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Delivering Effective Primary Care to Older Adults: A Randomized, Controlled Trial of the Senior Resource Team at Group Health Cooperative

Authors

  • Elizabeth A. Phelan MD, MS,

    1. From the Divisions of *Gerontology and Geriatric Medicine§General Medicine, Department of Medicine, and Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WashingtonCenter for Health StudiesThe MacColl Institute for Healthcare Innovation, Group Health Cooperative, Seattle, Washington
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  • Benjamin Balderson PhD,

    1. From the Divisions of *Gerontology and Geriatric Medicine§General Medicine, Department of Medicine, and Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WashingtonCenter for Health StudiesThe MacColl Institute for Healthcare Innovation, Group Health Cooperative, Seattle, Washington
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  • Martin Levine MD,

    1. From the Divisions of *Gerontology and Geriatric Medicine§General Medicine, Department of Medicine, and Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WashingtonCenter for Health StudiesThe MacColl Institute for Healthcare Innovation, Group Health Cooperative, Seattle, Washington
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  • Janet H. Erro RN, MN, PNP,

    1. From the Divisions of *Gerontology and Geriatric Medicine§General Medicine, Department of Medicine, and Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WashingtonCenter for Health StudiesThe MacColl Institute for Healthcare Innovation, Group Health Cooperative, Seattle, Washington
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  • Luesa Jordan BA,

    1. From the Divisions of *Gerontology and Geriatric Medicine§General Medicine, Department of Medicine, and Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WashingtonCenter for Health StudiesThe MacColl Institute for Healthcare Innovation, Group Health Cooperative, Seattle, Washington
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  • Lou Grothaus MS,

    1. From the Divisions of *Gerontology and Geriatric Medicine§General Medicine, Department of Medicine, and Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WashingtonCenter for Health StudiesThe MacColl Institute for Healthcare Innovation, Group Health Cooperative, Seattle, Washington
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  • Nirmala Sandhu MPH,

    1. From the Divisions of *Gerontology and Geriatric Medicine§General Medicine, Department of Medicine, and Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WashingtonCenter for Health StudiesThe MacColl Institute for Healthcare Innovation, Group Health Cooperative, Seattle, Washington
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  • Patrick J. Perrault,

    1. From the Divisions of *Gerontology and Geriatric Medicine§General Medicine, Department of Medicine, and Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WashingtonCenter for Health StudiesThe MacColl Institute for Healthcare Innovation, Group Health Cooperative, Seattle, Washington
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  • James P. LoGerfo MD, MPH,

    1. From the Divisions of *Gerontology and Geriatric Medicine§General Medicine, Department of Medicine, and Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WashingtonCenter for Health StudiesThe MacColl Institute for Healthcare Innovation, Group Health Cooperative, Seattle, Washington
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  • Edward H. Wagner MD, MPH

    1. From the Divisions of *Gerontology and Geriatric Medicine§General Medicine, Department of Medicine, and Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WashingtonCenter for Health StudiesThe MacColl Institute for Healthcare Innovation, Group Health Cooperative, Seattle, Washington
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Address correspondence to Elizabeth A. Phelan, MD, MS, Department of Medicine/Division of Gerontology and Geriatric Medicine, 325 9th Avenue, PO Box 359755, Seattle, WA 98104–2499. E-mail: phelane@u.washington.edu

Abstract

OBJECTIVES: To assess the effect of a team of geriatrics specialists on the practice style of primary care providers (PCPs) and the functioning of their patients aged 75 and older.

DESIGN: Randomized, controlled trial.

SETTING: Two primary care clinics in the Seattle, Washington, area.

PARTICIPANTS: Thirty-one PCPs and 874 patients aged 75 and older.

INTERVENTION: An interdisciplinary team of geriatrics specialists worked with patients and providers to enhance the geriatric focus of care.

MEASUREMENTS: Main outcomes were a practice style reflecting a geriatric orientation and patient scores on the physical and affect subscales of the Arthritis Impact Measurement Scale 2—Short Form. Secondary outcomes were hospitalizations, incident disability in activities of daily living (ADLs), and PCP perceptions of the intervention. Death rates were also assessed.

RESULTS: Intervention providers screened significantly more for geriatric syndromes at 12 months, but this finding did not persist at 24 months. There were no significant differences in adequate hypertension control or high-risk prescribing at 12 or 24 months of follow-up. There were no significant differences in patient functioning or significant differences in hospitalization rates at either time point. Meaningful differences were observed in ADL disability at 12 but not 24 months. PCPs viewed the intervention favorably. Seventy-eight participants died over the 24 months of follow-up; the proportion dying was higher in the intervention group (11.4% in intervention group vs 7.1% of controls, P=.03).

CONCLUSION: The addition of an interdisciplinary geriatric team was acceptable to PCPs and had some effect on care of geriatric conditions but little effect on patient function or the use of inpatient care and was associated with greater mortality.

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