know about patient targeting in geriatric evaluation and management (GEM) programs?

Cited by 35 publications

References 62 publications

Collaboration improves the quality of care: methodological challenges and evidence from US health care research

Collaboration improves the quality of care: methodological challenges and evidence from US health care research

A Controlled Trial of Inpatient and Outpatient Geriatric Evaluation and Management

Geriatric Inpatient Units in the Care of Hospitalized Frail Adults with a History of Heart Failure

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