View GRACE Team Care profile at AHRQ Health Care Innovations Exchange

A number of peer-reviewed research journals have published the results of the GRACE randomized trial and reviewed the dissemination of the GRACE model in various settings. The links to publications are organized by topic for ease of reference.

The Model

Counsell SR, Callahan CM, Buttar AB, et al. Geriatric Resources for Assessment and Care of Elders (GRACE): A New Model of Primary Care for Low-Income Seniors.
Journal of the American Geriatrics Society. 2006; 54(7): 1136-1141.
This article provides an overview of the GRACE Team Care model and outlines the program’s key components, including the structure of the support team and interdisciplinary team, care protocols, and development of an individualized care plan. With the support of a web-based longitudinal tracking system, the GRACE support team provides ongoing care management and coordination of care across multiple geriatric syndromes, providers, and sites of care.

Boult C, Wieland GD. Comprehensive Primary Care for Older Patients with Multiple Chronic Conditions : “Nobody rushes you through.”
JAMA. 2010; 304(17): 1936-1943.
GRACE Team Care is one of three models described in this article as including four proactive, continuous processes that can substantially improve the primary care of older adults with multiple chronic conditions. The four processes of note are comprehensive assessment, evidence-based care planning and monitoring, promotion of patients' and (family caregivers') active engagement in care, and coordination of professionals in care of the patient.

Bielaszka-DuVernay C. The 'GRACE' Model: In-Home Assessments Lead To Better Care For Dual Eligibles .
Health Affairs. 2011; 30(3): 431-434.
This article was commissioned by Health Affairs and is based partly on a presentation by Dr. Steve Counsell that was delivered at a Health Affairs conference, Innovations across the Nation in Health Care Delivery, December 16, 2010, in Washington, DC.

Counsell SR. Integrating Medical and Social Services with GRACE.
Generations – Journal of the American Society on Aging. 2011; 35(1): 56-59.
This article summarizes GRACE Team Care and highlights new payment models in the Affordable Care Act that will provide opportunities for further dissemination of the model. Potential payment models include the Patient-Centered Medical Home, Medicaid Health Home, and Accountable Care Organizations.


Counsell SR, Callahan CM, Clark DO, et al. Geriatric care management for low-income seniors: a randomized controlled trial.
JAMA. 2007; 298(22): 2623-2633.
This article explores the integrated and home-based geriatric care management techniques tested in the GRACE Team Care model. A controlled clinical trial was conducted among 951 adults 65+ with annual income less than 200% of the federal poverty level from January 2002 - August 2004. The trial enrolled 474 patients who received the GRACE Team Care intervention, while 477 patients received usual care. The results indicated that integrated and home-based geriatric care management resulted in improved quality of care and reduced acute care utilization among a high-risk group.

Counsell SR. Aging with GRACE: Quality Integrated Care for Low-Income Elders .
American Society on Aging – Aging Today. 2009; 30(5).
This article summarizes the GRACE model and the outcomes of the controlled clinical trial. Results show improved quality of care and reduced acute care utilization among participants.

Cost Analysis

Counsell SR, Callahan CM, Tu W, et al. Cost analysis of the Geriatric Resources for Assessment and Care of Elders care management intervention.
J Am Geriatr Soc. 2009; 57(8): 1420-1426.
This article analyzes the cost of providing the GRACE Team Care model, based on the randomized controlled trial. Chronic and preventive care costs, acute care costs, and total costs in the full sample and predefined high-risk and low-risk groups were measured. In patients at high risk of hospitalization, the GRACE intervention was cost neutral in the first two years, and cost saving in the third year.

Schubert CC, Myers LJ, Allen K, Counsell SR

Implementing Geriatric Resources for Assessment and Care of Elders Team Care in a Veterans Affairs Medical Center: Lessons Learned and Effects Observed. Journal of the American Geriatrics Society. 2016; 64(7): 1503-1509. This article outlines the positive results achieved when the GRACE Team Care model was implemented at a Veterans Affairs Medical Center in Indianapolis, IN. (please hyperlink title to the aforementioned link used for Latest News)

Ritchie CR, Andersen R, Eng J, Garrigues SK, et al.
Implementation of an Interdisciplinary, Team-Based Complex Care Support Health Care Model at an Academic Medical Center: Impact on Health Care Utilization and Quality of Life. PLOS One. 2016. Article available online: here. This article describes the adaptation of the GRACE model to include adults of all ages (named Care Support) and to evaluate the process and impact of Care Support implementation at an urban academic medical center.