title: Impact on hospital admissions of an integrated primary care model for very frail elderly patients.
abstract: Very frail elderly patients living in the community, present complex needs and have a higher rate of hospital admissions with emergency department (ED) visits. Here, we evaluated the impact on hospital admissions of the COPA model (CO-ordination Personnes Agées), which provides integrated primary care with intensive case management for community-dwelling, very frail elderly patients. We used a quasi-experimental study in an urban district of Paris with four hundred twenty-eight very frail patients (105 in the intervention group and 323 in the control group) with one-year follow-up. The primary outcome measures were the presence of any unplanned hospitalization (via the ED), any planned hospitalizations (direct admission, no ED visit) and any hospitalization overall. Secondary outcome measures included health parameters assessed with the RAI-HC (Resident Assessment Instrument-Home Care). Comparing the intervention group with the control group, the risk of having at least one unplanned hospital admission decreased at one year and the planned hospital admissions rate increased, without a significant change in total hospital admissions. Among patients in the intervention group, there was less risk of depression and dyspnea. The COPA model improves the quality of care provided to very frail elderly patients by reducing unplanned hospitalizations and improving some health parameters.
authors: University of Versailles St-Quentin, EA 2506 Santé-Environnement-Vieillissement Research Group, Sainte Perine Hospital, AP-HP, Paris, France; Solidage Research Group on Frailty and Aging, McGill University - University of Montreal, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada. Electronic address: matthieu.destampa@spr.aphp.fr.
authors: Matthieu
authors: M
authors: de Stampa
authors: Department of Family Medicine, McGill University, Montreal, Quebec, Canada; Division of Geriatric Medicine, McGill University, Jewish General Hospital, Montreal, Quebec, Canada; Solidage Research Group on Frailty and Aging, McGill University - University of Montreal, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
authors: Isabelle
authors: I
authors: Vedel
authors: University of Versailles St-Quentin, EA 2506 Santé-Environnement-Vieillissement Research Group, Sainte Perine Hospital, AP-HP, Paris, France.
authors: Jean-François
authors: JF
authors: Buyck
authors: Desautels Faculty of Management, McGill University, Montreal, Quebec, Canada; Solidage Research Group on Frailty and Aging, McGill University - University of Montreal, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
authors: Liette
authors: L
authors: Lapointe
authors: Department of Family Medicine, McGill University, Montreal, Quebec, Canada; Division of Geriatric Medicine, McGill University, Jewish General Hospital, Montreal, Quebec, Canada; Solidage Research Group on Frailty and Aging, McGill University - University of Montreal, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
authors: Howard
authors: H
authors: Bergman
authors: Department of Health Administration, University of Montreal, Quebec, Canada; Solidage Research Group on Frailty and Aging, McGill University - University of Montreal, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada.
authors: Francois
authors: F
authors: Beland
authors: University of Versailles St-Quentin, EA 2506 Santé-Environnement-Vieillissement Research Group, Sainte Perine Hospital, AP-HP, Paris, France.
authors: Joel
authors: J
authors: Ankri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D016330:Frail Elderly; D005602:France; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D015397:Program Evaluation; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Hospital admissions; Integrated primary care model; Very frail elderly patient