GRACE Program Provides More Evidence that Team Care
Best for Chronically Ill Seniors
New health care delivery model improves care,
quality of life, saves money
Aug. 11, 2009 The evidence continues to grow that
shows some form of team approach to care for chronically ill senior
citizens improves care and saves money. The latest such report is from
the Geriatric Resources for Assessment and Care of Elders (GRACE)
program, which improved health and quality of life, decreased emergency
department visits and lowered hospital admission rates. By the second
year the new model saved money for the sickest (those with three to four
chronic diseases), and in the third year, a year after the home-based
intervention ended, it saved even more.
Studies say Guided Care improves quality of patients' care, reduces family caregiver strain and improves
physicians' satisfaction with chronic care.. link to video in story.
In 2008, there were barely 7,000 geriatricians to
treat 38 million seniors; in 2006-2007 just 253 physicians were enrolled
in geriatric medicine fellowships
By
Howard Gleckman, Senior Research Associate at the Urban Institute
GRACE was developed by researchers from the Indiana
University School of Medicine, the IU Center for Aging Research and the
Regenstrief Institute to involve seniors and their primary care
physicians in a program to optimize health and functional status, and to
decrease high-cost emergency department visits and hospital admissions.
"Healthcare reform is calling out for ways to
improve health and lower costs. We have found a strategy to do that for
a very vulnerable growing population in a way that shows cost savings
over time and has the added benefit of providing services that these
seniors desperately need but can't get elsewhere," said study leader
Steven R. Counsell, M.D., Mary Elizabeth Mitchell Professor of
Geriatrics at the IU School of Medicine, IU Center for Aging Research
center scientist and affiliated scientist of the Regenstrief Institute.
The cost analysis of the home-based program appears
in the August 2009 issue of the Journal of the American Geriatrics
Society (JAGS).
In a previous study published in the Dec. 12, 2007,
issue of the Journal of American Medical Association (JAMA) the
researchers reported their success in improving both quality of care and
health-related quality of life measures while reducing emergency
department use. Hospital admissions were reduced in the second year of
the program for those at high risk of hospitalization.
The randomized control trial enrolled 951
low-income seniors (average age 72); 477 received usual care, 474
participated in GRACE. Both the usual care and the GRACE groups were
comprised of lower risk for hospitalization and higher risk for
hospitalization individuals, were predominately female (77 percent) and
African-American and were seen at six community-based health centers.
The key to GRACE is two teams.
● The support team, consisting of a nurse
practitioner and a social worker, meet with each patient at his home to
conduct an initial comprehensive geriatric assessment from the medicine
cabinet to the kitchen cabinet.
● The larger interdisciplinary team,
including a geriatrician, pharmacist, physical therapist, mental health
social worker, and community-based services liaison, acts on the support
teams findings to develops an individualized care plan.
Then the ball is back in the support team's court.
The nurse practitioner and the social worker meet with the patient's
primary care doctor to come up with a health-care plan consistent with
the patient's goals, such as maintaining the ability to participate in
social and religious activities.
The support team then works with the patient to
implement the plan which contains strategies for medical issues of
concern as well as elements related to maintaining quality of life.
With the assistance of an electronic medical record
and tracking system, the GRACE support team provides ongoing
comprehensive care management.
"With GRACE we focused on the many issues faced by
aging low-income adults -- access to needed services, medications,
mobility, depression, transportation, nutrition, as well as other health
issues of aging," said Dr. Counsell, who is a geriatrician.
"Using a model for geriatrics care based on our
prior work, we were able to deliver care which was very popular with
patients and their doctors, improved health outcomes, and saved money
because it helped keep seniors from having to use the emergency
department or be admitted to the hospital."
Dr. Counsell is director of geriatrics for IU
Medical Group which is the physician group responsible for patient care
at the health centers of Wishard Health Services where the study was
conducted. He also is director of the IU Center of Excellence in
Geriatric Medicine and Training, one of 25 sites supported nationally by
the John A. Hartford Foundation.
In addition to Dr. Counsell, coauthors of the JAGS
paper entitled, "Cost Analysis of the Geriatric Resources for Assessment
and Care of Elders (GRACE) Care Management Intervention", are
Christopher M. Callahan, M.D., Wanzhu Tu, Ph.D., Timothy E. Stump, M.S.
and Greg Arling, Ph.D. of the IU School of Medicine, the Regenstrief
Institute and the IU Center for Aging Research.
The GRACE study was funded by the National
Institute on Aging, the Nina Mason Pulliam Charitable Trust and Wishard
Health Services.
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Keep up with the latest news for senior citizens, baby
boomers
Aug. 11, 2009 The evidence continues to grow that
shows some form of team approach to care for chronically ill senior
citizens improves care and saves money. The latest such report is from
the Geriatric Resources for Assessment and Care of Elders (GRACE)
program, which improved health and quality of life, decreased emergency
department visits and lowered hospital admission rates. By the second
year the new model saved money for the sickest (those with three to four
chronic diseases), and in the third year, a year after the home-based
intervention ended, it saved even more. 
