A system of integrated care for older persons with disabilities in Canada:: Results from a randomized controlled trial
A system of integrated care for older persons with disabilities in Canada:: Results from a randomized controlled trial
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DOI：
10.1093/gerona/61.4.367
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发表时间：
2006-04-01
影响因子：
5.1
通讯作者：
Dallaire, L
中科院分区：
文献类型：
--
作者：
Béland, F;Bergman, H;Dallaire, L
背景对老年残疾人的护理通常具有分散的特点，往往导致住院和机构化等更具侵入性和更昂贵的护理形式。有越来越多的兴趣的能力，综合模型，以改善健康，满意度和服务利用的结果。一项针对弱势社区居住老年人的综合护理计划（SIPA [老年人综合护理系统的法语缩写]）与常规护理进行了随机对照试验。国家卫生保护局提供基于社区的护理，地方机构负责全面协调社区和机构（急性和长期）保健和社会服务。主要结果是机构和社区护理的利用率和公共成本。次要结果包括健康状况、护理满意度、照顾者负担和自付费用。随着家庭保健的加强，获得保健和社会家庭保健的机会增加。有50%的医院替代水平住院时间（“床封锁”），但没有显着差异的利用和急诊科的费用。医院急性住院病人。和疗养院对于所有研究参与者，SIPA组的人均社区成本高出3390加元，但机构成本低3770加元，假设两组的人均总成本没有差异。SIPA照顾者的满意度有所提高，而照顾者的负担或自付费用没有增加。正如预期的那样，在健康结果方面没有差异。综合系统似乎是可行的，并有可能减少医院和疗养院的利用率，而不增加成本。
Background. Care for elderly persons with disabilities is usually characterized by fragmentation, often leading to more intrusive and expensive form of care such as hospitalization and institutionalization. There has been increasing interest in the ability of integrated models to improve health, satisfaction, and service utilization outcomes.Methods. A program of integrated care for vulnerable community-dwelling elderly persons (SIPA [French acronym for System of Integrated Care for Older Persons]) was compared to usual care with a randomized control trial. SIPA offered community-based care with local agencies responsible for the full range and coordination of community and institutional (acute and long-term) health and social services. Primary outcome were utilization and public costs of institutional and community care. Secondary outcomes included health status, satisfaction with care, caregiver burden, and out-of-pocket expenses.Results. Accessibility was increased for health and social home care with increased intensification of home health care. There was a 50% reduction in hospital alternate level inpatient stays ("bed blockers") but no significant differences in utilization and costs of emergency department. hospital acute inpatient. and nursing home stays. For ail study participants, average community costs per person were C$3390 higher in the SIPA group but institutional costs were C$3770 lower with, as hypothesized, no difference in total overall costs per person in the two groups. Satisfaction was increased for SIPA caregivers with no increase in caregiver burden or out-of-pocket costs. As expected, there was no difference in health outcomes.Conclusions. Integrated systems appear to be feasible and have the potential to reduce hospital and nursing home utilization without increasing costs.