BMJ 1998;316:1348-1351 ( 2 May )

Papers

Randomised trial of impact of model of integrated care and case management for older people living in the community

Roberto Bernabei, associate professor, ^a Francesco Landi, assistant professor, ^a Giovanni Gambassi, assistant professor, ^a Antonio Sgadari, assistant professor, ^a Giuseppe Zuccala, assistant professor, ^a Vincent Mor, professor, ^b Laurence Z Rubenstein, professor, ^c PierUgo Carbonin, professor. ^a

^a Istituto di Medicina Interna e Geriatria, Università Cattolica del Sacro Cuore, 00168 Rome, Italy, ^b Center for Gerontology and Health Care Research, Department of Community Health, Brown University Medical School, Providence, RI 02912, USA, ^c Geriatric Research, Education and Clinical Center, UCLA School of Medicine, Sepulveda, CA 91343, USA

Correspondence to: Dr Bernabei md0516{at}mclink.it

Objective: To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community.
Design: Randomised study with 1 year follow up.
Setting: Town in northern Italy (Rovereto).
Subjects: 200 older people already receiving conventional community care services.
Intervention: Random allocation to an intervention group receiving integrated social and medical care and case management or to a control group receiving conventional care.
Main outcome measures: Admission to an institution, use and costs of health services, variations in functional status.
Results: Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls (hazard ratio 0.69; 95% confidence interval 0.53 to 0.91). Health services were used to the same extent, but control subjects received more frequent home visits by general practitioners. In the intervention group the estimated financial savings were in the order of £1125 ($1800) per year of follow up. The intervention group had improved physical function (activities of daily living score improved by 5.1% v 13.0% loss in controls; P<0.001). Decline of cognitive status (measured by the short portable mental status questionnaire) was also reduced (3.8% v 9.4%; P<0.05).
Conclusion: Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the community.

Key messages Responsibility for management of care of elderly people living in the community is poorly defined Integration of medical and social services together with care management programmes would improve such care in the community In a comparison of this option with a traditional and fragmented model of community care the integrated care approach reduced admission to institutions and functional decline in frail elderly people living in the community and also reduced costs

---

© BMJ 1998
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Article

Integrated case management reduces functional decline and costs in older patients
BMJ 1998 316: 0. [Full Text]

This article has been cited by other articles:

