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Person-centred, integrated and pro-active care for multi-morbid elderly with advanced care needs: a propensity score-matched controlled trial
- Source :
- BMC Health Services Research, Vol 19, Iss 1, Pp 1-17 (2019), BMC Health Services Research
- Publication Year :
- 2019
- Publisher :
- Springer Science and Business Media LLC, 2019.
-
Abstract
- BackgroundPerson-centred care (PCC) focusing on personalised goals and care plans derived from “What matters to you?” has an impact on single disease outcomes, but studies on multi-morbid elderly are lacking. Furthermore, the combination of PCC, Integrated Care (IC) and Pro-active care are widely recognised as desirable for multi-morbid elderly, yet previous studies focus on single components only, leaving synergies unexplored. The effect of a synergistic intervention, which implements 1) Person-centred goal-oriented care driven by “What matters to you?” with 2) IC and 3) pro-active care is unknown.MethodsInspired by theoretical foundations, complexity science, previous health service research and a patient-driven evaluation of care quality, we designed the Patient-Centred Team (PACT) intervention across primary and secondary care. The PACT team collaborate with the patient to make and deliver a person-centred, integrated and proactive multi-morbidity care-plan. The control group receives conventional care. The study design is a pragmatic six months prospective, controlled clinical trial based on hospital electronic health record data of 439 multi-morbid frail elderly at risk for emergency (re) admissions referred to PACT and 779 propensity score matched controls in Norway, 2014–2016. Outcomes are emergency admissions, the sum of emergency inpatient bed days, 30-day readmissions, planned and emergency outpatient visits and mortality at three and six months follow-up.ResultsThe Rate Ratios (RR) for emergency admissions was 0,9 (95%CI: 0,82-0,99), for sum of emergency bed days 0,68 (95%CI:0,52-0,79) and for 30-days emergency readmissions 0,72 (95%CI: 0,41-1,24). RRs were 2,3 (95%CI: 2,02-2,55) and 0,9 (95%CI: 0,68-1,20) for planned and emergency outpatient visits respectively. The RR for death at 3 months was 0,39 (95% CI: 0,22-0,70) and 0,57 (95% CI: 0,34-0,94) at 6 months.ConclusionCompared with propensity score matched controls, the care process of frail multi-morbid elderly who received the PACT intervention had a reduced risk of high-level emergency care, increased use of low-level planned care, and substantially reduced mortality risk. Further study of process differences between groups is warranted to understand the genesis of these results better.Trial registrationClinicalTrials.gov (identifier:NCT02541474), registered Sept 2015.
- Subjects :
- Male
medicine.medical_specialty
Frail Elderly
Propensity score matched controls
Patient Readmission
Health informatics
Patient Care Planning
law.invention
Health administration
Proactive care
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Patient-Centered Care
medicine
Humans
Multiple Chronic Conditions
Prospective Studies
030212 general & internal medicine
Mortality
Propensity Score
Aged
Health care utilisation
VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801
Delivery of Health Care, Integrated
Norway
business.industry
lcsh:Public aspects of medicine
030503 health policy & services
Health Policy
Nursing research
Public health
Person-centred care
Integrated care
lcsh:RA1-1270
Hospitalization
Self Care
Clinical trial
Propensity score matching
Emergency medicine
Female
Morbidity
VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801
Emergency Service, Hospital
0305 other medical science
business
Research Article
Subjects
Details
- ISSN :
- 14726963
- Volume :
- 19
- Database :
- OpenAIRE
- Journal :
- BMC Health Services Research
- Accession number :
- edsair.doi.dedup.....b296d3774a7d0dd537bc02e899612a88