ABSTRACT
The effectiveness and efficiency of outpatient geriatric evaluation and management (GEM) was compared to usual outpatient primary care (UPC). Although GEM had no overall impact on health care utilization or cost of care for the entire study period, significant reductions were found during the sixteen- to twenty-four-month study period, suggesting a possible investment effect. In the first eight months of the study, GEM patients incurred 34.8% more in health care costs than UPC patients, but in the final eight months of the study the cost of care for UPC patients exceeded that for GEM patients by 37.8%.
Subject(s)
Ambulatory Care/statistics & numerical data , Geriatric Assessment , Health Care Costs , Health Services for the Aged/statistics & numerical data , Veterans , Aged , Aged, 80 and over , Ambulatory Care/economics , Data Interpretation, Statistical , Female , Frail Elderly , Health Services for the Aged/economics , Humans , Interviews as Topic , Male , Middle Aged , Patient Care Team , Primary Health Care , Survival AnalysisABSTRACT
OBJECTIVE: To compare the effectiveness of geriatric evaluation and management (GEM) with usual primary care (UPC). DESIGN: A 2 x 3 randomized controlled group design. SETTING: A 450-bed Department of Veterans Affairs Medical Center (VAMC) that provides general medical and surgical care to eligible veterans. PARTICIPANTS: One-hundred sixty male subjects (mean age = 72 years), who were above average users of VAMC outpatient clinics and who had at least two Activity of Daily Living (ADL) or Instrumental Activity of Daily Living (IADL) impairments, were assigned to GEM (n = 80) or UPC (n = 80). MEASUREMENTS: Data were collected about patients' (1) health and functional status, (2) psychosocial well-being, (3) quality of health and social care, (4) health care utilization, and (5) health care costs. Data were obtained before randomization, and again at 8 and 16 months. RESULTS: The results indicated that GEM was more effective than UPC in improving some aspects of the quality of health and social care and in increasing patient satisfaction with care. GEM also reduced emergency room use, and showed a trend toward decreasing acute admissions. It was not effective, however, in improving patients' psychosocial well-being. Except for a short-term survival advantage, it was also not effective in preventing deterioration in their health and functional status. Further, GEM did not reduce overall utilization of outpatient or inpatient services, and it significantly increased total outpatient health care costs. CONCLUSIONS: Outpatient GEM improves patient satisfaction and some aspects of the quality of care patients' receive but does not reduce the cost of outpatient or inpatient care. Longer-term follow-up studies are needed to determine whether reductions in emergency room use and inpatient admissions persist over time and result in reductions in the overall cost of care.
Subject(s)
Ambulatory Care , Geriatric Assessment , Geriatrics , Outcome and Process Assessment, Health Care , Activities of Daily Living , Aged , Aged, 80 and over , Geriatrics/methods , Geriatrics/standards , Health Services Research , Health Status , Hospitals, Veterans , Humans , Male , Middle Aged , Multivariate Analysis , New York , Patient Satisfaction , Primary Health Care , Quality of Health Care/economicsABSTRACT
The effectiveness and efficiency of outpatient geriatric evaluation and management (GEM) was compared with usual outpatient primary care (UPC). One hundred sixty frail elderly outpatients were assigned randomly to GEM or UPC and assessed at baseline and at 8 months on measures of (1) health and functional status, (2) psychosocial well-being, (3) quality of health and social care, (4) use of inpatient and outpatient services, and (5) cost of care. The results indicate that GEM was significantly more effective than UPC in reducing mortality, increasing patient satisfaction, and improving the quality of health and social care. However, it was not effective in reducing health care use or the cost of care.
Subject(s)
Frail Elderly , Geriatric Assessment , Health Status Indicators , Outpatient Clinics, Hospital/organization & administration , Primary Health Care/organization & administration , Activities of Daily Living , Aged , Follow-Up Studies , Health Services Research , Hospital Costs , Hospitals, Veterans , Humans , Male , New York , Outcome Assessment, Health Care , Patient Care Team , Patient Satisfaction , Program EvaluationABSTRACT
The results after operations for rupture of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb are reported to be good. Few authors describe the measurements used to assess the postoperative function of the thumb. We review the results of 15 patients, who underwent surgery between 1982 and 1987. We found that the number of patients satisfied with the operation was consistent with that reported in the literature. On the other hand, we found poor agreement between the subjective complaints and the objective findings. We therefore propose and describe a scoring system to assess subjective impressions of the result and the objective findings. Surgical procedures are not discussed. However, the duration of immobilization of the thumb should, perhaps, be reconsidered. Further studies may show that a shorter period of immobilization in plaster, the use of dynamic bandaging, or early starting of physiotherapy produce better results.
