Original article
A new model of integrated home care for the elderly: impact on hospital use

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Abstract

The objective of the present study was to examine the effect of a home care program based on comprehensive geriatric assessment—Minimum Data Set for Home Care—and case management on hospital use/cost of frail elderly individuals. We determined all hospital admissions and days spent in hospital during the first year since the implementation of the home care program, and compared them to the rate of hospitalization that the same patients had experienced in the year preceding the implementation of such program. Following the implementation of this program, there was a significant reduction of the number of hospitalizations (pre 44% vs. post 26%, P < 0.001), associated with a reduction of hospital days, both at the individual patient level and for each admission. In conclusion, an integrated home care program based on the implementation of a comprehensive geriatric assessment instrument guided by a case manager has a significant impact on hospitalization and is cost-effective.

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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    Citation Excerpt :

    The aim of home care services is to help people with functional limitations to live in their own homes. Home care is considered a possible strategy for reducing hospital use among older people (Landi, Onder, & Russo, 2001), and in fact, there are studies showing that home care prevents hospitalizations among selected older people (Bernabei, Landi, & Gambassi, 1998; Vasquez, 2008). Nevertheless, unplanned hospitalizations and emergency room visits occur frequently among home care clients, and they are often associated with adverse outcomes (Doran, Hirdes, & Poss, 2009; Dorr, Jones, & Burns, 2006; Ronneikko, Makela, & Jamsen, 2017).

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