Integrated care for severely disabled long-term care facility residents: is it better?
The demands of long-term care facilities (LTCFs) residents are complex which usually require a range of professionals and caregivers to provide treatment and care. To reduce this fragmentation of care, integrated care models are developed in modern health care system, and a gradual change from traditional LTCF care to integrated care has occurred in many countries. Although integrated care is assumed to improve the quality of care, evidences supporting these effects are insufficient. We recruited 7 private LTCF (74 residents) in northern Taipei and randomized them into integrated care model (N=42, mean age=82.8+/-8.0 years, 54.8% males) and traditional model (N=32, 81.7+/-8.8 years, 43.8% males). Integrated care model group was provided an actively working interdisciplinary team in addition to traditional nursing and personal care in traditional model group. Physical function, nutritional status and several quality indicators (unplanned feeding tube replacement, unplanned urinary catheter replacement, pneumonia, urinary tract infection and so on) were compared with both groups. Overall, LTCF residents in the integrated care model group showed significant improvement in serum levels of albumin (3.78+/-0.32 vs. 3.60+/-0.45, p=0.004) and hemoglobin (12.62+/-1.58 vs. 12.03+/-1.24, p=0.004) during the study period. Among selected quality indicators, subjects in integrated care model group were similar to traditional model group except that integrated care model group had a significantly reduced unplanned feeding tube replacement rate. In conclusion, the clinical effectiveness of integrated care model among severly disabled LTCF residents is minimal and a further cost-effectiveness study is needed to promote optimal quality of care in this setting.
Wu
Meng-Ping
MP
Department of Nursing, Taipei City Hospital, Yangming Branch, and National Ying Ming University, School of Medicine, Taipei, Taiwan.
Lin
Pay-Fan
PF
Lin
Kuan-Jia
KJ
Sun
Rui-Sheng
RS
Yu
Wen-Rui
WR
Peng
Li-Ning
LN
Chen
Liang-Kung
LK
D000368:Aged; D000369:Aged, 80 and over; D019033:Delivery of Health Care, Integrated; D003704:Dementia / Q000628:therapy; D004750:Enteral Nutrition; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes; D009752:Nutritional Status; D011787:Quality of Health Care; D020521:Stroke / Q000628:therapy; D013624:Taiwan; D016896:Treatment Outcome