Cost analysis of the Geriatric Resources for Assessment and Care of Elders care management intervention.

Autor: Counsell SR; Center for Aging Research, School of Medicine, Indiana University, Indianapolis, Indiana 46202, USA. scounsel@iupui.edu, Callahan CM, Tu W, Stump TE, Arling GW
Jazyk: angličtina
Zdroj: Journal of the American Geriatrics Society [J Am Geriatr Soc] 2009 Aug; Vol. 57 (8), pp. 1420-6.
DOI: 10.1111/j.1532-5415.2009.02383.x
Abstrakt: 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 (n5951) and predefined high-risk (n5226) and low-risk (n5725) 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.
Databáze: MEDLINE
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