Report: Healthcare delivery model for the aging improves outcomes, saves money

A new team approach to preventive healthcare delivery for older adults reportedly improves health and quality of life, decreases emergency department visits and lowers hospital admission rates.

By the second year the new model, Geriatric Resources for Assessment and Care of Elders (GRACE), developed by researchers from Indiana University and the Regenstrief Institute, saved money for the sickest patients (those with three to four chronic diseases).

The cost analysis of the home-based program appears in the August 2009 issue of the Journal of the American Geriatrics Society (JAGS).

In a previous study published in the Dec. 12, 2007, issue of the Journal of American Medical Association (JAMA),  researchers reported their success in improving both quality of care and health-related quality of life measures while reducing emergency department use. Hospital admissions were reduced in the second year of the program for those at high risk of hospitalization.

GRACE was developed to involve seniors and their primary care physicians in a program to optimize health and functional status and decrease high-cost emergency department visits and hospital admissions.

“Healthcare reform is calling out for ways to improve health and lower costs,” said study leader Steven R. Counsell, MD, Mary Elizabeth Mitchell Professor of Geriatrics at the IU School of Medicine, a scientist at the IU Center for Aging Research Center and an affiliated scientist of the Regenstrief Institute. “We have found a strategy to do that for a very vulnerable growing population in a way that shows cost savings over time and has the added benefit of providing services that these seniors desperately need but can’t get elsewhere.”

In the model, a support team consisting of a nurse practitioner and a social worker meets with each patient at his or her home to conduct an initial comprehensive geriatric assessment. Based on the team's findings, a larger interdisciplinary team (including a geriatrician, pharmacist, physical therapist, mental health social worker and community-based services liaison) develops an individualized care plan.

With the assistance of an electronic medical record and tracking system, the GRACE support team provides ongoing comprehensive care management.

"With GRACE we focused on the many issues faced by aging low-income adults – access to needed services, medications, mobility, depression, transportation, nutrition, as well as other health issues of aging," said Counsell. "Using a model for geriatrics care based on our prior work, we were able to deliver care which was very popular with patients and their doctors, improved health outcomes and saved money because it helped keep seniors from having to use the emergency department or be admitted to the hospital."

The randomized control trial enrolled 951 low-income seniors (average age 72), 477 of which received usual care, while 474 participated in GRACE. Both groups were comprised of people at lower risk for hospitalization as well as those at higher risk for hospitalization, were predominately female (77 percent) and African-American and were seen at six community-based health centers.

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