Table 9.
Study | Endpoints | Findings | |||
GEMU vs UCIP | GEMC vs UCOP | ||||
Cohen, et al., 200244 | Basic ADL score - at discharge - at 12 monthsInstrumental ADL score - at discharge - at 12 monthsPhysical performance - at discharge - at 12 monthsQuality of life Physical functioning - at discharge - at 12 months Physical limitations - at discharge - at 12 months Emotional limitations - at discharge - at 12 months Bodily pain - at discharge - at 12 months Energy - at discharge - at 12 months Mental health - at discharge - at 12 months Social activity - at discharge - at 12 months General health - at discharge - at 12 months | Mean change in score0.230.27−0.30−0.203.124.50−1.56.74.534.013.022.015.324.90.84.5−0.34.52.718.3−0.02−5.5 | Mean change in score0.15†0.25−0.30−0.201.75†4.24†−5.4†4.54.729.812.020.39.2†20.0†−2.6†1.8−1.52.51.016.4−3.4−7.1 | Mean change in score0.200.27 (0.05)*−0.28−0.18 (0.09)2.344.67 (2.13)−3.76.8 (9.7)5.931.3 (24.1)13.422.1 (9.2)11.921.9 (10.2)0.85.4 (3.6)−0.66.3 (5.7)2.418.3 (16.0)−0.5−4.4 (−5.5) | Mean change in score0.200.25 (0.03)−0.30−0.21 (0.08)2.604.07 (1.30)†−3.24.5 (7.2)3.232.5 (29.2)†11.620.2 (8.0)12.822.9 (9.6)−2.5†1.0† (3.2)−1.20.8† (1.5)†1.216.4 (13.8)−2.9†−8.2† (−7.1) |
Survival at one year - Main effect of GEMU - Deaths (%) - Probability of survival - Relative risk of death (95% CI) - Main effect of GEMC - Deaths (%) - Probability of survival - Relative risk of death (95% CI) | 22%78.4 ± 1.61.02 (0.81–1.28) | 21%78.8 ± 1.6 | 22%78.0 ± 1.61.07 (0.86–1.35) | 21%79.2 ± 1.5 | |
Resource utilization - Number of days in the hospital - Number of days of initial hospitalization - Number of medical consultations - Number of surgical consultations - Number of days in long-term care | Mean (±SD)35.3 ± 1.423.2 ± 12.8 ± (not provided)2.1 ± (not provided)15.0 ± 1.8 | Mean (±SD)28.3 ± 1.4†15.0 ± 0.9†1.3 ± (not provided)†1.2 ± (not provided)†17.1 ± 1.8† | Mean (±SD)15.4 ± 1.8 | Mean (±SD)16.8 ± 1.8 | |
Costs of care** (dollars) - initial hospitalization - care after discharge - total | 13,449 ± 62122,816 ± 1,08036,265 ± 1,298 | 10,758 ± 592†26,533 ± 1,20137,292 ± 1,369 | 12,254 ± 58423,689 ± 1,09135,943 ± 1,292 | 11,954 ± 66325,654 ± 1,19437,608 ± 1,374 | |
Study | Endpoints | Findings multifactorial interdisciplinary intervention | Usual care | ||
Fairhall, et al., 201532 | Prevalence of frailty - at baseline - at 3 months - at 12 months | (%)1006462 | (%)1007577† | ||
Health-related quality of life - at baseline - at 3 months - at 12 months | Mean (±SD)0.67 ± 0.230.56 ± 0.310.49 ± 0.32 | Mean (±SD)0.66 ± 0.230.47 ± 0.340.47 ± 0.34 | |||
Total cost (in Australian dollars) of - Hospital admissions - General practitioner consultation - Nursing or other health professional appointment - Permanent resident care (high level care) - Permanent resident care (low-level care) - Respite residential care (low-level care) - Transport - Home help - Meal delivery | 2,314,122128,892135,44577,45835,442709314,905172,01840,238 | 2,229,381126,960105,420141,39964,859920612,402132,5059,923† | |||
Total cost per participant (Australian dollars) - All participants - Frail subgroup - Very frail subgroup | 25,030 ± 29,82723,006 ± 26,32328,742 ± 35,416 | 22,885 ± 32,35418,550 ± 29,54031,133 ± 36,081 | |||
QALYs over 12 months | 0.52 ± 0.26 | 0.54 ± 0.27 | |||
Costs per extra person who transitioned out of frailty - All participants - Frail subgroup - Very frail subgroup | 0.34 ± 0.480.39 ± 0.490.26 ± 0.45 | 0.21 ± 0.410.28 ± 0.460.07 ± 0.26 |
†Between-group significant difference.
*Values in brackets: values adjusted for the length of s64tay.
**Costs include all costs of inpatient, outpatient, and long-term care provided by Veterans Affairs medical centers, as well as care in private nursing homes. The costs of inpatient and outpatient care at non–Veterans Affairs facilities are not included.
ADL, activities of daily living; GEMC, geriatric evaluation and management clinic; GEMU, geriatric evaluation and management unit; QALYs, quality adjusted life years; RCT, randomized control trial; SD, standard deviation; SF-36, Short Form 36 Health Survey; UCIP, usual inpatient care; UCOP, usual outpatient care.