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Impact of Integrated Home Care Services on Hospital Use
Author(s) -
Landi Francesco,
Gambassi Giovanni,
Pola Roberto,
Tabaccanti Sandro,
Cavinato Tullio,
Carbonin PierUgo,
Bernabei Roberto
Publication year - 1999
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1999.tb01562.x
Subject(s) - medicine , geriatrics , health care , multidisciplinary team , integrated care , multidisciplinary approach , home health , emergency medicine , case management , nursing , social science , psychiatry , sociology , economics , economic growth
OBJECTIVE : To examine the effect of a home care program based on comprehensive geriatric assessment and case management on hospital use and costs among frail older individuals. DESIGN : Quasi‐experimental study with a 6‐month follow‐up. SETTING : Vittorio Veneto, a town in northern Italy. PARTICIPANTS : One hundred fifteen frail older people who applied for integrated home care services. INTERVENTION : Each patient was assessed with the Minimum Data Set for Home Care, and, subsequently, a case manager and a multidisciplinary team delivered social and health care services as indicated. MAIN OUTCOME MEASURES : We determined the hospital admissions and days spent in the hospital for all subjects during the first 6 months after the implementation of the home care program and compared them with the rate of hospitalization that the same patients had experienced in the 6 months preceding the implementation of the program. RESULTS : After the implementation of the integrated home care program, there was a significant reduction in the number of hospitalizations compared with pre‐implementation (56% vs 46%, respectively; P < .001), associated with a reduction in the number of hospital days, both at the individual patient level (28 ± 23 days vs 18 ± 15 days, respectively; P < .01) and for each admission (16 ± 12 days vs 12 ± 8 days, respectively; P < .01). This resulted in a 29% cost reduction with an estimated savings of $1260 per patient. CONCLUSIONS : The implementation of an integrated home care program based on the use of a comprehensive geriatric assessment instrument guided by a case manager has a significant impact on hospitalization and is cost‐effective. J Am Geriatr Soc 47:1430–1434, 1999.