Please use this identifier to cite or link to this item: http://hdl.handle.net/10668/286
Title: Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study
Authors: Morales Asencio, José Miguel
Gonzalo Jiménez, Elena
Martín Santos, J F
Morilla Herrera, J C
Celdrán Mañas, Miriam
Millán Carrasco, Almudena
García Arrabal, J J
Toral López, I
metadata.dc.contributor.authoraffiliation: [Morales-Asencio, JM; Gonzalo-Jimenez, E; Martin-Santos, FJ; Morilla-Herrera, JC; Celdrán-Mañas, M; Millán Carrasco, A] Andalusian School of Public Health, Granada, España. [Martin-Santos, FJ; Morilla-Herrera, JC] Healthcare District, Andalusian Healthcare Service, Malaga, Spain. [Garcia-Arrabal, JJ] Healthcare District, Andalusian Healthcare Service, Almeria, Spain. [Toral-Lopez, I] Healthcare District, Andalusian Healthcare Service, Granada, Spain.
Keywords: Manejo de caso;Servicios de atención de salud a domicilio;Evaluación de procesos y resultados (atención de salud);Cuidadores;Atención Primaria de Salud;España
metadata.dc.subject.mesh: Medical Subject Headings::Health Care::Health Services Administration::Patient Care Management::Comprehensive Health Care::Patient Care Planning::Case Management
Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Services::Community Health Services::Home Care Services
Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Personnel::Caregivers
Medical Subject Headings::Health Care::Health Services Administration::Quality of Health Care::Outcome and Process Assessment (Health Care)
Medical Subject Headings::Health Care::Environment and Public Health::Public Health::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Follow-Up Studies
Medical Subject Headings::Health Care::Health Care Facilities, Manpower, and Services::Health Services::Nursing Services::Home Care Services
Medical Subject Headings::Health Care::Health Services Administration::Patient Care Management::Comprehensive Health Care::Primary Health Care
Issue Date: Sep-2008
Publisher: Biomed Central
Citation: Morales-Asencio JM, Gonzalo-Jiménez E, Martin-Santos FJ, Morilla-Herrera JC, Celdrán-Mañas M, Millán Carrasco A, et al. Effectiveness of a nurse-led case management home care model in primary health care. A quasi-experimental, controlled, multi-centre study. BMC Health Serv Res. 2008 Sep 23;8:193
Abstract: Background Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). Methods Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. Results Base-line differences in functional capacity – significantly lower in the intervention group (RR: 1.52 95%CI: 1.05–2.21; p = 0.0016) – disappeared at six months (RR: 1.31 95%CI: 0.87–1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77–59.34 vs. 60.50 95%CI: 53.63–67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67–57.92 vs. 66.26 95%CI: 60.66–71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22–10.62 vs. 3.24 95%CI: 1.37–5.310; p = 0.0001) and, on average, required fewer home care visits (9.40 95%CI: 7.89–10.92 vs.11.30 95%CI: 9.10–14.54). No differences were found in terms of frequency of visits to A&E or hospital re-admissions. Furthermore, patients in the control group perceived higher levels of satisfaction (16.88; 95%CI: 16.32–17.43; range: 0–21, vs. 14.65 95%CI: 13.61–15.68; p = 0,001). Conclusion A home care service model that includes nurse-led case management streamlines access to healthcare services and resources, while impacting positively on patients' functional ability and caregiver burden, with increased levels of satisfaction.
URI: http://hdl.handle.net/10668/286
metadata.dc.relation.publisherversion: http://www.biomedcentral.com/1472-6963/8/193
metadata.dc.identifier.doi: 10.1186/1472-6963-8-193
Appears in Collections:01- Artículos - DAP Almería
01- Artículos - DAP Granada
01- Artículos - DAP Málaga
01- Artículos - EASP. Escuela Andaluza de Salud Pública

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