1. Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study
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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, [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., and 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)
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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 - Abstract
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