Skip to main content
NCBI home page
American Journal of Public Health logoLink to American Journal of Public Health
. 1991 Oct;81(10):1302–1306. doi: 10.2105/ajph.81.10.1302

Impact of a geriatric assessment unit on subsequent health care charges.

W B Applegate 1, M J Graney 1, S T Miller 1, J T Elam 1
PMCID: PMC1405339  PMID: 1928529

Abstract

BACKGROUND. In a recent randomized controlled trial assessing the efficacy of an inpatient geriatric assessment unit (GAU), we demonstrated that patients assigned to the unit were less likely than those in the usual care group to be admitted to a nursing home and more likely to remain living in the community. Despite evidence of benefits of GAU care, questions remain about its cost. We examine the impact of GAU treatment on subsequent health care charges. METHODS. Sequential referrals of elderly disabled patients considered at risk for institutionalization or likely to improve with rehabilitation were randomized to the GAU or to usual care. Charge data were collected on utilization of a wide variety of health care services starting at the point of randomization. RESULTS. The group randomized to the GAU experienced significantly higher rehabilitation charges per participant ($10,583 vs $2066, P = .0001), but lower mean nursing home charges ($1798 vs $3426, P = .004). Total health care charges per participant over the 1 year follow-up were greater for the GAU group ($28,406 vs $16,444, P = .004). When charges were adjusted per year of life survived, the GAU group still showed a substantial (but nonsignificant, P = .10) increase in total charges. However, when charges were adjusted per day subsequently spent residing in the community, adjusted total charges were similar between the two groups. CONCLUSIONS. Our results indicated that improved outcomes from GAU care require an investment in rehabilitation that is not totally offset by decreased institutional charges in the following year.

Full text

PDF
1302

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Allen C. M., Becker P. M., McVey L. J., Saltz C., Feussner J. R., Cohen H. J. A randomized, controlled clinical trial of a geriatric consultation team. Compliance with recommendations. JAMA. 1986 May 16;255(19):2617–2621. [PubMed] [Google Scholar]
  2. Applegate W. B., Akins D. E., Elam J. T. A geriatric assessment and rehabilitation unit in a rehabilitation hospital. Clin Geriatr Med. 1987 Feb;3(1):145–154. [PubMed] [Google Scholar]
  3. Applegate W. B., Akins D., Vander Zwaag R., Thoni K., Baker M. G. A geriatric rehabilitation and assessment unit in a community hospital. J Am Geriatr Soc. 1983 Apr;31(4):206–210. doi: 10.1111/j.1532-5415.1983.tb05096.x. [DOI] [PubMed] [Google Scholar]
  4. Applegate W. B., Miller S. T., Graney M. J., Elam J. T., Burns R., Akins D. E. A randomized, controlled trial of a geriatric assessment unit in a community rehabilitation hospital. N Engl J Med. 1990 May 31;322(22):1572–1578. doi: 10.1056/NEJM199005313222205. [DOI] [PubMed] [Google Scholar]
  5. Avorn J. Benefit and cost analysis in geriatric care. Turning age discrimination into health policy. N Engl J Med. 1984 May 17;310(20):1294–1301. doi: 10.1056/NEJM198405173102005. [DOI] [PubMed] [Google Scholar]
  6. Becker P. M., McVey L. J., Saltz C. C., Feussner J. R., Cohen H. J. Hospital-acquired complications in a randomized controlled clinical trial of a geriatric consultation team. JAMA. 1987 May 1;257(17):2313–2317. [PubMed] [Google Scholar]
  7. Epstein A. M., Hall J. A., Besdine R., Cumella E., Jr, Feldstein M., McNeil B. J., Rowe J. W. The emergence of geriatric assessment units. The "new technology of geriatrics". Ann Intern Med. 1987 Feb;106(2):299–303. doi: 10.7326/0003-4819-106-2-299. [DOI] [PubMed] [Google Scholar]
  8. Hendriksen C., Lund E., Strømgård E. Consequences of assessment and intervention among elderly people: a three year randomised controlled trial. Br Med J (Clin Res Ed) 1984 Dec 1;289(6457):1522–1524. doi: 10.1136/bmj.289.6457.1522. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Hogan D. B., Fox R. A., Badley B. W., Mann O. E. Effect of a geriatric consultation service on management of patients in an acute care hospital. CMAJ. 1987 Apr 1;136(7):713–717. [PMC free article] [PubMed] [Google Scholar]
  10. Jette A. M., Branch L. G. The Framingham Disability Study: II. Physical disability among the aging. Am J Public Health. 1981 Nov;71(11):1211–1216. doi: 10.2105/ajph.71.11.1211. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lefton E., Bonstelle S., Frengley J. D. Success with an inpatient geriatric unit: a controlled study of outcome and follow-up. J Am Geriatr Soc. 1983 Mar;31(3):149–155. doi: 10.1111/j.1532-5415.1983.tb04854.x. [DOI] [PubMed] [Google Scholar]
  12. McVey L. J., Becker P. M., Saltz C. C., Feussner J. R., Cohen H. J. Effect of a geriatric consultation team on functional status of elderly hospitalized patients. A randomized, controlled clinical trial. Ann Intern Med. 1989 Jan 1;110(1):79–84. doi: 10.7326/0003-4819-110-1-79. [DOI] [PubMed] [Google Scholar]
  13. Rubenstein L. Z., Abrass I. B., Kane R. L. Improved care for patients on a new geriatric evaluation unit. J Am Geriatr Soc. 1981 Nov;29(11):531–536. doi: 10.1111/j.1532-5415.1981.tb03357.x. [DOI] [PubMed] [Google Scholar]
  14. Rubenstein L. Z., Josephson K. R., Wieland G. D., English P. A., Sayre J. A., Kane R. L. Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med. 1984 Dec 27;311(26):1664–1670. doi: 10.1056/NEJM198412273112604. [DOI] [PubMed] [Google Scholar]
  15. Saltz C. C., McVey L. J., Becker P. M., Feussner J. R., Cohen H. J. Impact of a geriatric consultation team on discharge placement and repeat hospitalization. Gerontologist. 1988 Jun;28(3):344–350. doi: 10.1093/geront/28.3.344. [DOI] [PubMed] [Google Scholar]
  16. Williams M. E., Hadler N. M., Earp J. A. Manual ability as a marker of dependency in geriatric women. J Chronic Dis. 1982 Feb;35(2):115–122. doi: 10.1016/0021-9681(82)90112-6. [DOI] [PubMed] [Google Scholar]
  17. Williams M. E., Williams T. F., Zimmer J. G., Hall W. J., Podgorski C. A. How does the team approach to outpatient geriatric evaluation compare with traditional care: a report of a randomized controlled trial. J Am Geriatr Soc. 1987 Dec;35(12):1071–1078. doi: 10.1111/j.1532-5415.1987.tb04923.x. [DOI] [PubMed] [Google Scholar]
  18. Yeo G., Ingram L., Skurnick J., Crapo L. Effects of a geriatric clinic on functional health and well-being of elders. J Gerontol. 1987 May;42(3):252–258. doi: 10.1093/geronj/42.3.252. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES