Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial
- 27 June 2011
- journal article
- research article
- Published by CMA Impact Inc. in CMAJ : Canadian Medical Association Journal
- Vol. 183 (11), E724-E732
- https://doi.org/10.1503/cmaj.101498
Abstract
Background: Sophisticated approaches are needed to improve the quality of care for elderly people living in residential care facilities. We determined the effects of multidisciplinary integrated care on the quality of care and quality of life for elderly people in residential care facilities. Methods: We performed a cluster randomized controlled trial involving 10 residential care facilities in the Netherlands that included 340 participating residents with physical or cognitive disabilities. Five of the facilities applied multidisciplinary integrated care, and five provided usual care. The intervention, inspired by the disease management model, consisted of a geriatric assessment of functional health every three months. The assessment included use of the Long-term Care Facility version of the Resident Assessment Instrument by trained nurse-assistants to guide the design of an individualized care plan; discussion of outcomes and care priorities with the family physician, the resident and his or her family; and monthly multidisciplinary meetings with the nurse-assistant, family physician, psychologist and geriatrician to discuss residents with complex needs. The primary outcome was the sum score of 32 risk-adjusted quality-of-care indicators. Results: Compared with the facilities that provided usual care, the intervention facilities had a significantly higher sum score of the 32 quality-of-care indicators (mean difference − 6.7, p = 0.009; a medium effect size of 0.72). They also had significantly higher scores for 11 of the 32 indicators of good care in the areas of communication, delirium, behaviour, continence, pain and use of antipsychotic agents. Interpretation: Multidisciplinary integrated care resulted in improved quality of care for elderly people in residential care facilities compared with usual care. Trial registration: www.controlled-trials.com trial register no. ISRCTN11076857.Keywords
This publication has 30 references indexed in Scilit:
- Utilization of acute and long-term care in the last year of life: comparison with survivors in a population-based studyBMC Health Services Research, 2009
- The cost-effectiveness of a new disease management model for frail elderly living in homes for the elderly, design of a cluster randomized controlled clinical trialBMC Health Services Research, 2008
- Use of the Minimum Data Set—Home Care: A cluster randomized controlled trial among the Chinese older adultsAging & Mental Health, 2006
- Care management for older people: Does integration make a difference?Journal of Interprofessional Care, 2006
- Predicting transitions in the use of informal and professional care by older adultsAgeing and Society, 2005
- Residential and nursing home care—issues of balance and quality of careInternational Journal of Geriatric Psychiatry, 2003
- Improving nursing home quality of care through outcomes data: the MDS quality indicatorsInternational Journal of Geriatric Psychiatry, 2003
- Which chronic conditions are associated with better or poorer quality of life?Journal of Clinical Epidemiology, 2000
- A short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validationPsychological Medicine, 1994
- Validating the SF-36 health survey questionnaire: new outcome measure for primary care.BMJ, 1992