Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis

J. W. Blom; W. B. Van den Hout; W. P. J. Den Elzen; Y. M. Drewes; N. Bleijenberg; I. N. Fabbricotti; A. P. D. Jansen; G. I. J. M. Kempen; R. Koopmans; W. M. Looman; R. J. F. Melis; S. F. Metzelthin; E. P. Moll van Charante; M. E. Muntinga; M. E. Numans; F. G. H. Ruikes; S. L. W. Spoorenberg; T. Stijnen; J. J. Suijker; N. J. De Wit; K. Wynia; A. W. Wind; J. Gussekloo; TOPICS-MDS Res Consortium

doi:10.1093/ageing/afy091

Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis

J. W. Blom^*, W. B. Van den Hout, W. P. J. Den Elzen, Y. M. Drewes, N. Bleijenberg, I. N. Fabbricotti, A. P. D. Jansen, G. I. J. M. Kempen, R. Koopmans, W. M. Looman, R. J. F. Melis, S. F. Metzelthin, E. P. Moll van Charante, M. E. Muntinga, M. E. Numans, F. G. H. Ruikes, S. L. W. Spoorenberg, T. Stijnen, J. J. Suijker, N. J. De WitK. Wynia, A. W. Wind, J. Gussekloo, TOPICS-MDS Res Consortium

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Purpose: to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: primary care sector. Interventions: combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome: activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: quality of life (visual analogue scale 0-10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3-level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was -0.01 (95% confidence interval -0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.

Original language	English
Pages (from-to)	705-714
Number of pages	10
Journal	Age and Ageing
Volume	47
Issue number	5
DOIs	https://doi.org/10.1093/ageing/afy091
Publication status	Published - 1 Sept 2018

Keywords

aged
primary care
integrated care
older people
RANDOMIZED CONTROLLED-TRIAL
FUNCTIONAL DECLINE
ELDERLY-PEOPLE
ADULTS
PROGRAM
MODEL
INDEX
INTERVENTIONS
EXPERIENCES
SCALE

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10.1093/ageing/afy091Licence: CC BY-NC

Cite this

Blom, J. W., Van den Hout, W. B., Den Elzen, W. P. J., Drewes, Y. M., Bleijenberg, N., Fabbricotti, I. N., Jansen, A. P. D., Kempen, G. I. J. M., Koopmans, R., Looman, W. M., Melis, R. J. F., Metzelthin, S. F., van Charante, E. P. M., Muntinga, M. E., Numans, M. E., Ruikes, F. G. H., Spoorenberg, S. L. W., Stijnen, T., Suijker, J. J., ... TOPICS-MDS Res Consortium (2018). Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis. Age and Ageing, 47(5), 705-714. https://doi.org/10.1093/ageing/afy091

@article{34fccf10de664da684275be8162de247,

title = "Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis",

abstract = "Purpose: to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: primary care sector. Interventions: combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome: activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: quality of life (visual analogue scale 0-10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3-level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was -0.01 (95% confidence interval -0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.",

keywords = "aged, primary care, integrated care, older people, RANDOMIZED CONTROLLED-TRIAL, FUNCTIONAL DECLINE, ELDERLY-PEOPLE, ADULTS, PROGRAM, MODEL, INDEX, INTERVENTIONS, EXPERIENCES, SCALE",

author = "Blom, {J. W.} and {Van den Hout}, {W. B.} and {Den Elzen}, {W. P. J.} and Drewes, {Y. M.} and N. Bleijenberg and Fabbricotti, {I. N.} and Jansen, {A. P. D.} and Kempen, {G. I. J. M.} and R. Koopmans and Looman, {W. M.} and Melis, {R. J. F.} and Metzelthin, {S. F.} and {van Charante}, {E. P. Moll} and Muntinga, {M. E.} and Numans, {M. E.} and Ruikes, {F. G. H.} and Spoorenberg, {S. L. W.} and T. Stijnen and Suijker, {J. J.} and {De Wit}, {N. J.} and K. Wynia and Wind, {A. W.} and J. Gussekloo and {TOPICS-MDS Res Consortium}",

