Evidence-based Synthesis Program Department of Veterans Affairs

Health Services Research & Development Service

June 2012

Evidence Brief: 

Effect of Geriatricians 

on Outcomes of Inpatient 

and Outpatient Care

SUPPLEMENTAL MATERIALS

Prepared for:

Department of Veterans Affairs

Veterans Health Administration

Quality Enhancement Research Initiative

Health Services Research & Development Service

Washington, DC 20420

Prepared by:

Evidence-based Synthesis Program (ESP) Coordinating Center

Portland VA Medical Center

Portland, OR

Mark Helfand, MD, MPH, MS, Director

Investigators:

Principal Investigator: 

Annette Totten, PhD

Contributing Investigators: 

Susan Carson, MPH

Kimberly Peterson, MS

Allison Low, BA

Vivian Christensen, PhD

Arpita Tiwari, MPH
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 1 

TABLE OF CONTENTS

SEARCH STRATEGY ........................................................................................................... 1 

DETAILED INCLUSION AND EXCLUSION CRITERIA............................................... 3 

QUALITY RATING OF SYSTEMATIC REVIEWS: INPATIENT ................................ 4 

QUALITY RATING OF SYSTEMATIC REVIEWS: OUTPATIENT ............................ 5 

QUALITY ASSESSMENT OF RANDOMIZED TRIALS ................................................. 6 

QUALITY ASSESSMENT OF COHORT STUDIES ......................................................... 9 

INPATIENT STUDIES WITH POOR QUALITY RATINGS ........................................ 10 

OUTPATIENT STUDIES WITH POOR QUALITY RATINGS .................................... 11 

REVIEW COMMENTS/RESPONSES .............................................................................. 12 

LIST OF EXCLUDED STUDIES ....................................................................................... 22 

REFERENCES ...................................................................................................................... 32 

   
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 1 

SEARCH STRATEGY 

MEDLINE (PubMed) searched 3/2/2012 

Concept Search# Search string Results Notes 

Geriatrics #1 "Geriatrics"[Mesh] 25696 Note: Mesh terms 

aged, and aged 

80 and over 

retrieved too 

many irrelevant 

hits to include 

#2 (((gerontologist) OR geriatrician) OR 

geriatrics) OR gerontology

57551 

#3 #1 AND #2 57551 

Care models #4 (((((((("Geriatric Assessment"[Mesh]) OR 

"Personnel Staffing and 

Scheduling"[Mesh]) OR "Health Services 

for the Aged"[Mesh]) OR "Referral and 

Consultation"[Mesh]) OR "PatientCentered Care"[Mesh]) OR ( "Patient 

Care"[Mesh] OR "Patient Care 

Team"[Mesh] )) OR "Case 

Management"[Mesh]) OR "Program 

Evaluation"[Mesh]) OR "Interdisciplinary 

Communication"[Mesh]

677349 

Nongeriatricians #5 (((("Medical Staff"[Mesh]) OR 

"Physicians"[Mesh]) OR "Primary Health 

Care"[Mesh]) OR "Internal 

Medicine"[Mesh]) OR "General 

Practice"[Mesh]

263691 These broad 

Mesh terms 

include primary 

care physicians 

and hospitalists, 

and attempt to 

cover inpatient 

and outpatient 

settings, and are 

included to 

capture the 

relationship of 

geriatrics to other 

providers 

Union of 

concepts 

#6 #3 AND #4 AND #5 848 

Geriatric 

referrals 

#7 (“Geriatrics”[Mesh]) AND “Referral and 

Consultation”[Mesh]

212 Targeted search 

for geriatric 

consults 

 #8 #6 OR #7 987 

Cochrane Central Register of Controlled Trials ; Cochrane Library of Systematic Reviews ; 

Cochrane Database of Reviews of Effects (OVID) Searched 3/2/2012 

Concept Search# Search string Results Notes 

Geriatrics #6 1 exp Geriatrics/ 

2 geriatrics.mp. 

3 geriatrition.mp. 

4 gerontology.mp. 

5 gerontologist.mp. 

6 1 or 2 or 3 or 4 or 5 

460 With such a small 

retrieval 

(especially after 

deduplication), 

rather than further 

specify the 

search, it was left 

as is 

Deduplication After deduplication with MEDLINE citations 103 unique citations remain 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 2 

MEDLINE (PubMed) searched 3/9/2012 

Concept Search# Search string Results Notes 

Geriatric 

assessment 

#1 "Geriatric Assessment"[Mesh] 15550 Informed by Ellis 

2011 Cochrane 

Review 

#2 "Health Services for the Aged"[Mesh] 13697 

#3 "Geriatrics"[Mesh] 25701 

#4 (((((("Needs Assessment"[Mesh]) OR 

"Risk Assessment"[Mesh]) OR 

"Diagnostic Services"[Mesh]) OR "Health 

Services Needs and Demand"[Mesh]) OR 

"Health Services"[Mesh]) OR "Delivery of 

Health Care"[Mesh]) OR "Outcome and 

Process Assessment (Health 

Care)"[Mesh]

2353860 

#5 3 AND 4 6030 

#6 1 OR 3 OR 5 32979 

Geriatrics in 

the hospital 

#7 ("Hospitals"[Mesh]) AND 

"Geriatrics"[Mesh] 

1051 

#8 7 OR 6 33370 

RCT #9 ((((((((groups[tiab])) OR (trial[tiab])) OR 

(randomly[tiab])) OR (drug therapy[sh])) 

OR (placebo[tiab])) OR 

(randomized[tiab])) OR (controlled clinical 

trial[pt])) OR (randomized controlled 

trial[pt]) 

2941705 Cochrane RCT 

hedge 

 #10 8 AND 9 975 

After deduplication with previous searches: 877 unique citations 

 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 3 

DETAILED INCLUSION AND EXCLUSION CRITERIA 

Inclusion criteria for inpatient studies (PICOTS): 

• Population: Medical and surgical in-patients 

• Intervention: A geriatrician serving in the role of consultant or co-manager either individually or as 

part of a care team 

• Comparator: Standard care (without the care of a geriatrician) 

• Outcomes: Mortality, falls, length of hospital stay, re-admission rates, functional status, incident 

reports, discharge to nursing home, and the number of prescriptions prescribed 

• Timing: No restriction on minimum study duration 

• Setting: In-patient medical and surgical wards 

Inclusion criteria for outpatient studies (PICOTS): 

• Population: Outpatient (primary care) patients 

• Intervention: A geriatrician serving in the role of consultant or as part of a co-management team, or 

as a primary care physician 

• Comparator: Standard care (without the care of a geriatrician) 

• Outcomes: Mortality, hospital admission, emergency department visits, functional status, nursing 

home placement, falls, and the number of prescriptions prescribed 

• Timing: No restriction on minimum study duration 

• Setting: Outpatient (primary care) facilities 

• Additional inclusion criteria: International studies (studies conducted outside of the United States) 

will be reviewed and included on an individual basis per their applicability to the specified 

outcomes of interest. 

• In order to focus on the current and thus more relevant literature, we will include studies published 

after 1985 

Exclusions: 

• Population: Studies that focus on disease specific populations, such as elderly cancer patients or 

patients with diabetes 

• Intervention: (providers) Studies that do not include a geriatrician, including only other geriatric 

care providers such as Geriatric Nurse Practitioners (GNPs) and other non-physician health care 

providers such as geriatric pharmacists, as well as specialists who have extra geriatric training 

• Intervention: (model of care) Studies that examine models of care that integrate acute and long-term 

care, such as PACE and EVERCARE 

• Comparator: Studies that do not include an appropriate comparison group 

• Outcomes: Studies that do not include outcomes (e.g., opinion articles, descriptive/discussion 

articles, and consensus statements.) and studies that examine outcomes outside of the proposed 

scope of work (e.g., patient satisfaction, physician job satisfaction) 

• Setting: Nursing homes or other long-term care facilities 

 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 4 

QUALITY RATING OF SYSTEMATIC REVIEWS: INPATIENT USING AMSTAR CRITERIA* *Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Medical  1 2 3 4 5 6 7 8 9 Author, year 

Was an 'a priori' design provided? 

Was there duplicate study selection and data extraction? 

Was a comprehensive literature search performed? 

Was the status of publication (i.e., grey literature) used as an inclusion criterion? 

Was a list of studies (included and excluded) provided? 

Were the characteristics of the included studies provided? 

Was the scientific quality of the included studies assessed and documented? 

Was the scientific quality of the included studies used appropriately in formulating conclusions? 

Were the methods usto combine findings of studies appropriate

Bachmann 20101

Can't answer 

Yes Yes Yes; included 

some unpublished data 

Yes (excluded studies list available on request) 

Yes Yes Yes Yes 

Baztan 20092

Can't answer 

Yes Yes Yes No for 

excluded studies; yes for included studies 

Yes Yes Unclear; reported 

results of QA, but not clear how quality was used in synthesis 

Yes 

Conroy 20113

Can't answer 

Yes Yes Yes; appears 

to have included published data only, excluded one study for abstract-only 

No for excluded studies; yes for included studies 

Yes Yes Trials scoring 

less than a mean of 9 on the van Tulder critical appraisal score were excluded 

Yes 

Day 20044

Can't answer 

Can't answer; not reported 

Yes No; published 

studies only; English language only 

Yes Yes Yes Yes Yes 

Ellis 20115

Can’t answer 

Yes Yes Yes Yes Yes Yes Yes Yes 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 5 

QUALITY RATING OF SYSTEMATIC REVIEWS: OUTPATIENT USING AMSTAR CRITERIA* *Shea BJ, Grimshaw JM, Wells GA, et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Medical 

 1 2 3 4 5 6 7 8 9 

Author, year 

Was an 'a priori' design provided? 

Was there duplicate study selection and data extraction? 

Was a comprehensive literature search performed? 

Was the status of publication (i.e. grey literature) used as an inclusion criterion? 

Was a list of studies (included and excluded) provided? 

Were the characteristics of the included studies provided? 

Was the scientific quality of the included studies assessed and documented? 

Was the scientific quality of the included studies used appropriately in formulating conclusions? 

Were the methods useto combine tfindings of studies appropriate? 

Beswick 20086

Can't answer 

No for study selection; yes for data extraction 

Yes No Yes for 

included; no for excluded 

Yes Yes Yes Yes 

Byles 20007

Can't answer 

Can't answer for study selection; yes for data extraction and QA 

Yes Yes; only 

included published studies 

Yes for included; no for excluded 

Yes Yes Yes N/A; metaanalysis not 

attempted 

Eklund 20098

Can't answer 

Yes Yes Yes; only 

English language and published in peer-reviewed journals 

Yes for included; no for excluded 

Yes Yes Yes N/A; metaanalysis not 

attempted 

Huss 20089

Can't answer 

Yes Yes No; no 

language restrictions; included unpublished data 

Yes for included; no for excluded 

Yes Yes Yes Yes 

Kuo 200410

Can't answer 

Yes No; only 1 

electronic source (Medline) plus supplemental 

No Yes for 

included; no for excluded 

Yes No N/A Yes 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 6 

QUALITY ASSESSMENT OF RANDOMIZED TRIALS

1 2 3 4 5 6 7 8 9

Author, Year 

Setting Country Appropriate 

randomization technique 

Allocation concealment adequate? 

Groups (intervention and control) similar at baseline? 

Eligibility criteria specified? 

Outcome assessors masked? 

Reporting of:  a) attrition  b) crossovers  c) adherence  d) contamination 

Drop out rate <20 percent 

Intention-totreat (ITT) analysis 

Appropr

statisticanalyse

Bula 199911

Outpatient USA Unclear No Yes Yes No 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: yes 

No Unclear Yes 

Counsell 2007 & 200912, 13

Outpatient USA Yes Yes Yes Yes Yes 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: yes 

Yes Yes Yes 

EloniemiSulkava 200914

Outpatient Finland Yes Yes Yes Yes Unclear 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: no 

Yes Yes Yes 

Fallon 200615

Inpatient USA No No No Yes No 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: no 

Unclear Yes Yes 

Gayton 198716

Inpatient Canada No No Yes Yes Yes 6a) attrition: yes 

6b) crossovers: no 6c) adherence: sort of 6d) contamination: no 

No No No 

Germain 199517

Inpatient US Yes Unclear No Yes No 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: yes 

Yes No Yes 

Hogan 199018

Inpatient Canada Unclear Yes Yes Yes Unclear 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: yes 

Yes Yes Yes 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 7 

1 2 3 4 5 6 7 8 9

Author, Year 

Setting Country Appropriate 

randomization technique 

Allocation concealment adequate? 

