Engelhardt J B, Toseland R W, O'Donnell J C, Richie J T, Jue D, Banks S
Samuel S. Stratton Department of Veterans Affairs Medical Center (VAMC), Albany, New York 12208, USA.
J Am Geriatr Soc. 1996 Jul;44(7):847-56. doi: 10.1111/j.1532-5415.1996.tb03747.x.
To compare the effectiveness of geriatric evaluation and management (GEM) with usual primary care (UPC).
A 2 x 3 randomized controlled group design.
A 450-bed Department of Veterans Affairs Medical Center (VAMC) that provides general medical and surgical care to eligible veterans.
One-hundred sixty male subjects (mean age = 72 years), who were above average users of VAMC outpatient clinics and who had at least two Activity of Daily Living (ADL) or Instrumental Activity of Daily Living (IADL) impairments, were assigned to GEM (n = 80) or UPC (n = 80).
Data were collected about patients' (1) health and functional status, (2) psychosocial well-being, (3) quality of health and social care, (4) health care utilization, and (5) health care costs. Data were obtained before randomization, and again at 8 and 16 months.
The results indicated that GEM was more effective than UPC in improving some aspects of the quality of health and social care and in increasing patient satisfaction with care. GEM also reduced emergency room use, and showed a trend toward decreasing acute admissions. It was not effective, however, in improving patients' psychosocial well-being. Except for a short-term survival advantage, it was also not effective in preventing deterioration in their health and functional status. Further, GEM did not reduce overall utilization of outpatient or inpatient services, and it significantly increased total outpatient health care costs.
Outpatient GEM improves patient satisfaction and some aspects of the quality of care patients' receive but does not reduce the cost of outpatient or inpatient care. Longer-term follow-up studies are needed to determine whether reductions in emergency room use and inpatient admissions persist over time and result in reductions in the overall cost of care.
比较老年评估与管理（GEM）和常规初级保健（UPC）的效果。
2×3随机对照分组设计。
一家拥有450张床位的退伍军人事务医疗中心（VAMC），为符合条件的退伍军人提供普通医疗和外科护理。
160名男性受试者（平均年龄 = 72岁），他们是VAMC门诊的高频率使用者，且至少有两项日常生活活动（ADL）或工具性日常生活活动（IADL）受损，被分配到GEM组（n = 80）或UPC组（n = 80）。
收集了关于患者的以下数据：（1）健康和功能状况；（2）心理社会幸福感；（3）健康和社会护理质量；（4）医疗保健利用率；（5）医疗保健成本。在随机分组前以及8个月和16个月时再次获取数据。
结果表明，GEM在改善健康和社会护理质量的某些方面以及提高患者对护理的满意度方面比UPC更有效。GEM还减少了急诊室的使用，并呈现出减少急性住院的趋势。然而，它在改善患者的心理社会幸福感方面并不有效。除了短期生存优势外，它在预防患者健康和功能状况恶化方面也无效。此外，GEM并没有降低门诊或住院服务的总体利用率，并且显著增加了门诊医疗保健的总成本。
门诊GEM提高了患者满意度以及患者接受的护理质量的某些方面，但并未降低门诊或住院护理的成本。需要进行长期随访研究，以确定急诊室使用和住院人数的减少是否会随着时间持续存在，并导致护理总成本的降低。
