ORIGINAL RESEARCH Bringing Geriatricians to the Front Lines: Evaluation of a Quality Improvement Intervention in Primary Care

Background: Frail elders often receive low-quality primary care, yet the optimal role of geriatricians in primary care settings remains uncertain. We evaluated the health utilization impacts of an innovative intervention emphasizing chronic disease self-management and physical activity promotion among frail elders in primary care. Methods: The intervention was implemented within two primary care practices at a single clinic serv-ing a large population of frail elders enrolled in a western Washington health plan. Subjects included older patients (age>65 years) with disproportionate baseline outpatient service use who attended two on-site visits with a geriatrician during which each received comprehensive assessment and a problem-solving intervention to enhance chronic disease self-management and promote physical activity (N 146). Our evaluation had a retrospective matched cohort design. Controls receiving primary care at other health plan clinics were matched 3:1 to intervention subjects by sex and a propensity score (N 437), which was computed using demographic, clinical, and health care utilization factors that were predic-tive of attending the intervention. Among intervention subjects and controls following the intervention, we compared relative rates of hospitalization, outpatient and specialty visits, nursing home admission, mortality, and prescription of selected high-risk medications, as well as total health care costs