Clinical and financial outcome impacts of comprehensive geriatric assessment in a level 1 geriatric emergency department

Austin Haynesworth; Todd P Gilmer; Jesse J Brennan; Emily H Weaver; Vaishal M Tolia; Theodore C Chan; James P Killeen; Edward M Castillo

doi:10.1111/jgs.18468

Clinical and financial outcome impacts of comprehensive geriatric assessment in a level 1 geriatric emergency department

J Am Geriatr Soc. 2023 Sep;71(9):2704-2714. doi: 10.1111/jgs.18468. Epub 2023 Jul 12.

Authors

Austin Haynesworth¹, Todd P Gilmer², Jesse J Brennan³, Emily H Weaver⁴, Vaishal M Tolia³, Theodore C Chan³, James P Killeen³, Edward M Castillo³

Affiliations

¹ School of Medicine, University of California San Diego, San Diego, California, USA.
² Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, California, USA.
³ Department of Emergency Medicine, University of California San Diego, San Diego, California, USA.
⁴ Clinical Research Department, West Health Institute, San Diego, California, USA.

PMID: 37435746
DOI: 10.1111/jgs.18468

Abstract

Background: The aging population has led to an increase in emergency department (ED) visits by older adults who have complex medical conditions and high social needs. The purpose of this study was to assess if comprehensive geriatric evaluation and management impacted service utilization and cost by older adults admitted to the ED.

Methods: This is a retrospective matched case-control study at a level 1 geriatric ED (GED) from January 1, 2018-March 31, 2020. Geriatric nurse specialists (GENIEs) provided comprehensive evaluations and management for GED patients. Propensity score matching was used to match patients receiving GENIE consultations to ED patients who did not receive a GENIE consult. Regression was used to assess the impact of the GENIE services on inpatient admissions, ED revisits and cost of inpatient and ED care from the payor perspective.

Results: GENIE consults were associated with a 13.0% reduction in absolute risk of admission through the ED at index (95% confidence interval [CI] -17.0%, -9.0%, p < 0.001) and a reduction in risk for total admissions at 30 and 90-days post discharge (-11.3%, 95% CI -15.6%, -7.1%, p-value < 0.001; and -10.0, 95% CI -13.8%, -6.0%; p < 0.001 respectively), both driven by reduced risk of admission at the index visit. GENIE consults were associated with a 4% increase in absolute risk of revisits to the ED within 30 days (95% CI 0.6%, 7.3%; p = 0.001). GENIE consults were associated with a decrease in cost of inpatient and ED care, with savings of $2344 within 30 days (95% CI $2247, $2441, p < 0.001) and savings of $2004 USD within 90 days (95% CI $1895, $2114, p < 0.001), driven by reduced costs at the index visit.

Conclusions: GENIE consults were associated with decreased inpatient admissions through the ED, modestly increased ED revisits, and decreased cost of inpatient and ED care. The results of this study can be useful for EDs considering approaches to better serve older adults. They can also be of interest to payers as an area of potential cost savings.

Keywords: Medicare; cost savings; emergency department; geriatric assessment; hospital costs.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aftercare
Aged
Case-Control Studies
Emergency Service, Hospital
Geriatric Assessment* / methods
Humans
Patient Discharge*
Retrospective Studies

Substances

Genie