A system of integrated care for older persons with disabilities in Canada: Results from a randomized controlled trial

François Béland, Howard Bergman, Paule Lebel, A. Mark Clarfield, Pierre Tousignant, André Pierre Contandriopoulos, Luc Dallaire

    Research output: Contribution to journalArticlepeer-review

    166 Scopus citations

    Abstract

    Background. Care for elderly persons with disabilities is usually characterized by fragmentation, often leading to more intrusive and expensive forms 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 outcomes 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 all 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.

    Original languageEnglish
    Pages (from-to)367-373
    Number of pages7
    JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
    Volume61
    Issue number4
    DOIs
    StatePublished - 1 Jan 2006

    ASJC Scopus subject areas

    • Aging
    • Geriatrics and Gerontology

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