The effects of a collaborative model of primary care on the mortality and hospital use of community-dwelling older adults

Background. This study evaluates the ability of a model of collaborative pr imary care practice to reduce mortality and hospital use in community-dwell ing elderly persons. Methods. Pour rural and four urban clinic sites in east central Illinois we re randomized to form treatment and comparison clinics from which patients were enrolled and followed prospectively for 2 years. Patients from the pra ctices of participating physicians were eligible if they were aged 65 and o lder. were living in the community, and had at least one risk factor as det ermined prior to the study. Medicare hospital data were obtained from the H ealth Care Financing Administration. Demographic and health status measures were obtained by telephone interview every IZ months throughout the study. Results. The treatment group experienced a 49% reduction in all-cause morta lity during the second year of the study (odds ratio. 0.51, 95% confidence interval. 0.29-0.91, p = .02). There were no significant differences betwee n treatment and comparison patients in percentage of persons hospitalized, hospital length of stay, or Medicare payments. Although measures of health status indicated that the treatment group was significantly sicker at basel ine at the end of 1 year, these differences disappeared by the end of 2 yea rs. Conclusions. The collaborative primary care model evaluated in this study s ignificantly reduced mortality in the second year, without increasing hospi tal use. These findings suggest that a collaborative primary core team that enhances primary care practice can result in better patient outcomes.