GRACE: Geriatric Resources for Assessment and Care of Elders

Aging Clinical Trial

Official title:

Geriatric Resources for Assessment and Care of Elders

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT00182962
• Other study ID #: AG0042
• Secondary ID: R01AG020175
• Status: Completed
• Phase: N/A
• First received: September 13, 2005
• Last updated: November 16, 2006
• Start date: March 2002
• Est. completion date: October 2006

Study information

• Verified date: November 2006
• Source: National Institute on Aging (NIA)
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Federal Government
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1270
• Est. completion date: October 2006
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: Both
• Age group: 65 Years and older

Eligibility

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

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind, Primary Purpose: Treatment

Related Conditions & MeSH terms

• Aging
• Functional Decline

Intervention

Behavioral:
• Geriatric Resources for Assessment & Care of Elders (GRACE)

Locations

Country	Name	City	State
United States	Indiana University School of Medicine	Indianapolis	Indiana

Sponsors (3)

Lead Sponsor	Collaborator
National Institute on Aging (NIA)	Nina Mason Pulliam Charitable Trust, Wishard Health Services

Country where clinical trial is conducted

United States, 

References & Publications (7)

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. — View 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. — View 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).

Clark DO, Callahan CM, Counsell SR. Reliability and validity of a steadiness score. J Am Geriatr Soc. 2005 Sep;53(9):1582-6. — View 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. — View 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. — View Citation

Stuck AE, Minder CE, Peter-Wüest 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. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Functional status
Primary	health status
Primary	hospitalization and nursing home placement
Secondary	Patient satisfaction and quality of care