title: Effectiveness and cost-effectiveness of a proactive, goal-oriented, integrated care model in general practice for older people. A cluster randomised controlled trial: Integrated Systematic Care for older People--the ISCOPE study.
abstract: BACKGROUND
  older people often experience complex problems. Because of multiple problems, care for older people in general practice needs to shift from a 'problem-based, disease-oriented' care aiming at improvement of outcomes per disease to a 'goal-oriented care', aiming at improvement of functioning and personal quality of life, integrating all healthcare providers. Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established.
  
  
  METHODS
  cluster randomised trial.
  
  
  METHODS
  all persons aged ≥75 in 59 general practices (30 intervention, 29 control), with a combination of problems, as identified with a structured postal questionnaire with 21 questions on four health domains.
  
  
  METHODS
  for participants with problems on ≥3 domains, general practitioners (GPs) made an integrated care plan using a functional geriatric approach. Control practices: care as usual.
  
  
  METHODS
  (i) quality of life (QoL), (ii) activities of daily living, (iii) satisfaction with delivered health care and (iv) cost-effectiveness of the intervention at 1-year follow-up.
  
  
  BACKGROUND
  Netherlands trial register, NTR1946.
  
  
  RESULTS
  of the 11,476 registered eligible older persons, 7,285 (63%) participated in the screening. One thousand nine hundred and twenty-one (26%) had problems on ≥3 health domains. For 225 randomly chosen persons, a care plan was made. No beneficial effects were found on QoL, patients' functioning or healthcare use/costs. GPs experienced better overview of the care and stability, e.g. less unexpected demands, in the care.
  
  
  CONCLUSIONS
  GPs prefer proactive integrated care. 'Horizontal' care using care plans for older people with complex problems can be a valuable tool in general practice. However, no direct beneficial effect was found for older persons.
authors.affiliation: Public Health and Primary Care, Leiden University Medical Center, Leiden2300 RC, The Netherlands.
authors.forename: Jeanet
authors.initials: J
authors.lastname: Blom
authors.affiliation: Public Health and Primary Care, Leiden University Medical Center, Leiden2300 RC, The Netherlands.
authors.forename: Wendy
authors.initials: W
authors.lastname: den Elzen
authors.affiliation: Public Health and Primary Care, Leiden University Medical Center, Leiden2300 RC, The Netherlands.
authors.forename: Anne H
authors.initials: AH
authors.lastname: van Houwelingen
authors.affiliation: Public Health and Primary Care, Leiden University Medical Center, Leiden2300 RC, The Netherlands.
authors.forename: Margot
authors.initials: M
authors.lastname: Heijmans
authors.affiliation: Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Wilbert
authors.initials: W
authors.lastname: Van den Hout
authors.affiliation: Public Health and Primary Care, Leiden University Medical Center, Leiden2300 RC, The Netherlands.
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000458:organization & administration; D005240:Feasibility Studies; D005260:Female; D058006:General Practice / Q000191:economics* / Q000458:organization & administration; D015577:Geriatric Assessment; D017048:Health Care Costs; D006302:Health Services Research; D006299:Health Services for the Aged / Q000191:economics* / Q000458:organization & administration; D006801:Humans; D008297:Male; D017146:Models, Organizational; D009426:Netherlands; D010347:Patient Care Planning / Q000191:economics* / Q000458:organization & administration; D017060:Patient Satisfaction; D011788:Quality of Life; D020127:Recovery of Function; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: aged; integrated care; older people; primary care; proactive care