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Cost Analysis of the Geriatric Resources for Assessment and Care of Elders Care Management Intervention

Authors

  • Steven R. Counsell MD, AGSF,

    1. From the *Center for Aging Research and Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana; and Regenstrief Institute, Inc., Indianapolis, Indiana.
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  • Christopher M. Callahan MD,

    1. From the *Center for Aging Research and Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana; and Regenstrief Institute, Inc., Indianapolis, Indiana.
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  • Wanzhu Tu PhD,

    1. From the *Center for Aging Research and Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana; and Regenstrief Institute, Inc., Indianapolis, Indiana.
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  • Timothy E. Stump MA,

    1. From the *Center for Aging Research and Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana; and Regenstrief Institute, Inc., Indianapolis, Indiana.
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  • Gregory W. Arling PhD

    1. From the *Center for Aging Research and Department of Medicine, School of Medicine, Indiana University, Indianapolis, Indiana; and Regenstrief Institute, Inc., Indianapolis, Indiana.
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  • 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.

Address correspondence to Steven R. Counsell, Indiana University School of Medicine, 1001 West 10th Street, WOP-M200, Indianapolis, IN 46202. E-mail: scounsel@iupui.edu

Abstract

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.

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