Groups (intervention and control) similar at baseline? 

Eligibility criteria specified? 

Outcome assessors masked? 

Reporting of:  a) attrition  b) crossovers  c) adherence  d) contamination 

Drop out rate <20 percent 

Intention-totreat (ITT) analysis 

Appropr

statisticanalyse

Kerski 198719

Outpatient USA Unclear Unclear Yes Yes Unclear 6a) attrition: yes, 

6b) crossovers: no 6c) adherence: no 6d) contamination: no 

Yes Unclear Yes 

Legrain 201120

Inpatient France Yes Yes Yes Yes Unclear 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: no 

Yes Yes Yes 

Li 201021

Outpatient Taiwan No Unclear Yes Yes No 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: no 

No No Yes 

McLean 199422

Inpatient UK No No Unclear Unclear Unclear Unclear Unclear Unclear Yes 

Monteserin 201023

Outpatient USA Yes No Yes Yes Yes 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: no 

Yes No Yes 

Phelan 200724

Outpatient USA Yes Yes Yes Yes Yes 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: no 

No Yes Yes 

Phelan 200825

Outpatient USA Yes Yes Yes Yes Yes 6a) attrition: yes, 

6b) crossovers: no 6c) adherence: no 6d) contamination: no 

No Yes Yes 

Rubenstein 200726

Outpatient USA Unclear Unclear Yes Yes No 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: yes 

No Unclear Yes 

Schmader 200427

Inpatient, outpatient 

USA Yes Yes Yes Yes Yes 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: no 

Yes Yes Yes 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 8 

1 2 3 4 5 6 7 8 9

Author, Year 

Setting Country Appropriate 

randomization technique 

Allocation concealment adequate? 

Groups (intervention and control) similar at baseline? 

Eligibility criteria specified? 

Outcome assessors masked? 

Reporting of:  a) attrition  b) crossovers  c) adherence  d) contamination 

Drop out rate <20 percent 

Intention-totreat (ITT) analysis 

Appropr

statisticanalyse

Slaets 199728

Inpatient The 

Netherlands 

Unclear Yes Yes Yes No 6a) attrition: yes 

6b) crossovers: no 6c) adherence: no 6d) contamination: yes 

Yes Yes Yes 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 9 

QUALITY ASSESSMENT OF COHORT STUDIES 

1 2 3 4 5 6 7 

Author, year 

Setting Country Did the study attempt 

to enroll all (or a random sample of) patients meeting inclusion criteria, or a random sample (inception cohort)? 

Were the groups comparable at baseline on key prognostic factors (e.g., by restriction or matching)? 

Did the study maintain comparable groups through the study period? 

Did the study use accurate methods for ascertaining exposures and potential confounders? 

Were outcome assessors and/or data analysts blinded to the exposure being studied? 

Did the article report attrition? 

Did the study perform appropriate statistical analyses on potential confounders? 

Is theimpordiffereto folloverato foll

AvilaBeltran 

200829

Outpatient Mexico Yes No No Yes No Yes Yes No 

Egger 200630

Inpatient Switzerland Yes No No Yes Unclear No No 

Famadas 200831

Outpatient USA Yes Yes Yes Yes No Yes Yes No 

Fenton 200632

Outpatient USA Yes Yes Yes Yes Unclear Yes Yes No 

Hermush 200933

Outpatient Israel Unclear No No No No No No Uncle

Inouye 199334

Inpatient USA No No No Yes Yes Yes Yes No 

Pawlson 198835

Inpatient USA Yes No No Unclear Unclear No No No 

Peleg 200836

Outpatient Israel Yes Unclear Unclear No No No Uncle

Phillips 200537

Outpatient USA Yes No Unclear No Unclear No No Uncle

Sennour 200938

Inpatient USA Unclear Unclear Unclear Unclear No No No Uncle
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 10 

INPATIENT STUDIES WITH POOR QUALITY RATINGS 

Year, First 

Author 

Study Design 

(# subjects) 

Type of 

Intervention Comments/Reason for Poor Rating

2006, Egger30

Obs 

(800) 

Special Units Unit patients had lower mortality and fewer prescriptions at follow-up 

compared to baseline, but results must be interpreted with caution 

given baseline differences in groups and methodological challenges. 

2006, Fallon15

Trial 

(285) 

Consultation Non-random assignment by time of day of admissions determined if 

patient received a consultation. Additionally, other study design 

elements have the potential to introduce significant bias in the results. 

1987, Gayton16

RT 

(402) 

Team No difference in mortality, LOS, NH admission or function. 

Poor quality due to randomization issues, drop out and non intention 

to treat approach to analyses. 

1994 

McLean22

Obs 

(2,496) 

Consultation Based on need patients were assessed when admitted, and assigned 

both a general physician and a geriatrician. Several elements of the 

study were not described. 

1988, Pawlson35

Obs 

(270) 

Consultation Study compared inpatient management by geriatricians to 

management by general internists; however, groups were not 

comparable at baseline, and data collection and measurement issues 

were not described or addressed. 

2009, Sennour38

Obs 

(1,538) 

Consultation A descriptive study of consultation model in one hospital. Many 

elements of the evaluation study were not described and data were 

not always provided for the comparison group. 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 11 

OUTPATIENT STUDIES WITH POOR QUALITY RATINGS 

Year, First 

Author 

Study Design

Type of 

Intervention Comments/Primary Reasons for Poor Rating

2007, 

Famadas31

Obs 

Team/Clinic Primarily descriptive study of new program and most elements of the 

evaluation component are not described. Authors caution that selection 

bias is likely to be very high. 

2009, 

Hermush33

Obs 

Consultation Visits to general practitioners were lower in patients seen by the 

geriatrician, but groups differed; confounding was not addressed 

sufficiently, and key criteria were not reported or met. 

1987, Kerski19

RT 

Team All patients received a CGA, and then were randomized to follow-up in 

geriatric clinic with an interdisciplinary team or a general clinic with no 

team. No difference was found in key outcomes. Rating is based on lack 

of reporting of key characteristics of the trial. 

2008, Peleg36

Obs 

Consultation Hospitalizations declined after the implementation of a multipart 

intervention that included a geriatric liaison service to the primary care 

clinic. The study is a pre-post design that did not meet many quality 

criteria and did not provide statistical tests of reported differences. 

2005, 

Phillips37

Obs 

Primary Care Study compares patients in geriatric primary care practice to those in 

general medicine practices in the same health plan and finds that they 

have different utilization patterns and lower costs. However, differences 

are not statistically significant; the groups differ and confounding is not 

sufficiently addressed. 

   
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 12 

REVIEW COMMENTS/RESPONSES 

Reviewer 

No. Comment Response 

1. Are the objectives, scope, and methods for this review clearly described? 

1 Yes. -- 

2 Yes -- The Authors have done a complete analysis of 

the available data. 

-- 

3 No -- As noted in the comments below and attached 

documents, many of the terms and outcomes are 

poorly or loosely defined, i.e. effectiveness. Even the 

title, value of geriatricians, while catchy, is vague. 

We have attempted to be more precise 

in specifying outcomes when reporting 

results. 

We have changed the title of the 

review. 

4 Yes. -- 

5 Yes. -- 

6 Yes. -- 

7 Yes. -- 

8 Yes. -- 

2. Is there any indication of bias in our synthesis of the evidence? 

1 No. -- 

2 No. -- 

3 Yes. 

1. The choice of the impact of the geriatrician on 

mortality as the main outcome measure is 

problematic. The vast majority of geriatric 

consults and management issues focus on 

geriatric syndromes, quality of life, rehabilitation, 

case management in older adults with multiple 

medical problems. A priori one would not 

anticipate that in the majority of the settings, the 

intervention, often only one of many that these 

complex patients have received would have any 

measureable impact on mortality. Delayed 

admission to a nursing facility, reduced stress in 

a caregiver, reduced polypharmacy, etc. are 

highly significant outcomes in this population. 

The focus on mortality sends the wrong 

message. 

2. The study eliminates PACE and other 

interventions that are more broadly integrated 

along the continuum of care in older adults 

(supplement). These are the types of 

interventions that would most likely show benefit, 

and potentially reduce mortality yet they have 

been excluded from this paper. 

3. The VA health care system has its own rewards 

and challenges. The vast majority of studies 

quoted were not conduced in the VA and their 

applicability to the integrated VA health care 

system is uncertain. The authors should temper 

their conclusions given the scarcity of high quality 

1. We revised the methods section to 

clarify that our outcomes included 

mortality, function, nursing home 

admission/or living at home, 

utilization (hospital admission or 

readmission, emergency 

department visits, outpatient visits), 

or medication management 

(appropriateness, number, or 

adverse events). These were 

specified at the start of the review, 

before the evidence was collected. 

2. We excluded PACE and similar 

interventions because long-term 

care was excluded in the scope of 

work for this review. Programs 

such as PACE integrate long term 

care and acute care and the 

impact cannot be separated. This 

was specified before we conducted 

the search and corresponded to 

the priorities of the requestors. 

3. We agree that direct evidence is 

sparse. Our objective was to 

summarize all available research. 

4. This is a ‘future research need’ and 

could be a possible result of the 

review. 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 13 

Reviewer 

No. Comment Response 

randomized clinical trials in older veterans. 

Certainly except for the GEM trial conducted 

more than a decade ago, few if any trials have 

sufficient power to detect changes in mortality. 

4. QUERI and cooperative studies programs at the 

VA should partner with the GRECCs to initiative 

multicenter trials to more definitively examine the 

issues raised in this manuscript. 

4 No. -- 

5 No. -- 

6 No. -- 

7 No. -- 

8 Yes -- No really bias but more a misunderstanding of 

the goals of the review. For example mortality is an 

irrelevant outcome when evaluating the value of 

geriatricians but the synthesis makes it look like the 

most important (negative) outcome 

The organizations requesting this brief 

specified a priori that mortality was one 

of several outcomes of interest. When 

appropriate, we have edited the report 

to clarify that mortality was not our only 

outcome of interest (e.g., by reporting 

other outcomes before mortality 

outcomes in summary statements, 

etc). However, we cannot change the 

fact that it is one of the most frequently 

studied outcomes, and we believe we 

should report that information. 

3. Are there any published or unpublished studies that we may have overlooked? 

1 No -- I have limited experience to really address this 

question. 

-- 

2 No. -- 

3 Yes -- No overt mention about interventions to 

prevent or manage delirium in hospitalized patients. 

These studies should be included. 

When identifying and managing 

delirium was part of geriatric care, the 

studies were included. 

4 No. -- 

5 Yes -- Possibly, see #4 re: search strategy. See response below. 

6 No. -- 

7 No. -- 

8 Yes -- Studies related to patient/family satisfaction, 

improved communication and its relation to tort 

claims. 

These outcomes were specifically 

excluded by the scope of work agreed 

to by the researchers and the groups 

requesting this review. 

4. Please write additional suggestions or comments below. If applicable, please indicate the page 

and line numbers from the draft report. 

1 Page 17: under Bottom line: the second para must 

have been truncated. “ an initial assessment ......are 

more like???? 

Text was revised. 

1 Page 6. It is unclear if you are referring to comparison 

between care on an acute medicine unit and a 

specialized geriatric unit. ( para 2. ) It has not been 

my experience that acute admissions are made to a 

In the RCTs, patient who are admitted 

are randomly assigned to these 

specialized units. These are not longterm care or transitional units. They 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 14 

Reviewer 

No. Comment Response 

geriatric specialized unit but rather to an acute 

medicine unit and then once stable the patient is sent 

to the specialized geriatric unit. It is unclear whether 

this is truly a direct comparison. 

SIMILAR COMMENT FROM EMAIL MESSAGE: Just 

a question for clarity: 

Page: 6. Interventions on specialized units vs. floats 

on units . Were the “floats” providing care on rehab 

specialized units or acute medicine wards units? 

Were the” specialized hospital units” rehab or 

considered acute medicine units? 

are acute care units that specialize in 

the care of elderly patients. 

The assignment of the teams varied 

somewhat by study, but from the 

descriptions in most studies the 

‘floating teams’ provided care across a 

variety of units. What varies is how the 

patients are referred to the team 

(automatically or at the request of a 

treating physician), and whether the 

team becomes directly involved in care 

or if its recommendations are given to 

the clinicians with primary 

responsibility. 

We have edited the report to clarify 

these points. 

