R. Bernabei et al., RANDOMIZED TRIAL OF IMPACT OF MODEL OF INTEGRATED CARE AND CASE-MANAGEMENT FOR OLDER-PEOPLE LIVING IN THE COMMUNITY, BMJ. British medical journal, 316(7141), 1998, pp. 1348-1351
Objective: To elaluate the impact of a programme of integrated social
and medical care among frail elderly people lining in the community. D
esign: Randomised study with 1 year follow up. Setting: Town in northe
rn Italy (Rovereto). Subjects: 200 older people already receiving conv
entional community care services. Intervention: Random allocation to a
n intervention group receiving integrated social and medical care and
case management or to a control group receiving conventional care. Mai
n outcome measures: Admission to an institution, use and costs of heal
th services, variations in functional status. Results: Survival analys
is showed that admission to hospital or nursing home in the interventi
on group occurred later and was less common than in controls (hazard r
atio 0.69; 95% confidence internal 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 es
timated financial savings were in the order of pound 1125 ($1800) per
year of follow up. The intervention group had improved physical functi
on (activities of daily living score improved by 5.1% v 13.0% loss in
controls; P < 0.001). Decline of cognitive status (measured bt the sho
rt 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 livin
g in the community.