Dataset Information

Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data.

ABSTRACT:

Objectives

To determine the impact on outcomes in patients of the Evercare approach to case management of elderly people.

Design

Practice level before and after analysis of hospital admissions data with control group.

Setting

Nine primary care trusts in England that, in 2003-5, piloted case management of elderly people selected as being at high risk of emergency admission.

Main outcome measures

Rates of emergency admission, emergency bed days, and mortality from April 2001 to March 2005 in 62 Evercare practices and 6960-7695 control practices in England (depending on the analysis being carried out).

Results

The intervention had no significant effect on rates of emergency admission (increase 16.5%, (95% confidence interval -5.7% to 38.7%), emergency bed days (increase 19.0%, -5.3% to 43.2%), and mortality (increase 34.4%, -1.7% to 70.3%) for a high risk population aged >65 with a history of two or more emergency admissions in the preceding 13 months. For the general population aged > or =65 effects on the rates of emergency admission (increase 2.5%, -2.1% to 7.0%), emergency bed days (decrease -4.9%, -10.8% to 1.0%), and mortality (increase 5.5%, -3.5% to 14.5%) were also non-significant.

Conclusions

Case management of frail elderly people introduced an additional range of services into primary care without an associated reduction in hospital admissions. This may have been because of identification of additional cases. Employment of community matrons is now a key feature of case management policy in the NHS in England. Without more radical system redesign this policy is unlikely to reduce hospital admissions.

SUBMITTER: Gravelle H

PROVIDER: S-EPMC1764106 | biostudies-literature | 2007 Jan

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data.

Gravelle Hugh H Dusheiko Mark M Sheaff Rod R Sargent Penny P Boaden Ruth R Pickard Susan S Parker Stuart S Roland Martin M

BMJ (Clinical research ed.) 20061115 7583

<h4>Objectives</h4>To determine the impact on outcomes in patients of the Evercare approach to case management of elderly people.<h4>Design</h4>Practice level before and after analysis of hospital admissions data with control group.<h4>Setting</h4>Nine primary care trusts in England that, in 2003-5, piloted case management of elderly people selected as being at high risk of emergency admission.<h4>Main outcome measures</h4>Rates of emergency admission, emergency bed days, and mortality from Apri ...[more]

PMID: 17107984

Similar Datasets

Project description:Frail elderly people need an integrated and coordinated care. The two-armed study "Continuum of care for frail elderly people" is a multi-professional and multidimensional intervention for frail community-dwelling elderly people. It was designed to evaluate whether the intervention programme for frail elderly people can reduce the number of visits to hospital, increase satisfaction with health and social care and maintain functional abilities. The implementation process is explored and analysed along with the intervention. In this paper we present the study design, the intervention and the outcome measures as well as the baseline characteristics of the study participants.The study is a randomised two-armed controlled trial with follow ups at 3, 6 and 12 months. The study group includes elderly people who sought care at the emergency ward and discharged to their own homes in the community. Inclusion criteria were 80 years and older or 65 to 79 years with at least one chronic disease and dependent in at least one activity of daily living. Exclusion criteria were acute severely illness with an immediate need of the assessment and treatment by a physician, severe cognitive impairment and palliative care. The intention was that the study group should comprise a representative sample of frail elderly people at a high risk of future health care consumption. The intervention includes an early geriatric assessment, early family support, a case manager in the community with a multi-professional team and the involvement of the elderly people and their relatives in the planning process.The design of the study, the randomisation procedure and the protocol meetings were intended to ensure the quality of the study. The implementation of the intervention programme is followed and analysed throughout the whole study, which enables us to generate knowledge on the process of implementing complex interventions. The intervention contributes to early recognition of both the elderly peoples' needs of information, care and rehabilitation and of informal caregivers' need of support and information. This study is expected to show positive effects on frail elderly peoples' health care consumption, functional abilities and satisfaction with health and social care.ClinicalTrials.gov: NCT01260493.

