goal attainment of blood density lipoprotein pressure, fasting blood cholesterol and HbA1c lipids, body mass index were not significant. (BMI), and, among patients with diabetes, haemoglobin A1c (HbA1c). Repeated- measures logistic regression to analyse goal attainment and repeated measures Poisson regression to analyse service use. Randomised trial of impact of model of To evaluate the impact Main outcome measures: Survival analysis Integrated social and Admission to an showed that admission medical care with case integrated care and case management for of a programme of institution, use and costs to hospital or nursing management older people living in the community. integrated social and of health services, home in the intervention programmes may medical care among frail variations in functional group occurred later provide a cost effective BMJ1998;316doi: elderly people living in status. and was less common approach to reduce 10.1136/bmj.316.7141.1348(Published 2 May the community. than in controls (hazard admission to institutions 1998) Cite this as:BMJ1998;316:1348 Randomised study with 1 ratio 0.69; 95% and functional decline in confidence interval 0.53 older people living in the year follow up. Setting: to 0.91). Health services Community. Town in northern Italy were used to the same (Rovereto) extent, but control subjects received more frequent home visits by general practitioners. In Subjects: 200 older the intervention group people already receiving the estimated financial conventional community savings were in the care services. order of £1125 (r1800) per year of follow up. Intervention: The intervention group Random allocation to an had improved physical intervention group function (activities of receiving integrated daily living score social and medical care improved by 5.1% and case management v13.0% loss in controls; or to a control group
goal attainment of blood pressure, fasting blood lipids, body mass index (BMI), and, among patients with diabetes, haemoglobin A1c (HbA1c). Repeated- measures logistic regression to analyse goal attainment and repeated measures Poisson regression to analyse service use. density lipoprotein cholesterol and HbA1c were not significant. Randomised trial of impact of model of integrated care and case management for older people living in the community. BMJ1998;316doi: 10.1136/bmj.316.7141.1348(Published 2 May 1998) Cite this as:BMJ1998;316:1348 To evaluate the impact of a programme of integrated social and medical care among frail elderly people living in the community. Randomised study with 1 year follow up. Setting: Town in northern Italy (Rovereto) Subjects: 200 older people already receiving conventional community care services. Intervention: Random allocation to an intervention group receiving integrated social and medical care and case management or to a control group Main outcome measures: Admission to an institution, use and costs of health services, variations in functional status. Survival analysis showed that admission to hospital or nursing home in the intervention group occurred later and was less common than in controls (hazard ratio 0.69; 95% confidence interval 0.53 to 0.91). Health services were used to the same extent, but control subjects received more frequent home visits by general practitioners. In the intervention group the estimated financial savings were in the order of £1125 (r1800) per year of follow up. The intervention group had improved physical function (activities of daily living score improved by 5.1% v13.0% loss in controls; Integrated social and medical care with case management programmes may provide a cost effective approach to reduce admission to institutions and functional decline in older people living in the Community.