Effectiveness of case management and post-acute services in older people after hospital discharge

Lim, W. K., Lambert, S. F. and Gray, L. C. (2003) Effectiveness of case management and post-acute services in older people after hospital discharge. Medical Journal of Australia, 178 6: 262-266.

Author Lim, W. K.
Lambert, S. F.
Gray, L. C.
Title Effectiveness of case management and post-acute services in older people after hospital discharge
Journal name Medical Journal of Australia   Check publisher's open access policy
ISSN 0025-729X
Publication date 2003
Sub-type Article (original research)
Volume 178
Issue 6
Start page 262
End page 266
Total pages 5
Editor Martin Van Der Weyden
Place of publication Australia
Publisher Australasian Medical Publishing Company
Collection year 2003
Language eng
Subject C1
321215 Health Care Administration
730203 Health related to ageing
11 Medical and Health Sciences
Abstract Objective: To evaluate the benefits of coordinating community services through the Post-Acute Care (PAC) program in older patients after discharge from hospital. Design: Prospective multicentre, randomised controlled trial with six months of follow-up with blinded outcome measurement. Setting: Four university-affiliated metropolitan general hospitals in Victoria. Participants: All patients aged 65 years and over who were discharged between August 1998 and October 1999 and required community services after discharge. Interventions: Participants were randomly allocated to receive services of a Post-Acute Care (PAC) coordinator (intervention) versus usual discharge planning (control). Main outcome measures: Comparison of quality of life and carer stress at one-month post-discharge, mortality, hospital readmissions, use of community services and community and hospital costs over the six months post-discharge. Results: 654 patients were randomised, and 598 were included in the analysis (311 in the PAC group and 287 in the control group). There was no difference in mortality between the groups (both 6%), but significantly greater overall quality-of-life scores at one-month follow-up in the PAC group. There was no difference in unplanned readmissions, but PAC patients used significantly fewer hospital bed-days in the six months after discharge (mean, 3.0 days; 95% CI, 2.1-3.9) than control patients (5.2 days; 95% CI, 3.8-6.7). Total costs (including hospitalisation, community services and the intervention) were lower in the PAC than the control group (mean difference, $1545; 95% CI, $11-$3078). Conclusions: The PAC program is beneficial in the transition from hospital to the community in older patients.
Keyword Medicine, General & Internal
Randomized Clinical-trial
Frail Elderly Patients
Q-Index Code C1

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
2004 Higher Education Research Data Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 44 times in Thomson Reuters Web of Science Article | Citations
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Created: Wed, 15 Aug 2007, 01:28:08 EST