Geriatric Care Management for Low-Income Seniors: A Randomized Controlled Trial

CONTEXT Low-income seniors frequently have multiple chronic medical conditions for which they often fail to receive the recommended standard of care. OBJECTIVES To test the effectiveness of a geriatric care management model on improving the quality of care for low-income seniors in primary care. DESIGN, SETTING, AND PATIENTS Controlled clinical trial of 951 adults 65 years or older with an annual income less than 200% of the federal poverty level, whose primary care physicians were randomized from January 2002 through August 2004 to participate in the intervention (474 patients) or usual care (477 patients) in community-based health centers. INTERVENTION Patients received 2 years of home-based care management 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. MAIN OUTCOME MEASURES The Medical Outcomes 36-Item Short-Form (SF-36) scales and summary measures; instrumental and basic activities of daily living (ADLs); and emergency department (ED) visits not resulting in hospitalization and hospitalizations. RESULTS Intention-to-treat analysis revealed significant improvements for intervention patients compared with usual care at 24 months in 4 of 8 SF-36 scales: general health (0.2 vs −2.3, P = .045), vitality (2.6 vs −2.6, P