TRIAL OF OUTPATIENT GERIATRIC EVALUATION AND MANAGEMENT

本项目的目标是评估 为体弱长者提供门诊老人科评估服务， 管理（GEM）。将测试的GEM模式包括评估 在影响长者健康的众多因素中， 三个月的密集的跨学科治疗，然后， 合作监测该人的健康状况9个月 他或她的主治医生。 这项研究的主要假设是， 通过以下措施，可以显著减少急诊医院的入院人数： 门诊GEM。 次要假设是，门诊GEM减少了 降低医疗保健成本，提高老年人的生存率和生活质量 根据他们的虚弱程度精心挑选 为了 为了检验这些假设，将进行随机临床试验（n=600）， 进行。 一个庞大的老年人口的医疗保险登记将是 使用一个简短的，邮寄的，自我管理的问卷进行筛选， 确定经常入院的高危长者 在未来 高风险的老年人谁可能受益于外- GEM患者将被随机分配到两组之一：接受者 或接受常规护理的患者。 两组使用 卫生服务、生活质量和死亡率将在 随机分组后18个月。 试验的结果 将从HCFA MADRS文件（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）。 筛选程序和实验性GEM方案已经过试点- 在过去的18个月里进行了测试， 在未来的研究和临床应用中在其他研究中心进行。 的 项目的领导者，在大学的长期同事， 明尼苏达州，将提供临床医学所需的专业知识， 流行病学、卫生服务研究、公共卫生和公共政策。 国家老龄问题研究所被要求提供180万美元， 进一步开发和测试这种有前途的 门诊GEM模式。

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.