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.
