Researchers at the University of New South Wales in Sydney Australia have published a new systematic review that explores three different home and community care models for the elderly.
The evidence in this field is patchy. Studies are heterogeneous (i.e. too different from one another to be pooled in a meta-analysis) and results are inconsistent.
However, there are some interesting findings in their free online review:
- Evidence from randomized controlled trials showed that case management improves function and appropriate use of medications, increases use of community services and reduces nursing home admission.
- Evidence mostly from non-randomized trials, showed that integrated care increases service use; randomized trials reported that integrated care does not improve clinical outcomes.
- The lowest quality evidence was for consumer directed care which appears to increase satisfaction with care and community service use but has little effect on clinical outcomes.
The researchers concluded that:
The outcomes of each model of care differ and correspond to the model’s focus. Combining key elements of all three models may maximize outcomes.
Low LF, Yap MH, Brodaty H. A systematic review of different models of home and community care services for older persons. BMC Health Serv Res. 2011 May 9;11(1):93.