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The Cost-Effectiveness of Homecare Services for Adults and Older Adults: A Systematic Review.

ABSTRACT: This study provides an overview of the literature on the cost-effectiveness of homecare services compared to in-hospital care for adults and older adults. A systematic review was performed using Medline, Embase, Scopus, Web of Science, CINAHL and CENTRAL databases from inception to April 2022. The inclusion criteria were as follows: (i) (older) adults; (ii) homecare as an intervention; (iii) hospital care as a comparison; (iv) a full economic evaluation examining both costs and consequences; and (v) economic evaluations arising from randomized controlled trials (RCTs). Two independent reviewers selected the studies, extracted data and assessed study quality. Of the 14 studies identified, homecare, when compared to hospital care, was cost-saving in seven studies, cost-effective in two and more effective in one. The evidence suggests that homecare interventions are likely to be cost-saving and as effective as hospital. However, the included studies differ regarding the methods used, the types of costs and the patient populations of interest. In addition, methodological limitations were identified in some studies. Definitive conclusions are limited and highlight the need for better standardization of economic evaluations in this area. Further economic evaluations arising from well-designed RCTs would allow healthcare decision-makers to feel more confident in considering homecare interventions.

SUBMITTER: Curioni C

PROVIDER: S-EPMC9960182 | biostudies-literature | 2023 Feb

REPOSITORIES: biostudies-literature

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The Cost-Effectiveness of Homecare Services for Adults and Older Adults: A Systematic Review.

Curioni Cintia C Silva Ana Carolina AC Damião Jorginete J Castro Andrea A Huang Miguel M Barroso Taianah T Araujo Daniel D Guerra Renata R

International journal of environmental research and public health 20230215 4

This study provides an overview of the literature on the cost-effectiveness of homecare services compared to in-hospital care for adults and older adults. A systematic review was performed using Medline, Embase, Scopus, Web of Science, CINAHL and CENTRAL databases from inception to April 2022. The inclusion criteria were as follows: (i) (older) adults; (ii) homecare as an intervention; (iii) hospital care as a comparison; (iv) a full economic evaluation examining both costs and consequences; and ...[more]

PMID: 36834068

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Project description:IntroductionOne-third of adults aged 65+ fall annually. Injuries from falls can be devastating for individuals and account for 1.5% of annual healthcare spending. With the growing ageing population, falls place increased strain on scarce health resources. Prevention strategies that target individuals at high risk for falls demonstrate the best value for money; however, limited efficiency (ie, cost-effectiveness) information for fall prevention interventions hinders the implementation of effective falls prevention programmes. Living systematic reviews provide a timely up-to-date evidence-based resource to inform clinical guidelines and health policy decisions. This protocol details the methodology for a living systematic review of the efficiency (ie, cost-effectiveness) of fall prevention interventions for older adults in three settings: community-dwelling, aged care and hospitals.Methods and analysisThis protocol used the reporting guidelines from the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol. Peer-reviewed economic evaluations of controlled clinical trials or health state models will be included. Reports will be obtained through monthly systematic searches of CENTRAL (Ovid), CINAHL (EBSCO), Embase (Ovid), MEDLINE (Ovid), SCOPUS (Elsevier) and Web of Science (Clarivate) alongside snowballing and handsearching EconLit and the Tufts Cost Effectivness Analysis Registry. Screening, data extraction, quality assessment and risk of bias will be assessed by multiple reviewers. The primary outcomes will be the incremental cost-effectiveness (ie, incremental cost per fall prevented), incremental cost-utility (ie, incremental cost per quality-adjusted life year gained) or cost-benefit ratio. Additional outcomes will include falls and cost-related measures. All economic outcomes will be reported in a common year and currency. Results will be reported as a narrative synthesis; meta-analysis will be considered based on data quality, suitability and availability.Ethics and disseminationEthical approval is not required as primary human data will not be collected. Results will be disseminated through peer-reviewed publications and a dedicated website.Prospero registration numberCRD42024532485.

