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BMC Health Services Research
Published in: BMC Health Services Research 1/2019

Open Access 01-12-2019 | Care | Research article

Person-centred, integrated and pro-active care for multi-morbid elderly with advanced care needs: a propensity score-matched controlled trial

Authors: G. K. R. Berntsen, M. Dalbakk, J. S. Hurley, T. Bergmo, B. Solbakken, L. Spansvoll, J. G. Bellika, S. O. Skrøvseth, T. Brattland, M. Rumpsfeld

Published in: BMC Health Services Research | Issue 1/2019

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Abstract

Background

Person-centred care (PCC) focusing on personalised goals and care plans derived from “What matters to you?” has an impact on single disease outcomes, but studies on multi-morbid elderly are lacking. Furthermore, the combination of PCC, Integrated Care (IC) and Pro-active care are widely recognised as desirable for multi-morbid elderly, yet previous studies focus on single components only, leaving synergies unexplored. The effect of a synergistic intervention, which implements 1) Person-centred goal-oriented care driven by “What matters to you?” with 2) IC and 3) pro-active care is unknown.

Methods

Inspired by theoretical foundations, complexity science, previous health service research and a patient-driven evaluation of care quality, we designed the Patient-Centred Team (PACT) intervention across primary and secondary care. The PACT team collaborate with the patient to make and deliver a person-centred, integrated and proactive multi-morbidity care-plan. The control group receives conventional care. The study design is a pragmatic six months prospective, controlled clinical trial based on hospital electronic health record data of 439 multi-morbid frail elderly at risk for emergency (re) admissions referred to PACT and 779 propensity score matched controls in Norway, 2014–2016. Outcomes are emergency admissions, the sum of emergency inpatient bed days, 30-day readmissions, planned and emergency outpatient visits and mortality at three and six months follow-up.

Results

The Rate Ratios (RR) for emergency admissions was 0,9 (95%CI: 0,82-0,99), for sum of emergency bed days 0,68 (95%CI:0,52-0,79) and for 30-days emergency readmissions 0,72 (95%CI: 0,41-1,24). RRs were 2,3 (95%CI: 2,02-2,55) and 0,9 (95%CI: 0,68-1,20) for planned and emergency outpatient visits respectively. The RR for death at 3 months was 0,39 (95% CI: 0,22-0,70) and 0,57 (95% CI: 0,34-0,94) at 6 months.

Conclusion

Compared with propensity score matched controls, the care process of frail multi-morbid elderly who received the PACT intervention had a reduced risk of high-level emergency care, increased use of low-level planned care, and substantially reduced mortality risk. Further study of process differences between groups is warranted to understand the genesis of these results better.

Trial registration

ClinicalTrials.gov (identifier: NCT02541474), registered Sept 2015.
Appendix
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Metadata
Title
Person-centred, integrated and pro-active care for multi-morbid elderly with advanced care needs: a propensity score-matched controlled trial
Authors
G. K. R. Berntsen
M. Dalbakk
J. S. Hurley
T. Bergmo
B. Solbakken
L. Spansvoll
J. G. Bellika
S. O. Skrøvseth
T. Brattland
M. Rumpsfeld
Publication date
01-12-2019
Publisher
BioMed Central
Keyword
Care
Published in
BMC Health Services Research / Issue 1/2019
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-019-4397-2

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