What do we know about patient targeting in geriatric evaluation and management (GEM) programs?

Area of Science:

• Gerontology
• Health Services Research
• Evidence-Based Medicine

Background:

• Institution-based geriatric evaluation and management (GEM) programs show potential for improving patient care outcomes.
• However, significant variability exists in study results, impacting the consistent effectiveness of GEM programs.
• The cost-effectiveness of GEM programs is a concern, leading to the exploration of targeted approaches.

Purpose of the Study:

• To describe various approaches to targeting in GEM programs and the development of selection criteria.
• To assess the impact of targeting on patient outcomes using evidence from randomized trials.
• To propose future research directions and development strategies for GEM program targeting.

Main Methods:

• Systematic review of randomized trials evaluating targeted geriatric evaluation and management (GEM) programs.
• Analysis of different targeting strategies and selection criteria used in GEM interventions.
• Synthesis of evidence on the effects of targeting on patient outcomes.

Main Results:

• Targeting, or the selective admission of frail elderly subgroups, is proposed to enhance the cost-effectiveness of GEM programs.
• Meta-analysis results offer some support for the concept of targeting in GEM.
• Evidence from randomized trials regarding the specific effects of targeting on outcomes requires further comprehensive assessment.

Conclusions:

• Targeting frail elderly patients within GEM programs is a strategy with potential to improve efficiency and outcomes.
• Further research is essential to refine selection criteria and validate the effectiveness of targeted GEM interventions.
• An agenda for future research and development in GEM targeting is proposed to optimize care for vulnerable older adults.