OBJECTIVES: To evaluate the effects of integrated home care and discharge practice (IHCaD-practice) on the use of services and cost-effectiveness. METHODS: A cluster randomised trial with Finnish municipalities (n=22) as the units of randomisation. At baseline the sample included 668 home care patients aged 65 years or over. Data consisted of interviews (discharge, 3-week, 6-month) and care registers. The intervention was a generic prototype of care/case management-practice that was tailored to each municipality's needs. The effects were evaluated in terms of the use and cost of health and social care services. Unit costs of services were calculated. Cost-effectiveness was calculated for changes in health-related quality of life using the Nottingham Health Profile (NHP) and the EQ-5D instruments. All analyses were based on intention-to-treat. RESULTS: At 6-month follow-ups, the patients in the trail group used less home care, doctor and laboratory services than patients in the non-trial group. Similar differences between groups were found regarding costs. According to the NHP instrument, the IHCaD-practice showed higher cost-effectiveness compared to the old practice. No evidence for cost-effectiveness was found with the EQ-5D instrument. CONCLUSIONS: The study suggests that the IHCaD-practice may be a cost-effective alternative to usual care.
RCT Entities:
OBJECTIVES: To evaluate the effects of integrated home care and discharge practice (IHCaD-practice) on the use of services and cost-effectiveness. METHODS: A cluster randomised trial with Finnish municipalities (n=22) as the units of randomisation. At baseline the sample included 668 home care patients aged 65 years or over. Data consisted of interviews (discharge, 3-week, 6-month) and care registers. The intervention was a generic prototype of care/case management-practice that was tailored to each municipality's needs. The effects were evaluated in terms of the use and cost of health and social care services. Unit costs of services were calculated. Cost-effectiveness was calculated for changes in health-related quality of life using the Nottingham Health Profile (NHP) and the EQ-5D instruments. All analyses were based on intention-to-treat. RESULTS: At 6-month follow-ups, the patients in the trail group used less home care, doctor and laboratory services than patients in the non-trial group. Similar differences between groups were found regarding costs. According to the NHP instrument, the IHCaD-practice showed higher cost-effectiveness compared to the old practice. No evidence for cost-effectiveness was found with the EQ-5D instrument. CONCLUSIONS: The study suggests that the IHCaD-practice may be a cost-effective alternative to usual care.
Authors: David C Mohr; Justin K Benzer; Varsha G Vimalananda; Sara J Singer; Mark Meterko; Nathalie McIntosh; Kimberly L L Harvey; Marjorie Nealon Seibert; Martin P Charns Journal: J Gen Intern Med Date: 2019-05 Impact factor: 5.128
Authors: Kara Schick-Makaroff; Mehri Karimi-Dehkordi; Lena Cuthbertson; Duncan Dixon; S Robin Cohen; Neil Hilliard; Richard Sawatzky Journal: Gerontologist Date: 2021-04-03
Authors: Susan Baxter; Maxine Johnson; Duncan Chambers; Anthea Sutton; Elizabeth Goyder; Andrew Booth Journal: BMC Health Serv Res Date: 2018-05-10 Impact factor: 2.655