Substudy 13 Fact Sheet

The Geriatric Outcome Evaluation Study (GOES) (NA101-13)

Sponsor Organization:
University of Victoria

Rationale/Goals:
This project is one of fifteen sub-studies of the National Evaluation of the Cost-Effectiveness of Home Care Project (NA101). In Canada, geriatric day hospitals have emerged as one of a variety of services available to older adults, yet there is a paucity of information concerning their effectiveness. Sub-study 13 explored the utilization of services within a geriatric services program and examined how a geriatric day hospital (GDH) fits into this spectrum of services in Victoria, British Columbia. The researchers wished to determine if patient needs could best be served by such specialized services within the continuum of care concept, or if they could be substituted by inpatient and other services.

Activities:
Data were obtained for all persons admitted to each of the 5 service components of the geriatric services program: a geriatric outpatient clinic, a geriatric day hospital, post-acute geriatric inpatient rehabilitation, residential geriatric rehabilitation for people admitted from the community, and inpatient psychogeriatric rehabilitation. Measures of clients' mental health, physical health, daily functioning and bodily pain were administered to family members involved in providing care at admission, discharge and 4 months post-discharge. Data on health care utilization and costs of care were obtained through existing data bases, manual record reviews and reports of caregivers, and addressed issues related to costs of self-care, informal care, and formal care.

Key Findings:
The project leaders identified the following outcomes:

• Persons admitted to each of the service components differed with respect to their profile of mental health, physical health, daily functioning, and bodily pain - in other words, each service did appear to address a particular need or constellation of needs.
  
• Within each service, health status appeared to improve when receiving care, and examination of the sustainability of improved health status over time supported the present model of care in that little change in functioning was seen in the post-discharge period.
  
• Researchers were unable to assess the cost-effectiveness of the various services to determine if there could be a cost-effective substitution of services. This was due in part to a restructuring of outpatient programs during the research period.

Implications:
The project leaders indicated that their findings are important because, in their view:

• The results of the study support the notion that a spectrum of care services is required for geriatric care and that health benefits are realized and sustained across a broad spectrum of services.
  
• The data available will be further examined with respect to a variety of specific topics in the future.

Evaluation Methodology:
As this project was an evaluation study, please see the "Activities" section.

HTF Contribution to the Project:
$1,505,000 (divided among the 15 sub-studies)

Language of Report:
English

• Executive summary
• Full report