Care management for hospital-discharged older persons: An 18-month randomised controlled trial

Abstract

Background. A group of 83 elderly subjects and their informal carers were randomly selected to receive an 18-month care management programme starting in July 2000. Another group of 83 subjects with similar characteristics were recruited as controls to compare the effect of care management on the health care utilisation pattern over that period.Methods. The health conditions of the subjects were assessed using Minimum Data Set-Home Care. Health care utilisation patterns were evaluated by means of the total number of (1) attendances at the accident and emergency (A&E) department, (2) bed-days in acute and rehabilitation hospitals, (3) community nursing service (CNS) visits, and (4) geriatric day hospital (GDH) use per patient per month.Results. The health conditions of the subjects deteriorated over time, the proportion of deterioration being greater in the intervention group than in the controls. The total number of bed-days occupied in acute hospitals over time for the intervention group decreased by 38% (p<0.001) but among controls by 5% only (p<0.001). The reduction of bed-days in acute hospitals per patient per month in the intervention group was significantly greater than that in the controls (p<0.05). The total number of bed-days spent in rehabilitation hospitals over time by those in the intervention group decreased by 56% (p<0.001), whereas in the controls the number decreased by 47% (p<0.001). The corresponding reduction of bed-days in rehabilitation hospitals in the intervention group was also greater than that in the controls. There were no statistical differences in the change over time for usage of A&E services, the CNS and the GDH between the two groups.Conclusion. Care management intervention could reduce elderly persons’ dependence on health care services because of an appropriate use of a comprehensive assessment tool, effective interfacing among disciplines, and adequate support for and training of informal carers.