Project description:INTRODUCTION:Premedication of surgical patients with benzodiazepines has become questionable regarding risk-benefit ratio and lack of evidence. Though preoperative benzodiazepines might alleviate preoperative anxiety, a higher risk for adverse events is described, particularly for elderly patients (??65?years). Several German hospitals already withhold benzodiazepine premedication from elderly patients, though evidence for this approach is lacking. The patient-centred outcome known as global postoperative patient satisfaction is recognised as a substantial quality indicator of anaesthesia care incorporated by the American Society of Anesthesiologists. Therefore, we aim to assess whether the postoperative patient satisfaction after premedication with placebo compared to the preoperative administration of 3.75?mg midazolam in elderly patients differs. METHODS:This study is a multicentre, randomised, placebo-controlled, double-blinded, two-arm parallel, interventional trial, conducted in nine German hospitals. In total 614 patients (??65-80?years of age) undergoing elective surgery with general anaesthesia will be randomised to receive either 3.75?mg midazolam or placebo. The primary outcome (global patient satisfaction) will be assessed with the validated EVAN-G questionnaire on the first postoperative day. Secondary outcomes will be assessed until the first postoperative day and then 30?days after surgery. They comprise among other things: functional and cognitive recovery, postoperative delirium, health-related quality of life assessment, and mortality or new onset of serious cardiac or pulmonary complications, acute stroke, or acute kidney injury. Analysis will adhere to the intention-to-treat principle. The primary outcome will be analysed with the use of mixed linear models including treatment effect and study centre as factors and random effects for blocks. Exploratory adjusted and subgroup analyses of the primary and secondary outcomes with regard to gender effects, frailty, pre-operative anxiety level, patient demographics, and surgery experience will also be performed. DISCUSSION:This is, to the best of our knowledge, the first study analysing patient satisfaction after premedication with midazolam in elderly patients. In conclusion, this study will provide high-quality data for the decision-making process regarding premedication in elderly surgical patients. TRIAL REGISTRATION:ClinicalTrials.gov, NCT03052660 . Registered on 14 February 2017. EudraCT 2016-004555-79 .

Project description:ObjectivesOwing to a lack of data, our aim was to evaluate and compare the impact of various common neurological diseases on the risk for falls in independent community dwelling senior citizens.DesignProspective case-controlled study.SettingGeneral hospital.ParticipantsOf 298 consecutive patients and 214 controls enrolled, 228 patients (aged 74.5±7.8; 61% women) and 193 controls (aged 71.4±6.8; 63% women) were included. The exclusion criteria were as follows: for patients, severe disability, disabling general condition or severe cognitive impairment; for controls, any history of neurological disorders or disabling medical conditions; and for both, age below 60 years. A matching process led to 171 age-matched and gender-matched pairs of neurological patients and healthy controls.Main outcome measuresA 1-year incidence of falls based on patients' 12-month recall; motor and non-motor function tests to detect additional risk factors.Results46% of patients and 16% of controls fell at least once a year. Patients with stroke (89%), Parkinson's disease (77%), dementia (60%) or epilepsy (57%) had a particularly high proportion of fallers, but even subgroups of patients with the least fall-associated neurological diseases like tinnitus (30%) and headache (28%) had a higher proportion of fallers than the control group. Neuropathies, peripheral nerve lesions and Parkinson's disease were predisposing to recurrent falls. A higher number of neurological comorbidities (p<0.001), lower Barthel Index values (p<0.001), lower Activities-Specific Balance Confidence scores (p<0.001) and higher Center of Epidemiological Studies Depression scores (p<0.001) as well as higher age (p<0.001) and female gender (p=0.003) proved to further increase the risk of falls.ConclusionsMedical practitioners, allied health professionals and carers should be aware that all elderly neurological patients seen in outpatient settings are potentially at high risk for falls; they should query them routinely about previous falls and fall risks and advise them on preventive strategies.

Dataset Information

Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data.

Objectives

Design

Setting

Main outcome measures

Results

Conclusions

Publications

Impact of case management (Evercare) on frail elderly patients: controlled before and after analysis of quantitative outcome data.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure