Proactive primary care model for frail older people in New Zealand delays aged-residential care: A quasi-experiment.
Aged
Aged, 80 and over
Female
Frail Elderly
/ statistics & numerical data
Geriatric Assessment
Hospitalization
/ statistics & numerical data
Humans
Independent Living
Male
Mortality
New Zealand
Primary Care Nursing
Primary Health Care
/ organization & administration
Residential Facilities
/ statistics & numerical data
aged
comprehensive health care
geriatric assessment
patient care planning
primary health care
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
06 2021
06 2021
Historique:
revised:
13
01
2021
received:
02
11
2020
accepted:
23
01
2021
pubmed:
26
2
2021
medline:
7
10
2021
entrez:
25
2
2021
Statut:
ppublish
Résumé
To determine the effect of a proactive primary care program on acute hospitalization and aged-residential care placement for frail older people. Controlled before and after, and controlled after only quasi-experimental studies, with a comparison group created via propensity score matching. One-year follow-up. Nine general practices in Auckland, New Zealand. Community-dwelling people aged 75 and older identified as at increased risk of hospitalization. One thousand and eighty five patients are compared with 3750 comparison patients matched by propensity score based on known risks. Primary healthcare based, registered nurse-led, comprehensive geriatric assessment, goal-setting, care planning, and regular follow-up. Patients were also provided self-management education, health and social care navigation, and transitional care for hospital discharges. Practices received program support, workforce development, and mentoring of primary healthcare nurses by gerontology nurse specialists. Outcomes from routinely collected administrative data. Primary: aged-residential care placement. acute hospitalization, mortality, and other health service utilization. Aged-residential care placement (odds ratio [OR] 0.66, 95% confidence interval (CI) = 0.48-0.91) and mortality (OR 0.66, 95% CI = 0.49-0.88) were significantly lower over the first year in Kare patients compared with matched controls. There was no difference in acute hospitalization (+0.06 admissions per year, 95% CI = -0.01-0.13). Support service use (allied health therapists and assessment for social support) was increased, and emergency department use decreased. The Kare participants had lower aged-residential care placement and mortality in the first year, but no decrease in acute hospitalization. Because the design is nonexperimental caution is required in interpreting these results.
Sections du résumé
BACKGROUND/OBJECTIVES
To determine the effect of a proactive primary care program on acute hospitalization and aged-residential care placement for frail older people.
DESIGN
Controlled before and after, and controlled after only quasi-experimental studies, with a comparison group created via propensity score matching. One-year follow-up.
SETTING
Nine general practices in Auckland, New Zealand.
PARTICIPANTS
Community-dwelling people aged 75 and older identified as at increased risk of hospitalization. One thousand and eighty five patients are compared with 3750 comparison patients matched by propensity score based on known risks.
INTERVENTION
Primary healthcare based, registered nurse-led, comprehensive geriatric assessment, goal-setting, care planning, and regular follow-up. Patients were also provided self-management education, health and social care navigation, and transitional care for hospital discharges. Practices received program support, workforce development, and mentoring of primary healthcare nurses by gerontology nurse specialists.
MEASUREMENTS
Outcomes from routinely collected administrative data. Primary: aged-residential care placement.
SECONDARY OUTCOMES
acute hospitalization, mortality, and other health service utilization.
RESULTS
Aged-residential care placement (odds ratio [OR] 0.66, 95% confidence interval (CI) = 0.48-0.91) and mortality (OR 0.66, 95% CI = 0.49-0.88) were significantly lower over the first year in Kare patients compared with matched controls. There was no difference in acute hospitalization (+0.06 admissions per year, 95% CI = -0.01-0.13). Support service use (allied health therapists and assessment for social support) was increased, and emergency department use decreased.
CONCLUSION
The Kare participants had lower aged-residential care placement and mortality in the first year, but no decrease in acute hospitalization. Because the design is nonexperimental caution is required in interpreting these results.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1617-1626Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2021 The American Geriatrics Society.
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