1 “Veterans who seek medical care are aging. The 

proportion of all Veterans 65 and older who enroll in 

the VA health care system is projected to increase to 

43 percent in 2013, up from 31 percent in 2003.1

Enrollees age 85 and older are expected to have an 

even greater growth: from 20 percent in 2003 to 51 

percent in 2013.” 

Do they mean who are enrolled? Or are these data 

for expected new enrollments? 

The text has been revised to clarify 

that this is the percent of older 

Veterans who enroll in VHA for health 

care. 

2 Clearly one of the reasons why a CGA done on 

inpatients may not have as much benefit if there is no 

direct involvement by the Geriatrician in the patient's 

care is the lack of follow-through by the primary care 

team on the recommendations made by the Geriatric 

Assessment Team. A mechanism to insure better 

follow-through would improve care/outcome in my 

opinion and the data should not be misinterpreted 

that the CGA has no value.. it does! 

The commenter raises a good point, 

but because studies within our scope 

did not report results according to 

whether primary care teams followed 

through on the geriatrician’s 

recommendations, it is not possible to 

draw conclusions about this. Studies 

of follow through on recommendations 

probably do exist but they were outside 

the scope of this review. 

3 This document has been reviewed by myself and my 

colleague Dr. Jacob Blumenthal, a geriatrician who 

co-directs our geriatric medicine fellowship program 

and geriatric assessment clinics. We both had major 

concerns about this manuscript, particularly the use 

of mortality as the main outcome metric. We have 

provided many comments in the reviewer sheets and 

throughout the document (including one major typo). 

It is clear that few high quality larger randomized 

clinical trials have been performed that would 

specifically address many of the issues that this 

review is examining. QUERI and cooperative studies 

programs at the VA should partner with the GRECCs 

to initiative multicenter trials to more definitively 

examine the issues raised in this manuscript. 

Thank you for the comments and we 

have revised the text. 

Mortality is one of several outcomes 

included in the scope of work as 

agreed to and specified by the 

requestor. We have edited the text to 

clarify this point. 

3 The key messages (page 1) seem frankly biased, and We believe an evidence review should 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 15 

Reviewer 

No. Comment Response 

not the conclusion I draw from the scant literature. I 

would argue that what is the message from this 

review is that there is insufficient research into the 

value of Geriatrician involvement. The null 

hypothesis is that there is no difference in outcomes 

when Geriatricians are involved, and if any conclusion 

is to be drawn, it is that there is insufficient evidence 

to reject this. 

1. However, I would point out that certainly, 

mortality is likely the wrong primary metric! It 

may be interesting to compare mortality among 

patients cared for by Geriatricians/not, but to do 

these sort of randomized controlled trials would 

likely involve huge numbers, given the high 

likelihood of the outcome regardless of group 

assignment. 

2. A number of more meaningful metrics might 

include measures of morbidity such as 

ED/unplanned office visits, falls, adverse drug 

events, dependency, institutionalization.... 

3. For example, I would suspect that post discharge 

geriatric follow-up would be associated with lower 

readmission (as follow-up arrangements have 

been demonstrated to do in a number of other 

settings – c.f. CHF, psych, ED), although this is 

by no means universal in the literature. This 

latter point highlights the importance of also 

understanding/accounting for the baseline 

characteristics of the group(s) examined (c.f. 

below – point 7). 

summarize what is known from the 

available research. Reviews may also 

highlight where more research is 

needed, but to avoid conclusions and 

only suggest more research is needed 

is not sufficient in our opinion. 

We have revised the key point 

wording. 

1 and 2: Outcome measures were prespecified. Mortality was one of but not 

our primary outcome measure. We 

included these other outcomes (ED 

visits, adverse drug events, 

institutionalization, etc.) and reported 

them when available. We have revised 

the text to clarify this. 

3. Follow-up was not reported in all 

studies, but was included when it was 

available. Our ability to address this is 

limited by the research available. 

Results for Key Question 1B include 

what information we were able to 

locate. The recent Cochrane review 

did compare the results of studies of 

interventions that included outpatient 

follow-up after inpatient geriatric care 

and those that did not. They found no 

difference in the outcomes across 

studies when they compared these two 

groups. 

3 On the same page, Geriatric Syndromes may 

contribute to, but don’t necessarily cause many of the 

problems listed. 

Edited as suggested. 

3 The handling of systemic reviews in these analyses is 

unclear (page 3). Are data from included studies 

“double-counted” (once as individual trial and again 

as meta-analysis? 

We revised the methods to clarify that 

we only included individual studies that 

were not already included in a 

systematic review. 

3 On page 4, and following, the metric upon which 

these conclusions are made remains unclear. The 

words “effectiveness” is used (Key Question #1A, 

page 4 and following), but the measure appears to be 

mortality (problematic as above). Furthermore, also 

unclear (?uniform across study) is at what point in 

time it is assessed.... No one gets out of this world 

alive, and certainly those cared for by Geriatricians 

are no exception 

(Page 4 lists the key question) 

We have listed our outcome measures 

(which include, but are not limited to, 

mortality) and when discussing 

particular studies, have made sure to 

note the time period of the outcome 

measure. 

3 The final paragraph on page 5 seems all alone and 

without a conclusion. What was the conclusion of the 

“technology assessment” (and what is this?) 

The technology assessment is not 

discussed in detail because it included 

the same studies that are also included 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 16 

Reviewer 

No. Comment Response 

conducted by the New Zealand Department of Public 

Health and General Practice? What model(s) of care 

were examined? What were the measures? 

outcomes? 

in another, more recent systematic 

review. We have clarified this in the 

text. 

3 The speculation of the authors cited on page 6 

“special units allow the geriatric team to have more 

control over care, including implementation of the 

recommendations based on CGA, and permit the 

development of greater expertise among everyone 

who works on the unit” is certainly a reasonable and 

testable hypothesis. This again points out another 

“hole” in the literature needing filling. Although, 

again, just because we don’t know what the effect 

is/haven’t proven its existence, does not mean that 

there is no effect. Prior to the DCCT, the value of 

“tighter” glycemic control was unproven, yet such an 

approach certainly was beneficial prior to 1993. 

We revised the text to clarify that this 

speculation was made by the authors 

of the cited review, not the authors of 

this brief. The literature and the 

summary in this brief suggest several 

potential avenues for future research; 

however, developing a future research 

agenda is outside the scope of an 

Evidence Brief. We do hope the Brief 

might inform others who might take on 

this task in the future. 

3 With regards to Key Question 1b, on page 8, if 

outcome = 3 month mortality, not surprising that no 

relationship found with follow-up.... Certainly it is 

intuitive (at least to me) that there are “baseline” 

characteristics that are predictive of better outcomes. 

If data is insufficient to account for these, I don’t see 

how one can dismiss this likely “confounder.” As 

above, would suspect that post discharge follow-up 

(geriatric or otherwise) would be associated with 

lower readmission, but this is likely significantly 

impacted by characteristics of the discharged patient.

Yes, this is a possible and a potentially 

useful area for future research. In 

conducting a brief review of existing 

evidence, we are limited to the studies 

available, and have attempted to 

provide enough information without 

making this Brief excessively long to 

allow different readers to assess these 

potential issues. 

3 Bottom lines on page 9 are overstated, as above. In 

particular: 

1. I should hope that Geriatric Teams don’t reduce 

MORALITY (sic).... 

2. Similarly, this statement (understood as referring 

to mortality) is not evidence-based, as intimated 

above in #1. 

Corrected typo. Thank you for pointing 

this out. 

3 On page 12, it is noted that the summarized 

systematic reviews have a “focus on models of care 

and...summarize a mix of studies that both include 

and do not include geriatricians.” Furthermore, the 

role(s) of the Geriatrician(s) is often unclear, and 

certainly not obviously uniform. Given these 

limitations, it is difficult to then use these as blanket 

indictments of Geriatrician involvement. 

Text has been revised to clarify. We 

agree that it is difficult to separate out 

the effect of the geriatrician in many 

studies – this was a major limitation of 

the evidence base. However, we did 

not include a systematic review unless 

it was possible to tell if studies included 

geriatricians, and we provided this 

information in Tables 1 and 3. We 

used results based on the studies that 

include geriatricians when presenting 

the conclusions of systematic reviews.

3 Certainly the “bottom line” found on page 17 does not 

make it to the “Key Messages” on page 1...and likely 

should. 

The Bottom Line box is about the 

finding for outpatient studies, and the 

Key Messages are the overall 

conclusions of the review. We have 

clarified wording, but they are not 

meant to be the same. 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 17 

Reviewer 

No. Comment Response 

3 With regards to the limitations listed on page 22, 

these are understated. Certainly, the “large number” 

of studies cited is somewhat of an overstatement 

given their broad diversity. It is exactly because “the 

model was usually evaluated” and it differs between 

studies, that it is difficult reach blanket conclusions 

about “Geriatric Assessment” or Geriatrician 

“involvement.” Nonetheless, evaluating “parts” of 

what is often a multidisciplinary process, and always 

a multifaceted one, will likely underestimate its net 

effect(s). 

Text has been revised to clarify and 

incorporate these points. 

3 The “take home” message of this review is that there 

is a paucity of data regarding the effect Geriatricians 

have, as well as the reasons behind this. The “key 

questions” outlined on page 2 are excellent starting 

points, and should (with specific, measurable and 

clinically meaningful outcomes) be the subject of 

large, randomized controlled trials. 

Text has been revised to highlight the 

limitations of the data available. 

4 On page 17 in Bottom Line box: the 3rd item, second 

sentence (beginning “An initial assessment 

suggests...”) has a typo or missing words. 

Text has been revised to address this. 

4 See copy of draft for more suggestions. Comments in the draft have been 

addressed. 

5 RE: 3/2/12 search (#1,2,5,6,7) add a [tiab] tag at the 

end of the search term so it only searches for the 

keyword phrase in the title and abstract of a PubMed 

record, which helps improve precision in the retrieval. 

RE: 3/2/12 search (#4) The subject terms used in the 

current search strategy in the document you sent are 

pretty thorough and appropriate. The main issue I see 

after further searching is that there's no good/precise 

Medical Subject Heading (MeSH) term in 

PubMed/Medline and other databases that captures 

"Care Model" as a concept. 

 

Below are some keywords that could be used for 

searching the titles and abstracts in PubMed to 

perhaps pull in some relevant articles related to Care 

Models. 

management model[tiab] 

model of care[tiab] 

care approach[tiab] 

care intervention[tiab] 

care program[tiab] 

integrated approach[tiab] 

integrated system[tiab] 

integrated model[tiab] 

system of care[tiab] 

framework[tiab] 

paradigm[tiab] 

 

I would "OR" these phrases together and combine 

them with other relevant MeSH terms, such as 

Thank you for these suggestions. 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 18 

Reviewer 

No. Comment Response 

Geriatrics Assessment or Health Services for the 

Aged and then NOT the publications I don't want, 

such as letters, case reports, editorials, etc. 

 

Example: 

(management model[tiab] OR model of care[tiab] OR 

care approach[tiab] OR care intervention[tiab] OR 

care program[tiab] OR integrated approach[tiab] OR 

integrated system[tiab] OR integrated model[tiab] OR 

system of care[tiab]) AND ("Health Services for the 

Aged"[Mh] OR "Geriatric Assessment"[tw]) NOT 

(letter[pt] OR case reports[pt] OR editorial[pt]) AND 

english[la] 

 

The strategy above yields about 237 citations. Many 

will be related to a specific disease or condition (e.g., 

falls, dementia, depression) , but you may also find 

some that are specific to geriatric assessment and 

care models in general. 

RE 3/9-12 Search (#1-10) add a [tiab] tag at the end 

of the search term so it only searches for the keyword 

phrase in the title and abstract of a PubMed record, 

which helps improve precision in the retrieval. 

6 Page 1: “Key Messages”—I would reorder so that the 

first bullet is the last (i.e., list positive findings first, 

then negative finding) 

Edited as suggested. 

6 Page 1: “Introduction” 3rd paragraph, 4th-5th line: 

“Given these small numbers”—not very informative. 

Why are those numbers small? (e.g., 500,000 MDs 

for 300M people is a ratio of 600:1; 7000 geriatricians 

for 40M people age 65 and over is 1:5,700) 

The sentence has been deleted. 

Discussing why there is a shortage of 

geriatricians is outside the scope of 

this Brief. 

