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Definition
Geriatric Evaluation and Management Program is a specialized program of services in an inpatient or outpatient setting where an interdisciplinary health care team performs multidimensional evaluations on a targeted group of elderly patients who will most likely benefit from these services. This team approach to assessment of the patient is followed by an interdisciplinary plan of care, including treatment, rehabiliation, health promotion and social service interventions.
History
The concepts of comprehensive geriatric evaluation and specialized geriatric evaluation and management programs were developed first in Great Britain during the 1930's and were based largely on the work of geriatric pioneer, Dr. Marjory Waren. In the United States, formal geriatric evaluation programs were not established until the 1970's. The VA's first experieinces with this approach to care came during the mid and late 1970's, when some of the Geriatric Research Education and Clinical Centers (GRECCs) established GEM's as part of their clinical demonstation activities.
The First VA GEM was opened in June 1976 by the GRECC at the VA Medical Center, Little Rock, Arkansas. This unit's published findings show that many new major psychiatric conditions were discovered in the patients transferred to the GEM from acute, medical and surgical wards. At the VA Medical Center in Sepulveda, CA, these demonstration activities developed into a randomized, controlled study of the efficacy of GEMs. Findings from this study, published in the New England Journal of Medicine, revealed significant benefits associated with admission to the GEM. In comparison with a control group, patients in the GEM had a signigicantly lower mortality and discharge rate to nursing homes. The Department of Veterans Affairs (VA) medical system has assumed a leadership role in the U.S. in promoting the establishment of geriatric evaluation and managment programs. The VA's commitment to promoting GEM program devleopment was illustrated by the ambitious goals set for the expansion of the program in the 1984 agency report, Caring for the Older Veteran.
Goals and Objectives
1. Improve the process and outcome of clinical care by:
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Improving diagnostic accuracy
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Optimizing drug prescribing
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Assuring the most appropriate discharge location (most independent and least restrictive level of care);
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Minimizing repeated hospitalizations
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Maximizing physical and psychosocial functional status
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Reducing inappropriate use of resources (acute hospital, nursing home and community)
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Providing interdisciplinary patient evaluations
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Establsihing and coordinating an interdisciplinary plan for long-term management of care, and
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Developing clinical indicators and monitoring the quality of care provided.
2. Provide geriatric education for health professionals and trainees by:
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Educating medical center professionals on geriatric issues
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Providing a clinical environment for the training of health care professional trainees and
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Teaching medical center staff and trainees of all health disciplines the principles and techniques of geriatric evaluation and management.
3. Ensure efficient use of hospital and community resources by:
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Reducing unnecessary use of hospital services and other resources
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Avoiding inappropriate use of nursing home and other long term care services and
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Promoting coordinated use of appropriate community resources.
4. Encourage geriatric research by:
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