• Hebert, R., Raiche, M., Dubois, M.-F., Gueye, N. R., Dubuc, N., Tousignant, M., The PRISMA Group, (2009). Impact of PRISMA, a Coordination-Type Integrated Service Delivery System for Frail Older People in Quebec (Canada): A Quasi-experimental Study. J Gerontol B Psychol Sci Soc Sci 0: gbp027v1-gbp027 [Abstract] [Full text]  
• Liebel, D. V., Friedman, B., Watson, N. M., Powers, B. A. (2009). Review: Review of Nurse Home Visiting Interventions for Community-Dwelling Older Persons With Existing Disability. Med Care Res Rev 66: 119-146 [Abstract]  
• Minkman, M., Ahaus, K., Fabbricotti, I., Nabitz, U., Huijsman, R. (2009). A quality management model for integrated care: results of a Delphi and Concept Mapping study. Int J Qual Health Care 21: 66-75 [Abstract] [Full text]  
• Cameron, J. I., Tsoi, C., Marsella, A. (2008). Optimizing Stroke Systems of Care by Enhancing Transitions Across Care Environments. Stroke 39: 2637-2643 [Abstract] [Full text]  
• Wieland, D., Ferrucci, L. (2008). Multidimensional Geriatric Assessment: Back to the Future. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 63: 272-274 [Full text]  
• Melis, R. J. F., van Eijken, M. I. J., Teerenstra, S., van Achterberg, T., Parker, S. G., Borm, G. F., van de Lisdonk, E. H., Wensing, M., Rikkert, M. G. M. O. (2008). Multidimensional Geriatric Assessment: Back to the Future A Randomized Study of a Multidisciplinary Program to Intervene on Geriatric Syndromes in Vulnerable Older People Who Live at Home (Dutch EASYcare Study). Journals of Gerontology Series A: Biological Sciences and Medical Sciences 63: 283-290 [Abstract] [Full text]  
• Bouman, A., van Rossum, E., Evers, S., Ambergen, T., Kempen, G., Knipschild, P. (2008). Multidimensional Geriatric Assessment: Back to the Future Effects on Health Care Use and Associated Cost of a Home Visiting Program for Older People With Poor Health Status: A Randomized Clinical Trial in the Netherlands. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 63: 291-297 [Abstract] [Full text]  
• Bernabei, R., Landi, F., Onder, G., Liperoti, R., Gambassi, G. (2008). Multidimensional Geriatric Assessment: Back to the Future Second and Third Generation Assessment Instruments: The Birth of Standardization in Geriatric Care. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 63: 308-313 [Abstract] [Full text]  
• Counsell, S. R., Callahan, C. M., Clark, D. O., Tu, W., Buttar, A. B., Stump, T. E., Ricketts, G. D. (2007). Geriatric Care Management for Low-Income Seniors: A Randomized Controlled Trial. JAMA 298: 2623-2633 [Abstract] [Full text]  
• Markle-Reid, M., Browne, G., Weir, R., Gafni, A., Roberts, J., Henderson, S. R. (2006). The Effectiveness and Efficiency of Home-Based Nursing Health Promotion for Older People: A Review of the Literature. Med Care Res Rev 63: 531-569 [Abstract]  
• Pahor, M. (2006). Randomized controlled trials involving multidisciplinary interventions in the community.. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 61: 472-473 [Abstract] [Full text]  
• Beland, F., Bergman, H., Lebel, P., Clarfield, A. M., Tousignant, P., Contandriopoulos, A.-P., Dallaire, L. (2006). A system of integrated care for older persons with disabilities in Canada: results from a randomized controlled trial.. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 61: 367-373 [Abstract] [Full text]  
• McCusker, J., Verdon, J. (2006). Do Geriatric Interventions Reduce Emergency Department Visits? A Systematic Review. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 61: 53-62 [Abstract] [Full text]  
• Audisio, R. A., Ramesh, H., Longo, W. E., Zbar, A. P., Pope, D. (2005). Preoperative Assessment of Surgical Risk in Oncogeriatric Patients. The Oncologist 10: 262-268 [Abstract] [Full text]  
• Hoogervorst, E L J, de Jonge, P, Jelles, B, Huyse, F J, Heeres, I, van der Ploeg, H M, Uitdehaag, B M J, Polman, C H (2003). The INTERMED: a screening instrument to identify multiple sclerosis patients in need of multidisciplinary treatment. J. Neurol. Neurosurg. Psychiatry 74: 20-24 [Abstract] [Full text]  
• Stuck, A. E., Egger, M., Beck, J. C., Bernabei, R., Gambassi, G., Carbonin, P., Nikolaus, T., Becker, C., Meuleman, J., Cohen, H. J., Weinberger, M., Feussner, J. R. (2002). A Controlled Trial of Geriatric Evaluation. NEJM 347: 371-373 [Full text]  
• Repetto, L., Fratino, L., Audisio, R. A., Venturino, A., Gianni, W., Vercelli, M., Parodi, S., Dal Lago, D., Gioia, F., Monfardini, S., Aapro, M. S., Serraino, D., Zagonel, V. (2002). Comprehensive Geriatric Assessment Adds Information to Eastern Cooperative Oncology Group Performance Status in Elderly Cancer Patients: An Italian Group for Geriatric Oncology Study. JCO 20: 494-502 [Abstract] [Full text]  
• Sommers, L. S., Marton, K. I., Barbaccia, J. C., Randolph, J. (2000). Physician, Nurse, and Social Worker Collaboration in Primary Care for Chronically Ill Seniors. Arch Intern Med 160: 1825-1833 [Abstract] [Full text]  
• Stuck, A. E., Minder, C. E., Peter-Wuest, I., Gillmann, G., Egli, C., Kesselring, A., Leu, R. E., Beck, J. C. (2000). A Randomized Trial of In-Home Visits for Disability Prevention in Community-Dwelling Older People at Low and High Risk for Nursing Home Admission. Arch Intern Med 160: 977-986 [Abstract] [Full text]  
• Thomas, C. F. (1999). A nurse led programme improved physical function in older adults with chronic disease. Evid. Based Nurs. 2: 86-86 [Full text]  
• Brittian, O. (1999). Integration of services for elderly people reduced costs and use of health services. Evid. Based Nurs. 2: 20-20 [Full text]  
• Coleston-Shields, D. M. (1998). Integration of medical and social services for elderly people in the community reduced costs and use of health services. Evid. Based Ment. Health 1: 106-106 [Full text]  

Online poll

Find out more >>