6 Page 2: “Methods”—paragraph 2. insert “:” following 

the first use of “intervention” in line 3.; lline 4, change 

“living at home” to “discharge to home”; line5, insert 

“Bed Days of Care” after “readmission” [only if this is 

true, of course...) 

Text revisions have been made to 

address these points. 

6 Page 6: bottom 1/3 of page, third bullet point “And 

no difference in readmission at three months”—

following the Confidence Interval, should the word 

“or” instead be the word “among?” 

Text corrected as suggested. 

6 Page 9: “Bottom Line”—would move 2nd bullet to 

become first bullet (as above, Positive finding, then 

negative findings). 

Text edited as suggested. 

6 Page 14: top of page, second open bullet: after 

Relative Riak figures, should this read “and a few 

instances...” instead of “and few instances?” 

Text corrected. 

6 Page 17: top 1/3 of page, first open bullet: “then” 

should be “than” 

Text corrected. 

6 Page 17, bottom 1/3 of page, red-bordered box: 

1. any reason for the different format compared to 

“Bottom Line” on page 9? 

1. Made format consistent 

2. Edited as suggested 

3. Corrected typo 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 19 

Reviewer 

No. Comment Response 

2. move second statement to end (positive findings, 

negative findings) 

3. second line: change “bout” to “about” 

4. Third paragraph, third line, I am guessing this 

should read “...are more likely to improve 

outcomes than intervention where...” 

4. Edited sentence 

7 I was very interested in the primacy that the outcome 

of mortality seemed to take in the manuscript. While 

this is clearly one of the outcomes that emerged as 

being common to many of the individual studies, for 

this analysis there is no reason to place the mortality 

outcomes first in each area of discussion. I believe 

that many geriatricians would feel that mortality is a 

confounded outcome in many of these studies. The 

goal of geriatric care and geriatric models of care is 

frequently not to extend mortality. I have been 

involved in studies of models where the geriatric 

approach led to early referral to hospice or comfort 

care, making the mortality effects difficult to interpret. 

Since functional outcomes are likely to be more 

valued by patients and providers for this population, 

there is no reason to present the functional effects as 

a “secondary outcome.” 

Mortality was one of our outcomes, but 

not our primary outcome measure. 

This has been clarified in the text. The 

frequency with which mortality is 

discussed is the result of how many 

studies included this as an outcome. 

7 I also felt that there is a lack of parallelism between 

the inpatient and outpatient analyses as presented in 

the manuscript. On face value the key messages 

seemed the same across the inpatient and outpatient 

realms, i.e. that more direct involvement by 

geriatricians produced better functional outcomes. 

However, the split for inpatient was most important for 

who had charge of the patient i.e. special geriatric 

unit vs. float team or consultation. This seems quite 

different from the split in the outpatient realm which 

fell between direct patient contact and indirect 

involvement. The difference can be highlighted by 

the role of consultation by an individual geriatrician 

which seemed to be not effective on the inpatient 

side, but associated with positive outcomes on the 

outpatient side. I think that the analyses and choices 

of split were fine for inpatient and outpatient side, but 

they were presented as showing parallel and 

analogous outcomes that are really not justified by 

the data. 

We have attempted to clarify this in the 

text revisions. 

8 Please see numerous comments entered directly on 

the draft document. 

Thank you. These have been 

addressed. 

5. Are there any VA clinical performance measures, programs, quality improvement measures, 

patient care services, or conferences that will be directly affected by this report? If so, please 

provide detail. 

1 Yes, an increase in outpatient geriatricians was 

requested and this will be used in that deliberation. 

-- 

3 If in fact this report is accepted as providing evidence 

of minimal impact of geriatricians on healthcare 

outcomes in a variety of settings in older adults, 

-- 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 20 

Reviewer 

No. Comment Response 

ongoing initiatives to integrate geriatricians into 

PACTs, implementation of geriatric emergency 

departments, GEM and geriatric acute care units, etc. 

may be scaled back or eliminated. This is particularly 

problematic given that few of the studies have been 

conducted in the VA and the metric of whether the 

clinical care provided by geriatricians in these settings 

decreases mortality is not the main outcome(s) of 

interest. These analyses highlight the need for larger 

scale, good quality randomized control trials to more 

directly test the key questions proposed on page 2. 

4 Validates value of GEM Unit program in the VA 

system. Supports further development of Acute Care 

for the Elderly inpatient units in the VA as well as 

outpatient geriatric consultation teams providing 

direct patient contact. 

-- 

6 Ongoing discussion within the Healthcare Delivery 

Committee of the NLC concerning recommendation 

for growing geriatric inpatient and outpatient presence 

in VAMCs. 

-- 

7 This seems to directly inform the role of geriatrics in 

PACT models. 

-- 

8 Yes, big impact on workforce deployment in geriatric 

settings. 

-- 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 21 

Reviewer 

No. Comment Response 

6. Please provide any recommendations on how this report can be revised to more directly 

address or assist implementation needs. 

1 Has there been the opportunity to review surgical 

inpatient care with and with geriatrics for same age 

groups to see if the outcomes are improved with 

geriatric care? 

We did not separately evaluate studies 

of surgical inpatient care. There are 

some studies available that look at 

specific orthopedic surgeries with and 

without geriatric involvement, but these 

were outside the scope of this Brief. 

1 And can we group by gender at all ( since VA has 

many more men and private sector many more 

women in clinics ?) 

Studies and systematic reviews do not 

provide enough information to allow this 

within the format of an Evidence Brief. 

2 It would be worth prospectively evaluating CGA 

recommendations and determine how follow-through 

affected outcome versus merely grouping all patients 

who had the CGA together. 

Agree that this would be a useful area 

for future research. 

3 Many areas should be changed (also see attached 

comments). 

1. The title itself, “The value of geriatricians” should be 

changed as geriatricians typically are part of larger 

multidisciplinary teams and virtually none of the 

studies quoted were designed to tease out the 

contribution of the geriatrician per se to the outcomes. 

Would recommend a more generic, broader title, 

“impact of geriatric consultation and management on 

health care outcomes in older adults” or something 

along these lines. 

2. Key message first bullet about mortality should be 

moved to the third bullet with more emphasis on 

functional outcomes, rather than mortality 

3. The term effectiveness is used loosely without clear 

definition. 

4. Time points of downstream outcome measures are not 

consistently defined (for example discussion about 

inpatient geriatric teams page 7). 

1. Title has been revised, but we do 

include studies where geriatricians 

are not part of the team and function 

as individual specialists or primary 

care providers, so we cannot have 

the title be limited to specific models.

2. Bullets have been reorganized 

3. We have added the outcomes that 

we used to define effectiveness for 

this review. 

4. When they were provided and/or 

considered in a study or systematic 

review they are reported. In the 

Evidence Brief format, we are not 

able to follow up with authors or 

check other sources to obtain 

additional details. 

5 Agree with summary findings as reported – use of 

search strategy in #4 may yield additional pertinent 

references. 

6 None -- nice job. -- 

7 I would like to see more direct suggestions about 

studies that could address current deficiencies in the 

data. 

Developing a future research needs 

report would be interesting and could be 

informed by this initial effort; however, it is 

outside the scope of an Evidence Brief. 

8 English language search may have limited valuable 

data. The European Union based on their review of 

literature has recently mandated geriatric specialty in 

all its member nations and established very strict 

guidelines regarding staffing by geriatricians at all 

levels of clinical care. 

Although we agree that the exclusion 

of non-English language literature is a 

limitation of this rapid review, we did 

not have the resources to permit 

translation. 

7. Please provide us with contact details of any additional individuals/stakeholders who should 

be made aware of this report. 

 -- 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 22 

LIST OF EXCLUDED STUDIES 

Excluded Trials 

Exclusion 

Code 

1 AARP, Academy of Managed Care P, American College of Clinical P, et al. Sound medication 

therapy management programs. Case Manager. Jul-Aug 2006;17(4):47-50. 

Publication 

type 

2 Ahmed A, Allman RM, Kiefe CI, et al. Association of consultation between generalists and 

cardiologists with quality and outcomes of heart failure care. Am Heart J. Jun 2003;145(6):1086-

1093. 

Intervention 

3 Allard J, Hebert R, Rioux M, Asselin J, Voyer L. Efficacy of a clinical medication review on the 

number of potentially inapprrropriate prescriptions prescribed for community - dwelling elderly 

people. CMAJ. 2001;164(9):1291-1296. 

Intervention 

4 Allen CM, Becker PM, McVey LJ, Saltz C, Feussner JR, Cohen HJ. A randomized, controlled 

clinical trial of a geriatric consultation team. Compliance with recommendations. JAMA. May 16 

1986;255(19):2617-2621. 

Outcome 

5 Applebaum R, Straker J, Mehdizadeh S, Warshaw G, Gothelf E. Using high-intensity care 

management to integrate acute and long-term care services: substitute for large scale system 

reform? Care Manag J. Spring 2002;3(3):113-119. 

Setting 

6 Applegate WB, Miller ST, Graney MJ, Elam JT, Burns R, Akins DE. A randomized, controlled 

trial of a geriatric assessment unit in a community rehabilitation hospital. N Engl J Med. May 31 

1990;322(22):1572-1578. 

Population 

7 Arbaje AI, Maron DD, Yu Q, et al. The geriatric floating interdisciplinary transition team. J Am 

Geriatr Soc. Feb 2010;58(2):364-370. 

Outcome 

8 Asplund K, Gustafson Y, Jacobsson C, et al. Hospital care for the elderly with acute medical 

illness. A randomised comparison of geriatric-based versus general wards [abstract]. 2000. 

Publication 

type 

9 Atkin NL, McInnes EC, Mira M, Kennedy P. GPs and geriatricians working together. Med J Aust. 

Oct 20 1997;167(8):455-456. 

Outcome 

10 Bachman SS, Collard AF, Greenberg JN, et al. An innovative approach to geriatric acute care 

delivery: the Choate-Symmes experience. Hosp Health Serv Adm. Nov 1987;32(4):509-520. 

Intervention 

11 Bakker FC, Robben SHM, Olde Rikkert MGM. Effects of hospital-wide interventions to improve 

care for frail older inpatients: a systematic review. BMJ Qual Saf. Aug 2011;20(8):680-691. 

Intervention 

12 Barker WH, Williams TF, Zimmer JG, Van Buren C, Vincent SJ, Pickrel SG. Geriatric 

consultation teams in acute hospitals: impact on back-up of elderly patients. J Am Geriatr Soc. 

Jun 1985;33(6):422-428. 

Intervention 

13 Barrick C, Karuza J, Levitt J. Impacting quality: assessment of a hospital-based geriatric acute 

care unit. American Journal of Medical Quality. 1999;14(3):133-137. 

Setting 

14 Baztan JJ, Gil L, Andres E, Vega E, Ruiperez I. [The community activity of a hospital geriatrics 

service: a practical example of coordination between primary and specialized care]. Aten 

Primaria. Oct 15 2000;26(6):374-382. 

Foreign 

language 

15 Beck A, Scott J, Williams P, et al. A randomized trial of group outpatient visits for chronically ill 

older HMO members: the Cooperative Health Care Clinic. J Am Geriatr Soc. May 

1997;45(5):543-549. 

Intervention 

16 Beland F, Bergman H, Lebel P, et al. A system of integrated care for older persons with 

disabilities in Canada: results from a randomized controlled trial. Journals of Gerontology Series 

A-Biological Sciences & Medical Sciences. Apr 2006;61(4):367-373. 

Intervention 

17 Beland F, Bergman H, Lebel P, et al. Integrated services for frail elders (SIPA): a trial of a model 

for Canada. Can J Aging. Spring 2006;25(1):25-42. 

Intervention 

18 Blain A, Dardalhon B, Jouaffre V, et al. [Multidisciplinary work of a mobile geriatric team]. Soins 

Gerontol. Mar-Apr 2007(64):42. 

Foreign 

language 

19 Blewett LA, Johnson K, McCarthy T, Lackner T, Brandt B. Improving geriatric transitional care 

through inter-professional care teams. Journal of Evaluation in Clinical Practice. Feb 

2010;16(1):57-63. 

Setting 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 23 

Excluded Trials 

Exclusion 

Code 

20 Borok GM, Reuben DB, Zendle LJ, et al. Rationale and design of a multi-center randomized trial 

of comprehensive geriatric assessment consultation for hospitalized patients in an HMO. J Am 

Geriatr Soc. May 1994;42(5):536-544. 

