A CONTROLLED TRIAL OF OUTPATIENT GERIATRIC EVALUATION AND MANAGEMENT

被引:71
作者
BOULT, C [1 ]
BOULT, L [1 ]
MURPHY, C [1 ]
EBBITT, B [1 ]
LUPTAK, M [1 ]
KANE, RL [1 ]
机构
[1] UNIV MINNESOTA, SCH PUBL HLTH, MINNEAPOLIS, MN 55455 USA
关键词
D O I
10.1111/j.1532-5415.1994.tb04965.x
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
Objective: To evaluate the effects of targeted outpatient geriatric evaluation and management (GEM). Design: Controlled clinical trial. Elderly persons were identified as being at high risk for hospital admission on the basis of their responses to a short, mailed, self-administered questionnaire. The high-risk elders who chose to participate in the GEM program were compared to those who continued to receive usual care. Setting: Outpatient GEM clinic at an urban university hospital. Subjects: Elderly Medicaid recipients whose probability of repeated hospital admission (P-ra) within 4 years was calculated as 40% or greater (P(ra)greater than or equal to 0.40). Main Outcome Measures: Mortality, use of institutional services, satisfaction. Results: Of the 1210 persons who were sent questionnaires, 624 responded (response rate = 51.6%), of whom 154 (24.7%) were deemed to be a high risk for hospitalization. Of these, 43 received GEM (experimental subjects); 111 received usual care (controls). At baseline, the experimental and control groups' demographic and health-related characteristics did not differ significantly. The average experimental subject was 76.5 years old, had 9.6 significant medical problems, and took 6.7 significant long-term prescription medications. During the program's first 17 months of follow-up, the experimental subjects had lower annual rates of mortality (2.9% vs 19.2%, P = 0.03) and emergency room use (0.6 vs 1.0 visits, P = 0.01) than did the controls. The experimental subjects also tended to use nursing homes, but not hospitals, at a lower rate than the controls. All of the experimental subjects rated the program as either excellent (81.0%) or good (19.0%); 100% said they would recommend it to others. Their established primary physicians rated the GEM services as appropriate and helpful. Conclusion: Targeted outpatient GEM was associated with reduced mortality, reduced use of emergency rooms, and a trend toward reduced use of nursing homes.
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页码:465 / 470
页数:6
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