{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T15:26:50Z","timestamp":1792078010148,"version":"4.4.0"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,8,10]],"date-time":"2018-08-10T00:00:00Z","timestamp":1533859200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"OHSU Faculty Practice Plan"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2018,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To design a value\u2010driven, interprofessional inpatient geriatric consultation program coordinated with systems\u2010level changes and studied outcomes and costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Propensity\u2010matched case\u2013control study of older adults hospitalized at an academic medical center (AMC) who did or did not receive geriatric consultation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Single tertiary\u2010care AMC in Portland, Oregon.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Adults aged 70 and older who received an inpatient geriatric consultation (n=464) and propensity\u2010matched controls admitted before development of the consultation program (n=2,381). Pre\u2010 and postintervention controls were also incorporated into cost difference\u2010in\u2010difference analyses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>Daily charges, total charges, length of stay (LOS), 30\u2010day readmission, intensive care unit (ICU) days, Foley catheter days, total medication doses per day, high\u2010risk medication doses per day, advance directive and Physician Orders for Life Sustaining Treatment (POLST) documentation, restraint orders, discharge to home, and mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>On average, individuals who received a geriatric consultation had $611 lower charges per day than those without a consultation (p=.02). They spent on average 0.36 fewer days in the ICU (p&lt;.001). They were less likely to have restraint orders (20.0% vs 27.9%, p&lt;0.001), more likely to have a POLST (58.2% vs 44.6%, p&lt;.001), and more likely to be discharged to home (33.4% vs 28.2%, p=.03). They received fewer doses of antipsychotics, benzodiazepines, and antiemetics (10, 5, and 7 fewer doses per 100 patient\u2010days, respectively) and had lower in\u2010hospital mortality (2.4% vs 4%, p=.01). There was no difference in hospital LOS or 30\u2010day readmission.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our consultation program resulted in significant reductions in daily charges, ICU days, potentially inappropriate medication use, and use of physical restraints and increased end\u2010of\u2010life planning. This model has potential for dissemination to other institutions operating in resource\u2010scarce, value\u2010driven settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.15473","type":"journal-article","created":{"date-parts":[[2018,8,10]],"date-time":"2018-08-10T03:43:53Z","timestamp":1533872633000},"page":"1790-1795","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Higher Quality, Lower Cost with an Innovative Geriatrics Consultation Service"],"prefix":"10.1111","volume":"66","author":[{"given":"Juliana M.","family":"Bernstein","sequence":"first","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Oregon Health &amp; Science University Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Graven","sequence":"additional","affiliation":[{"name":"Center for Health Systems Effectiveness Oregon Health &amp; Science University Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Drago","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Oregon Health &amp; Science University Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konrad","family":"Dobbertin","sequence":"additional","affiliation":[{"name":"Center for Health Systems Effectiveness Oregon Health &amp; Science University Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Eckstrom","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine and Geriatrics Oregon Health &amp; Science University Portland Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,8,10]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.906"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/jhm.589"},{"key":"e_1_2_6_4_1","unstructured":"Institute of Medicine (US) Committee on the Future Health Care Workforce for Older Americans. 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