Volume 49, Issue 4 p. 351-359

A Randomized Clinical Trial of Outpatient Geriatric Evaluation and Management

Chad Boult MD, MPH, MBA

Chad Boult MD, MPH, MBA

Department of Family Practice and Community Health

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Lisa B. Boult MD, MPH

Lisa B. Boult MD, MPH

Department of Family Practice and Community Health

Division of History of Medicine, Department of Surgery;

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Lynne Morishita MSN

Lynne Morishita MSN

Department of Family Practice and Community Health

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Bryan Dowd PhD

Bryan Dowd PhD

Division of Health Services Research and Policy

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Robert L. Kane MD

Robert L. Kane MD

Division of Health Services Research and Policy

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Cristina F. Urdangarin MD, MPH

Cristina F. Urdangarin MD, MPH

Division of Epidemiology, University of Minnesota School of Public Health, Minneapolis, Minnesota.

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First published: 21 December 2001
Citations: 195
Address correspondence to Chad Boult, MD, MPH, MBA, Professor and Director, Aging and Geriatric Medicine Program, University of Minnesota Medical School, MMC 8152, 420 Delaware St. SE, Minneapolis, MN 55455.

Abstract

OBJECTIVES: To measure the effects of outpatient geriatric evaluation and management (GEM) on high-risk older persons' functional ability and use of health services.

DESIGN: Randomized clinical trial.

SETTING: Ambulatory clinic in a community hospital.

PARTICIPANTS: A population-based sample of community-dwelling Medicare beneficiaries age 70 and older who were at high risk for hospital admission in the future (N = 568).

INTERVENTION: Comprehensive assessment followed by interdisciplinary primary care.

MEASUREMENTS: Functional ability, restricted activity days, bed disability days, depressive symptoms, mortality, Medicare payments, and use of health services. Interviewers were blinded to participants' group status.

RESULTS: Intention-to-treat analysis showed that the experimental participants were significantly less likely than the controls to lose functional ability (adjusted odds ratio (aOR) = 0.67, 95% confidence interval (CI) = 0.47–0.99), to experience increased health-related restrictions in their daily activities (aOR = 0.60, 95% CI = 0.37–0.96), to have possible depression (aOR = 0.44, 95% CI = 0.20–0.94), or to use home healthcare services (aOR = 0.60, 95% CI = 0.37–0.92) during the 12 to 18 months after randomization. Mortality, use of most health services, and total Medicare payments did not differ significantly between the two groups. The intervention cost $1,350 per person.

CONCLUSION: Targeted outpatient GEM slows functional decline.