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Consultative Geriatric Assessment for Ambulatory PatientsA Randomized Trial in a Health Maintenance Organization
Arnold M. Epstein, MD, MA;
Judith A. Hall, PhD;
Marsha Fretwell, MD;
Michael Feldstein, PhD;
Mary Lou DeCiantis, PhD;
Janet Tognetti, MA;
Charles Cutler, MD;
Muriel Constantine, MS;
Richard Besdine, MD;
John Rowe, MD;
Barbara J. McNeil, MD, PhD
JAMA. 1990;263(4):538-544.
Abstract
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Previous studies have shown that comprehensive geriatric assessment and follow-up can improve the health of hospitalized elderly patients. To evaluate the effectiveness of consultative geriatric assessment and limited follow-up for ambulatory patients, we randomized 600 elderly patients who were enrolled in a health maintenance organization into three groups: (1) consultation by a geriatric assessment team, (2) consultation by a "second opinion" internist, and (3) only traditional health maintenance organization services (control patients). The geriatric assessment team identified previously unrecognized problems in 35% of patients and advised changes in medication regimens for more than 40%. Nevertheless, patients who received assessment achieved only a small benefit in cognitive function after 3 months, which was not sustained for 1 year. There was no difference among groups in other measures of health status. Consultative geriatric assessment with limited follow-up did not benefit most older ambulatory patients in a health maintenance organization; if such care can be used effectively for ambulatory patients, it will require either additional targeting or continuing care or both.
(JAMA. 1990;263:538-544)
Author Affiliations
From the Departments of Medicine (Division of General Medicine, Section on Health Services and Policy Research) (Dr Epstein) and Radiology (Dr McNeil), Brigham and Women's Hospital, Boston, Mass; the Department of Health Care Policy, Harvard Medical School, Boston, Mass (Drs Epstein and McNeil); the Departments of Health Policy and Management (Dr Epstein) and Biostatistics (Dr Feldstein), Harvard School of Public Health, Boston, Mass; the Department of Psychology, Northeastern University, Boston, Mass (Dr Hall): The Rhode Island Group Health Association, Providence (Dr Cutler and Ms Constantine); The Roger Williams General Hospital, Brown University Program in Medicine, Providence, RI (Dr Fretwell); The Traveler's Center on Aging at the University of Connecticut Medical School, Farmington (Dr Besdine); Rhode Island Department of Health, Division of Disease Control, Providence (Dr DeCiantis); and Mount Sinai Medical Center, New York, NY (Dr Rowe).
Footnotes
Reprint requests to the Department of Health Care Policy, Harvard University, 25 Shattuck St, Parcel B, First Floor, Boston, MA 02115 (Dr Epstein).
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