Retirement of the baby boom generation, which will begin over the next decade, will bring with it widespread disability and increased long-term care costs. One way to slow functional decline among the elderly is through outpatient geriatric evaluation and management (GEM), concludes a study supported through an interagency agreement between the National Institute on Aging and the Agency for Healthcare Research and Quality (AG/HS11047). GEM uses an interdisciplinary team of healthcare professionals to assess an older person's medical, functional, psychosocial, nutritional, and environmental needs. The team then creates a comprehensive plan of care that is communicated to the person's physician and then implemented by the GEM interdisciplinary team.
Chad Boult, M.D., M.P.H., M.B.A., and his University of Minnesota colleagues compared the effects of outpatient GEM with those of usual health care on the functional ability and use and cost of healthcare services among Medicare beneficiaries age 70 and older who were at high risk of repeated hospitalization. They randomized 274 patients to usual care and 294 patients to GEM. The primary physicians of the participants assigned to usual care doctors were notified that their patients were at high risk for repeated hospitalizations so that they could modify ongoing usual care to address this risk.
After adjustment for patient differences, GEM patients were 33 percent less likely than usual care patients to lose functional ability, 40 percent less likely to experience increased health-related restrictions in their daily activities or to use home healthcare services, and 56 percent less likely to have possible depression during the next 12 to 18 months. Mortality rates, use of most health services, and total Medicare payments did not differ significantly between the two groups. The GEM intervention cost $1,250 per person. In communities where the usual primary care of older people is less ideal than the medically progressive study community, GEM may produce cost savings and even greater preservation of function.
More details are in "A randomized clinical trial of outpatient geriatric evaluation and management," by Dr. Boult, Lisa B. Boult, M.D., M.P.H., Lynne Morishita, M.S.N., and others, in the April 2001 Journal of the American Geriatrics Society 49, pp. 351-359.