Integrated Care for Older Adults Improves Perceived Quality of Care: Results of a Randomized Controlled Trial of Embrace

Ronald J Uittenbroek,Sophie L W Spoorenberg,Sijmen A Reijneveld,Klaske Wynia,Hubertus P H Kremer

doi:10.1007/s11606-016-3742-y

Ronald J Uittenbroek, Sophie L W Spoorenberg + Show 3 more

Open Access

https://doi.org/10.1007/s11606-016-3742-y

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Abstract

BackgroundAll community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care.ObjectiveTo examine the impact of Embrace, a community-based integrated primary care service, on perceived quality of care.DesignStratified randomized controlled trial.ParticipantsIntegrated care and support according to the “Embrace” model was provided by 15 general practitioners in the Netherlands. Based on self-reported levels of case complexity and frailty, a total of 1456 community-living older adults were stratified into non-disease-specific risk profiles (“Robust,” “Frail,” and “Complex care needs”), and randomized to Embrace or control groups.InterventionEmbrace provides integrated, person-centered primary care and support to all older adults living in the community, with intensity of care dependent on risk profile.MeasurementsPrimary outcome was quality of care as reported by older adults on the Patient Assessment of Integrated Elderly Care (PAIEC). Effects were assessed using mixed model techniques for the total sample and per risk profile. Professionals’ perceived level of implementation of integrated care was evaluated within the Embrace condition using the Assessment of Integrated Elderly Care.Key resultsOlder adults in the Embrace group reported a higher level of perceived quality of care than those in the control group (B = 0.33, 95 % CI = 0.15-0.51, ES d = 0.19). The advantages of Embrace were most evident in the “Frail” and “Complex care needs” risk profiles. We found no significant advantages for the “Robust” risk profile. Participating professionals reported a significant increase in the perceived level of implementation of integrated care (ES r = 0.71).ConclusionsThis study shows that providing a population-based integrated care service to community-living older adults improved the quality of care as perceived by older adults and participating professionals.

Highlights

All community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care
The oldest older adults, and older adults who lived in rural areas declined participation more frequently
Offering integrated care services should be considered for all older adults, considering that proactive preventive care and support could be increasingly effective for their health outcomes in the longer run.[12,14,16]

Summary

Introduction

All community-living older adults might benefit from integrated care, but evidence is lacking on the effectiveness of such services for perceived quality of care. An example of a CCM-based integrated care service is the BGuided Care" model for multimorbid older adults.[10] Within Guided Care, a physician–nurse primary care team provides care for the most complex patients, with the aim of increasing both quality of care and quality of life while lowering costs. Studies on this service have shown encouraging effects on perceptions of quality of care among older adults.[11] as is typical of such initiatives, this service targets only those already in need of care. Preventive and proactive care may help to delay declining health status among older adults.[12,13,14,15,16]

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