Clinical trial NCT00182962: GRACE: Geriatric Resources for Assessment and Care of Elders
Official title: Geriatric Resources for Assessment and Care of Elders
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Functional Decline
Aging
Keywords: Activities of Daily Living
Low-income
geriatric medicine
computer assisted patient care
Lead sponsor: National Institute on Aging (NIA)
Sponsor class: NIH
Collaborators: name: Nina Mason Pulliam Charitable Trust
name: Wishard Health Services
First posted: 2005-09-16
Enrollment: 1270
Sex: ALL
Minimum age (years): 65
Standard ages: OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: The purpose of this study is to test the effectiveness of a collaborative model of team care as compared to usual care in improving functional outcomes among community-dwelling low-income older adults.

Detailed description: This collaborative model of care, Geriatric Resources for Assessment and Care of Elders (GRACE), involves a geriatric nurse practitioner and a geriatric social worker caring for the vulnerable older adult in collaboration with the patient's primary care physician to improve coordination and quality of care. The specific components of GRACE mirror those recommended in recent reviews: a) specific targeting of elders at risk; b) availability of collaborative expertise in geriatrics; c) integration of the program into primary care; d) coordination of care across all sites of care; e) integration of data systems that support physician's practice and facilitate monitoring of pertinent clinical parameters; and f) institutionally endorsed clinical practice guidelines. To our knowledge, there are no prior studies investigating the effectiveness of such a comprehensive approach among vulnerable older adults.

We are hypothesizing that, compared to usual care, patients enrolled in the intervention will have:

1. greater independence in activities of daily living over 2 years of follow-up;
2. better health status scores as assessed by the HEDIS® 2000 Health Outcomes Survey
3. fewer nursing home days over 2 years of follow-up; and
4. fewer hospitalizations over the 2 years of follow-up.

Eligibility criteria: Inclusion Criteria:

* 65 years old or older
* Annual income less than 200% of the federal poverty level
* Have had one or more primary care visits in the past 12 months
* Reside in the community (non-institutionalized)

Exclusion Criteria:

* Non-English speaking
* No regular access to a telephone
* Currently undergoing kidney dialysis treatments
* Residing with a patient already participating in the GRACE clinical trial

Primary outcomes:
measure: Functional status
measure: health status
measure: hospitalization and nursing home placement
Secondary outcomes:
measure: Patient satisfaction and quality of care
Other outcomes:
Locations:
city: Indianapolis
country: United States
facility: Indiana University School of Medicine
state: Indiana
Study officials:
affiliation: Indiana University Geriatrics Program, Indiana University Center for Aging Research, Indiana University School of Medicine
name: Steven R. Counsell, MD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Bernabei R, Landi F, Gambassi G, Sgadari A, Zuccala G, Mor V, Rubenstein LZ, Carbonin P. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ. 1998 May 2;316(7141):1348-51. doi: 10.1136/bmj.316.7141.1348.
citation: Callahan CM, Stump TE, Stroupe KT, Tierney WM. Cost of health care for a community of older adults in an urban academic healthcare system. J Am Geriatr Soc. 1998 Nov;46(11):1371-7. doi: 10.1111/j.1532-5415.1998.tb06003.x.
citation: Counsell SR, Holder CM, Liebenauer LL, Palmer RM, Fortinsky RH, Kresevic DM, Quinn LM, Allen KR, Covinsky KE, Landefeld CS. Effects of a multicomponent intervention on functional outcomes and process of care in hospitalized older patients: a randomized controlled trial of Acute Care for Elders (ACE) in a community hospital. J Am Geriatr Soc. 2000 Dec;48(12):1572-81. doi: 10.1111/j.1532-5415.2000.tb03866.x.
citation: Stuck AE, Minder CE, Peter-Wuest I, Gillmann G, Egli C, Kesselring A, Leu RE, Beck JC. A randomized trial of in-home visits for disability prevention in community-dwelling older people at low and high risk for nursing home admission. Arch Intern Med. 2000 Apr 10;160(7):977-86. doi: 10.1001/archinte.160.7.977.
citation: Chen A, Brown R, Archibald N, Aliotta S, Fox PD. Best practice in coordinated care. Health Care Financing Administration. 2000. Contract No. HCFA 500-95-0048 (04).
citation: 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 Jul;54(7):1136-41. doi: 10.1111/j.1532-5415.2006.00791.x.
citation: Clark DO, Callahan CM, Counsell SR. Reliability and validity of a steadiness score. J Am Geriatr Soc. 2005 Sep;53(9):1582-6. doi: 10.1111/j.1532-5415.2005.53485.x.
citation: 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. 2009 Aug;57(8):1420-6. doi: 10.1111/j.1532-5415.2009.02383.x.
citation: Counsell SR, Callahan CM, Clark DO, Tu W, Buttar AB, Stump TE, Ricketts GD. Geriatric care management for low-income seniors: a randomized controlled trial. JAMA. 2007 Dec 12;298(22):2623-33. doi: 10.1001/jama.298.22.2623.