TRIAL OF OUTPATIENT GERIATRIC EVALUATION AND MANAGEMENT

该项目的目标是评估以下项目的成本效益 为体弱老年人提供门诊老年评估和 管理(创业板)。拟测试的创业板模型包括评估 在与老年人健康有关的众多因素中， 三个月的强化跨学科治疗，然后 在协作中连续九个月监测个人的健康状态 和他或她的主治医生。 这项研究的主要假设是，虚弱老年人的比例 住进急救医院的人数可以显著减少 门诊部的宝石。次要假设是门诊创业板可降低 医疗保健费用，提高老年人的生存和生活质量 他们是根据他们的脆弱程度精心挑选出来的。按顺序 为了验证这些假设，接下来将进行随机临床试验(n=600) 被引导了。医保参保者中的大量老年人口将是 使用简短的邮寄自我管理的调查问卷进行筛选 确定经常住院的高危老年人 在未来。高风险的老年人，他们可能会从Out- 患者GEM将被随机分配到两组中的一组：接受者 门诊宝石或接受常规护理的人。这两组人使用了 卫生服务、生活质量和死亡率将在 随机化后的18个月。试验的结果 将根据从HCFA MADRS文件中获得的数据进行衡量(使用健康 服务)、电话采访(生活质量)和明尼苏达州 卫生部和国家死亡指数(生存)。 筛选程序和创业板试验计划已经试点- 在过去18个月内进行了测试，旨在进行复制 在未来的研究和临床应用中，可以在其他地方使用。这个 项目负责人，加州大学的长期同事 明尼苏达州，将提供所需的临床医学专业知识， 流行病学、卫生服务研究、公共卫生和公共政策。 国家老龄研究所被要求在#年提供180万美元 进一步开发和测试这一前景看好的产品的直接成本 门诊部宝石模型。

The goal of this project is to evaluate the cost-effectiveness of providing frail elderly people with outpatient geriatric evaluation and management (GEM). The model of GEM to be tested includes an assessment of the many factors related to an elderly person's health, the provision of intensive interdisciplinary therapy for three months, and then the monitoring of the person's health status for nine months in collaboration with his or her primary physician. The study's primary hypothesis is that the proportion of frail elders admitted to acute care hospitals can be significantly reduced by outpatient GEM. Secondary hypotheses are that outpatient GEM reduces the cost of health care and improves survival and quality of life for elders who are carefully selected according to their level of frailty. In order to test these hypotheses, a randomized clinical trial (n=600) will then be conducted. A large elderly population of Medicare enrollees will be screened using a short, mailed, self-administered questionnaire that identifies elders who are at high risk for frequent hospital admission in the future. High-risk elders who are likely to benefit from out- patient GEM will be randomly assigned to one of two groups: recipients of outpatient GEM or recipients of usual care. The two groups' use of health services, quality of life, and mortality will be compared during the eighteen months following randomization. The outcomes of the trial will be measured from data obtained from HCFA MADRS files (use of health services), telephone interviews (quality of life), and the Minnesota Department of Health and the National Death Index (survival). The screening procedure and the experimental GEM program have been pilot- tested during the past eighteen months and are designed to be replicated at other sites in future investigations and clinical applications. The project's leaders, long-standing colleagues at the University of Minnesota, will provide the needed expertise in clinical medicine, epidemiology, health services research, public health and public policy. The National Institute on Aging is requested to provide $1.8 million in direct costs for the further development and testing of this promising model of outpatient GEM.