Capsule Commentary on Uittenbroek et al., Integrated Care for Older Adults Improves Perceived Quality of Care: Results of a Randomized Controlled Trial of Embrace
Capsule Commentary on Uittenbroek et al., Integrated Care for Older Adults Improves Perceived Quality of Care: Results of a Randomized Controlled Trial of Embrace
Jeffrey L. Jackson 0
Sheila Scott 0
Frances Gutierrez 0
Zablocki VAMC 0
Milwaukee 0
0 Compliance with Ethical Standards:
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U usual care or multi-disciplinary home-based case
manittenbroek and colleagues randomized elderly patients to
agement. They found that a multi-disciplinary home-based
team improved the quality of care for the frail or complex
elderly patients, but not for those considered robust.1
One interesting finding is that among Dutch citizens 75
years or older, nearly 60% of them were considered robust;
16% were frail and 25% had complex care needs. This mirrors
findings in France2 and England.3 This generation of elderly is
aging well with a substantial portion healthy well into their
90s. However, 40% are frail or have complex care needs, and
healthcare systems need to develop plans to deal with this
group, particularly as developed countries deal with the baby
boomer bulge.
One limitation not mentioned by Uittenbroek is that the
control group in their study had relatively robust systems of
integrated healthcare. The Dutch healthcare system includes
comprehensive care for all citizens.4 It is likely that the impact
of integrated care would be greater in a more fragmented
healthcare system, such as in the US. Another limitation is
the lack of information on other critical outcomes, such as
transition to nursing homes. Keeping elderly citizens in their
own home and reducing the need to move to higher levels of
care could be very important. The Veterans Administration has
developed a system of home-based primary care for veterans
who are frail and/or have complex care needs,3 which is
remarkably similar to the approach used by Uittenbroek. The
VA program has been shown to improve quality of care and to
reduce ER and hospitalization costs by about 12%.5 The
impact of delaying transition to nursing homes has yet to be
reported. Given how expensive institutional care is, minimal
delays in transitioning to institutional care could produce
sufficient cost reductions to render these interventions
costeffective. Nations and health systems with integrated care
should watch these innovative programs closely.
Conflict of Interest: The authors have no conflicts of interest with this
article.
1. Uittenbroek , RJ , Kremer HPH , Spoorenberg SLW , Reijneveld SA , Wynia K. Integrated care for older adults improves perceived quality of care: results of a randomized controlled trial of Embrace . J Gen Intern Med. SPI 3742.
2. Herr M , Arvieu JJ , Robine JM , Ankri J . Health, frailty and disability after ninety: Results of an observational study in France . Arch Gerontol Geriatr . 2016 ; 66 : 166 - 175 .
3. Gale CR , Cooper C , Sayer AA . Prevalence of frailty and disability: findings from the English Longitudinal study of Ageing . Age Ageing . 2015 ; 44 ( 1 ): 162 - 165 .
4. Jackson JL . The Dutch health care system: lessons for reform in the United States . South Med J. 1996 ; 89 ( 6 ): 567 - 72 .
5. Edes T , Kinosian B , Vuckovic NH , Nichols LO , Becker MM , Hossain M. Better access, quality, and cost for clinically complex veterans with homebased primary care . J Am Geriatr Soc . 2014 ; 62 ( 10 ): 1954 - 61 . (...truncated)