A Randomized Clinical Trial of Outpatient Comprehensive Geriatric Assessment Coupled with an Intervention to Increase Adherence to Recommendations

Reuben, David B.; Frank, Janet C.; Hirsch, Susan H.; McGuigan, Kimberly A.; Maly, Rose C.

doi:10.1111/j.1532-5415.1999.tb02988.x

Cited by 215 publications

(154 citation statements)

References 49 publications

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“…Community-based care: assessment followed by referrals and recommendations (N = 4) Eligible participants for these four studies were identified by a self-administered postal questionnaire (Robichaud et al 2000;Hebert et al 2001), telephone interview (Silverman et al 1995), or an interviewer-assisted selfadministered screening (Reuben et al 1999). Extensive assessment was performed by a nurse during home visits (Hebert et al 2001;Robichaud et al 2000) or by a team in community-based clinics (Reuben et al 1999;Silverman et al 1995).…”

Section: Transmural Care (N = 7)mentioning

confidence: 99%

Interventions to prevent disability in frail community-dwelling older persons: an overview

et al. 2010

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This narrative review was conducted to provide an overview of the variety of interventions aimed at disability prevention in community-dwelling frail older persons and to summarize promising elements. The search strategy and selection process found 48 papers that met the inclusion criteria. The 49 interventions described in these 48 papers were categorized into 'comprehensive geriatric assessment', 'physical exercise', 'nutrition', 'technology', and 'other interventions'. There is a large diversity within and between the groups of interventions in terms of content, disciplines involved, duration, intensity, and setting. For 18 of the 49 interventions, significant positive effects for disability were reported for the experimental group. Promising features of interventions seem to be: multidisciplinary and multifactorial, individualized assessment and intervention, case management, long-term follow-up, physical exercise component (for moderate physically frail older persons), and the use of technology. Future intervention studies could combine these elements and consider the addition of new elements.

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Section: Transmural Care (N = 7)mentioning

confidence: 99%

Interventions to prevent disability in frail community-dwelling older persons: an overview

et al. 2010

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“…The comprehensive geriatric assessment (CGA) is considered by many to be the "gold standard" and is an effective clinical tool for identifying frailty in elderly patients (13,14). The CGA has demonstrated utility for the management of various geriatric problems including prevention of institutionalization and maintenance of independence, prevention of delirium in hospitalized patients, falls, and hospital readmission (15)(16)(17).…”

Section: Introductionmentioning

confidence: 99%

Utility of the Edmonton Frail Scale in identifying frail elderly patients during treatment of colorectal cancer

Meyers

Al-Shamsi

Rask

et al. 2017

J. Gastrointest. Oncol.

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“…When paired with outreach to improve adherence to recommendations among primary care clinicians, comprehensive assessment has preserved physical function and improved health-related quality of life among highrisk elders. 4 Other geriatric interventions with close links to primary care have been associated with reduced risk of hospitalization, including: a senior center-based disability prevention program, 5 multidisciplinary team primary care emphasizing chronic disease self-management, 6 and primary care-based group medical visits. 7 Positive studies, however, contrast with studies of brief outpatient geriatric interventions that have found little or no effects on clinical outcomes or health service use.…”

mentioning

confidence: 99%

Bringing Geriatricians to the Front Lines: Evaluation of a Quality Improvement Intervention in Primary Care

Fenton

Levine

Mahoney

et al. 2006

The Journal of the American Board of Family Medicine

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Background: Frail elders often receive low-quality primary care, yet the optimal role of geriatricians in primary care settings remains uncertain. We evaluated the health utilization impacts of an innovative intervention emphasizing chronic disease self-management and physical activity promotion among frail elders in primary care.Methods: The intervention was implemented within two primary care practices at a single clinic serving a large population of frail elders enrolled in a western Washington health plan. Subjects included older patients (age >65 years) with disproportionate baseline outpatient service use who attended two on-site visits with a geriatrician during which each received comprehensive assessment and a problemsolving intervention to enhance chronic disease self-management and promote physical activity (N ‫؍‬ 146). Our evaluation had a retrospective matched cohort design. Controls receiving primary care at other health plan clinics were matched 3:1 to intervention subjects by sex and a propensity score (N ‫؍‬ 437), which was computed using demographic, clinical, and health care utilization factors that were predictive of attending the intervention. Among intervention subjects and controls following the intervention, we compared relative rates of hospitalization, outpatient and specialty visits, nursing home admission, mortality, and prescription of selected high-risk medications, as well as total health care costs.Results: From March 2002 to November 2003, the geriatrician evaluated 146 of 725 elderly subjects (20%) in the two primary care practices. During a mean follow-up of 1.3 years, intervention subjects had a reduced rate of hospitalization relative to matched controls (incidence rate ratio 0.57; 95% CI: 0.37 to 0.86; P < .01). Intervention and control subjects did not have significantly different rates of specialty visits, outpatient visits, nursing home admission, mortality, or high-risk prescriptions. Relative to matched controls during follow-up, total health care costs were 26.3% lower among intervention subjects (95% CI: 1.3%, 44.9%; P ‫؍‬ .04).Conclusions: Outpatient geriatric interventions emphasizing collaboration between geriatricians and primary care physicians, chronic disease self-management, and physical activity may reduce hospitalization risk and total health care costs among vulnerable elders. (J Am Board Fam Med 2006;19: 331-9.)

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A Randomized Clinical Trial of Outpatient Comprehensive Geriatric Assessment Coupled with an Intervention to Increase Adherence to Recommendations

Abstract: A single outpatient comprehensive geriatric assessment coupled with an adherence intervention can prevent functional and health-related quality-of-life decline among community-dwelling older persons who have specific geriatric conditions.

Cited by 215 publications

References 49 publications

Interventions to prevent disability in frail community-dwelling older persons: an overview

Interventions to prevent disability in frail community-dwelling older persons: an overview

Utility of the Edmonton Frail Scale in identifying frail elderly patients during treatment of colorectal cancer

Bringing Geriatricians to the Front Lines: Evaluation of a Quality Improvement Intervention in Primary Care

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