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Impact of integrated home care services on hospital use
1Istituto di Medicina Interna e Geriatria, Centro di Medicina dell'Invecchiamento, Università Cattolica del Sacro Cuore, Rome, Italy.
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.