Abstract
This report describes the findings of a randomized study of a new team approach to home care for homebound chronically or terminally ill elderly. The team includes a physician, nurse practitioner, and social worker delivering primary health care in the patient's home, including physician house calls. Weekly team conferences assure coordination of patient care. The team is available for emergency consultation through a 24-hour telephone service. The team physician attends to the patient during necessary hospitalizations. This approach was evaluated in a randomized experimental design study measuring its impact on health care utilization, functional changes in patients, and patient and caretaker satisfaction. The team patients had fewer hospitalizations, nursing home admissions, and outpatient visits than the controls. They were more often able to die at home, if this was their wish. As expected, they used more in-home services, measured in weighted cost figures; their overall cost was lower than their controls, but the difference was not statistically significant. Their functional abilities did not change differently from the controls, but they, and especially their informal caretakers in the home, expressed significantly higher satisfaction with the care received.
Full text
PDF







Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bergner M., Bobbitt R. A., Carter W. B., Gilson B. S. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981 Aug;19(8):787–805. doi: 10.1097/00005650-198108000-00001. [DOI] [PubMed] [Google Scholar]
- Bloom B. S., Soper K. A. Health and medical care for the elderly and aged population: the state of the evidence. J Am Geriatr Soc. 1980 Oct;28(10):451–455. doi: 10.1111/j.1532-5415.1980.tb01118.x. [DOI] [PubMed] [Google Scholar]
- Dunlop B. D. Expanded home-based care for the impaired elderly: solution or pipe dream? Am J Public Health. 1980 May;70(5):514–519. doi: 10.2105/ajph.70.5.514. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hammond J. Home health care cost effectiveness: an overview of the literature. Public Health Rep. 1979 Jul-Aug;94(4):305–311. [PMC free article] [PubMed] [Google Scholar]
- Klimt C. R. The conduct and principles of randomized clinical trials. Control Clin Trials. 1981 May;1(4):283–293. doi: 10.1016/0197-2456(81)90031-3. [DOI] [PubMed] [Google Scholar]
- Lawton M. P. The Philadelphia Geriatric Center Morale Scale: a revision. J Gerontol. 1975 Jan;30(1):85–89. doi: 10.1093/geronj/30.1.85. [DOI] [PubMed] [Google Scholar]
- Lewis B., Chait A., Wootton I. D., Oakley C. M., Krikler D. M., Sigurdsson G., February A., Maurer B., Birkhead J. Frequency of risk factors for ischaemic heart-disease in a healthy British population. With particular reference to serum-lipoprotein levels. Lancet. 1974 Feb 2;1(7849):141–146. doi: 10.1016/s0140-6736(74)92438-6. [DOI] [PubMed] [Google Scholar]
- McCusker J. Development of scales to measure satisfaction and preferences regarding long-term and terminal care. Med Care. 1984 May;22(5):476–493. doi: 10.1097/00005650-198405000-00011. [DOI] [PubMed] [Google Scholar]
- Mitchell J. B. Patient outcomes in alternative long-term care settings. Med Care. 1978 Jun;16(6):439–452. doi: 10.1097/00005650-197806000-00001. [DOI] [PubMed] [Google Scholar]
- Nielsen M., Blenkner M., Bloom M., Downs T., Beggs H. Older persons after hospitalization: a controlled study of home aide service. Am J Public Health. 1972 Aug;62(8):1094–1101. doi: 10.2105/ajph.62.8.1094. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Roghmann K. J., Haggerty R. J. Measuring the use of health services by household interviews: A comparison of procedures used in three child health surveys. Int J Epidemiol. 1974 Mar;3(1):71–81. doi: 10.1093/ije/3.1.71. [DOI] [PubMed] [Google Scholar]
- Skellie F. A., Coan R. E. Community-based long-term care and mortality: preliminary findings of Georgia's alternative health services project. Gerontologist. 1980 Jun;20(3 Pt 1):372–379. doi: 10.1093/geront/20.3_part_1.372. [DOI] [PubMed] [Google Scholar]
- Wan T. T., Weissert W. G., Livieratos B. B. Geriatric day care and homemaker services: an experimental study. J Gerontol. 1980 Mar;35(2):256–274. doi: 10.1093/geronj/35.2.256. [DOI] [PubMed] [Google Scholar]
- Weissert W. G., Wan T. T., Livieratos B. B., Pellegrino J. Cost-effectiveness of homemaker services for the chronically ill. Inquiry. 1980 Fall;17(3):230–243. [PubMed] [Google Scholar]
- Zimmer J. G., Groth-Juncker A. A time-motion study of patient care activities of a geriatric home care team. Home Health Care Serv Q. 1983 Spring;4(1):67–78. doi: 10.1300/J027v04n01_07. [DOI] [PubMed] [Google Scholar]
- Zimmer J. G., Groth-Juncker A. Off-hour telephone calls to a geriatric home care team. Home Health Care Serv Q. 1982 Summer;3(2):63–70. doi: 10.1300/J027v03n02_05. [DOI] [PubMed] [Google Scholar]