Healthy geriatrics do better when managed as outpatients

By Sarah Guy, medwireNews Reporter

The burden of morbidity (BOM) is significantly reduced in otherwise healthy geriatric individuals when they are part of an outpatient geriatric evaluation and management (GEM) model of care, shows Taiwanese research.

Furthermore, GEM did not increase total medical expenditure for such individuals over a 2-year period, or increase their volume of medical utilization, report the researchers.

"The results were compatible with the intentions of the GEM programs to provide better quality of care and to reduce acute medical needs," say Liang-Kung Chen (Taipei Veterans General Hospital) and co-investigators in Geriatrics and Gerontology International.

Notably, the findings emerge in the context of the near free-access and self-referral healthcare system in place in Taiwan, remarks the team.

Data from 2004 through 2006 for 4254 patients (aged a mean 77 years) were included in the study. Of these patients, 709 (cases) attended a GEM program during 2005, and were matched in a 1:5 ratio to 3545 control individuals who had not attended.

The researchers measured BOM using the Adjusted Clinical Group (ACG) program. The program regards people with a higher ACG weighting as having a higher BOM and more medical needs than the general population, and assigns a resource utilization band (RUB) according to this weighting.

Study participants were categorized as either having low (RUB ≤3; healthy to moderate) or high (RUB >3; high to very high) morbidity.

Among the 1870 low-morbidity patients, generalized estimating equations analysis revealed that entry into the outpatient GEM program (n=333) significantly reduced total medical expenditure and total outpatient visits, as well as significantly reducing the growth of BOM, report the authors.

Conversely, there were no significant interactions between outpatient GEM and BOM or any other medical utilization variables for the 2387 patients with high morbidity, of whom 376 took part in GEM.

"GEM could be considered as required training for physicians, especially for family practice and general medicine physicians, as a result of the rapid growth of the elderly population," write Chen and colleagues.

"By promoting GEM, a health-care system should be beneficial when the vast majority of users in the system are becoming older," they conclude.

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