year = "2018",

month = sep,

day = "1",

doi = "10.1093/ageing/afy091",

language = "English",

volume = "47",

pages = "705--714",

journal = "Age and Ageing",

issn = "0002-0729",

publisher = "Oxford University Press",

number = "5",

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Blom, JW, Van den Hout, WB, Den Elzen, WPJ, Drewes, YM, Bleijenberg, N, Fabbricotti, IN, Jansen, APD, Kempen, GIJM, Koopmans, R, Looman, WM, Melis, RJF, Metzelthin, SF, van Charante, EPM, Muntinga, ME, Numans, ME, Ruikes, FGH, Spoorenberg, SLW, Stijnen, T, Suijker, JJ, De Wit, NJ, Wynia, K, Wind, AW, Gussekloo, J & TOPICS-MDS Res Consortium 2018, 'Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis', Age and Ageing, vol. 47, no. 5, pp. 705-714. https://doi.org/10.1093/ageing/afy091

Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis. / Blom, J. W.; Van den Hout, W. B.; Den Elzen, W. P. J. et al.
In: Age and Ageing, Vol. 47, No. 5, 01.09.2018, p. 705-714.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Effectiveness and cost-effectiveness of proactive and multidisciplinary integrated care for older people with complex problems in general practice: an individual participant data meta-analysis

AU - Blom, J. W.

AU - Van den Hout, W. B.

AU - Den Elzen, W. P. J.

AU - Drewes, Y. M.

AU - Bleijenberg, N.

AU - Fabbricotti, I. N.

AU - Jansen, A. P. D.

AU - Kempen, G. I. J. M.

AU - Koopmans, R.

AU - Looman, W. M.

AU - Melis, R. J. F.

AU - Metzelthin, S. F.

AU - van Charante, E. P. Moll

AU - Muntinga, M. E.

AU - Numans, M. E.

AU - Ruikes, F. G. H.

AU - Spoorenberg, S. L. W.

AU - Stijnen, T.

AU - Suijker, J. J.

AU - De Wit, N. J.

AU - Wynia, K.

AU - Wind, A. W.

AU - Gussekloo, J.

AU - TOPICS-MDS Res Consortium

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Purpose: to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: primary care sector. Interventions: combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome: activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: quality of life (visual analogue scale 0-10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3-level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was -0.01 (95% confidence interval -0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.

AB - Purpose: to support older people with several healthcare needs in sustaining adequate functioning and independence, more proactive approaches are needed. This purpose of this study is to summarise the (cost-) effectiveness of proactive, multidisciplinary, integrated care programmes for older people in Dutch primary care. Methods design: individual patient data (IPD) meta-analysis of eight clinically controlled trials. Setting: primary care sector. Interventions: combination of (i) identification of older people with complex problems by means of screening, followed by (ii) a multidisciplinary integrated care programme for those identified. Main outcome: activities of daily living, i.e. a change on modified Katz-15 scale between baseline and 1-year follow-up. Secondary outcomes: quality of life (visual analogue scale 0-10), psychological (mental well-being scale Short Form Health Survey (SF)-36) and social well-being (single item, SF-36), quality-adjusted life years (Euroqol-5dimensions-3-level (EQ-5D-3L)), healthcare utilisation and cost-effectiveness. Analysis: intention-to-treat analysis, two-stage IPD and subgroup analysis based on patient and intervention characteristics. Results: included were 8,678 participants: median age of 80.5 (interquartile range 75.3; 85.7) years; 5,496 (63.3%) women. On the modified Katz-15 scale, the pooled difference in change between the intervention and control group was -0.01 (95% confidence interval -0.10 to 0.08). No significant differences were found in the other patient outcomes or subgroup analyses. Compared to usual care, the probability of the intervention group to be cost-effective was less than 5%. Conclusion: compared to usual care at 1-year follow-up, strategies for identification of frail older people in primary care combined with a proactive integrated care intervention are probably not (cost-) effective.

KW - aged

KW - primary care

KW - integrated care

KW - older people

KW - RANDOMIZED CONTROLLED-TRIAL

KW - FUNCTIONAL DECLINE

KW - ELDERLY-PEOPLE

KW - ADULTS

KW - PROGRAM

KW - MODEL

KW - INDEX

KW - INTERVENTIONS

KW - EXPERIENCES

KW - SCALE

U2 - 10.1093/ageing/afy091

DO - 10.1093/ageing/afy091

M3 - Article

SN - 0002-0729

VL - 47

SP - 705

EP - 714

JO - Age and Ageing

JF - Age and Ageing

IS - 5

ER -