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Clinical and financial outcome impacts of comprehensive geriatric assessment in a level 1 geriatric emergency department.
Haynesworth, Austin; Gilmer, Todd P; Brennan, Jesse J; Weaver, Emily H; Tolia, Vaishal M; Chan, Theodore C; Killeen, James P; Castillo, Edward M.
Affiliation
  • Haynesworth A; School of Medicine, University of California San Diego, San Diego, California, USA.
  • Gilmer TP; Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California, USA.
  • Brennan JJ; Department of Emergency Medicine, University of California San Diego, San Diego, California, USA.
  • Weaver EH; Clinical Research Department, West Health Institute, San Diego, California, USA.
  • Tolia VM; Department of Emergency Medicine, University of California San Diego, San Diego, California, USA.
  • Chan TC; Department of Emergency Medicine, University of California San Diego, San Diego, California, USA.
  • Killeen JP; Department of Emergency Medicine, University of California San Diego, San Diego, California, USA.
  • Castillo EM; Department of Emergency Medicine, University of California San Diego, San Diego, California, USA.
J Am Geriatr Soc ; 71(9): 2704-2714, 2023 09.
Article in En | MEDLINE | ID: mdl-37435746
BACKGROUND: The aging population has led to an increase in emergency department (ED) visits by older adults who have complex medical conditions and high social needs. The purpose of this study was to assess if comprehensive geriatric evaluation and management impacted service utilization and cost by older adults admitted to the ED. METHODS: This is a retrospective matched case-control study at a level 1 geriatric ED (GED) from January 1, 2018-March 31, 2020. Geriatric nurse specialists (GENIEs) provided comprehensive evaluations and management for GED patients. Propensity score matching was used to match patients receiving GENIE consultations to ED patients who did not receive a GENIE consult. Regression was used to assess the impact of the GENIE services on inpatient admissions, ED revisits and cost of inpatient and ED care from the payor perspective. RESULTS: GENIE consults were associated with a 13.0% reduction in absolute risk of admission through the ED at index (95% confidence interval [CI] -17.0%, -9.0%, p < 0.001) and a reduction in risk for total admissions at 30 and 90-days post discharge (-11.3%, 95% CI -15.6%, -7.1%, p-value < 0.001; and -10.0, 95% CI -13.8%, -6.0%; p < 0.001 respectively), both driven by reduced risk of admission at the index visit. GENIE consults were associated with a 4% increase in absolute risk of revisits to the ED within 30 days (95% CI 0.6%, 7.3%; p = 0.001). GENIE consults were associated with a decrease in cost of inpatient and ED care, with savings of $2344 within 30 days (95% CI $2247, $2441, p < 0.001) and savings of $2004 USD within 90 days (95% CI $1895, $2114, p < 0.001), driven by reduced costs at the index visit. CONCLUSIONS: GENIE consults were associated with decreased inpatient admissions through the ED, modestly increased ED revisits, and decreased cost of inpatient and ED care. The results of this study can be useful for EDs considering approaches to better serve older adults. They can also be of interest to payers as an area of potential cost savings.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Discharge / Geriatric Assessment Type of study: Health_economic_evaluation / Observational_studies / Risk_factors_studies Limits: Aged / Humans Language: En Journal: J Am Geriatr Soc Year: 2023 Document type: Article Affiliation country: Country of publication:

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Patient Discharge / Geriatric Assessment Type of study: Health_economic_evaluation / Observational_studies / Risk_factors_studies Limits: Aged / Humans Language: En Journal: J Am Geriatr Soc Year: 2023 Document type: Article Affiliation country: Country of publication: