Integrated Care for Older Adults Improves Perceived Quality of Care: Results of a Randomized Controlled Trial of Embrace.
BACKGROUND
All community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care.


OBJECTIVE
To examine the impact of Embrace, a community-based integrated primary care service, on perceived quality of care.


METHODS
Stratified randomized controlled trial.


METHODS
Integrated care and support according to the "Embrace" model was provided by 15 general practitioners in the Netherlands. Based on self-reported levels of case complexity and frailty, a total of 1456 community-living older adults were stratified into non-disease-specific risk profiles ("Robust," "Frail," and "Complex care needs"), and randomized to Embrace or control groups.


METHODS
Embrace provides integrated, person-centered primary care and support to all older adults living in the community, with intensity of care dependent on risk profile.


METHODS
Primary outcome was quality of care as reported by older adults on the Patient Assessment of Integrated Elderly Care (PAIEC). Effects were assessed using mixed model techniques for the total sample and per risk profile. Professionals' perceived level of implementation of integrated care was evaluated within the Embrace condition using the Assessment of Integrated Elderly Care.


RESULTS
Older adults in the Embrace group reported a higher level of perceived quality of care than those in the control group (B = 0.33, 95 % CI = 0.15-0.51, ES d = 0.19). The advantages of Embrace were most evident in the "Frail" and "Complex care needs" risk profiles. We found no significant advantages for the "Robust" risk profile. Participating professionals reported a significant increase in the perceived level of implementation of integrated care (ES r = 0.71).


CONCLUSIONS
This study shows that providing a population-based integrated care service to community-living older adults improved the quality of care as perceived by older adults and participating professionals.
Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, P.O. BOX 196, 9700 AD, Groningen, The Netherlands. r.j.uittenbroek@umcg.nl.
Ronald J
RJ
Uittenbroek
Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. BOX 30001, 9700 RB, Groningen, The Netherlands.
Hubertus P H
HPH
Kremer
Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, P.O. BOX 196, 9700 AD, Groningen, The Netherlands.
Sophie L W
SLW
Spoorenberg
Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, P.O. BOX 196, 9700 AD, Groningen, The Netherlands.
Sijmen A
SA
Reijneveld
Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, P.O. BOX 196, 9700 AD, Groningen, The Netherlands.|Department of Neurology, University Medical Center Groningen, University of Groningen, P.O. BOX 30001, 9700 RB, Groningen, The Netherlands.
Klaske
K
Wynia
D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D019033:Delivery of Health Care, Integrated / Q000592:standards* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D057187:Independent Living / Q000523:psychology* / Q000639:trends; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D017060:Patient Satisfaction; D010465:Perception; D011787:Quality of Health Care / Q000592:standards* / Q000639:trends; D016037:Single-Blind Method
integrated care; older adults; patient-centered care; quality of care; randomized controlled trial