title: The effects of a pro-active integrated care intervention for frail community-dwelling older people: a quasi-experimental study with the GP-practice as single entry point.
abstract: BACKGROUND
  This study explored the effectiveness of a pro-active, integrated care model for community-dwelling frail older people compared to care as usual by evaluating the effects on a comprehensive set of outcomes: health outcomes (experienced health, mental health and social functioning); functional abilities; and quality of life (general, health-related and well-being).
  
  
  METHODS
  The design of this study was quasi-experimental. In this study, 184 frail older patients of three GP practices that implemented the Walcheren Integrated Care Model were compared with 193 frail older patients of five GP practices that provided care as usual. In the Walcheren Integrated Care Model, community-dwelling elderly were pro-actively screened for frailty from the GP practice using the Groningen Frailty Indicator, and care needs were assessed with the EASYcare instrument. The GP practice functioned as single entry point from which case management was provided, and the GP was the coordinator of care. The entire process was supported by multidisciplinary meetings, multidisciplinary protocols and web-based patient files. The outcomes of this study were obtained at baseline, after 3 months and after 12 months and analyzed with linear mixed models of repeated measures.
  
  
  RESULTS
  The Walcheren Integrated Care Model had a positive effect on love and friendship and a moderately positive effect on general quality of life. The ability to receive love and friendship and general quality of life decreased in the control group but was preserved in the experimental group. No significant differences were found on health outcomes such as experienced health, mental health, social functioning and functional abilities.
  
  
  CONCLUSIONS
  The results indicated that pro-active, integrated care can be beneficial for frail older people in terms of quality of life and love and friendship but not in terms of health outcomes and functional abilities. Recommendations for future research are to gain greater insight into what specific outcomes can be achieved with proactive and integrated care, considering the specific content of this care, and to allow for the heterogeneity of frail older people in evaluation research.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN05748494. Registration date: 14/03/2013.
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands. looman@bmg.eur.nl.
authors.forename: Wilhelmina Mijntje
authors.initials: WM
authors.lastname: Looman
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
authors.forename: Isabelle Natalina
authors.initials: IN
authors.lastname: Fabbricotti
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
authors.forename: Ruben
authors.initials: R
authors.lastname: de Kuyper
authors.affiliation: Erasmus University Rotterdam, Institute of Health Policy and Management, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
authors.forename: Robbert
authors.initials: R
authors.lastname: Huijsman
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D061345:Early Medical Intervention / Q000379:methods*; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D058006:General Practice / Q000379:methods*; D006801:Humans; D057187:Independent Living / Q000523:psychology*; D008297:Male; D011788:Quality of Life / Q000523:psychology