Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study
| Autor: | M Celdráan-Mañas, I Toral-López, José Miguel Morales-Asencio, JJ García-Arrabal, F.J. Martín-Santos, J.C. Morilla-Herrera, A Millán Carrasco, Elena Gonzalo-Jiménez |
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| Přispěvatelé: | [Morales-Asencio, JM, Gonzalo-Jimenez, E, Martin-Santos, FJ, Morilla-Herrera, JC, Celdrán-Mañas, M, Millán Carrasco, A] Andalusian School of Public Health, Granada, España. [Martin-Santos, FJ, Morilla-Herrera, JC] Healthcare District, Andalusian Healthcare Service, Malaga, Spain. [Garcia-Arrabal, JJ] Healthcare District, Andalusian Healthcare Service, Almeria, Spain. [Toral-Lopez, I] Healthcare District, Andalusian Healthcare Service, Granada, Spain., This research was carried out with the support of two research grants, one awarded by the Regional Health Ministry of Andalusia (Exp. 134/02) and the other from the Health Research Fund of the National Health Ministry (FIS PI031161I) |
| Předmět: |
Gerontology
Male Multivariate analysis España Health Care::Health Services Administration::Patient Care Management::Comprehensive Health Care::Patient Care Planning::Case Management [Medical Subject Headings] Efficiency Organizational Health administration Atención Primaria de Salud Health care Medicine Functional ability Health Care::Environment and Public Health::Public Health::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Follow-Up Studies [Medical Subject Headings] Aged 80 and over education.field_of_study Manejo de caso Health Policy Nursing research lcsh:Public aspects of medicine Cuidadores Caregiver burden Middle Aged Community Health Nursing Health Care::Health Care Facilities Manpower and Services::Health Services::Nursing Services::Home Care Services [Medical Subject Headings] Home Care Services Health Care::Health Services Administration::Patient Care Management::Comprehensive Health Care::Primary Health Care [Medical Subject Headings] Health Care::Health Care Facilities Manpower and Services::Health Services::Community Health Services::Home Care Services [Medical Subject Headings] Outcome and Process Assessment Health Care Caregivers Workforce Evaluación de procesos y resultados (atención de salud) Female Servicios de atención de salud a domicilio Research Article medicine.medical_specialty Health Care::Health Care Facilities Manpower and Services::Health Personnel::Caregivers [Medical Subject Headings] Population Quality of life (healthcare) Humans education Aged Patient Care Team business.industry Health Care::Health Services Administration::Quality of Health Care::Outcome and Process Assessment (Health Care) [Medical Subject Headings] lcsh:RA1-1270 Spain Models Organizational Physical therapy Linear Models business Case Management Follow-Up Studies |
| Zdroj: | ResearcherID BMC Health Services Research BMC Health Services Research, Vol 8, Iss 1, p 193 (2008) |
| Popis: | Background Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). Methods Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. Results Base-line differences in functional capacity – significantly lower in the intervention group (RR: 1.52 95%CI: 1.05–2.21; p = 0.0016) – disappeared at six months (RR: 1.31 95%CI: 0.87–1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77–59.34 vs. 60.50 95%CI: 53.63–67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67–57.92 vs. 66.26 95%CI: 60.66–71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22–10.62 vs. 3.24 95%CI: 1.37–5.310; p = 0.0001) and, on average, required fewer home care visits (9.40 95%CI: 7.89–10.92 vs.11.30 95%CI: 9.10–14.54). No differences were found in terms of frequency of visits to A&E or hospital re-admissions. Furthermore, patients in the control group perceived higher levels of satisfaction (16.88; 95%CI: 16.32–17.43; range: 0–21, vs. 14.65 95%CI: 13.61–15.68; p = 0,001). Conclusion A home care service model that includes nurse-led case management streamlines access to healthcare services and resources, while impacting positively on patients' functional ability and caregiver burden, with increased levels of satisfaction. Trial registration ISRCTN44054549 |
| Databáze: | OpenAIRE |
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