scholarly journals Effects of preventive home visits on health care costs for ambulatory frail elders: a randomized controlled trial

2013 ◽  
Vol 25 (5) ◽  
pp. 575-581 ◽  
Author(s):  
Ayumi Kono ◽  
Yukiko Kanaya ◽  
Chieko Tsumura ◽  
Laurence Z. Rubenstein
Keyword(s):  
Health Care ◽  
Randomized Controlled Trial ◽  
Health Care Costs ◽  
Controlled Trial ◽  
Home Visits ◽  
Preventive Home Visits ◽  
Frail Elders ◽  
Randomized Controlled ◽  
Care Costs

scholarly journals Factors contributing to post-stroke health care utilization and costs. Secondary results from the Life After Stroke (LAST) study, a pragmatic randomized controlled trial

2020 ◽  
Author(s):  
Øystein Døhl ◽  
Vidar Halsteinli ◽  
Torun Askim ◽  
Mari Gunnes ◽  
Hege Ihle Hansen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Gait Speed ◽  
Standard Care ◽  
Controlled Trial ◽  
Health Care Use ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Care Costs

Abstract Background The result from the Life After Stroke (LAST) study showed that an 18-month follow up program as part of the primary health care, did not improve maintenance of motor function for stroke survivors. In this study we evaluated whether the follow-up program could lead to a reduction in the use of health care compared to standard care. Furthermore, we analyse to what extent differences in health care costs for stroke patients could be explained by individual need factors (such as physical disability, cognitive impairment, age, gender and marital status), and we tested whether a generic health related quality of life (HRQoL) is able to predict the utilisation of health care services for patients post-stroke as well as more disease specific indexes. Methods The Last study was a multicentre, pragmatic, single-blinded, randomized controlled trial. Adults (age ≥18 years) with first-ever or recurrent stroke, community dwelling, with modified Rankin Scale <5. The study included 380 persons recruited 10 to 16 weeks post-stroke, randomly assigned to individualized coaching for 18 months (n=186) or standard care (n=194). Individual need was measured by the Motor assessment scale (MAS), Barthel Index, Hospital Anxiety and Depression Scale (HADS), modified Rankin Scale (mRS) and Gait speed. HRQoL was measured by EQ-5D-5L. Health care costs were estimated for each person based on individual information of health care use. Multivariate regression analysis was used to analyse cost differences between the groups and the relationship between individual costs and determinants of health care utilisation. Results There were higher total costs in the intervention group. MAS, Gait speed, HADS and mRS were significant identifiers of costs post-stroke, as was EQ-5D-5L. Conclusion Long term, regular individualized coaching did not reduce health care costs compared to standard care. We found that MAS, Gait speed, HADS and mRS were significant predictors for future health care use. The generic EQ-5D-5L performed equally well as the more detailed battery of outcome measures, suggesting that HRQoL measures may be a simple and efficient way of identifying patients in need of health care after stroke and targeting groups for interventions. Clinical Trial Registration : https://www.clinicaltrials.gov NCT01467206.

scholarly journals Feasibility and effects of preventive home visits for at-risk older people: Design of a randomized controlled trial

2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Malcolm P Cutchin ◽  
Susan Coppola ◽  
Vibeke Talley ◽  
Judie Svihula ◽  
Diane Catellier ◽  
...  
Keyword(s):  
At Risk ◽  
Randomized Controlled Trial ◽  
Older People ◽  
Controlled Trial ◽  
Home Visits ◽  
Preventive Home Visits ◽  
Randomized Controlled

scholarly journals Psychosocial resources in middle-aged and older adults with complex health care needs: results of a qualitative study

2020 ◽  
Author(s):  
Imad Maatouk ◽  
Stefanie Wilke ◽  
Friederike Böhlen ◽  
Christoph Nikendei ◽  
Ben Schöttker ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Randomized Controlled Trial ◽  
Controlled Trial ◽  
Home Visits ◽  
Health Care Needs ◽  
Vulnerable Group ◽  
Care Needs ◽  
Randomized Controlled ◽  
Supportive Counseling

