GRACE Program Can Improve Healthcare for Elderly Patients, Lower Costs

A recent study published in PLOS ONE evaluating The Geriatric Resources for the Assessment and Care of Elders (GRACE) program found it decreased the use of acute care and increased patient’s self-rated health compared with typical care received.

GRACE was created to improve care while controlling costs and to provide a support system between patients and primary care providers.

The study included 152 low-income senior patients from community-based health centers who were considered high-risk, defined as having 5 or more emergency department visits and 2 or more hospitalizations in 12 months prior to the study.

The study was conducted from April 2013 to March 2014.

This randomized, controlled trial, included patients receiving GRACE care and a control group of patients receiving “usual care.”

Patients initially received an extensive in-home assessment from a nurse practitioner/social worker team to assess patient needs and resources.

Once the assessment was completed, the nurse practitioner/social worker team would then meet with a larger team composed of a geriatrician, mental health liaison, and pharmacist to create an individualized care plan for the patients.

These teams would then create an individualized healthcare plan, which includes specific care protocols. The plan would then be reviewed and modified by the patient’s primary care physician, according to the study.

Follow up visits were typically by phone, unless a home visit was critical.

Researchers evaluated data gathered from hospitalizations and found 6 months after enrollment there was a decline in the median number of emergency department visits (5.5 to 0, p= 0.015) compared with 6 months prior to enrollment.

There was also a decline in the median number of hospitalizations after enrollment (5.5 to 0, p< 0.001) compared with pre-enrollment.

Self-rated health also increased from 31% at enrollment to 64% after 9 months of enrollment (p= 0.002).

Interviews with support team members stated that patients with complex conditions, little community support, or mild anxiety benefitted most from the program.

Overall, patients in the GRACE program showed decreased healthcare utilization, decreased costs, improved quality of care, increased patient satisfaction, and improved quality of life, the study concluded.