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Objectives: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care. Design: Assessor-blinded, single-center randomized controlled trial. Setting: AGU in an acute hospital in southeastern Sweden. Participants: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n ¼ 208) or control group (CG; n ¼ 174). Mean age (SD) was 82.5 (4.9) years. Intervention: Participants in the IG received CGA-based care at the AGU in addition to usual care. Outcome measures: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant’ sense of security in care, and health-related quality of life (HRQoL). Results: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P ¼.035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988e2.310; P ¼.057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371£ (39,947£) and 30,490£ (31,568£; P ¼ .432). Conclusions and relevance: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people. Trial Registration: clinicaltrials.gov identifier: NCT01446757. 2015 AMDA e The Society for Post-Acute and Long-Term Care Medicine. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Objective The objective of this study was to estimate the 3-month within-trial cost-effectiveness of comprehensive geriatric assessment (CGA) in acute medical care for frail elderly patients compared to usual medical care, by estimating health-related quality of life and costs from a societal perspective. Design Clinical, prospective, controlled, 1-center intervention trial with 2 parallel groups. Intervention Structured, systematic interdisciplinary CGA-based care in an acute elderly care unit. If the patient fulfilled the inclusion criteria, and there was a bed available at the CGA unit, the patient was included in the intervention group. If no bed was available at the CGA unit, the patient was included in the control group and admitted to a conventional acute medical care unit. Setting and Participants A large county hospital in western Sweden. The trial included 408 frail elderly patients, 75 years or older, in need of acute in-hospital treatment. The patients were allocated to the intervention group (n = 206) or control group (n = 202). Mean age of the patients was 85.7 years, and 56% were female. Measures The primary outcome was the adjusted incremental cost-effectiveness ratio associated with the intervention compared to the control at the 3-month follow-up. Results We undertook cost-effectiveness analysis, adjusted by regression analyses, including hospital, primary, and municipal care costs and effects. The difference in the mean adjusted quality-adjusted life years gained between groups at 3 months was 0.0252 [95% confidence interval (CI): 0.0082-0.0422]. The incremental cost, that is, the difference between the groups, was −3226 US dollars (95% CI: −6167 to −285). Conclusion The results indicate that the care in a CGA unit for acutely ill frail elderly patients is likely to be cost-effective compared to conventional care after 3 months.

Importance: The care of older persons with multimorbidity is a future challenge for the welfare sector in many countries in terms of organization of care and provision of sufficient health care resources. Objective: To determine whether an alternative with an ambulatory geriatric unit (AGU) additional to usual care based on Comprehensive Geriatric Assessment (CGA) is more effective than usual care (UC) only. Design: Randomized, controlled, assessor blinded, single center trial of community dwelling patients ≥75 years, hospitalized at least three times during the past 12 months, having at least three concomitant diagnoses [intervention (AGU) n = 208, control group (UC) n = 175]. Outcomes: Hospitalizations, mortality, health related quality of life (HRQoL) and costs of care. Results: After 24 months there was no difference in number of hospitalizations (2.1 in AGU versus 2.4 in CG (P = 0.19). However, patients in AGU had less inpatient days (11.1) compared to the UC (15.2) (P = 0.03). Further, the UC had 54% higher mortality rate than the IG (HR = 1.54 (95% CI: 1.01-2.34), P = 0.046). The cost of care was € 19,941 in the AGU and € 17,730 in the UC group. There was no difference in HRQoL between the groups. Conclusion: The superiority of the alternative with AGU in important findings such as decreased inpatient days and mortality, but to slightly higher total cost after 24 months follow up. This finding is important knowledge when organizing the care for the elderly. (Less)