Department of Medical Affairs and Planning, National Yang Ming University, Taipei, Taiwan.
Geriatr Gerontol Int. 2012 Oct;12(4):612-21. doi: 10.1111/j.1447-0594.2011.00823.x. Epub 2012 Feb 2.
That geriatric evaluation and management (GEM) is associated with better quality of care for elderly patients has been reported by previous studies, but evidence supporting that GEM can reduce the burden of morbidity (BOM) was lacking. The aim of this study was to evaluate the benefits of outpatient GEM on reducing BOM and medical utilization in Taiwan.
Data of this retrospective case-control study were obtained from the 2004-2006 Taiwan National Health Insurance Research Database (NHIRD). Patients who attended the outpatient GEM program for over 6 months in a tertiary medical center in 2005 were enrolled as the case group, and a 1:5 age and gender-matched control group was formed by randomly-selected patients from the same medical center for comparisons. BOM was obtained by applying the Adjusted Clinical Group (ACG) program, and medical utilization variables were totalled for each patient from the NHIRD. Patients were further reassigned to two morbidity categories, the low (resource utilization bands ≤ 3) and high (resource utilization bands > 3) morbidity category, according to their degree of morbidity before statistical analyses.
Data of 4254 elderly patients (709 cases, 3545 controls) were included in the study. BOM and medical utilization were increased in both groups in both morbidity categories during the study period. However, the growth of BOM, total medical expenditure, number of emergency department visit, and days and expenditure of hospitalization were significantly reduced in the case than the control group in the low morbidity category, not the high morbidity category.
Outpatient GEM could effectively reduce growth of BOM and medical utilization for relatively healthy elderly patients in Taiwan where elderly patients have relatively free access to general and specialty care. The results of this study implied the potential benefits of systematically implementing GEM in primary health-care settings to improve the quality of care and slow down the growth of BOM for elderly patients.
先前的研究报告称，老年评估和管理（GEM）与改善老年患者的护理质量有关，但缺乏证据支持 GEM 可以减轻发病率负担（BOM）。本研究旨在评估门诊 GEM 对降低台湾发病率负担和医疗利用的益处。
本回顾性病例对照研究的数据来自 2004-2006 年台湾全民健康保险研究数据库（NHIRD）。2005 年在一家三级医疗中心参加门诊 GEM 计划超过 6 个月的患者被纳入病例组，通过从同一医疗中心随机选择患者组成年龄和性别匹配的对照组进行比较。发病率负担通过应用调整后的临床组（ACG）程序获得，NHIRD 中为每位患者总计医疗利用变量。根据患者在统计分析前的发病程度，患者进一步分为两个发病类别，低（资源利用波段≤3）和高（资源利用波段>3）发病类别。
本研究共纳入 4254 名老年患者（709 例，3545 例对照）的数据。在研究期间，两个发病类别中，两组的发病率负担和医疗利用均增加。然而，在低发病类别中，与对照组相比，病例组的发病率负担、总医疗支出、急诊就诊次数、住院天数和住院支出的增长显著降低，而在高发病类别中则没有。
门诊 GEM 可有效降低台湾相对健康老年患者发病率负担和医疗利用的增长，台湾老年患者享有相对自由获得普通和专科医疗的机会。本研究结果表明，在基层医疗保健环境中系统实施 GEM 以改善护理质量和减缓老年患者发病率负担增长具有潜在益处。
