Presented in part at the American Geriatrics Society Annual Scientific Meeting, Chicago, Illinois, April 30, 2009; the Society of General Internal Medicine Annual Meeting, Miami, Florida, May 15, 2009; the AcademyHealth Annual Research Meeting, Chicago, Illinois, June 29, 2009; and IAGG World Congress of Gerontology and Geriatrics, Paris, France, July 8, 2009.
Cost Analysis of the Geriatric Resources for Assessment and Care of Elders Care Management Intervention
Article first published online: 21 JUL 2009
© 2009, Copyright the Authors. Journal compilation © 2009, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 57, Issue 8, pages 1420–1426, August 2009
How to Cite
Counsell, S. R., Callahan, C. M., Tu, W., Stump, T. E. and Arling, G. W. (2009), Cost Analysis of the Geriatric Resources for Assessment and Care of Elders Care Management Intervention. Journal of the American Geriatrics Society, 57: 1420–1426. doi: 10.1111/j.1532-5415.2009.02383.x
- Issue published online: 29 JUL 2009
- Article first published online: 21 JUL 2009
- cost analysis;
- primary care;
- geriatric assessment;
- care management;
- interdisciplinary team
OBJECTIVES: To provide, from the healthcare delivery system perspective, a cost analysis of the Geriatric Resources for Assessment and Care of Elders (GRACE) intervention, which is effective in improving quality of care and outcomes.
DESIGN: Randomized controlled trial with physicians as the unit of randomization.
SETTING: Community-based primary care health centers.
PARTICIPANTS: Nine hundred fifty-one low-income seniors aged 65 and older; 474 participated in the intervention and 477 in usual care.
INTERVENTION: Home-based care management for 2 years by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocols for common geriatric conditions.
MEASUREMENTS: Chronic and preventive care costs, acute care costs, and total costs in the full sample (n=951) and predefined high-risk (n=226) and low-risk (n=725) groups.
RESULTS: Mean 2-year total costs for intervention patients were not significantly different from those for usual care patients in the full sample ($14,348 vs $11,834; P=.20) and high-risk group ($17,713 vs $18,776; P=.38). In the high-risk group, increases in chronic and preventive care costs were offset by reductions in acute care costs, and the intervention was cost saving during the postintervention, or third, year ($5,088 vs $6,575; P<.001). Mean 2-year total costs were higher in the low-risk group ($13,307 vs $9,654; P=.01).
CONCLUSION: In patients at high risk of hospitalization, the GRACE intervention is cost neutral from the healthcare delivery system perspective. A cost-effectiveness analysis is needed to guide decisions about implementation in low-risk patients.