Other: 

Protocol only

21 Boult C, Reider L, Leff B, et al. The effect of guided care teams on the use of health services: 

results from a cluster-randomized controlled trial. Archives of internal medicine. 

2011;171(5):460-466. 

Intervention 

22 Boyd CM, Shadmi E, Conwell LJ, et al. A pilot test of the effect of guided care on the quality of 

primary care experiences for multimorbid older adults. J Gen Intern Med. May 2008;23(5):536-

542. 

Intervention 

23 Bula C, Waeber G. [General internal medicine and geriatrics in the acute care setting: 

opportunities for collaboration]. Rev Med Suisse. Nov 8 2006;2(86):2540-2543. 

Foreign 

language 

24 Burns R, Nichols LO, Graney MJ, Cloar FT. Impact of continued geriatric outpatient 

management on health outcomes of older veterans. Archives of internal medicine. Jun 

1995;155(12):1313-1318. 

Intervention 

25 Buurman BM, Parlevliet JL, van Deelen BA, de Haan RJ, de Rooij SE. A randomised clinical trial 

on a comprehensive geriatric assessment and intensive home follow-up after hospital discharge: 

the Transitional Care Bridge. BMC Health Serv Res. 2010;10:296. 

Other: 

Protocol, 

study not 

completed 

26 Callahan CM, Weiner M, Counsell SR. Defining the domain of geriatric medicine in an urban 

public health system affiliated with an academic medical center. J Am Geriatr Soc. Oct 

2008;56(10):1802-1806. 

Other: 

Descriptive 

study 

27 Campbell KH, Sachs GA, Hemmerich JA, Smith SG, Stankus N, Dale W. Physician referral 

decisions for older chronic kidney disease patients: a pilot study of geriatricians, internists, and 

nephrologists. J Am Geriatr Soc. Feb 2010;58(2):392-395. 

Outcome 

28 Campion EW, Jette A, Berkman B. An interdisciplinary geriatric consultation service: a controlled 

trial. J Am Geriatr Soc. Dec 1983;31(12):792-796. 

Published 

before 1985 

29 Campion EW. The merits of geriatric consultation. JAMA. May 1 1987;257(17):2336-2337. Publication 

type 

30 Carlsen WR, Galluzzi KE, Forman LF, Cavalieri TA. Comprehensive geriatric assessment: 

applications for community-residing, elderly people with mental retardation/developmental 

disabilities. Ment Retard. Oct 1994;32(5):334-340. 

Setting 

31 Cefalu CA, Colbourne G, Duffy M, Johnson E, Lestter M, Wright J. A university-affiliated 

community hospital inpatient geriatrics program functioning in an administrative and educational 

capacity. J Am Geriatr Soc. Mar 1997;45(3):355-360. 

No 

comparator 

32 Cefalu CA. Adhering to inpatient geriatric consultation recommendations. J Fam Pract. Mar 

1996;42(3):259-263. 

Intervention 

33 Cefalu CA. Preoperative geriatric assessment. J Am Geriatr Soc. Mar 1996;44(3):333. Publication 

type 

34 Challis D, Clarkson P, Williamson J, et al. The value of specialist clinical assessment of older 

people prior to entry to care homes. Age and ageing. Jan 2004;33(1):25-34. 

Intervention 

35 Champion G, Henschke P, Harris R, et al. The Geriatric Assessment Research Project: a 

randomised study. [abstract]. Aust NZ J Med Suppl. 1987;17(1):111. 

Publication 

type 

36 Chesney TR, Alvarado BE, Garcia A. A mild dementia knowledge transfer program to improve 

knowledge and confidence in primary care. J Am Geriatr Soc. May 2011;59(5):942-944. 

Outcome 

37 Chin MH, Wang JC, Zhang JX, Sachs GA, Lang RM. Differences among geriatricians, general 

internists, and cardiologists in the care of patients with heart failure: a cautionary tale of quality 

assessment. J Am Geriatr Soc. Nov 1998;46(11):1349-1354. 

Population 

38 Cho CY, Alessi CA, Cho M, et al. The association between chronic illness and functional change 

among participants in a comprehensive geriatric assessment program. J Am Geriatr Soc. Jun 

1998;46(6):677-682. 

No 

comparator 

39 Chun AK. When is it the right time to ask for a geriatrician? Mt Sinai J Med. Jul-Aug 

2011;78(4):485-488. 

Other: NonSR 

40 Clarkson P, Brand C, Hughes J, Challis D. Integrating assessments of older people: examining 

evidence and impact from a randomised controlled trial. Age Ageing. May 2011;40(3):388-391. 

Intervention 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 24 

Excluded Trials 

Exclusion 

Code 

41 Clarkson P, Venables D, Hughes J, Burns A, Challis D. Integrated specialist assessment of 

older people and predictors of care-home admission. Psychol Med. Jul 2006;36(7):1011-1021. 

Intervention 

42 Coast J, Peters TJ, Inglis A. Factors associated with inappropriate emergency hospital 

admission in the UK. Int J Qual Health Care. Feb 1996;8(1):31-39. 

Intervention 

43 Collard AF, Bachman SS, Beatrice DF. Acute care delivery for the geriatric patient: an 

innovative approach. QRB Qual Rev Bull. Jun 1985;11(6):180-185. 

Intervention 

44 Conroy S, Ferguson C, Woodard J, Banerjee J. Interface geriatrics: evidence-based care for frail 

older people with medical crises. Br J Hosp Med (Lond). Feb 2010;71(2):98-101. 

Other: NonSR 

45 Corbett HM, Lim WK, Davis SJ, Elkins AM. Care coordination in the Emergency Department: 

improving outcomes for older patients. Aust Health Rev. Feb 2005;29(1):43-50. 

Intervention 

46 Cordato NJ, Saha S, Price MA. Geriatric interventions: the evidence base for comprehensive 

health care services for older people. Australian Health Review. May 2005;29(2):151-155. 

Publication 

type 

47 Couderc AL, Bailly-Agaledes C, Camalet J, et al. [Adaptations of psychotropic drugs in patients 

aged 75 years and older in a departement of geriatric internal medecine: report of 100 cases]. 

Geriatr Psychol Neuropsychiatr Vieil. Jun 2011;9(2):163-170. 

Foreign 

language 

48 Counsell SR, Callahan CM, Buttar AB, Clark DO, Frank KI. Geriatric Resources for Assessment 

and Care of Elders (GRACE): a new model of primary care for low-income seniors. J Am Geriatr 

Soc. 2006;54(7):1136-1141. 

Outcome 

49 Covinsky KE, King JT, Jr., Quinn LM, et al. Do acute care for elders units increase hospital 

costs? A cost analysis using the hospital perspective. Journal of the American Geriatrics 

Society. 1997;45(6):729-734. 

Intervention 

50 Cravens DD, Mehr DR, Campbell JD, Armer J, Kruse RL, Rubenstein LZ. Home-based 

comprehensive assessment of rural elderly persons: the CARE project. J Rural Health. 

2005;21(4):322-328. 

No 

comparator 

51 Crotty M, Halbert J, Rowett D, et al. An outreach geriatric medication advisory service in 

residential aged care: a randomised controlled trial of case conferencing. Age & Ageing. Nov 

2004;33(6):612-617. 

Setting 

52 Cunliffe AL, Gladman JR, Husbands SL, Miller P, Dewey ME, Harwood RH. Sooner and 

healthier: a randomised controlled trial and interview study of an early discharge rehabilitation 

service for older people. Age Ageing. May 2004;33(3):246-252. 

Intervention 

53 Dapp U, Anders JA, von Renteln-Kruse W, et al. A randomized trial of effects of health risk 

appraisal combined with group sessions or home visits on preventive behaviors in older adults. J 

Gerontol A Biol Sci Med Sci. May 2011;66(5):591-598. 

Intervention 

54 De Jonge E, Taler G. Is there a doctor in the house? Caring. Aug 2002;21(8):26-29. Population 

55 de Vries OJ, Peeters GM, Elders PJ, et al. Multifactorial intervention to reduce falls in older 

people at high risk of recurrent falls: a randomized controlled trial. Arch Intern Med. Jul 12 

2010;170(13):1110-1117. 

Population 

56 Duncan G, Caird FI. Collaboration between geriatricians and general surgeons. Health Bull 

(Edinb). Mar 1992;50(2):163-167. 

No 

comparator 

57 Eagle DJ, Guyatt GH, Patterson C, Turpie I, Sackett B, Singer J. Effectiveness of a geriatric day 

hospital. CMAJ. Mar 15 1991;144(6):699-704. 

Intervention 

58 Edmans J, Conroy S, Harwood R, et al. Acute medical unit comprehensive geriatric assessment 

intervention study (AMIGOS). Trials. 2011;12:200. 

Other: 

Protocol only

59 Elkan R, Kendrick D, Dewey M, et al. Effectiveness of home based support for older people: 

systematic review and meta-analysis. BMJ. 2001;323(7315):719-725. 

Intervention 

60 Elliot JR, Wilkinson TJ, Hanger HC, et al. The added effectiveness of early geriatrician 

involvement on acute orthopaedic wards to orthogeriatric rehabilitation. N Z Med J. Mar 8 

1996;109(1017):72-73. 

Population 

61 Ellis G, Langhorne P. Comprehensive geriatric assessment for older hospital patients. Br Med 

Bull. 2004;71:45-59. 

Other: 

Review has 

been 

updated 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 25 

Excluded Trials 

Exclusion 

Code 

62 Enguidanos SM, Gibbs NE, Simmons WJ, et al. Kaiser Permanente community partners project: 

improving geriatric care management practices. J Am Geriatr Soc. May 2003;51(5):710-714. 

Outcome 

63 Evans DJ, Oakey S, Almdahl S, Davoren B. Goal attainment scaling in a geriatric day hospital. 

Team and program benefits. Can Fam Physician. Apr 1999;45:954-960. 

Intervention 

64 Fairhall N, Aggar C, Kurrle SE, et al. Frailty Intervention Trial (FIT). BMC Geriatrics. 2008;8:27. Other: 

Protocol only

65 Fisher A, Davis M, Rubenach S, Sivakumaran S, Smith P, Budge M. Outcomes for Older 

Patients With Hip Fractures: The Impact of Orthopedic and Geriatric Medicine Cocare. Journal 

of Orthopaedic Trauma March. 2006;20(3):172-180. 

Population 

66 Fletcher AE, Jones DA, Bulpitt CJ, Tulloch AJ. The MRC trial of assessment and management 

of older people in the community: objectives, design and interventions [ISRCTN23494848]. BMC 

Health Serv Res. Oct 25 2002;2(1):21. 

Other: 

Protocol only

67 Foley KT, Szabo E, Whitelaw N. Can geriatricians maintain separate consultative and primary 

care roles? J Am Geriatr Soc. Sep 1995;43(9):1065. 

Publication 

type 

68 Forster A, Young J, Lambley R, Langhorne P. Medical day hospital care for the elderly versus 

alternative forms of care [Systematic Review]. Cochrane Database of Systematic Reviews. 

2009(1). 

Population 

69 Friedman G, Brodsky J, Bentur N, Ben-Yehuda A, Stern Z, Isaacs B. Evaluation of a geriatric 

consultation unit in an acute university hospital. Aging (Milano). Jun 1995;7(3):234-236. 

Outcome 

70 Ganz DA, Fung CH, Sinsky CA, Wu S, Reuben DB. Key elements of high-quality primary care 

for vulnerable elders. Journal of General Internal Medicine. Dec 2008;23(12):2018-2023. 

Intervention 

71 Gilchrist WJ, Newman RJ, Hamblen DL, Williams BO. Prospective randomised study of an 

orthopaedic geriatric inpatient service. BMJ. Oct 29 1988;297(6656):1116-1118. 

Population 

72 Gold S, Bergman H. A geriatric consultation team in the emergency department. J Am Geriatr 

Soc. Jun 1997;45(6):764-767. 

No 

comparator 

73 Gonzalez-Montalvo JI, Alarcon T, Mauleon JL, Gil-Garay E, Gotor P, Martin-Vega A. The 

orthogeriatric unit for acute patients: a new model of care that improves efficiency in the 

management of patients with hip fracture. Hip Int. Apr-Jun 2010;20(2):229-235. 

Population 

74 Hackstaff L, Davis C, Katz L. The case for integrating behavior change, client-centered practice 

and other evidence-based models into geriatric care management. Soc Work Health Care. 

2004;38(3):1-19. 

