title: Effectiveness of case management and post-acute services in older people after hospital discharge.
abstract: OBJECTIVE
  To evaluate the benefits of coordinating community services through the Post-Acute Care (PAC) program in older patients after discharge from hospital.
  
  
  METHODS
  Prospective multicentre, randomised controlled trial with six months of follow-up with blinded outcome measurement.
  
  
  METHODS
  Four university-affiliated metropolitan general hospitals in Victoria.
  
  
  METHODS
  All patients aged 65 years and over who were discharged between August 1998 and October 1999 and required community services after discharge.
  
  
  METHODS
  Participants were randomly allocated to receive services of a Post-Acute Care (PAC) coordinator (intervention) versus usual discharge planning (control).
  
  
  METHODS
  Comparison of quality of life and carer stress at one-month post-discharge, mortality, hospital readmissions, use of community services and community and hospital costs over the six months post-discharge.
  
  
  RESULTS
  654 patients were randomised, and 598 were included in the analysis (311 in the PAC group and 287 in the control group). There was no difference in mortality between the groups (both 6%), but significantly greater overall quality-of-life scores at one-month follow-up in the PAC group. There was no difference in unplanned readmissions, but PAC patients used significantly fewer hospital bed-days in the six months after discharge (mean, 3.0 days; 95% CI, 2.1-3.9) than control patients (5.2 days; 95% CI, 3.8-6.7). Total costs (including hospitalisation, community services and the intervention) were lower in the PAC than the control group (mean difference, $1545; 95% CI, $11-$3078).
  
  
  CONCLUSIONS
  The PAC program is beneficial in the transition from hospital to the community in older patients.
authors.affiliation: Centre for Applied Gerontology, Bundoora Extended Care, 1231 Plenty Road, Bundoora, VIC 3083, Australia. kwang.lim@nh.org.au
authors.forename: Wen K
authors.initials: WK
authors.lastname: Lim
authors.forename: Sue F
authors.initials: SF
authors.lastname: Lambert
authors.forename: Len C
authors.initials: LC
authors.lastname: Gray
mesh_terms: D000367:Age Factors; D000368:Aged; D017028:Caregivers; D019090:Case Management; D003153:Community Health Services / Q000191:economics; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay; D008297:Male; D010351:Patient Discharge; D010359:Patient Readmission; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D013997:Time Factors