International experiments in integrated care for the elderly: a synthesis of the evidence.
BACKGROUND
The OECD countries have recently promoted policies of deinstitutionalisation and community-based care for the elderly. These policies respond to common cost pressures associated with population aging, and the challenge of providing improved care for the elderly. They aim to substitute less costly services for institutional ones, to improve patient satisfaction and decrease expenses. However, views concerning their success are mixed. We took a comparative cross-national approach to examine the evidence, to identify common features of an effective system of integrated care, and to examine the potential of such models to positively affect care of the elderly, and public finances.


METHODS
We conducted a systematic review of recent demonstration projects testing innovative models of care for the elderly in OECD countries. Projects included aimed to create comprehensive integration of acute and long-term care services, and were evaluated using a comparison group.


RESULTS
For each project, we report available results on rates of hospitalisation, long term care institutionalisation, utilisation and costs, impact on process of care, and health outcomes. In addition, the following common features of an effective integrated system of care were identified: a single entry point system; case management, geriatric assessment and a multidisciplinary team; and use of financial incentives to promote downward substitution.


CONCLUSIONS
Community-based care can impact favourably on rates of institutionalisation and costs. Comprehensive approaches to program restructuring are necessary, as cost-effectiveness depends on characteristics of the system of care. Expansion of successful programmes to achieve widespread use remains a critical challenge.
Johri
Mira
M
Département d'administration de la santé, Université de Montréal, Montreal, Canada. mira.johri@umontreal.ca
Beland
Francois
F
Bergman
Howard
H
D000368:Aged; D003153:Community Health Services; D003365:Costs and Cost Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000592:standards*; D019049:Developed Countries; D005381:Financing, Organized; D005544:Forecasting; D015577:Geriatric Assessment; D006297:Health Services Accessibility; D006299:Health Services for the Aged / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D006760:Hospitalization; D006801:Humans; D007326:Institutionalization; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D015397:Program Evaluation; D011787:Quality of Health Care / Q000592:standards; D012922:Social Change