Effects on health care use and associated cost of a home visiting program for older people with poor health status: a randomized clinical trial in the Netherlands.
BACKGROUND
Home visiting programs have been developed to improve the functional abilities of older people and subsequently to reduce the use of institutional care services. The results of trials have been inconsistent and their cost-effectiveness uncertain. Home visits for a high-risk population rather than the general population seems a promising approach. We therefore studied the effects of a home visiting program for older people with poor health. This article describes the effects on health care use and associated cost.


METHODS
We conducted a randomized clinical trial among 330 community-dwelling citizens, aged 70-84 years, in the Netherlands. Participants in the intervention group (n = 160) received eight home visits by a trained home nurse over an 18-month period; a multidimensional geriatric assessment of problems was included. The main outcomes are: admissions to hospital, nursing home, and home for older persons; contacts with medical specialists, general practitioners, and paramedics; and hours of home care help. The data on health care use were mostly obtained from computerized databases of various medical administration offices; the follow-up period was 24 months.


RESULTS
Inpatient and outpatient health care use was similar for both groups, with the exception of a higher distribution of aids and in-home modifications in favor of the intervention group. No differences were found between the intervention and control group in health care cost.


CONCLUSIONS
The home visiting program did not appear to have any effect on the health care use of older people with poor health and had a low chance of being cost-effective. We conclude that these visits are probably not beneficial for such persons within the health care setting in the Netherlands or comparable settings in other Western countries.
Bouman
Ans
A
Maastricht University, Department of Epidemiology, Maastricht, The Netherlands. ans.nicolaides@epid.unimaas.nl
van Rossum
Erik
E
Evers
Silvia
S
Ambergen
Ton
T
Kempen
Gertrudis
G
Knipschild
Paul
P
D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000191:economics* / Q000706:statistics & numerical data; D006304:Health Status; D006699:Home Care Services / Q000191:economics / Q000706:statistics & numerical data; D006792:House Calls / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009426:Netherlands; D017063:Outcome Assessment, Health Care / Q000191:economics / Q000379:methods