The cost-effectiveness of a new disease management model for frail elderly living in homes for the elderly, design of a cluster randomized controlled clinical trial.
BACKGROUND
The objective of this article is to describe the design of a study to evaluate the clinical and economic effects of a Disease Management model on functional health, quality of care and quality of life of persons living in homes for the elderly.


METHODS
This study concerns a cluster randomized controlled clinical trial among five intervention homes and five usual care homes in the North-West of the Netherlands with a total of over 500 residents. All persons who are not terminally ill, are able to be interviewed and sign informed consent are included. For cognitively impaired persons family proxies will be approached to provide outcome information. The Disease Management Model consists of several elements: (1) Trained staff carries out a multidimensional assessment of the patients functional health and care needs with the interRAI Long Term Care Facilities instrument (LTCF). Computerization of the LTCF produces immediate identification of problem areas and thereby guides individualized care planning. (2) The assessment outcomes are discussed in a Multidisciplinary Meeting (MM) with the nurse, primary care physician, nursing home physician and Psychotherapist and if necessary other members of the care team. The MM presents individualized care plans to manage or treat modifiable disabilities and risk factors. (3) Consultation by an nursing home physician and psychotherapist is offered to the frailest residents at risk for nursing home admission (according to the interRAI LTCF). Outcome measures are Quality of Care indicators (LTCF based), Quality Adjusted Life Years (Euroqol), Functional health (SF12, COOP-WONCA), Disability (GARS), Patients care satisfaction (QUOTE), hospital and nursing home days and mortality, health care utilization and costs.


CONCLUSIONS
This design is unique because no earlier studies were performed to evaluate the effects and costs of this Disease Management Model for disabled persons in homes for the elderly on functional health and quality of care. TRAIL REGISTRATION NUMBER: ISRCTN11076857.
Boorsma
Marijke
M
Department of General Practice, EMGO-Institute, VU University medical center, Amsterdam, The Netherlands. ma.boorsma@wxs.nl
van Hout
Hein P J
HP
Frijters
Dinnus H
DH
Ribbe
Miel W
MW
Nijpels
Giel
G
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D016330:Frail Elderly; D006707:Homes for the Aged / Q000191:economics*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010346:Patient Care Management / Q000191:economics / Q000458:organization & administration; D010865:Pilot Projects; D011320:Primary Health Care / Q000191:economics; D011787:Quality of Health Care; D019057:Quality-Adjusted Life Years; D016037:Single-Blind Method