Boult C, Boult L, Murphy C, Ebbitt B, Luptak M, Kane R L
Dept. of Family Practice and Community Health, University of Minnesota Medical School, Minneapolis 55414-3034.
J Am Geriatr Soc. 1994 May;42(5):465-70. doi: 10.1111/j.1532-5415.1994.tb04965.x.
To evaluate the effects of targeted outpatient geriatric evaluation and management (GEM).
Controlled clinical trial. Elderly persons were identified as being at high risk for hospital admission on the basis of their responses to a short, mailed, self-administered questionnaire. The high-risk elders who chose to participate in the GEM program were compared to those who continued to receive usual care.
Outpatient GEM clinic at an urban university hospital.
Elderly Medicaid recipients whose probability of repeated hospital admission (Pra) within 4 years was calculated as 40% or greater (Pra > or = 0.40).
Mortality, use of institutional services, satisfaction.
Of the 1210 persons who were sent questionnaires, 624 responded (response rate = 51.6%), of whom 154 (24.7%) were deemed to be a high risk for hospitalization. Of these, 43 received GEM (experimental subjects); 111 received usual care (controls). At baseline, the experimental and control groups' demographic and health-related characteristics did not differ significantly. The average experimental subject was 76.5 years old, had 9.6 significant medical problems, and took 6.7 significant long-term prescription medications. During the program's first 17 months of follow-up, the experimental subjects had lower annual rates of mortality (2.9% vs 19.2%, P = 0.03) and emergency room use (0.6 vs 1.0 visits, P = 0.01) than did the controls. The experimental subjects also tended to use nursing homes, but not hospitals, at a lower rate than the controls. All of the experimental subjects rated the program as either excellent (81.0%) or good (19.0%); 100% said they would recommend it to others. Their established primary physicians rated the GEM services as appropriate and helpful.
Targeted outpatient GEM was associated with reduced mortality, reduced use of emergency rooms, and a trend toward reduced use of nursing homes.
评估针对性门诊老年评估与管理（GEM）的效果。
对照临床试验。根据对一份简短的邮寄自填问卷的回答，确定老年人为住院高风险人群。将选择参与GEM项目的高风险老年人与继续接受常规护理的老年人进行比较。
城市大学医院的门诊GEM诊所。
4年内再次住院概率（Pra）计算为40%或更高（Pra≥0.40）的老年医疗补助受助人。
死亡率、机构服务使用情况、满意度。
在1210名收到问卷的人中，624人回复（回复率=51.6%），其中154人（24.7%）被认为是住院高风险人群。其中，43人接受了GEM（实验组）；111人接受常规护理（对照组）。基线时，实验组和对照组的人口统计学和健康相关特征无显著差异。实验组受试者的平均年龄为76.5岁，有9.6项重大医疗问题，服用6.7种重大长期处方药。在项目的前17个月随访期间，实验组受试者的年死亡率（2.9%对19.2%，P=0.03）和急诊室使用率（0.6次对1.0次就诊，P=0.01）低于对照组。实验组受试者使用养老院的比例也往往低于对照组，但使用医院的比例并非如此。所有实验组受试者对该项目的评价为优秀（81.0%）或良好（19.0%）；100%的人表示会向他人推荐。他们既定的初级医生认为GEM服务恰当且有帮助。
针对性门诊GEM与降低死亡率、减少急诊室使用以及养老院使用呈减少趋势相关。
