MORE EFFECTIVE AND LESS EXPENSIVE - LESSONS FROM 5 STUDIES EXAMINING COMMUNITY APPROACHES TO CARE

Does the nature of community health services used by chronically ill c lients and their caregivers have an impact on utilization of services, expenditure and well-being outcomes? A series of five studies, (four historic cohort and one randomized trial) examined clients suffering f rom a variety of chronic conditions in a number of community settings in different regions of Southern Ontario, Study sample composition and size varied. Each study was designed to quantify the well-being outco mes, and expenditure associated with different community approaches is covered under a nation-wide system of health insurance plans. As a co llective, these studies represent increasing methodological rigor. Mul tiple-perspective client well-being outcome measures were used. Caregi ver burden was also analyzed. A common approach to quantification and evaluation of expenditure for service consumption was applied across a ll five studies. The nature of community health services (proactive ve rsus reactive approaches to care) was found to have direct and measura ble impact on total expenditure for health service utilization and cli ent well-being outcomes. A recurring pattern of lower expenditure for community health service utilization and equal or better client outcom es was associated with well-integrated proactive services when compare d with individual fragmented, reactive approaches to care. The main le sson emerging from examining the five studies on approaches to communi ty care is that it is as, or more, effective and less expensive to off er complete proactive health care services to chronically ill people i n the early stages of their illness than to provide services on demand in a piecemeal manner.