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Substudy 13 Executive Summary

Substudy 13: The Victoria Geriatric Outcome and Evaluation Study

by Holly Tuokko

This project, the Geriatric Outcomes Evaluation Study, explored the concept of substitutability of services within the structure of a spectrum of care developed for a geriatric services program. Specifically, we were interested in examining how a geriatric day hospital (GDH) fits within this spectrum of services. In the context of the geriatric services program in Victoria, British Columbia, the GDH is seen as a mechanism for meeting the needs of those geriatric patients who have multiple problem areas, who require multidisciplinary consultation, and for whom there is an expectation that the patients would benefit from outpatient case rehabilitation and clinical case management. In Canada, GDHs have emerged as one of a variety of services available to older adults yet there is a paucity of information concerning the effectiveness of these programs. Speculations as to the cost effectiveness of GDH treatment assume 1) substitutability and availability of these programs, 2) that patients in one program (e.g., inpatient rehabilitation) can be served as adequately through GDHs as through the inpatient unit, and 3) that outcomes may be measured using an appropriate set of standard instruments.

To address the issue of substitutability of services within an existing structured geriatric services program, data were obtained for all persons admitted to each of the 5 service components (i.e., outpatient - Geriatric Outpatient Clinic and Geriatric Day Hospital; inpatient - inpatient - Postacute geriatric rehabilitation [7C], Geriatric rehabilitation for persons admitted directly from the community [7D], and Psychogeriatric Rehabilitation [Homer 2] ). Measures of mental health, physical health, daily functioning and bodily pain were administered to persons attending all of the services within the Geriatric Services Program at admission, discharge and 4 months post-discharge. Measures of health status, depression and reactions to caregiving were administered to family members involved in providing care to these persons at admission, discharge and 4 months post-discharge. Data on health care utilization and costs of care were obtained through existing data bases, manual record review and report of caregivers and addressed issues related to costs of self-care, informal care, and formal care.

The central finding of this study was that persons admitted to each of the service components of the geriatric services program differed with respect to their profile of mental health, physical health, daily functioning and bodily pain. This supports the notion that these services represent a spectrum of care and that one service is not substitutable for another. That is, each service is addressing the needs of a specific subpopulation. Within each service, health status appeared to improve when receiving care, and examination of the sustainability of improved health status over time supported the present model of care in that little change in functioning was seen from discharge until 4 months post-discharge. Unfortunately, we were unable to assess the cost-effectiveness of the various services and so it was not possible to determine if there could be a cost-effective substitution of services.

These findings support the notion that a spectrum of care services are required for geriatric care and that health benefits are realized and sustained across a broad spectrum of services. Included in this report are some of the many valuable lessons learned during the implementation phase of the study. This report addresses only the findings relevant to the specific objectives of the project. The rich data available will be further examined with respect to a variety of specific topics in the future.