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Context: Low-income seniors frequently have multiple chronic medical conditions for which they often fail to receive the recommended standard of care. Objectives: To test the effectiveness of a geriatric care management model on improving the quality of care for low-income seniors in primary care. Design, Setting, and Patients: Controlled clinical trial of 951 adults 65 years or older with an annual income less than 200% of the federal poverty level, whose primary care physicians were randomized from January 2002 through August 2004 to participate in the intervention (474 patients) or usual care (477 patients) in community- based health centers. Intervention Patients received 2 years of home-based care management by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocols for common geriatric conditions. Main Outcome Measures The Medical Outcomes 36-ltem Short-Form (SF-36) scales and summary measures; instrumental and basic activities of daily living (ADLs); and emergency department (ED) visits not resulting in hospitalization and hospitalizations. Results Intention-to-treat analysis revealed significant improvements for intervention patients compared with usual care at 24 months in 4 of 8 SF-36 scales: general health (0.2 vs -2.3, P= .045), vitality (2.6 vs -2.6, P< .001), social functioning (3.0 vs -2.3, P=.008), and mental health (3.6 vs-0.3, P=.OO1); and in the Mental Component Summary (2.1 vs -0.3, P< .001). No group differences were found for ADLs or death. The cumulative 2-year ED visit rate per 1000 was lower in the intervention group (1445 [n=474] vs 1748 [n=477], P=.O3) but hospital admission rates per 1000 were not significantly different between groups (700 [n=474] vs 740 [n=477], P=.66). In a predefined group at high risk of hospitalization (comprising 112 intervention and 114 usual-care patients), ED visit and hospital admission rates were lower INSET: Key Components of the Geriatric Resources for Assessment and Care. [ABSTRACT FROM AUTHOR]