Intervention 

75 Hastings SN, Heflin MT. A systematic review of interventions to improve outcomes for elders 

discharged from the emergency department. Acad Emerg Med. Oct 2005;12(10):978-986. 

Intervention 

76 Hebert R, Raiche M, Dubois M-F, et al. Impact of PRISMA, a coordination-type integrated 

service delivery system for frail older people in Quebec (Canada): A quasi-experimental study. 

Journals of Gerontology Series B-Psychological Sciences & Social Sciences. Jan 

2010;65B(1):107-118. 

Intervention 

77 Henschke P. The Geriatric Assessment Research Project: a randomised study [abstract]. Proc 

Annu Conf Aust Assoc Gerontol. 1986;21(77). 

Publication 

type 

78 Hershfield NB. Effect of a geriatric consultation service on the management of patients in an 

acute care hospital. CMAJ. Jul 1 1987;137(1):12-13. 

Publication 

type 

79 Hinkka K, Karppi SL, Pohjolainen T, Rantanen T, Puukka P, Tilvis R. Network-based geriatric 

rehabilitation for frail elderly people: feasibility and effects on subjective health and pain at one 

year. J Rehabil Med. Jul 2007;39(6):473-478. 

Population 

80 Huber M, Kennard A. Functional and mental status outcomes of clients discharged from acute 

gerontological versus medical/surgical units. J Gerontol Nurs. Jul 1991;17(7):20-24. 

Intervention 

81 Hui E, Lum CM, Woo J, Or KH, Kay RL. Outcomes of elderly stroke patients. Day hospital 

versus conventional medical management. Stroke. Sep 1995;26(9):1616-1619. 

Population 

82 Jayadevappa R, Chhatre S, Weiner M, Raziano DB. Health resource utilization and medical 

care cost of acute care elderly unit patients. Value in Health. 2006;9(3):186-192. 

Intervention 

83 Kafetz K, O'Farrell J, Parry A, et al. Age-related geriatric medicine: relevance of special skills of 

geriatric medicine to elderly people admitted to hospital as medical emergencies. J R Soc Med. 

Nov 1995;88(11):629-633. 

Intervention 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 26 

Excluded Trials 

Exclusion 

Code 

84 Kafetz K. How effective are acute geriatric wards at admitting geriatric patients? Clin Med. Aug 

2010;10(4):420-421. 

Intervention 

85 Kagan SH. Revisiting interdisciplinary teamwork in geriatric acute care. Geriatr Nurs. Mar 4 

2010;31(2):133-136. 

Publication 

type 

86 Karppi P. Effects of a geriatric inpatient unit on elderly home care patients: a controlled trial. 

Aging (Milan, Italy). Jun 1995;7(3):207-211. 

Setting 

87 Kay G, MacTavish M, Moffatt C, Lau G. Development and evaluation of a geriatric assessment 

unit in a community hospital. Perspectives. 1992;16(3):2-9. 

Population 

88 Keeler EB, Robalino DA, Frank JC, Hirsch SH, Maly RC, Reuben DB. Cost-effectiveness of 

outpatient geriatric assessment with an intervention to increase adherence. Med Care. Dec 

1999;37(12):1199-1206. 

Publication 

type 

89 Kehusmaa S, Autti-Ramo I, Valaste M, Hinkka K, Rissanen P. Economic evaluation of a geriatric 

rehabilitation programme: a randomized controlled trial. J Rehabil Med. Nov 2010;42(10):949-

955. 

Outcome 

90 Kelley-Gillespie N. Mobile medical care units: an innovative use of Medicare funding. J Health 

Soc Policy. 2005;20(2):33-48. 

Intervention 

91 Kimber J, Silver CP. Home visiting by a geriatric department. J R Coll Gen Pract. Jan 

1981;31(222):41-44. 

No 

comparator 

92 Kravitz RL, Reuben DB, Davis JW, et al. Geriatric home assessment after hospital discharge. J 

Am Geriatr Soc. Dec 1994;42(12):1229-1234. 

No 

comparator 

93 Lampela P, Hartikainen S, Lavikainen P, Sulkava R, Huupponen R. Effects of medication 

assessment as part of a comprehensive geriatric assessment on drug use over a 1-year period: 

a population-based intervention study. Drugs Aging. Jun 1 2010;27(6):507-521. 

Intervention 

94 Landefeld CS, Palmer RM, Kresevic DM, Fortinsky RH, Kowal J. A randomized trial of care in a 

hospital medical unit especially designed to improve the functional outcomes of acutely ill older 

patients. N Engl J Med. May 18 1995;332(20):1338-1344. 

Intervention 

95 Landefeld CS. Care of hospitalized older patients: opportunities for hospital-based physicians. J 

Hosp Med. Jan 2006;1(1):42-47. 

Intervention 

96 Lang VJ, Clark NS, Medina-Walpole A, McCann R. Hazards of hospitalization: hospitalists and 

geriatricians educating medical students about delirium and falls in geriatric inpatients. Gerontol 

Geriatr Educ. 2008;28(4):94-104. 

Intervention 

97 Ledesert B, Lombrail P, Yeni P, Carbon C, Brodin M. The impact of a comprehensive multidimensional geriatric assessment programme on duration of stay in a French acute medical 

ward. Age & Ageing. 1994;23(3):223-227. 

Intervention 

98 Lichtenstein H, Winograd CH. Geriatric consultation: a functional approach. J Am Geriatr Soc. 

May 1984;32(5):356-361. 

No 

comparator 

99 Lundstrom M, Edlund A, Karlsson S, Brannstrom B, Bucht G, Gustafson Y. A multifactorial 

intervention program reduces the duration of delirium, length of hospitalization, and mortality in 

delirious patients. Journal of the American Geriatrics Society. Apr 2005;53(4):622-628. 

Intervention 

100 MacLean DS. Outcome and cost of family physicians' care--pilot study of three diagnosis-related 

groups in elderly inpatients. J Am Board Fam Pract. Nov-Dec 1993;6(6):588-593. 

Intervention 

101 MacLennan WJ, Chapman BJ, Smith M, Prescott RJ, Wang JX. Co-ordinating geriatric and 

general medical services; experience of a geriatric assessment ward in the Royal Infirmary of 

Edinburgh. Scott Med J. Jun 1992;37(3):80-82. 

No 

comparator 

102 Maly RC, Leake B, Frank JC, DiMatteo MR, Reuben DB. Implementation of consultative 

geriatric recommendations: the role of patient-primary care physician concordance. J Am Geriatr 

Soc. Aug 2002;50(8):1372-1380. 

No 

comparator 

103 Marcantonio ER, Flacker JM, Wright RJ, Resnick NM. Reducing delirium after hip fracture: a 

randomized trial. J Am Geriatr Soc. May 2001;49(5):516-522. 

Population 

104 Martin F, Oyewole A, Moloney A. A randomized controlled trial of a high support hospital 

discharge team for elderly people. Age Ageing. May 1994;23(3):228-234. 

Intervention 

105 Martinez Lozano MD, Guzman Quilo C, Primeras Consultas Study G. Management of 

suspected Alzheimer's disease patients by specialist physicians at the first visit in Spain: First 

Consultation Study. Expert Rev Neurother. May 2011;11(5):657-663. 

Population 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 27 

Excluded Trials 

Exclusion 

Code 

106 Masters S, Halbert J, Crotty M, Cheney F. What are the first quality reports from the Transition 

Care Program in Australia telling us? Australas J Ageing. 2008;27(2):97-102. 

No 

comparator 

107 McCusker J, Dendukuri N, Tousignant P, Verdon J, Poulin de Courval L, Belzile E. Rapid twostage emergency department intervention for seniors: impact on continuity of care. Acad Emerg 

Med. Mar 2003;10(3):233-243. 

Intervention 

108 McCusker J, Verdon J. Do geriatric interventions reduce emergency department visits: a 

systematic review. Journals of Gerontology Series A - Biological Sciences and Medical 

Sciences. 2006;61(1):53-62. 

Intervention 

109 McInnes E, Mira M, Atkin N, Kennedy P, Cullen J. Can GP input into discharge planning result in 

better outcomes for the frail aged: results from a randomized controlled trial. Fam Pract. Jun 

1999;16(3):289-293. 

Intervention 

110 Mehta SS, Siegler EL, Henderson CR, Jr., Reid MC. Acute pain management in hospitalized 

patients with cognitive impairment: a study of provider practices and treatment outcomes. Pain 

Med. Oct 2010;11(10):1516-1524. 

No 

comparator 

111 Meissner P, Andolsek K, Mears PA, Fletcher B. Maximizing the functional status of geriatric 

patients in an acute community hospital setting. Gerontologist. 1989;29(4):524-528. 

Intervention 

112 Melis RJ, Adang E, Teerenstra S, et al. Cost-effectiveness of a multidisciplinary intervention 

model for community-dwelling frail older people. J Gerontol A Biol Sci Med Sci. Mar 

2008;63(3):275-282. 

Setting 

113 Melis RJ, van Eijken MI, Teerenstra S, et al. A randomized study of a multidisciplinary program 

to intervene on geriatric syndromes in vulnerable older people who live at home (Dutch 

EASYcare Study). J Gerontol A Biol Sci Med Sci. Mar 2008;63(3):283-290. 

Intervention 

114 Merel SE, McCormick W. Geriatricians and hospitalists: opportunities for partnership. J Am 

Geriatr Soc. Sep 2010;58(9):1803-1805. 

Publication 

type 

115 Mesteig M, Helbostad JL, Sletvold O, Rosstad T, Saltvedt I. Unwanted incidents during 

transition of geriatric patients from hospital to home: a prospective observational study. BMC 

Health Serv Res. 2010;10:1. 

No 

comparator 

116 Mion LC, Palmer RM, Meldon SW, et al. Case finding and referral model for emergency 

department elders: a randomized clinical trial. Ann Emerg Med. Jan 2003;41(1):57-68. 

Intervention 

117 Mulder J, Groenier KH, Dekker JJ, Berendsen AJ, Schuling J. Is there a need for a GP 

consultant at a university hospital? BMC Fam Pract. 2008;9:55. 

Outcome 

118 National Institutes of Health Consensus Development Conference Statement: geriatric 

assessment methods for clinical decision-making. Journal of the American Geriatrics Society. 

Apr 1988;36(4):342-347. 

Publication 

type 

119 Naylor MD, Brooten D, Campbell R, et al. Comprehensive discharge planning and home followup of hospitalized elders: a randomized clinical trial. JAMA. 1999;281(7):613-620. Intervention 

120 Nikolaus T, Detterbeck H, Gartner U, et al. [Diagnostic house call within the scope of inpatient 

geriatric assessment]. Z Gerontol Geriatr. Jan-Feb 1995;28(1):14-18. 

Foreign 

language 

121 Nikolaus T, Specht-Leible N, Bach M, Oster P, Schlierf G. A randomized trial of comprehensive 

geriatric assessment and home intervention in the care of hospitalized patients. Age Ageing. Oct 

1999;28(6):543-550. 

Intervention 

122 Nikolaus T, Specht-Leible N, Bach M, Wittmann-Jennewein C, Oster P, Schlierf G. Effectiveness 

of hospital-based geriatric evaluation and management and home intervention team (GEM-HIT). 

Rationale and design of a 5-year randomized trial. Z Gerontol Geriatr. Jan-Feb 1995;28(1):47-

53. 

Other: 

Protocol only

123 O'Donnell JC, Toseland RW. Does geriatric evaluation and management improve the health 

behavior of older veterans in psychological distress? J Aging Health. Nov 1997;9(4):473-497. 

Other: 

Primary 

reports are 

covered by 

SRs 

124 O'Reilly J, Lowson K, Young J, Forster A, Green J, Small N. A cost effectiveness analysis within 

a randomised controlled trial of post-acute care of older people in a community hospital. BMJ. 

Jul 29 2006;333(7561):228. 

Intervention 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 28 

Excluded Trials 

Exclusion 

Code 

125 Parker SG, Oliver P, Pennington M, et al. Rehabilitation of older patients: day hospital compared 

with rehabilitation at home. Clinical outcomes. Age Ageing. Sep 2011;40(5):557-562. 

Intervention 

126 Parsons M, Senior H, Kerse N, et al. Should care managers for older adults be located in 

primary care? A randomized controlled trial. J Am Geriatr Soc. Jan 2012;60(1):86-92. 

Intervention 

127 Peeters GMEE, de Vries OJ, Elders PJM, Pluijm SMF, Bouter LM, Lips P. Prevention of fall 

incidents in patients with a high risk of falling: design of a randomised controlled trial with an 

economic evaluation of the effect of multidisciplinary transmural care. BMC Geriatrics. 