Abstract Background Older adults with multiple chronic somatic diseases are challenged by mental comorbidities and social environmental changes resulting in complex bio-psychosocial healthcare needs. Comparatively few studies have addressed the coping strategies and resources of this highly vulnerable group. This study used the INTERMED interview method as a basis to investigate the resources of home-dwelling older adults with complex health care needs. Methods Following a randomized controlled trial this qualitative study analyzed detailed notes taken by a trained psychosomatic doctor during 24 interventional supportive counseling home visits. The randomized controlled trial participants were recruited from the ESTHER cohort study, a population-based study of older adults conducted in the state of Saarland, Southwest Germany. Patients with complex health care needs identified with the INTERMED interview received the supportive counseling home visit intervention, which followed the principles of narrative-based medicine and explored the personal resources of the participants. Notes from 24 supportive counseling home visits were analyzed using thematic content analysis. Results The qualitative analysis from 24 home visits identified 387 single codes, from which two main categories and 14 subcategories were derived. Participants with complex health care needs named currently available present resources and personal/long-lasting resources representing the main categories. Eight main categories were derived within the field of currently available resources that were deemed helpful to cope with the actual situation. Personal/long-lasting resources comprise statements that reflect personal experiential and attitudinal resources gained through socialization and internalization of interpersonal experiences. Conclusion The highly vulnerable group of complex patients reported many social, personal and structural resources that play significant roles in helping them to deal with their current situation. Home care professionals need skills to recognize and use the many different potential resources each client is able to access, which could enhance their well-being.

scholarly journals Factors contributing to post-stroke health care utilization and costs. Secondary results from the Life After Stroke (LAST) study, a pragmatic randomized controlled trial

2020 ◽  
Author(s):  
Øystein Døhl ◽  
Vidar Halsteinli ◽  
Torun Askim ◽  
Mari Gunnes ◽  
Hege Ihle Hansen ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Gait Speed ◽  
Standard Care ◽  
Controlled Trial ◽  
Health Care Use ◽  
Post Stroke ◽  
Randomized Controlled ◽  
Care Costs

Abstract Background The result from the Life After Stroke (LAST) study showed that an 18-month follow up program as part of the primary health care, did not improve maintenance of motor function for stroke survivors. In this study we evaluated whether the follow-up program could lead to a reduction in the use of health care compared to standard care. Furthermore, we analyse to what extent differences in health care costs for stroke patients could be explained by individual need factors (such as physical disability, cognitive impairment, age, gender and marital status), and we tested whether a generic health related quality of life (HRQoL) is able to predict the utilisation of health care services for patients post-stroke as well as more disease specific indexes.Methods The Last study was a multicentre, pragmatic, single-blinded, randomized controlled trial. Adults (age ≥18 years) with first-ever or recurrent stroke, community dwelling, with modified Rankin Scale <5. The study included 380 persons recruited 10 to 16 weeks post-stroke, randomly assigned to individualized coaching for 18 months (n=186) or standard care (n=194). Individual need was measured by the Motor assessment scale (MAS), Barthel Index, Hospital Anxiety and Depression Scale (HADS), modified Rankin Scale (mRS) and Gait speed. HRQoL was measured by EQ-5D-5L. Health care costs were estimated for each person based on individual information of health care use. Multivariate regression analysis was used to analyse cost differences between the groups and the relationship between individual costs and determinants of health care utilisation.Results There were higher total costs in the intervention group. MAS, Gait speed, HADS and mRS were significant identifiers of costs post-stroke, as was EQ-5D-5L.Conclusion Long term, regular individualized coaching did not reduce health care costs compared to standard care. We found that MAS, Gait speed, HADS and mRS were significant predictors for future health care use. The generic EQ-5D-5L performed equally well as the more detailed battery of outcome measures, suggesting that HRQoL measures may be a simple and efficient way of identifying patients in need of health care after stroke and targeting groups for interventions.Clinical Trial Registration: https://www.clinicaltrials.gov NCT01467206. The trial was retrospectively registered after the first 6 participants were included.

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