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International experiments in integrated care for the elderly: a synthesis of the evidence
Author(s) -
Johri Mira,
Beland Francois,
Bergman Howard
Publication year - 2003
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.819
Subject(s) - institutionalisation , multidisciplinary approach , incentive , restructuring , business , long term care , integrated care , population ageing , health care , medicine , population , public economics , nursing , economic growth , economics , environmental health , political science , finance , psychiatry , law , microeconomics
Abstract Background The OECD countries have recently promoted policies of deinstitutionalisation and community‐based care for the elderly. These policies respond to common cost pressures associated with population aging, and the challenge of providing improved care for the elderly. They aim to substitute less costly services for institutional ones, to improve patient satisfaction and decrease expenses. However, views concerning their success are mixed. We took a comparative cross‐national approach to examine the evidence, to identify common features of an effective system of integrated care, and to examine the potential of such models to positively affect care of the elderly, and public finances. Methods We conducted a systematic review of recent demonstration projects testing innovative models of care for the elderly in OECD countries. Projects included aimed to create comprehensive integration of acute and long‐term care services, and were evaluated using a comparison group. Results For each project, we report available results on rates of hospitalisation, long term care institutionalisation, utilisation and costs, impact on process of care, and health outcomes. In addition, the following common features of an effective integrated system of care were identified: a single entry point system; case management, geriatric assessment and a multidisciplinary team; and use of financial incentives to promote downward substitution. Conclusions Community‐based care can impact favourably on rates of institutionalisation and costs. Comprehensive approaches to program restructuring are necessary, as cost‐effectiveness depends on characteristics of the system of care. Expansion of successful programmes to achieve widespread use remains a critical challenge. Copyright © 2003 John Wiley & Sons, Ltd.