2007;7:15. 

Other: 

Protocol only

128 Phelan EA, Williams B, LaCroix AZ, Grothaus L, LoGerfo JP, Wagner EH. Effects of provider 

practice on functional independence in older adults. Journal of the American Geriatrics Society. 

Aug 2004;52(8):1233-1239. 

Intervention 

129 Pitkala KH, Laurila JV, Strandberg TE, Kautiainen H, Sintonen H, Tilvis RS. Multicomponent 

geriatric intervention for elderly inpatients with delirium: effects on costs and health-related 

quality of life. J Gerontol A Biol Sci Med Sci. Jan 2008;63(1):56-61. 

Population 

130 Pope G, Wall N, Peters CM, et al. Specialist medication review does not benefit short-term 

outcomes and net costs in continuing-care patients. Age Ageing. May 2011;40(3):307-312. 

Setting 

131 Popplewell PY, Henschke PJ. What is the value of a Geriatric Assessment Unit in a teaching 

hospital? A comparative study of the management of elderly inpatients. Aust Health Rev. May 

1983;6(2):23-25. 

Published 

before 1985 

132 Powell C, Montgomery P. The age study: the admission of geriatric patients through emergency. 

Age & Ageing. 1990;19(Suppl):21-22. 

Publication 

type 

133 Raj V, Parulekar M, Steel RK. Geriatric medicine in the intensive care unit. J Am Geriatr Soc. 

Aug 2011;59(8):1570-1571. 

Publication 

type 

134 Reuben DB, Maly RC, Hirsch SH, et al. Physician implementation of and patient adherence to 

recommendations from comprehensive geriatric assessment. Am J Med. Apr 1996;100(4):444-

451. 

Outcome 

135 Reuben DB. Organizational interventions to improve health outcomes of older persons. Med 

Care. May 2002;40(5):416-428. 

Other: Mixed 

interventions

136 Rikala M, Korhonen MJ, Sulkava R, Hartikainen S. The effects of medication assessment on 

psychotropic drug use in the community-dwelling elderly. Int Psychogeriatr. Apr 2011;23(3):473-

484. 

Intervention 

137 Riley CG. A geriatric assessment unit: the first twelve months. N Z Med J. Nov 27 

1974;80(528):435-442. 

Published 

before 1985 

138 Rizza P, Bianco A, Pavia M, Angelillo IF. Preventable hospitalization and access to primary 

health care in an area of Southern Italy. BMC Health Serv Res. 2007;7:134. 

Intervention 

139 Rockwood K, Howlett S, Stadnyk K, Carver D, Powell C, Stolee P. Responsiveness of goal 

attainment scaling in a randomized controlled trial of comprehensive geriatric assessment. J Clin 

Epidemiol. Aug 2003;56(8):736-743. 

Other: 

Psychometric study of 

scale 

140 Roller PD, Allman RM. Comprehensive geriatric assessment in Medicare managed care: the 

geriatrician's calling card. Am J Med. Apr 1996;100(4):383-385. 

Publication 

type 

141 Romeis JC, Schey HM, Marion GS, Keith JF, Jr. Extending the extenders. Compromise for the 

geriatric specialization-manpower debate. J Am Geriatr Soc. Aug 1985;33(8):559-565. 

Intervention 

142 Rozzini R, Sabatini T, Trabucchi M. Hospital organization: general internal medical and 

geriatrics wards. J Gerontol A Biol Sci Med Sci. Apr 2005;60(4):535. 

No 

comparator 

143 Rubenstein LZ. Documenting impacts of geriatric consultation. J Am Geriatr Soc. Aug 

1987;35(8):829-830. 

Publication 

type 

144 Rubin CD, Sizemore MT, Loftis PA, Adams-Huet B, Anderson RJ. The effect of geriatric 

evaluation and management on Medicare reimbursement in a large public hospital: a 

randomized clinical trial. Journal of the American Geriatrics Society. Oct 1992;40(10):989-995. 

Intervention 

145 Saad M, Harisingani R, Katinas L. Impact of geriatric consultation on the number of medications 

in hospitalized older patients. Consult Pharm. Jan 2012;27(1):42-48. 

No 

comparator 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 29 

Excluded Trials 

Exclusion 

Code 

146 Sahadevan S, Earnest A, Koh YL, Lee KM, Soh CH, Ding YY. Improving the diagnosis related 

grouping model's ability to explain length of stay of elderly medical inpatients by incorporating 

function-linked variables. Ann Acad Med Singapore. Sep 2004;33(5):614-622. 

No 

comparator 

147 Scott I. Optimising care of the hospitalised elderly: a literature review and suggestions for future 

research. Australian and New Zealand Journal of Medicine. 1999;29(2):254-264. 

Publication 

type 

148 Scott IA. Care of older people in acute care hospitals: do we know how? Med J Aust. Nov 1 

1999;171(9):485-488. 

Publication 

type 

149 Shaw FE, Bond J, Richardson DA, et al. Multifactorial intervention after a fall in older people with 

cognitive impairment and dementia presenting to the accident and emergency department: 

randomised controlled trial. BMJ. Jan 11 2003;326(7380):73. 

Intervention 

150 Shyu YI, Liang J, Wu CC, et al. Two-year effects of interdisciplinary intervention for hip fracture 

in older Taiwanese. J Am Geriatr Soc. Jun 2010;58(6):1081-1089. 

Intervention 

151 Silliman RA, McGarvey ST, Raymond PM, Fretwell MD. The Senior Care Study. Does inpatient 

interdisciplinary geriatric assessment help the family caregivers of acutely ill older patients? J 

Am Geriatr Soc. Apr 1990;38(4):461-466. 

Outcome 

152 Siu AL, Morishita L, Blaustein J. Comprehensive geriatric assessment in a day hospital. Journal 

of the American Geriatrics Society. Oct 1994;42(10):1094-1099. 

No 

comparator 

153 Somme D, Andrieux N, Guerot E, et al. Loss of autonomy among elderly patients after a stay in 

a medical intensive care unit (ICU): a randomized study of the benefit of transfer to a geriatric 

ward. Arch Gerontol Geriatr. May-Jun 2010;50(3):e36-40. 

Intervention 

154 Sonu IS, High KP, Clayton CP, Woolard NF, Hazzard WR. An evaluation of geriatrics activities 

within internal medicine subspecialties. Am J Med. Nov 2006;119(11):995-1000. 

Intervention 

155 Spinewine A, Swine C, Dhillon S, et al. Effect of a collaborative approach on the quality of 

prescribing for geriatric inpatients: a randomized, controlled trial. Journal of the American 

Geriatrics Society. May 2007;55(5):658-665. 

Intervention 

156 Steel K, Hays A. A consultation service in geriatric medicine at a university hospital. JAMA. Apr 

10 1981;245(14):1410-1411. 

Publication 

type 

157 Stenvall M, Olofsson B, Nyberg L, Lundstrom M, Gustafson Y. Improved performance in 

activities of daily living and mobility after a multidisciplinary postoperative rehabilitation in older 

people with femoral neck fracture: a randomized controlled trial with 1-year follow-up. J Rehabil 

Med. Apr 2007;39(3):232-238. 

Population 

158 Stewart DA, Burns JM, Beard K, et al. The roles of general and geriatric medicine in the 

provision of acute medical care for elderly patients. Health Bull (Edinb). May 1992;50(3):259-

266. 

No 

comparator 

159 Stock RD, Reece D, Cesario L. Developing a comprehensive interdisciplinary senior healthcare 

practice. Journal of the American Geriatrics Society. Dec 2004;52(12):2128-2133. 

No 

comparator 

160 Stuck AE, Egger M, Hammer A, Minder CE, Beck JC. Home visits to prevent nursing home 

admission and functional decline in elderly people: systematic review and meta-regression 

analysis. JAMA. 2002;287(8):1022-1028. 

Other: 

Review has 

been 

updated 

161 Stuck AE, Kharicha K, Dapp U, et al. The PRO-AGE study: an international randomised 

controlled study of health risk appraisal for older persons based in general practice. BMC Med 

Res Methodol. 2007;7:2. 

Intervention 

162 Stuck AE, Siu AL, Wieland GD, Adams J, Rubenstein LZ. Comprehensive geriatric assessment: 

a meta-analysis of controlled trials. Lancet. Oct 23 1993;342(8878):1032-1036. 

Other: 

Review has 

been 

updated 

163 Stuck AE, Zwahlen HG, Neuenschwander BE, Meyer Schweizer RA, Bauen G, Beck JC. 

Methodologic challenges of randomized controlled studies on in-home comprehensive geriatric 

assessment: the EIGER project. Evaluation of In-Home Geriatric Health Visits in Elderly 

Residents. Aging (Milano). Jun 1995;7(3):218-223. 

Other: 

Method 

article 

164 Templeton VH. Dementia care: an outpatient, community-based, multi-disciplinary approach. N 

C Med J. Jan-Feb 2005;66(1):64-66. 

Publication 

type 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 30 

Excluded Trials 

Exclusion 

Code 

165 Thomas DR, Brahan R, Haywood BP. Inpatient community-based geriatric assessment reduces 

subsequent mortality. J Am Geriatr Soc. Feb 1993;41(2):101-104. 

Intervention 

166 Todd M, Crawford V, Stout RW. Differences between "geriatric" and "medical" patients aged 75 

and over. Ulster Med J. Apr 1993;62(1):4-10. 

No 

comparator 

167 Torres C, Ciocon JO, Galindo D, Ciocon DG. Clinical approach to urinary incontinence: a 

comparison between internists and geriatricians. Int Urol Nephrol. 2001;33(3):549-552. 

Outcome 

168 Trentini M, Semeraro S, Rossi E, et al. A multicenter randomized trial of comprehensive geriatric 

assessment and management: experimental design, baseline data, and six-month preliminary 

results. Aging (Milano). Jun 1995;7(3):224-233. 

Other: 

Review has 

been 

updated 

169 Tucker MA, Davison JG, Ogle SJ. Day hospital rehabilitation--effectiveness and cost in the 

elderly: a randomised controlled trial. Br Med J (Clin Res Ed). Nov 3 1984;289(6453):1209-

1212. 

Intervention 

170 Twomey C, Crowley MJ, Delaney L, Hyland CM. Patient throughput in an acute geriatric unit. Ir 

Med J. Jul-Aug 1995;88(4):126-128. 

No 

comparator 

171 Van Craen K, Braes T, Wellens N, et al. The effectiveness of inpatient geriatric evaluation and 

management units: a systematic review and meta-analysis. Journal of the American Geriatrics 

Society. Jan 2010;58(1):83-92. 

Intervention 

172 Vidan Astiz MT, Sanchez Garcia E, Alonso Armesto M, et al. [Functional decline during 

hospitalization in elderly patients. Benefits of admission to the geriatrics service]. Rev Esp 

Geriatr Gerontol. May-Jun 2008;43(3):133-138. 

Foreign 

language 

173 Vidan M, Serra JA, Moreno C, Riquelme G, Ortiz J. Efficacy of a comprehensive geriatric 

intervention in older patients hospitalized for hip fracture: a randomized, controlled trial. J Am 

Geriatr Soc. Sep 2005;53(9):1476-1482. 

Population 

174 Vind AB, Andersen HE, Pedersen KD, Joergensen T, Schwarz P. Effect of a program of 

multifactorial fall prevention on health-related quality of life, functional ability, fear of falling and 

psychological well-being. A randomized controlled trial. Aging Clin Exp Res. Jun 

2010;22(3):249-254. 

Intervention 

175 von Sternberg T, Hepburn K, Cibuzar P, et al. Post-hospital sub-acute care: an example of a 

managed care model. J Am Geriatr Soc. Jan 1997;45(1):87-91. 

Setting 

176 Wald H, Huddleston J, Kramer A. Is there a geriatrician in the house? Geriatric care approaches 

in hospitalist programs. J Hosp Med. Jan 2006;1(1):29-35. 

Intervention 

177 Wald HL, Glasheen JJ, Guerrasio J, Youngwerth JM, Cumbler EU. Evaluation of a hospitalistrun acute care for the elderly service. J Hosp Med. Jul-Aug 2011;6(6):313-321. Intervention 

178 Warshaw G. Geriatrics in the family practice center. Fam Med. Jan 1998;30(1):10-11. Publication 

type 

179 Warshaw G. Providing quality primary care to older adults. J Am Board Fam Med. May-Jun 

2009;22(3):239-241. 

