Cost Analysis of the Geriatric Resources for Assessment and Care of Elders Care Management Intervention

OBJECTIVES To provide, from the healthcare delivery system perspective, a cost analysis of the Geriatric Resources for Assessment and Care of Elders (GRACE) intervention, which is effective in improving quality of care and outcomes. DESIGN Randomized controlled trial with physicians as the unit of randomization. SETTING Community-based primary care health centers. PARTICIPANTS Nine hundred fifty-one low-income seniors aged 65 and older; 474 participated in the intervention and 477 in usual care. INTERVENTION Home-based care management for 2 years 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. MEASUREMENTS Chronic and preventive care costs, acute care costs, and total costs in the full sample (n=951) and predefined high-risk (n=226) and low-risk (n=725) groups. RESULTS Mean 2-year total costs for intervention patients were not significantly different from those for usual care patients in the full sample ($14,348 vs $11,834; P=.20) and high-risk group ($17,713 vs $18,776; P=.38). In the high-risk group, increases in chronic and preventive care costs were offset by reductions in acute care costs, and the intervention was cost saving during the postintervention, or third, year ($5,088 vs $6,575; P <.001). Mean 2-year total costs were higher in the low-risk group ($13,307 vs $9,654; P=.01). CONCLUSION In patients at high risk of hospitalization, the GRACE intervention is cost neutral from the healthcare delivery system perspective. A cost-effectiveness analysis is needed to guide decisions about implementation in low-risk patients.