Effectiveness of case management and post-acute services in older people after hospital discharge

Abstract

In this Australian study, post acute care (PAC) co-ordinators provided short-term case management (maximum six months) to frail people aged over 65 years following hospital discharge. As case managers, the PAC coordinators assessed care needs, mobilised and purchased community services, and acted as a single point of contact for the older person and service providers. Older people eligible for PAC were randomly allocated before discharge to the intervention group (n=340) or control receiving normal discharge care (n=314). Eligibility centred on need for community services related to, for example, reduced ability to self-care. Outcome measures included hospital admission, quality of life, carer stress, mortality and community service utilisation. At the six-month follow-up, the proportion of people hospitalised were similar for both the PAC and control group (26 per cent vs. 28 per cent), but length of stay was significantly lower for the PAC group compared to the control (mean, 3.0 vs. 5.2). Correspondingly, a higher proportion of the PAC group used community nursing services (58 per cent vs. 52 per cent) and personal care services (10 per cent vs. 3 per cent) compared to the control. Quality of life scores improved significantly at one month follow up for the PAC group compared to the control (p=0.02).