Capsule Commentary on Uittenbroek et al., Integrated Care for Older Adults Improves Perceived Quality of Care: Results of a Randomized Controlled Trial of Embrace

Journal of General Internal Medicine, Jul 2016

Jeffrey L. Jackson MD MPH, Sheila Scott MSc, Frances Gutierrez MBA

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs11606-016-3820-1.pdf

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: - 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 .


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs11606-016-3820-1.pdf

Jeffrey L. Jackson MD MPH, Sheila Scott MSc, Frances Gutierrez MBA. Capsule Commentary on Uittenbroek et al., Integrated Care for Older Adults Improves Perceived Quality of Care: Results of a Randomized Controlled Trial of Embrace, Journal of General Internal Medicine, 2017, 557, DOI: 10.1007/s11606-016-3820-1