The impact of integrated care on direct nursing home care.
OBJECTIVE
The introduction of integrated nursing home care is an important policy goal in many countries and is expected to affect the type, frequency and duration of activities delivered to nursing home residents. The exact impact however is unknown. The aim of this paper is to reduce this information gap in order to provide decision supporting information to policy makers and managers. DESIGN/METHODS/ETHICAL ISSUES: At three measurement points between 1999 and 2003, caregivers belonging to 18 functions registered activities delivered to somatic and psycho-geriatric nursing home residents in The Netherlands. Residents either received traditional care, integrated care or care that contained elements of traditional and integrated care (hybrid care). Thirty-six thousand and seventy-one registration lists were used for data analysis. Data analysis included determining, comparing and linking the (total) average frequency and duration of each activity per care type, measurement point and type of resident.


RESULTS
The (total) average frequency and total duration of most activities were higher for integrated care than for traditional and hybrid care. The average duration per activity was generally higher for traditional care. The (total) average frequency of most direct care activities at most measurement points and the total average duration per resident per day were higher for somatic care than for psycho-geriatric care.


CONCLUSIONS
The introduction of integrated nursing home care affects the total average duration and frequency of direct care activities. However, there is no noticeable impact on individual activities or on differences in activities received by somatic and psycho-geriatric residents and the degree to which the occurrence of an activity is related to the duration of that activity. This is because a large proportion of care delivery represents patterned behaviour (routines). Because existing routines are difficult to get rid of, we should not have too high expectations about the effect of integrated care on service delivery.
University of Maastricht, Care and Public Health Research Institute (CAPHRI), Department of Health Organization, Policy and Economics (HOPE), P.O. Box 616, 6200 MD Maastricht, The Netherlands. a.paulus@beoz.unimaas.nl
Aggie T G
AT
Paulus
Arno J A
AJ
van Raak
D000368:Aged; D003660:Decision Support Systems, Management; D019033:Delivery of Health Care, Integrated; D004059:Diffusion of Innovation; D005851:Geriatric Nursing / Q000458:organization & administration; D006707:Homes for the Aged / Q000458:organization & administration*; D006801:Humans; D009313:National Health Programs; D009426:Netherlands; D009732:Nursing Care / Q000458:organization & administration; D009735:Nursing Homes / Q000458:organization & administration*; D013647:Task Performance and Analysis; D013997:Time Factors