title: Effects on healthcare utilization of case management for frail older people: a randomized controlled trial (RCT).
abstract: OBJECTIVE
  Various healthcare interventions have been launched targeting the growing population of older people. The objective of this study was to investigate the of a case management intervention for frail old people (aged 65+ years) effects on healthcare utilization.
  
  
  METHODS
  The study was conducted in a municipality in southern Sweden and included people aged 65+ years who lived in their ordinary homes, were dependent in two or more activities of daily living (ADL), and had at least two hospital admissions, or four physician visits, in the previous year. One-hundred-fifty-three participants were randomly assigned to either an intervention (n=80) or a control group (n=73). The one-year intervention comprised home visits, at least once a month, by case managers. Group differences were investigated 6-12 and 0-6 months before, and 0-6 and 6-12 months after, baseline.
  
  
  RESULTS
  The intervention group had, compared to the control group, significant lower mean number (0.08 vs. 0.37, p=0.041) and proportion (17.4 vs. 46.9%, p=0.016) of ED visits not leading to hospitalization 6-12 months after baseline. The intervention group also had a significantly lower mean number of visits to physicians in outpatient care 6-12 months after baseline (4.09 vs. 5.29, p=0.047).
  
  
  CONCLUSIONS
  The effect on ED visits not leading to hospitalization meant that those in the control group were more likely to visit the ED for reasons that did not require hospitalization, suggesting that they may have been less monitored than the intervention group. The intervention has the potential to reduce the burden on outpatient care and ED.
authors.affiliation: Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden; The Swedish Institute for Health Sciences (Vårdalinsitutet), Lund University, P.O. Box 187, SE-221 00 Lund, Sweden. Electronic address: Magnus.Sandberg@med.lu.se.
authors.forename: Magnus
authors.initials: M
authors.lastname: Sandberg
authors.affiliation: Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00 Lund, Sweden; The Swedish Institute for Health Sciences (Vårdalinsitutet), Lund University, P.O. Box 187, SE-221 00 Lund, Sweden.
authors.forename: Jimmie
authors.initials: J
authors.lastname: Kristensson
authors.affiliation: Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, SE-205 02 Malmö, Sweden; Center for Primary Health Care Research, Faculty of Medicine, Lund University, SE-205 02 Malmö, Sweden.
authors.forename: Patrik
authors.initials: P
authors.lastname: Midlöv
authors.affiliation: Department of Clinical Sciences in Malmö, Faculty of Medicine, Lund University, SE-205 02 Malmö, Sweden; Center for Primary Health Care Research, Faculty of Medicine, Lund University, SE-205 02 Malmö, Sweden.
authors.forename: Ulf
authors.initials: U
authors.lastname: Jakobsson
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D019090:Case Management; D004636:Emergency Service, Hospital; D005260:Female; D016330:Frail Elderly; D006296:Health Services / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006792:House Calls / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D013548:Sweden; D016896:Treatment Outcome
keywords: Case management; Frail elderly; Healthcare utilization; Inpatient care; Outpatient care; Randomized controlled trail