|Title||Impact of integrated home care services on hospital use|
|Publication Type||Journal Article|
|Year of Publication||1999|
|Authors||Landi F., Gambassi G., Pola R., Tabaccanti S., Cavinato T., Carbonin P.U, Bernabei R.|
|Journal||J Am Geriatr Soc|
|Keywords||*Frail Elderly, Aged, Analysis of Variance, Case Management/economics, Comparative Study, Cost Control, Cost-Benefit Analysis, Delivery of Health Care, Integrated/*economics, Female, Geriatric Assessment, Home Care Services/*economics, Hospitalization/*economics/*statistics & numerical data, Human, Length of Stay/economics/statistics & numerical data, Male, Needs Assessment, Patient Admission/economics/statistics & numerical data, Statistics, Nonparametric, Support, Non-U.S. Gov't|
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.