title: Should care managers for older adults be located in primary care? A randomized controlled trial.
abstract: OBJECTIVE
  To determine the effect of a primary care-based care management initiative on residential care placement and death in a population of frail older adults referred for needs assessment in New Zealand.
  
  
  METHODS
  Randomized controlled trial with follow-up at 3, 6, 12, 18, and 24 months for residential care placement and mortality.
  
  
  METHODS
  Fifty-five family physician practices in New Zealand that established a care management initiative for older adults assessed as being at high risk of residential care placement in 2004 to 2006.
  
  
  METHODS
  Three hundred fifty-one individuals (243 female, 108 male) aged 65 and older (mean 81) who were assessed as being at risk of permanent residential care placement.
  
  
  METHODS
  The care management program (Coordinator of Services for Elderly) consisted of a nominated health professional care manager geographically aligned to family physicians housed with the family physician or located nearby.
  
  
  METHODS
  Rates of permanent residential care placement and mortality.
  
  
  RESULTS
  The risk of permanent residential care placement or death was 0.36 for usual care (control group) and 0.26 for the care management initiative, a 10.2% absolute risk reduction, with the majority of the risk reduction seen in residential care placement (control group 0.25, intervention group 0.16).
  
  
  CONCLUSIONS
  A family physician-aligned community care management approach reduces frail older adults' risk of mortality and permanent residential care placement.
authors.affiliation: Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. m.parsons@auckland.ac.nz
authors.forename: Matthew
authors.initials: M
authors.lastname: Parsons
authors.forename: Hugh
authors.initials: H
authors.lastname: Senior
authors.forename: Ngaire
authors.initials: N
authors.lastname: Kerse
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Chen
authors.forename: Stephen
authors.initials: S
authors.lastname: Jacobs
authors.forename: Stephen
authors.initials: S
authors.lastname: Vanderhoorn
authors.forename: Craig
authors.initials: C
authors.lastname: Anderson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D015577:Geriatric Assessment; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D009520:New Zealand / Q000453:epidemiology; D010346:Patient Care Management / Q000458:organization & administration*; D010821:Physicians, Family / Q000600:supply & distribution*; D011320:Primary Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors