Original articleA new model of integrated home care for the elderly: impact on hospital use
Introduction
Research shows that comprehensive geriatric assessment and community case management improves outcomes and saves money 1, 2, 3. We recently conducted a randomized trial testing the effect of an integrated home care program that resulted in a significant reduction in hospitalization and institutionalization, with a substantial cost savings [3]. However, despite evidence showing that home care treatment is feasible, effective and generally preferred by frail older patients and their relatives, its widespread implementation is still awaited 4, 5.
The present study was undertaken to examine the impact on hospital use of a specific home care program based on comprehensive geriatric assessment and case management, and to take advantage of a new internationally validated assessment instrument, the Minimum Data Set for Home Care [6].
Section snippets
Methods
We evaluated all the subjects (n = 1204) who, between January 1998 and June 1999, were identified as eligible for the new integrated home care services delivered by four different Italian Health Care Agencies (Pieve di Soligo, n = 634; Bergamo, n = 92; Orvieto, n = 293; Lecce, n = 185). These agencies decided to participate in a national home care program with the aim of reorganizing the care of frail older people living in the community, adopting an integrated social and medical care program
Results
The sample was comprised of 704 women and 500 men; mean age was 77.4 ± 9.7 years old. Nearly half of the sample was widowed (46%), but less than 20% lived alone or had no informal care available (16%). Patients had a moderate-to-severe impairment in basic and instrumental activities of daily living, while cognitive function was relatively more preserved. On average, patients were diagnosed with nearly four clinical conditions (Table 1).
Following the implementation of the integrated home care
Discussion
Inappropriate or unplanned hospital admissions of elderly patients are the most important determinants of the health care expenditure. Nonetheless, older people living in community are too often forgotten in the midst of primary, secondary and social care [2], thus leaving the emergency room and the hospital as the only available resources. The diffusion and expansion of home care programs and services is viewed as a possible strategy to reduce hospital use among elderly people. However, the
Acknowledgements
We thank F. Pagano and A. Valiani for collecting data. We also thank the Silvernet-HC Study Group of Vittorio Veneto, Pieve di Soligo, Conegliano, Lecce, Orvieto, Bergamo. The participants list appears in [7]. This study was supported by grants from the “Progetto Finalizzato Invecchiamento” of the National Research Council and Pfizer-Italy Silver Network Project.
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