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dc.contributor.authorBerntsen, Gro Karine Rosvold
dc.contributor.authorDalbakk, Monika
dc.contributor.authorHurley, Joseph
dc.contributor.authorBergmo, Trine Strand
dc.contributor.authorSolbakken, Beate
dc.contributor.authorSpansvoll, Lisbeth
dc.contributor.authorBellika, Johan Gustav
dc.contributor.authorSkrøvseth, Stein Olav
dc.contributor.authorBrattland, Trond
dc.contributor.authorRumpsfeld, Markus
dc.date.accessioned2020-02-25T08:42:22Z
dc.date.available2020-02-25T08:42:22Z
dc.date.issued2019-10-03
dc.description.abstract<i>Background</i> - Person-centred care (PCC) focusing on personalised goals and care plans derived from “What matters to you?” has an impact on single disease outcomes, but studies on multi-morbid elderly are lacking. Furthermore, the combination of PCC, Integrated Care (IC) and Pro-active care are widely recognised as desirable for multi-morbid elderly, yet previous studies focus on single components only, leaving synergies unexplored. The effect of a synergistic intervention, which implements 1) Person-centred goal-oriented care driven by “What matters to you?” with 2) IC and 3) pro-active care is unknown.<p> <p><i>Methods</i> - Inspired by theoretical foundations, complexity science, previous health service research and a patient-driven evaluation of care quality, we designed the Patient-Centred Team (PACT) intervention across primary and secondary care. The PACT team collaborate with the patient to make and deliver a person-centred, integrated and proactive multi-morbidity care-plan. The control group receives conventional care. The study design is a pragmatic six months prospective, controlled clinical trial based on hospital electronic health record data of 439 multi-morbid frail elderly at risk for emergency (re) admissions referred to PACT and 779 propensity score matched controls in Norway, 2014–2016. Outcomes are emergency admissions, the sum of emergency inpatient bed days, 30-day readmissions, planned and emergency outpatient visits and mortality at three and six months follow-up.<p> <p><i>Results</i> - The Rate Ratios (RR) for emergency admissions was 0,9 (95%CI: 0,82-0,99), for sum of emergency bed days 0,68 (95%CI:0,52-0,79) and for 30-days emergency readmissions 0,72 (95%CI: 0,41-1,24). RRs were 2,3 (95%CI: 2,02-2,55) and 0,9 (95%CI: 0,68-1,20) for planned and emergency outpatient visits respectively. The RR for death at 3 months was 0,39 (95% CI: 0,22-0,70) and 0,57 (95% CI: 0,34-0,94) at 6 months.<p> <p><i>Conclusion</i> - Compared with propensity score matched controls, the care process of frail multi-morbid elderly who received the PACT intervention had a reduced risk of high-level emergency care, increased use of low-level planned care, and substantially reduced mortality risk. Further study of process differences between groups is warranted to understand the genesis of these results better.en_US
dc.identifier.citationBerntsen G K R, Dalbakk M, Hurley J, Bergmo TS, Solbakken B, Spansvoll, Bellika JG, Skrøvseth SO, Brattland T, Rumpsfeld MT. Person-centred, integrated and pro-active care for multi-morbid elderly with advanced care needs: A propensity score-matched controlled trial. BMC Health Services Research. 2019;19:682:1-17en_US
dc.identifier.cristinIDFRIDAID 1739885
dc.identifier.doi10.1186/s12913-019-4397-2
dc.identifier.issn1472-6963
dc.identifier.urihttps://hdl.handle.net/10037/17477
dc.language.isoengen_US
dc.publisherBMJ Publishing Groupen_US
dc.relation.journalBMC Health Services Research
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2019 The Author(s)en_US
dc.subjectVDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801en_US
dc.subjectVDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801en_US
dc.titlePerson-centred, integrated and pro-active care for multi-morbid elderly with advanced care needs: A propensity score-matched controlled trialen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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