Intervention 

180 Warshaw GA, Modawal A, Kues J, et al. Community physician education in geriatrics: applying 

the assessing care of vulnerable elders model with a multisite primary care group. J Am Geriatr 

Soc. Sep 2010;58(9):1780-1785. 

Intervention 

181 Wasserman MR, Holthaus KM, Cosgrove K. The MedWise Center--an innovation in primary 

care geriatrics. Continuum. Jan-Feb 1998;18(1):18-23. 

No 

comparator 

182 Wenger NS, Roth CP, Shekelle PG, et al. A practice-based intervention to improve primary care 

for falls, urinary incontinence, and dementia. Journal of the American Geriatrics Society. Mar 

2009;57(3):547-555. 

Intervention 

183 Whinney C, Michota F. Surgical comanagement: a natural evolution of hospitalist practice. J 

Hosp Med. Sep 2008;3(5):394-397. 

Intervention 

184 Whitehead CH, Harding S, Giles LC, Crotty M. Establishment of and first 20 months of operating 

an outreach geriatric clinic in a regional centre. Rural Remote Health. 2006;6(1):444. 

No 

comparator 

185 Wilhelmson K, Duner A, Eklund K, et al. Design of a randomized controlled study of a multiprofessional and multidimensional intervention targeting frail elderly people. BMC Geriatr. 

2011;11:24. 

Intervention 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 31 

Excluded Trials 

Exclusion 

Code 

186 Willett RM, Boling PA, Meyers ME, Hoban JD, Lawson SR, Schlesinger JB. Professional 

development in geriatrics for community-based generalist faculty. J Am Geriatr Soc. Feb 

2007;55(2):300-304. 

Intervention 

187 Williams ME, Pulliam CC, Hunter R, et al. The short-term effect of interdisciplinary medication 

review on function and cost in ambulatory elderly people. J Am Geriatr Soc. Jan 2004;52(1):93-

98. 

Intervention 

188 Winograd CH, Gerety MB, Brown E, Kolodny V. Targeting the hospitalized elderly for geriatric 

consultation. J Am Geriatr Soc. Dec 1988;36(12):1113-1119. 

Outcome 

189 Winograd CH, Stearns C. Inpatient geriatric consultation. Challenges and benefits. J Am Geriatr 

Soc. Aug 1990;38(8):926-932. 

Publication 

type 

190 Wong R, Chittock D, Malean N, Wilbur K. Discharge outcomes of older medical in-patients in a 

specialized acute care for elders unit compared with non-specialized units. Can J Geriatr. 

2006;9(3):96-101. 

Intervention 

191 Xakellis GC. Who provides care to Medicare beneficiaries and what settings do they use? J Am 

Board Fam Pract. Sep-Oct 2004;17(5):384-387. 

Outcome 

   
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 32 

REFERENCES 

1. Bachmann S, Finger C, Huss A, Egger M, Stuck AE, Clough-Gorr KM. Inpatient 

rehabilitation specifically designed for geriatric patients: systematic review and metaanalysis of randomised controlled trials. BMJ. 2010;340:c1718. 

2. Baztan JJ, Suarez-Garcia FM, Lopez-Arrieta J, Rodriguez-Manas L, Rodriguez-Artalejo 

F. Effectiveness of acute geriatric units on functional decline, living at home, and case 

fatality among older patients admitted to hospital for acute medical disorders: metaanalysis. BMJ. 2009;338(b50). 

3. Conroy S, Stevens T, Parker S, Gladman J. A systematic review of comprehensive 

geriatric assessment to improve outcomes for frail older people being rapidly discharged 

from acute hospital: 'interface geriatrics'. Age and Ageing. 2011;40(4):436-443. 

4. Day P, Rasmussen P. What is the evidence for the effectiveness of specialist geriatric 

services in acute, post-acute and sub-acute settings? A critical appraisal of the literature.

Christchurch: New Zealand Health Technology Assessment (NZHTA);2004. 1465-1858. 

5. Ellis G, Whitehead M, A., O'Neill D, Langhorne P, Robinson D. Comprehensive geriatric 

assessment for older adults admitted to hospital [Systematic Review]. Cochrane 

Database of Systematic Reviews. 2011:DOI: 

10.1002/14651858.CD14006211.pub14651852. 

6. Beswick AD, Rees K, Dieppe P, et al. Complex interventions to improve physical 

function and maintain independent living in elderly people: a systematic review and 

meta-analysis. Lancet. Mar 1 2008;371(9614):725-735. 

7. Byles JE. A thorough going over: evidence for health assessments for older persons 

(Structured abstract). Australian and New Zealand Journal of Public Health. 

2000;24(2):117-123. 

8. Eklund K, Wilhelmson K. Outcomes of coordinated and integrated interventions 

targeting frail elderly people: a systematic review of randomised controlled trials. Health 

& Social Care in the Community. Sep 2009;17(5):447-458. 

9. Huss A, Stuck AE, Rubenstein LZ, Egger M, Clough-Gorr KM. Multidimensional 

preventive home visit programs for community-dwelling older adults: a systematic 

review and meta-analysis of randomized controlled trials. Journals of Gerontology Series 

A-Biological Sciences & Medical Sciences. 2008;63(3):298-307. 

10. Kuo H-K, Scandrett KG, Dave J, Mitchell SL. The influence of outpatient comprehensive 

geriatric assessment on survival: a meta-analysis. Archives of Gerontology & Geriatrics. 

Nov-Dec 2004;39(3):245-254. 

11. Bula CJ, Berod AC, Stuck AE, et al. Effectiveness of preventive in-home geriatric 

assessment in well functioning, community-dwelling older people: secondary analysis of 

a randomized trial. J Am Geriatr Soc. Apr 1999;47(4):389-395. 

12. Counsell SR, Callahan CM, Tu W, Stump TE, Arling GW. Cost analysis of the Geriatric 

Resources for Assessment and Care of Elders care management intervention. J Am 

Geriatr Soc. Aug 2009;57(8):1420-1426. 

13. Counsell SR, Callahan CM, Clark DO, et al. Geriatric care management for low-income 

seniors: a randomized controlled trial. JAMA. Dec 12 2007;298(22):2623-2633. 

14. Eloniemi-Sulkava U, Saarenheimo M, Laakkonen M-L, et al. Family care as 

collaboration: effectiveness of a multicomponent support program for elderly couples 

with dementia. Randomized controlled intervention study. Journal of the American 

Geriatrics Society. Dec 2009;57(12):2200-2208. 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 33 

15. Fallon WF, Jr., Rader E, Zyzanski S, et al. Geriatric outcomes are improved by a geriatric 

trauma consultation service. J Trauma. Nov 2006;61(5):1040-1046. 

16. Gayton D, Wood-Dauphinee S, de Lorimer M, Tousignant P, Hanley J. Trial of a 

geriatric consultation team in an acute care hospital. J Am Geriatr Soc. Aug 

1987;35(8):726-736. 

17. Germain M, Knoeffel F, Wieland D, Rubenstein LZ. A geriatric assessment and 

intervention team for hospital inpatients awaiting transfer to a geriatric unit: a 

randomized trial. Aging (Milano). Feb 1995;7(1):55-60. 

18. Hogan DB, Fox RA. A prospective controlled trial of a geriatric consultation team in an 

acute-care hospital. Age & Ageing. 1990;19(2):107-113. 

19. Kerski D, Drinka T, Carnes M, Golob K, Craig WA. Post-geriatric evaluation unit 

follow-up: team versus nonteam. J Gerontol. Mar 1987;42(2):191-195. 

20. Legrain S, Tubach F, Bonnet-Zamponi D, et al. A new multimodal geriatric dischargeplanning intervention to prevent emergency visits and rehospitalizations of older adults: 

the optimization of medication in AGEd multicenter randomized controlled trial. J Am 

Geriatr Soc. Nov 2011;59(11):2017-2028. 

21. Li CM, Chen CY, Li CY, Wang WD, Wu SC. The effectiveness of a comprehensive 

geriatric assessment intervention program for frailty in community-dwelling older 

people: a randomized, controlled trial. Arch Gerontol Geriatr. Feb 2010;50 Suppl 1:S39-

42. 

22. McLean KA, Austin CA, Neal KR, Channer KS. Integration between general and 

geriatric medicine: a needs related policy. J R Coll Physicians Lond. Sep-Oct 

1994;28(5):415-418. 

23. Monteserin R, Brotons C, Moral I, et al. Effectiveness of a geriatric intervention in 

primary care: a randomized clinical trial. Fam Pract. Jun 2010;27(3):239-245. 

24. Phelan EA, Balderson B, Levine M, et al. Delivering effective primary care to older 

adults: a randomized, controlled trial of the senior resource team at group health 

cooperative. J Am Geriatr Soc. Nov 2007;55(11):1748-1756. 

25. Phelan EA, Genshaft S, Williams B, LoGerfo JP, Wagner EH. A comparison of how 

generalists and fellowship-trained geriatricians provide "geriatric" care. J Am Geriatr 

Soc. Oct 2008;56(10):1807-1811. 

26. Rubenstein LZ, Alessi CA, Josephson KR, Trinidad Hoyl M, Harker JO, Pietruszka FM. 

A randomized trial of a screening, case finding, and referral system for older veterans in 

primary care. J Am Geriatr Soc. Feb 2007;55(2):166-174. 

27. Schmader KE, Hanlon JT, Pieper CF, et al. Effects of geriatric evaluation and 

management on adverse drug reactions and suboptimal prescribing in the frail elderly. 

Am J Med. Mar 15 2004;116(6):394-401. 

28. Slaets JP, Kauffmann RH, Duivenvoorden HJ, Pelemans W, Schudel WJ. A randomized 

trial of geriatric liaison intervention in elderly medical inpatients. Psychosom Med. NovDec 1997;59(6):585-591. 

29. Avila-Beltran R, Garcia-Mayo E, Gutierrez-Robledo LM, Avila-Funes JA. Geriatric 

medical consultation is associated with less prescription of potentially inappropriate 

medications. J Am Geriatr Soc. Sep 2008;56(9):1778-1779. 

30. Egger SS, Bachmann A, Hubmann N, Schlienger RG, Krahenbuhl S. Prevalence of 

potentially inappropriate medication use in elderly patients: comparison between general 

medical and geriatric wards. Drugs Aging. 2006;23(10):823-837. 
Evidence Brief: Effect of Geriatricians on Outcomes of Inpatient and Outpatient Care 

Supplemental Materials 34 

31. Famadas JC, Frick KD, Haydar ZR, Nicewander D, Ballard D, Boult C. The effects of 

interdisciplinary outpatient geriatrics on the use, costs and quality of health services in 

the fee-for-service environment. Aging Clin Exp Res. Dec 2008;20(6):556-561. 

32. Fenton JJ, Levine MD, Mahoney LD, Heagerty PJ, Wagner EH. Bringing geriatricians to 

the front lines: evaluation of a quality improvement intervention in primary care. J Am 

Board Fam Med. Jul-Aug 2006;19(4):331-339. 

33. Hermush V, Daliot D, Weiss A, Brill S, Beloosesky Y. The impact of geriatric 

consultation on the care of the elders in community clinics. Arch Gerontol Geriatr. SepOct 2009;49(2):260-262. 

34. Inouye SK, Wagner DR, Acampora D, Horwitz RI, Cooney LM, Jr., Tinetii ME. A 

controlled trial of a nursing-centered intervention in hospitalized elderly medical patients: 

the Yale Geriatric Care Program. Journal of the American Geriatrics Society. 

1993;41(12):1353-1360. 

35. Pawlson LG. Hospital length of stay of frail elderly patients. Primary care by general 

internists versus geriatricians. J Am Geriatr Soc. Mar 1988;36(3):202-208. 

36. Peleg R, Press Y, Asher M, et al. An intervention program to reduce the number of 

hospitalizations of elderly patients in a primary care clinic. BMC Health Serv Res. 

2008;8:36. 

37. Phillips SL, Phillips JV, Branaman-Phillips J, Miller DJ. Geriatric versus non-geriatric 

approach of care to moderate Pra risk senior population. J Am Med Dir Assoc. Nov-Dec 

2005;6(6):396-399. 

38. Sennour Y, Counsell SR, Jones J, Weiner M. Development and implementation of a 

proactive geriatrics consultation model in collaboration with hospitalists. J Am Geriatr 

Soc. Nov 2009;57(11):2139-2145.