Project description:BackgroundAmong the older population, Parkinson disease (PD) stands out as a leading contributor to disability. Clinically, the foremost objectives in managing PD involve proactively delaying and preventing disability. Understanding the pivotal role of gait and balance in daily functionality holds substantial clinical significance, signaling imminent disability and prompting a reevaluation of management approaches. A key priority lies in identifying novel and effective interventions for symptoms that substantially contribute to disability.ObjectiveThis paper presents a systematic review that critically examines the existing body of literature on the use of technology in the rehabilitation of older patients with PD. By synthesizing current evidence, we aim to provide insights into the state of the field, identify gaps in knowledge, and offer recommendations for future research and clinical practice.MethodsA systematic review of the literature was conducted in September 2023 analyzing manuscripts and papers of the last 5 years from the PubMed, Scopus, Embase, Web of Science, and CINAHL databases following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 14 papers were included. The inclusion criteria are as follows: (1) randomized controlled trial, (2) PD in people aged 65 years and older, and (3) use of technology in the rehabilitation training in the older population.ResultsA large portion of effective interventions relies on the incorporation of technology, particularly through virtual reality exergames. This technology appears to have effects not only on the cognitive aspect but also on the physical domain. The analysis of the results clearly indicates that, in terms of gait and balance performance, the technological intervention outperforms the traditional approach, irrespective of the specific technology employed.ConclusionsThis systematic review seeks to shed light on the evolving landscape of technology-assisted rehabilitation for older individuals with PD. As we delve into the available evidence, we will assess the extent to which technology can serve as a valuable adjunct to conventional therapy, offering new avenues for optimized care and improved outcomes in this growing patient demographic. As we sift through the existing evidence, our goal is to evaluate the potential of technology as a valuable supplement to traditional therapy, presenting fresh opportunities for enhanced care and better outcomes in this expanding patient demographic.

Project description:Background/objectivesHomecare staff often take over activities instead of "doing activities with" clients, thereby hampering clients from remaining active in daily life. Training and supporting staff to integrate reablement into their working practices may reduce clients' sedentary behavior and improve their independence. This study evaluated the effectiveness of the "Stay Active at Home" (SAaH) reablement training program for homecare staff on older homecare clients' sedentary behavior.DesignCluster randomized controlled trial (c-RCT).SettingDutch homecare (10 nursing teams comprising a total of 313 staff members).Participants264 clients (aged ≥65 years).InterventionSAaH seeks to equip staff with knowledge, attitude, and skills on reablement, and to provide social and organizational support to implement reablement in homecare practice. SAaH consists of program meetings, practical assignments, and weekly newsletters over a 9-month period. The control group received no additional training and delivered care as usual.MeasurementsSedentary behavior (primary outcome) was measured using tri-axial wrist-worn accelerometers. Secondary outcomes included daily functioning (GARS), physical functioning (SPPB), psychological functioning (PHQ-9), and falls. Data were collected at baseline and at 12 months; data on falls were also collected at 6 months. Intention-to-treat analyses using mixed-effects linear and logistic regression were performed.ResultsWe found no statistically significant differences between the study groups for sedentary time expressed as daily minutes (adjusted mean difference: β 18.5 (95% confidence interval [CI] -22.4, 59.3), p = 0.374) and as proportion of wake/wear time (β 0.6 [95% CI -1.5, 2.6], p = 0.589) or for most secondary outcomes.ConclusionOur c-RCT showed no evidence for the effectiveness of SAaH for all client outcomes. Refining SAaH, by adding components that intervene directly on homecare clients, may optimize the program and require further research. Additional research should explore the effectiveness of SAaH on behavioral determinants of clients and staff and cost-effectiveness.

Dataset Information

The Cost-Effectiveness of Homecare Services for Adults and Older Adults: A Systematic Review.

Publications

The Cost-Effectiveness of Homecare Services for Adults and Older Adults: A Systematic Review.

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