title: The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care.
abstract: OBJECTIVE
  This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months.
  
  
  METHODS
  Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files.
  
  
  METHODS
  The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis.
  
  
  CONCLUSIONS
  In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is required to study the value of integrated care on changes in health and the preservation of the positive effects on quality of life and health care use.
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: Wilhelmina Mijntje
authors.initials: WM
authors.lastname: Looman
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: Isabelle Natalina
authors.initials: IN
authors.lastname: Fabbricotti
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy and Management, Rotterdam, The Netherlands.
authors.forename: Robbert
authors.initials: R
authors.lastname: Huijsman
keywords: frail elderly; integrated care; short-term effects