ABSTRACT
OBJECTIVE: To study the effect of outpatient geriatric evaluation and management on physical function, mental status, and subjective well-being. DESIGN: Prospective randomized controlled trial with a 1-year study period. SETTING: Large medical school-affiliated public hospital in an urban community. SUBJECTS: Patients at least 70 years old admitted to the medicine service were screened, randomized, and completed a 1-year follow-up interview. INTERVENTIONS: Comprehensive geriatric evaluation and an outpatient care management program. MAIN OUTCOME MEASURES: Mental status (SPMSQ), ADL (Katz Index), IADL (Five-Item OARS Scale), Life satisfaction (LSI-Z), and self-perception of health status (physical health section of OARS). RESULTS: No significant differences were found for cognitive status, ADL functioning, life satisfaction, nursing home placement, or mortality. The experimental patients reported significantly higher function in IADL and more favorable self-perception of health status compared with controls. CONCLUSION: Outpatient comprehensive geriatric evaluation and management appears to be a useful model for providing care to medically frail elderly patients.
Subject(s)
Ambulatory Care Facilities , Geriatric Assessment , Health Services for the Aged , Activities of Daily Living , Aged , Attitude to Health , Female , Hospitalization , Hospitals, Public , Humans , Mental Status Schedule , Mortality , Personal Satisfaction , Prospective StudiesABSTRACT
OBJECTIVE: To study the effect of a geriatric evaluation and management program on health care charges and Medicare reimbursement. DESIGN: Prospective randomized controlled trial during a 1-year study period. SETTING: Large medical school-affiliated public hospital in an urban community. SUBJECTS: Patients at least 70 years old admitted to the medicine service were screened and randomized into two groups of 100 patients each. INTERVENTION: Patients randomized to the experimental group underwent initial comprehensive geriatric evaluation and once discharged from the hospital were enrolled in a geriatric care management and treatment program. The control group received usual care only. The major intervention of this study was in outpatient long-term care. MAIN OUTCOME MEASURE: Total charges for services billed to Medicare Part A and Part B and total Medicare reimbursement. The Medicare charge and reimbursement data were obtained by use of the Medicare Automated Data Retrieval System, a linked Medicare Part A and Part B utilization file. RESULTS: Total charges and reimbursement were greater for the control group but not significantly so. Subset analysis revealed significantly greater inpatient charges (P < 0.03) and Medicare reimbursement (P < 0.005) for the control patients and a greater likelihood of utilization of home health care services in the experimental group (P < 0.01). CONCLUSION: A geriatric evaluation and management program appeared to shift utilization and Medicare expenditures from inpatient services to home health care services. There was no evidence that the experimental program resulted in increased expenditures for Medicare. In selected populations, geriatric evaluation and management programs may contribute to cost containment.
Subject(s)
Fees and Charges/statistics & numerical data , Geriatric Assessment , Geriatrics/standards , Patient Care Team/standards , Reimbursement Mechanisms/economics , Activities of Daily Living , Aged , Cost Control , Female , Geriatrics/economics , Health Services Research , Home Care Services/economics , Home Care Services/statistics & numerical data , Hospitals, Public , Hospitals, University , Humans , Male , Medicare/economics , Mental Status Schedule , Outcome Assessment, Health Care , Patient Admission/economics , Patient Admission/statistics & numerical data , Patient Care Team/economics , Prospective Studies , Texas , United StatesABSTRACT
Limited information in Spanish concerning the availability of health services results in limited access to these services for the Hispanic population. This article describes a model for producing a health education videotape in Spanish. The planning strategy, script translation, and problems encountered with non-Spanish-speaking technical production staff are discussed.
